1
500
72
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https://clinton.presidentiallibraries.us/files/original/e72d7e610be60d828458df7a9775545b.pdf
57d819573e587baf71cdafebef1b657f
PDF Text
Text
Case Number: 2006-0223-F ·
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by t4e Clinton Presidential
Library Staff.
Original OA/ID Number:
161
Document ID:
9306983
Stack:
Row:
Section:
Shelf:
Position:
Kr
44
~
~
1
�UNCLASSIFIED
NSC/RMO PROFILE
RECORD ID: 9306983
RECEIVED: 15 SEP 93 15
TO: SOLIS, P
FROM: ITOH
DOC DATE: 21 SEP 93
SOURCE REF:
KEYWORDS: GERMANY
MP
APPOINTMENT FIRST LADY
PERSONS:
SUBJECT:
SCHEDULING RECOM
ACTION: ITOH SGD MEMO
DUE DATE: 18 SEP 93
STAFF OFFICER: HOLL
FILES: WH
LOGREF:
NSCP:
CODES:
D 0 C U ME N T
FOR ACTION
STATUS: C
DI S T R I BUT I 0 N
FOR CONCURRENCE
FOR INFO
EXEC SEC
COMMENTS:
DISPATCHED BY - - - - - - - - - - DATE - - - - - BY HAND
OPENED BY: NSWEA
CLOSED BY: NSJEB
UNCLASSIFIED
DOC
2 OF
W/ATTCH
2
�UNCLASSIFIED
ACTION DATA SUMMARY REPORT
DOC ACTION OFFICER
RECORD ID: 9306983
CAO ASSIGNED ACTION REQUIRED
001 HOLL
001 ITOH
002
Z 93091515 PREPARE MEMO FOR ITOH
Z 93092019 FOR SIGNATURE
X 93092108 ITOH SGD MEMO
DISPATCH DATA SUMMARY REPORT
DISPATCH FOR ACTION
002
930921
DISPATCH FOR INFO
SOLIS, P
UNCLASSIFIED
~-----~-
~
_ _ _ _ _ _ _ _ _ _ _ _ _ __ j
�National Security Council
The White House
PROOFED BY:
-----taf..JfA:-.L.--.
LOG#
-----'(o=-'l-~----'3==-------~
URGENT NOT PROOFED: _ __
SYSTEM
BYPASSED WW DESK: _ _ __
DOCLOG _ _ _ _ A/0 _ _ __
HAS SEEN
SEQUENCE TO
NSC
/NT
DISPOSITION
DepExecSec
A
ExecSec
\
Staff Director
D/APNSA
APNSA
Situation Room
West Wing Desk
NSC Secretariat
A= Action
cc:
I = Information
VP
D =Dispatch
R =Retain
N = No Further Action
Other _ _ _ _ _ __
Mclarty
Should be seen by: _ _ _ _ _ _ __
(Date!Time)
COMMENTS:
DISPATCH INSTRUCTIONS:
•
£
�6983
NATIONAL SECURITY COUNCIL
WASHINGTON. D.C. 20506
September 21, 1993
MEMORANDUM FOR PATTI SOLIS
FROM:
WILLIAM H. ITOH ~
SUBJECT:
Scheduling Recommendation
The NSC staff feels that there is no compelling national security
or foreign policy reason for the First Lady to accept this
invitation. However, given her involvement in the subject
matter, she may wish to respond favorably.
�MEDICAL
CoNSULT
N
Ms. Caputo
Secretary of
Ms. Hillary Clinton
White House
Washington DC 20500
U. S. A.
Bonn, March 11, 1993
MCB wl I pa
Invitation to assist in the reform of American health care
Dear Ms. Caputo,
On behalf of one of our clients we would like to invite the
chair of the National council for the Reform of American
Health Care, Ms. Hillary Clinton, to Germany.
She would be able to meet the leading German executives and
individuals who prepared and implemented the 1992 reform of
German health care and who are now putting this into practice.
This extremely far-reaching and fundamental reform aims to
reduce health-care costs in Germany. All those involved in its
adoption have already achieved great success in the first few
months of this process.
Our agency, M c B- Medical Consult Bonn GmbH, is one of the
most prominent public affairs and PR consul tancies in the
German health sector. Our client, the German subsidiary of one
of the world's ten largest pharmaceuticals companies, would
like to arrange a private exchange of ideas between Ms. Hillary Clinton and the following leading executives and individuals
e.g.:
panel doctors
Union of Panel Doctors (Kassen~rztliche Vereinigungen)
pharmacists' associations
the pharmaceuticals industry
and politicians.
MCB-MEDICAL CoNSULT BoNN · lNFORMATIONSGESELLSCHAFT rM GESUNDHEITSWESEN MBH
PosTANSCHRIFT: PosTFACH uosor · noo BoNN r ·TEL.: o228/47oo78-79 ·FAx: o228/47752I
BtiRo: HERMANNSTR. 69 · 5300 BoNN 3
GEsCHAFTSFUHRER: ~OLFGANG G. LANGE · HRB BoNN NR. 4605
BANKVERBINDUNGEN: DT. APOTHEKER- UND ARZTEBANK E.G., KOLN (BLZ 37060615) KONTO-NR.: 0002977265
SPARDA-BANK K6LN E. G. (BLZ 370 6os 90) KoNTo-NR.: 848 7oo
- - - - - - - - - - - - - -
- - -
�..
- 2 -
Our client proposes to present Ms. Clinton and the experts who
accompany her with a comprehensive picture of German health
care services and the successes of the reform, thus providing
a positive stimulus for the reform of American health care.
This will not only serve to intensify the friendship and mutual understanding between the Federal Republic of Germany and
the United States of America, but could also be of great help
for all concerned.
Our client is willing to organize and sponsor all events which
interest Ms. Clinton here in Germany. Should Ms. Clinton wish
the conversations to be off-the-record we would take care to
ensure that this is the case. If, however, off-the-record
conversations are not desired, we are instructed to assist you
with not only the organizational part of the work but also
the public relations work here in Germany.
It would be advantageous if the visit could take place during
the second quarter. If it is not possible to set a date for
the visit during this period our client would also be interested in aranging a delegation of German health care representatives to meet Ms. Clinton in Washington.
We can clear up any further questions and provide more information by telephone over the next few days.
Wolfgan G. Lange
Managing Director
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Magnetic Disk: Hard Drive
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
9306983
Creator
An entity primarily responsible for making the resource
NSC Records Management System
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7388808" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7388808-20060223F-006-023-2015
7388808
-
https://clinton.presidentiallibraries.us/files/original/b81539eaddacb2c1688dc1ed21411077.pdf
4bf1c4dd73e2d11681d45b1b1657250e
PDF Text
Text
Case Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the Clinton Presidential
Library Staff.
Original OAIID Number:
2264
Document ID:
9300842
Stack:
Row:
Section:
Shelf:
~osition:
v
~5
6
7
1
�UNCLASSIFIED
NSC/RMO PROFILE
RECORD ID: 9300842
RECEIVED: 22 FEB 93 19
TO: WILLIAMS, MAGGIE
FROM: ITOH
DOC DATE: 13 APR 93
SOURCE REF:
KEYWORDS: GERMANY
PERSONS:
SEEHOFER, HORST
SUBJECT:
REPLY TO GERMAN GOVT INVITATION TO OBSERVE GERMANY HEALTH
CARE SYSTEM
ACTION: ITOH SGD MEMO
DUE DATE: 25 FEB 93
STAFF OFFICER: HOLL
FILES: WH
LOGREF:
NSCP:
CODES:
D 0 C U ME N T
FOR ACTION
STATUS: C
DI S T R I BUT I 0 N
FOR CONCURRENCE
C:. -
FOR INFO ___
. EXECSEC
WAYNE
COMMENTS:
OPENED BY: NSWE
CLOSED BY: NSJEB
DOC
/
UNCLASSIFIED
3 OF
3
�NATIONAL SECURITY COUNCIL
WASHINGTON. D.C. 20506
April 13, 1993
MEMORANDUM FOR MAGGIE WILLIAMS
ITOH~
FROM:
WILLIAM H.
SUBJECT:
Reply to the German Government's Invitation to
Observe Germany's Health Care System
As requested, a draft reply from the First Lady to German
Ambassador Stabreit is attached.
Attachments
Tab A
Draft Reply
Tab B
Incoming
0842
�Dear Mr. Ambassador:
Please accept my sincere thanks for the generous
offer extended by Foreign Minister Kinkel on
behalf of the German government to study
Germany's health care system.
Unfortunately, I
do not see that I will have the opportunity to
accept your offer in the near future.
It could,
however, be helpful to our efforts if you might
provide my staff with some basic documents
outlining how your system operates and a point
of contact with whom we might pursue any
questions about your health care system.
Again,
please express my appreciation for your
government's thoughtful offer.
I look forward
to the time when I will be able to visit
Germany.
Sincerely,
Hillary Clinton
His Excellency
Immo Stabreit
Ambassador of Germany
4645 Reservoir Road, N.W.
Washington, D.C. 20005
�.,
DER BOTSCHAFTER
DER BUNDESREPUBUK DEUTSCHLAND
THE AMBASSADOR
OF THE FEDERAL REPUBUC OF GERMANY
Washington, 02-12-1993
The First Lady
Mrs. Hilliuy Rodham Clinton
The White House
Washington, D.C. 20500
Dear Mrs. Rodham Clinton:
During the meeting with President Clinton on February, 4th, 1993, the Minister for Foreign
Affairs of the Federal Republic of Germany, Klaus Kinke~ extended an invitation to you to visit
Germany for a fact finding mission concerning the German healthcare system.
In order to make preparations beforehand, the Federal Minister of Health, Horst Seehofer,
would like to know if you will be able to accept this invitation and if so whether your schedule would
allow you to come to Germany personally or if you would have to send a representative. The time
schedule for this visit is at your convenience.
Minister Seehofer would be very happy to inform your personally about the German health
care system; to accommodate your probably very tight schedule he could arrange a one day program,
comprising talks to the representatives of the Federal Association of Sickness Funds ''Bundesverband
der Krankenkassen'~ the National Charrtber of Physicians ''Bundesiirztekammer" and the Health
Administration on state leveL Should you have more available time, the program could be extended
and enhanced at your convenience.
�•
In order to make the necessQI}' anangements, Minister Seehafer would appreciate knowing
your wishes and the tentative dates for the visit.
If you would like to get some additional information, I would be more than happy to provide
you with more details.
Yours sincerely,
sgd.
lmmo Stabreit
c.c.
Ms. Jenonne Walker
Special Assistant
to the President for
European and Eurasian Affairs
National Security Council
Old Executive Office Bldg.
Room368
17th St. & Pennsylvania Ave., N.W.
Washington, D.C. 20506
_I
�•
'
NATIONAL SECURITY COUNCIL
0842
WASHINGTON. D.C. 20506
March 12, 1993
ACTION
MEMORANDUM FOR WILLIAM H. ITOH
WALKER~
THROUGH:
JENONNE
FROM:
TONY
SUBJECT:
Draft Reply from First Lady to German Ambassador
WAYN~(tJ
As requested, attached is a draft reply from the First Lady to
the German Ambassador declining the invitation to observe
Germany's health care system.
RECOMMENDATION
That you sign the attached memo to Maggie Williams.
Approve
/Disapprove
Attachments
Tab I
Memo to Williams
Tab A
Draft Reply
Tab B
Incoming
'
...
.......
.
�I
•
I
I
I
...
THE WHITE HOUSE
WASHINGTON
March 9, 1993
MEMORANDUM FOR NANCY SODERBERG
National Security Council
FROM:
MAGGIE WILLI~uJ~\\\J
Office of th~l~~t Lady
SUBJECT:
Invitation for First Lady Visit to Germany to
Observe the German Health Care System
Mrs. Clinton does not see a time in the near future when she
might visit Germany to observe the German Health Care system.
Would you please suggest a draft which thanks them for their
generous offer, and declines their invitation?
Attachment
�..
I
NATIONAL SECURITY COUNCIL
ID
REFERRAL
9300842
DATE: 22 FEB 93
MEMORANDUM FOR: MARGARET WILLIAMS
OFFICE OF FIRST LADY
DOCUMENT DESCRIPTION:
TO: CLINTON, H
SOURCE: STABREIT, !MHO
DATE: 12 FEB 93
SUBJ: INVITATION FIRST LADY VISIT GERMANY TO OBSERVE GERMAN HEALTHCARE
SYSTEM
REQUIRED ACTION: APPROPRIATE ACTION
DUEDATE:
COMMENT:
~
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NSC RECORDS MANAGEMENT OFFICE
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WILLIAH H. LEARY
I
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_
�DER BOTSCHAFTER
DER BUNDESREPUBUK DEUTSCHLAND
THE AMBASSADOR
OF THE FEDERAL REPUBLIC OF GERMANY
Washington, 02/16/1993
Mr. Thomas F. McLarty
Chief of.Staff
The White House
Washington, D.C. 20500
Dear Mr. McLarty:
The Minister of Health of the Federal Republic of Gennany, Horst Seehafer, has extended an
invitation to the First Lady, Mrs. Hillary Rodham Clinton, to visit Gennany for a fact finding
mission on the Gennan Health Care System.
I am enclosing my letter to the First Lady regarding this invitation and would appreciate it if
you could transmit it to her. Thank you very much in advance!
Youn sincerely,
sgd.
lmmo Stabreit
Ms. Jenonne Walker
Special Assistant
to the President for
Ewopean and Eurasian Affairs
National Security Council
Old Executive Office Bldg.
Room 368.
17th St. & Pennsylvania Ave., N. W
Washington. D.C. 20506
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Magnetic Disk: Hard Drive
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
9300842
Creator
An entity primarily responsible for making the resource
NSC Records Management System
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7388808" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7388808-20060223F-006-022-2015
7388808
-
https://clinton.presidentiallibraries.us/files/original/420c3fc1e38c8c0407d13c9f275b7603.pdf
f0ffbb639b50e1a8fb3e569789d9ba13
PDF Text
Text
Case Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the Clinton Presidential
Library Staff.
Original OA/ID Number:
167
Document ID:
9307946
Stack:
tRow:
Section:
Shelf:
~osition:
~
~4.
~
4
1
�UNCLASSIFIED
NSCIRMO PROFILE
RECORD ID: 9307946
RECEIVED: 14 OCT 93 13
•,
TO: CtiNTON, H
DOC DATE: 09 SEP 93
SOURCE REF:
FROM: KARGBO, AMINATA
KEYWORDS: SIERRA LEONE
PERSONS:.
SUBJECT:
LTR TO FIRST LADY FM WIFE OF SIERRA LEONE AMB TO US CONGRATULATING
ON FIRST LADY PROGRAMS FOR DEPRIVED I WOMEN I CHILDREN & HEALTH CARE
ACTION: APPROPRIATE ACTION
DUE DATE: 18 OCT 93
STAFF OFFICER: WARD
STATUS: C
LOGREF:
FILES: WH
NSCP:
CODES:
D 0 C U ME N T
FOR ACTION
DOMESTICE POLICY COU
DI S T R I BUT I 0 N
FOR CONCURRENCE
FOR INFO
SOLIS, P
COMMENTS:
DISPATCHED BY - - - - - - - - - - DATE - - - - - BY HAND
OPENED BY: NSKDB
CLOSED BY: NSWEA
UNCLASSIFIED
DOC
1 OF
WIATTCH
1
�UNCLASSIFIED
ACTION DATA SUMMARY REPORT .
DOC ACTION OFFICER
RECORD ID: 9307946
CAO ASSIGNED ACTION REQUIRED
001 WARD
001 DOMESTIC POLICY COUNCIL
Z 93101414 PREPARE MEMO FOR ITOH
X 93101516 APPROPRIATE ACTION
DISPATCH DATA SUMMARY REPORT
DISPATCH FOR ACTION
001
930909
DISPATCH FOR INFO
DOMESTIC POLICY COUNCIL
UNCLASSIFIED
��.-
UNCLASSIFIED
NSCIRMO PROFILE
RECORD ID: 9307946
RECEIVED: 14 OCT 93 13
TO: CLINTON, H
DOC DATE: 09 SEP 93_
SOURCE REF:
FROM: KARGBO, AMINATA
KEYWORDS: SIERRA LEONE
PERSONS:
SUBJECT:
LTR TO FIRST LADY FM WIFE OF SIERRA LEONE AMB TO US CONGRATULATING
ON FIRST LADY PROGRAMS FOR DEPRIVED I WOMEN I CHILDREN & HEALTH CARE
ACTION: PREPARE MEMO FOR ITOH
DUE DATE: 18 OCT 93
STAFF OFFICER: WARD
FILES: WH
LOGREF:
CODES:
NSCP:
D 0 CUM E NT
FOR ACTION
WARD
STATUS: S
D I S.T R I BUT I 0 N
FOR CONCURRENCE
FOR INFO
COMMENTS:
DISPATCHED B Y - - - - - - - - - - DATE----- BY HAND
OPENED BY: NSKDB
CLOSED BY:
DOC
UNCLASSIFIED
1 OF
W/ATTCH
1
�NATIONAL SECURITY COUNCIL
REFERRAL
ID 9307946
DATE: 15 OCT 93
MEMORANDUM FOR: RASCO, C
DOMESTIC POLICY COUNCIL
DOCUMENT DESCRIPTION:
TO: CLINTON, H
SOURCE: KARGBO, AMINATA
DATE: 09 SEP 93
SUBJ: LTR TO FIRST LADY FM WIFE OF SIERRA LEONE AMB TO US CONGRATULATING
ON FIRST LADY PROGRAMS FOR DEPRIVED I WOMEN I CHILDREN & HEALTH CARE
REQUIRED ACTION: APPROPRIATE ACTION
DUEDATE:
COMMENT:
WILLIAM H. LEARY
NSC RECORDS MANAGEMENT OFFICE
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AMBASSADOR
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1701 19TH STRE.ET, N.W. • WASHINGTON, D.C. 20009
PHONE: (202) 939-9361 • FAX: (202) 483-1793
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Magnetic Disk: Hard Drive
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
9307946
Creator
An entity primarily responsible for making the resource
NSC Records Management System
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7388808" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7388808-20060223F-006-021-2015
7388808
-
https://clinton.presidentiallibraries.us/files/original/b966a097f236c2d2bb2a8bf0b88f9a69.pdf
fef2e9d16aba4f7c63062911f1924a18
PDF Text
Text
Case Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the Clinton Presidential
Library Staff.
Original OA/ID Number:
159
Document ID:
9306576
Stack:
Row:
Section:
Shelf:
Position:
~
44
2
1
2
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001.letter
DATE
SUBJECTffiTLE
Wendy Gauthier to Hillary Rodham Clinton. [partial] (1 page).
07/20/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number:
159
FOLDER TITLE:
9306576
2006-0223-F
ab630
RESTRICTION CODES
Presidential Records Act -(44 U.S.C. :Z:Z04(a))
Freedom of Information Act -(5 U.S.C. SS:Z(b))
Pl National Security Classified Information ((a)(l) ofthe PRA)
P:Z Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy ((a)(6) ofthe PRA)
b(l) National security classified Information ((b)(l) ofthe FOlA)
b(2) Release would disclose Internal personnel rules and practices of
an agency ((b)(:Z) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOlA)
b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) ofthe FOlA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) ofthe FOlA)
b(8) Release would disclose Information concerning the regulation of
financial Institutions [(b)(8) of the FOlA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOlA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�UNCLASSIFIED
NSC/RMO PROFILE
,,
RECORD ID: 9306576
RECEIVED: 31 AUG 93 19
TO: SOLIS, P
DOC DATE: 07 SEP 93
SOURCE REF:
FROM: ITOH
APPOINTMENT FIRST LADY
KEYWORDS: CANADA
MP
PERSONS:
GAUTHIER, WENDY
SUBJECT:
INVITATION FOR FIRST LADY TO ATTEND HELATH CARE CONF IN ONTARIO 13
OCT
ACTION: KENNEY SGD MEMO
DUE DATE: 03 SEP 93
STAFF OFFICER: LOWENKRON
FILES: WH
LOGREF:
CODES:
NSCP:
D 0 C U ME N T
FOR ACTION
STATUS: C
DI S T R I BUT I 0 N
FOR CONCURRENCE
FOR INFO
EXEC SEC
LOWENKRON
COMMENTS:
DISPATCHED B Y - - - - - - - - - - DATE----- BY HAND
OPENED BY: NSWEA
CLOSED BY: NSMEM
UNCLASSIFIED
DOC
2 OF
W/ATTCH
2
�UNCLASSIFIED
ACTION DATA SUMMARY REPORT
RECORD ID: 9306576
CAO ASSIGNED ACTION REQUIRED
DOC ACTION OFFICER
Z 93083119 PREPARE MEMO FOR ITOH
Z 93090717 FOR SIGNATURE
X 93090808 KENNEY SGD MEMO
001 LOWENKRON
001 ItOH
002
DISPATCH DATA SUMMARY REPORT
DISPATCH FOR ACTION
002
930907
DISPATCH FOR INFO
SOLIS, P
UNCLASSIFIED
�National Security Council
The White House
~
PROOFED BY:
LOG#
---="::--='5_7---..::b;:::,___ __
URGENT NOT PROOFED: _ __
SYSTEM
BYPASSED WW DESK: _ _ __
DOCLOG
J
--F-
HAS SEEN
SEQUENCE TO
NSC
/NT
A/0 _ _ __
DISPOSITION
\vJk:
•
)
DepExecSec
@._
ExecSec
Staff Director
D/APNSA
APNSA
Situation Room
West Wing Desk
NSC Secretariat
A= Action
cc:
I = Information
VP
D =Dispatch
A= Retain
N = No Further Action
Other _ _ _ _ _ __
Mclarty
Should be seen by: _ _ _ _ _ _ __
(DatefTime)
COMMENTS:
DISPATCH INSTRUCTIONS:
T
.m
�.. ~
1:
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"::;.."'
}
,(> CE QU'EST L'I-NSTITUT
t:lnstitut canadien de Ia retraite et des
avantages sociaux est une association a but
non lucratif fondee en 1960 dont Ia mission
est ainsi formulee:
L'INSTITUT SE VEUT LE P~US IMPORTANT
FORUM NATIONAL ET REGIONAL
PORTANT SUR LA RETRAITE ET LES
AVANTAGES SOCIAUX
SES OBJECTIFS
UNE ASSOCIATION
POUR LA PROMOTION
DE LA CONNAISSANCE
RETRAITE ET
D"VANTAGES
SOCIAUX
• Faciliter l'echange d'informations entre les
membres {reseaul.
• Accroitre les connaissances des membres
en leur procurant des renseignements
pertinents et de haute qualite en ce qui a
trait a Ia retra1te et aux avantages sociaux.
plus specifiquement sur:
les recents developpements et tendances
dans le domaine de Ia retraite et des
avantages cociaux.
les sujets d'ordre technique utiles a
!'administration des regimes.
• Recruter et conserver un bassin de
membres de diverses disciplines
susceptibles de participer activement
aux activites offertes.
• Mettre en valeur nos ressources de fa~on
strategiquement efficace dans le but de
satisfa1re aux besoins des membres.
t:lnstitut canadien de Ia retraite et des
avantages sociaux traite de toutes questions
d'actualite qui concernent Ia retraite. les
avantages sociaux et les programmes de
securite du revenu lors de ses colloques et
conferences organises a l'echelle locale,
regionale ou nationale.
t:lnstitut favorise un echange de points de
vue divers et d'informations d"actualite entre
ses membres, les gouvernements et le public.
II se veut une tnbune neutre et objective ou
diverses opinions peuvent etre presentees.
SES-MEMBRES
,·.
.~-
IJnstitut accueille toutes les personnes
interessees au domaine de Ia retraite, des
avantages sociaux et de Ia securite du revenu.
Ces personnes proviennent de differents
milieux, notamment des:
• entreprises. des gouvemements ou des syndicats
• organismes sans but lucratif
• Institutions financieres
• comites de retraite
• compagnies d'assurance
• societes de gestion de placements
• groupements professionnels
• firmes de consultants
• media d'information
• cabinets d'avocats
t.:efficacite de l'lnstitut reside dans le regroupement de membres de formations differentes qui
representent toutes les regions du pays.
SES AVANTAGES
• les membres sont invites a assister et a
participer a des colloques locaux. regionaux
et natlonaux qui constituent les principaux
vehiCUles Utilises pour l'echange d'informations sur Ia securite du revenu.
• les membres peuvent s'inscrire aux
colloques. aux conferences et aux autres
activites a un prix reduit.
• le congres national annuel attire des conferenciers de prestige, des specialistes ainsi
que des participants canadiens et etrangers.
• les membres recoivent Je repertoive des
membres et un bulletin trimestriel qui Jes
rense1gne sur des sujets d'actualite. sur Jes
activites passees et a venir dans toutes Jes
regions et sur les nouveaux membres.
• Les membres r~oivent egalement a taus
les trois mois:
- une liste des plus recentes publications
portant sur Ia retraite et les avantages
soCJaux;
- un sommaire des changements apportes
aux lois concernant Ia retraite et les
avantages sociaux;
- un resume des decisions recentes des
tribunaux se rapportant au meme domaine.
I> DEMAN DE
D~HESION
'
·I
Si vous desirez devenir membre de
nnstitut, veuillez remplir et retourner
le present formulaire. Pour plus de
renseignements, communiquez avec
notre Bureau national situe au
800 boulevard Rene-Levesque ouest
Bureau 1100
Montreal, Quebec
H38 IX9
Telephone: (5141 866-3687
Telecopieur: (5141 871-8772
Nom de famille _ _ _ _ _ _ _ __
Prenom ____________
Fonction - - - - - - - - - - Employeur _ _ _ _ _ _ _ _ __
Adresse _ _ _ _ _ _ _ _ _ __
Ville/Province _ _ _ _ _ _ _ __
Code postal _ _ _ _ _ _ _ __
Numerode
telephone au bureau _______
Telecopieur _ _ _ _ _ _ _ _ __
Comment evaluez-vous le niveau de
votre paste dans votre organisation?
0 debutant 0 intermediaire 0 seni
Cotisations annuelles:
0 125$ I membre
0 25$ I retraite
La TPS est incluse dans le montant de
Ia cotisation. TPS # R-106865330
Mon paiement est joint 0 ou
Veuillez me facturer 0
�I>
WHO
I> WHAT IS THE I> JOIN?SHOULD
..· CPBC?
-.
CPBC
MEMBERSHIP
APPLICATION
The Canadian Pension & Benefits
Conference is a non-profit association
established in 1960. The association·s
mission statement is:
To become a member, please complete
and return this form. For more
information. contact the National
office at:
TO BE THE LEADING NATIONAL
AND REGIONAL FORUM ON
PENSIONS AND EMPLOYEE
BENEFITS
CPBC
800 Reni!-t.evesque Blvd. W.
Suite 1100
Montreal, Quebec
H3B 1X9
CPBc·s MAJOR
GOALS ARE:
Telephone: (514) 866-3687
Fax: (514) 871-8772
Surname: __________________
Name: _____________________
Title: ----------------------Employer:----------------Address: _____________________
City/Province: _ _ _ _ _ _ _ __
Postal Code: _ _ _ _ _ _ _ __
Business Telephone: _____________
Fax: _______________________
How would you categorize your
current position in your organization?
0 Junior
0 Middle
0 Senior
Annual Membership Fees
0 S125 I Individual
0 S25 I Retired Person
GST is included in membership fees
quoted above GST # R-106865330
Please invoice me. 0
My cheque is enclosed. 0
AN ASSOCIATION
TO PROMOTE
THE
UNDERSTANDING
OF PENSIONS
AND
BENEFITS
• To provide regular opportunities to
meet and share information
(Networking)
• To increase knowledge of members by
providing high quality and relevant
pension and benefits information on:
New Developments/Industry Trends
Technical Matters For Practical
Application
• To develop and maintain a diversely
based membership which participates
actively in programs
• To manage our resources in an effective
and strategic manner to meet member
needs
The CPBC examines topical issues in
all aspects of pensions. benefits and
income security programs at its local.
regional and national seminars and
conferences.
The CPBC acts as a channel through
which various informed views and reliable
information is transmitted among CPBC
members. government and the public.
The CPBC presents diverse opinions in
a neutral and objective forum.
Anyone involved with pensions. benefits
and income security issues. This includes:
•
•
•
•
•
•
•
•
•
•
Industry. Government and labour
Non-profit Organizations
Insurance Companies
Investment Managers
Financial Institutions
Professional Groups
Consulting Firms
Benefit Trustees
Journalists
legal Firms
The strength of the CPBC comes from its
diverse individual membership representing
all regions of the country.
WHY SHOULD
YOU JOIN?
• Members are invited to attend and
participate in local. regional and
national seminars which are the
principal vehicles used to discuss and
debate information on income security.
• Members are admitted to seminars
and conferences at a reduced cost.
• The annual national conference
attracts top-level speakers. panelists
and participants from across canada
and abroad.
• Members receive a membership directory
and a quarterly newsletter that reports
on the activities in all regions. new
members and has a calendar of
upcoming events.
• Members also receive quarterly
publications of:
- Index of Pensions & Benefits
Information
- Regulatory Summary
- Recent Court Cases.
�THE WHITE HOUSE
WASHINGTON
August 30, 1993
MEMORANDUM FOR WILLIAM ITOH
FROM:
PATTI SOLIS
DIRECTOR OF
RE:
()c:tKL{
~~EDULING
FOR THE FIRST LADY
SCHEDULING RECOMMENDATIONS
The enclosed is an invitation from Wendy Gauthier inviting
the First Lady to participate in a conference on the future of
health care in the province of Ontario. The event will be held
in Toronto on October 13, 1993.
Please advise on the course of action.
···----
September 7, 1993
MEMORANDUM FOR PATTI SOLIS
\
.. ~
IT~
FROM:
WILLIAM H.
SUBJECT:
Scheduling Recommendation
The NSC staff feels that there is no compelling foreign policy
reason for the First Lady to participate in this conference.
�·------
,,)
c.~ ~-:rr
b"" ~.s
~)lb
July 20, 1993
Ms. Hilary Rodham Clinton
1600 Pennsylvania Avenue
The White House
Washington, D.C.
Dear Ms. Rodham Clinton:
I am writing to invite you to participate in a conference on the future of health
care in the province of Ontario which is being sponsored by the Regional Council
of the Canadian Pension and Benefits Conference (CPBC).
The event is scheduled for October 13, 1993 and is to be held in Toronto.
Professor Jane Fulton of the University of Ottawa has agreed to participate in the
programme. Dr. Fulton is a professor at the University of Ottawa and on the
faculty of the Banff School of Advanced Management. She has been a visiting
professor at many U.S. universities including Princeton, USC, Harvard and Duke.
She was Canada's delegate to the UN World Health Organization conference in
1988 and 1990 and participated in the April 1992 PBS broadcast entitled
"Condition Critical" with Phil Donahue.
Our objective in organizing this event is to acknowledge that there are serious
problems with our current health care system and that in order to avoid a crisis
all parties have to work together toward solutions. To that end we have also
invited representatives from business, labour and the government to participate
in the programme. The honourable Ruth Grier, Minister of Health has been
invited to speak and we are looking forward to her confrrmation in the vezy near
future.
This would be an opportunity for you to share your thoughts on health care and
to hear first hand some of the problems we face in Ontario. This event will be
promoted to over 2200 members of the CPBS as well as to the general business,
labour and government community. Your participation in this programme would
attract many interested individuals and would greatly enhance the programme.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECTffiTLE
DATE
RESTRICTION
AND TYPE
001. letter
Wendy Gauthier to Hillary Rodham Clinton. [partial] (1 page)
07/20/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
ONBox Number: 159
FOLDER TITLE:
9306576
2006-0223-F
ab630
RESTRICTION CODES
Presidential Records Act -(44 U.S.C. 2204(a))
~
'
'
Freedom of Information Act -IS U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) ofthe PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial Information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted Invasion of
· personal privacy ((a)(6) ofthe PRA)
b(l) National security classified Information ((b)(l) ofthe FOIA)
b(2) Release would disclose Internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disclose Information concerning the regulation of
finanelallnstltutions ((b)(8) of the FOIA)
b(9) Release would disclose geologleal or geophysleallnformatlon
eoneernlng wells ((b)(9) ofthe FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�-2-
The CPBC. a non-profit associaUon established in 1960. is a forum on pension
and employee benefits. The CPBC acts as a channel through which various
informed views and reliable information is transmitted among CPBS members,
government and the public. The CPBC presents diverse opinions in a neutral and
objective forum.
have also recently become aware that you have been invited by the Legal
Eduction and Action Fund (L.E.A.F.) to speak in Toronto in commemoration of
"Persons Day". The organizers for that event have indicated a willingness to rearrange their schedule in order to accommodate both speaking engagements on
October 13. if this would be more convenient for you.
I
The CPBC would also be pleased to ensure all travel and accommodation were
addr~sscd subject to security provisions and is willing to be as flexible as possible
in accommodating any requests that you may have.
1 have included additional material on the CPBC and its programmes and
mandates and please do not hesitate to contact me directly if you should have any
further questions.
I look forward to your favourable reply.
Yours truly.
Wendy Gauthier
Co-chair
Programme Committee
Ontario Reg.ional Council
Canadian Pension and Benefits Conference
home:
business:
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Magnetic Disk: Hard Drive
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
9306576
Creator
An entity primarily responsible for making the resource
NSC Records Management System
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7388808" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7388808-20060223F-006-020-2015
7388808
-
https://clinton.presidentiallibraries.us/files/original/b219140290df94feb5e8b6edbc55fb20.pdf
95f5683873586f083905434fe6e1c62b
PDF Text
Text
Case Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the Clinton Presidential
Library Staff.
Original OA/ID Number:
159
Document ID:
9306537
Stack:
Section:
Shelf:
!Position:
~
-
!Row:
~4
~
1
2
----------------
- - - -
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. fax
DATE
SUBJECTffiTLE
Letter tp Patti Solis from Wendy Gauthier. [partial] (2 pages)
07/20/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number:
159
FOLDER TITLE:
9306537
2006-0223-F
ab629
RESTRICTION CODES
Presidential Records Aet- (44 U.S.C. 2204(a))
Freedom of Information Aet- (5 U.S.C. 552(b))
-PI National Security Classified Information [(a)(l) orthe PRA)
Pl Relating to the appointment to Federal office ((a)(l) ofthe PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confldendal commercial or
finanelallnformadon [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy [(a)(6) orthe PRA[
b(l) National security classified informadon [(b)(l) orthe FOIA)
b(l) Release would disclose Internal personnel rules and praetlces of
an ageney ((b)(l) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidendal or financial
Information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose lnformadon compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�RECORD ID: 9306537
RECEIVED: 31 AUG 93 07
UNCLASSIFIED
NSC/RMO PROFILE
TO: SOLIS, P
DOC DATE: 04 SEP 93
SOURCE REF:
FROM: ITOH
KEYWORDS: CANADA
APPOINTMENT FIRST LADY
PERSONS:
GAUTHIER, WENDY
SUBJECT:
REQUEST FIRST LADY SPEAK TO CONF ON FUTURE OF HEALTH CARE IN ONTARIO
ACTION: KENNEY SGD MEMO
DUE DATE: 03 SEP 93
STAFF OFFICER: LOWENKRON
FILES: WH
LOGREF:
NSCP:
CODES:
D 0 C U ME N T
FOR ACTION
STATUS: C
DI S T R I BUT I 0 N
FOR CONCURRENCE
FOR INFO
EXEC SEC
LOWENKRON
COMMENTS: ----------------------------------------------------------
DISPATCHED BY _ _ _ _ _
OPENED BY: NSJDA
.._LAt:~-- DATE
CLOSED BY: NSWEA
UNCLASSIFIED
'11 '1
BY HAND
DOC
2 OF
W/ATTCH
2
�UNCLASSIFIED
ACTION DATA SUMMARY REPORT
RECORD ID: 9306537
CAO ASSIGNED ACTION REQUIRED
DOC ACTION OFFICER
Z 93083107 PREPARE MEMO FOR ITOH
Z 93090314 FOR SIGNATURE
X 93090413 KENNEY SGD .MEMO
001 LOWENKRON
001 ITOH
002
DISPATCH DATA SUMMARY REPORT
DISPATCH FOR INFO
DISPATCH FOR ACTION
002
930904
SOLIS, P
UNCLASSIFIED
�...,.. ,--·_._
,-
...
UNCLASSIFIED
NSC/RMO PROFILE
RECORD ID: 9306537
RECEIVED: 31 AUG 93 07
TO: ITOH
DOC DATE: 27 AUG 93
SOURCE REF:
FROM: SOLIS, P
KEYWORDS: CANADA
APPOINTMENT FIRST LADY
PERSONS:
GAUTHIER, WENDY
SUBJECT:
SCHEDULING REQUEST FOR FIRST LADY TO SPEAK TO CONF ON FUTURE OF
HEALTH CARE IN CANADA ON 13 OCT
ACTION: PREPARE MEMO FOR ITOH
DUE DATE: 03 SEP 93
STAFF OFFICER: LOWENKRON
FILES: WH
LOGREF:
NSCP:
CODES:
D 0 C U ME N T
FOR A 0
LOW KRON
STATUS: S
DI S T R I BUT I 0 N
FOR CONCURRENCE
rfolf ~~·
FOR INFO
ITOH
KENNEY
KUPCHAN
WALKER
COMMENTS:
DISPATCHED BY - - - - - - - - - - DATE - - - - - BY HAND
OPENED BY: NSJDA
CLOSED BY:
DOC
UNCLASSIFIED
1 OF
W/ATTCH
1
/'
\
�· National Security Council
The White House
PROOFED BY:
- - ~- =- - - 3'- - -1 - - -
LOGkDSl=
~
URGENT NOT PROOFED: _ __
SYSTEM
BYPASSED WW DESK: _ _ __
DOCLOG~ A/0 _ _ __
HAS SEEN
SEQUENCE TO
~ExecSec
NSC
/NT
DISPOSITION
\fJJ-PV
"
I
ExecSec
Staff Director
D/APNSA
APNSA
Situation Room
West Wing Desk
NSC Secretariat
I = Information
cc:
VP
D =Dispatch
R =Retain
N = No Further Action
Other _ _ _ _ _ __
Mclarty
Should be seen by: _ _ _ _ _ _ __
(DatefTime)
COMMENTS:
DISPATCH INSTRUCTIONS:
'C
P'
�THE WHITE HOUSE
WASHINGTON
August 27, 1993
MEMORANDUM
~OR
WILLIAM ITOH
PATTI SOLIS~
DIRECTOR OF SCHEDULING FOR THE
~ROM:
~IRST
LADY
SCHEDULING RECOMMENDATIONS
RE:
The enclosed letter from wendy Gauthier is a request for the
Lady to speak to a conference on the future of health care
in ontario, canada on October 13, 1993.
~irst
Please advise on the course of action.
----------------------------------------~----~-------------------
September 4, 1993
MEMORANDUM FOR PATTI SOLIS
IT~)
~
FROM:
WILLIAM H.
SUBJECT:
Scheduling Recommendation
The NSC staff feels that there is no compelling foreign policy
reason for the First Lady to accept this speaking invitation.
�'
07/20193
13:59
u
OMERS 4
Ill 001
ONTARIO MUNICIPAL EMPLOYEES RETIREMENT BOARD
OM uniYersily Avenue. Suite 1000. Tomnao, Ontario, MSJ 2P1
Tel: (418) ~2400, Fau: (418) 360-0217.
Wo.*ing
toga/her
for your
retirament
PIMI." t:DifiP/411 IIIli PAX CoWJt Slwt~r U. 1M aNl lit d«<r priM. T1kW )'OIL
Compaay~
.
1
I ~o lo71 ?31
If thftf .,., . , , pro,._ willa thl6 tl'lll&rlllialo11, or V10• lunf IUJt
riUINd till llfllll Ill il&tlkl*d IJJ 1111 COHr 1,_1, J11ft1R COIIIMI OMBRS
tJt (416) 369-UIJfJ 11114 llluudiiii41J ui/• 1%11111ioll IZSlO.
�•..
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. fax
SUBJECTtriTLE
DATE
Letter to Patti Solis from Wendy Gauthier. [partial] (2 pages)
07/20/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: 159
FOLDER TITLE:
9306537
2006-0223-F
ab629
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. ll04(a)]
Freedom oflnformation Act- [5 U.S.C. 552(b)]
Pl National Security Classified Information [(a)(l) ofthe PRA]
P2 Relating to the appointment to Federal office ((a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial Information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA).
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(l) ofthe FOlA]
b(2) Release would disclose Internal personnel rules and practices of
an agency [(b)(2) ofthe FOlA)
b(3) Release would violate a Federal statute ((b)(3) ofthe FOlA)
b(4) Release would disclose trade secrets or confidential or financial
Information [(b)(4) of the FOlA]
b(6) Release would constitute a elearly unwarranted Invasion of
personal privacy ((b)(6) of the FOlA(
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) of the FOIA(
·
b(8) Release would disclose Information concerning the regulation of
financial institutions ((b)(8) of the FOlA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) ofthe FOlA]
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�OMERS
.a
~002
JUly 20, 1993
Ms. Pattt Solis
Director of Scheduling
Fir&t La.dys Sc:heduling Office
The White House
1600 Pc:nnsyJvanta Avenue
Wa.Shlngton. D.C. 20500
Dear Ms. Solis:
l have attached a. copy o! a. letter wbieb has been sent to Ms. Rodhan1 Clintuu r~uestu:'18
her consideration of a speAking engagement to be held in Toronto. OnUuio on October
18, 1993.
we would he particularly ple&$ed to have Ms. Rodham Clinton pa.rUcipate 1n the
conference on the future of health an 1n the province of Ontario because her vfP.W!'; And
perspectiVe on health care would add great value 1.o the programme. It wQuld also
provide Ms. Nod ham Clinton With An opportunity to hear firsthand some of the probler:r:la
we face 1n Ontario - what works and what doesn't world
It ts proposed tl1at Ms. Rodham Clinton parUclpate tn the programme as a speaker,
howev~ we. would b~ vay rcceptJ~e to her va.rttmpauon m any way. My letter outunes
the othp.r speakers who have been invited. however. we would be pleased to make
cha.nges to the programme or redirect itS focus to accommodate the Interests of the FU'st
Lady.
I would be pleased to discuss this math>.r with you h\rther and I may be reached at the
numbers 11sted below.
Yours truly,
Wendy Gauthier
Co-chair
Programme Committee
RegionAl C"'.ount"il
Canadian Pension & Benefits Conferertce
�OMERS 4
July 20, 1993
Ms. Hllary Ilodham Clinton
1600 Pennsylvania Avenue
The White House
WashJngton. D.C.
Dear Ms. :Rodha w Clinton:
I am wrtttng to invite you to participate 1n a conference on the futw'e of health
care 1n the province of Ontario whiC'.h iR hP.tng sponsored by the Regional Council
of the Canadian Pension and Benefits Conference (CPBC).
The event is scheduled for October 13, 1993 and is to be held tn Toronto.
Professor Jane .l'Ulton of the University of Ottawa has agreed t.o partiCipate In the
programme. Dr. Fulton ts a professor at tbe University of Otta.wa and on the
faculty of the Banff School of Advanced Management. She has been a ViSiting
professor at many U.S. universities including Pl1nceton. USC, Harvard and Duke.
She was Canada's delegate to the UN World Health Organization conference in
1988 and !990 and partiCipated 1n the April 1992 PBS broadcast entitled
"ConditiOn Critical.. with Phtl Donahue.
Our objective ln orgnnizing this event iS to acknowledge that ilien~ are t;er1ous
problems with our current health care system and that in order to avoid a crisis
an parties have to work together tOward solutions. To that end we have also
tnvtted representatives from bustness. labour and thP. government to participate
in the programme. The honourable Ruth Grier, Minister of Health has been
.l11.vlted to speok and we arc looking .forward to her conflrmatlon .In lhe vecy near
future.
1bls would be an opportuniLy far you to share your thought.R nn health care and
to hear 1lrst hand some of the problems we face fn Ontario. Thls event will be
promoted to over 2200 members of the CPBS o.s well as to the general business,
labour and government community. Your participation In this programme would
1:1ttract many mterested indiViduals and would greatly enhance the programme.
Ill 003
�Oi-·::0-93
Ol!ERS 4
.tt
14:01
- 2-
. The CPBC. a non-profit a.ssooiatJon established 1n 1960. ls a forum on pension
and employee benefits. The CPBC acts as a cbarulel through which various
informed Views and reliable Information is transmitted among CPBS members,
government and the public. The CPBC presents diverse opinions tn a neutral and
objective forum.
1 have also recently become aware that you have been invited by the Legal
Eduction and Action Fund 0.-.E.A.F.) to Rpt=!Rlc 1.n Toronto in commemora.tlon of
"Persons Day". The organizers for that event have indtcated a willingness to rearrange their schedule in order to accommodate both tipea.klng engagements on
October 13. U' this would be more convenient for you.
The CPBC would also be pleased to ensure a 11 travel and accommodation were
addressed subject to security proVisions and is willlng lObe as flexible as possible
ln aeeom.modat:lng any tequesta that you may have.
I have tncludcd additional matertaJ on the CPBC and its programmes and
mandates and please do not hesitate to contact m~ clirectly ifyou should have any
further questions.
t look forward
to
your favourable reply.
Yours truly.
Wendy Gauthier
Co~chair
Programme Committee
Ontarlo Regional Council
Canadtan Pension and BenP.fits Cnnf~rP.n~P.
home:
bU$lne:SS:
I
'';?t<' (bj(6)J!!'J,&Ji;;
(4161 369-2416
,j
�I> WHAT IS THE I> WHO SHOULD
JOIN?
CPBC?
;
. ·,
lhe Canad an Pens len & Bene1ts
.Anyore involve_d With pensions. benefit
and _income security issL:e. This include
Confe-ence rs a non-profit as:sccicttion
established in 1960. Tile assoc:~tion's
mission statement is:
·:: ~ .. :
llndm;try. C..overnmem and I.L'Ibou
• Non-profit Organizations
TO BE TH£ LEADING NATIONAL
AND REGIONAL FORUM ON
1
PENSIONS AND EMPIDYEE
BENEFITS
1
CPBCIS MAJOR
GOALS ARE:
• To provide regular opportunities i"O
meet and share iniormation
{Ne!Wor.ting}
• To increaie krl:>wfedge of members by
prOYiding high quality and relevant
pension and benefits irfornlr3tior: on:
ASSOCIAnON
TO PROMOTE
THE
DERSTANDING
OF PENSIONS
AND
BENEFITS
!\lew Developments/Jndustry Trends
Technical Matters For Practical
AppriG:ltion
• To develop and mainta'n a diversely
based membership which particiJ:C!les
actr~ery in programs
• To manage ou resourceJ in an effer:rive
and strategic manner to meet member
needs
'The CP8C exanine5 topk:al il.sues in
ell aspects of pensions. benefits and
income security programl at its iocaJ.
~gjonar and nctionaJ seminar~ anc
confe-ences.
The CPBC acts as a channel throug'l
which various informed viev.~S and .~
information is transmitted among CPBC
members. government and the public.
The CPBC presents Gverse opin.ioru in
a neutraJ and objecr:ive forum.
Jnsurance Compan;es
....
• Jrwestment Managers
Q
Anancia1 lnstitutio.1s
• Professional Groups
• Consurting Firms
• Benefit Trustees
• Journalists
• Legar F1rrns
rne strength of the CPBC comes from it
dfv~..e indiYidL'af member~hp representin~
aA regions of th~ country.
WHY SHOULD
YOU JOIN?
• ,\tember!; are .rMted to attend and
participate in loc~t ~nal and
nationai seminars vmich are the
principal vehicles used
to discuss and
delEte i!lfoJTTBtion on income securit'l
• Member"i are adm·tted to sernir.ars
anc conFerences at .a reduced cost
• rne anno.Jal national conrerence
attracts top-lcvc: speakers, J=«"lnclists
anc parlicipa'1ts from across Can..lda
ane abroad.
• Members receive d .lre~Tlber.ship di,r~to
and a quarterfy nev;sletter that reports
on lhe activities in aU regions. new
members and has a calendilr of
upcoming events.
• Membets also receive quarterry
pubficatbns of:
- fndex of Pensions & Be:1efits
fnfcrmation
· R~ulatory SummarJ
· Recent Court Cases.
....
..
·"'"
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Magnetic Disk: Hard Drive
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
9306537
Creator
An entity primarily responsible for making the resource
NSC Records Management System
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7388808" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7388808-20060223F-006-019-2015
7388808
-
https://clinton.presidentiallibraries.us/files/original/e361140c6a1bbd8ef32fa6c7a066be37.pdf
99dd3ce834e998fe27d8ce882d97e8db
PDF Text
Text
Case Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the Clinton Presidential
Library Staff.
Original OA/ID Number:
151
Document ID:
9304409
Stack:
!Row:
Section:
Shelf:
!Position:
~
~4
1
8
~
�UNCLASSIFIED
NSC/RMO PROFILE
RECORD ID: 9304409
RECEIVED: 16 JUN 93 08
'' TO: .SOLIS, P
FROM: ITOH
DOC DATE: 21 JUN 93
SOURCE REF:
KEYWORDS: SPAIN
PERSONS:
GARCIA DE ARBOLEYA, JOSE L
SUBJECT:
REQUEST FOR FIRST LADY TO MEET W/ JOSE LUIS GARCIA DE ARBOLEYA
MINISTER OF HEALTH SPAIN
ACTION: ORIGINALS RETURNED TO NSC/S
DUE DATE: 19 JUN 93
STAFF OFFICER: KELLY, C
FILES: WH
LOGREF: 9304743
NSCP:
CODES:
D 0 C U ME N T
FOR ACTION
STATUS: C
DI S T R I BUT I 0 N
FOR CONCURRENCE
FOR INFO
EXEC SEC
KELLY, C
COMMENTS:
DISPATCHED BY - - - - - - - - - - DATE ....,.------ BY HAND
OPENED BY: NSJDA
CLOSED BY: NSJEB
UNCLASSIFIED
DOC
3 OF
W/ATTCH
3
�RECORD ID: 9304409
UNCLASSIFIED
ACTION DATA SUMMARY REPORT
' DOC ACTION OFFICER
CAO ASSIGNED ACTION REQUIRED
001 KELLY, C
002 ITOH
003
003
Z
Z
X
X
93061608
93062109
93062109
93100610
PREPARE MEMO ITOH TO SOLIS
FOR SIGNATURE
ITOH SGD MEMO
ORIGINALS RETURNED TO NSC/S
DISPATCH DATA SUMMARY REPORT
DISPATCH FOR ACTION
003
930621
DISPATCH FOR INFO
SOLIS, P
UNCLASSIFIED
�NATIONAL SECURITY COUNCIL
4409
WASHINGTON, D.C. 20506
June 21, 1992
MEMORANDUM FOR PATTI SOLIS
,.-
FROM:
WILLIAM H. ITOH ~
SUBJECT:
Request for the First Lady to Meet with Jose Luis
Garcia de Arboleya, Minister of Health of
Andalucia, Spain
There are no major foreign policy implications whether the First
Lady accepts or declines the above mentioned invitation. Please
note that Garcia de Arboleya is the Health Minister of the region
of Andalucia in southern Spain -- not of Spain itself. As an
"autonomous community" within Spain, Andalucia is able to launch
its own initiatives in health care distinct from those of the
central government.
Attachment
Tab A
Incoming
�THE WHITE HOUSE
WASHINGTON
August 12, 1993
MEMORANDUM FOR PATTY SOLIS
FROM: Reta Lewis
Office of Political Affairs
RE: Spanish Minister of Health meeting with Health Care Task Force
Representative.
In May you received an invitation for Mrs. Clinton to meet with the
Spanish Minister of Health, Senor Jose Luis Garcia de Arbolya. The
dates the Minister of Health will be in Washington are September
22-24.
The purpose of the meeting is to establish a formal exchange of
information about national health care systems.
Spain has a
national health care system, which spends less than 7 percent of
the GNP.
Senator Wofford, and Thomas o. Pyle, Chairman of the Jackson Hole
Group and recent member of the White House Task Force on Health
Care have agreed to attend the September meeting.
Is this
something that Mrs. Clinton would be interested in attending?
�THE WHITE HOUSE
WASHINGTON
June 14, 1993
MEMORANDUM FOR WILLIAM~
FROM:
RE:
PATTI SOLIS
DIRECTOR OF
HEDULING FOR THE FIRST LADY
SCHEDULING RECOMMENDATIONS
The enclosed letter from Lori D. Hinz is a request
he
First Lady to meet with Jose Luis Garcia de Arboleya,· Spain's
Minister of Health, to discuss healthcare-related iss
fac·
both the u.s. and Spain.
Please advise on the course of action.
�I'IH 1 -.:::::.- · ";j.:..
.l. .l.: ..)l::i
J.lJ: ol'lo
.I. I'll
l.UR~
lt:.L NU:
51 VaHey Stream Parkway
MIWtrn. PA 19355
215-29&6300 Fax I
21!~251-3124
May 18.1993
Ms. Hillary Rodham Clinton
First Lady of the United States of America
1be White House
Wasblngton, DC 20500
t{crF
A1?1f/ (/
(O>h
{..
_t!
Dear Ms. Clinton:
On behalf of the President of the Spanish Oovenunent. the Minister of Health of Andalucia. Sef'or
Jo~ Luis Garcia de Arboleya. would like to begin to establlsh a folDlal exchange of htfonnatlon
between our two countries concerning healthcare. His first undertaking besins with an October 1993
conference for Spanish government leaders in Seville. Spain. Several members of your healthcare
refonn task force staff have been invited to speak. To assist in the preparation of this conference,
Se.ftor Garcla de Arboleya is requestins a brief meeting with you prior to the conference. preferably
within July or August. to discuss healthcare-relaled issues facing both the U.S. and Spain.
Although Spain provides national healthciU'e for their people, spending less than seven percent of
GNP. there is. just as in the U.S •• an increasing need to control healthcare costs. Some of the
communities in Spain may introduce a prospective payment system. like or similar to DRGs, in as
little as two years.
The folloWing people will be attending this meeting.
•
Q
•
•
Se.ftor Jo~ Luis Oarcla de Arboleya. Minister of Health
PresideiU of Andalucian Health Services
Secretary of Ministry of Health
Sefior Ouillenno Ramas. General Manager of SMS Southern Burope
Andalucia consists of eight provinces in the southern part of Spain. similar in size to the state of
New York. SMS, the leading provider of healthcare infonnation systems and seJVices in the world.
is helping the Minister and his staff arrange the conference.
I will be contacting the White House within the next week to provide any additional infonnation and
to discuss your availability. I appreciate your taking the time to consider this request and hope your
busy schedule might accommodate a meeting With these Spanish leaders.
Sincerely,
~J}~J
Lori D. Hinz
f
International Product Specialist
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Magnetic Disk: Hard Drive
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
9304409
Creator
An entity primarily responsible for making the resource
NSC Records Management System
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7388808" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7388808-20060223F-006-018-2015
7388808
-
https://clinton.presidentiallibraries.us/files/original/efdec92ffb784962dc1860ce79a02568.pdf
54805171f6229640a701cbbd8c7ba928
PDF Text
Text
Case Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the Clinton Presidential
Library Staff.
Original OA/ID Number:
148
Document ID:
9303128
Stack:
Row:
Section:
Shelf:
Position:
~
44
1
7
1
�UNCLASSIFIED
NSC/RMO PROFILE
RECORD.ID: 9303128
RECEIVED: OS MAY 93 16
TO: CLINTON, H
DOC DATE: 03 MAR 93
SOURCE REF:
FROM: BLUNKETT, DAVID
KEYWORDS: GREAT BRITAIN
PERSONS:
SUBJECT:
REQUEST TO MEET W/ FIRST LADY DURING VISIT TO BRITAIN TO DISCUSS
HEALTH CARE POLICY
ACTION: OBE / STATUS OF (JRIGINAL UNKNOWN
STAFF OFFICER: LOWENKRON
FILES: WH
STATUS: C
LOGREF:
NSCP:
CODES:
D 0 CUM EN T.
FOR ACTION
DUE DATE: 08 MAY 93
DIS T RIB UTI 0 N
FOR CONCURRENCE
FOR INFO
COMMENTS:
DISPATCHED BY - - - - - - - - - - DATE - - - - - BY HAND
OPENED BY: NSJWF
CLOSED BY: NSVJD
UNCLASSIFIED
DOC
1 OF
W/ATTCH
1
�UNCLASSIFIED
ACTION DATA SUMMARY REPORT
DOC ACTION OFFICER
001 LOWENKRON
001
RECORD ID:. 9303128
CAO ASSIGNED ACTION REQUIRED
Z 93050516 PREPARE MEMO ITOH TO WILLIAMS
X 95021612 OBE / STATUS OF ORIGINAL UNKNOWN
r
UNCLASSIFIED
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Magnetic Disk: Hard Drive
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
9303128
Creator
An entity primarily responsible for making the resource
NSC Records Management System
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7388808" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7388808-20060223F-006-017-2015
7388808
-
https://clinton.presidentiallibraries.us/files/original/1fdb1c4d7a5aac3f29b1fb14fbfb734e.pdf
7ba18c06b32ce400663bc6094891be35
PDF Text
Text
Case Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the Clinton Presidential
Library Staff.
Original OAIID Number:
143
Document ID:
9301514
Stack:
Row:
Section:
Shelf:
~osition:
rv
~4
1
4
~
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECTfi'ITLE
DATE
RESTRICTION
OOla. memo
Martin Indyk to Nancy Soderberg. Subject: Background Information
for your meeting with Mrs. Rabin at 11:00 a.m., Wednesday, March
17,1993. (2 pages)
03/15/1993
P1/b(1)
001b. memo
Martin lndyk to Nancy Soderberg. Subject: Background Information
for your meeting with Mrs. Rabin at 11:00 a.m., Wednesday, March
17,1993. (2 pages)
03/15/1993
P1/b(1)
001c. memo
Anthony Lake to the President. Subject: [Meeting with Israeli Prime
Minister Rabin] (2 pages)
0311211993
P1/b(1)
00 1d. scope paper
Meeting with Prime Minister Rabin (9 pages)
03115/1993
P1/b(1)
001e. letter
Prime Minister Yitzahk Rabin to President Bill Clinton (2 pages)
02/24/1993
P1/b(1)
001f. memo
Warren Christopher to the President. Subject: Meeting with the Israeli
Prime Minister Rabin March 15, 1993. (6 pages)
03/09/1993
P1/b(1)
00 1g. cover sheet
Background Papers (1 page)
[none]
P1/b(1)
00 1h. report
Middle East Peace Process- State of Play (3 pages)
[none]
P1/b(1)
00 li. report
[Technology ... ] (1 page)
[none]
P1/b(1)
OOlj. report
[Creating a U.S. Israeli Dialogue] (1 page)
[none]
P1/b(1)
001k. report
[Technology Commission] (2 pages)
[none]
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number:
143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act- (5 u.s.c. 55~(b))
Pl National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) ofthe PRA)
P3 Release would violate a Federal statute ((a)(3) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECTfi'ITLE
DATE
RESTRICTION
0011. report
[U.S. -Isreal Development Cooperation: ... ] (1 page)
[none]
P1/b(1)
001m report
Arab League Boycott of Israel. ( 1 page)
[none]
P1/b(1)
001 n. report
Jonathan Pollard Case (1 page)
[none]
P1/b(1)
001o. report
A-4S (1 page) .
[none]
P1/b(1)
001 p. report
Status of U.S. -Israeli Military Cooperation (1 page)
[none]
P1/b(1)
001q. note
Points to be made for one-on-one meeting Prime Minister Yitzak
Rabin (7 pages)
[none]
P1/b(1)
001r. note
Points to be made for expanded meeting Prime Minister Yitzak Rabin
(3 pages)
[none]
P1/b(1)
001s. note
Supplementary Points for meeting with Prime Minister Rabin (3
pages)
[none]
P1/b(1)
001 t. briefing
paper
Leah Rabin. (1 page)
[none]
P1/b(1)
001 u. briefmg
paper
Leah Rabin. (1 page)
[none]
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
Pl National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial Information ((a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) ofthe PRA]
b(l) National security classified Information ((b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) oftbe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical Information
concerning wells ((b)(9) ofthe FOIA]
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�RECORD ID: 9301514
RECEIVED: 16 MAR 93 09
-eoNFII>EN*l-AI.-
NSC/RMO PROFILE
TO: CLINTON, H
DOC DATE: 16 MAR 93
SOURCE REF:
FROM: INDYK
SODERBERG
KEYWORDS: ISRAEL
PERSONS:
SUBJECT:
FIRST LADY MTG W/ MRS RABIN RE HEALTH CARE
DUE DATE: 19 MAR 93
ACTION: SODERBERG SGD MEMO
STAFF OFFICER: INDYK
FILES: PA
LOGREF:
NSCP:
CODES:
D 0 C U ME N T
FOR ACTION
STATUS: C
DI S T R I BUT I 0 N
FOR CONCURRENCE
FOR INFO
INDYK
NSC CHRON
COMMENTS:
DISPATCHED B Y - - - - - - - - - - DATE----- BY HAND
OPENED BY: NSJEB
CLOSED BY: NSJWF
-€0NFIDENTIAL
DOC
1 OF
W/ATTCH
1
DECLASSIFIED .
E.O. 12958, As Amended, Sec. 3.5 (b)
WhiteHouse Guidelines, August 28, 1997 ·
By4C1 NARA, Date L1kp/.,.t
�~CTION
DOC ACTION OFFICER
CONFIDENTIAL
DATA SUMMARY REPORT
RECORD ID: 9301514
CAO ASSIGNED ACTION REQUIRED
001 SODERBERG
001
Z 93031613 FOR SIGNATURE
X 93111912 SODERBERG SGD MEMO
DISPATCH DATA SUMMARY REPORT
DISPATCH FOR ACTION
001
DISPATCH FOR INFO
930316 CLINTON, H
DECLASSIFIED
E:O· 12958, As Amended, Sec. 3.5 {b)
WhiteHo~ Guidelines, August 28, ·1997
By~ARA, Date t t,l-aoLo~
-CONFIBENTIAI.
�'"',.-:
I
National Security Council
~PROOFED BY:
The White House
LK~.
!SILl
LOG#
ce;=:,
URGENT NOT PROOFED: _ __
SYSTEM
BYPASSED WW DESK: _ _ __
DOCLOG , ~
~pExecSec
±
ExecSec
Staff Director
D/APNSA
..,,
Situation Room
NSC Secretariat
k-,4 311~
~
'
~
D =Dispatch
cc:
VP
DISPOSITION
vtY
APNSA
West Wingbesk
/NT
A/0 _ __
"\,;V
SEQUENCE TO
NSC
R= Retain
~
N = No Further Action
Other _ _ _ _ __
Mclarty
Should
~e
seen by: _ _ _ _ _ __
(Date/Time)
COMMENTS:
DISPATCH INSTRUCTIONS:
DECLASSIFIED
E.O. 12958, As Amended, Sec. 3.5 (b)
White House Guidelines, August 28, 1997
By~ARA; Date \1 ,12o (o~
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
OOla. memo
SUBJECTtriTLE
DATE
Martin Indyk to Nancy Soderberg. Subject: Background Infonnation
for your meeting with Mrs. Rabin at 11 :00 a.m., Wednesday, March
17,1993. (2 pages)
03/15/1993
RESTRICTION
Pl/b(l)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a)]
Freedom oflnformation Act- (5 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA]
P4 Release would diselose trade secrets or confidential commerelal or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) ofthe PRA]
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) ofthe FOIA)
b(2) Release would disclose Internal personnel rules 'and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA]
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions ((b)(8) oftbe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
c. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECTffiTLE
DATE
RESTRICTION
AND TYPE
001b. memo
Martin lndyk to Nancy Soderberg. Subject: Backgr~und Information
for your meeting with Mrs. Rabin at 11:00 a.m, Wednesday, March ·
17,1993. (2 pages)
03/15/1993
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady ~d Health Care])
OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) ofthe PRA)
P4 Release would disclose trade secrets or confldentlalcommerdal or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a elearly unwarranted Invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified Information [(b)(l) of the FOIA)
b(2) Release would disclose Internal personnel rules and practices of
an agency ((b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) ofthe FOIA)
b(6) Release would constitute a dearly unwarranted Invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information eompiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(S) Release would disclose Information concerning the regulation of
financial institutions [(b)(S) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed In aecordanee with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
i
_I_
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001c. memo
SUBJECTfi'ITLE
DATE
Anthony Lake to the President. Subject: [Meeting with Israeli Prime
Minister Rabin] (2 pages)
03112/1993
RESTRICTION
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Records Aet- (44 U.S.C. 2204(a))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) ofthe PRA)
P3 Release would violate a Federal statute ((a)(3) ofthe PRA)
P4 Release would disclose trade seerets or confidential commercial or
financial Information ((a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advlson, or between such advisors (a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy ((a)(6) of the PRA)
C. Closed In accordance with restrletlons contained In donor's deed
of gift.
PRM. Personal reeord misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
Freedom of Information Aet- (5 U.S.C. 552(b))
. b(l) National seeurlty classified Information ((b)(l) of the FOIA)
b(2) Release would dlselose Internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade seerets or confidential or financial
Information ((b)(4) ofthe FOIA)
b(6) Release would constitute a elearly unwarranted Invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would dlselose information concerning the regulation of
financial Institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
�"
r
4
SCENARIO
ta; :;x;~.
.
~.
'.&
�l-
3/12/93
SCENARIO FOR WORKING VISIT OF
ISRAELI PRIME MINISTER RABIN
March 15, 1993
10:30 a.m.
Prime Minister Rabin and party arrive at the West
Lobby, will be greeted by the State Department
Acting Chief of Protocol (Richard Gookin), who
will escort the Prime Minister into the Roosevelt
Room to sign the Guest Book. Other meeting
participants will be escorted to the Cabinet Room.
(A military cordon will line the drive.)
10:35 a.m.
The Chief of Protocol escorts Prime. Minister Rabin
into the Oval Office, via the hallway entrance,
and introduces him to the President. White House
Photographers/TV and Press enter the Oval for
brief photos and Press coverage (approximately 5
minutes), then depart via the Hallway door.
10:40 a.m.
One-on-One Meeting begins.
Participants
The President
Anthony Lake
11:25 a.m.
Prime Minister Rabin
Ambassador Rabinovich
President and Prime Minister Rabin enter Cabinet
Room for expanded meeting.
Participants
The President
Vice President
Warren Christopher
Mack McLarty
Anthony Lake
Ed Djerejian
Martin Indyk, notetaker
Prime Minister Rabin
Ambassador Rabinovich
Elyakim Rubinstein
Shimon Sheves
David Ivri
Eitan Haber
Eitan Benzur
12:25 p.m.
Cabinet Room meeting adjourns. The President
invites Prime Minister Rabin to freshen up in his
Private Office. This allows time for the
remainder of the party to walk over to the Old
Family Dining Room.
12:35 p.m.
The President escorts Prime Minister Rabin down
the colonnade to the Old Family Dining Room.
�2
12:45 p.m.
The President invites guests to be seated for
lunch.
Participants
The President
Vice President
Warren Christopher
Les Aspin
Anthony Lake
Ed Djerejian
Martin Indyk, notetaker
Prime Minister Rabin
Ambassador Rabinovich
Elyakim Rubinstein
Shimon Sheves
David Ivri
Eitan Haber
Eitan Benzur
1:50 p.m.
The President invites Prime Minister (only) either
to the residence or on a stroll of the State
Floor. This allows time for the remainder of the
party to walk downstairs and position themselves
at the site of the Press Availability. (The
Social Office will have cards on the lecterns for
the two Heads of State; toe markers will be in
place for the remainder).
2:00 p.m.
Prime Minister Rabin will stand to the right of
the President, each _Head of State being flanked
with their accompanying meeting participants.
2:05 p.m.
The President makes brief (5 minute) remarks,
·followed by Prime Minister Rabin. Qs and As
follow.
2:30 p.m.
Press availability ends. The two Heads of State
shake hands, bid farewell, (the rest of the party
will be boarding their vehicles at this time); the
first car drives up to pick up Prime Minister
Rabin, the official party departs South Lawn.
�NSC SCOPE PAPER
'\r;'
'
.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001d. scope paper
SUBJECTffiTLE
DATE
Meeting with Prime Minister Rabin (9 pages)
03/15/1993
RESTRICTION
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Records Ad- [44 U.S.C. 2204(a))
Freedom of Information Act -(5 U.S.C. 55l(b))
Pl National Security Classified Information ((a)(l) oftbe PRA)
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial Information [(a)(4) oftbe PRA)
PS Release would dlsc:lose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security c:lasslfied Information [(b)(l) of the FOIA)
b(l) Release would dlsc:lose internal personnel rules and practic:es of
an agency [(b)(2) oftbe FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade sec:rets or c:onfidential or financ:ial
information ((b)(4) oftbe FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA) ·
b(8) Release would disclose Information concerning the regulation of
financial Institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) oftbe FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�TAB
A
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
00 1e. letter
SUBJECT/riTLE
DATE
Prime Minister Yitzahk Rabin to President Bill Clinton (2 pages)
02/24/1993
RESTRICTION
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number:
143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Records Aet - (44 U.S.C. 2204(a))
Freedom of Information Aet- (5 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy [(a)(6) ofthe PRA)
b(l) National security classified Information [(b)(l) of the FOIA)
b(2) Release would disclose Internal personnel rules and praetices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial Institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�r
--~---------------
--------
-~ '"4¥:r;.f
STATE ME;MQ
---- ---- --·-- --
'
--
- . ·- -- -- -~---
-
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001f. memo
DATE
SUBJECTfi'ITLE
Warren Christopher to the President. Subject: Meeting with the Israeli .
Prime Minister Rabin March 15, 1993. (6 pages)
03/09/1993
RESTRICTION
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Records Aet- [44 U.S.C. 2204(a))
Freedom of Information Aet- [5 U.S.C. 552(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial Information [(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA]
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified Information [(b)(l) ofthe FOIA]
b(2) Release would disclose Internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
Information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy [(b)(6) ofthe FOIA]
b(7) Release would dlsc:lose Information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
b(8) Release would disclose Information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would dlsc:lose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�....,...,.,;.~~;~'
;,
•• , t
. 'l'
·~'
BACKGROUND PAPERS
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECTffiTLE
DATE
RESTRICTION
~DTYPE
001g. cover sheet
Background Papers (1 page)
[none]
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. l204(a)]
Freedom of Information Act- [S U.S.C. SS:Z(b))
Pl National Security Classltled Information [(a)(l) of the PRA]
P:Z Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(J) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) orthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy ((a)(6) of the PRA]
b(l) National security classified Information [(b)(l) ofthe FOIA)
b(:Z) Release would disclose Internal personnel rules and practices of
an agency ((b)(2) or the FOIA)
b(J) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) of the FOIA]
b(8) Release would disclose Information concerning the regulation of
financial Institutions ((b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) orthe FOIA]
C. Closed in accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001 h. report
SUBJECTffiTLE
DATE
Middle East Peace Process- State of Play (3 pages)
[none]
RESTRICTION
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Reeords Act -(44 U.S.C. 2204(a))
Freedom of Information Act- (S U.S.C. SS2(b))
Pl National Seeurlty Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal offiee ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between sucb advisors (a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted Invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security elassifled Information ((b)(l) ofthe FOIA)
b(2) Release would dlselose Internal personnel rules and practices of
an agency ((b)(l) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial Institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
eoneernlng wells ((b)(9) of the FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal reeord misfile defined In accordance with 44 U.S.C.
2201(3).
~ Document will be reviewed upon request
_I
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
00 li. report
SUBJECTffiTLE
DATE
[Technology ... ] (1 page)
[none]
RESTRICTION
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Records Act -(44 U.S.C. ll04(a))
Freedom of Information Act- (5 U.S.C. SSl(b)J
PI National Security Classified Information ((a)(l) ofthe PRAJ
Pl Relating to the appointment to Federal office ((a)(l) of the PRAJ
PJ Release would violate a Federal statute ((a)(J) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRAJ
PS Release woul.d disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy ((a)(6) ofthe PRA)
b(l) National security classified information ((b)(l) of the FOlAJ
b(l) Release would disclose Internal personnel rules and practices of
an agency ((b)(l) ofthe FOlA)
b(J) Release would violate a Federal statute ((b)(J) ofthe FOlA)
b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) of the FOlA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) ofthe FOlA)
b(8) Release would disclose Information concerning the regulation of
financial Institutions ((b)(8) ofthe FOlA)
·
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misDie defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001j. report
SUBJECT/fiTLE
DATE
[Creating a U.S. Israeli Dialogue] (1 page)
[none]
RESTRICTION
P1/b(1)
COLLECTION:
. Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Records Ad- [44 U.S.C. 2204(a))
Freedom of Information Act- [S U.S.C. SS2(b))
PI National Security Classltled Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose Internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001 k. report
SUBJECTtriTLE
DATE
[Technology Commission] (2 pages)
[none]
RESTRICTION
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Records Aet- [44 U.S.C. 2204(a))
Freedom of Information Aet- [5 U.S.C. 552(b))
PI National Seeurlty Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal offiee [(a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would dlselose trade secrets or eonfldendal eommereial or
finaneialinformation ((a)(4) of the PRA)
PS Release would dlselose eonfldendal adviee between the President
and his advisors, or between sueh advisors (a)(S) ofthe PRA)
P6 Release would eonstitute a eiearly unwarranted Invasion of
· personal privacy ((a)(6) of the PRA)
b(l) National security elasslfied Information ((b)(l) ofthe FOIA]
b(2) Release would dlselose internal personnel rules and praedees of
an agency ((b)(2) oftbe F()IA)
b(3) Release would violate a Federal statute [(b)(3) oftbe FOIA)
b(4) Release would diselose trade seerets or eonfldendal or finanelal
information ((b)(4) of the F.OIA]
b(6) Release would eonstitute a elearly unwarranted invasion of
personal prlvaey ((b)(6) oftbe FOIA)
b(7) Release would diselose information eompiled for law enforeement
purposes ((b)(7) ofthe FOIA)
b(8) Release would dlselose Information eoneerning the regulation of
flnanelalinstltutlons ((b)(8) of the FOIA)
b(9) Release would dlselose geologleal or geophysleallnformadon
eoneerning wells ((b)(9) of the FOIA)
C. Closed In aeeordanee with restrletlons eontalned In donor's deed
of gift.
PRM. Personal record misfile defined In aeeordanee with 44 U.S.C.
2201(3).
RR. Doeument will be reviewed upon request.
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
0011. report
DATE
SUBJECTtriTLE
[U.S. -Isreal Development Cooperation: ... ] (1 page)
[none]
RESTRICTION
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Records Ad - (44 U.S.C. :Z:Z04(a))
PI National Security Classified Information ((a)(l) ofthe PRA)
P:Z Relating to the appointment to Federal office ((a)(l) ofthe PRA)
PJ Release would violate a Federal statute ((a)(J) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy ((a)(6) of the PRA)
1
·
Freedom oflnformation Ad- (S U.S.C. SS:Z(b))
b(l) National security classified Information ((b)(l) of the FOIA)
b(l) Release would disclose Internal personnel rules and practices of
an agency [(b)(l) ofthe FOIA)
b(J) Release would violate a Federal statute [(b)(J) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwaJ."ranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) ofthe FOIA)
C. Closed In accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
\
......................................................................
I
I
- - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __J
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001 m. report
SUBJECTmTLE
DATE
Arab League Boycott of Israel. ( 1 page)
[none]
RESTRICTION
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. ll04(a))
Freedom oflnformatlon Act- [5 U.S.C. 55l(b))
PI National Security Classified Information [(a)(l) ofthe PRA)
Pl Relating to the appointment to Federal office ((a)(l) of the PRA)
PJ Release would violate a Federal statute [(a)(J) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy [(a)(6) ofthe PRA)
b(l) National seeurlty classified Information ((b)(l) ofthe FOIA)
b(l) Release would disclose Internal personnel rules and practices of
an agency ((b)(l) ofthe FOIA)
b(J) Release would violate a Federal statute [(b)(J) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
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DOCUMENT NO.
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001 n. report
SUBJECTffiTLE
DATE
Jonathan Pollard Case (1 page)
[none]
RESTRICTION
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Records Ad- [44 U.S.C.ll04(a))
Freedom oflnformatlon Act- [S U.S.C. SS2(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified Information [(b)(l) of the FOIA)
b(2) Release would disclose Internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) oftbe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disclose Information concerning the regulation of
financial Institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
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001 o. report
SUBJECTrriTLE
DATE
A-48 (1 page)
[none]
RESTRICTION
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
Pl National Security Classified Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial Information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified Information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or·financial
Information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
finanelallnstltutlons [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
001 p. report
SUBJECTffiTLE
DATE
Status ofU.S. -Israeli Military Cooperation (1 page)
[none]
RESTRICTION
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [S U.S.C. SSl(b)]
Pl National Security Classified Information ((a)(l) ofthe PRA)
Pl Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
finanelallnformatlon ((a)(4) oftbe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy ((a)(6) of the PRA]
b(l) National security classified information ((b)(l) oftbe FOIA)
b(2) Release would disclose Internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) oftbe FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy )(b)(6) ofthe FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes((b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions ((b)(8) oftbe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) ofthe FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�·JW'*'fC)#~~;1
•,ir 1
-.~·
.
·.
I
•
jJ
TALKING POINTS
�AGENDA FOR MEETINGS WITH PRIME MINISTER RABIN
One-on-One Meeting
I.
Opening Remarks
II.
Strategic Outlook
III. Peace Process
o
0
i.
IV.
U.S. Role
Israel-Syria Track
Security Issues
o
Security Assistance
o
Qualitative Edge
o
Technology Transfers
o
Strategic Planning Group
o
Nuclear Non-Proliferation
Expanded Meeting
I.
Summary of O!le-on-One Discussi.ons
II.
Peace Process:
Israeli-Palestinians Track
III. U.S.-Israel Science and Technology Commission (USISTC)
Lunch
I.
Strategic/Defense Issues
II.
Bilateral Issues
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
OOlq. note
SUBJECTffiTLE
DATE
Points to be made for one-on-one meeting Prime Minister Yitzak
Rabin (7 pages)
[none]
RESTRICTION
Pl/b(l)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
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Presidential Records Aet- (44 U.S.C. 2204(a))
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P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidendal eommereial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA)
P6 Release would consdtute a dearly unwarranted Invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified Information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and praetlces of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) of the FOIA)
b(6) Release would consdtute a dearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disclose lnformadon concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) ofthe FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
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DOCUMENT NO.
AND TYPE
001r. note
SUBJECTffiTLE
DATE
Points to be made for expanded meeting Prime Minister Yitzak Rabin
(3 pages)
[none]
RESTRICTION
P1/b(1)
COLLECTION:
Clinton Presidential Records
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OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
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Presidential Reeords Act· [44 U.S.C. 2204(a))
Freedom of Information Act· [5 U.S.C. 552(b)J
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy [(a)(6) ofthe PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIAJ
b(3) Release would violate a Federal statute ((b)(3) ofthe FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
Information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIAJ
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purposes [(b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed In accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document wlll be reviewed upon request.
�Withdrawal/Redaction Marker
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DOCUMENT NO.
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OOls. note
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DATE
Supplementary Points for meeting with Prime Minister Rabin (3
pages)
[none]
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Pl/b{l)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: . 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
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Presidential Reeords Act- [44 U.S.C. 2204(a))
Freedom oflnformation Act- [S U.S.C. SS2(b))
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P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
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financial information [(a)(4) of the PRA)
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and his advisors, or between such advlson [a)(S) ofthe PRA)
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penonal privacy [(a)(6) of the PRA)
b(l) National security classified Information [(b)(l) ofthe FOIA)
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an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
penonal privacy ((b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) oftbe FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained In donor's deed
of gift.
PRM. Penonal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�,_..,..~,~..r
~1.
PRESS STATEMENT
�REMARKS OF PRESIDENT WILLIAM J. CLINTON
ON HIS MEETING WITH ISRAELI PRIME MINISTER RABIN
March 15, 1993
It is a great pleasure for me to welcome Prime Minister Rabin
back to Washington.
We met here last August for the first time.
It has been a world of change and continuity since then.
Happily
for us both the change was here in Washington and the continuity
was over there in Israel.
I have spoken over the past few months about change in America,
but there is one area where I would like to emphasize an
essential:
That is the unique bond that unites the United States
and Israel.
It is a bond that goes back to the founding of the
State of Israel, and, in important ways, beyond.
It is a bond
that unites our cultures back to ancient times and scriptures.
It is a bond that is also based on shared democratic values and
ideals, for Israel is the region's paragon of democracy.
More
and more people around the world aspire to develop democratic
cultures, and we hope to see an evolution toward more accountable
governance and democratic ideals in the Middle East as well.
During the campaign, I pledged to strengthen U.S.-Israeli
relations.
One of my first phone calls from the Oval Office was
to Prime Minister Rabin's home in Tel Aviv.
Since then, I have
enjoyed working closely with the Prime Minister directly and through
DRAFT
�DRAFT
Secretary Christopher.
His visit today is another significant
step in strengthening our relationship.
Privately and now
publicly, I have reiterated our firm commitment to Israel's ·
security, including its qualitative military edge.
I am also
pleased to announce today the establishment of a Science and
Technology Commission through which we will work together to
sharpen our common "technological edge" so that we can both
better compete in the international market place.
Our talks today have been extensive
East and ranging beyond.
strategic partners.
They have been discussions worthy of
We have looked at today's problems.
also looked at the tomorrow's promise.
strategic dialogue.
encompassing the Middle
We have
We want to maintain this
It will be a hallmark of this
Administration.
During the campaign, I also pledged to re-invigorate the Middle
East peace process.
To demonstrate that commitment, I sent
Secretary Christopher to the Middle East on his first foreign
mission.
These talks today with Prime Minister Rabin have been
aimed at building momentum.
The U.S. will be a full partner when
the parties resume negotiations.
The U.S. will also be actively
involved in supporting fully agreements reached between the
parties.
DRAFT
�DRAFT
3
I will also be meeting with President Mubarak next month, and
our peace team will be meeting with representatives of the
negotiating parties prior to resuming bilateral talks on April
20.
These talks are not intended merely to re-convene the
negotiations, but also to prepare the ground for early
substantive results.
Hard choices must be made.
Peace will not come without a price.
My discussions today with Prime Minister Rabin indicate that the
Israeli side understands this.
What must also be understood, and
accepted by all, is the benefits that can and should result from
peace -- treaties, diplomatic relations, commerce, tourism,
freedom from fear -- the human bonds that are both the fruits and
the best guarantee of peace in the long run.
What must also be
grasped is the far higher price of failing to seize this
opportunity.
After my discussions, I am convinced that Prime Minister Rabin is
a strategist, fully aware of the opportunities as well as the
risks.
He will find in me a partner ready to maximize those
opportunities and minimize the risks.
�DRAFT
4
This year -- 1993
the Middle East.
can be and should be the year of peace in
We stand here resolved not to let the
opportunity pass.
I'IIIIIII.A'..... .,.,..,
;~
~
i
IP~¥-,.i
J
D
f\. ..
�PRESS Q&A'S
�PRESS QUESTIONS AND ANSWERS
U.S. ASSISTANCE TO ISRAEL
Q:
What is your Administration's position on future assistance
levels for Israel?
A:
The budget I submitted for FY 94 maintains current aid
levels to Israel.
It is our intention to continue significant levels of
aid to Israel.
Q:
A:
How can you ask Americans to tighten their belts and not
ask the largest foreign aid recipient to.do the same?
Israel is in the process of reforming its economy and
that is at times a painful process.
We are encouraging the Israelis to perservere, and we
will have an active dialogue on how we can strengthen
Israel's economy so it can be more self sufficient.
While the Cold War has ended, peace has yet to come to
the Middle East and I remain committed to our strong
support for Israel.
Q:
A:
Are we satisfied with Israel's economic reform efforts?
What else should they be doing?
As I said, we will have an active dialogue on how we
can strengthen Israel's economy.
�2
DEFENSE AGREEMENTS WITH ISRAEL
Q:
A:
Have you and the Prime Minister agreed .to new defense
arrangements between the United States and Israel?
This Administration is unalterably committed to
Israel's security and to preserving its qualitative
military edge in the region.
I have reiterated that commitment to Prime Minister
Rabin today.
We will be looking for areas to cooperate more
intensively, especially in the area of science and
technology.
·
SCIENCE AND TECHNOLOGY COMMISSION
Q:
A:
What is involved in the new Science and Technology
commission? What are its objectives? Who will head it?
We anticipate intensified cooperation in four areas:
o
Encouraging high-tech industries in the U.S. and
Israel to link up in joint projects that will
benefit both countries,
o
Fostering scientific exchanges between U.S. and
Israeli universities and research institutions,
o
Promoting development of agricultural and
enviromental technologies,
o
Assisting in the adaptation of military technology
for civilian production.
I have asked (name to be provided) to head up the
American side.
�3
PEACE PROCESS
Q:
How do you view the Israeli proposals for the peace process?
Do you feel their positions will lead to a settlement?
·A:
Today, the Prime Minister and I have discussed at
length the peace process and I have conveyed to him my
deep commitment to helping move the process forward.
I do not want to discuss specific aspects of the
Israeli proposals. This is better left to the
negotiators at the table.
But I will say that the Prime Minister has reiterated
his firm commitment to the negotiations for a
comprehensive settlement. And I have reiterated my
offer for the u.s. to be an active full partner in
helping the parties achieve progress toward peace.
Q:
Have the· parties accepted our invitation to return to the
negotiating table? What is the hang up and how will we fix
it?
A:
We do not yet have responses from all the parties. We
remain hopeful that all the parties will return to the
negotiating table.
JERUSALEM
Q:
What is your position on Jerusalem?
A:
My position has not changed from the campaign. But as I
said, I am not going to take any step that might disrupt the
negotiations.
Q:
Will you move the U.S. Embassy to Jerusalem?
A:
My position has not changed from the campaign. But as I
said, I am not going to take any step that might disrupt the
negotiations.
�4
Q:
Do you recognize Jerusalem as Israel's capital as you stated
during your campaign?
A:
My position has not changed from the campaign. But as I
said, I am not going to take any step that might disrupt the
negotiations.
ARAB BOYCOTT
Q:
A:
What is your position on the Arab boycott?
doing to end it?
What are you
I am firmly opposed to the boycott which is an
anachronism given the negotiations underway between
Israel and her Arab neighbors.
Secretary Christopher made our strong opposition known
to Arab governments during his recent visit.
We are also encouraging other industrialized countries
to emulate ?Ur anti-boycott measures.
Q:
A:
Did Christopher make any progress?
It is a high priority, and we expect it to be a
continuing effort on our part.
SETTLEMENTS
Q:
A:
What is our position on Israeli settlements in the Occupied
Territories? Do you oppose them?
I oppose settlements as obstacles to peace, and we
welcome Prime Minister Rabin's reorientation of
investment away from settlements to Israel proper.
�5
(IF PRESSED)
I stated my view during the campaign; however, it is up
to the parties themselves to decide the final status of
Jerusalem in their negotiations, and I have said that I
will not take any action that would undermine the
negotiations.
JONATHAN POLLARD
Q:
A:
What is your position on commutation of Jonathan Pollard's
sentence?
I will review his case when his appeal reaches my desk. -
SALE OF ISRAELI A-4 AIRCBAFT TO INDONESIA
Q.
A.
Are we willing to facilitate the sale of Israeli A-4
aircraft to Indonesia?
I have asked the Secretary of State to look into this
issue and provide me with a recommendation.
�--------1
----~-
--------------·
····------~----------------
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DOCUMENT NO.
AND TYPE
001 t. briefing
paper
SUBJECTffiTLE
DATE
Leah Rabin. (1 page)
[none]
RESTRICTION
Pl/b(l}
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Records Aet -(44 U.S.C. 2204(a))
Pl National Security Classified Information [(a)(l) of the PRA[
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would dlselose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted Invasion of
personal privacy ((a)(6) ofthe PRA)
C. Closed In accordance with restrictions eontalned In donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
Freedom oflnformatlon Aet- (5 U.S.C. 552(b))
b(l) National security classified Information ((b)(l) of the FOIA)
b(2) Release would disclose Internal personnel rules and practices of
· an agency ((b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute ((b)(3) ofthe FOIA)
· b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
�Mordecbai SHANI
ISRAEL
(Phonetic: SHAnee)
Director General, Ministry
of Health (since 1978)
..
Addressed as: Dr. Shani
The top dvil servant at~ Ministry of Health. Mordechai Shani has overseen the day·
to-day operations of the Ministry for nearly IS years. Before moving to the Health Ministry's
headquarters he had been associated .with the govemment.:run Haim Sheba Medical Center at
Tel Jiashomcr since 1965. During 196{•70 Sharli headed a group of physicians seconded
from Haim Sheba lo rebuild and expand llcalth care seiVice in the occupied Sinai Peninsula
following rbe 1967 Araf>.Isracll War•. He was awarded an Albert Schweiter Prize by the
Bns.ssels·based Goethe Foundation in 1970 for his work in Sinai. Shani subsequently served
as director of Haim Sheba from 1971 until assuming his current position.
Shani was born in Palestine in 1938. He graduated from the Medical School of Hebrew
UnivctSfty in Jerusalem. He is married and has at least two children. Shani's Englishlanguage capabWty is unknown.
15 March 1993
�~-
3
PEACE PROCESS
Q:
How do you view the Israeli proposals for the peace process?
Do you feel their positions will lead to a settlement?
·A:
Today, the Prime Minister and I have discussed at
length the peace process and I have conveyed to him my
deep commitment to helping move the process forward.
I do not want to discuss specific aspects of the
Israeli proposals. This is better left to the
negotiators at the table.
But I will say that the Prime Minister has reiterated
his firm commitment to the negotiations for a
comprehensive settlement. And I have reiterated my
offer for the U.S. to be an active full partner in
helping the parties achieve progress toward peace.
Q:
Have the· parties accepted our invitation to return to the
negotiating table? What is the hang up. and how will we fix
it?
A:
We do not yet have responses from,all the parties. We
remain hopeful that all the parties will return to the
negotiating table.
JERUSALEM
Q:
What is your position on Jerusalem?
A:
My position has not changed from the campaign. But as I
said, I am not going to take any step that might disrupt the
negotiations.
Q:
Will you move the U.S. Embassy to Jerusalem?
A:
My position has not changed from the campaign. But as I
said, I am not going to take any step that might disrupt the
negotiations.
�.
4
Q:
Do you recognize Jerusalem as Israel's capital as you stat.ed
during your campaign?
A:
My position has not changed from the campaign. But as I
said, I am not going to take any step that might disrupt the
negotiations.
ARAB BOYCOTT
Q:
A:
What is your position on the Arab boycott?
doing to end it?
What are you
I am firmly opposed to the boycott which is an
anachronism given the negotiations underway between
Israel and her Arab neighbors.
Secretary Christopher made our strong opposition known
to Arab governments during his recent visit.
We are also encouraging other industrialized countries
to emulate our anti-boycott measures.
Q:
A:
Did Christopher make any progress?
It is a high priority, and we expect it to be a
continuing effort on our part.
SETTLEMENTS
Q:
A:
What is our position on Israeli settlements in the Occupied
Territories? Do you oppose them?
I oppose settlements as obstacles to peace, and we
welcome Prime Minister Rabin's reorientation of
investment away from settlements to Israel proper.
�5
(IF PRESSED)
I stated my view during the campaign; however, it is up
to the parties themselves to decide the final status of
Jerusalem in their negotiations, and I have said that I
will not take any action that would undermine the
negotiations.
JONATHAN POLLARD
Q:
A:
What is your position on commutation of Jonathan Pollard's
sentence?
I will review his case when his appeal reaches my desk. ·
SALE OF ISRAELI A-4 AIRCRAFT TO INPONESIA
Q.
A.
Are we willing to facilitate the sale of Israeli A-4
aircraft to Indonesia?
I have asked the Secretary of State to look into this
issue and provide me with a recommendation.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001u. briefing
paper
SUBJECT/fiTLE
DATE
Leah Rabin. ( 1 page)
[none]
RESTRICTION
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSC Records Management
([First Lady and Health Care])
OA/Box Number: 143
FOLDER TITLE:
9301514
2006-0223-F
ab628
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(l) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial Information [(a)(4) oftbe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy [(a)(6) of tbe PRA)
b(l) National security classified Information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) oftbe FOIA]
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial Institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�I)J, .......·gJ
... -..; ...._;-
,
"a
Mordecbai SHANI
1410021002
ISRAEL
(Phonetic: SHAnee)
Director Geneml, Ministry
of Health (since 1978)
Addressed a: Dr. Shani
The top civil SCIVant at~ Ministry of Health, Mordechai Shani has overseen the day·
to-day operations of the Ministry for nearly lS years. Before moving to the Health Ministty's
headquarters he had been assoCiated .with the government-run Haim Sheba Medical Center at·
Tel Hashomcr since 1965. During 1967•70 Shani headed a group of physicians seconded
from Haim Sheba to rebuild and expand health care service in the occupied Sinai Peninsula
following the 1967 Arab-Israeli War•. He was awarded an Alben: Schweiter Prize by the
Brussels-based Goethe Foundation in 1970 for his work in Sinai. Shani subsequently selVed
as director of Haim Sheba from 1971 until assuming his cunent position.
Shani was bam in Palestine in 1938. He graduated from the Medical School of Hebrew
University in IcnJSalem. He ls married and has at least two children. Shani's Englishlanguage capability is unknown.
15 March 1993
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
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White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
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1993
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2006-0223-F
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This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
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72 files in 6 boxes
Provenance
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Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
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William J. Clinton Presidential Library & Museum
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<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
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Magnetic Disk: Hard Drive
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2006-0223-F
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Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7388808" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
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1/8/2015
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42-t-7388808-20060223F-006-016-2015
7388808
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https://clinton.presidentiallibraries.us/files/original/f7fbee63ae6d96bdd2b8bcfb58c52aba.pdf
d936a1588a0ba7c954ff7eaf05a765cb
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Text
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DOCUMENT NO.
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RESTRICTION
001. email
Edmund J. Hull to MartinS. Indyk. Subject: USISTC: Legal Issues.
(2 pages)
04/14/1993
P5
002. email
Earl A Wayne to Brenda I. Hilliard. Subject: Briefing Materials for
the First Lady and Brundtland. (1 page)
01128/1993
P1/b(1)
003.email
Cathy Millison to Barry F. Lowenkron. Subject: First: Lady's
Correspndence. (1 page)
08/20/1993
Pllb(l)
COLLECTION:
Clinton Presidential Records
NSC Emails
A1-Record (Jan 93-Sept 94) (fFirst Lady; Health Carel)
OA/Box Number: 570000
FOLDER TITLE:
[01127/1993- 08/20/1993]
2006-0223-F
ab627
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a))
Freedom of Information Act -IS U.S.C. SS2(b))
Pl National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
fmandal information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or fmancial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document wiD be reviewed upon request.
�F:\Email\Data_Source\A1\Record\CD001~an93\000154.html
Page 1 of 1
NATIONAL SECURITY COUNCIL
27-Jan-1993 18:55 EDT
UNCLASSIFIED
MEMORANDUM FOR: SEE BELOW
FROM:
Earl A. Wayne
(WAYNE)
SUBJECT:
FYI First Lady and Norwegian Prime Minister
FYI:
Please inform the appropriate individuals
The First Lady's office has informed us that she will see Norwegian Prime
Minister Brundtland ~hursday January 28 at 4:30pm, just before the Vice
President's meeting with Brundtland. Norway's health care system will be a
major topic of conversation.
(Brundtland is a physician by training and has
done much work on health care.) I have informed the Norwegian embassy and the
Vice President's office.
Distribution:
FOR:
FOR:
FOR:
FOR:
FOR:
FOR:
CC:
CC:
Wendy E. Gray
Brenda I. Hilliard
Cathy Millison
Mary C. Emery
Allison M. Wright
M. Brooke Darby
Records
Betty A. Marshall
Additional Header Information Follows
Date Created: 27-Jan-1993 18:47
Deletable Flag: Y
DOCNUM: 000154
VMS Filename: OA$SHARE54:ZUNFR1HVH.WPL
Al Folder: JAN93
Message Format:
Message Status: READ
Date Modified: 27-Jan-1993 18:47
Forward Flag: YES
Read-Receipt Requested: NO
Delivery-Receipt Requested: NO
Message Priority: FIRST CLASS
GRAY )
HILLIARD
MILL I SON
EMERY )
WRIGHT )
DARBY )
RECORDS )
MARSHALL )
�F:\Email\Data_Source\A 1\Record\CDOO 1\jan93\000 157 .html
J.~
Page 1 of2
.....
NATIONAL SECURITY COUNCIL
27-Jan-1993 19:16 EDT
UNCLASSIFIED
MEMORANDUM FOR:
( ITOH )
William H. Itoh
FROM:
Brenda I. Hilliard
(HILLIARD)
SUBJECT:
See attached note
Also re visit of PM Brundtland with Mrs. Clinton.
CC: Records
( RECORDS )
Additional Header Information Follows
Date Created: 27-Jan-1993 19:14
Deletable Flag: Y
DOCNUM: 000157
VMS Filename: OA$SHARE51:ZUNFRJI22.WPL
A1 Folder: JAN93
Message Format:
Message Status: READ
Date Modified: 27-Jan-1993 19:14
Forward Flag: YES
Read-Receipt Requested: NO
Delivery-Receipt Requested: NO
Message Priority: FIRST CLASS
0
NATIONAL SECURITY COUNCIL
27-Jan-1993 18:55 EDT
UNCLASSIFIED
MEMORANDUM FOR: SEE BELOW
FROM:
Earl A. Wayne
(WAYNE)
SUBJECT:
FYI First Lady and Norwegian Prime Minister
FYI:
Please inform the appropriate individuals
The First Lady's office has informed us that she will see Norwegian Prime
Minister Brundtland Thursday January 28 at 4:30pm, just before the Vice
President's meeting with Brundtland. Norway's health care system will be a
major topic of conversation.
(Brundtland is a physician by training and has
�F:\Email\Data_Source\A 1\Record\CDOO 1\jan93\000 157 .html
done much work on health care.)
Vice President's office.
I have informed the Norwegian embassy and the
Distribution:
FOR:
FOR:
FOR:
FOR:
FOR:
FOR:
CC:
CC:
Wendy E. Gray
Brenda I. Hilliard
Cathy Millison
Mary C. Emery
Allison M. Wright
M. Brooke Darby
Records
Betty A. Marshall
Page 2 of2
GRAY )
HILLIARD
MILL I SON
EMERY )
WRIGHT )
DARBY )
RECORDS )
MARSHALL )
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. email
DATE
SUBJECTffiTLE
EdmundJ. Hull to MartinS. Indyk. Subject: USISTC: Legal Issues.
(2 pages)
04/14/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
NSC Emails
At-Record (Jan 93-Sept 94) ([First Lady; Health Carel)
OA/Box Number: 570000
FOLDER TITLE:
[01127/1993- 08/20/1993]
2006-0223-F
ab627
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act- (S U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wens ((b)(9) of the FOIA)
Pl Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record minlle defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. email
DATE
SUBJECI'/TITLE
Earl A. Wayne to Brenda I. Hilliard. Subject: Briefing Materials for
the First Lady and Brundtland. (1 page)
01128/1993
RESTRICTION
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSCEmails
A1-Record (Jan 93-Sept 94) (!First Lady; Health Carel)
OA/Box Number: 570000
FOLDER TITLE:
[01127/1993- 08/20/1993]
2006-0223-F
ab627
RESTRICTION CODES
Presidential Records Aet -(44 U.S.C. 2204(a))
Freedom of Information Act- (S U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal offiee ((a)(l) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would diselose trade seerets or eonfidential eommereial or
finaneial information ((a)(4) of the PRA)
PS Release would diselose eonfidential adviee between the President
and his advisors, or between sueh advisors (a)(S) of the PRA)
P6 Release would eonstitute a elearly unwarranted invasion of
personal privaey ((a)(6) of the PRA)
b(l) National security elassified information ((b)(l) of the FOIA)
b(l) Release would diselose internal personnel rules and praetiees of
an ageney ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would diselose trade seerets or eonfidential or fmaneial
information ((b)(4) of the FOIA)
b(6) Release would eonstitute a elearly unwarranted invasion of
personal privaey ((b)(6) of the FOIA)
b(7) Release would diselose information eompiled for law enforeement
purposes ((b)(7) of the FOIA)
b(B) Release would diselose information eoneerning the regulation of
finaneial institutions ((b)(B) of the FOIA)
b(9) Release would diselose geologieal or geophysieal information
eoneerning weDs ((b)(9) of the FOIA)
C. Closed in aeeordanee with restrietions eontained in donor's deed
of gift.
PRM. Personal reeord misfile defined in aeeordanee with 44 U.S.C.
2201(3).
RR. Doeument will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. email
DATE
SUBJECTffiTLE
Cathy Millison to Barry F. Lowenkron. Subject: First: Lady's
Correspndence. (1 page)
08/20/1993
RESTRICTION
Pl/b(l)
COLLECTION:
Clinton Presidential Records
NSC Emails
At-Record (Jan 93-Sept 94) (fFirst Lady; Health Carel)
OA/Box Number: 570000
FOLDER TITLE:
[01127/1993 - 08/20/1993]
2006-0223-F
ab627
RESTRICTION CODES
Presidential Records Aet - (44 U.S.C. 2204(a))
Freedom of Information Aet- (S U.S.C. SS2(b))
Pl National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) ofthe PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information complled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfde defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Magnetic Disk: Hard Drive
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
[01/27/1993 - 08/20/1993]
Creator
An entity primarily responsible for making the resource
NSC Emails
A1-Record (January 1993 – September 1994)
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7585710" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7585710-20060223F-006-015-2015
7585710
-
https://clinton.presidentiallibraries.us/files/original/5aa839d51155237713cd5ca4beab9bf0.pdf
e622b313106b4179930c7eb8ed8d1c4c
PDF Text
Text
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
DATE
SUBJECTffiTLE
RESTRICTION
AND TYPE
001. cable
Subject: British Columbia Invitation for First Lady to Examine
Province's Health Care System (2 pages)
02/22/1993
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSC Cables
Jan 1993- Dec 1994 ([First Lady and Health Care])
OA!Box Number: 505,000
FOLDER TITLE:
[01/03/1993 - 09/29/1993]
2006-0223-F
ab626
RESTRICTION CODES
Presidential Records Ad -(44 U.S.C. 2204(a))
Freedom oflnformation Ad -(5 U.S.C. SS2(b))
Pl National Security Classlfled Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial Information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy ((a)(6) ofthe PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose Internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disclose Information concerning the regulation of
financial Institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical Information
concerning wells ((b)(9) of the FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�lo
F:\Cable\Data_ Source\Cables\CD002\JUN93\MSGS\M0422315 .html
..
Cab 1e
PREC:
CLASS:
LINEl:
LINE2:
LINE3:
LINE4:
OSRI:
DTG:
ORIG:
TO:
INFO:
SUBJ:
IMMEDIATE
UNCLASSIFIED
OAAUZYUW RUFHFRA4277 1541042-UUUU--RHEHAAA.
ZNR UUUUU ZZH
0 031042Z JUN 93
FM AMEMBASSY PARIS
RUFHFR
031042Z JUN 93
AMEMBASSY PARIS
RUEHIA/USIA WASHDC IMMEDIATE 9576
RUEAIIA/CIA WASHDC
RUEATRS/DEPARTMENT OF TREASURY
RUEKJCS/DIA WASHDC
RUEKJCS/SECDEF WASHDC//ASD/ISA//
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RHEHAAA/WHITE HOUSE
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RUEHRO/AMEMBASSY ROME 2442
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RUFHZG/AMEMBASSY ZAGREB 1075
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RUFHNA/USMISSION USNATO IMMEDIATE 0652
RUFHMB/USMISSION USVIENNA 8336
RUFRQJQ/COMSIXTHFLT
DAILY MEDIA REACTION REPORT
PARIS -- THURSQAY JUNE 3, 1993
(A) SUMMARY OF TYPE OF COVERAGE:
GOVERNMENT PLANS TO CURB IMMIGRATION AND UNEMPLOYMENT
ARE THE TOP STORIES IN THE PRESS TODAY.
TEXT:
UNCLAS SECTION 01 OF 04 PARIS 14277
USIA
USIA FOR P/RC; P/P; P/FW P/FN; VOA NEWS/CA; EU; AF; P/M;
STATE FOR EUR/P/SP; EU/WE; AF; INR/P; PM; OSD ISA FOR
ILN; FOR NEA; WHITE HOUSE FOR NSC/WEUROPE; DOC FOR
ITA/EUR/FR AND PASS USTR/PA (PAT NORMAN); USCINCEUR FOR
PAO; NATO FOR USIS; MOSCOW FOR P&C; ROME FOR USIS/AIO;
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CSCE.
E.O. 12356: N/A
TAGS: NONE
SUBJECT: DAILY MEDIA REACTION REPORT
PARIS -- THURSDAY JUNE 3, 1993
(A) SUMMARY OF TYPE OF COVERAGE:
GOVERNMENT PLANS TO CURB IMMIGRATION AND UNEMPLOYMENT
ARE THE TOP STORIES IN THE PRESS TODAY.
PRIME MINISTER EDOUARD BALLADUR WAS THE GUEST OF A TWOHOUR LONG TV SPECIAL ON FRANCE 3 LAST NIGHT. HE TRIED
Page 1 of6
�F:\Cable\Data Source\Cables\CD002\JUN93\MSGS\M0422315.html
TO JUSTIFY THE "NECESSARY SACRIFICES" WHICH HE IS ASKING
THE FRENCH TO MAKE. ON GATT, BALLADUR SAID THAT FRANCE
WILL NOT ACCEPT NEGOTIATIONS THAT "WOULD ... PUT
EUROPEAN FIRMS IN A WEAK POSITION VIS-A-VIS THE REST OF
THE WORLD". HE SAID HE WAS SPEAKING FOR EUROPEAN FIRMS
AND NOT ONLY FOR FRENCH, AND ADDED: "EUROPE AS AN
ECONOMIC BODY MUST BE DEFENDED AS WELL AS OTHERS (I.E.
U.S.); (IT MUST NOT BE) THE ONE OF WHOM MOST SACRIFICES
ARE ASKED." SPEAKING OF TRADE PROTECTION, BALLADUR SAID
THAT THE UNITED STATES HAS 'A WHOLE ARSENAL' OF SUCH
PROTECTIONIST MEASURES AND SAID: "IT IS NOT A QUESTION
OF GETTING FOR EUROPE MORE PROTECTION THAN OTHERS HAVE,
IT IS A QUESTION OF NOT PROTECTING IT LESS .... AND
REJECTING UNFAIR PRACTICES." (AFP QUOTES).
THE FRANCO-GERMAN SUMMIT, WHICH ENDED YESTERDAY IN
BEAUNE, IS ANOTHER MAJOR STORY. COMMENTATORS REPORT
THAT PARIS AND BONN AGREE ON BOSNIA AND GATT. MASSAPPEAL LE PARISIEN SPEAKS OF "A SUMMIT OF CONSENSUS",
AFP OF A "FRANCO-GERMAN RAPPROCHEMENT ON BOSNIA AND
GATT".
ON BOSNIA, PARIS AND BONN ISSUED A JOINT COMMUNIQUE
WHICH SAYS THAT "FRANCE AND GERMANY CONFIRM THEIR
SUPPORT FOR THE VANCE-OWEN PEACE PLAN AND THINK THAT THE
CREATION OF SAFE AREAS IS NEEDED TO PROTECT CIVILIANS IN
BOSNIA". LES ECHOS SPEAKS OF THE "SUCCESS OF COMPROMISE
DIPLOMACY".
ON GATT, BOTH COUNTRIES AGREE ON A "GLOBAL" APPROACH,
AND NOT A "FRAGMENTATION" OF THE CURRENTLY DISCUSSED
ISSUES. AFP QUOTES CHANCELOR KOHL AS SAYING "TALKING OF
AGRICULTURE AND PUSHING ASIDE OTHER ISSUES HAS GIVEN AN
ADVANTAGE TO OUR AMERICAN FRIENDS". AFP SAYS THIS IS AN
"UNUSUAL" CRITICISM OF THE U.S. ON THE PART OF THE
GERMANS. FINANCIAL LA TRIBUNE'S SPECIAL ENVOY REPORTS
THAT "THE GERMANS HAVE COME CLOSER TO THE FRENCH
POSITIONS".
THE CONFLICT IN EX-YUGOSLAVIA STILL MAKES THE HEADLINES.
FOCUS IS ON TUESDAY'S RIOTS IN BELGRADE, FOLLOWING THE
OUSTER OF YUGOSLAV PRESIDENT DOBRICA COSIC.
RIGHT-OF-CENTER LE QUOTIDIEN REPORTS ON ITS FRONT. PAGE
ON U.S. SECRETARY OF STATE WARREN CHRISTOPHER'S
'INTERVIEW ON PBS: "WASHINGTON WASHES ITS HANDS" (SEE
PART D OF REPORT) .
THE PARIS BUREAU OF ASSOCIATED PRESS REPORTS ON FORMER
PRESIDENT GEORGE BUSH'S SPEECH TO THE BOARD OF DIRECTORS
OF VISA INTERNATIONAL IN THE FRENCH RIVIERA CITY OF
CANNES: "GEORGE BUSH SAYS FORCE IS NOT THE WAY TO BRING
PEACE TO BOSNIA, BUT IF PRESIDENT CLINTON DECIDES TO USE
THE MILITARY, HE'D BETTER BE READY TO COMMIT GROUND
UNCLAS SECTION 02 OF 04 PARIS 14277
USIA
USIA FOR P/RC; P/P; P/FW P/FN; VOA NEWS/CA; EU; AF; P/M;
STATE FOR EUR/P/SP; EU/WE; AF; INR/P; PM; OSD ISA FOR
ILN; FOR NEA; WHITE HOUSE FOR NSC/WEUROPE; DOC FOR
ITA/EUR/FR AND PASS USTR/PA (PAT NORMAN); 'USCINCEUR FOR
PAO; NATO FOR USIS; MOSCOW FOR P&C; ROME FOR USIS/AIO;
BRUSSELS FOR USIS AND USEC (PAO); USVIENNA FOR USDEL
CSCE.
E.O. 12356: N/A
Page 2 of6
�F:\Cable\Data_Source\Cables\CD002\JUN93\MSGS\M0422315 .html
TAGS: NONE
SUBJECT: DAILY MEDIA REACTION REPORT
TROOPS TO THE TASK.
'IN MY VIEW, YOU DON'T USE THE
MILITARY TO SEND A MESSAGE--YOU SEND IT TO PERFORM A
MISSION, I BUSH SAID."
THE PRESS REPORTS ON THE ON-GOING OECD MINISTERIAL
MEETING. FOCUS IS ON U.S. TREASURY SECRETARY BENTSEN'S
"CRITICISMS" AGAINST JAPAN AND THE EUROPEAN COMMUNITY.
AGENCE FRANCE PRESSE REPORTS ON BENTSEN'S STATEMENTS,
AND HEADLINES: "THE UNITED STATES CRITICIZES JAPAN AND
URGES EUROPE TO (MAKE) GREATER EFFORTS"; ECONOMIC LES
ECHOS SPEAKS OF BENTSEN'S "BRUTAL FRANKNESS".· (SEE PART
D OF REPORT) .
COMMENTATORS ALSO REPORT ON A QUADRILATERAL MEETING ON
THE URUGUAY ROUND THAT TOOK PLACE WITH REPRESENTATIVES
OF THE U.S., THE EC, JAPAN AND CANADA. LE FIGARO'S
FIGECO SPEAKS OF "PROGRESS"; FINANCIAL LA TRIBUNE QUOTES
EC COMMISSIONER LEON BRITTAN AS SPEAKING OF "A
SIGNIFICANT BREAKTHROUGH IN THE GATT TALKS." LIBERATION
SPEAKS OF "CALMER WINDS ON COMMERCIAL ISSUES".
(SEE
PART D OF REPORT) .
IN THE U.S.-EC MARKET ACCESS DISPUTE, LIBERATION AND AFP
REPORT THAT THE 12 AMBASSADORS TO THE EC AGREED
YESTERDAY IN PRINCIPLE ON A SERIES OF RETALIATION
MEASURES AGAINST THE UNITED"STATES, FOLLOWING THE U.S.
DECISION TO IMPOSE SANCTIONS ON THE EC.
FINANCIAL LA TRIBUNE PUBLISHES A TWO-PAGE DOSSIER ON
HILLARY RODHAM CLINTON'S "RISKY AND HUGE TASK"--TO
REFORM THE U.S. HEALTH CARE SYSTEM. LA TRIBUNE CALLS
MRS. CLINTON "THE MOST INFLUENTIAL FIRST LADY IN U.S.
HISTORY".
COMMUNIST L'HUMANITE PUBLISHES A TWO-PAGE INTERVIEW WITH
MARIE-FRANCE TOINET, A WELL-KNOWN SPECIALIST ON THE U.S.
POLITICAL SYSTEM. "TODAY, ONE HAS·THE IMPRESSION THAT
THE UNITED STATES CANNOT FIND THE WAY TO SUCCESS AND
PROGRESS. DIFFICULTIES ARE PILING UP .... FUNDAMENTALLY,
ONE HAS THE IMPRESSION THAT THE UNITED STATES DID NOT
KNOW HOW TO PREPARE FOR THE FUTURE", TOINET SAYS.
(B) STORIES COVERED IN REPORT:
1. EX-YUGOSLAVIA
2. OECD MINISTERIAL
(C) HEADLINES:
OECD MINISTERIAL:
"THE UNITED STATES CRITICIZES JAPAN AND URGES EUROPE TO
(MAKE) GREATER EFFORTS" (AGENCE FRANCE PRESSE)
"WASHINGTON ATTACKS THE EC AND JAPAN" (LES ECHOS-FRONT
PAGE)
.
.
"THE U.S. CRITICIZES EUROPEAN AND JAPANESE
PUSILLANIMITY" (LES ECHOS-PAGE 6)
(D) SUPPORTING TEXT:
1. EX-YUGOSLAVIA:
RIGHT-OF-CENTER LE QUOTIDIEN ON ITS FRONT PAGE: "IN AN
UNCLAS SECTION 03 OF 04 PARIS 14277
USIA
USIA FOR P/RC; P/P; P/FW P/FN; VOA NEWS/CA; EU; AF; P/M;
STATE FOR EUR/P/SP; EU/WE; AF; INR/P; PM; OSD ISA FOR
ILN; FOR NEA; WHITE HOUSE FOR NSC/WEUROPE; DOC FOR
ITA/EUR/FR AND PASS USTR/PA (PAT .NORMAN); USCINCEUR FOR
Page 3 of6
�F:\Cable\Data Source\Cables\CD002\JUN93\MSGS\M0422315.html
PAO; NATO FOR USIS; MOSCOW FOR P&C; ROME FOR USIS/AIO;
BRUSSELS FOR USIS AND USEC (PAO); USVIENNA FOR USDEL
CSCE.
E.O. 12356: N/A
TAGS: NONE
SUBJECT: DAILY MEDIA REACTION REPORT
OUTBURST OF FRANKNESS, U.S. SECRETARY OF STATE WARREN
CHRISTOPHER SAID TUESDAY NIGHT (ON TV PBS) THAT THE
UNITED STATES HAD NO VITAL INTERESTS IN BOSNIA AND THAT
THE MILITARY OPTIONS ADVOCATED BY WASHINGTON WERE NOT
VERY EFFECTIVE."
AGENCE FRANCE PRESSE REPORTS ON THE SAME TV INTERVIEW:
" ... U.S. SECRETARY OF STATE WARREN CHRISTOPHER TRIED TO
PLAY DOWN THE IMPORTANCE THAT ONE SHOULD ATTACH ... TO THE
AIR COVER THAT THE U.S. COULD PROVIDE. IN A TV
INTERVIEW TUESDAY NIGHT, HE SAID THAT U.S. MILITARY
EXPERTS THOUGHT THAT THE EFFECTIVENESS OF STRIKES
AGAINST SERB ARTILLERY WOULD NOT LAST BEYOND THE SECOND
DAY."
STILL LE QUOTIDIEN WITH PHILIPPE MARCOVICI ON PAGE 12:
" ... ALTHOUGH THEY SIGNED THE WASHINGTON ACCORD, THE
AMERICANS ARE ONCE AGAIN SHOWING THEIR IRRESOLUTENESS-WHICH IS IN FACT THAT OF THEIR PRESIDENT: THEY SUDDENLY
HAVE RESERVATIONS ABOUT 'SAFE HAVENS'. THEY WOULD LIKE
TO GET A MORE PRECISE DEFINITION OF TERMS UNDER WHICH
U.S. AIRPLANES WOULD EXTEND SUPPORT TO BLUE HELMETS IN
THE PROTECWED AREAS. IN THE MINDS OF THE AMERICANS,
THIS SUPPORT WOULD ONLY BE PROVIDED IN CASE OF A DIRECT
THREAT AGAINST UN FORCES, NOT TO PROTECT THE CIVILIAN
POPULATION."
JEAN-JACQUES MEVEL IN CONSERVATIVE LE FIGARO: "ALREADY
DERIDED BY SOME SERBS WHO ARE DETERMINED TO GET RID OF
THE LAST MUSLIM GHETTOS IN BOSNIA, THE WEST JUST
SUFFERED A NEW EXASPERATING SETBACK IN BELGRADE. PARIS,
LONDON, WASHINGTON AND MOSCOW WERE DREAMING OF SLOBODAN
MILOSEVICDONNING THE FIREMAN UNIFORM AND EXTI8#8,&
5#3 !843 8, 5#3 ?-) (-,. BUT THE BELGRADE STRONGMAN HAS
JUST PUT HIMSELF IN THE RANKS OF THE ARSONISTS (OUSTER
OF DOBRICA COSIC, TUESDAY RIOTS)."
IN LIBERATION, PIERRE HASKI COMMENTS ON THE GERMAN
SUPPORT FOR THE WASHINGTON JOINT ACTION PROGRAM,
EXPRESSED AT THE FRANCO-GERMAN SUMMIT IN BEAUNE:
" ... THIS (FRANCO-GERMAN) AGREEMENT HARDLY HIDES THE
AMBIGUITIES IN THE WASHINGTON PROGRAM, WHICH LACKS ANY
COERCITIVE MEANS. BY SPEAKING OF A 'PROGRESSIVE
IMPLEMENTATION' OF THE VANCE-OWEN PLAN, BY
STRESSING ... THE 'PRIORITY IS TO AVOID NEW MASSACRES',
WESTERNERS RUN THE RISK OF FREEZING THE SITUATION AND
SERBIAN CONQUESTS. YESTERDAY, PARIS AND BONN OPTED FOR
THE POSITIVE READING OF AN AMBIGUOUS TEXT."
PAUL GUILBERT IN CONSERVATIVE LE FIGARO: " ... ONE COULD
SAY THAT (THE FRANCO-GERMAN JOINT COMMUNIQUE ON BOSNIA)
IS A MONUMENT OF SHARED HYPOCRISY, SINCE EVERY ONE KNOWS
THAT THE VANCE-OWEN PLAN IS MORE DIPLOMATIC FICTION THAN
REALISTIC PROMISE."
HELENE DESPIC-POPOVIC REPORTS FROM BELGRADE IN
LIBERATION: "VIOLENCE REAPPEARED IN THE BELGRADE STREETS
Page 4 of6
�-
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AFTER THE OUSTER OF YUGOSLAV PRESIDENT DOBRICA COSIC,
UNCLAS SECTION 04 OF 04 PARIS 14277
USIA
USIA FOR P/RC; P/P; P/FW P/FN; VOA NEWS/CA; EU; AF; P/M;
STATE FOR EUR/P/SP; EU/WE; AF; INR/P; PM; OSD ISA FOR
ILN; FOR NEA; WHITE HOUSE FOR NSC/WEUROPE; DOC FOR
ITA/EUR/FR AND PASS USTR/PA (PAT NORMAN); USCINCEUR FOR
PAO; NATO FOR USIS; MOSCOW FOR P&C; ROME FOR USIS/AIO;
BRUSSELS FOR USIS AND USEC (PAO); USVIENNA FOR USDEL
CSCE.
E.O. 12356: N/A
TAGS: NONE
SUBJECT: DAILY MEDIA REACTION REPORT
THUS CONFIRMING THE PREDICTIONS THAT HIS DEPARTURE WOULD
INCREASE POLITICAL INSTABILITY IN THE COUNTRY."
2. OECD MINISTERIAL:
BIANCA RIEMER IN FINANCIAL LA TRIBUNE: "FOR HIS DEBUT IN
OECD MINISTERIALS, THE NEW U.S. TREASURY SECRETARY,
LLOYD BENTSEN, PLAYED A TUNE WELL KNOWN FROM HIS .
PREDECESSORS' REPERTOIRE: STRONG CRITICISM OF JAPAN AND
A CALL FOR NEW CUTS IN EUROPEAN INTEREST RATES IN ORDER
TO REVIVE WORLD GROWTH .... WHAT IS NEW IS THAT LLOYD
BENTSEN DID NOT TRY TO HIDE HIS DISAPPOINTMENT OVER
RECENT U.S. ECONOMIC PERFORMANCE."
ECONOMIC LES ECHOS' MARTINE ROYO.: "WITHOUT KID GLOVES,
U.S. TREASURY SECRETARY LLOYD BENTSEN URGED EUROPE AND
JAPAN YESTERDAY AT THE OECD MINISTERIAL TO MAKE EXTRA
EFFORTS TO REVIVE THEIR ECONOMIES. HE SAID TO JAPANESE
OFFICIALS THAT THEIR HUGE TRADE SURPLUSES HINDER WORLD
GROWTH; HE TOLD EUROPEAN OFFICIALS THAT THEY ARE TOO
TIMID IN BRINGING DOWN THEIR INTEREST RATES. WITH HIS
BRUTAL FRANKNESS, LLOYD BENTSEN DID NOT HIDE THAT
RECOVERY IN JAPAN AND EUROPE WAS NECESSARY FOR THE
SUCCESS OF THE U.S. POLICY OF REDUCING THE BUDGET AND
TRADE DEFICITS .... BENTSEN WAS PARTICULARLY CONCERNED
ABOUT ECONOMIC TRENDS IN JAPAN."
AGENCE FRANCE PRESSE: "THE MINISTERS OF THE
INDUSTRIALIZED WORLD, WHICH IS SICK WITH RECESSION AND
UNEMPLOYMENT, TRIED TO FIND REMEDIES FOR THE CRISIS ON
WEDNESDAY IN PARIS. BUT THEY DID NOT SUCCEED IN TONING
DOWN THEIR TRADE DISPUTES. ONCE AGAIN, JAPAN FOUND
ITSELF IN THE POSITION OF THE NUMBER-ONE CULPRIT ....
U.S. TREASURY SECRETARY LLOYD BENTSEN OPENED THE
HOSTILITIES WHEN HE PUBLICLY SAID THAT JAPAN'S HUGE
TRADE SURPLUSES 'HURT WORLD GROWTH'."
AGENCE FRANCE PRESSE, IN ANOTHER REPORT: "U.S. TREASURY
SECRETARY LLOYD BENTSEN EXPRESSED STRONG CRITICISMS
AGAINST JAPAN WEDNESDAY IN PARIS, SAYING THAT JAPANESE
TRADE SURPLUSES HAD BECOME A 'GLOBAL PROBLEM 1 .WHICH IS
'HURTING WORLD GROWTH'. THE U.S. OFFICIAL SAID 'THE
WORLD CANNOT DEPEND ON GROWTH IN THE UNITED STATES TO
PULL IT OUT OF RECESSION.' HE URGED JAPAN TO MAKE EXTRA
EFFORTS TO STIMULAJE ITS ECONOMY AND EUROPE TO PURSUE
ITS EFFORTS TO ADAPT ITSELF TO WORLD COMPETITION."
ASSOCIATED PRESS REPORTS FROM PARIS: "JAPAN AND THE
UNITED STATES, USING A MEETING ON ECONOMIC COOPERATION
TO ATTACK EACH OTHER'S TRADING SYSTEMS, SHOW NO SIGN OF
EASING THEIR LATEST CONFRONTATION OVER THE SOARING
Page 5 of6
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SECT:
SSN:
TOR:
JAPANESE TRADE SURPLUS."
FIGARO'S FIGECO SAYS: "AT LAST A RAY OF HOPE FOR THE
URUGUAY ROUND? THE U.S., EUROPEAN, JAPANESE AND
CANADIAN NEGOTIATORS ... SAID YESTERDAY THEY HAD MADE
SATISFACTORY PROGRESS ON A PACKAGE FOR MARKET ACCESS ....
THE AMERICANS HAVE DECIDED TO PRESS THEIR PARTNERS.
'THE TIME HAS COME FOR US TO BE BOLD,' MICKEY KANTOR
SAID." KORENGOLD
BT
#4277
NNNN
SECTION: 01 OF 04
<"SECT>SECTION: 02 OF 04
<"SECT>SECTION: 03 OF 04
<"SECT>SECTION: 04 OF 04
4277
<"SSN>4277
<"SSN>4277
<"SSN>4277
930603065400 M0422315
<"TOR>930603065510 M0422319
<"TOR>930603065556 M0422322
<"TOR>930603065657 M0422323
DIST:
SIT: VAX
.D
Page 6 of6
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t.
Cab 1e
PREC:
CLASS:
OSRI:
LINEl:
LINE2:
LINE3:
LINE4:
DTG:
ORIG:
TO:
INFO:
SUBJ:
IMMEDIATE
UNCLASSIFIED ·
RUFHFR
OATUZYUW RUFHFR 1923 0261043-UUUU--RHEHAAA.
ZNR UUUUU ZZH
0 261043Z JAN 93
FM AMEMBASSY PARIS
261043Z JAN 93
AMEMBASSY PARIS
RUEHIA/USIA WASHDC IMMEDIATE 7750
RUEAIIA/CIA WASHDC
RUEATRS/DEPARTMENT OF TREASURY
RUEKJCS/DIA WASHDC
RUEKJCS/SECDEF WASHDC//ASD/ISA//
RUEHC/SECSTATE WASHDC 9291
RHEHAAA/WHITE HOUSE
RUCPDC/USDOC WASHDC
RUEHXQ/ALLEC COLLECTIVE
RUEHGV/USMISSION GENEVA 8958
RUFHNA/USMISSION USNATO IMMEDIATE 0157
RUFHMB/USMISSIOK USVIENNA 1824
RUFRQJQ/COMSIXTHFLT
DAILY MEDIA REACTION REPORT
PARIS -- TUESDAY JANUARY 26, 2993
(A) SUMMARY OF TYPE OF COVERAGE:
EX-YUGOSLAVIA CONTINUES TO BE THE LEAD INTERNATIONAL
STORY IN THE FRENCH PRESS, AS FIGHTING BETWEEN SERBS AND
TEXT:
UNCLAS SECTION 01 OF 03 PARIS 01923
USIA
USIA
USIA FOR P/RC; P/P; P/FW P/FN; VOA NEWS/CA; EU; AF; P/M;
STATE FOR EUR/P/SP; EU/WE; AF; INR/P; PM; OSD ISA FOR
ILN; FOR NEA; WHITE HOUSE FOR NSC/WEUROPE; DOC FOR
ITAEUR/FR; USCINCEUR FOR PAO; NATO FOR USIS; GENEVA FOR
USIS; USDEL NST GENEVA; MOSCOW FOR P&C; ROME FOR
USIS/AIO; BRUSSELS FOR USIS AND USEC (PAO); USVIENNA FOR
USDEL CSCE.
E.O. 12356: N/A
TAGS: NONE
SUBJECT: DAILY MEDIA REACTION REPORT
PARIS -- TUESDAY JANUARY 26, 2993
(A) SUMMARY OF TYPE OF COVERAGE:
EX-YUGOSLAVIA CONTINUES TO BE THE LEAD INTERNATIONAL
STORY IN THE FRENCH PRESS, AS FIGHTING BETWEEN SERBS AND
CROATS HAS BEEN GOING ON. TWO FRENCH UN-PEACEKEEPERS
WERE KILLED AS A RESULT YESTERDAY. LIBERATION'S FOREIGN
DESK CHIEF PATRICK SABATIER FOCUSES ON THE QUESTION OF
THE INVOLVEMENT OF THE UN PEACEKEEPERS--"AN EASY TARGET
FOR THE BELLIGERENTS." (SEE PART D OF REPORT).
THIS MORNING, ALL ELECTRONIC MEDIA REPORTED PRESIDENT
Page 1 of4
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CLINTON'S DECISION TO NAME HIS WIFE, HILLARY, AT THE
HEAD OF A NATIONAL HEALTH CARE TASK FORCE. ALL
COMMENTATORS UNDERLINED THAT SINCE THE CAMPAIGN, IT WAS
EXPECTED THAT MRS. CLINTON WOULDN'T STAY INACTIVE.
LIBERATION PUBLISHES AN OP-ED PIECE BY JEROME CHATEAU,
FROM THE UNIVERSITY OF MINNESOTA, URGING FOR REFORM OF
THE US HEALTH CARE SYSTEM: "A CLEAR POSITION FROM THE
CLINTON TEAM IS NECESSARY. THE COMING WEEKS WILL BE
CRUCIAL. ALTHOUGH THERE ARE IMPORTANT OBSTACLES, REFORM
OF THE HEALTH CARE SYSTEM IS A MUST; AMERICA IS PERHAPS
ON THE EVE OF A MAJOR IDEOLOGICAL TURN·IN ITS HISTORY."
THE PRESS REPORTS ON A US-BELGIAN ATTACK AGAINST CLAN
MILITIAS IN KISMAYU, SOMALIA.
AFP, LE MONDE AND L'HUMANITE REPORT ON US REPRESENTATIVE
IN ANGOLA EDMUND DEJARNETTE'S "VERY FIRM WARNING" TO
UN ITA LEADER SAVIMBI. "ON SUNDAY JANUARY 24, MR.
DEJARNETTE WAS A DETERRENT WEAPON", GEORGES MARION
REPORTS FROM CABINDA IN LE MONDE.
AFP'S MOSCOW BUREAU REPORTED THAT IN BORIS YELTSIN'S
VIEW (EXPRESSED IN THE COURSE OF A PRESS CONFERENCE
MONDAY), THE UNITED STATES "HAS RECENTLY SHOWN A
TENDENCY TO DICTATE ITS TERMS ON THE QUESTIONS OF IRAQ
AND YUGOSLAVIA".
INFLUENTIAL LE MONDE EDITOR DOMINIQUE DHOMBRES AUTHORS A
REPORT ABOUT JUSTICE THURGOOD MARSHALL. "JUSTICE
MARSHALL WAS A GREAT FIGURE," DHOMBRES WRITES.
(B) STORIES COVERED IN REPORT:
1. HILLARY CLINTON (ELECTRONIC MEDIA ONLY)
2. EX-YUGOSLAVIA
3.
IRAQ
4.
ANGOLA
(C) HEADLINES:
EX-YUGOSLAVIA:
"CROATIA: UN BLUE HELMETS UNDER FIRE" (LIBERATION-FRONT
PAGE)
.
"TWO FRENCH SOLDIERS KILLED IN CROATIA" (LE FIGARO-FRONT
PAGE)
"SERBS AND CROATS CONTINUE TO NEGOTIATE IN GENEVA" (LE
MONDE-FRONT PAGE)
(D) SUPPORTING TEXT:
UNCLAS SECTION 02 OF 03 PARIS 01923
USIA
USIA
USIA FOR P/RC; P/P; P/FW P/FN; VOA NEWS/CA; EU; AF; P/M;
STATE FOR EUR/P/SP; EU/WE; AF; INR/P; PM; OSD ISA FOR
ILN; FOR NEA; WHITE HOUSE FOR NSC/WEUROPE; DOC FOR
ITAEUR/FR; USCINCEUR FOR PAO; NATO FOR USIS; GENEVA FOR
USIS; USDEL NST GENEVA; MOSCOW FOR P&C; ROME FOR
USIS/AIO; BRUSSELS FOR USIS AND USEC (PAO); USVIENNA FOR
USDEL CSCE.
E.O. 12356: N/A
TAGS: NONE
SUBJECT: DAILY MEDIA REACTION REPORT
1. HILLARY CLINTON:
PHILIPPE RELTIN ON RADIO FRANCE INTER: " ... PRESIDENT
CLINTON OFFICIALLY NOMINATED HIS WIFE AT THE HEAD OF A
HEALTH CARE REFORM TASK FORCE. THE TASK FORCE WILL WORK
TO COUNTER THE CONSEQUENCES OF THE RECESSION IN THE AREA
Page 2 of4
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..
OF HEALTH CARE. FOR AMERICANS, THIS IS A TOP PRIORITY."
TV PRANCE 2 AT 8:00AM, WITH ANCHORMAN ETIENNE LEHNARDT:
"A CONSIDERABLE TASK; A DECISION WHICH PROVES THAT MRS.
CLINTON WILL NOT BE JUST A WALLFLOWER."
LUC BAZIZIN ON TV FRANCE 2: " ... DURING THE CAMPAIGN,
HILLARY CLINTON HAD PROMISED THAT SHE WOULDN'T ONLY BAKE
COOKIES AT THE WHITE HOUSE--A PROMISE SHE KEPT. THE
UNITED STATES' FIRST LADY IS GOING TO GET DOWN TO
WORK .... SHE IS ALREADY CALLED THE PRESIDENT'S CLOSEST
ADVISOR."
2. EX-YUGOSLAVIA:
PATRICK SABATIER IN LIBERATION: " ... AS THE NUMBER OF
VICTIMS (AMONG UN FORCES) WILL INCREASE, THE QUESTION TO
MAINTAIN OR WITHDRAW THE UN BLUE HELMET FORCES ... WILL BE
POSED MORE ACUTELY .... THE PRINCIPAL--PERHAPS THE ONLY-MERIT OF THE BLUE HELMETS IS THEIR PRESENCE. INDEED,
FEW EXPERTS DOUBT THAT THEIR WITHDRAWAL WOULD LEAD TO A
NEW GEN'ERAL CONFLAGRATION. THE CROATS HAVE NOT GIVEN UP
ON THE IDEA OF RECAPTURING THE SERB-OCCUPIED PARTS OF
THEIR TERRITORY AND HAVE BEEN PREPARING FOR THIS OVER
THE LAST YEAR; AS FOR THE SERBS--THOSE OF KRAJINA LIKE
THOSE OF BOSNIA, STILL WANT TO ATTACH THEIR SELFPROCLAIMED 'REPUBLICS' TO GREATER SERBIA. ALL KNOW THAT
THE LAW OF THE STRONGEST REMAINS THE BEST. AS LONG AS
PEACE IS NOT THE ACCEPTED ORDER, THE UN BLUE HELMET
SOLDIERS WILL UNFORTUNATELY BE NOTHING BUT ALIBIS,
HOSTAGES OR EVEN WORSE SACRIFICIAL LAMBS."
CONSERVATIVE LE FIGARO HEADLINES ON PAGE 3: "AFTER SERB
SLOBODAN MILOSEVIC, THE CROATIAN PRESIDENT HAS LEARNED
THE LESSONS OF WESTERN IMPOTENCE."
JEAN LEVALLOIS IN REGIONAL LA PRESSE DE LA MANCHE:
" ... WHAT IS AT STAKE IN THE BALKANS IS THE FUTURE OF THE
(WHOLE) WORLD, AT LEAST FOR THE NEAR TERM; BECAUSE IT IS
ALSO THE UNITED NATIONS WHOSE FORTUNES ARE AT STAKE
THERE."
GILLES DAUXERRE IN REGIONAL L'YONNE REPUBLICAINE:
" ... THE IMMENSE HOPES FOR PEACE AND LIBERTY THAT EMERGED
AFTER THE COLLAPSE OF COMMUNISM AND THE FALL OF THE WALL
ARE DISAPPEARING IN THE YUGOSLAV CALDRON. WESTERN
DEMOCRACIES ARE DOING NOTHING, MAKING US BELIEVE THAT
THEY PREFER A POLITICAL SOLUTION RATHER THAN A MILITARY
'ADVENTURE'; BUT THEIR LACK OF WILL IS EVEN MORE OBVIOUS
THAN THEIR IMPOTENCE."
3.
IRAQ:
PIERRE BEYLAU IN WEEKLY LIBERAL LE POINT: "SADDAM
HUSSEIN HAS PERHAPS SCORED HIS FIRST VICTORY SINCE THE
GULF WAR--NOT IN MILITARY TERMS OBVIOUSLY .... BUT THE
UNCLAS SECTION 03 OF 03 PARIS 01923
USIA
USIA
USIA FOR P/RC; P/P; P/FW P/FN; VOA NEWS/CA; EU; AF; P/M;
STATE FOR EUR/P/SP; EU/WE; AF; INR/P; PM; OSD ISA FOR
ILN; FOR NEA; WHITE HOUSE FOR NSC/WEUROPE; DOC FOR
ITAEUR/FR; USCINCEUR FOR PAO; NATO FOR USIS; GENEVA FOR
USIS; USDEL NST GENEVA; MOSCOW FOR P&C; ROME FOR
USIS/AIO; BRUSSELS FOR USIS AND USEC (PAO); USVIENNA FOR
USDEL CSCE.
E.O. 12356: N/A
Page 3 of4
�F:\Cable\Data Source\Cables\CDOO 1\JAN93\MSGS\MO 187774.html
TAGS: NONE
SUBJECT: DAILY MEDIA REACTION REPORT
RECENT STEEL THUNDER OVER IRAQI SKIES SEEMED TO SOUND
THE DEATH KNOLL OF THE COALITION WHICH HAD OVERCOME
SADDAM'S LEGIONS IN FEBRUARY 1991. MOST OF THE ARAB OR
MUSLIM NATIONS WHICH HAD TAKEN PART IN THE CRUSADE
AGAINST THIS MODERN NABUCHODONOSOR HAVE BEEN VERY
CAUTIOUS; EVEN EGYPT, TRADITIONALLY ALIGNED WITH
WASHINGTON'S POSITION, HAS DISTANCED ITSELF FROM IT;
TURKEY IS ANGRY; RUSSIA, FRUSTRATED BECAUSE
MARGINALIZED, HAS EXPRESSED ITS DISPLEASURE. PRANCE,
FOR ITS PART, HAS SHOWN A NICE DIPLOMATIC MESS .... IN
HIS FINAL CONFRONTATION WITH SADDAM HUSSEIN, GEORGE BUSH
MADE PERHAPS A MISTAKE ON TIMING: WEAKENED, IRAQ IS NO
LONGER PERCEIVED AS THE MAIN THREAT TO SECURITY IN THE
REGION--EXCEPT BY KUWAIT. IN THE FACE OF IRAN'S
AMBITIONS, THE IRAQI ARMY MAY REDISCOVER ITS ROLE AS
DEFENDER OF THE ARAB WORLD."
STEPHANE MARCHAND REPORTS IN FIGARO FROM WASHINGTON:
" ... SINCE HE CAME TO POWER, PRESIDENT CLINTON HAS
CONTINUED ... TO LAUNCH AIR RAIDS (AGAINST IRAQ) IN ORDER
TO PROVE, AT THE LOWEST COST POSSIBLE, THE CONTINUITY OF
US POLICY. HIS DETERMINATION IS STRENGTHENED BY US
OPINION (LOS ANGELES TIMES POLL) . THE DEMOCRATIC
PRESIDENT WILL PERSIST IN THIS LINE OF ACTION UNTIL THE
MOMENT WHEN HE THINKS HE CAN NO LONGER BE ACCUSED OF
WEAKNESS VIS-A-VIS SADD~, A VIEW ALREADY HELD BY MANY
AMERICANS (39, SAME POLL). BUT THE NEW ADMINISTRATION
HAS SOME DOUBTS. IT IS TEMPTED TO SEE THE IRAQI
LEADER'S APPARENT GOOD WILL·As AN ENCOURAGING SIGN."
4. ANGOLA:
ECONOMIC LES ECHOS BACK-PAGE UNATTRIBUTED EDITORIAL:
" ... THIS WAS THE MOST SEVERE WARNING EVER ADDRESSED TO
JONAS SAVIMBI BY (THE UNITED STATES), A COUNTRY WHICH
DOESN'T USUALLY JOKE WHEN ITS CITIZENS AND ITS ECONOMIC
INTERESTS ARE AT STAKE. CEASE-FIRE NEGOTIATIONS ARE TO
TAKE PLACE LATER THIS WEEK IN ADDIS ABABA. IF THEY END
IN FAILURE, THE UNITED NATIONS HAS THREATENED IT MAY
WITHDRAW ITS TROOPS FROM ANGOLA. THIS WOULD BE A
RADICAL OUTCOME, UNACCEPTABLE TO WASHINGTON, WHICH MAY
THEN HAVE TO GET INVOLVED ALL OVER AGAIN IN THIS AFRICAN
CONFLICT." KORENGOLD
BT
#1923
NNNN
SECT: SECTION: 01 OF 03
<"SECT>SECTION: 02 OF 03
<"SECT>SECTION: 03 OF 03
SSN: 1923
<"SSN>1923
<"SSN>1923
TOR: 930126055230 M0187774
<"TOR>930126055232 M0187775
<"TOR>930126055333 M0187776
DIST:
SIT: VAX
0
Page 4 of4
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fl.
Cab 1e
IMMEDIATE
CLASS: UNCLASSIFIED
OSRI: RUFHOL
LINEl: OATUZYUW RUFHOL 2096 0271300-UUUU--RUEADWW.
LINE2: ZNR UUUXX
LINE3: · 0 271259Z JAN 93 ZNZ1
LINE4: FM USIS BONN
DTG: 271259Z JAN 93
ORIG: USIS BONN
TO: RUEHIA/USIA WASHDC IMMEDIATE
INFO: RUEADWW/WHITE HOUSE NATIONAL SECURITY COUNCIL WASH DC
RUEHC/SECSTATE WASHDC
RUEKJCS/SECDEF WASHDC//USDP//ISA/DSAA
RUEKJCS/DIA WASHDC//DC-4A
R.UEAIIA/CIA WASHDC
RUEATRS/TREASURY WASHDC
RUEAUSA/DEPT/LABOR WASHDC//MCCAFFREY
RUCNFRG/FRG COLLECTIVE
RUEHGV/USMISSION GENEVA//NST/ACDA
RUEHBS/AMEMBASSY BRUSSELS//NESSEE
RUFHLD/AMEMBASSY LONDON
RUFHFR/AMEMBASSY PARIS
RUEHRO/AMEMBASSY ROME
RUDOGHA/USNMR SHAPE BE//PAA
RUFHMB/USMISSION USVIENNA//CSBM/PAA
RUFHNA/USMISSION USNATO
RHFQAAA/AFOSI DET 501 RAMSTEIN AB GE//EAC//
RUSNNOA/USCINCEUR VAIHINGEN GM//ECPA/POLAD/ECJ5//Cy1-HN
RUFDAAA/CINCUSAREUR HEIDELBERG GM
RUFTAKC/UDITUSAREUR HEIDELBERG GM
RXFMB/USSUPPORT ELEMENT HQ BALTAP//PIO/NA
RHFQSAF/17AF SEMBACH AB GE//CCH//
SUBJ:
GERMAN MEDIA REACTION REPORT
FOLLOWING IS A REVIEW OF GERMAN MEDIA OF JANUARY 27, 1993
PREC:
TEXT:
**************** INCOMPLETE MESSAGE ************************
UNCLAS SECTION 01 OF 07 BONN GM 02096
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR WUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD
USCINCEUR VAIHINGEN GE ALSO FOR//ECJ5-E
USCINCEUR VAIHINGEN GE ALSO FOR//CJ1-HN
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
Page 1 of5
�F:\Cable\Data Source\Cables\CDOO 1\JAN93\MSGS\MO 190409 .html
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART TWO OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
FOLLOWING IS A REVIEW OF GERMAN MEDIA OF JANUARY 27, 1993
D. U.S.: HILLARY CLINTON TO REFORM HEALTH CARE
1. CENTRIST STUTTGARTER ZEITUNG AND CENTRIST
MITTELDEUTSCHE ZEITUNG OF HALLE CARRIES AN EDITORIAL BY
WASHINGTON CORRESPONDENT JUERGEN KOAR UNDER THE HEADLINE:
"JOB FOR THE FIRST LADY."
"SOME HAD FEARED IT, OTHERS HAD HOPED FOR IT, BUT
NOBODY HAD DOUBTED THAT HILLARY CLINTON WOULD TAKE OVER
TASKS IN HER HUSBAND'S ADMINISTRATION. SOONER THAN
EXPECTED, THE PRESIDENT HAS NOW CREATED FACTS WHICH ARE
GIVING NEW MEANING TO THE TITLE OF 'FIRST LADY'. HE HAS
COMMISSIONED HIS WIFE TO COME UP WITH A HEALTH CARE
REFORM WITHIN THE NEXT HUNDRED DAYS. THIS IS A
PATHBREAKING DECISION FOR TWO REASONS: NEVER BEFORE HAS
THE WIFE OF A PRESIDENT AS OPENLY PARTICIPATED IN THE
POLITICAL DECISION-MAKING PROCESS, AND NEVER BEFORE HAS
THIS ISSUE BEEN ASSIGNED SUCH A HIGH PRIORITY IN THE
WHITE HOUSE. IT IS A HERCULEAN TASK, A JOB CUT OUT FOR
SUPERMAN, AND IF HILLARY CLINTON SUCCEEDS, SHE WILL HAVE
QUALIFIED HERSELF AS SUPERWOMAN .....
"THE COST EXPLOSION IN THE HEALTH CARE SECTOR IS
UNCLAS SECTION 02 OF 07 BONN GM 02096
USIA .
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE. FOR WUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD
USCINCEUR VAIHINGEN GE ALSO FOR//ECJ5-E
USCINCEUR VAIHINGEN GE ALSO FORf/CJl-HN
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT 'ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//.
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART TWO OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
BURDENING TO AN ALARMING EXTENT THE PRIVATE AND PUBLIC
BUDGETS, APPROXIMATELY 35 MILLION AMERICANS DO NOT CARRY
HEALTH INSURANCE. IN ORDER TO FINALLY CREATE A
WATERTIGHT SYSTEM AND KEEP THE.COSTS WITHIN A REASONABLE
FRAMEWORK, LAWMAKERS, PUBLIC AGENCIES, INSURANCE
COMPANIES AND THE PHARMACEUTICAL INDUSTRY MUST BE BROUGHT
UNDER ONE ROOF. THIS - AND THE 'LACK OF POLITICAL WILLHAVE SO FAR CONDEMNED ALL EFFORTS TO FAILURE. HILLARY
Page 2 of5
�F:\Cable\Data Source\Cables\CDOO 1\JAN93\MSGS\MO 190409 .html
CLINTON OVERCAME SIMILAR RESISTANCE IN ARKANSAS AND
INITIATED A REFORM OF THE SCHOOL SYSTEM. NOW SHE WILL
WORK WITH HER HUSBAND AGAIN AT NO COST AND, IN THE END,
SHARE THE PRAISE AND CRITICISM WITH HIM. IT TAKES
COURAGE TO BREAK WITH TRADITIONS AND DARE AN EXPERIMENT
WHOSE OUTCOME HAS A LOT OF IMPLICATIONS - NOT LEAST FOR
ONE'S OWN REPUTATION."
2. LEFT-OF-CENTER (FORMER PDS YOUTH PAPER) JUNGE
WELT OF BERLIN CARRIES AN EDITORIAL BY ALMUTH NEHRING
UNDER THE HEADLINE:
"SHOCK FOR PURITANS."
"BILL CLINTON IS GIVING HIS PURITAN CITIZENS A SHOCK
THERAPY. FIRST HE LOOSENS THE RESTRICTIONS ON ABORTIONS
AND NOW IT IS TO BE MADE POSSIBLE FOR HOMOSEXUAL MEN AND
WOMEN TO JOIN THE ARMY. STUPIDITY AND PRUDISHNESS ARE
COMING TO THE FORE WHEN MILITARY AND CONGRESSIONAL
REPRESENTATIVES FEAR THAT MORALE AND ORDER COULD BE
DISTURBED AT MISSILE BASES, ON TANKS, AIRCRAFT CARRIERS
AND IN THE CORRIDORS OF THE PENTAGON. IN THE PAST TEN
YEARS, 14,000 OF 1,8 MILLION SOLDIERS HAD TO RESIGN FROM
THE MILITARY BECAUSE THEY WERE HOMOSEXUAL. ONLY DURING
THE GULF WAR NONE OF THESE SOLDIERS WERE DISMISSED.
APPARENTLY HOMOSEXUALS DID NOT POSE A RISK FOR AMERICA AT
THE FRONT.· ...
"CLINTON WILL HAVE TO THINK ABOUT HOW HE WANTS TO
FULFILL HIS ELECTION CAMPAIGN PROMISE. OPEN
CONFRONTATION APPARENTLY DOES NOT WORK. NEW PENTAGON
CHIEF ASPIN HAS SUGGESTED HOLDING OFF THE DECISION
ANOTHER SIX MONTHS AND TO TAKE A MORE DIPLOMATIC
APPROACH. HOWEVER, THE NEW CREW IN THE WHITE HOUSE WILL
HAVE A HARD TIME STANDING UP AGAINST THE THOUSANDS OF
HOMOSEXUALS WHO SUPPORTED CLINTON IN ,THE ELECTION
CAMPAIGN. AFTER ALL, EVERY SEVENTH VOTE FOR THE
PRESIDENT CAME FROM A HOMOSEXUAL. CLINTON WAS THE FIRST
PRESIDENTIAL CANDIDATE TO MAKE THE DE-CRIMINALIZATION OF
HOMOSEXUALS AN ELECTION CAMPAIGN ISSUE."
E. ECONOMIC: GATT, U.S. ECONOMY
1. LEFT-OF-CENTER FRANKFURTER RUNDSCHAU CARRIES A
UNCLAS SECTION 03 OF 07 BONN GM 02096
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR WUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD
USCINCEUR VAIHINGEN GE ALSO FOR//ECJS-E
USCINCEUR VAIHINGEN GE ALSO FOR//CJ1-HN
CINCUSAFE RAMSTEIN AB GE ALSO FOR_//PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART TWO OF TWO
E.O. 12356: N/A
Page3 of5
�F:\Cable\Data Source\Cables\CDOO 1\JAN93\MSGS\MO 190409 .html
SUBJECT: GERMAN MEDIA REACTION REPORT
REPORT UNDER THE HEADLINE:
"KINKEL CALLS UPON PARIS TO SHOW WILLINGNESS FOR
COMPROMISE."
"FOREIGN MINISTER KLAUS KINKEL DIRECTED AN URGENT
APPEAL TO THE PARIS GOVERNMENT NOT TO FOIL THE GATT
NEGOTIATIONS. DURING A SPEECH AT FREIBURG UNIVERSITY,
KINKEL SAID THAT A SUCCESS OF THE GATT TALKS IS A
'MUST.' BONN 'SHOWED ITS SOLIDARITY' (WITH FRANCE) 'WITH
A WILLINGNESS BORDERING ON SELF-DENIAL.' KINKEL DEMANDED
THAT 'FRANCE MUST NOW ALSO SHOW SOLIDARITY.' HE ADDED
THAT THE INTEREST OF NO PARTNER COUNTRY IN THE EC SHOULD
RESULT IN A TRADE WAR WITH THE OTHER BIG INDUSTRIALIZED
POWERS OF THE WORLD.
"KINKEL WARNED THAT A FAILURE OF THE GATT TALKS WOULD
STYMIE THE POWER CENTERS OF THE GLOBAL ECONOMY, I.E. THE
THREE INDUSTRIALIZED REGIONS IN EUROPE, JAPAN AND THE
U.S. IF 'THESE THREE' TURNED THEIR FORCES AGAINST EACH
OTHER, THERE WOULD HARDLY BE A CHANCE TO OVERCOME THE
GLOBAL CHALLENGES - LIKE THE VICIOUS CIRCLE OF POVERTY,
POPULATION EXPLOSION AND THE DESTRUCTION OF THE
ENVIRONMENT .... "
2. IN AN EDITORIAL ON THIS SPEECH, LEFT-OF-CENTER
FRANKFURTER RUNDSCHAU OPINES UNDER THE HEADLINE:
"EDUCATION TO WEARINESS."
"WELL ROARED, LION KINKEL. OF COURSE, FRANCE SHOULD
NOT FOIL THE GATT TALKS. IT IS SELF-EVIDENT THAT A
SUCCESS OF THE GATT TALKS IS A 'MUST.'
NATURALLY, A
TRADE WAR WOULD BE DETRIMENTAL TO ALL PARTIES INVOLVED.
THESE ARE TRUISMS ... BUT TO BE HONEST, THEY ARE GETTING ON
OUR NERVES. POLITICS WOULD BE MORE CREDIBLE IF IT
DEMONSTRATED ITS ABILITY TO TAKE ACTION INSTEAD OF
RELYING ON GREAT WORDS.
"IN AN EXEMPLARY MANNER, THE GATT TALKS SHOW ON AN
INTERNATIONAL LEVEL HOW THE PUBLIC CAN BE EDUCATED TO
ADOPT A NOTORIOUS WEARINESS OF POLITICS, SINCE THE
POLITICIANS HAVE NOW BEEN PALAVERING FOR MORE THAN SEVEN
YEARS ABOUT A REDUCTION OF TARIFF BARRIERS .... AND THEY
ALWAYS MADE PROMISES THAT, IN HINDSIGHT, DID NOT COME
TRUE ....
"THIS IS 1993 AND A CONCLUSION OF THE GATT TALKS IS
NOT IN SIGHT. INSTEAD, THE 'TRADE PARTNERS' ARE FIGHTING
EACH OTHER WITH OLD AND PARTLY MORE WEAPONS .... THEY ALL
VIOLATE THE SPIRIT OF FREE TRADE,· SOME WITH REGARD TO
CARS, SOME WITH REGARD TO RICE, AND STILL OTHERS WITH
UNCLAS SECTION 07 OF 07 BONN GM 02096
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR WUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD
USCINCEUR VAIHINGEN GE ALSO FOR//ECJ5-E
USCINCEUR VAIHINGEN GE ALSO FOR//CJl-HN
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
Page 4 of5
�F:\Cable\Data_Source\Cables\CDOO 1\JAN93\MSGS\MO 190409 .html
SECT:
SSN:
TOR:
Page 5 of5
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART TWO OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
DRAFT JUSTICE. AND THE SITUATION WILL PROBABLY BECOME
EVEN MORE PROBLEMATIC IN CASE OF MILITARILY DANGEROUS
MISSIONS OUTSIDE OF NATO OR A LARGE NUMBER OF CASUALTIES.
"FOR ALL THESE REASONS, DEFENSE MINISTER RUEHE'S
DECISIONS WILL ULTIMATELY TURN OUT TO BE DECISIONS
POINTING IN THE DIRECTION OF A PROFESSIONAL ARMY. THE
PARTIES CURRENTLY STILL HOLDING ON TO THE DRAFT COULD
QUICKLY ADJUST TO THE ALTERED SITUATION AND, IN THIS
PROCESS, EVEN REFER TO A CONCLUSIVE POLITICAL ARGUMENT.
THE DRAFT IS A CHILD OF A SOVEREIGN NATIONAL STATE. ONLY
THIS STATE CREATED THE DEGREE OF COLLECTIVE IDENTITY THAT
IS THE PREREQUISITE FOR DEMANDING THAT SOMEONE RISK HIS
LIFE AS HIS DUTY AS A CITIZEN. IF THE TASK OF DEFEFE IS
PASSED ON FROM THE NATIONAL STATE TO A SUPRANATIONAL
ORGANIZATION, WHICH BONN IS TRYING TO ACHIEVE IN THE
COURSE OF EUROPEAN UNIFICATION, THE QUESTION ARISES ANEW
OF WHO SHOULD FULFILL THIS TASK AND HOW. UNDER THESE
CIRCUMSTANCES, A PROFESSIONAL ARMY COULD BY ALL MEANS
LOOK TO THE POLITICIANS AND THE PUBLIC LIKE THE MOST
SUITABLE INSTRUMENT TO ENSURE SECURITY IN EUROPE."
MILLER
BT
#2096
NNNN
SECTION: 01 OF 07
<"SECT>SECTION: 02 OF 07
<"SECT>SECTION: 03 OF 07
<"SECT>SECTION: 07 OF 07
2096
<"SSN>2096
<"SSN>2096
<"SSN>2096
930127080234 M0190409
<"TOR>930127092531 M0190546
<"TOR>930127092634 M0190549
<"TOR>930127080339 M0190413
DIST:
SIT: VAX
0
---
---------------'
�I
t
.F:\Cable\Data_Source\Cables\CDOO 1\JAN93\MSGS\MO 196907 .html
Page 1 of5
Cab 1e
IMMEDIATE
UNCLASSIFIED
OSRI : RUEKJCS
LINEl: OTTUZYUW RUEKJCS8675 0292318-UUUU--RHEHAAA.
LINE2: ZNR UUUUU
LINE3: RHFJVTA T COMCRUDESGRU TWO
LINE4: RUADANW T CGFIRSTMAW
DTG: 292250Z JAN 93
ORIG: SECDEF WASHINGTON DC//ASD,PA//
TO: AIG 8777
AIG 8798
AIG 8799
PREC:
CLASS:
INFO:
SUBJ:
****
PUBLIC AFFAIRS GUIDANCE -- HOMOSEXUALS IN THE MILITARY
ALL ADDRESSEES ARE AUTHORIZED AND ENCOURAGED TO READDRESS THIS
MESSAGE AS APPROPRIATE.
TEXT:
UNCLAS SECTION 01 OF 02
SUBJ: PUBLIC AFFAIRS GUIDANCE -- HOMOSEXUALS IN THE MILITARY
ALL ADDRESSEES ARE AUTHORIZED AND ENCOURAGED TO READDRESS THIS
MESSAGE AS APPROPRIATE.
1. TODAY THE PRESIDENT ANNOUNCED ACTION ON THE ISSUE OF HOMOSEXUALS
IN THE MILITARY. TEXT OF THE ANNOUNCEMENT IS AS FOLLOWS:
PRESIDENT CLINTON:
(QUOTE) GOOD AFTERNOON, LADIES AND
GENTLEMEN.
I'M SORRY, WE HAD A LAST MINUTE DELAY OCCASIONED BY
ANOTHER ISSUE,,NOT THIS ONE.
THE DEBATE OVER WHETHER TO LIFT THE BAN ON HOMOSEXUALS
IN THE MILITARY HAS, TO PUT IT MILDLY, SPARKED A GREAT DEAL OF
INTEREST OVER THE LAST FEW DAYS.
TODAY, AS YOU KNOW, I HAVE REACHED AN AGREEMENT, AT
LEAST WITH SENATOR NUNN AND SENATOR MITCHELL, ABOUT HOW WE WILL
PROCEED IN THE NEXT FEW DAYS.
BUT FIRST I'D LIKE TO EXPLAIN WHAT I BELIEVE ABOUT
THIS ISSUE AND WHY, AND WHAT I HAVE DECIDED TO DO; AFTER A LONG
CONVERSATION, AND A VERY GOOD ONE WITH THE JOINT CHIEFS OF
STAFF, AND DISCUSSIONS WITH SEVERAL MEMBERS OF CONGRESS.
THE ISSUE IS NOT WHETHER THERE SHOULD BE HOMOSEXUALS
IN THE MILITARY. EVERYONE CONCEDES THAT THERE ARE. THE ISSUE IS
WHETHER MEN AND WOMEN WHO CAN AND HAVE SERVED WITH REAL
DISTINCTION SHOULD BE EXCLUDED FROM MILITARY SERVICE SOLELY ON
THE BASIS OF THEIR STATUS.
AND I BELIEVE THEY SHOULD NOT. THE PRINCIPLE ON WHICH
I BASE THIS POSITION IS THIS. I BELIEVE THAT AMERICAN CITIZENS
WHO WANT TO SERVE THEIR COUNTRY SHOULD BE ABLE TO DO SO UNLESS
THEIR CONDUCT DISQUALIFIES THEM FROM DOING SO.
MILITARY LIFE IS FUNDAMENTALLY DIFFERENT FROM CIVILIAN
SOCIETY. IT NECESSARILY HAS A DIFFERENT AND STRICTER CODE OF
CONDUCT, EVEN A DIFFERENT CODE OF JUSTICE.
NONETHELESS, INDIVIDUALS WHO ARE PREPARED TO ACCEPT
ALL NECESSARY RESTRICTIONS ON .THEIR BEHAVIOR, MANY OF WHICH
�.f:\Cable\Data Source\Cables\CDOO 1\JAN93\MSGS\MO 196907 .html
WOULD BE INTOLERABLE IN CIVILIAN SOCIETY, SHOULD BE ABLE TO
SERVE THEIR COUNTRY HONORABLY AND WELL.
I HAVE ASKED THE SECRETARY OF DEFENSE TO SUBMIT BY
JULY THE 15TH A DRAFT EXECUTIVE ORDER, AFTER FULL CONSULTATION
WITH MILITARY AND CONGRESSIONAL LEADERS, AND CONCERNED
INDIVIDUALS OUTSIDE OF THE GOVERNMENT, WHICH WOULD END THE
PRESENT POLICY SOLELY ON THE BASIS OF--EXCUSE ME--OF EXCLUSION
FROM MILITARY SERVICE SOLELY ON THE BASIS OF SEXUAL ORIENTATION,
AND AT THE SAME TIME, ESTABLISH RIGOROUS STANDARDS
REGARDING SEXUAL CONDUCT TO BE APPLIED TO ALL MILITARY
PERSONNEL.
THIS DRAFT ORDER WILL BE ACCOMPANIED BY A STUDY
CONDUCTED DURING THE NEXT SIX MONTHS ON THE REAL PRACTICAL
PROBLEMS THAT WOULD Bg INVOLVED IN THIS REVISION OF POLICY, SO
THAT WE WILL HAVE A PRACTICAL, REALISTIC APPROACH CONSISTENT
WITH THE HIGH STANDARDS OF COMBAT EFFECTIVENESS AND UNIT
COHESION THAT OUR ARMED SERVICES MUST MAINTAIN.
I AGREE WITH THE JOINT CHIEFS THAT THE HIGHEST
STANDARDS OF CONDUCT MUST BE REQUIRED. THE CHANGE CANNOT AND
SHOULD NOT BE ACCOMPLISHED OVERNIGHT. IT DOES REQUIRE EXTENSIVE
CONSULTATION WITH THE JOINT CHIEFS, EXPERTS IN THE CONGRESS AND
IN THE LEGAL COMMUNITY, JOINED BY MY ADMINISTRATION AND OTHERS.
WE'VE CONSULTED CLOSELY TO DATE AND WILL DO SO IN THE FUTURE.
DURING THAT PROCESS, INTERIM MEASURES WILL BE PLACED INTO
EFFECT, WHICH I HOPE AGAIN SHARPEN THE FOCUS OF THIS DEBATE.
THE JOINT CHIEFS OF STAFF HAVE AGREED TO REMOVE THE
QUESTION REGARDING ONE'S SEXUAL ORIENTATION FROM FUTURE VERSIONS
OF THE ENLISTMENT APPLICATION AND IT WILL NOT BE ASKED IN THE
INTERIM.
WE ALSO ALL AGREE THAT A VERY HIGH STANDARD OF CONDUCT
CAN AND MUST BE APPLIED. SO THE SINGLE AREA OF DISAGREEMENT IS
THIS. SHOULD SOMEONE BE ABLE TO SERVE THEIR COUNTRY IN UNIFORM
IF THEY SAY THEY ARE HOMOSEXUAL BUT THEY DO NOTHING WHICH
VIOLATES THE CODE OF CONDUCT, UNDERMINES UNIT COHESION OR MORALE
APART FROM THAT STATEMENT?
THAT IS WHAT THE FUROR OF THE LAST FEW DAYS HAS BEEN
ABOUT. AND THE PRACTICAL AND NOT INSIGNIFICANT ISSUES RAISED BY
THAT ISSUE ARE WHAT WILL BE STUDIED IN THE NEXT SIX MONTHS.
THROUGH THIS PERIOD ENDING JULY 15TH, THE DEPARTMENT
OF JUSTICE WILL SEEK CONTINUANCES IN PENDING COURT CASES
INVOLVING REINSTATEMENT, AND ADMINISTRATIVE SEPARATIONS UNDER
CURRENT DEPARTMENT OF DEFENSE POLICIES BASED ON STATUS ALONE
WILL BE STAYED, PENDING COMPLETION OF THIS REVIEW'
THE FINAL DISCHARGE IN CASES BASED ONLY ON STATUS WILL
BE SUSPENDED UNTIL THE PRESIDENT HAS AN OPPORTUNITY TO REVIEW
AND ACT UPON THE FINAL RECOMMENDATIONS OF THE SECRETARY OF
DEFENSE WITH RESPECT TO THE CURRENT POLICY.
IN THE MEANTIME, A MEMBER WHO'S DISCHARGE HAS BEEN
SUSPENDED BY THE ATTORNEY GENERAL WILL BE SEPARATED FROM ACTIVE
DUTY AND PLACED IN STAND-BY RESERVE UNTIL THE FINAL REPORT OF
THE SECRETARY OF DEFENSE AND THE FINAL ACTION OF THE PRESIDENT.
THIS IS THE AGREEMENT THAT I HAVE REACHED WITH SENATOR
NUNN AND SENATOR MITCHELL. DURING THIS REVIEW PROCESS, I WILL
WORK WITH THE CONGRESS AND I BELIEVE THE COMPROMISE ANNOUNCED
TODAY BY THE SENATORS AND BY ME SHOWS THAT WE CAN WORK TOGETHER
TO END THE GRIDLOCK THAT HAS PLAGUED OUR CITY FOR TOO LONG. THIS
COMPROMISE IS NOT EVERYTHING I WOULD HAVE HOPED FOR, OR
EVERYTHING THAT I HAVE STOOD FOR, BUT IT IS PLAINLY A
Page 2 ofS
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Page j or:>
SUBSTANTIAL STEP IN THE RIGHT DIRECTION.
AND IT WILL ALLOW US TO MOVE FORWARD ON OTHER TERRIBLY
IMPORTANT ISSUES AFFECTING FAR MORE AMERICANS. MY ADMINISTRATION
CAME TO THIS CITY WITH A MISSION--TO BRING CRITICAL ISSUES OF
REFORM AND RENEWAL, AND ECONOMIC REVITALIZATION TO THE PUBLIC
DEBATE--ISSUES THAT ARE CENTRAL TO THE LIVES OF ALL AMERICANS.
WE ARE WORKING ON AN ECONOMIC REFORM AGENDA THAT WILL
BEGIN WITH AN ADDRESS TO THE JOINT SESSION OF CONGRESS ON
FEBRUARY 17TH.
IN THE COMING MONTHS THE WHITE HOUSE TASK FORCE ON
HEALTH CARE, CHAIRED BY THE FIRST LADY, WILL COMPLETE WORK ON A
COMPREHENSIVE HEALTH CARE REFORM PROPOSAL TO BE SUBMITTED TO
CONGRESS WITHIN 100 DAYS OF THE COMMENCEMENT OF THIS
ADMINISTRATION.
WE WILL BE DESIGNING A SYSTEM OF NATIONAL SERVICE, TO
BEGIN A SEASON OF SERVICE IN WHICH OUR NATION'S UNMET NEEDS ARE
ADDRESSED, AND WE PROVIDE MORE YOUNG PEOPLE THE OPPORTUNITY TO
GO TO COLLEGE.
WE WILL BE PROPOSING COMPREHENSIVE WELFARE REFORM
LEGISLATION, AND OTHER IMPORTANT INITIATIVES.
I APPLAUD THE WORK THAT HAS BEEN DONE IN THE LAST TWO
OR THREE DAYS BY SENATOR NUNN, SENATOR MITCHELL AND OTHERS, TO
UNCLAS FINAL SECTION OF 02
ENABLE US TO MOVE FORWARD ON A PRINCIPLE THAT IS IMPORTANT TO
ME, WITHOUT SHUTTING THE GOVERNMENT DOWN AND RUNNING THE RISK OF
NOT EVEN ADDRESSING THE FAMILY AND MEDICAL LEAVE ISSUE WHICH IS
SO IMPORTANT TO AMERICA'S FAMILIES, BEFORE CONGRESS GOES INTO
ITS RECESS.
I AM LOOKING FORWARD TO GETTING ON WITH THIS ISSUE
OVER THE NEXT SIX MONTHS, AND WITH THESE OTHER ISSUES WHICH WERE
SO CENTRAL TO THE CAMPAIGN, AND FAR MORE IMPORTANTLY, ARE SO
IMPORTANT TO THE LIVES OF ALL THE AMERICAN PEOPLE.
(UNQUOTE)
2. THE WHITE HOUSE ALSO ISSUED THE FOLLOWING PRESS RELEASE TODAY
CONCERNING DEPARTMENT OF DEFENSE POLICY REGARDING HOMOSEXUALS IN
THE MILITARY:
(QUOTE) THE PRESIDENT HAS DIRECTED THE SECRETARY OF DEFENSE TO
CONDUCT A REVIEW OF THE CURRENT DEPARTMENT OF DEFENSE POLICY THAT
EXCLUDES HOMOSEXUALS FROM MILITARY SERVICE AND PREPARE A DRAFT
EXECUTIVE ORDER BASED UPON THAT REVIEW BY JULY 15, 1993.
CURRENT DEPARTMENT OF DEFENSE PERSONNEL POLICIES RELATED TO THIS
ISSUE WILL REMAIN IN EFFECT AT LEAST THROUGH JULY 15, 1993, WHILE
THE DEPARTMENT OF DEFENSE IS CONDUCTING THE REVIEW DIRECTED BY THE
PRESIDENT, SUBJECT TO THE FOLLOWING GUIDANCE:
FIRST, QUESTIONS REGARDING SEXUAL ORIENTATION WILL BE REMOVED
FROM FUTURE VERSIONS OF THE INDUCTION APPLICATION, AND WILL NOT BE
ASKED IN THE INTERIM. THE BRIEFINGS ON MILITARY JUSTICE WHICH ALL
RECRUITS ARE REQUIRED TO RECEIVE UPON ENTRY TO MILITARY SERVICE AND
PERIODICALLY THEREAFTER UNDER ARTICLE 137 OF THE UNIFORM CODE OF
MILITARY JUSTICE WILL INCLUDE A DETAILED EXPLANATION OF THE APPLICABLE LAWS AND REGULATIONS GOVERNING SEXUAL CONDUCT BY MEMBERS OF
THE ARMED SERVICES.
SECOND, THE DEPARTMENT OF JUSTICE IS SEEKING CONTINUANCES IN
PENDING COURT-CASES INVOLVING FORMER SERVICE MEMBERS WHO HAVE BEEN
DISCHARGED ON THE BASIS OF HOMOSEXUALITY AND WHO ARE SEEKING
REINSTATEMENT INTO MILITARY SERVICE. THE CONTINUANCES WOULD FREEZE
THOSE CASES PENDING THE COMPLETION OF THE REVIEW DIRECTED BY THE
PRESIDENT.
THIRD, COMMANDING OFFICESS WILL CONTINUE TO PROCESS CASES UNDER
�F:\Cable\Data Source\Cables\CDOO 1\JAN93\MSGS\MO 196907 .html
Page.4 of5
THE CURRENT CASES AND REGULATIONS RELATED TO HOMOSEXUALITY.
-- CASES INVOLVING HOMOSEXUAL CONDUCT WILL BE PROCESSED THROUGH
ACTUAL SEPARATION AND DISCHARGE IN ACCORDANCE WITH CURRENT POLICY.
,- WHEN A CASE INVOLVES ONLY HOMOSEXUAL STATUS AND THE PERSON
INVOLVED REQUESTS A DISCHARGE, THE PERSON WILL BE RELEASED FROM
ACTIVE DUTY.
-- CASES INVOLVING ACKNOWLEDGED HOMOSEXUAL STATUS BEING CONTESTED BY THE INDIVIDUAL WILL BE PROCESSED THROUGH ALL APPLICABLE
STAGES, INCLUDING NOTICE OF THE BASIS FOR SEPARATION, HEARING
BEFORE A BOARD OF OFFICERS, REVIEW OF THE BOARD'S RECOMMENDATIONS
BY THE SEPARATION AUTHORITY, AND ACTION BY THE SEPARATION AUTHORITY
TO DISCHARGE THE PERSON. IF DIRECTED BY THE ATTORNEY GENERAL, THE
FINAL DISCHARGE IN THE CASES BASED ONLY ON STATUS WILL BE SUSPENDED
UNTIL THE PRESIDENT ACTS ON THE RECOMMENDATIONS OF THE SECRETARY OF
DEFENSE WITH RESPECT TO CURRENT POLICY. A MEMBER WHOSE DISCHARGE
HAS BEEN SUSPENDED BY THE ATTORNEY GENERAL WILL BE SEPARATED FROM
ACTIVE DUTY AND PLACED IN THE STANDBY RESERVE. INDIVIDUALS IN THE
STANDBY RESERVE WOULD HAVE THE OPTION TO RETURN, UPON REQUEST, TO
ACTIVE DUTY SHOULD THE CURRENT POLICY BE CHANGED. THOSE PERSONNEL
WHOSE CASES HAVE NOT BEEN SUSPENDED WILL BE DISCHARGED.
-- COMMANDING OFFICERS MAY, IN THE INTERESTS OF THE INDIVIDUAL
OR THE UNIT CONCERNED, DIRECT CHANGES IN THE ASSIGNMENT OF PERSON,
NEL DURING THE COURSE OF SEPARATION PROCEEDINGS.
(UNQUOTE)
3. THE FOLLOWING IS INITIAL PUBLIC AFFAIRS GUIDANCE CONCERNING THE
ISSUE OF HOMOSEXUALS IN THE MILITARY:
A. DETAILS OF HOW THE POLICY REVIEW PROCESS WILL PROCEED AND OF
MANY OF THE POLICY IMPLICATIONS WHILE THE REVIEW IS IN PROGRESS ARE
NOT YET AVAILABLE. UNTIL THE DEPARTMENT OF DEFENSE REVIEW HAS
PRO~RESSED FURTHER AND MORE INFORMATION IS AVAILABLE,
IT IS INAPPROPRIATE TO SPECULATE ON THE REVIEW PROCESS, ITS PARAMETERS,
PROGRESS OR OUTCOME. MUCH OF THE INFORMATION THE MEDIA OR GENERAL
PUBLIC WILL REQUEST REGARDING THE STATUS OF LEGAL CASES, AND THE
IMPACT ON EXISTING MILITARY DISCIPLINE, HOUSING AND OTHER APPLICA,
BLE POLICIES IS NOT YET KNOWN AND IS CENTRAL TO THE POLICY REVIEW.
B. AUTHORIZED SPOKESPERSONS MAY DRAW FROM THE TEXT OF THE
PRESIDENTIAL STATEMENT AND/OR WHITE HOUSE PRESS RELEASE IN RESPONSE
TO QUERY. IF ASKED ABOUT DOD POLICY, UNIT COMMANDERS AND AUTHORIZED SPOKESPERSONS SHOULD RESPOND TO MEDIA AND PUBLIC INQUIRIES AS
FOLLOWS UNTIL FURTHER GUIDANCE IS RECEIVED:
(QUOTE) THE DEPARTMENT OF DEFENSE WILL ISSUE ORDERS NEXT WEEK TO IMPLEMENT THE
PRESIDENT'S INSTRUCTIONS. THE CONSULTATION AND REVIEW PROCESS
WHICH WILL LEAD TO A DRAFT EXECUTIVE ORDER IS UNDERWAY. (UNQUOTE)
C' REQUESTS FOR INTERVIEWS SHOULD BE HANDLED AT THE UNIT LEVEL
IN A WAY THAT IS CONSISTENT WITH REQUESTS ON ANY DEFENSE/UNIT-RELATED TOPIC. CONSISTENT WITH OPERATIONS AND A UNIT'S ABILITY TO
SUPPORT, MEDIA WILL CONTINUE TO BE PERMITTED TO CONDUCT "PERSON ON
THE STREET" INTERVIEWS TO SOLICIT INDIVIDUAL MILITARY MEMBERS'
OPINIONS ON THE ISSUE OF HOMOSEXUALS IN THE MILITARY. ALL REQUESTS
FOR ON-BASE MEDIA AVAILABILITIES OR INTERVIEWS WITH ANY MILITARY
PERSON WILL BE COORDINATED THROUGH THE LOCAL PUBLIC AFFAIRS OFFICE'
ALL OPINIONS EXPRESSED BY MILITARY MEMBERS WILL BE CLEARLY IDENTIFIED AS PERSONAL OPINION.
4. OASD(PA) POINTS OF CONTACT FOR PLANS ARE LT COL P.J. CROWLEY,
USAF, OR LCDR CHUCK FRANKLIN, USN, DSN 223,1076, COMM 703,693-1076.
POC FOR MEDIA QUERIES IS LT COL DOUG HART, USAF, DSN 227-5131, COMM
703-697,5131.
BT
#8676
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. I
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<ATOR>930129184306 M0196908
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CLASS: UNCLASSIFIED
OSRI : RUEKJCS
LINE1: OTTUZDSW RUEKJCS9020 0300017-UUUU--RHEHAAA.
LINE2: ZNR UUUUU
LINE3: RHFJVTA T COMCRUDESGRU TWO
LINE4: RUADANW T CGFIRSTMAW
DTG: 292250Z JAN 93
ORIG: SECDEF WASHINGTON DC//ASD-PA//
TO: AIG 8777
AIG 8798
AIG 8799
PREC:
INFO:
SUBJ:
****.
PUBLIC AFFAIRS GUIDANCE -- HOMOSEXUALS IN THE MILITARY
ALL ADDRESSEES ARE AUTHORIZED AND ENCOURAGED TO READDRESS THIS
MESSAGE AS APPROPRIATE.
TEXT:
UNCLAS SECTION 01 OF 02
SUBJ: PUBLIC AFFAIRS GUIDANCE -- HOMOSEXUALS IN THE MILITARY
ALL ADDRESSEES ARE AUTHORIZED AND ENCOURAGED TO READDRESS THIS
MESSAGE AS APPROPRIATE.
1. TODAY THE PRESIDENT ANNOUNCED ACTION ON THE ISSUE OF HOMOSEXUALS
IN THE MILITARY. TEXT OF THE ANNOUNCEMENT IS AS FOLLOWS:
PRESIDENT CLINTON:
(QUOTE) GOOD AFTERNOON, LADIES AND
GENTLEMEN.
I'M SORRY, WE HAD A LAST MINUTE DELAY OCCASIONED BY
ANOTHER ISSUE--NOT THIS ONE.
THE DEBATE OVER WHETHER TO LIFT THE BAN ON HOMOSEXUALS
IN THE MILITARY HAS, TO PUT IT MILDLY, SPARKED A GREAT DEAL OF
INTEREST OVER THE LAST FEW DAYS.
TODAY, AS YOU KNOW, I HAVE REACHED AN AGREEMENT, AT
LEAST WITH SENATOR NUNN AND SENATOR MITCHELL, ABOUT HOW WE WILL
PROCEED IN THE NEXT FEW DAYS.
BUT FIRST I'D LIKE TO EXPLAIN WHAT I BELIEVE ABOUT
THIS ISSUE AND WHY, AND WHAT I HAVE DECIDED TO DD, AFTER A LONG
CONVERSATION, AND A VERY GOOD ONE WITH THE JOINT CHIEFS OF
STAFF, AND DISCUSSIONS WITH SEVERAL MEMBERS OF CONGRESS.
THE ISSUE IS NOT WHETHER THERE SHOULD BE HOMOSEXUALS
IN THE MILITARY. EVERYONE CONCEDES THAT THERE ARE. THE ISSUE IS
WHETHER MEN AND WOMEN WHO CAN AND HAVE SERVED WITH REAL
DISTINCTION SHOULD BE EXCLUDED FROM MILITARY SERVICE SOLELY ON
THE BASIS OF THEIR STATUS.
AND I BELIEVE THEY SHOULD NOT. THE PRINCIPLE ON WHICH
I BASE THIS POSITION IS THIS. I BELIEVE THAT AMERICAN CITIZENS
WHO WANT TO SERVE THEIR COUNTRY SHOULD BE ABLE TO DO SO UNLESS
THEIR CONDUCT DISQUALIFIES THEM FROM DOING SO.
MILITARY LIFE IS FUNDAMENTALLY DIFFERENT FROM CIVILIAN
SOCIETY. IT NECESSARILY HAS A DIFFERENT AND STRICTER CODE OF
CONDUCT, EVEN A DIFFERENT CODE OF JUSTICE.
NONETHELESS, INDIVIDUALS WHO ARE PREPARED TO ACCEPT
ALL NECESSARY RESTRICTIONS ON THEIR BEHAVIOR, MANY OF WHICH
L __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - - - - - - - - - - -
�-
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WOULD BE INTOLERABLE IN CIVILIAN SOCIETY, SHOULD BE ABLE TO
SERVE THEIR COUNTRY HONORABLY AND WELL.
I HAVE ASKED THE SECRETARY OF DEFENSE TO SUBMIT BY
JULY THE 15TH A DRAFT EXECUTIVE ORDER, AFTER FULL CONSULTATION
WITH MILITARY AND CONGRESSIONAL LEADERS, AND CONCERNED
INDIVIDUALS OUTSIDE OF THE GOVERNMENT, WHICH WOULD END THE
PRESENT POLICY SOLELY ON THE BASIS OF--EXCUSE ME--OF EXCLUSION
FROM MILITARY SERVICE SOLELY ON THE BASIS OF SEXUAL ORIENTATION,
AND AT THE SAME TIME, ESTABLISH RIGOROUS STANDARDS
REGARDING SEXUAL CONDUCT TO BE APPLIED TO ALL MILITARY
PERSONNEL.
THIS DRAFT ORDER WILL BE ACCOMPANIED BY A STUDY
CONDUCTED DURING THE NEXT SIX MONTHS ON THE REAL PRACTICAL
PROBLEMS THAT WOULD BE INVOLVED IN THIS REVISION OF POLICY, SO
THAT WE WIL.L HAVE A PRACTICAL, REALISTIC APPROACH CONSISTENT
COHESION THAT OUR ARMED SERVICES MUST MAINTAIN.
I AGREE WITH THE JOINT CHIEFS THAT THE HIGHEST
STANDARDS OF CONDUCT MUST BE REQUIRED. THE CHANGE CANNOT AND
SHOULD NOT BE ACCOMPLISHED OVERNIGHT. IT DOES REQUIRE EXTENSIVE
CONSULTATION WITH THE JOINT CHIEFS, EXPERTS IN THE CONGRESS AND
IN THE LEGAL COMMUNITY, JOINED BY MY ADMINISTRATION AND OTHERS.
WE'VE CONSULTED CLOSELY TO DATE AND WILL DO SO IN THE FUTURE.
DURING THAT PROCESS, INTERIM MEASURES WILL BE PLACED INTO
EFFECT, WHICH I HOPE AGAIN SHARPEN THE FOCUS OF THIS DEBATE.
THE JOINT CHIEFS OF STAFF HAVE AGREED TO REMOVE THE
QUESTION REGARDING ONE'S SEXUAL ORIENTATION FROM FUTURE VERSIONS
OF THE ENLISTMENT APPLICATION AND IT WILL NOT BE ASKED IN THE
INTERIM.
WE ALSO ALL AGREE THAT A VERY HIGH STANDARD OF CONDUCT
CAN AND MUST BE APPLIED. SO THE SINGLE AREA OF DISAGREEMENT IS
THIS. SHOULD SOMEONE BE ABLE TO SERVE THEIR COUNTRY IN UNIFORM
IF THEY SAY THEY ARE HOMOSEXUAL BUT THEY DO NOTHING WHICH
VIOLATES THE CODE OF CONDUCT, UNDERMINES UNIT COHESION OR MORALE
APART FROM THAT STATEMENT?
THAT IS WHAT THE FUROR OF THE LAST FEW DAYS HAS BEEN
ABOUT. AND THE PRACTICAL AND NOT INSIGNIFICANT ISSUES RAISED BY
THAT ISSUE ARE WHAT WILL BE STUDIED IN THE NEXT SIX MONTHS.
THROUGH THIS PERIOD ENDING JULY 15TH, THE DEPARTMENT
OF JUSTICE WILL SEEK CONTINUANCES IN PENDING COURT CASES
INVOLVING REINSTATEMENT, AND ADMINISTRATIVE SEPARATIONS UNDER
CURRENT DEPARTMENT OF DEFENSE POLICIES BASED ON STATUS ALONE
WILL BE STAYED, PENDING COMPLETION OF THIS REVIEW.
THE FINAL DISCHARGE IN CASES BASED ONLY ON STATUS WILL
BE SUSPENDED UNTIL THE PRESIDENT HAS AN OPPORTUNITY TO REVIEW
AND ACT UPON THE FINAL RECOMMENDATIONS OF THE SECRETARY OF
D~FENSE WITH RESPECT TO THE CURRENT POLICY.
IN THE MEANTIME, A MEMBER WHO'S DISCHARGE HAS BEEN
SUSPENDED BY THE ATTORNEY GENERAL WILL BE SEPARATED FROM ACTIVE
DUTY AND PLACED IN ST~ND-BY RESERVE UNTIL THE FINAL REPORT OF
THE SECRETARY OF DEFENSE AND THE FINAL ACTION OF THE PRESIDENT.
THIS IS THE AGREEMENT THAT I HAVE REACHED WITH SENATOR
NUNN AND SENATOR MITCHELL. DURING THIS REVIEW PROCESS, I WILL
WORK WITH THE CONGRESS AND I BELIEVE THE COMPROMISE ANNOUNCED
TODAY BY THE SENATORS AND BY ME SHOWS THAT WE CAN WORK TOGETHER
COMPROMISE IS NOT EVERYTHING I WOULD HAVE HOPED FOR, OR
EVERYTHING THAT I HAVE STOOD FOR, BUT IT IS PLAINLY A
SUBSTANTIAL STEP IN THE RIGHT DIRECTION.
AND IT WILL ALLOW US TO MOVE FORWARD ON OTHER TERRIBLY
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IMPORTANT ISSUES AFFECTING FAR MORE AMERICANS. MY ADMINISTRATION
CAME TO THIS CITY WITH A MISSION--TO BRING .CRITICAL ISSUES OF
REFORM AND RENEWAL, AND ECONOMIC REVITALIZATION TO THE PUBLIC
DEBATE--ISSUES THAT ARE CENTRAL TO THE LIVES OF ALL AMERICANS.
WE ARE WORKING ON AN ECONOMIC REFORM AGENDA THAT WILL
BEGIN WITH AN ADDRESS TO THE JOINT SESSION OF CONGRESS ON
FEBRUARY 17TH.
IN THE COMING MONTHS THE WHITE HOUSE TASK FORCE ON
HEALTH CARE, CHAIRED BY THE FIRST LADY, WILL COMPLETE WORK ON A
COMPREHENSIVE HEALTH CARE REFORM PROPOSAL TO BE SUBMITTED TO
CONGRESS WITHIN 100 DAYS OF THE COMMENCEMENT OF THIS
ADMINISTRATION.
WE WILL BE DESIGNING A SYSTEM OF NATIONAL SERVICE, TO
BEGIN A SEASON OF SERVICE IN WHICH OUR NATION'S UNMET NEEDS ARE
ADDRESSED, AND WE PROVIDE MORE YOUNG PEOPLE THE OPPORTUNITY TO
GO TO COLLEGE.
WE WILL BE PROPOSING COMPREHENSIVE WELFARE REFORM
LEGISLATION, AND OTHER IMPORTANT INITIATIVES.
I APPLAUD THE WORK THAT HAS BEEN DONE IN THE LAST TWO
OR THREE DAYS BY. SENATOR NUNN, SENATOR MITCHELL AND OTHERS, TO
ENABLE US TO MOVE FORWARD ON A PRINCIPLE THAT IS IMPORTANT TO
ME, WITHOUT SHUTTING THE GOVERNMENT DOWN AND RUNNING THE RISK OF
UNCLAS FINAL SECTION OF 02
NOT EVEN ADDRESSING THE FAMILY AND MEDICAL LEAVE ISSUE WHICH IS
SO IMPORTANT TO AMERICA'S FAMILIES, BEFORE CONGRESS GOES INTO
ITS RECESS.
I AM LOOKING FORWARD TO GETTING ON WITH THIS ISSUE
OVER THE NEXT SIX MONTHS, AND WITH THESE OTHER ISSUES WHICH WERE
SO CENTRAL TO THE CAMPAIGN, AND FAR MORE IMPORTANTLY, ARE SO
IMPORTANT TO THE LIVES OF ALL THE AMERICAN PEOPLE.
(UNQUOTE)
2. THE WHITE HOUSE ALSO ISSUED THE FOLLOWING PRESS RELEASE TODAY
CONCERNING DEPARTMENT OF DEFENSE POLICY REGARDING HOMOSEXUALS IN
THE MILITARY:
(QUOTE) THE PRESIDENT HAS DIRECTED THE SECRETARY OF DEFENSE TO
CONDUCT A REVIEW OF THE CURRENT DEPARTMENT OF DEFENSE POLICY THAT
EXCLUDES HOMOSEXUALS FROM MILITARY SERVICE AND PREPARE A DRAFT
EXECUTIVE ORDER BASED UPON THAT REVIEW BY JULY 15, 1993.
CURRENT DEPARTMENT OF DEFENSE PERSONNEL POLICIES RELATED TO THIS
ISSUE WILL REMAIN IN EFFECT AT LEAST THROUGH JULY 15, 1993, WHILE
THE DEPARTMENT OF DEFENSE IS CONDUCTING THE REVIEW DIRECTED BY THE
PRESIDENT, SUBJECT TO THE FOLLOWING GUIDANCE:
FIRST, QUESTIONS REGARDING SEXUAL ORIENTATION WILL BE REMOVED
FROM FUTURE VERSIONS OF THE INDUCTION APPLICATION, AND WILL NOT BE
ASKED IN THE INTERIM. THE BRIEFINGS ON MILITARY JUSTICE WHICH ALL
RECRUITS ARE REQUIRED TO RECEIVE UPON ENTRY TO MILITARY SERVICE AND
PERIODICALLY THEREAFTER UNDER ARTICLE 137 OF THE UNIFORM CODE OF
MILITARY JUSTICE WILL INCLUDE A DETAILED EXPLANATION OF THE APPLICABLE LAWS AND REGULATIONS GOVERNING SEXUAL CONDUCT BY MEMBERS OF
THE ARMED FORCES.
SECOND, THE DEPARTMENT OF JUSTICE IS SEEKING CONTINUANCES IN
PENDING COURT-CASES INVOLVING FORMER SERVICE MEMBERS WHO HAVE BEEN
DISCHARGED ON THE BASIS OF HOMOSEXUALITY AND WHO ARE SEEKING
REINSTATEMENT INTO MILITARY SERVICE. THE CONTINUANCES WOULD FREEZE
THOSE CASES PENDING THE COMPLETION OF THE REVIEW DIRECTED BY THE
PRESIDENT.
THIRD, COMMANDING OFFICERS WILL CONTINUE TO PROCESS CASES UNDER
THE CURRENT LAWS AND REGULATIONS RELATED TO HOMOSEXUALITY.
-- CASES INVOLVING HOMOSEXUAL CONDUCT WILL BE PROCESSED THROUGH
�F:\Cable\Data Source\Cables\CDOO 1\JAN93\MSGS\MO 19717l.html
SECT:
Page 4 of5
ACTUAL SEPARATION AND DISCHARGE IN ACCORDANCE WITH CURRENT POLICY.
-- WHEN A CASE INVOLVES ONLY HOMOSEXUAL STATUS AND THE PERSON
INVOLVED REQUESTS A DISCHARGE, THE PERSON WILL BE RELEASED FROM
ACTIVE DUTY.
-- CASES INVOLVING ACKNOWLEDGED HOMOXEXUAL STATUS BEING CONTESTED BY THE INDIVIDUAL WILL BE PROCESSED THROUGH ALL APPLICABLE
STAGES, INCLUDING NOTICE OF THE BASIS FOR SEPARATION, HEARING
BEFORE A BOARD OF OFFICERS, REVIEW OF THE BOARD'S RECOMMENDATIONS
BY THE SEPARATION AUTHORITY, AND ACTION BY THE SEPARATION AUTHORITY
TO DISCHARGE THE PERSON. IF DIRECTED BY THE ATTORNEY GENERAL, THE
FINAL DISCHARGE IN CASES BASED ONLY ON STATUS WILL BE SUSPENDED
UNTIL THE PRESIDENT ACTS ON THE RECOMMENDATIONS OF THE SECRETARY OF
DEFENSE WITH RESPECT TO CURRENT POLICY. A MEMBER WHOSE DISCHARGE
HAS BEEN SUSPENDED BY THE ATTORNEY GENERAL WILL BE SEPARATED FROM
ACTIVE DUTY AND PLACED IN THE STANDBY RESERVE. INDIVIDUALS IN THE
STANDBY RESERVE WOULD HAVE THE OPTION TO RETURN, UPON REQUEST, TO
ACTIVE DUTY SHOULD THE CURRENT POLICY BE CHANGED. THOSE PERSONNEL
WHOSE CASES HAVE NOT BEEN SUSPENDED WILL BE DISCHARGED.
-- COMMANDING OFFICERS MAY, IN THE INTERESTS OF THE INDIVIDUAL
OR THE UNIT CONCERNED, DIRECT CHANGES IN THE ASSIGNMENT OF PERSONNEL DURING THE COURSE OF SEPARATION PROCEEDINGS.
(UNQUOTE)
3. THE FOLLOWING IS INITIAL PUBLIC AFFAIRS GUIDANCE CONCERNING THE
ISSUE OF HOMOSEXUALS IN THE MILITARY:
A. DETAILS OF HOW THE POLICY REVIEW PROCESS WILL PROCEED AND OF
MANY OF THE POLICY IMPLICATIONS WHILE THE REVIEW IS IN PROGRESS ARE
NOT YET AVAILABLE. UNTIL THE DEPARTMENT OF DEFENSE REVIEW HAS
PROGRESSED FURTHER AND MORE INFORMATION IS AVAILABLE, IT IS INAPPROPRIATE TO SPECULATE ON THE REVIEW PROCESS, ITS PARAMETERS,
PROGRESS OR OUTCOME. MUCH OF THE INFORMATION THE MEDIA OR GENERAL
PUBLIC WILL REQUEST REGARDING THE STATUS OF LEGAL CASES, AND THE
IMPACT ON EXISTING MILITARY DISCIPLINE, HOUSING AND OTHER APPLICABLE POLICIES IS NOT YET KNOWN AND IS CENTRAL TD THE POLICY REVIEW.
B. AUTHORIZED SPOKESPERSONS MAY DRAW FROM THE TEXT OF THE
PRESIDENTIAL STATEMENT AND/OR WHITE HOUSE PRESS RELEASE IN RESPONSE
TO QUERY. IF ASKED ABOUT DOD POLICY, UNIT COMMANDERS AND AUTHORIZED SPOKESPERSONS SHOULD RESPOND TO MEDIA AND PUBLIC INQUIRIES AS
FOLLOWS UNTIL FURTHER GUIDANCE IS RECEIVED:
(QUOTE) THE DEPARTMENT OF DEFENSE WILL ISSUE ORDERS NEXT WEEK TO IMPLEMENT THE
PRESIDENT'S INSTRUCTIONS. THE CONSULTATION AND REVIEW PROCESS
WHICH WILL LEAD TO A DRAFT EXECUTIVE ORDER IS UNDERWAY. (UNQUOTE)
C. REQUESTS FOR INTERVIEWS SHOULD BE HANDLED AT THE UNIT LEVEL
IN A WAY THAT IS CONSISTENT WITH REQUESTS ON ANY DEFENSE/UNIT-RELATED TOPIC. EONSISTENT WITH OPERATIONS AND A UNIT'S ABILITY TO
SUPPORT, MEDIA WILL CONTINUE TO BE PERMITTED TO CONDUCT "PERSON ON
THE STREET" INTERVIEWS TO SOLICIT INDIVIDUAL MILITARY MEMBERS.
OPINIONS ON THE ISSUE OF HOMOSEXUALS IN THE MILITARY. ALL REQUESTS
FOR ON-BASE MEDIA AVAILABILITIES OR INTERVIEWS WITH AND MILITARY
PERSON WILL BE COORDINATED THROUGH THE LOCAL PUBLIC AFFAIRS OFFICE.
ALL OPINIONS EXPRESSED BY MILITARY MEMBERS WILL BE CLEARLY IDENTIFIED AS PERSONAL OPINION.
4. OASD(PA) POINTS OF CONTACT FOR PLANS ARE LT COL P.J. CROWLEY,
USAF, OR LCDR CHUCK FRANKLIN, USN, DSN 223-1076, COMM 703-693-1076.
POC. FOR MEDIA QUERIES IS LT COL DOUG HART, USAF, DSN 227-5131, COMM
703-697-5131.
BT
#9021
NNNN
SECTION: 01 OF 02
�(
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<ASECT>SECTION: 02 OF 02
9020
<ASSN>9021
930129203857 M0197171
<ATOR>930129203859 M0197172
DIST:
SIT: VAX
0
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DTG:
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SUBJ:
I,
I
IMMEDIATE
UNCLASSIFIED
RUFHLD
OATUZYUW RUFHLD 1841 0321210-UUUU--RHEHAAA.
ZNR UUUUU ZZH
0 011209Z FEB 93
FM AMEMBASSY LONDON
011209Z FEB 93
AMEMBASSY LONDON
RUEHIA/USIA WASHDC IMMEDIATE 5541
RUEAIIA/CIA WASHDC
RUEATRS/DEPTTREAS WASHDC
RUCPDC/USDOC WASHDC
RUEKJCS/DIA WASHDC
RUEKJCS/SECDEF WASHDC
RUEHC/SECSTATE WASHDC 6500
RHEHAAA/WHITEHOUSE WASHDC
RUEHAM/AMEMBASSY AMMAN 5133
RUFHBE/AMEMBASSY BELGRADE 5380
RUFHOL/AMEMBASSY BONN 7926
RUEHBS/AMEMBASSY BRUSSELS 8141
RUFHDB/AMEMBASSY DUBLIN 0024
RUFHBG/AMEMBASSY LUXEMBOURG 9046
RUFHFR/AMEMBASSY PARIS 2489
RUEHRO/AMEMBASSY ROME 5324
RUFHMB/USMISSION USVIENNA 1763
RUFHNA/USMISSION USNATO 0330
RUEHGV/USMISSION GENEVA 8460
RUDOVFA/3AF RAF MILDENHALL UK
RBDBAAX//BRITISH ARMY STAFF COLLEGE CAMBERLEY UK
MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
BROADCAST MEDIA
BOSNIA
ON BBC TV'S BREAKFAST NEWS, REPORTER GEORGE EAKIN
TEXT:
UNCLAS SECTION 01 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
Page 1 of 14
�F:\Cable\Data Source\Cables\CDOO 1\FEB93\MSGS\MO 199123.html
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
BROADCAST MEDIA
BOSNIA
ON BBC TV'S BREAKFAST NEWS, REPORTER GEORGE EAKIN
INTERVIEWED PEACE CONFERENCE CO-CHAIRMAN LORD OWEN ON HIS
ARRIVAL AT HEATHROW LAST NIGHT. LORD OWEN SAID :
"MY OWN VIEW IS THAT OVER DISCUSSIONS IN NEW YORK, WE
WILL GET AGREEMENT, EVEN ON THE MAP, PRIOR TO ANY
SECURITY COUNCIL RESOLUTION. AT LEAST, I HOPE SO. I
COULD DRAW YOU A MAP NOW WHICH WOULD PLEASE BOTH THE
BOSNIANS, SERBS AND BOSNIAN MUSLIMS. BUT AT THE MOMENT,
THEY ARE NOT YET PREPARED TO TRADE OFF AGAINST EACH
OTHER, BUT I THINK THAT THEY WILL. "
UNCLASSIFIED
EAKIN COMMENTED: "LORD OWEN SAYS ONE REASON WHY THE
MUSLIMS ARE HOLDING OUT IS THAT THEY THINK THE AMERICANS
ARE ABOUT TO SEND THEM MILITARY AID. INSTEAD, OWEN SAYS,
PRESIDENT CLINTON SHOULD BACK THE PEACE PLAN. "
LORD OWEN WENT ON
"I WOULD LIKE HIM (CLINTON) TO GO
ONE STEP FURTHER, WHICH WOULD BE REALLY SIGNIFICANT,
WHICH WOULD BE TO SAY HE WOULD ACCEPT U.S. FORCES IN BLUE
BERETS CONTRIBUTING TO THE PEACE EFFORT IN BOSNIAHERCEGOVINA, PERHAPS CO-ORDINATED BY NATO. "
A. TODAY'S MAJOR NEWS STORIES
1. ERM
2. U.S. POLITICS
3. BRITISH ARMY
B. SUMMARY
1. ERM
THE WEEKEND DEVALUATION OF THE IRISH PUNT HAS TURNED MANY
UNCLAS SECTION 02 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
PAPERS' ATTENTION BACK TO THE TWIN SUBJECTS OF THE
MAASTRICHT TREATY AND ERM. OF THE FIVE EDITORIALS THIS
Page 2 of 14
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MORNING, FOUR CATEGORICALLY STATED THAT THE ERM IN ITS
PRESENT FORM WOULD SOON COLLAPSE, AND THAT THIS WOULD BE
A SUBJECT OF CELEBRATION, NOT MOURNING. ONLY THE LIBERAL
GUARDIAN WAS MORE CAUTIOUS, STATING IN NON-SPECIFIC TERMS
THAT:
"EVERYTHING THAT HAS HAPPENED TO THE ERM SHOWS THAT MORE
UNCLASSIFIED
·CO-OPERATION, NOT LESS, IS THE ONLY LONG-TERM ANSWER.
WITHOUT IT, EUROPE WILL CONTINUE TO SPLINTER UNDER THE
WEIGHT OF RECESSION INTO A SERIES OF COMPETITIVE
DEFLATIONARY NATIONAL ECONOMIES. "
THE CENTRIST INDEPENDENT LIKENED THE PRESIDENT OF THE
BUNDESBANK TO GODOT. "WAITING FOR HIM AND HIS COUNCIL TO
MAKE SOME MINIMAL REDUCTION IN GERMAN INTEREST RATES IS
NO LONGER AN ADEQUATE SUBSTITUTE FOR SUBSTANTIVE REFORM."
2. U.S. POLITICS
HOMOSEXUALS AND HEALTHCARE STILL FEATURE AS TOPICS OF
INTEREST, AS WELL AS EVALUATIONS OF THE NEW PRESIDENT'S
POPULARITY. THE CENTRIST INDEPENDENT'S RUPERT CORNWELL
REPORTED FROM WASHINGTON, ON THE PAPER'S FRONT PAGE:
"WHATEVER HAPPENED TO THE U.S. PRESIDENTIAL HONEYMOON?
THE STANDARD PERIOD OF GRACE USED TO BE 100 DAYS, EVEN
SIX MONTHS. ON JANUARY 20, THE INAUGURATION OF THE FIRST
BABY-BOOMER IN THE WHITE HOUSE WAS HAILED AS A NEW
BEGINNING. TO JUDGE FROM THIS WEEKEND'S HEADLINES, THE
ASSEMBLED RANKS OF AMERICAN PUNDITRY ARE ALREADY SUING
FOR DIVORCE. "
3. BRITISH ARMY
ONE EDITORIAt IN THE CONSERVATIVE DAILY TELEGRAPH,
CALLING. FOR A DELAY IN THE PROPOSED CUTS IN THE BRITISH
ARMY, IN THE LIGHT OF NEW DEVELOPMENTS IN BOSNIA AND
ELSEWHERE.
UNCLAS SECTION 03 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR OSLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
C. HEADLINES
UNCLASSIFIED
1. ERM
"GOOD NEWS FROM DUBLIN" (TIMES EDITORIAL)
"AFTER THE PUNT DEVALUATION" (FINANCIAL TIMES EDITORIAL)
Page 3 of14
�F:\Cable\Data Source\Cables\CDOO 1\FEB93\MSGS\MO 199123.html
"THE WORST OF ALL WORLDS" (INDEPENDENT EDITORIAL)
"THE PUNT TAKES A POUNDING" (GUARDIAN EDITORIAL)
"BURY TREATY WITH THE ERM" (TODAY EDITORIAL)
2. U.S. POLITICS
"FORCE OF UNREASON" (GUARDIAN COMMENTARY)
."CALLING THE PHONE-IN PRESIDENT" (GUARDIAN COMMENTARY)
"THE IMPORTANCE OF BEING HILLARY" (FINANCIAL TIMES
COMMENTARY)
3. BRITISH ARMY
"PEACE DIVIDEND DEFERRED" (DAILY TELEGRAPH COMMENTARY)
D. TEXT
1. ERM
THE CONSERVATIVE TIMES EDITORIALIZED:
"SATURDAY'S DEVALUATION OF THE IRISH PUNT WAS GOOD NEWS
FOR IRISH INDUSTRY AND FOR THE 17 PER CENT OF THE
UNCLASSIFIED
COUNTRY'S WORKFORCE WHO ARE NOW JOBLESS LARGELY BECAUSE
OF THE GOVERNMENT'S VAIN EFFORT TO CLING TO A NEEDLESSLY
HIGH EXCHANGE RATE. DEVALUATION WAS ALSO WELCOME TO THE
MANY SENSIBLE PEOPLE IN IRELAND WHO SWITCHED THEIR
UNCLAS SECTION 04 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
SAVINGS INTO FOREIGN CURRENCIES BEFORE THE WEEKEND.
HOWEVER, THE FULL BENEFITS OF THE WEEKEND'S WORK BY
EUROPEAN FINANCE MINISTERS WILL GRADUALLY SPREAD ACROSS
ALL EUROPE IF THE IRISH DEVALUATION TURNS OUT TO BE THE
BEGINNING OF THE END FOR THE ENTIRE EXCHANGE-RATE
MECHANISM. FORTUNATELY, THIS IS QUITE LIKELY.
"MONETARY STRAINS IN EUROPE ARE NOT CAUSED BY SPECULATION
OR BY SMALL MISALIGNMENTS IN EXCHANGE RATES. THEY ARE
CAUSED BY A FUNDAMENTAL DIVERGENCE BETWEEN THE ECONOMIC
REQUIREMENTS OF GERMANY AND THE OTHER ~EMBERS OF THE ERM.
"THE ERM, AT LEAST IN THE RIGID FORM THAT EVOLVED AFTER
Q1989 WHE/ JACQUES DELORS LAUNCHED HIS DRIVE FOR MONETARY
UNION, HAS DONE GREAT HARM TO EUROPE. NOT ONLY HAVE HIGH
INTEREST RATES AND OVERVALUED EXCHANGE RATES CONTRIBUTED
TO THE SHOCKING LEVELS OF UNEMPLOYMENT THAT HAVE TURNED
LARGE PARTS OF FRANCE, ITALY AND SPAIN, AS WEQL AS
Page 4 of 14
�F:\Cable\Data Source\Cables\CDOO 1\FEB93\MSGS\MO 199123 .html
IRELAND, INTO INDUSTRIAL DESERTS. ~UST AS SERIOUSLY, THE
PREOCCUPATION OF EUROPEAN POLITICIANS WITH EXCHANGE RATES
HAS DISTRACTED ATTENTION FROM THE INFINITELY MORE
IMPORTANT ECONOMIC AND POLITICAL CHALLENGES THROWN UP BY
EVENTS IN THE PAST TWO YEARS -- THE THREAT TO THE WORLD
TRADING SYSTEM FROM THE BREAKDOWN OF GATT, THE CHALLENGE
OF CREATING A TRULY COMPETITIVE AND OPEN SINGLE MARKET,
THE NEED TO DEREGULATE INDUSTRIES AND LABOR MARKETS TO
IMPROVE EUROPE'S PRODUCTIVITY TO THE LEVELS PREVAILING IN
AMERICA AND JAPAN, AND THE CHALLENGE OF ASSISTING RUSSIA
UNCLASSIFIED
AND EASTERN EUROPE AND INTEGRATING THEM INTO THE WESTERN
MARKET SYSTEM.
"AT THE START OF THIS DECADE THESE WERE THE TASKS
UNIVERSALLY ACKNOWLEDGED AS THE HISTORIC CHALLENGES OF
THE 1990S FOR EUROPE. YET THEY HAVE BEEN SHAMEFULLY
NEGLECTED BY MANY GOVERNMENTS THAT HAVE INSTEAD PUT THEIR
ENERGIES INTO FIGHTING SPECULATORS AND TRYING TO
MANIPULATE EXCHANGE RATES. THE ERM, FAR FROM TURNING
EUROPE INTO A 'ZONE OF MONETARY STABILITY' AS ITS
FOUNDING FATHERS INTENDED, HAS PRODUCED DESTABILIZING
FINANCIAL CRISES. THE BEST HOPE FOR EUROPE IS THAT THE
UNCLAS SECTION 05 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
ERM'S NEXT CRISIS WILL BE ITS LAST. "
THE INDEPENDENT FINANCIAL TIMES EDITORIALIZED:
"YET ANOTHER PUNCH-DRUNK EUROPEAN CURRENCY, THE IRISH
PUNT, HAS THROWN IN THE TOWEL . . . . EVERY COUNTRY IN
EUROPE, EXCEPT GERMANY (THOUGH MANY WOULD DISAGREE THERE
TOO), NEEDS FAR LOWER INTEREST RATES. THE QUESTION IS
WHETHER THEY WILL GET THEM IN TIME. EVEN PARIS, THE MOST
RESOLUTE UPHOLDER OF THE 'HARD ERM', MUST RECOGNIZE THAT
PERSISTENCE WITH 'RIGUEUR' MAY LEAD NOT TO THE SUNLIT
UPLANDS, BUT TO A BREAKDOWN WITH DAMAGING POLITICAL, AS
WELL AS ECONOMIC, CONSEQUENCES. TACTICAL FLEXIBILITY MAY
NOW BE A MORE SATISFACTORY ROUTE TO THE STRATEGIC GOAL OF
EMU THAN PERSISTENCE ALONG THE EC'S PRESENT COURSE. THE
ONLY ESCAPE WOULD BE A LARGE REDUCTION IN GERMAN INTEREST
RATES . . . . IF THE BUNDESBANK IS NOT TO PROVIDE RELIEF,
�F:\Cable\Data Source\Cables\CDOOI \FEB93\MSGS\MOI YYI23.html
WHAT ARE THE ALTERNATIVES?
"GREATER CO-OPERATION OVER EXCHANGE RATE INTERVENTION IS
OF MODEST HELP WHEN THE FORM OF CO-OPERATION MOST
UNCLASSIFIED
NEEDED -- LOOSER GERMAN MONETARY POLICY AND TIGHTER
GERMAN FISCAL POLICY -- IS UNAVAILABLE. REALIGNMENTS,
THOUGH INESCAPABLE UNDER SEVERE PRESSURE, ARE OF LIMITED
BENEFIT TOO, UNLESS LARGE. THE PROBLEM OF PERSISTENTLY
HIGH INTEREST RATES REMAINS, SINCE REALIGNMENT CAN HELP
HERE ONLY IF SUBSEQUENT UPWARD REALIGNMENTS AGAINST THE
D-MARK BECOME CREDIBLE.
"IT WOULD HAVE BEEN BEST TO HAVE AGREED A TEMPORARY
SUSPENSION OF THE D-MARK UPON GERMAN REUNIFICATION. IT
REMAINS THE BEST OPTION. LET THE BUNDESBANK FIGHT ITS
BATTLE FOR STABILITY UNHAMPERED BY THE MONETARY
CONSEQUENCES OF FOREIGN EXCHANGE INTERVENTION AND RELINK
EXCHANGE RATES WHEN GERMAN INFLATION IS ONCE MORE WHERE
THE BUNDESBANK WANTS IT. YET AN AGREED SUSPENSION OF
OTHER CURRENCIES NEED NOT DO THEM MUCH HARM. GIVEN THE
STRONG FUNDAMENTALS OF THE FRENCH ECONOMY, IN PARTICULAR,
THE FRANC MIGHT LOSE LITTLE VALUE, EVEN WITH LOWER
INTEREST RATES.
UNCLAS SECTION 06 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION SNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
"'C'EST MAGNIFIQUE, MAIS CE N'EST PAS LAGUERRE; AND IT
IS NOT SENSIBLE MONETARY POLICY EITHER. EUROPEAN LEADERS
SHOULD ASK THEMSELVES WHETHER THEIR STRATEGIC GOAL OF
EUROPEAN UNION MIGHT NOT BE BETTER SERVED BY A TEMPORARY
RETREAT THAN BY GALLOPING ON TO GLORIOUS DEFEATS OR
PYRRHIC VQCTORIES. "
('IT'S MAGNIFICENT, BUT IT'S NOT WAR')
THE CENTRIST INDEPENDENT EDITORIALIZED:
"THANKS TO THE FOREIGN EXCHANGE DEALERS' CONTINUING
SUCCESS IN EXPLOITING THE GAP BETWEEN PRETENSIONS AND
UNCLASSIFIED
KNOWN WEAKNESSES, THE ERM IS CLOSE TO LOSING ITS LAST
SHREDS OF CREDIBILITY.
"THERE WAS NEVER ANYTHING FUNDAMENTALLY WRONG WITH ITS
CENTRAL CONCEPT : THAT PEGGING WEAKER CURRENCIES
Paget> or
14
�t":\Cable\Data Source\Cables\CDOOl \FEB93\MSGS\M0199123 .html
Page 7 of14
INCREASINGLY CLOSELY TO A CENTRAL OR ANCHOR CURRENCY
WOULD CREATE A ZONE OF STABILITY THAT WOULD BENEFIT ALL
THOSE WITHIN IT. THIS CAME TO BE SEEN AS A PRECURSOR OF
MONETARY UNION, FOR WHICH A TARGET DATE OF 1999 WAS SET.
WHAT WAS NEVER FORESEEN WAS THAT THE ANCHOR CURRENCY, THE
MARK, WOULD ITSELF COME UNDER SEVERE THREAT FROM
INFLATIONARY PRESSURES SPRINGING FROM THE HUGE COSTS OF
GERMAN REUNIFICATION.
"IN ONE MEMBER STATE AFTER ANOTHER, THE DEFLATION FORCED
ON THE ERM'S MEMBERS BY POLICIES DESIGNED FOR PURELY
GERMAN CONSUMPTION HAVE PROVED POLITICALLY UNACCEPTABLE
AND ECONOMICALLY TRAUMATIC. FIRST THE ITALIAN LIRA AND
STERLING LEFT. THEN THE SPANISH PESETA AND PORTUGUESE
ESCUDO WERE DEVALUED. NOW ONLY THE FRENCH FRANC, DANISH
KRONA AND BENELUX CURRENCIES (THE LATTER EFFECTIVELY FORM
PART OF A MARK ZONE) ARE CLINGING ON, DESPITE HEAVY AND
FREQUENT ASSAULTS ON THEIR FINGERTIPS.
"COUNTRIES STILL IN THE ERM NOW HAVE THE WORST OF ALL
POSSIBLE WORLDS, WITH AN APPALLING DEFLATIONARY SQUEEZE
ACCEPTED BY THEIR GOVERNMENTS FOR LARGELY POLITICAL
REASONS.
UNCLAS SECTION 07 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
"WHICH CURRENCY WILL BE THIS WEEK'S TARGET WILL SOON
BECOME EVIDENT. IF THE ERM IS NOT TO BE UTTERLY
DISCREDITED, ACTION TO REFORM IT CANNOT BE DELAYED MUCH
LONGER. THE MOST OBVIOUS ALTERNATIVES ARE FOR IT TO
UNCLASSIFIED
PAGE
REVERT TO ITS MORE FLEXIBLE FORM IN WHICH EXCHANGE RATE
ADJUSTMENTS, GENERALLY QUITE SMALL, WERE RELATIVELY
FREQUENT; OR FORWARDS, BY ACCELERATING THE TIMETABLE FOR
MONETARY UNION LAID DOWN IN THE MAASTRICHT TREATY. THAT
IS PROBABLY WHAT THE FRENCH AND BENELUX COUNTRIES WOULD
PREFER, ALTHOUGH LAST WEEK HELMUT SCHLESIGNER, PRESIDENT
OF THE BUNDESBANK, ADVISED AGAINST SUCH A MOVE. IN THIS
CONTEXT, MR SCHLESIGNER IS GODOT. WAITING FOR HIM AND
HIS COUNCIL TO MAKE SOME MINIMAL REDUCTION IN GERMAN
INTEREST RATES IS NO LONGER AN ADEQUATE SUBSTITUTE FOR
�F:\Cable\Data Source\Cables\CDOO 1\FEB93\MSGS\MO 199123.html
Page 8 of 14
SUBSTANTIVE REFORM. "
THE LIBERAL GUARDIAN EDITORIALIZED:
"MORE THAN EVER, THE FATE OF THE PUNT UNDERLINES THE
DISASTROUS MISTAKE WHICH EUROPEAN FINANCE MINISTERS MADE
LAST SUMMER WHEN THEY FAILED TO PROMOTE 'A MANAGED GENERAL
REALIGNMENT OF ERM CURRENCIES. THAT FAILURE BY
POLITICIANS HAS LEFT THE FIELD OPEN TO BANKERS AND
SPECULATORS TO DO THE JOB THEIR WAY. THE WEAK HAVE BEEN
PICKED OFF ONE BY ONE, WITHOUT THE PROTECTION OF A MUTUAL
SUPPORT SYSTEM. FRANCE AS WELL AS DENMARK WILL BE NEXT,
AS SPECULATORS BET AGAINST THE RESULT OF THE FRENCH
ELECTION IN MARCH. SOME WILL DRAW THE CONCLUSION THAT IT
QALL PROV/S THAT CO-OPERATION CANNOT WORK. IN FACT IT
PROVES THE OPPOSITE. EVERYTHING THAT HAS HAPPENED TO THE
ERM SHOWS THAT MORE CO-OPERATION, NOT LESS, IS THE ONLY
LONG-TERM ANSWER. WITHOUT IT, EUROPE WILL CONTINUE TO
SPLINTER UNDER THE WEIGHT OF RECESSION INTO A SERIES OF
COMPETITIVE DEFLATIONARY NATILZIBZAFDFORIALIZED:
UNCLASSIFIED
PAGE
"THE QUESTION IS NO LONGER WHETHER THE EUROPEAN ERM WILL
UNCLAS SECTION 08 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
TOTALLY COLLAPSE, BUT WHEN.
"FORTUNATELY BRITAIN CAN WATCH ITS DEATH THROES
DISPASSIO~ATELY.
SINCE BLACK WEDNESDAY WE HAVE BEEN OUT
OF ITS CLUTCHES.
"JOHN MAJOR DOES NOT HAVE TO BOTHER ABOUT WHEN TO REJOIN
THE ERM. BY THE TIME HE DECIDES TO, IT WILL NOT EXIST.
BUT THAT DOES NOT MEAN MR MAJOR CAN IGNORE WHAT IS
HAPPENING TO IT. HE IS CURRENTLY PUSHING THE
RATIFICATION OF THE MAASTRICHT TREATY THOUGH THE COMMONS,
FORCING MPS TO STAY UP ALL NIGHT, NIGHT AFTER NIGHT. AND
THE KEYSTONE OF THAT TREATY IS EUROPEAN MONETARY UNION.
"ALL THE EXPERIENCE OF THE PAST MONTHS HAS BEEN THAT THIS
CANNOT WORK. IT IS A DREAM OF THE POLITICIANS AND
BUREAUCRATS. YET THEY WILL NOT LET THE IMPOSSIBLE DREAM
GO.
"IT WOULD BE MADNESS TO TIE UP OUR CURRENCY, AND OUR
�f:\Cable\Data Source\Cables\CDOO 1\FEB93\MSGS\MO 199123 .html
Page 9 of 14
ECONOMY, IN AN UNWORKABLE EUROPEAN SYSTEM AGAIN. AND
THAT MAKES IT MADNESS TO CARRY ON WITH THE MAASTRICHT
RATIFICATION.
"IF OUR MPS ARE GOING TO SPEND THEIR NIGHTS ARGUING THEY
SHOULD DO IT ABOUT THE GREAT ISSUES FACING THE COUNTRY
THE STATE OF THE HEALTH SERVICE, SCHOOLS AND
UNEMPLOYMENT. THEY SHOULD NOT BE WASTING THEIR TIME
PUSHING THROUGH AN ARRANGEMENT WHICH IS AT BEST
UNWORKABLE AND AT WORST WOULD DRAG THE ECONOMY DOWN
AGAIN. "
UNCLASSIFIED
PAGE
2. U.S. POLITICS
THE LIBERAL GUARDIAN EDITORIALIZED:
"IT IS BAD NEWS THAT ARMED FORCES WHICH WERE NOBLY IN THE
FOREFRONT OF BREAKING DOWN RACIAL DISCRIMINATION IN
AMERICA ARE NOW RESISTING MOVES TO ABOLISH DISCRIMINATION
AGAINST GAYS. THAT THE MAN LEADING THIS FIGHT TO
MAINTAIN THE PREJUDICE IS AMERICA'S FIRST BLACK CHAIRMAN
OF THE JOINT CHIEFS OF STAFF, GENERAL COLIN POWELL, IS
UNCLAS SECTION 09 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
ESPECIALLY IRONIC. TODAY, EVERY ARGUMENT ONCE USED TO
SUPPORT DISCRIMINATION AGAINST BLACK, AND THEN FEMALE
RECRUITS, IS BEING USED AGAINST HOMOSEXUALS.
"OF COURSE WOMEN AND BLACK PEOPLE STILL FACE HARASSMENT
AND DISCRIMINATION WITHIN THE ARMED SERVICES, BUT THE
IMPORTANF DISTINCTION IS THAT THESE PREJUDICES ARE NOW
UNLAWFUL.
"THE REAL ISSUE IS CLEAR ENOUGH : THOUSANDS OF AMERICANS
ARE BEING UNREASONABLY DENIED THEIR CIVIL RIGHT TO FIGHT
FOR THEIR COUNTRY . . . . THE PRESIDENT WAS UNEQUIVOCAL IN
HIS .CAMPAIGN COMMITMENT. HE SHOULD BE AS RESOLUTE IN
OFFICE. TO BACK DOWN NOW WILL DESTROY HIS CREDIBILITY
ACROSS A WIDER AGENDA. HE IS BEING CLOSELY WATCHED TO
SEE IF HE IS READY TO KEEP HIS WORD, AND STAND UP FOR
UNPOPULAR CAUSES. EQUAL RIGHTS FOR GAY SOLDIERS HAS
BECOME THE TEST OF WHETHER HE INTENDS TO STICK TO HIS
GUNS. "
�F:\Cable\Data Source\Cables\CDOO 1\FEB93\MSGS\MO 199123.html
Page 10 of 14
IN THE SAME PAPER, WASHINGTON CORRESPONDENT SIMON TISDALL
REPORTED:
UNCLASSIFIED
PAGE
"FORGET THE FIRST 100 DAYS. BILL CLINTON IS ALREADY
SCREWING UP AFTER ONLY 10 DAYS IN OFFICE -- OR SO THE
POLITICIANS, PUNDITS AND POSTURERS WHO FORMULATE
WASHINGTON'S 'CONVENTIONAL WISDOM' WOULD HAVE YOU
BELIEVE.
"IT'S ALL NONSENSE, OF COURSE. CLINTON'S YOUNG
PRESIDENCY.IS CERTAINLY BESIEGED. BUT THOSE COMMANDING
THE CANNON AND CATAPULTS ARE NOT CONGRESSIONAL PRIMA
DONNAS LIKE SAM NUNN, NOR THE SNEERING SABOTEURS OF THE
REPUBLICAN RIGHT, NOR EVEN THE GANG-BANGERS OF THE WHITE
HOUSE PRESS CORPS. CLINTON IS UNDER SIEGE FROM THE
AMERICAN PEOPLE. HAVING PROMISED A POPULIST PRESIDENCY
WHERE THE ORDINARY VOTER'S VOICE WOULD BE HEARD, HE IS
BEING HELD TO HIS WORD. HIS IS BECOMING THE PHONE-IN
PRESIDENCY. FOR CLINTON IS REAPING THE WHIRLWIND OF THE
POLITICS OF INCLUSION, DIVERSITY AND RENEWED HOPE WHICH
PUT HIM WHERE HE IS NOW. WHERE HE IS NOW HAS BECOME
VIRTUALLY IMPOSSIBLE TO REACH, ALTHOUGH THAT HASN'T PUT
UNCLAS SECTION 10 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
ANYONE OFF. JUST TRY CALLING THE MAIN WHITE HOUSE
NUMBER. THE SWITCHBOARD IS CONSTANTLY ENGAGED.
"YET SO FAR, AT LEAST, DESPITE THE PREMATURE
PROGNOSTICATIONS OF THE CAPITAL'S CASSANDRAS, CLINTON
SEEMS TO BE ENJOYING EVERY MINUTE OF IT. IN FACT, THE
BOY'S DOING ALL RIGHT. AS THE NEW KID ON THE BLOCK GOES
THROUGH HIS PACES, IT'S THE WASHINGTON ESTABLISHMENT
WHICH IS CONFUSED. HONEYMOON IS THE WRONG WORD : THIS IS
A NEW ENGAGEMENT, IN THE BROADEST SENSE.
"MORE THAN ANY U.S. LEADER BEFORE HIM, CLINTON HAS THE
MEANS AND THE OPPORTUNITY TO CUT OUT THE MIDDLE MAN AND
CONNECT DIRECT. AND IT IS IN THIS CONTEXT THAT THE
UNCLASSIFIED
PAGE
REJECTION OF ZOE BAIRD'S NOMINATION CAN BE SEEN NOT AS A
�F:\Cable\Data Source\Cables\CDOO 1\FEB93\MSGS\MO 199 i 23.html
Page 11 of14
DEFEAT, BUT AS A DEFT RESPONSE TO PUBLIC OPINION .
... WHEN THE PUBLIC GOT TO HEAR ABOUT IT, THE WHITE HOUSE
SWITCHBOARD LIT UP AND THE TALK-SHOWS WENT WILD. CALLERS
SOUGHT TO REMIND CLINTON THAT HE HAD PROMISED THAT THE
RICH AND PRIVILEGED WOULD NO LONGER GET PREFERENTIAL
TREATMENT, ESPECIALLY WHEN THEY BROKE THE LAW. LISTENING
CLOSELY, CLINTON THOUGHT AGAIN, AGREED, AND WITHIN A
REMARKABLY SHORT TIME SPAN, BAIRD'S NOMINATION WAS
HISTORY.
"DESPITE SENATOR NUNN'S SELF-SERVING CLAIMS TO HAVE ·SAVED
CLINTON FROM HIMSELF, LAST FRIDAY'S COMPROMISE OVER
ENDING THE BAN ON HOMOSEXUALS IN THE MILITARY WAS A
PRODUCT OF THE SAME PROCESS.
"FOR BEHIND-THE-CURVE WASHINGTON INSIDERS, THE DUCKING
AND WEAVING EVIDENT DURING THE BAIRD AND GAYS-IN-THE
MILITARY EPISODES SHOWED SLICK WILLIE AT HIS WORST. FOR
THE CAPITAL'S MEDIA ELITE, SUCH UNBLUSHING FLEXIBILITY
AFTER THE OH-SO-BRITTLE GEORGE BUSH TOOK THE COLLECTIVE
BREATH AWAY. FOR THE CAPITOL HILL MOB, CLINTON IS
ALREADY BECOMING A FAST-MOVING TARGET.
"WHAT ALL OF THEM HAVE SO FAR FAILED TO UNDERSTAND IS
THAT CLINTON ISN'T LISTENING TO THEM. AS BEST HE CAN
UNCLAS SECTION 11 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
AMID THE CLAMOR, HE IS LISTENING TO THE AMERICAN PEOPLE
IN A WAY HIS PREDECESSORS HAD NEITHER THE MEANS NOR THE
INCLINATION TO DO. FOR THE 90S AMERICAN AUDIENCE, IT'S
NOT CONSISTENCY THAT MATTERS -- IT'S RESULTS, BASED ON A
QFAIR HEA/ING. AND BY THE WAY, EVERYONE 'OUT THERE' KNEW
HE'D HAVE TO RAISE TAXES, WHATEVER HE SAID IN THE
CAMPAIGN : ASK ANY VOTER. NEXT QUESTION. "
UNCLASSIFIED
PAGE
IN THE INDEPENDENT FINANCIAL TIMES, MICHAEL PROWSE
. COMMENTED:
"THEY MIGHT HAVE BEEN MORE HONEST. FOR MOST OF THE
CAMPAIGN MRS HILLARY CLINTON WENT INTO 'COOKIE-BAKING'
MODE, GAZING ADORINGLY AT HER HUSBAND AND PROMISING TO BE
A TRADITIONAL FIRST LADY. BUT WITHIN HOURS OF THE
�f:\Cable\Data Source\Cables\CDOO 1\FEB93\MSGS\MO 199123.html
Page 12 of 14
INAUGURATION, THE OLD ASSERTIVE HILLARY HAD REAPPEARED,
COMPLETE WITH MAIDEN NAME AND HEADBAND.
"HILLARY IS AS WELL-QUALIFIED ACADEMICALLY AS BILL AND,
AS A TOP ARKANSAS LAWYER, .EARNED FIVE OR SIX TIMES BILL'S
MEAGER SALARY AS GOVERNOR. SHE ADVISED HIM THROUGHOUT
HIS CAREER, TO THE POINT OF CHAIRING THE COMMITTEE THAT
DEVISED THE EDUCATIONAL REFORMS NOW REGARDED AS HIS MAIN
ACHIEVEMENT IN ARKANSAS. AS AN EQUAL PARTNER FOR SO MANY
YEARS, HER DESIRE FOR HANDS-ON RESPONSIBILITY IS
UNDERSTANDABLE.
"EVEN SO, HER NEW POSITION RAISES QUESTIONS. AFTER JOHN
F KENNEDY MADE HIS BROTHER ROBERT ATTORNEY GENERAL, ANTINEPOTISM LAWS WERE PASSED TO PREVENT THE APPOINTMENT OF
CLOSE RELATIVES TO POWERFUL POSITIONS. BY NOT PAYING HIS
WIFE, "MR CLINTON HAS DODGED THESE CONSTRAINTS. YET
PEOPLE SEEM ODDLY RELUCTANT TO CRITICIZE HILLARY'S ROLE,
PERHAPS BECAUSE GREATER RESPONSIBILITY FOR WOMEN IS SEEN
AS SO OBVIOUSLY A GOOD THING. YET IF MR CLINTON HAD PUT
A BROTHER OR FAVORITE UNCLE IN CHARGE OF HEALTH-CARE
REFORM, ALL HELL WOULD HAVE BROKEN LOOSE.
"THE U.S. HAS HAD ALMOST AS MANY DIFFERENT FYPES OF
PRESIDENCIES AS THERE HAVE BEEN PRESIDENTS. IN AN AGE
WHEN POWER IS INCREASINGLY DISTRIBUTED EQUALLY BETWEEN
UNCLASSIFIED
UNCLAS SECTION 12 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
PAGE
THE SEXES, A HUSBAND AND WIFE WORKING IN HARNESS CAN
ARGUABLY LEAD THE COUNTRY MORE .EFFECTIVELY THAN EITHER
SPOUSE ALONE. THE PITY IS THAT THE ELECTORATE WAS NOT
ASKED MORE EXPLICITLY TO SUPPORT SUCH AN INTRIGUING
INNOVATION.
3. BRITISH ARMY
THE CONSERVATIVE DAILY TELEGRAPH EDITORIALIZED:
"THE HOUSE OF COMMONS SELECT COMMITTEE ON DEFENSE IS DUE
TO REPORT SHORTLY, AND IS WIDELY RUMORED TO BE URGING A
HALT TO THE OPTIONS FOR CHANGE SHRINKAGE (OF THE BRITISH
ARMY) WHILE THE GOVERNMENT GIVES FURTHER THOUGHT TO
BRITAIN'S MILITARY NEEDS. SUCH A CALL SHOULD BE HEEDED.
II
�f:\Cable\Data Source\Cables\CDOO 1\FEB93\MSGS\MO 199123.html
Page 13 of -14
THOSE PARTS OF BRITAIN'S ARMED FORCES WHICH WERE DESIGNED
SPECIFICALLY FOR A NATO-WARSAW PACT CONFLAGRATION
CONTINUE TO LOOK OUT OF BALANCE WITH THE REST, NOW THAT
SUCH A SCENARIO IS HARDLY CONCEIVABLE.
"BUT BRITAIN IS TODAY ONE OF ONLY TWO OR THREE WORLD
POWERS WHICH MAINTAIN THE ABILITY TO PLACE EFFICIENT
MILITARY FORCE AT THE DISPOSAL OF UN PEACEKEEPING OR
PEACEMAKING EFFORTS. BRITAIN'S STATUS AS ONE OF THE FIVE
PERMANENT MEMBERS OF THE SECURITY COUNCIL IMPLIES
ACCEPTANCE OF RESPONSIB·ILITIES MOST OTHER GOVERNMENTS DO
NOT NEED TO CATER FOR.
"FOR A RELATIVELY SMALL POWER WITH AILING ECONOMIC
STRENGTH, BRITAIN CAN TAKE PRIDE IN POSSESSING MORE THAN
ITS SHARE OF EXPERTISE IN THE MILITARY ARTS. THIS IS
VALUABLE NOT MERELY WHERE FULL SCALE WAR IS AT STAKE BUT
UNCLASSIFIED
PAGE
SECT:
ALSO IN LOWER INTENSITY OPERATIONS DEMANDING THE CAREFUL
APPLICATION OF LIMITED FORCE. NORTHERN IRELAND, BELIZE
AND NOW BOSNIA HAVE ALL HELPED TO SHARPEN THOSE SKILLS,
WHICH ARE ESSENTIALLY INFANTRY SKILLS.
"FOR ONCE, THE ARMY'S COMPLAINT THAT IT IS FULLY
COMMITTED TO THE POINT OF OVERSTRETCH SHOULD NOT BE
UNCLAS SECTION 13 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO·FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
TREATED AS SPECIAL PLEADING TO PROTECT THE VESTED
INTERESTS OF FAMOUS INFANTRY REGIMENTS, BUT AS A REALITY
TO WHICH THE GOVERNMENT MUST RESPOND." COURTNEY
BT
#1841
NNNN
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<ASSN>1841
<ASSN>1841
<ASSN>1841
<ASSN>1841
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<ATOR>930201072857 M0199164
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<ATOR>930201072901 M0199166
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<ATOR>930201073108 M0199168
<ATOR>930201073109 M0199169
DIST:
SIT: VAX
0
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
DATE
SUBJECTffiTLE
RESTRICTION
AND TYPE
001. cable
Subject: British Columbia Invitation for First Lady to Examine
Province's Health Care System (2 pages)
02/22/1993
P1/b(1)
COLLECTION:
Clinton Presidential Records
NSCCables
Jan 1993 - Dec 1994 ([First Lady and Health Care])
OA/Box Number: 505,000
FOLDER TITLE:
[01/03/1993 - 09/29/1993]
2006-0223-F
ab626
RESTRICTION CODES
Presidential Records Aet- [44 U.S.C. 2204(a))
Freedom of Information Aet- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
fina.ncial information [(a)(4) of the PRA)
PS Release would disclose con~dentlal advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA)
b(l) National security classified Information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
· C. Closed In accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�j
F:\Cable\Data Source\Cables\CD002\APR93\MSGS\M0365445.html
Cab 1e
PREC:
CLASS:
LINEl:
LINE2:
LINE3:
LINE4:
OSRI:
DTG:
ORIG:
TO:
INFO:
SUBJ:
IMMEDIATE
UNCLASSIFIED
OAAUZYUW RUFHMDA5193 1201549-UUUU--RUEADWW.
ZNR UUUUU ZZH
0 301548Z APR 93
FM AMEMBASSY MADRID
RUFHMD
301548Z APR 93
AMEMBASSY MADRID
RUEHC/SECSTATE WASHDC IMMEDIATE 7984
RUEADWW/THE WHITE HOUSE IMMEDIATE
SPANISH PRESS ON KING'S WHITE HOUSE VISIT
TEXT:
UNCLAS MADRID 05193
E.O. 12356: N/A
TAGS: OVIP, PREL, PGOV; SP
SUBJECT: SPANISH PRESS ON KING'S WHITE HOUSE VISIT
1. FOLLOWING IS A SUMMARY OF MADRID PRESS COVERAGE OF THE
APRIL 29 VISIT OF KING JUAN CARLOS AND QUEEN SOFIA TO THE WHITE
HOUSE.
2. MADRID NEWSPAPERS GAVE PROMINENT COVERAGE TO THE MEETING
BETWEEN THE ROYAL COUPLE AND THE PRESIDENT AND FIRST LADY, WITH
LEADING DAILIES "EL PAIS" AND "ABC" FEATURING LARGE PHOTOGRAPHS .
OF THE ENCOUNTER ON THEIR FRONT PAGES. MOST REPORTS, RELYING
HEAVILY ON GOS FOREIGN MINISTER SOLANA'S POST-MEETING REMARKS,
EMPHASIZED THE POLITICAL CONTENT OF THE EXCHANGE, PARTICULARLY
WITH REGARD TO THE BALKAN CONFLICT. SOLANA CHARACTERIZED THE
MEETING AS "EXTREMELY PLEASANT," "CREATING A VERY POSITIVE,
VERY INTENSE PERSONAL CLIMATE" BETWEEN THE TWO LEADERS. THE
SPANISH FOREIGN MINISTER ALSO NOTED THAT THE PRESIDENT ACCEPTED
THE KING'S INVITATION TO VISIT SPAIN.
3. NEWS ARTICLES NOTED THAT THE MEETING LASTED FOR MORE THAN
THE SCHEDULED 40 MINUTES AND THAT SOLANA, HIS WIFE, SECRETARY
CHRISTOPHER, NSA LAKE, SPANISH AMBASSADOR DE OJEDA, HEAD OF THE
ROYAL HOUSEHOLD ALMANSA AND TWO NOTETAKERS ALSO ATTENDED. THE
PRESIDENT'S STATEMENT OF GRATITUDE TO SPAIN FOR HER COOPERATION
IN THE FORMER YUGOSLAVIA WAS WIDELY FEATURED AS PART OF A
LARGER CONSULTATION SESSION WITH THE KING AND SOLANA ON
POSSIBLE WESTERN OPTIONS IN THE REGION. THE SPANISH FOREIGN
MINISTER WAS REPORTED AS SAYING THAT SECRETARY CHRISTOPHER HAD
PROMISED TO CONSULT WITH THE ALLIES BEFORE MAKING ANY DECISIONS
ON MILITARY ACTION. SOLANA CHARACTERIZED THE RUSSIAN PROPOSAL
TO HOLD A MEETING IN SARAJEVO OF SPANISH, FRENCH, BRITISH,
RUSSIAN, AND AMERICAN REPRESENTATIVES AS "POSITIVE IN
PRINCIPLE," BUT "PERHAPS A LITTLE HASTY."
4. ALL MADRID PAPERS REPORTED, WITH A MIXTURE OF AMUSEMENT AND
ADMIRATION, THAT THE PRESIDENT SURPRISED THE QUEEN BY RECALLING
A PREVIOUS ENCOUNTER BETWEEN THE TWO AT A CONFERENCE IN BADEN
BADEN YEARS AGO. MOST DAILIES NOTED THAT THE FIRST LADY AND
THE QUEEN HELD A SEPARATE DISCUSSION OF MRS. CLINTON'S WORK ON
HEALTH CARE REFORM WHILE THE OTHERS DISCUSSED BOSNIA, THE
Page 1 of2
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l
SECT:
SSN:
TOR:
MIDDLE EAST, AND LATIN AMERICA.
GREENLEE
BT
#5193
NNNN
SECTION: 01 OF 01
5193
930430115210 M0365445
DIST:
SIT: VAX
0
Page 2 of2
�F:\Cable\Data Source\Cables\CD002\MAY93\MSGS\M0380 193 .html
"'
.
Cab 1e
PREC:
IMMEDIATE
UNCLASSIFIED
LINEl: OAAUZYUW RUFHFRA2178 1311031-UUUU--RHEHAAA.
LINE2: ZNR UUUUU ZZH
LINE3: 0 111030Z MAY 93
LINE4: FM AMEMBASSY PARIS
OSRI: RUFHFR
DTG: 111030Z MAY 93
ORIG: AMEMBASSY PARIS
TO: RUEHIA/USIA WASHDC IMMEDIATE 9263
INFO: RUEAIIA/CIA WASHDC
RUEATRS/DEPARTMENT OF TREASURY
RUEKJCS/DIA WASHDC
RUEKJCS/SECDEF WASHDC//ASD/ISA//
RUEHC/SECSTATE WASHDC 5065
RHEHAAA/WHITE HOUSE
RUCPDC/USDOC WASHDC
RUFHOL/AMEMBASSY BONN 3384
RUFHLD/AMEMBASSY LONDON 3983
RUEHRO/AMEMBASSY ROME 2275
RUEHBS/AMEMBASSY BRUSSELS 5266
RUEHMO/AMEMBASSY MOSCOW 3402
RUFHZG/AMEMBASSY ZAGREB 0993
RUFHBE/AMEMBASSY BELGRADE 8055
RUFHNA/USMISSION USNATO IMMEDIATE 0576
RUFHMB/USMISSION USVIENNA 8263
RUFRQJQ/COMSIXTHFLT
SUBJ:
DAILY MEDIA REACTION REPORT
PARIS -- TUESDAY MAY 11, 1993
(A) SUMMARY OF TYPE OF COVERAGE:
THE FRENCH PRESS FOCUSES ON PREMIER BALLADUR'S PLAN FOR
SOCIAL AND ECONOMIC RECOVERY, WHICH HE OUTLINED
CLASS:
TEXT:
UNCLAS SECTION 01 OF 03 PARIS 12178
USIA
USIA FOR P/RC; P/P; P/FW P/FN; VOA NEWS/CA; EU; AF; P/M; ·
STATE FOR EUR/P/SP; EU/WE; AF; INR/P; PM; OSD ISA FOR
ILN; FOR NEA; WHITE HOUSE FOR NSC/WEUROPE; DOC FOR
ITA/EUR/FR AND PASS USTR/PA (PAT NORMAN); USCINCEUR FOR
PAO; NATO FOR USIS; MOSCOW FOR P&C; ROME FOR USIS/AIO;
BRUSSELS FOR USIS AND USEC (PAO); USVIENNA FOR USDEL
CSCE.
E.O. 12356: N/A
TAGS: NONE
SUBJECT: DAILY MEDIA REACTION REPORT
PARIS -- TUESDAY MAY 11, 1993
(A) SUMMARY OF TYPE OF COVERAGE:
THE FRENCH PRESS FOCUSES ON PREMIER BALLADUR'S PLAN FOR
SOCIAL AND ECONOMIC RECOVERY, WHICH HE OUTLINED
YESTERDAY AFTERNOON.
AS TO FOREIGN STORIES, BOSNIA IS STILL IN THE TOP NEWS.
Page 1 of4
�F:\Cable\Data Source\Cables\CD002\MAY93\MSGS\M0380193.html
FOCUS IS ON THE EC FOREIGN MINISTERS' MEETING IN
BRUSSELS YESTERDAY. ALL MEDIA REPORT THAT THE 12
MINISTERS DISCARDED THE MILITARY OPTION OPTING, INSTEAD,
TO RELY ON SERB PRESIDENT MILOSEVIC'S "GOOD WILL" AND
HIS PRESSURE ON BOSNIAN SERBS. LA TRIBUNE REPORTS THAT
"THE TWELVE THUS CONFIRMED THEIR REJECTION OF THE
CLINTON PLAN FOR MILITARY AIR STRIKES". LE MONDE AND LA
CROIX REPORT THAT U.S. OFFICIALS SEM TO "HAVE RESIGNED
THEMSELVES" TO THEIR ALLIES REFUSAL TO ACCEPT THEIR
PLAN.
(SEE PART D OF REPORT).
ON GATT, AGENCE FRANCE PRESSE REPORTS THAT FOREIGN
MINISTER ALAIN JUPPE REAFFIRMED YESTERDAY THAT FRANCE
WANTS A GLOBAL, THEREFORE MULTILATERAL, AND BALANCED
AGREEMENT. SPEAKING IN BRUSSELS IN THE FRAMEWORK OF THE
EC MEETING ON EX-YUGOSLAVIA, THE FRENCH MINISTER SAID
THAT FRANCE HAD FORMULATED ITS POSITION ON GATT AT A
CABINET COUNCIL MEETING EARLIER IN THE AFTERNOON.
DETAILS WILL BE INCLUDED IN A MEMORANDUM ADRESSED TO
FRANCE'S EC. PARTNERS LATER THIS WEEK. "IT SEEMS THAT
FRANCE DOESN'T ACCEPT THE WASHINGTON AGRICULTURAL
COMPROMISE .... FRANCE REJECTS THE OILSEED PART OF THIS
ACCORD", AFP ADDS, QUOTING JUPPE AS SAYING: "THIS ACCORD
IS UNACCEPTABLE IN ITS PRESENT FORM BECAUSE IT CREATES
AN IMBALANCE IN THE AGRICULTURAL SECTOR".
COMPARING THE BALLADUR GOVERNMENT TO ITS PREDECESSOR,
ECONOMIC LES ECHOS SEES A "DIFFERENCE IN THE STYLE, BUT
NOT IN THE SUBSTANCE OF THE FRENCH POSITION ON GATT"
(SEE PART D OF REPORT).
INFLUENTIAL LIBERATION'S WASHINGTON CORRESPONDENT PIERRE
BRIANCON REPORTS FROM WASHINGTON ON "AN OFFENSIVE" IN
THE U.S. MEDIA TO PRESENT HILLARY RODHAM CLINTON AT HER
BEST: "THE (U.S.) FIRST LADY TRIES TO MAKE PEOPLE FORGET
HER ALL TOO OBVIOUS TASTE FOR POWER". THIS OFFENSIVE,
BRIANCON SAYS, IS DUE TO THE IMPENDING ANNOUNCEMENT OF
HER PLAN FOR HEALTH CARE REFORM. "THE AIM IS TO SELL
THE MESSENGER BEFORE THE MESSAGE--THE LATTER PROMISES TO
BE CONTROVERSIAL", BRIANCON REPORTS.
(B) STORIES COVERED IN REPORT:
1. BOSNIA
2. GATT
(C) HEADLINES:
BOSNIA:
"RESIGNATION" (LA CROIX-PAGE 3)
"BILL CLINTON RESiGNS HIMSELF TO THE REJECTION OF HIS
PLAN BY THE EUROPEANS" (LE MONDE-PAGE 3)
"THE TWELVE SAY NO TO WAR" (FRANCE SOIR-PAGE 10)
UNCLAS SECTION 02 OF 03 PARIS 12178
USIA
USIA FOR P/RC; P/P; P/FW P/FN; VOA NEWS/CA; EU; AF; P/M;
STATE FOR EUR/P/SP; EU/WE; AF; INR/P; PM; OSD ISA FOR
ILN; FOR NEA; WHITE HOUSE FOR NSC/WEUROPE; DOC FOR
ITA/EUR/FR AND PASS USTR/PA (PAT NORMAN); USCINCEUR FOR
PAO; NATO FOR USIS; MOSCOW FOR P&C; ROME FOR USIS/AIO;
BRUSSELS FOR USIS AND USEC (PAO); USVIENNA FOR USDEL
CSCE.
E.O. 12356: N/A
TAGS: NONE
SUBJECT: DAILY MEDIA REACTION REPORT
Page 2 of4
�F:\Cable\Data Source\Cables\CD002\MAY93\MSGS\M0380193.html
"THE TWELVE WANT TO 'TEST' MILOSEVIC" (LE FIGARO-PAGE 3)
(D) SUPPORTING TEXT:
1. BOSNIA:
PAUL CAMBON AUTHORS AN EDITORIAL IN RIGHT-OF-CENTER LE
QUOTIDIEN: "ON THE VERY DAY WHEN FRENCH PRIME MINISTER
EDOUARD BALLADUR PRESENTED HIS PLAN FOR·ECONOMIC
RECOVERY IN FRANCE, U.S. PRESIDENT BILL CLINTON STARTED
A THREE-DAY TOUR IN CLEVELAND, CHICAGO AND NEW YORK IN
ORDER TO SHOW THAT HE HAS NOT FORGOTTEN U.S. DOMESTIC
REALITIES, NAMELY THE NEED TO FIGHT UNEMPLOYMENT AND TO
REVIVE THE ECONOMY. THE YUGOSLAV TRADEGY SEEMS TO BE
MOVING BACKSTAGE. THIS IS ALL THE MORE EASY TO DO
SINCE ... DIPLOMATIC COOPERATION BETWEEN THE AMERICANS AND
THEIR ALLIES HAS NOT GONE FURTHER THAN CONSULTATIONS AND
MUTUAL TESTING OF EACH OTHER'S INTENTIONS .... AMERICAN
AND EUROPEAN (LEADERS) ARE NOW ADVANCING TWO MYTHS TO
THEIR PUBLICS: THAT OF THE VANCE-OWEN PLAN--ALTHOUGH IT
HAS OBVIOUSLY FAILED TO STOP THE SERBS, AND THAT OF
VAGUE THEATS OF MILITARY ACTION--WHICH EVERY ONE
BELIEVES WOULD BE FUTILE AS WELL AS VERY RISKY. THIS IS
WHY, AFTER BEING UNABLE TO CLEARLY DEFINE THE LIMITS OF
THE ESCALATION OF THE WAR FOR MORE THAN ONE YEAR, THE
INTERNATIONAL COMMUNITY IS ENGAGED IN AN ENDLESS CYCLE
OF WITHDRAWAL, HUMILIATION, EVEN DENIALS--TO THE EXTENT
THAT (ITS) RHETORIC HAS VIRTUALLY NO CREDIBILITY TODAY."
CATHOLIC LA CROIX WITH BEATRICE TOULON: "STUNNED BUT
RESIGNED. SUCH IS, IN TWO WORDS, THE MOOD WHICH IS NOW
PREVAILING IN THE CLINTON TEAM AFTER WARREN CHRISTOPHER
CAME BACK FROM HIS EUROPEAN TOUR .... IN EIGHT DAYS OF
INTENSE CONSULTATIONS, WARREN CHRISTOPHER UNDERSTOOD
THAT THOSE EUROPEAN GOVERNMENTS WHICH HAVE THE CAPACITY
TO ACT--I.E. FRANCE, BRITAIN AND RUSSIA--HAD OPTED FOR
GETTING ALONG WITH SERBIAN POWER RATHER THAN FOR
DETERRING IT."
HENRI PIERRE REPORTS FROM WASHINGTON IN INFLUENTIAL LE
MONDE: " ... (THERE IS) NO MILITARY FEVER AMONG U.S.
LEADERS, WHO SEEM TO RESIGN THEMSELVES TO THE IDLE TIME
IMPOSED AFTER THE MEAGER RESULTS OF THE CHRISTOPHER
MISSION."
BAUDOUIN BOLLAERT REPORTS FROM BRUSSELS IN CONSERVATIVE
LE FIGARO: " ... ALL MINISTERS UNDERLINED THE NEED FOR
'CLOSE AND FRIENDLY CONSULTATIONS' BETWEEN EUROPE AND
THE UNITED STATES. HOWEVER, MOST OF THEM REJECTED THE
'TOUGH' OPTIONS SET FORWARD BY SOME WHITE HOUSE
ADVISORS--NAMELY LIFTING THE ARMS EMBARGO ON THE MUSLIMS
AND LIMITED AIR STRIKES AGAINST SERBIAN TARGETS."
FINANCIAL LA TRIBUNE ON ITS BACK PAGE: " ... THE 12 EC
FOREIGN MINISTERS CONFIRMED THEIR REJECTION OF THE
CLINTON PLAN FOR AIR STRIKES ... THE TWELVE REMAIN
COMMITTED TO THE 'PEACEFUL STRATEGY' OF THE VANCE-OWEN
PLAN AND DISCARD THE MILITARY OPTIONS FAVORED BY THE
UNITED STATES."
2. GATT:
UNCLAS SECTION 03 OF 03 PARIS 12178
USIA
USIA FOR P/RC; P/P; P/FW P/FN; VOA NEWS/CA; EU; AF; P/M;
STATE FOR EUR/P/SP; EU/WE; AF; INR/P; PM; OSD ISA FOR
UN; FOR NEA; WHITE HOUSE FOR NSC/WEUROPE; DOC FOR
Page 3 of4
�.
F:\Cable\Data Source\Cables\CD002\MAY93\MSGS\M0380193.html
..
SECT:
SSN:
TOR:
ITA/EUR/FR AND PASS USTR/PA (PAT NORMAN); USCINCEUR FOR
PAO; NATO FOR USIS; MOSCOW FOR P&C; ROME FOR USIS/AIO;
BRUSSELS FOR USIS AND USEC (PAO); USVIENNA FOR USDEL
CSCE.
E.O. 12356: N/A
TAGS: NONE
SUBJECT: DAILY MEDIA REACTION REPORT
ECONOMIC LES ECHOS' MARTINE ROYO AND JACQUES DOCQUIERT:
" ... THE POSITION OF THE BALLADUR GOVERNMENT IS NO
DIFFERENT FROM THAT OF THE BEREGOVOY GOVERNMENT ....
THERE IS MORE A DIFFERENCE OF STYLE THAN OF
SUBSTANCE .... IT IS A 'YES, BUT' INSTEAD OF A 'PERHAPS,
BUT'. IN BRUSSELS, ALAIN JUPPE SAID THAT 'THE CLINTON
ADMINISTRATION'S DESIRE FOR REAL CONSULTATIONS WITH THE
TWELVE HAS BEEN CONFIRMED'. THIS CORROBORATES EC
COMMISSION PRESIDENT JACQUES DELORS' DEBRIEFING TO THE
TWELVE ABOUT HIS MEETING WITH BILL CLINTON LATE LAST
WEEK IN WASHINGTON. THE CLIMATE IS NO LONGER THAT OF
WAR. THE NEW U.S. ADMINISTRATION WANTS A GATT ACCORD
AND IT SEEMS TO HAVE UNDERSTOOD THAT, IN ORDER TO GET
IT, IT SHOULD NOT START THE HOSTILITIES." KORENGOLD
BT
#2178
NNNN
SECTION: 01 OF 03
<"SECT>SECTION: 02 OF 03
<"SECT>SECTION: 03 OF 03
2178
<"SSN>2178
<"SSN>2178
930511063421 M0380193
<"TOR>930511063634 M0380199
<"TOR>930511063635 M0380200
DIST:
SIT: VAX
0
Page 4 of4
�.__F:\Cable\Data- Source\Cables\CD003\SEP93\MSGS\M0612861.html
--·~
Cab I e
PREC:
CLASS:
LINEl:
LINE2:
LINE3:
LINE4:
· OSRI:
DTG:
ORIG:
TO:
INFO:
SUBJ:
IMMEDIATE
UNCLASSIFIED
OAAUZYUW RUFHLDA7066 2631229-UUUU--RHEHAAA.
ZNR UUUUU ZZH
0 201225Z SEP 93
FM AMEMBASSY LONDON
RUFHLD
201225Z SEP 93
AMEMBASSY LONDON
RUEHIA/USIA WASHDC IMMEDIATE 8007
RUEAIIA/CIA WASHDC
RUEATRS/DEPTTREAS WASHDC
RUCPDC/USDOC WASHDC
RUEKJCS/DIA WASHDC
RUEKJCS/SECDEF WASHDC
RUEHC/SECSTATE WASHDC 9557
RHEHAAA/WHITEHOUSE WASHDC
RUFHBE/AMEMBASSY BELGRADE 7073
RUFHOL/AMEMBASSY BONN 0739
RUEHBS/AMEMBASSY BRUSSELS 0163
RUFHFR/AMEMBASSY PARIS 5465
RUEHBJ/AMEMBASSY BEIJING 3173
RUEHRO/AMEMBASSY ROME 7651
RUEHKO/AMEMBASSY TOKYO 2123
RUFHZG/AMEMBASSY ZAGREB 3230
RUCNDT/USMISSION USUN NEW YORK 2682
RUFHMB/USMISSION USVIENNA 3690
RUFHNA/USMISSION USNATO 2185
RUSNNOA/USCINCEUR VAIHINGEN
RUDOVFA/3AF RAF MILDENHALL UK
MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
BROADCAST MEDIA
CHINA OLYMPIC BID
ON BBC TV'S BREAKFAST NEWS THIS MORNING, REPORTER BRIAN
TEXT:
UNCLAS SECTION 01 OF 10 LONDON 17066
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C;. R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
Page 1 of 12
�F:\Cable\Data Source\Cables\CD003\SEP93\MSGS\M061286l.html
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
BROADCAST MEDIA
CHINA OLYMPIC BID
ON BBC TV'S BREAKFAST NEWS THIS MORNING, REPORTER BRIAN
BARRON SAID FROM CHINA:
"BEHIND THE MAWKISH VIDEO PROMOTION IS POLITBURO
WILLPOWER. THE QUEST FOR THE 2,000 OLYMPICS IS A MAJOR
FOREIGN POLICY GOAL. SO FAR THE PROMISE OF A MORE OPEN
CHINA IS NOTHING MORE.THAN A PROPAGANDA STATEMENT. THE
RELEASE OF SEVERAL PROMINENT POLITICAL PRISONERS IS A
CLUMSY ATTEMPT TO CARRY SUPPORT AT MONTE CARLO.
BEIJING'S MOST OBVIOUS SHORTCOMINGS, LIKE THE INADEQUATE
AIRPORT, HAVE LED TO AN ADVERSE.IOC TECHNICAL ASSESSMENT.
CHINA'S ANSWER IS TO FORGE AHEAD WITH OLYMPIC-RELATED
CONSTRUCTION.
"PERHAPS THE BEST POLITICAL ARGUMENT FOR BEIJING IS WHAT
HAPPENED AT SEOUL, SOUTH KOREA'S CAPITAL, WHICH HOSTED
THE 1988 GAMES. IN THE LENGTHY RUN-UP TO THOSE OLYMPICSt
THE REPRESSIVE MILITARY REGIME WAS FORCED BY POPULAR
PRESSURE TO MAKE DEMOCRATIC REFORMS. THE OLYMPICS COULD
BE A SIMILAR ENGINE FOR CHANGE FOR CHINA TOO."
A. TODAY'S MAJOR NEWS STORIES
1. WORLD TRADE
2. U.S. POLITICS/ HEALTHCARE REFORMS
3. BOSNIA
4. CHINA OLYMPIC BID
B. SUMMARY
1. WORLD TRADE
THIS HAS ONCE AGAIN COME TO THE FOREFRONT OF THE NEWS
AGENDA. THE LIBERAL GUARDIAN REPORTED:
"FRANTIC DIPLOMATIC EFFORTS WERE UNDER WAY IN BRUSSELS
LAST NIGHT TO AVERT A FRENCH VETO TODAY OF A KEY PILLAR
OF THE GATT WORLD TRADE AGREEMENT -- THE BLAIR HOUSE
ACCORD SLASHING BC FARM TRADE SUBSIDIES. A VETO OF THE
U.S.-EC FARM TRADE AGREEMENT WOULD PRECIPITATE A SPLIT IN
THE EC AND MIGHT TRIGGER THE COLLAPSE OF THE ENTIRE GATT
URUGUAY ROUND TRADE DEAL."
UNCLAS SECTION 02 OF 10 LONDON 17066
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PW
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
2. U.S. POLITICS/ HEALTHCARE REFORMS
Page 2 of 12
�F:\Cable\Data Source\Cables\CD003\SEP93\MSGS\M0612861.html
ALL OF THE SERIOUS PAPERS TODAY PREVIEW THIS WEEK'S
ANNOUNCEMENT BY PRESIDENT CLINTON ON HEALTHCARE, LOOKING
AT THE LIKELY CHANGES AND THEIR CHANCES OF BECOMING LAW.
PAPERS AGREE THAT THERE IS A MUCH WIDER POLITICAL
CONSENSUS ON HEALTHCARE REFORM THAN FOR, SAY, THE
PRESIDENTIAL BUDGET CHANGES. HOWEVER, COMMENTATORS ALSO
STRESS THE SCALE AND RADICAL NATURE OF THE REFOB.M,
CALLING IT A 'GAMBLE' FOR THE PRESIDENT AND THE COUNTRY.
THE INDEPENDENT FINANCIAL TIMES EXPLAINED TO ITS READERS:
"THE BEST WAY FOR NON-AMERICANS TO UNDERSTAND WHY REFORM
HAS BECOME A POLITICAL IMPERATIVE IS TO IMAGINE WHAT THE
HEALTH SYSTEM IN THE UK, SAY, MIGHT LOOK LIKE IF THE
NATIONAL HEALTH SERVICE HAD NOT BEEN CREATED IN THE LATE
1940S."
3. BOSNIA
THE LIBERAL GUARDIAN EDITORIALIZED:
"MORE NEW INITIATIVES, MORE NEW IDEAS, ARE URGENTLY
NEEDED. BOSNIA WILL SOON BE BACK ON OUR FRONT PAGES AND
THE WINTER IS LESS THAN A MONTH AWAY. "
4. CHINA OLYMPIC BID
THE INDEPENDENT FINANCIAL TIMES EDITORIALIZED:
"TRADE SANCTIONS ARE NOT AN APPROPRIATE WAY TO ADVANCE
THE CAUSE OF HUMAN RIGHTS IN CHINA. BUT TO COMMIT THE
WORLD TO HOLDING ITS TOP SPORTING EVENT IN BEIJING IN
SEVEN YEARS WOULD AMOUNT TO A VOTE OF CONFIDENCE IN
CHINA'S RULERS WHICH THEY CANNOT BE SAID TO HAVE EARNED .
... BEIJING SHOULD BE TOLD THAT IT CAN STAGE THE GAMES
ONLY WHEN ITS OWN PEOPLE ARE AT LIBERTY TO ENJOY THEM."
C. HEADLINES
1. WORLD TRADE
"PARIS THREATENS TO VETO GATT DEAL" (GUARDIAN REPORT)
"FRENCH BRINKMANSHIP THREAT TO GATT" (GUARDIAN REPORT)
"BALLADUR STANDS HIS GROUND AGAINST CUT IN FARM
SUBSIDIES" (INDEPENDENT FRONT PAGE REPORT)
"MAJOR TELLS FRANCE TO BACK DOWN OVER WORLD TRADE TALKS"
(TIMES REPORT)
UNCLAS SECTION 03 OF 10 LONDON 17066
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
2. U.S. POLITICS/ HEALTHCARE REFORMS
"POLITICAL IMPERATIVE TO END COSTLY HODGE-PODGE" (F.T.
COMMENTARY)
"CONGRESSIONAL ADVERSARIES FIND COMMON GROUND IN PLAN"
Page 3 of 12
�F:\Cable\Data Source\Cables\CD003\SEP93\MSGS\M0612861.html
(F.T. COMMENTARY)
"CLINTONS GAMBLE ON THE NATION'S HEALTH" (DAILY TELEGRAPH
COMMENTARY)
"CLINTON TO FULFIL HEALTH PLEDGE" (INDEPENDENT REPORT)
"CLINTON GAMBLES ON UTOPIAN DESIGNER'S HEALTH REFORMS"
(TIMES REPORT)
"BACK FROM THE WILDERNESS" (GUARDIAN PROFILE, CARTER)
3. BOSNIA
"BOSNIA AND THE 'PROBLEM' OF PEACE" (GUARDIAN EDITORIAL)
4. CHINA OLYMPIC BID
"SITING THE GAMES" (F.T. EDITORIAL)
D. TEXT
1. WORLD TRADE
THE LIBERAL GUARDIAN COMMENTED:
"FOREIGN AND FARM MINISTERS FROM THE 12 EC COUNTRIES
GATHER IN BRUSSELS TODAY, IN A MEETING WHICH COULD MAKE
OR BREAK THE SEVEN YEAR OLD TALKS TAKING PLACE UNDER THE
AUSPICES OF THE GATT.
"THERE CAN BE NO DOUBT OF THE IMPORTANCE OF DECISIONS
TAKEN TODAY: INSIDERS SAY IF THE COMMISSION CAN RESIST
FRENCH PRESSURE, THE GATT PROCESS WILL BE GALVANIZED AND
A FINAL AGREEMENT BY DECEMBER 15 WILL LOOK VERY LIKELY ;
IF THE FRENCH PERSUADE THE EC TO ATTEMPT TO RENEGOTIATE
THE BLAIR HOUSE DEAL, OR EVEN TO ASK FOR ANYTHING MORE
THAN COSMETIC CONCESSIONS FROM THE U.S., THE LIKELY
HOSTILE REACTION FROM THE U.S. WOULD FREEZE THE GATT
PROCESS AND BLOW THE WORLD'S CHANCES OF A FREE TRADE
AGREEMENT.
"THE HOPE IS THAT THE BALLADUR GOVERNMENT, WHILE MAKING
THE RIGHT NOISES TO PLACATE THE MILITANT FRENCH FARMING
LOBBY, WILL SETTLE FOR SOME FORMULA WHICH ALLOWS BOTH
SIDES TO CLAIM THE VICTORY WHILE LEAVING THE SUBSTANCE OF
UNCLAS SECTION 04 OF 10 LONDON 17066
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
BLAIR HOUSE UNCHANGED.
"BUT THE FEAR IS THAT THE FRENCH WILL GO TOO FAR WITH
THEIR BRINKMANSHIP -- THE RIGHT WORD FOR FRANCE'S
BEHAVIOR, MANY BELIEVE -- AND PUT THE CHANCES OF A WORLD
TRADE DEAL BACK ANOTHER SEVEN YEARS."
THE CENTRIST INDEPENDENT REPORTED ON ITS FRONT PAGE:
"THE FRENCH GOVERNMENT WAS TOLD TODAY BY JOHN MAJOR THAT
IT WOULD BE 'WRONG AND DANGEROUS' TO BLOCK A WORLD TRADE
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�F:\Cable\Data Source\Cables\CD003\SEP93\MSGS\M0612861.html
AGREEMENT. THE PRIME MINISTER, ADDRESSING JAPANESE
BUSINESSMEN IN TOKYO, ALSO WARNED FRANCE THAT IT COULD
THREATEN PROGRESS ON THE MAASTRICHT TREATY.
"BRITISH OFFICIALS SAID THE U.S. COULD REIMPOSE DUTIES ON
FRENCH GOODS, SUCH AS WINE, WHICH WERE THREATENED WHEN
GATT TALKS LAST BROKE DOWN, IF THE FRENCH REFUSED TO CUT
SUBSIDIES ON FARM EXPORTS. MR BALLADUR SHOWED NO SIGNS
OF BACKING DOWN . . . . MR MAJOR LAST NIGHT DENIED BRITAIN
WOULD BE SEEKING TO GIVE FRANCE A 'BLOODY NOSE' AT A
MEETING, DUBBED 'LE JUMBO' TODAY IN BRUSSELS.
'WHAT I
WANT TO HAPPEN IN THE MEETING IS FOR THE COMMISSION TO
HAVE AN UNFETTERED RIGHT TO CONTINUE THE NEGOTIATIONS.
WE ARE RUNNING OUT OF TIME. I KNOW SOME PEOPLE ARE
SAYING THAT THE DEADLINE IS NOT A REAL DEADLINE AND IT
CAN BE EXTENDED, BUT FRANKLY I DOUBT THAT VERY MUCH.'"
THE CONSERVATIVE TIMES REPORTED:
"JOHN MAJOR IS THREATENING TO BRING THE EC TO A VIRTUAL
HALT IF FRANCE DOES NOT ACCEPT A GATT DEAL ON WORLD
TRADE. THE PRIME MINISTER WILL BLOCK NEW INITIATIVES
FROM BRUSSELS IN AREAS SUCH AS SOCIAL AND ENVIRONMENTAL
POLICY UNLESS PARIS DROPS ITS DEMAND FOR A RENEGOTIATION
OF AN EC-U.S. DEAL ON AGRICULTURE SUBSIDIES AND ACCESS TO
MARKETS. THE TOUGH LINE SHOULD ALSO HELP HIM IN HIS
EFFORTS TO CALM REBELLIOUS TORY MPS.
"BRITAIN'S DIPLOMATIC OFFENSIVE INSIDE THE EC WOULD BE
BACKED UP BY DIRECT RETALIATION BY AMERICAN AND JAPAN, MR
MAJOR BELIEVES. SELECTED FRENCH EXPORTS WOULD BE THE
TARGET OF PUNITIVE TARIFFS AS THE WORLD SLID INTO A TRADE
WAR. THE THREAT OF BRITISH OBSTRUCTION INSIDE THE EC
EMERGED AS THE PRIME MINISTER PREPARED FOR A MEETING
TODAY WITH MORIHIRO HOSOKAWA, THE JAPANESE PRIME
MINISTER, TO DISCUSS THE GATT DEADLOCK. IT ALSO CAME ON
THE EVE OF TODAY'S 'JUMBO' MEETING OF EC FOREIGN,
FINANCE AND TRADE MINISTERS IN BRUSSELS THAT IS SEEN AS
CRITICAL IN RESOLVING THE DISPUTE."
2. U.S. POLITICS/ HEALTHCARE REFORMS
UNCLAS SECTION 05 OF 10 LONDON 17066
USIA
"PERI~HABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
THE INDEPENDENT FINANCIAL TIMES COMMENTED:
"THE DEBATE OVER HEALTHCARE REFORM HAS CARRIED NONE OF
THE POLITICAL SAVAGERY THAT ACCOMPANIED THE BATTLE OVER
PRESIDENT BILL CLINTON'S BUDGET. U.S. POLITICIANS ON ALL
Page 5 of 12
�-
F:\Cable\Data Source\Cables\CD003\SEP93\MSGS\M0612861.html
SIDES HAVE EXPRESSED RESPECT FOR THE EFFORTS IT PUT IN ON
THE ISSUE AND HAVE DECLARED THEIR WILLINGNESS TO WORK
TOGETHER TO CRAFT A BIPARTISAN REFORM . . . . THIS
GENTLEMANLINESS REFLECTS, IN PART, A GROWING CONSENSUS
THAT THE U.S. HEALTH SYSTEM MUST BE REFORMED -- A VIEW
THAT, JUST TWO YEARS AGO, WAS HELD BY ONLY A HANDFUL IN
WASHINGTON, MOSTLY BUDGET SPECIALISTS WHO SAW THE LONGTERM EFFECTS OF MEDICAL INFLATION ON THE GOVERNMENT
DEFICIT.
"BUT IT ALSO REVEALS A FEELING OF VULNERABILITY AND
UNCERTAINTY THROUGHOUT THE POLITICAL SPECTRUM. IT IS
EASY TO SUPPORT HEALTHCARE REFORM -- ALONG WITH MORE THAN
THREE QUARTERS OF THE POPULATION -- BUT LESS EASY TO
DETERMINE THE POLITICAL PLUSES AND MINUSES OF SPECIFIC
ELEMENTS OF HEALTHCARE POLICY.
"CONGRESSIONAL LEADERS HAVE BEGUN TO TAKE HEART AT THE
SIGHT OF SO MUCH POTENTIAL COMMON GROUND. NO ONE
RELISHES PASSING SUCH A FUNDAMENTAL REFORM BY THE SINGLEVOTE MARGINS WITH WHICH MR CLINTON PREVAILED ON HIS
BUDGET. BUT THE TASK MAY GROW HARDER AS NEXT YEAR'S
CONGRESSIONAL ELECTIONS GET CLOSER. THE WHITE HOUSE
PLANS TO SEND THE LEGISLATIVE LANGUAGE FOR ITS PROPOSAL
TO CONGRESS IN THE FIRST WEEK OF OCTOBER, AND HOPES IT
MAY PASS EARLY NEXT YEAR, BY SPRING AT THE LATEST. SOME
MEMBERS BELIEVE IT MAY TAKE LONGER THAN THAT."
THE CONSERVATIVE DAILY TELEGRAPH COMMENTED:
"WHEN PRESIDENT CLINTON CAME TO THE POINT IN JANUARY WHEN
HE HAD TO HONOR A CAMPAIGN PLEDGE TO UNTANGLE THE MULTI
BILLION DOLLAR MESS THAT IS THE AMERICAN HEALTH CARE
INDUSTRY, HE DECIDED IT WAS SUCH A MASSIVE UNDERTAKING
THAT IT COULD BE ENTRUSTED TO ONLY ONE PERSON, HIS WIFE.
"FEMINISTS CHEERED AND TRADITIONALISTS GROANED WHEN MRS
HILLARY CLINTON STEPPED FORWARD TO TAKE COMMAND OF THE
TASK FORCE ON REFORM. SHE WAS .NOT TO BE A CONVENTIONAL
FIRST LADY. MRS CLINTON ACKNOWLEDGED AT THE TIME THAT
SHE KNEW LITTLE ABOUT MEDICINE OR HEALTH ADMINISTRATION.
"SHE GAVE SPEECH AFTER SPEECH, REASSURING DOCTORS THAT
THEY WOULD NOT LOSE STATUS OR TOO MUCH INCOME UNDER THE
UNCLAS SECTION 06 OF 10 LONDON 17066
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
REFORMS SHE WAS CONSIDERING. THEN SHE WENT TO CAPITOL
Page 6 of12
�F:\Cable\Data_Source\Cables\CD003\SEP93\MSGS\M0612861.html
HILL, AN EXPLOSION OF ENERGY IN HER WASHINGTON POWER
SUIT, TO FLATTER, THEN BULLY, THE CONGRESSIONAL
LEADERSHIP. MRS CLINTON IS NOT AFRAID TO EXPLOIT HER
REPUTATION AS A TOUGH CUSTOMER WITH A SAVAGE TONGUE.
MOST MEN ARE TERRIFIED OF HER, BUT MOST PEOPLE WHO MEET
HER IN PERSON ARE SURPRISED BY HER CHARM. IT IS A POTENT
COMBINATION.
"AMERICA'S TELEVISION SCREENS ARE ALREADY SWAMPED BY
ADVERTISEMENTS DENOUNCING THE PLAN IN SUBTLE AND NOT SO
SUBTLE TERMS. THE IMPLIED MESSAGE IS : WATCH OUT, THE
CLINTONS ARE BAD FOR YOUR HEALTH. THE PROBLEM THE
CLINTONS HAVE IS THAT, THOUGH AMERICANS DO WORRY ABOUT
THE OVERALL SYSTEM, HEALTH CARE IN THE U.S. IS
EXCEPTIONALLY GOOD, IF YOU ARE WELL INSURED AND CAN
AFFORD THE BEST. MANY AMERICANS LACK A PERSONAL MOTIVE
FOR WANTING TO SEE RADICAL CHANGE.
"THE PLAN WILL INEVITABLY BE REVISED BETWEEN THE MOMENT
MR CLINTON FORMALLY UNVEILS IT ON WEDNESDAY NIGHT AND
WHEN IT FINALLY PASSES CONGRESS. BUT IT IS EQUALLY CLEAR
NOW THAT SOME FORM OF FUNDAMENTAL REFORM WILL BE ENACTED.
A REPUBLICAN COUNTER-PROPOSAL ANNOUNCED LAST WEEK WAS IN
MANY RESPECTS SIMILAR TO THE CLINTON PLAN. WHATEVER THE
SHORT-COMINGS OF THEIR PLAN, THE CLINTONS HAVE BEEN
SUCCESSFUL IN CREATING A POLITICAL CONSENSUS IN FAVOR OF
RADICAL CHANGE."
THE CENTRIST INDEPENDENT COMMENTED:
"ONE PROMISE, AT LEAST, BILL CLINTON IS KEEPING.
'I
PLEDGE THAT IN THE FIRST YEAR OF MY ADMINISTRATION,' HE
TOLD HUNDREDS OF CHEERING SUPPORTERS IN OCTOBER 1991 AS
HE ANNOUNCED HIS CANDIDACY FROM THE STEPS OF THE OLD
STATE HOUSE IN LITTLE ROCK, ' WE WILL PRESENT A PLAN TO
CONGRESS AND THE AMERICAN PEOPLE TO PROVIDE AFFORDABLE,
,QUALITY HEALTH CARE FOR ALL.' THIS WEDNESDAY, HE IS
DOING PRECISELY THAT.
"THE SETTING IS WORTHY OF THE TASK. TO A SPECIALLY
CONVENED JOINT SESSION OF CONGRESS, THAT MOST SOLEMN
OCCASION OF AMERICAN PUBLIC LIFE, THE 42ND PRESIDENT WILL
UNVEIL THE MOST MOMENTOUS SOCIAL INITIATIVE SINCE LYNDON
JOHNSON'S GREAT SOCIETY-- SOME SAY SINCE ROOSEVELT'S NEW
DEAL IN THE 1930S ; A REFORM THAT WILL BRING THE U.S. IN
LINE WITH EVERY OTHER ADVANCED INDUSTRIAL COUNTRY AND
GUARANTEE HEALTH COVERAGE FOR EVERY CITIZEN.
"THE VENTURE IS COLOSSAL. AT A MOMENT WHEN FAITH IN
GOVERNMENT HAS NEVER BEEN LOWER, HE IS PROPOSING
UNCLAS SECTION 07 OF 10 LONDON 17066
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA.
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
Page 7 of 12
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RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
GOVERNMENT INTERVENTION TO OVERHAUL FROM TOP TO BOTTOM AN
INDUSTRY THAT CONSUMED 15 CENTS OF EVERY DOLLAR OF WEALTH
CREATED IN THE U.S. EVERY INDIVIDUAL AND EVERY COMPANY
WILL BE AFFECTED. SUCCESS WILL ASSURE'MR CLINTON'S PLACE
IN HISTORY. FAILURE WOULD DEAL THE NATIONAL ECONOMY, A
DISCREDITED CONGRESS AND HIS OWN PRESIDENCY, IMMEASURABLE
BLOWS.
"HARRY TRUMAN, RICHARD NIXON, JIMMY CARTER, EVEN (HALF
HEARTEDLY) GEORGE BUSH TRIED TO TACKLE IT. NEVER THOUGH
HAVE THE STARS BEEN AS FAVORABLY SET. BIG BUSINESS,
ORDINARY WORKERS, NOT TO MENTION THE UNINSURED, ALL SEEK
CHANGE. DESPITE TODAY'S RUMBLES OF THUNDER, THE ODDS ARE
THAT SOME FORM OF THE CLINTON PACKAGE WILL BE VOTED INTO
LAW SOMETIME NEXT YEAR.
"MAYBE, AS CRITICS CHARGE, IT WOULD SIMPLY 'REPLACE ONE
MESS WITH ANOTHER'. IN ESSENCE, THROUGH, THE SYSTEM IS
BEING GIVEN ONE LAST CHANCE AT SURVIVAL BY ADJUSTMENT.
IF NOT, INEXORABLE ECONOMIC AND SOCIAL PRESSURES WILL
FORCE MORE RADICAL THERAPY : EITHER A CANADIAN SINGLEPAYER SYSTEM OR A MULTI-PAYER SYSTEM WITH RIGID
GOVERNMENT CONTROLS ALONG GERMAN LINES."
THE CONSERVATIVE TIMES COMMENTED:
"THIS IS THE WEEK THAT WILL SEE THE UNVEILING OF A
CENTERPIECE OF THE CLINTON PRESIDENCY, THE CULMINATION OF
EIGHT MONTHS' WORK BY HILLARY CLINTON DESIGNED TO SHAKE
UP THE AMERICAN HEALTH CARE SYSTEM. IT IS ALSO THE
BIGGEST WEEK IN THE LIFE OF A LESS HIGH-PROFILE FIGURE
THAN THE DAZZLING FIRST LADY : IRA MAGAZINER, AN
UNSHAKABLE IDEALIST AND VISIONARY WHO HAS DEVOTED MOST OF
HIS 45 YEARS TO TRYING TO IMPROVE THE HUMAN LOT.
"HE HAS STRIPPED THE HEALTH CARE SYSTEM DOWN TO ITS NUTS
AND BOLTS AND REASSEMBLED THE PARTS INTO THE UTTERLY
DIFFERENT CREATURE THAT MR CLINTON WILL UNVEIL FORMALLY
ON WEDNESDAY. MRS CLINTON IS THE PLAN'S MIDWIFE, CHARGED
WITH EASING ITS POLITICAL PASSAGE AND PRESENTING IT TO
THE WORLD, BUT IT IS UNQUESTIONABLY MR MAGAZINER'S BABY.
"MR MAGAZINER CAN NEVER BE ACCUSED OF THINKING SMALL. IF
IMPLEMENTED, HIS PLAN WILL AFFECT DIRECTLY EVERY AMERICAN
AND REPRESENT THE BIGGEST SOCIAL CHANGE SINCE FRANKLIN
ROOSEVELT'S NEW DEAL. IT IS SO COMPLEX AND RADICAL THAT
IT HAS ACHIEVED THE RARE FEAT IN WASHINGTON OF RENDERING
POTENTIAL ENEMIES ALMOST SPEECHLESS. IT IS THE WORK OF A
BRILLIANT THEORETICIAN, BUT WHETHER IT WILL WORK IS
ANYBODY'S GUESS. ESSENTIALLY, WHAT MR CLINTON WILL BE
ASKING AMERICA TO DO IS TAKE A HUGE GAMBLE ON A PLAN THAT
ONE CONGRESSMAN DESCRIBED AS A 'BEAUTIFUL ANIMAL IN
FAIRYLAND, BUT UNSEEN ON EARTH.'"
UNCLAS SECTION 08 OF 10 LONDON 17066
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); 8/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
Page 8 of12
�F:\Cable\Data Source\Cables\CD003\SEP93\MSGS\M0612861.html
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
THE LIBERAL GUARDIAN PROFILED FORMER PRESIDENT JIMMY
CARTER:
"AS THE MAN WHO ALWAYS MAINTAINED THAT 'TRUST' WAS THE
FUNDAMENTAL MEASURE OF ANY PRESIDENCY, CARTER IS RIGHT
BACK IN FASHION -- GIVEN THAT THE REPUBLICANS WHO
SUCCEEDED HIM ARE NOW PERCEIVED TO HAVE ALMOST RUINED THE
COUNTRY THROUGH THE DEFNCIT-FINANCED SPENDING SPREES AND
CORPORATE VANDALISM OF THE 1980S. BUT MOST SURPRISINGLY
OF ALL, CARTER'S ONCE VILIFIED RECORD AS 39TH PRESIDENT
OF THE UNITED STATES IS GAINING RESPECT. AMONG A
STRENGTHENING BAND OF HISTORIANS AND PRESIDENTIAL
BIOGRAPHERS, HE IS NOW VIEWED AS THE MOST FAR SIGHTED OF
AMERICA'S RECENT LEADERS.
"CARTER'S POLICY AGENDA LOOKED, IN FACT, VERY MUCH LIKE
BILL CLINTON'S DOES NOW. HE INITIATED GROUND-BREAKING
ENVIRONMENTAL AND CONSERVATION POLICIES. HE TRIED TO
REIN IN HOSPITAL COSTS ; AND STRONGLY SUPPORTED MEASURES
TO ENHANCE THE RIGHTS OF WOMEN AND MINORITIES.
"AS PRESIDENT, HE RAILED AGAINST GOVERNMENT WASTE AND
INEFFICIENCY. BUT IN CONTRAST TO JACK KENNEDY AND LYNDON
JOHNSON, HIS ANTI-POVERTY PROGRAMS STRESSED FISCAL
RESPONSIBILITY. ABORAD, CARTER MADE HUMAN RIGHTS AND
SUPPORT FOR DEMOCRACY A CENTRAL TENET OF HIS POLICY.
"JUST AS CLINTON NOW SEEKS ANTI-PROLIFERATION CONTROLS,
CARTER SOUGHT, UNSUCCESSFULLY AS IT HAPPENED, TO SLOW THE
COLD WAR ARMS RACE.
HIS BIGGEST CRISIS -- WITH IRAN IN
1980 -- WAS PRECIPITATED, TYPICALLY, BY A HUMANITARIAN
GESTURE : HE ALLOWED THE EXILED AND DYING SHAH TO SEEK
MEDICAL TREATMENT IN THE U.S.
"LAST TUESDAY MARKED THE HIGH POINT OF ONE OF THE LONGEST
COMEBACKS IN HISTORY. YET IN A FUNDAMENTAL SENSE, CARTER
IS STILL -BOTH TOO GOOD AND TOO AND FOR THE CLINTON ERA IN
WHICH PROMISES DON'T COUNT BUT WINNING DOES."
3. BOSNIA
THE LIBERAL GUARDIAN EDITORIALIZED:
"BOSNIA MAY GET A PEACE AGREEMENT SIGNED IN SARAJEVO
TOMORROW, IN A LAST DESPERATE EFFORT TO STOP THE WAR. OR
IT MAY NOT. EITHER WAY THIS IS NOT GOING TO STUN THE
WORLD. THERE HAVE BEEN TOO MANY NEGOTIATIONS, TOO MANY
AGREEMENTS, AND NOW THE POLE POSITION WHICH BOSNIA USED
TO OCCUPY HAS BEEN SEIZED BY YASSER ARAFAT AND YITZHAK
RABIN.
UNCLAS SECTION 09 OF 10 LONDON 17066
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
Page 9 of12
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Page 10 of 12
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
·SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
"MR IZETBEGOVIC'S GOVERNMENT MAY STILL HAVE TO SETTLE IN
THE END UNDER BRUTAL AND UNSUBTLE PRESSURE. AS ONE
OFFICIAL CLOSE TO THE TALKS PUTS IT, 'THERE'S BEEN AN
ACKNOWLEDGEMENT OF THE NEED FOR SPEED, TO GET A
SETTLEMENT QUICKLY ... BEFORE WINTER.' DECODED, THIS
MEANS : BEFORE THOUSANDS MORE BOSNIANS FREEZE TO DEATH.
MR IZETBEGOVIC'S HOPES OF A MORE ASSERTIVE U.S. POSITION
APPEAR TO HAVE BEEN DASHED. THIS WEEKEND. THE U.S. MEDIA
WAS ENUMERATING MR CLINTON'S DOMESTIC PREOCCUPATIONS
PLUS THE NEGATIVE FALLOUT FROM SOMALIA -- WHICH MADE HIM
WARY OF AN OPEN-ENDED ENTANGLEMENT IN BOSNIA.
"A COALITION OF SARAJEVO CIVILIANS HAS NOW LAUNCHED A
CAMPAIGN TO ESTABLISH A UN PROTECTORATE OVER THE CITY,
AND FOR A SIMILAR EC ADMINISTRATION IN MOSTAR. THE IDEA
WOULD TRANSLATE AT LEAST A SMALL BIT OF THE UN
RESOLUTIONS INTO REALITY. IT SHOULD NOT HAVE TO WAIT FOR
A WIDER AGREEMENT. MORE NEW INITIATIVES, MORE NEW IDEAS,
ARE URGENTLY NEEDED. BOSNIA WILL SOON BE BACK ON OUR
FRONT PAGES AND THE WINTER IS LESS THAN A MONTH AWAY.
MEANWHILE IN EAST MOSTAR, REUTERS REPORTED YESTERDAY, THE
LAST UNDERTAKER IN THE MUSLIM QUARTER HAS JUST BEEN
KILLED."
4. CHINA OLYMPIC BID
THE INDEPENDENT FINANCIAL TIMES EDITORIALIZED:
"IT WOULD SURELY BE IMPRUDENT, .AS WELL AS UNJUST, TO LET
MEMORIES OF 1936 COUNT AGAINST BERLIN WHILE GIVING
BEIJING THE BENEFIT OF THE DOUBT. IF 1936 LOOMS LARGE IN
BERLIN'S CASE, IT IS BECAUSE A MINORITY OF THE CITY'S OWN
INHABITANTS IS DEEPLY TROUBLED BY THOSE MEMORIES, AND IS
FREE TO DRAW ATTENTION TO THEM. THE MEMORY OF WHAT
HAPPENED IN BEIJING IN 1989 -- THE TIANENMEN SQUARE
MASSACRE -- MAY NOT HAVE BEEN DRAWN SO DIRECTLY TO THE
IOC'S ATTENTION, BUT IT SHOULD BE MUCH FRESHER.
"NO DOUBT THINGS HAVE IMPROVED IN CHINA SINCE THEN, AND
WITH LUCK BY 2000 THEY WILL HAVE IMPROVED EVEN MORE. BUT
WHO CAN POSSIBLY TELL? THE IOC SHOULD NOT RISK
INFLICTING ON THE WORLD ANOTHER DRAMA LIKE THAT OF MEXICO
IN 1968, WHEN THE GAMES WERE HELD IN A CITY FROM WHICH
THE BLOOD OF HUNDREDS OF STUDENT RIOTERS HAD SCARCELY
BEEN CLEANED ; NOR YET ANOTHER DILEMMA LIKE THAT OF
MOSCOW IN 1980, WHEN THOSE WHO COMPETED, IN DEFIANCE OF A
U.S.-LED BOYCOTT, FOUND THEMSELVES IMPLICITLY CONDONING
THE SOVIET INVASION OF AFGHANISTAN.
"TRADE SANCTIONS ARE NOT AN APPROPRIATE WAY TO ADVANCE
THE CAUSE OF HUMAN RIGHTS IN CHINA. BUT TO COMMIT THE
____
/
�F:\Cable\Data Source\Cables\CD003\SEP93\MSGS\M0612861.html
SECT:
SSN:
TOR:
UNCLAS SECTION 10 OF 10 LONDON 17066
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; RC; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
WORLD TO HOLDING ITS TOP SPORTING EVENT IN BEIJING IN
SEVEN YEARS WOULD AMOUNT TO A VOTE OF CONFIDENCE IN
CHINA'S RULERS WHICH THEY CANNOT BE SAID TO HAVE EARNED.
THE CHINESE AUTHORITIES HAVE IN RECENT WEEKS SOUGHT TO
BOOST THEIR CHANCES BY TAKING STEPS TO IMPROVE THEIR
IMAGE ON HUMAN RIGHTS. BUT THEY HAVE ALSO CORRALLED
THEIR CITIZENS INTO ASSISTING THEIR BID IN TYPICALLY
REPRESSIVE FASHION, AND WOULD ALMOST CERTAINLY DO
LIKEWISE DURING THE EVENT ITSELF. BEIJING SHOULD BE TOLD
THAT IT CAN STAGE THE GAMES ONLY WHEN ITS OWN PEOPLE ARE
AT LIBERTY TO ENJOY THEM." O'BRIEN
BT
#7066
NNNN
SECTION: 01 OF 10
<"SECT>SECTION: 02 OF 10
<"SECT>SECTION: 03 OF 10
<"SECT>SECTION: 04 OF 10
<"SECT>SECTION: 05 OF 10
<"SECT>SECTION: 06 OF 10
<"SECT>SECTION: 07 OF 10
<"SECT>SECTION: 08 OF 10
<"SECT>SECTION: 09 OF 10
<"SECT>SECTION: 10 OF 10
7066
<"SSN>7066
<"SSN>7066
<"SSN>7066
<"SSN>7066
<"SSN>7066
<"SSN>7066
<"SSN>7066
<"SSN>7066
<"SSN>7066
930920083138 M0612861
<"TOR>930920083239 M0612862
<"TOR>930920083240 M0612863
<"TOR>930920083343 M0612865
<"TOR>930920083444 M0612866
<"TOR>930920085053 M0612911
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<ATOR>930920085155
<ATOR>930920083648
<ATOR>930920083752
<ATOR>930920083900
DIST:
SIT: VAX
D
M0612912
M0612869
M0612872
M0612875
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�-
-
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Cab 1e
PREC:
CLASS:
LINEl:
LINE2:
LINE3:
LINE4:
OSRI:
DTG:
ORIG:
TO:
INFO:
SUBJ:
IMMEDIATE
UNCLASSIFIED
OAAUZYUW RUFHLDA7714 2721134-UUUU--RHEHAAA.
ZNR UUUUU ZZH
0 291133Z SEP 93
FM AMEMBASSY LONDON
RUFHLD
2 91133Z SEP 93
AMEMBASSY LONDON
RUEHIA/USIA WASHDC IMMEDIATE 8109
RUEAIIA/CIA WASHDC
RUEATRS/DEPTTREAS WASHDC
RUCPDC/USDOC WASHDC
RUEKJCS/DIA WASHDC
RUEKJCS/SECDEF WASHDC
RUEHC/SECSTATE WASHDC 0134
RHEHAAA/WHITEHOUSE WASHDC
RUFHBE/AMEMBASSY BELGRADE 7139
RUFHOL/AMEMBASSY BONN 0867
RUEHBS/AMEMBASSY BRUSSELS 0250
RUEHME/AMEMBASSY MEXICO 4900
RUEHMO/AMEMBASSY MOSCOW 3106
RUEHNR/AMEMBASSY NAIROBI 0216
RUEHOT/AMEMBASSY OTTAWA 8760
RUFHFR/AMEMBASSY PARIS 5607
RUEHRO/AMEMBASSY ROME 7765
RUEHSI/AMEMBASSY TBILISI 0161
RUFHZG/AMEMBASSY ZAGREB 3304
RUCNDT/USMISSION USUN NEW YORK 2780
RUFHMB/USMISSION USVIENNA 3777
RUFHNA/USMISSION USNATO 2271
RUSNNOA/USCINCEUR VAIHINGEN
RUDOVFA/3AF RAF MILDENHALL UK
MEDIA REACTION REPORT, LONDON, WEDNESDAY
SEPTEMBER 29 1993
TEXT:
-
UNCLAS SECTION 01 OF 10 LONDON 17714
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
�F:\Cable\Data Source\Cables\CD003\SEP93\MSGS\M0631256.html
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, WEDNESDAY
SEPTEMBER 29 1993
A. TODAY'S MAJOR NEWS STORIES
1. U.S. FOREIGN POLICY
2. U.S. HEALTHCARE REFORM
3. WORLD TRADE
4. FORMER SOVIET UNION
5. SOMALIA
B. SUMMARY
1. U.S. FOREIGN POLICY
TWO CRITIQUES THIS MORNING OF PRESIDENT CLINTON'S UN
SPEECH, IN THE LIBERAL GUARDIAN AND THE CONSERVATIVE
TIMES. THE GUARDIAN PIECE WAS PARTICULARLY HARD-HITTING,
ALLEGING THAT CURRENT U.S. PEACEKEEPING INVOLVEMENTS
COULD BE THE LAST, AND THAT WHAT IT SAW AS THE U.S.'S
GROWING UNWILLINGNESS TO COMMIT PEACEKEEPING TROOPS WAS
ACTIVELY WORKING AGAINST EMERGING DEMOCRACY THROUGHOUT
THE WORLD. SEE TEXT BELOW.
2. U.S. HEALTHCARE REFORM
THE FIRST LADY TODAY GETS RAVE REVIEWS FOR HER APPEARANCE
BEFORE CONGRESS THAT POLITICIANS CAN ONLY DREAM OF.
REPORTERS APPEARED TO BE AS BOWLED OVER BY HER AS THEY
CLAIM THE CONGRESSMEN WERE. THE LIBERAL GUARDIAN
COMMENTED: "IT WAS LIKE BARBARA BUSH WITH A PHD."
3. WORLD TRADE
THE INDEPENDENT FINANCIAL TIMES EDITORIALIZED:
"IF REFUSAL TO ACCEPT WHAT HAS BEEN AGREED AT BLAIR HOUSE
DESTROYS THE ROUND, THE EC WILL BE UNIVERSALLY BLAMED FOR
THE CATASTROPHE. THE OUTCOME WILL NOT BE A WORLD DIVIDED
INTO SEVERAL TRADING BLOCKS. IT IS FAR MORE LIKELY TO BE
ONE IN WHICH THE EC IS SET AGAINST VIRTUALLY EVERYONE
ELSE."
4. FORMER SOVIET UNION
THE CONSERVATIVE DAILY TEELGRAPH EDITORIALIZED:
"THE HOPE MUST BE THAT A YELTSIN VICTORY OVER THE
UNCLAS SECTION 02 OF 10 LONDON 17714
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
- RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, WEDNESDAY
SEPTEMBER 29 1993
HARDLINERS WILL BRING SUCH DESTABILISING FACTORS UNDER
CONTROL. IF IT DOES NOT, THEN THE WEST WILL HAVE TO
REMIND THE RUSSIAN LEADER THAT CONTINUED POLITICAL AND
FINANCIAL BACKING DEPENDS ON GOOD BEHAVIOR IN THE 'NEAR
Page 2 ofi2
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ABROAD' AS WELL AS THE PURSUIT OF DEMOCRACY AND ECONOMIC
REFORM AT HOME."
5. SOMALIA
MANY PAPERS REPORTED THE NEW U.S. STRATEGY IN SOMALIA.
THE CONSERVATIVE TIMES CALLED IT A "TACIT ADMI$SION OF
FAILURE" BY THE U.S.
THE CONSERVATIVE DAILY TELEGRAPH REPORTED:
"THE UNITED STATES THREW ITS FOREIGN POLICY INTO REVERSE
LAST NIGHT AND THREATENED THE UN PEACEKEEPING OPERATION
IN SOMALIA, ANNOUNCING IT WAS WITHDRAWING SOME TROOPS,
AND CALLING FOR NEGOTIATIONS WITH THE WARLORD GENERAL
AIDEED.
AS STATEMENTS FROM PRESIDENT CLINTON AND SENIOR
OFFICIALS EMERGED THROUGHOUT YESTERDAY, IT BECAME CLEAR
THAT WASHINGTON WAS PREPARING TO ABANDON ITS ROLE AS THE
TEETH OF THE 28,000-MAN UN FORCE"
C. HEADLINES
1. U.S. FOREIGN POLICY
"NO MORE PLAYING THE HERO FOR CAPTAIN AMERICA" (GUARDIAN
COMMENTARY)
"FEED THE HUNGRY SHEEP" (TIMES EDITORIAL)
2. U.S. HEALTHCARE REFORM
"FIRST LADY SPARKLES ON CAPITOL HILL" (TIMES REPORT)
"HILLARY DELIVERS HER REMEDY TO CAPITOL HILL" (DAILY
TELEGRAPH REPORT)
"WIFE, MOTHER AND POLITICAL ANIMAL" (GUARDIAN REPORT)
3. WORLD TRADE
"END GAME IN THE GATT" (F.T. EDITORIAL)
4. FORMER SOVIET UNION
"WEST'S BEST BET" (F.T. COMMENTARY)
UNCLAS SECTION 03 OC 10 LONDON 17714
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/ /!; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHIT.EHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, WEDNESDAY
SEPTEMBER 29 1993
"TROUBLING QUESTIONS IN THE CAUCASUS" (INDEPENDENT
EDITORIAL)
"A RESPONSIBLE RUSSIA" (DAILY TELEGRAPH EDITORIAL)
5. SOMALIA
"AMERICA TO BEGIN PULLING TROOPS OUT OF SOMALIA" (DAILY
TELEGRAPH REPORT)
"U.S. AIMS FOR SWIFT END TO SOMALIA INVOLVEMENT" (TIMES
REPORT)
"U.S. CHANGES TACK IN SOMALIA AND MOVES TO ISOLATE
AIDEED" (INDEPENDENT REPORT)
D. TEXT
Page 3 of 12
�F:\Cable\Data Source\Cables\CD003\SEP93\MSGS\M0631256.html
1. U.S. FOREIGN POLICY
WRITING IN THE LIBERAL GU~RDIAN, FOREIGN AFFAIRS
COMMENTATOR MARTIN WOOLLACOTT ANALYZED PRESIDENT
CLINTON'S MONDAY SPEECH THUS:
"NOTHING COULD BE MORE SYMPTOMATIC OF THE WAY THINGS ARE
GOING IN THE WORLD THAN THE CONJUNCTION OF EDUARD
SHEVARDNADZE'S DESPAIRING WORDS FROM BESIEGED SUKHUMI
WITH BILL CLINTON'S CIRCUMSPECT ADDRESS TO THE UN ON THE
LIMITS OF. PEACEKEEPING. FROM THE PRESIDENT AMIDST THE
RUBBLE ON THE BLACK SEA COAST, A DESPERATE CRY FOR HELP.
FROM THE PRESIDENT AT THE PODIUM ON THE EAST RIVER, AN
ASSURANCE TO AMERICANS -- NO MORE RISKY RESCUES, NO MORE
CRAZY ADVENTURES. THE MESSAGE WHICH CLINTON, IN SPITE OF
HIS TALKS ON INTERNATIONAL INVOLVEMENT AND OF THE
'ENLARGEMENT' OF DEMOCRACY, IS SENDING IS A WORRYING ONE.
THE ARGUMENTS SEEM COOL AND RATIONAL, BUT THEY ARE NOT.
"THE FOUR CONDITIONS (FOR U.S. PARTICIPATION IN
PEACEKEEPING) MAKE NO SENSE AT FACE VALUE, BUT THEY CAN
BE TRANSLATED INTO POPULIST SPEAK AS FOLLOWS : WE WILL
DECIDE WHEN, IF EVER, TO GET INVOLVED; WE WILL GET OUT
FAST IF IT GOES WRONG; SOMEBODY ELSE WILL PUT UP THF
MONEY.
"EVEN MORE IRRATIONAL WAS THE WHOLE TENOR OF A SPEECH IN
WHICH CLINTON PRESENTED HIMSELF AS A RESPONSIBLE LEADER
FORCED TO CAUTION AN IRRESPONSIBLE UN, A BODY WHICH, HE
IMPLIED, WAS IN DANGER OF FLINGING AMERICAN TROOPS ALL
OVER THE PLACE AND GETTING THEM KILLED IN SILLY
UNCLAS SECTION 04 OF 10 LONDON 17714
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;.
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, WEDNESDAY
SEPTEMBER 29 1993
OPERATIONS.
"BUT THE PIECE OF THEATER WHICH CLINTON HERE CREATES IS
AT WILD VARIANCE WITH THE FACTS. WHILE THERE ARE UN
OFFICIALS, INCLUDING THE SECRETARY GENERAL, WHO HAVE
WANTED TO EXPAND PEACEKEEPING AND TO REGULATE IT MORE
CONSISTENTLY, EVERY MAJOR UN EFFORT SINCE THE END OF THE
COLD WAR SINCE BOSNIA HAS BEEN WASHINGTON-DRIVEN, FROM
THE GULF TO ANGOLA AND CAMBODIA. THE SOMLIA OPERATION,
THE CASUALTIES IN WHICH ARE IN PART RESPONSIBLE FOR THE
AMERICAN POPULAR DISENCHANTMENT TO WHICH CLINTON IS
RESPONDING, WAS ALMOST ENTIRELY AN AMERICAN IDEA. THE
TRUTH IS THAT THE OPERATIONS WHICH CLINTON ALMOST MANAGES
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TO IMPLY WERE FOISTED ON THE UNITED STATES BY AN OVERACTIVE UN WERE, IN FACT, FOISTED ON THE UN BY AN OVERACTIVE U.S. IT IS THE U.S. WHICH HAS CHANGED, NOT THE
UN.
"AN ADMINISTRATION WHICH, ONLY A FEW MONTHS AGO, WAS
URGING AN ENHANCEMENT OF UN PEACEKEEPING CAPACITY AND THE
COMMITMENT OF FORCES, INCLUDING AMERICAN FORCES, TO THE
WORLD BODY, IS NOW BACKING AWAY AND IN BOSNIA, PREFERS
NATO TO UN CONTROL.
"THE MOOD OF WITHDRAWAL IN THE U.S., THE SUSPICION OF
FOREIGN ENTANGLEMENTS, HAS ANOTHER CONSEQUENCE THAT IS
VERY CLEAR TODAY. AMERICA'S POLICY OF BACKING THE
POWERS-THAT-BE ACROSS MUCH OF THE EX-COMMUNIST WORLD HAS
BEEN REINFORCED. THERE IS A CONNECTION BETWEEN THE NEW
DISTASTE FOR PEACEKEEPING AND THE READINESS TO BACK BORIS
YELTSIN IN RUSSIA : WHAT IT AMOUNTS TO IS THAT ANY FORCE
WHICH IS KEEPING THINGS TOGETHER IS BETTER THAN ANY FORCE
THAT MIGHT REND THEM AART, BECAUSE, WITH FURTHER
DISSOLUTION, WILL COME DANGERS AND YET MORE DEMANDS THAT
SOMETHING BE DONE. THAT IS WHY SHEVARDNADZE HAS TO ASK
WHY THERE IS 'AMIDST THE DEAFENING BURSTS OF BOMBS AND
SHELLS, AMIDST THE DISTRESSED CRIES OF PEOPLE DOOMED TO
DEATH, NOT A SINGLE WORD OF PROTEST, NOT A SINGLE PROMISE
OF HELP'.
"THE WEST IS SLIPPING TOWARDS AN ENDORSEMENT OF LESS THAN
DEMOCRACY IN RUSSIA AND TOWARDS GRANTING RUSSIA A FREE
HAND IN CENTRAL ASIA AND THE CAUCASUS, ON THE SIMPLE
BASIS THAT ANY KIND OF ORDER IS BETTER THAN DISORDER.
BUT IF DISORDER IS TO PREVAIL, WHEREVER IT MAY BE, THEN
AMERICA IS BEGINNING TO SIGNAL, AS MUCH TO ITS OWN PEOPLE
AS TO EVERYBODY ELSE, THAT IT WILL NOT INTERVENE.
"WE CAN CLEARLY SEE A SITUATION EMERGING IN WHICH THE
UNCLAS SECTION 05 OF 10 LONDON 17714
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, WEDNESDAY
SEPTEMBER 29 1993
DEPLOYMENT IN SOMALIA, AND A POSSIBLE DEPLOYMENT IN
BOSNIA (TOGETHER WITH A FEW TROOPS FOR THE GOLAN) COULD
BE THE LAST AMERICAN PEACE KEEPING DEPLOYMENTS, AND
THEREFORE, PERHAPS, THE LAST MAJOR PEACEKEEPING
DEPLOYMENTS ANYWHERE. PHYSICAL INTERVENTION BECOMES LESS
LIKELY IN AREAS WHERE ONE WOULD EXPECT AMERICAN POWER TO
BE EXERTED, WHILE DIPLOMATIC INTERVENTION BECOMES LESS
LIKELY IN MORE REMOTE AREAS BECAUSE OF THE PERCEIVED NEED
Page 5 of12
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TO PROP UP REGIONAL POWERS WHETHER OR NOT THEY ARE
MISBEHAVING.
"IN THE NEW ISOLATIONISM, KNOW-NOTHINGS ARE APPARENTLY
BEING REPLACED BY DO-NOTHINGS -- BY PEOPLE WHO KNOW HOW
BAD THINGS ARE OUT THERE, WHO DO CARE, BUT WHO ARGUE THAT
IT IS SIMPLY NOT POSSIBLE TO STOP IT.
"THIS IS A FAR CRY FROM THE VISION OF AN INCREASINGLY
DEMOCRATIC WORLD WHICH STILL FINDS AN ECHO IN PRESIDENT
CLINTON'S DOCTRINE OF ENLARGEMENT. THE PROPER RESPONSE
TO THIS HEAVEN AND HELL APPROACH IS SURELY TO REASSERT
THAT, JUST AS GO-ANYWHERE INTERVENTIONISM WAS ALWAYS AN
IMPOSSIBLE IDEA, THE ABANDONMENT OF THE WORLD BY THE MORE
POWERFUL AND RICHER SOCIETIES IS EQUALLY IMPOSSIBLE."
THE CONSERVATIVE TIMES EDITORIALIZED:
"ON THE EVIDENCE OF HIS SPEECH TO THE GENERAL ASSEMBLY OF
THE UN, PRESIDENT CLINTON STILL LACKS THE 'VISION THING'.
NO INCOMING PRESIDENT WOULD HAVE FOUND IT EASY TO
REPLACE THE SIMPLE VERITIES OF THE COLD WAR WITH A
COMPLEX FOREIGN POLICY THAT DEMANDS THE TALENTS OF A
PALMERSTONE OR TALLEYRAND RATHER THAN JOHN KENNEDY
HEROICS. BUT THE CHARGE OF INCOHERENCE NEVERTHELESS
WOUNDS. GIVEN AMERICA'S SUPERPOWER STATUS, ITS
PRESIDENTS NEED TO CUT A DASH IN THE WORLD. JUDGED BY
THE STANDARDS OF MR CLINTON'S OWN INTELLECTUAL
PRETENSIONS, HIS WORLD VISION APPEARS DECIDEDLY HAZY.
"THE UN SPEECH WAS SUPPOSED TO BE THE CULMINATION OF A
SUMMER RETHINK ON FOREIGN POLICY. MR CLINTON HAS BEEN
CLEARLY STUNG BY THE AMERICAN FOREIGN POLICY
ESTABLISHMENT'S CRITICISM OF HIS HAPHAZARD DIPLOMACY IN
BOSNIA AND SOMALIA. HIS CURATE'S EGG OF A SPEECH HAD ITS
GOOD PARTS. THE CALL TO CURB THE PROLIFERATION OF
NUCLEAR, CHEMICAL AND BIOLOGICAL WEAPONS IS MOST WELCOME,
NOTABLY IN THE LIGHT OF DEVELOPMENTS IN NORTH KOREA, IRAN
AND RUSSIA.
'THE ENLARGEMENT OF THE WORLD'S COMMUNITY
OF MARKET DEMOCRACIES', PURSUED BY EXTENDING THE BENEFITS
OF FREE TRADE, IS A COMMITMENT THAT DESERVES APPLAUSE.
MR CLINTON HAS LEFT IT LATE TO CRUSADE FOR THE NAFTA, BUT
UNCLAS SECTION 06 OF 10 LONDON 17714
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, WEDNESDAY
SEPTEMBER 29 1993
THE OBJECTIVE IS A WORTHWHILE ONE, AND THE CONCLUSION OF
THE GATT TRADE ROUND WOULD BE OF INESTIMABLE BENEFIT TO
THE WORLD.
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"FOLLOWING THE COLLAPSE OF SOVIET POWER, AMERICA HAS
NEVER BEEN IN A MORE POWERFUL POSITION IN THE WORLD BODY.
IF AMERICA IS TO BE THE UN'S 'FIRST FRIEND AND FIRST
CRITIC', IT HAD BETTER DO MORE THAN SPOUT PLATITUDES FROM
THE SIDELINES. IT SHOULD EMPLOY ACTIVE DIPLOMACY TO
REFORM THE INSTITUTION.
"IN THE BACKGROUND (OF THE SPEECH), AS EVER, WERE BOSNIA
AND AMERICA'S RELATIONSHIP WITH ITS EUROPEAN ALLIES
WITHIN NATO. MR CLINTON PRAISED THE UN HUMANITARIAN
EFFORT IN BOSNIA, AND PLEDGED AMERICAN SUPPORT FOR A
PEACE AGREEMENT. WHAT THU PROMISE OF SUPPORT MEANS IS
STILL UNCLEAR. MR CLINTON HAS CALLED FOR A NATO SUMMIT
IN JANUARY TO CLARIFY THE ALLIANCE'S ROLE. THERE WERE NO
POINTERS IN HIS SPEECH. WILL NATO EXTEND ITS SECURITY
INTERESTS EASTWARD FROM ITS CORE AREA? WILL IT TAKE IN
NEW MEMBERS? WILL AMERICA REALLY POLICE A PEACE
AGREEMENT IN BOSNIA? THE HUNGRY SHEEP LOOK UP, AND ARE
NOT FED."
2. U.S. HEALTHCARE REFORM
THE CONSERVATIVE TIMES REPORTED:
"HILLARY RODHAM CLINTON MADE A LITTLE BIT OF HISTORY
YESTERDAY MORNING. SHE NOT ONLY BECAME THE THIRD FIRST
LADY TO TESTIFY BEFORE A CONGRESSIONAL COMMITTEE, BUT THE
FIRST TO APPEAR AS CHIEF SALESWOMAN FOR THE SINGLE MOST
IMPORTANT PIECE OF LEGISLATION OF HER HUSBAND'S
PRESIDENCY . . . . LAST YEAR SHE WAS DENOUNCED AS 'FEMINAZI' AND 'LADY MACBETH' AND CONSIDERED A LIABILITY BY
HER HUSBAND'S CAMPAIGN ADVISERS. THIS YEAR SHE HAS COME
TO BE SEEN AS THE ADMINISTRATION'S GREATEST ASSET, AND IT
WAS NOT HARD YESTERDAY TO SEE WHY. QUITE SIMPLY, SHE
DAZZLED.
"MRS CLINTON HAS BECOME THE COMPASSIONATE HUMAN FACE OF
HEALTH CARE REFORM, THE NON POLITICIAN IN WHOM A CYNICAL
PUBLIC IS INCREASINGLY PLACING ITS TRUST . . . . IN TWO
HOURS, SHE SCARCELY GLANCED AT HER NOTES AND ELOQUENTLY
SWATTED AWAY ANY CONGRESSMEN'S WORRIES ABOUT THE PLAN'S
DUBIOUS FINANCING, ITS NEW LAYERS OF BUREAUCRACY AND ITS
LIKELY COST IN JOBS. FEW ARE BETTER EQUIPPED THAN MRS
CLINTON·TO HANDLE TOUGH QUESTIONS, BUT FEW CONGRESSIONAL
WITNESSES HAVE COMMANDED SUCH DEFERENCE. THE CONGRESSMEN
UNCLAS SECTION 07 OF 10 LONDON 17714
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAf MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, WEDNESDAY
SEPTEMBER 29 1993
Page 7 of12
�F:\Cable\Data Source\Cables\CD003\SEP93\MSGS\M0631256.html
LARDED THEIR COMMENTS WITH PRAISE."
THE CONSERVATIVE DAILY TELEGRAPH REPORTED:
"MRS CLINTON'S APPEARANCE ON CAPITOL HILL WAS RECOGNIZED
IN WASHINGTON AS A MAJOR EVENT IN THE DEVELOPMENT OF THE
FIRST LADY'S ROLE AND PERHAPS IN THE ANNALS OF AMERICAN
FEMINISM. TWO PREVIOUS PRESIDENT'S WIVES HAVE ADDRESSED
CONGRESSIONAL COMMITTEES, BUT THEY WENT TO PROMOTE THEIR
SPECIAL INTERESTS . . . . YESTERDAY, MRS CLINTON TOOK HE~
SEAT NOT AS A 'LADY BOUNTIFUL', BUT AS A PROFESSIONAL
WOMAN, A FEDERAL EMPLOYEE WORKING IN THE INTERESTS OF HER
HUSBAND'S ADMINISTRATION TO PULL OFF WHAT WILL, IF IT
SUCCEEDS, BE THE DEFI~ING SOCIAL VICTORY OF HIS
PRESIDENCY.
"SYCOPHANCY WAS SOMETHING THE GRAVEL-VOICED MR
ROSTENKOWSKI AND THE MEMBERS OF HIS HOUSE WAYS AND MEANS
COMMITTEE CLEARLY WISHED TO AVOID. BUT THEY MADE NO
BONES ABOUT THE FACT THAT THEY WERE HONORED BY THE FIRST
LADY'S PRESENCE. THEY TREATED HER GENTLY, PUTTING THEIR
QUESTIONS WITH UNACCUSTOMED POLITENESS AND SELDOM
INTERRUPTING HER ANSWERS. MANY EXECUTIVES WHO HAD
OCCUPIED HER SEAR AT PREVIOUS HEARINGS MST HAVE BEEN
ENVIOUS. IT WAS MRS CLINTON WHO SHOWED METTLE, REELING
OFF FACTS AND STATISTICS WITH APLOMB. JABBING THE AIR
WITH A DETERMINED FINGER AS SHE LEANED EARNESTLY FORWARD
IN HER LEATHER CHAIR, SHE SCARCELY GLANCED AT HER NOTES.
"FEW EXPECT THAT THE HEALTHCARE REFORM PROGRAM WILL
EMERGE FROM CONGRESS WITHOUT MAJOR CHANGES. THERE ARE
MONTHS OF DEBATE AHEAD. IN THIS OPENING ROUND THERE ARE
MANY POLITICIANS FROM BOTH SIDES WITH CONCERNS TO BE
AIRED AND CHALLENGES TO BE TABLED. JUDGING BY
YESTERDAY'S PERFORMANCE. THE FIRST LADY IS READY FOR
THEM."
THE LIBERAL GUARDIAN REPORTED:
"MRS CLINTON HAD IT BOTH WAYS YESTERDAY. SHE WAS THE
POLICY EXPERT WHO COULD TALK TO CONGRESSMEN ABOUT
DIFFERENTIAL MEDICARE PAYMENTS IN THEIR HOME
CONSTITUENCY. THEN SHE BECAME AN ORDINARY WIFE AND
MOTHER BESET BY THE BUREAUCRACY, COSTS AND REMOTE MEDICAL
PROFESSIONALISM OF THE U.S. SYSTEM., IT WAS LIKE BARBARA
BUSH WITH A PH.D.
3. WORLD TRADE
THE INDEPENDENT FINANCIAL TIMES EDITORIALIZED:
UNCLAS SECTION 08 OF 10 LONDON 17714
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
II
Page 8 of12
�F:\Cable\Data Source\Cables\CD003\SEP93\MSGS\M0631256.html
SUBJECT: MEDIA REACTION REPORT, LONDON, WEDNESDAY
SEPTEMBER 29 1993
"OCTOBER IS LIKELY TO DETERMINE WHETHER THE URUGUAY ROUND
OF MULTILATERAL TRADE NEGOTIATIONS WILL BE COMPLETED BY
THE MULTILATERALLY AGREED DEADLINE OF DECEMBER 15.
DURING THIS MONTH THE OUTLINES OF A TOTAL DEAL ON MARKET
ACCESS NEEDS TO BE COMPLETED IF THE TIMETABLE SET OUT BY
THE GATT'S DIRECTOR GENERAL PETER SUTHERLAND IS TO BE
MET. THIS IS ACHIEVABLE -- AND MUST BE ACHIEVED.
"COMPARED WITH THE CHASM IN 1986, WHAT DIVIDES THE EC AND
U.S. IN AGRICULTURE TODAY IS A CENTIMETER. THE U.S.
SHOULD REALLY BE ABLE TO AGREE TO TARIFFS ON TEXTILES
COMPARABLE TO THOSE OF THE EC. IT SHOULD ALSO BE ABLE TO
PERMIT COUNTRIES TO SUBSIDIZE DOMESTIC FILM PRODUCTION
FOR CULTURAL REASONS.
"THE BIGGEST CHALLENGES NOW ARE THOSE FACING THE U.S.,
AND THE EC, SIMPLY BECAUSE THEY ARE THE MOST SIGNIFICANT
PLAYERS. IN THE FORMER, PERHAPS THE GREATEST DANGER IS
SPILLOVER FROM THE HYSTERICAL OPPOSITION TO THE NAFTA.
THE PRESIDENT MADE THE GREAT MISTAKE OF ALLOWING THE
OPPONENTS OF NAFTA TO MAKE ALL THE RUNNING IN THE PUBLIC
DEBATE FOR EIGHT MONTHS. NOW IT MAY BE TOO LATE. BUT IF
NAFTA WERE TO BE VOTED DOWN IN CONGRESS, MR CLINTON WOULD
BE GRAVELY WEAKENED, AS WOULD THE CAUSE OF LIBERAL TRADE.
HOWEVER INEPTLY TRADE HAS BEEN HANDLED BY THE
ADMINISTRATION THUS FAR, MR CLINTON MUST NOW RETRIEVE
LOST GROUND, BY MAKING THE PASSING OF NAFTA AND AGREEMENT
ON THE URUGUAY ROUND HIS HIGHEST PRIORITIES OVER THE NEXT
FEW MONTHS.
"AS FOR THE EC, ITS LEADERS NEED TO RECOGNIZE THAT THE
PRIME FRENCH DEMAND IN AGRICULTURE -- TO MAKE THE WORLD
SAFE FOR DUMPING OF SUBSIDIZED COMMODITIES -- IS NOT
MERELY HYPOCRITICAL, SET AGAINST THE EC'S GENERAL STANCE
ON DUMPING, BUT IUS DETESTED BY MANY MORE COUNTRIES THAN
JUST THE U.S.
IF REFUSAL TO ACCEPT WHAT HAS BEEN AGREED
AT BLAIR HOUSE DESTROYS THE ROUND, THE EC WILL BE
UNIVERSALLY BLAMED FOR THE CATASTROPHE. THE OUTCOME WILL
NOT BE A WORLD DIVIDED INTO SEVERAL TRADING BLOCKS. IT
IS FAR MORE LIKELY TO BE ONE IN WHICH THE EC IS SET
AGAINST VIRTUALLY EVERYONE ELSE."
4. FORMER SOVIET UNION
WRITING IN THE INDEPENDENT FINANCIAL TIMES, COLUMNIST
EDWARD MORTIMER COMMENTED:
"THE PROBLEMS FACING RUSSIA NOW ARE HARDLY LESS THAN
THOSE THAT FACED PERU LAST YEAR. IN FACT, GIVEN THE SIZE
UNCLAS SECTION 09 OF 10 LONDON 17714
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
Page 9 of 12
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Page 10 of 12
VIENNA PASS.USDEL-CSCE;
RAF MILDENHALL FOR PA;
E;0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, WEDNESDAY
SEPTEMBER 29 1993
OF THE COUNTRY, ITS ETHNIC DIVERSITY, AND THE LEGACY
(BOTH ECONOMIC AND POLITICAL) OF 70 YEARS OF COMMUNISM,
THEY CAN SURELY BE CONSIDERED MUCH GREATER. MANY
RUSSIANS DOUBT WHETHER THEY CAN BE SOLVED DEMOCRATICALLY,
OR AT ALL. SO FAR, MR YELTSIN IS STILL TRYING TO
INTRODUCE A DEMOCRATIC CONSTITUTION, TO CARRY THE PEOPLE
WITH HIM AT EACH STAGE OF HIS REFORMS, AND TO AVOID A
RECOURSE TO VIOLENCE. SO LONG AS HE BEHAVES LIKE THAT,
HE DESERVES SUPPORT."
THE CENTRIST INDEPENDENT EDITORIALIZED:
"THE WEST HAS GOOD REASON TO BE GRATEFUL TO EDUARD
SHEVARDNADZE, WHO, AS MIKHAIL GORBACHEV'S FOREIGN
MINISTER, WAS ONE OF THE CHIEF ARCHITECTS OF THE SECOND
RUSSIAN REVOLUTION. WESTERN GOVERNMENTS SHOULD NOW BE
CONCERNED THAT THE GEORGIAN WHO BECAME SO CLOSELY
IDENTIFIED WITH GLASNOST FEELS BETRAYED BY BORIS YELTSIN
AND WHAT PASSES FOR A GOVERNMENT IN MOSCOW.
"IT IS BARELY CONCEIVABLE THAT THE ABKHAZIANS COULD HAVE
DEFEATED THE NUMERICALLY VASTLY SUPERIOR GEORGIANS
WITHOUT HELP FROM THE RUSSIAN MILITARY. MR
SHEVARDNADZE'S SENSE OF BETRAYAL IS UNDERSTANDABLE. THE
EPISODE RAISES SOME DISTURBING QUESTIONS. WAS THE FALL
OF SUKHUMI PART OF A DEAL BETWEEN PRESIDENT YELTSIN AND
GEN GRACHEV? IF SO, WHAT WERE ITS OTHER ELEMENTS? WERE
THEY RESTRICTED TO THE TERRITORY OF THE FORMER SOVIET
UNION? THE VALUE OF PEACE DEALS BROKERED BY RUSSIA HAS
ALSO BEEN CALLED INTO QUESTION. IT IS IN SUCH SITUATIO~S
THAT LEADERS OF SMALL COUNTRIES LOOK AROUND FOR FRESH
ALLIES -- A PROCESS THAT CAN ONLY INCREASE THE
INSTABILITY OF AN ALREADY WAR-RIDDEN REGION."
THE CONSERVATIVE DAILY TELEGRAPH EDITORIALIZED:
"WE IN THE WEST NEED NOT OBJECT IF MOSCOW ACTS AS A
STABILIZING FORCE IN VOLATILE REGIONS SUCH AS TRANSCAUCASIA AND CENTRAL ASIA, AND WE SHOULD ACCEPT THAT
RUSSIA HAS A LEGITIMATE INTEREST IN THE FATE OF THE
MILLIONS OF RUSSIANS WHO LIVE OUTSIDE ITS BORDERS. BUT
THIS DOES NOT MEAN APPROVAL OF WHAT MR YELTSIN HAS
ALLOWED TO HAPPEN IN GEORGIA, WHERE OUTSIDE SUPPORT FOR
THE SEPARATISTS IS CAUSING THE COUNTRY TO DISINTEGRATE.
THE HOPE MUST BE THAT A YELTSIN VICTORY OVER THE
HARDLINERS WILL BRING SUCH DESTABILISING FACTORS UNDER
CONTROL. IF IT DOES NOT, THEN THE WEST WILL HAVE TO
REMIND THE RUSSIAN LEADER THAT CONTINUED POLITICAL AND
FINANCIAL BACKING DEPENDS ON GOOD BEHAVIOR IN THE 'NEAR
UNCLAS SECTION 10 OF 10 LONDON 17714
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); 8/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
____
!
�F:\Cable\Data_Source\Cables\CD003\SEP93\MSGS\M0631256.html
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, WEDNESDAY
SEPTEMBER 29 1993
ABROAD' AS WELL AS THE PURSUIT OF DEMOCRACY AND ECONOMIC
REFORM AT HOME."
5. SOMALIA
THE CONSERVATIVE TIMES REPORTED:
"THE CLINTON ADMINISTRATION YESTERDAY UNVEILED A KEY
CHANGE OF STRATEGY IN SOMALIA AIMED AT EXTRICATING
AMERICAN TROOPS AS FAST AS POSSIBLE. THE NEW POLICY WILL
PLACE FAR LESS EMPHASIS ON CAPTURING GENERAL AIDEED AND
MUCH MORE ON ISOLATING THE MOGADISHU WARLORD BY BUILDING
A NEW POLITICAL STRUCTURE IN WHICH HE WOULD HAVE NO ROLE.
"THE CHANGE OF STRATEGY IS A TACIT ADMISSION OF FAILURE,
BUT ONE WHICH IS DRIVEN BY THE URGENT NEED TO ASSUAGE
SOMALI ANTAGONISM TOWARDS AMERICAN TROOPS AND TO PERSUADE
CONGRESS THAT U.S. INVOLVEMENT IN SOMALIA IS FINITE.
CONGRESSMEN COMPLAINED (LAST NIGHT) THAT SOMALIA HAD
BECOME A 'DEADLY SANDTRAP' FOR AMERICAN TROOPS."
THE CENTRIST INDEPENDENT REPORTED:
"BILL CLINTON HAS CONFIRMED THAT WASHINGTON HAS CHANGED
THE POLICY OF THE UN OPERATION IN SOMALIA TO SWITCH THE
EMPHASIS AWAY FROM THE HUNT FOR.GENERAL AIDEED TO A NEW
INITIATIVE AIMED AT ISOLATING HIM POLITICALLY.
PRESSURE FROM CONGRESS IS CAUSING THE CHANGE IN POLICY.
"WASHINGTON ALSO KNOWS THAT MORE AND MORE SOMALIS OF
WHATEVER FACTION ARE TURNING AGAINST THE AMERICAN AND UN
PRESENCE AND THAT THE POLICY OF HUNTING DOWN GENERAL
AIDEED IS TURNING HIM INTO A HERO. THERE ARE RELIABLE
REPORTS THAT EVEN AMONG FOLLOWERS OF ALI MAHDI MOHAMMED,
GENERAL AIDEED'S ARCH ENEMY, THERE IS A GROUNDSWELL OF
ANTI-U.S. AND ANTI-UN FEELING. THE ADMINISTRATION IS IN
A BIND. ON THE ONE HAND IT HAS TO SATISFY CONGRESS AND
THE AMERICAN PEOPLE THAT ITS COMMITMENT TO SOMALIA IS NOT
OPEN-ENDED, HAS BEEN SUCCESSFUL, AND THAT THE TROOPS WILL
BE HOME SOON. ON THE OTHER IT MUST NOT GIVE GENERAL
AIDEED THE IMPRESSION HE HAS GOT THE UN FORCES ON THE
RUN.
O'BRIEN
BT
#7714
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�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Magnetic Disk: Hard Drive
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
[01/03/1993 - 09/29/1993]
Creator
An entity primarily responsible for making the resource
NSC Cables
January 1993-December 1994
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7585710" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7585710-20060223F-006-014-2015
7585710
-
https://clinton.presidentiallibraries.us/files/original/f028867157b4d8f7bc9593774e65dda8.pdf
37e803dc5387c81fe510474afd7d6e3d
PDF Text
Text
,_ F:\Cable\Data Source\Cables\CDOO 1\FEB93\MSGS\M020 1561.html
.i
Cab 1e
PREC:
CLASS:
OSRI:
LINEl:
LINE2:
LINE3:
LINE4:
DTG:
ORIG:
TO:
INFO:
SUBJ:
IMMEDIATE
UNCLASSIFIED
RUFHOL
OATUZYUW RUFHOL 2671 0331349-UUUU--RUEADWW.
ZNR UUUXX
0 021347Z FEB 93 ZNZ1
FM USIS BONN
0 213 4 7Z FEB 9 3
USIS BONN
RUEHIA/USIA WASHDC IMMEDIATE
RUEADWW/WHITE HOUSE NATIONAL SECURITY COUNCIL WASH DC
RUEHC/SECSTATE WASHDC
RUEKJCS/SECDEF WASHDC//USDP//ISA/DSAA
RUEKJCS/DIA WASHDC//DC-4A
RUEAIIA/CIA WASHDC
RUEATRS/TREASURY WASHDC
RUEAUSA/DEPT/LABOR WASHDC//MCCAFFREY
RUCNFRG/FRG COLLECTIVE
RUEHGV/USMISSION GENEVA//NST/ACDA
RUEHBS/AMEMBASSY BRUSSELS//NESSEE
RUFHLD/AMEMBASSY LONDON
RUFHFR/AMEMBASSY PARIS
RUEHRO/AMEMBASSY ROME
RUDOGHA/USNMR SHAPE BE//PAA
RUFHMB/USMISSION USVIENNA//CSBM/PAA
RUFHNA/USMISSION USNATO
RHFQAAA/AFOSI DET 501 RAMSTEIN AB GE//EAC//
RUSNNOA/USCINCEUR VAIHINGEN GM//ECPA/POLAD/ECJ5//CJ1-HN
RUFDAAA/CINCUSAREUR HEIDELBERG GM
RUFTAKC/UDITUSAREUR HEIDELBERG GM
RXFMB/USSUPPORT ELEMENT HQ BALTAP//PIO/NA
RHFQSAF/17AF SEMBACH AB GE//CCH//
GERMAN MEDIA REACTION REPORT
FOLLOWING IS A REVIEW OF GERMAN MEDIA OF FEBRUARY 02, 1993
TEXT:
UNCLAS SECTION 01 OF 06 BONN GM 02671
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR EUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD/CJ1-HN/ECJ5-E
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
Page 1 of7
�F:\Cable\Data_ Source\Cables\CDOO 1\FEB93\MSGS\M020 1561.html
PART ONE OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
FOLLOWING IS A REVIEW OF GERMAN MEDIA OF FEBRUARY 02, 1993
CONTENTS:
A. LEAD STORIES SUMMARY
B. EX-YUGOSLAVIA: CONTINUING CRISIS
C. U.S.: EARLY DAYS OF THE CLINTON ADMINISTRATION
D. U.N.: REFORM
E. U.S.: PUNITIVE TARIFFS ON STEEL IMPORTS
F. EC: ENLARGEMENT, EMS
G. GERMANY-RUSSIA: TROOP WITHDRAWAL
A. LEAD STORIES SUMMARY
TODAY'S LEAD STORIES CENTER ON THE CRACKS IN THE
COOLING SYSTEM OF THE NUCLEAR POWER PLANT IN BRUNSBUETTEL
NEAR HAMBURG AND THE FIERCE FIGHTING IN DALMATIA.
EDITORIALS CENTER ON THESE SUBJECTS AND ON THE ALLEGED
CONNECTIONS OF SAARLAND'S STATE PREMIER OSKAR LAFONTAINE
WITH THE UNDERWORLD.
B. FORMER YUGOSLAVIA: CONTINUING CRISIS
1. KARL GROBE WRITES IN LEFT-OF-CENTER FRANKFURTER
RUNDSCHAU UNDER THE HEADLINE:
"INTERFERENCE FOR THE SAKE OF PEACE."
"VARIOUS EUROPEAN FOREIGN MINISTERS WERE BEING HONEST
WHEN THEY ADMITTED THAT THE EC IS POWERLESS TO DO
UNCLAS SECTION 02 OF 06 BONN GM 02671
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR EUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD/CJ1-HN/ECJ5-E
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART ONE OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
ANYTHING ABOUT THE WAR IN FORMER YUGOSLAVIA .... THE
FAILURE OF THE GENEVA CONFERENCE HAS MADE THIS
HELPLESSNESS EVEN WORSE. IT DOES NOT MATTER WHO WAS
RESPONSIBLE FOR THE FAILURE OF THE VANCE-OWEN PLAN ....
IF 'PRESSURE IS TO BE APPLIED,' WHO IS IT TO BE APPLIED
TO? SINCE THE EARLY SUMMER, ATTEMPTS TO DEPRIVE THE
SERBIAN GOVERNMENT OF THE MEANS TO WAGE WAR HAVE FAILED.
INSISTING THAT BULGARIA AND RUMANIA ENFORCE THE .EMBARGO
AGAINST SERBIA ON THE DANUBE IS PUSHING THE RISK AWAY
FROM THE EC. BULGARIA AND RUMANIA ARE STILL SUFFERING
THE CONSEQUENCES OF THEIR EMBARGO ON IRAQ. NOW THEY ARE
BECOMING HOSTAGES TO THE NEW EMBARGO SINCE THEIR TRADE ON
THE DANUBE IS BEING HALTED AND THEIR CITIZENS ARE BEING
HELD CAPTIVE IN SERBIAN PORTS. IN NEITHER CASE HAS ANY
Page 2 of7
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MEMBER OF THE WESTERN COMMUNITY DONE ANYTHING TO
COMPENSATE THESE COUNTRIES MATERIALLY.
"THE CONSEQUENCES OF MILITARY INTERVENTION ... WOULD
INEVITABLY AFFECT THESE NEIGHBORS OF FORMER YUGOSLAVIA
FIRST .... THERE IS NO PLAUSIBLE, RECOGNIZABLE AIM FOR
MILITARY ACTION. THERE COULD BE NO JUSTIFICATION FOR
TAKING SIDES EXCLUSIVELY AGAINST THE ?ERBIAN STATE OR THE
SMALLER NEW YUGOSLAVIA. EVEN IF THE FORMER WERE PUSHED
BACK INTO ITS FORMER BORDERS, THE QUESTION WOULD STILL
REMAIN OF HOW THE SERBIAN MINORITIES IN THE NEIGHBORING
STATES WERE SUPPOSED TO SURVIVE. NEITHER COULD ANYONE
HONESTLY JUSTIFY TREATING CROATIA (FOR EXAMPLE) AS IF IT
WERE A COUNTRY OF SAINTS ....
"SO SHOULD WE KEEP OUT OF IT AND LITERALLY LET THE
CONFLICT DIE OUT GRADUALLY? NO, THE ONLY WAY IS TO
DELIBERATELY SUPPORT THE FORCES WHICH ARE STILL IN
EXISTENCE AND ORGANIZED BUT HAVE BEEN CRIMINALLY
NEGLECTED - THE FORCES WHICH WANT PEACE AND UNDERSTANDING
BETWEEN THE ETHNIC GROUPS. THEY ARE NOT CURRENTLY IN
POWER. SUPPORTING THEM, EVEN TAKING THEM SERIOUSLY,
WOULD ALSO MEAN INTERFERING AND THERE WOULD BE NO
GUARANTEE OF SUCCESS. BUT THIS IS THE ONLY JUSTIFIABLE
WAY. TO REGARD NATIONALISM, ETHNICITY AND THE STATES
RESULTING FROM THEM AS THE SOLE BASIS OF POLITICS IS
WRONG. THESE THINGS CAN ONLY LEAD TO MORE FANATICISM,
'ETHNIC CLEANSING' AND VIOLENCE. THE RESULTS WOULD BE
INEVITABLE. THE OTHER APPROACH IS WORTH A SERIOUS TRY,
IF IT IS NOT ALREADY TOO LATE. NOT GIVING THIS APPROACH
A TRY NOW WOULD MEAN TO BEAR EVEN GREATER BLAME FOR WHAT
IS HAPPENING."
2. CARL GUSTAF STROEHM WRITES IN RIGHT-OF-CENTER DIE
WELT OF BONN AND REFERS TO CLAIMS MADE BY DAVID BINDER,
BONN CORRESPONDENT OF THE NEW YORK TIMES, DURING A
DISCUSSION BROADCAST ON GERMAN TELEVISION. BINDER
ACCUSED CHANCELLOR KOHL AND FORMER FOREIGN MINISTER
UNCLAS SECTION 03 OF 06 BONN GM 02671
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR EUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD/CJ1-HN/ECJ5-E
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE,· P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART ONE OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
GENSCHER OF BEING "WAR CRIMINALS" FOR SUPPORTING
RECOGNITION OF CROATIA AND BOSNIA. THE PIECE IS CARRIED
UNDER THE HEADLINE:
"AT A DEAD END."
Page 3 of7
�F:\Cable\Oata Source\Cables\CDOO 1\FEB93\MSGS\M020 156l.html
"ONLY THE MOST INCORRIGIBLE OPTIMISTS CAN HAVE BEEN
SURPRISED AT THE FAILURE OF THE GENEVA CONFERENCE ON
BOSNIA. NOW THE SECURITY COUNCIL IS TO REACH A DECISION
- AND THE CLINTON ADMINISTRATION IS LIKELY TO GET MORE
HEAVILY INVOLVED. AS FAR AS THE UN TROOPS IN BOSNIA AND
CROATIA ARE CONCERNED, THEY HAVE NOT (AND UNDER THE
PREVAILING CIRCUMSTANCES THEY COULD NOT HAVE) FULFILLED
THE EXPECTATIONS PLACED IN THEM .... THE UN MISSION SO
FAR HAS COME TO A DEAD END .... SO FAR, GERMAN FOREIGN
POLICY HAS EXERTED PRESSURE MAINLY ON THE CROATS. IT IS
NOW TIME TO HAVE A SERIOUS WORD WITH THE MOSLEMS AS WELL.
"WHEN AN AMERICAN CORRESPONDENT SAYS ON TELEVISION
THAT IN ADDITION TO MILOSEVIC, KOHL AND GENSCHER SHOULD
ALSO BE TRIED FOR WAR CRIMES BECAUSE THEY RECOGNIZED
CROATIA AND BOSNIA, THIS DEMONSTRATES NOT ONLY A LACK OF
STYLE AND TASTE BUT ALSO A LACK OF KNOWLEDGE.
UNFORTUNATELY, THE OLD PRO-YUGOSLAV, PRO-TITO ALLIANCE IS
STILL ACTIVE IN THE UNITED STATES - AND ELSEWHERE. IS IT
STRONG ENOUGH TO CONTINUE BLOCKING EFFORTS TO FIND A
SOLUTION TO THE PROBLEM?"
3. BUSINESS NEWSPAPER HANDELSBLATT OF DUESSELDORF
CARRIES AN EDITORIAL BY CHRISTOPH RABE UNDER THE HEADLINE:
"FINAL DESTINATION UN."
"SO WHAT CAN STILL BE DONE? IN VIEW OF THE
HAIR-RAISING.LOOPHOLES IN THE EMBARGO AGAINST SERBIA, IT
IS TIME TO WORK TOGETHER TO ENSURE THAT THE BLOCKADE IS
EFFECTIVE .... IF WE CUT OFF SERBIA'S OIL SUPPLY, THIS
WILL NOT AUTOMATICALLY MEAN THE END OF THE WAR BUT THIS
MEASURE SHOULD HAVE AN EFFECT AT LEAST IN THE MEDIUM
TERM. THE INTERNATIONAL COMMUNITY IS NOT LIKELY TO
REFUSE TO LIFT THE ARMS EMBARGO ON BOSNIA FOR MUCH
LONGER. THIS STEP IS NOT LOGICALLY IMPERATIVE, BUT WHO
WANTS TO KEEP ON BEING ACCUSED OF REFUSING THE VICTIMS OF
THIS WAR THE MEANS TO DEFEND THEMSELVES?
"AND WHAT ELSE? IN THE BALKANS, NO INTERNATIONALLY
VITAL COMMODITY IS UNDER SUCH THREAT THAT ACTION LIKE
THAT IN THE GULF WAR SEEMS JUSTIFIED. INTERVENTION ON
HUMANITARIAN GROUNDS LIKE IN SOMALIA CANNOT BE REPEATED
EITHER. MILITARY ENFORCEMENT OF THE NO-FLY ZONE OVER
BOSNIA ... WOULD MERELY BE A MEANS OF DISTRACTING PUBLIC
ATTENTION. IT WOULD NOT SILENCE THE ARTILLERY.
UNCLAS SECTION 04 OF 06 BONN GM 02671
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR EUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD/CJ1-HN/ECJ5-E
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART ONE OF TWO
Page 4 of7
�F:\Cable\Data Source\Cables\CDOO 1\FEB93\MSGS\M020 156l.html
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
"THE UN MUST FIRST SEEK A WAY OF BREAKING DOWN THE
PERFIDIOUS TACTICS OF THE WARRING FACTIONS. IT CAN NO
LONGER ALLOW COMPROMISES TO BE WORKED OUT AT THE
CONFERENCE TABLE WHILE THE KILLING CONTINUES ON THE
BATTLEFIELD. BUT IT LACKS THE MEANS TO ENFORCE A
CEASEFIRE AND END THE ETHNIC CLEANSING SINCE SENDING ANY
TROOPS INTO THE BOSNIAN WAR ZONE COULD END IN DISASTER.
U.S. PRESIDENT BILL CLINTON IS NOT LIKELY TO TAKE THIS
RISK AT THE BEGINNING OF HIS TERM AND IN THE FACE OF
STRONG WARNINGS FROM MOSCOW. AND WITHOUT THE U.S.; THE
EUROPEANS WILL REMAIN INACTIVE. AS USUAL."
4. CENTRIST MAGDEBURGER VOLKSSTIMME CARRIES AN
EDITORIAL BY RUDOLF MARQUARD UNDER THE HEADLINE:
"ONLY LOSERS."
"WHY ISN'T THE WORLD LISTENING TO SUCH A LEVEL-HEADED
MAN AS FORMER POLISH PRIME MINISTER MAZOWIECKI. THE UN
HAS APPOINTED HIM TO INVESTIGATE HUMAN RIGHTS VIOLATIONS
IN THE BALKANS. HE HAS SAID THAT ALL THE GROUPS INVOLVED
IN THE WAR ARE GUILTY. BUT HE REPORTS ONE THING AS A
CAST-IRON CERTAINTY: ONLY THE SERBS ARE SYSTEMATICALLY
DESTROYING THE MOSLEMS' CULTURE.
"WHY IS WESTERN POLICY ON THE BALKANS NOT PURSUING
THIS LINE? IT MAKES IT OBVIOUS WHO IS CONDUCTING A
DIABOLICAL POLICY OF EXPANSION. NOT ONLY THE LEADER OF
THE BOSNIAN SERBS KARADZIC AND HIS CRONIES ARE TO BLAME.
THEY ARE BEING BACKED BY SERBIAN PRESIDENT MILOSEVIC.
AND BEHIND MILOSEVIC STAND THE RUSSIANS, WHO ARE
PROTECTING THEIR SLAV BROTHERS IN SERBIA. THE WORLD MUST
MAKE IT ABSOLUTELY CLEAR TO THEM THAT CREDIBLE POLICY CAN
ONLY BE BASED ON JUSTICE."
C. U.S.: EARLY DAYS OF CLINTON ADMINISTRATION
BUSINESS NEWSPAPER HANDELSBLATT .OF DUESSELDORF
CARRIES AN EDITORIAL BY WASHINGTON CORRESPONDENT VIOLA
HERMS DRATH UNDER THE HEADLINE:
"CLINTON CAN NO LONGER CHOSE THE ISSUES."
"THE NOBLE RENEWAL THESES OF THE 42ND PRESIDENT AT
THE INAUGURATION ARE STILL RINGING IN OUR EARS. BUT A
LOOK AT THE EARLY DAYS OF THE CLINTON ADMINISTRATION
WHICH BROUGHT SOME HARSH CONFRONTATIONS WITH CONGRESS,
THE MILITARY AND THE VOTERS, CAUSED EVEN THE WALL STREET
JOURNAL, WHICH HAD WELCOMED THE ANNOUNCED CHANGE, TO
SPEAK IN A COMMENTARY OF A STRANGE, 'BUMPY START.'
UNCLAS SECTION 05 OF 06 BONN GM 02671
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR EUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD/CJ1-HN/ECJ5-E
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
Page 5 of7
�F:\Cable\Data Source\Cables\CDOO 1\FEB93\MSGS\M020 1561.html
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART ONE OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
"INSTEAD OF TAKING CARE OF CREATING NEW JOBS FOR THE
NINE MILLION UNEMPLOYED, REDUCING TAXES FOR THE MIDDLE
CLASS AND TACKLING THE DEFICIT AND THE HEALTH CARE
REFORM, WHICH IS TO GET A NEW BOOST WITH THE APPOINTMENT
OF HILLARY CLINTON TO A KEY POST, BILL CLINTON COMMITTED
FIRST OF ALL A BLUNDER WHEN HE NOMINATED AN ATTORNEY
GENERAL WHO PROVED TO HAVE DONE SOMETHING ILLEGAL.
"THE LIFTING OF THE REPUBLICAN RESTRICTIONS ON
ABORTION HAD ALREADY CAUSED QUITE A COMMOTION, BUT A
STORM THEN BROKE LOOSE DURING CLINTON'S ATTEMPT TO
INTEGRATE HOMOSEXUALS INTO THE U.S. MILITARY WHICH
QUICKLY DEVELOPED INTO THE FIRST CONFLICT WITH THE
DEMOCRATIC CONGRESS, THE GENERALLY RESPECTED MILITARY
CHIEF OF STAFF COLIN POWELL, AND NOT LEAST MILLIONS OF
WAR VETERANS.
"IN VIEW OF THIS POLITICAL DEBACLE, THE PRESIDENT
STANDING WITH HIS BACK TO THE WALL SOUNDED A RETREAT THAT
WAS STYLIZED AS A COMPROMISE WHICH WILL ALLOW HIS
OPPONENTS TO FOCUS ATTENTION ON THIS EXPLOSIVE CONFLICT
MATTER BY SCHEDULING HEARINGS IN THE U.S. SENATE UNTIL
THE DEADLINE IN MID-JULY ....
"IN THE DOMESTIC POLICY CRISIS MAKING THE HEADLINES,
THE FOREIGN POLICY ADVANCES REGARDING AN ACCESSION OF THE
FRG AND JAPAN TO THE UN SECURITY COUNCIL AND THE ANALYSIS
OF THE OPTIONS IN THE BALKANS WENT ALMOST UNNOTICED.
AFTER ALL, SECRETARY OF.STATE WARREN CHRISTOPHER MADE IT
KNOWN THAT BOSNIA IS A COUNTRY 'WHERE THE U.S. SHOULD
DEMONSTRATE AN ACTIVIST INTERNATIONAL POSITION.' IN
TERMS OF ISRAEL'S SITUATION ... , IT WAS MADE CLEAR THAT A
CONTINUATION OF THE PEACE PROCESS INITIATED BY WASHINGTON
WILL HINGE ON AN IMMEDIATE DEFUSING OF THE CRISIS. CAUSED
BY THE DEPORTATION OF 415 PALESTINIANS.
"AGGRAVATED ABOUT THE DELAYING TACTICS OF UN
SECRETARY GENERAL BOUTROS GHALI REGARDING THE SENDING OF
BLUE HELMETS TO SOMALIA, THE CLINTON ADMINISTRATION IS
FURTHERMORE IN A CLINCH WITH THE STUBBORN SECRETARY
GENERAL ABOUT THE STAFFING OF THE UN MANAGEMENT. WHILE
WASHINGTON INSISTS ON NOMINATING AN AMERICAN FOR THE OPEN
POSITION OF A DEPUTY SECRETARY GENERAL AND IN CASE OF A
REJECTION RAISES THE PROSPECT OF A HARSH REACTION FROM
CONGRESS, WHICH WOULD TRANSLATE INTO SUBSTANTIAL
FINANCIAL CUTBACKS, THE EGYPTIAN DIPLOMAT IS FAVORING A
FEMALE CANDIDATE FROM NORWAY. WASHINGTON HAS POINTED OUT
THAT THE NECESSARY REFORMS OF THE UN AIMED AT ELIMINATING
WASTE AND CORRUPTION CALL FOR A COMPETENT PERSON.
"THE PRESIDENT, WHO ADVOCATED SO IMPRESSIVELY A
SPIRITUAL RENEWAL, SACRIFICES, INDIVIDUAL RESPONSIBILITY,
UNCLAS SECTION 06 OF 06 BONN GM 02671
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR EUR/PA:MPEARSON
PASS FSI/CSFA
Page 6 of7
�•
F:\Cable\Data_ Source\Cables\CDOO 1\FEB93\MSGS\M0201561.html
SECT:
SSN:
TOR:
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD/CJ1-HN/ECJ5-E
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART ONE OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
A HEALING OF SOCIAL WOUNDS AND RECONCILIATION, COULD NOT
CHOSE THE TIMING OF THIS FIRST TEST. IT THUS REMAINS TO
BE SEEN HOW HIGH A POLITICAL PRICE BILL CLINTON WILL HAVE
TO PAY FOR HIS WILLINGNESS TO COMPROMISE (ON HOMOSEXUALS
IN THE MILITARY), SOMETHING THAT LEVELS THE PATH FOR
OTHER LOBBY GROUPS EXERTING PRESSURE ON THE PRESIDENT."
(END PART ONE OF TWO)
MILLER
BT
#2671
NNNN
SECTION: 01 OF 06
<"SECT>SECTION: 02 OF 06
<"SECT>SECTION: 03 OF 06
<"SECT>SECTION: 04 OF 06
<"SECT>SECTION: 05 OF 06
<"SECT>SECTION: 06 OF 06
2671
<"SSN>2671
<"SSN>2671
<"SSN>2671
<"SSN>2671
<"SSN>2671
930202085037 M0201561
<"TOR>930202091851 M0201599
<"TOR>930202091645 M0201596
<"TOR>930202091748 M0201597
<"TOR>930202085343 M0201565
<"TOR>930202085907 M0201577
DIST:
SIT: VAX
0
Page 7 of7
�,_
-
--
rage
'
Cab 1e
PREC:
CLASS:
OSRI:
LINEl:
LINE2:
LINE3:
LINE4:
DTG:
ORIG:
TO:
INFO:
SUBJ:
IMMEDIATE
UNCLASSIFIED
RUFHLD
OATUZYUW RUFHLD 1841 0321210-UUUU--RHEHAAA.
ZNR UUUUU ZZH
0 011209Z FEB 93
FM AMEMBASSY LONDON
011209Z FEB 93
AMEMBASSY LONDON
RUEHIA/USIA WASHDC IMMEDIATE 5541
RUEAIIA/CIA WASHDC
RUEATRS/DEPTTREAS WASHDC
RUCPDC/USDOC WASHDC
RUEKJCS/DIA WASHDC
RUEKJCS/SECDEF WASHDC
RUEHC/SECSTATE WASHDC 6500
RHEHAAA/WHITEHOUSE WASHDC
RUEHAM/AMEMBASSY AMMAN S133
RUFHBE/AMEMBASSY BELGRADE 5380
RUFHOL/AMEMBASSY BONN 7926
RUEHBS/AMEMBASSY BRUSSELS 8141
RUFHDB/AMEMBASSY DUBLIN 0024
RUFHBG/AMEMBASSY LUXEMBOURG 9046
RUFHFR/AMEMBASSY PARIS 2489
RUEHRO/AMEMBASSY ROME 5324
RUFHMB/USMISSION USVIENNA 1763
RUFHNA/USMISSION USNATO 0330
RUEHGV/USMISSION GENEVA 8460
RUDOVFA/3AF RAF MILDENHALL UK
RBDBAAX//BRITISH ARMY STAFF COLLEGE CAMBERLEY UK
MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
BROADCAST MEDIA
BOSNIA
ON BBC TV'S BREAKFAST NEWS, REPORTER GEORGE EAKIN
TEXT:
UNCLAS SECTION 01 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
1
or
1'+
�r; \\...,aOle\uata ~ource\CaOies\CUUU I
\l'EB93\MSGS\M0 199123 .html
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
BROADCAST MEDIA
BOSNIA
ON BBC TV'S BREAKFAST NEWS, REPORTER GEORGE EAKIN
INTERVIEWED PEACE CONFERENCE CO-CHAIRMAN LORD OWEN ON HIS
ARRIVAL AT HEATHROW LAST NIGHT. LORD OWEN SAID :
"MY OWN VIEW IS THAT OVER DISCUSSIONS IN NEW YORK, WE
WILL GET AGREEMENT, EVEN ON THE MAP, PRIOR TO ANY
SECURITY COUNCIL RESOLUTION. AT LEAST, I HOPE SO. I
COULD DRAW YOU A MAP NOW WHICH WOULD PLEASE BOTH THE
BOSNIANS, SERBS AND BOSNIAN MUSLIMS. BUT AT THE MOMENT,
THEY ARE NOT YET PREPARED TO TRADE OFF AGAINST EACH
OTHER, BUT I THINK THAT THEY WILL. "
UNCLASSIFIED
EAKIN COMMENTED: "LORD OWEN SAYS ONE REASON WHY THE
MUSLIMS ARE HOLDING OUT IS THAT THEY THINK THE AMERICANS
ARE ABOUT TO SEND THEM MILITARY AID. INSTEAD, OWEN SAYS,
PRESIDENT CLINTON SHOULD BACK THE PEACE PLAN. "
LORD OWEN WENT ON
"I WOULD LIKE HIM (CLINTON) TO GO
ONE STEP FURTHER, WHICH WOULD BE REALLY SIGNIFICANT,
WHICH WOULD BE TO SAY HE WOULD ACCEPT U.S. FORCES IN BLUE
BERETS CONTRIBUTING TO· THE PEACE EFFORT IN BOSNIAHERCEGOVINA, PERHAPS CO-ORDINATED BY NATO. "
A. TODAY'S MAJOR NEWS STORIES
1. ERM
2. U.S. POLITICS
3. BRITISH ARMY
B. SUMMARY
1. ERM
THE WEEKEND DEVALUATION OF THE IRISH PUNT HAS TURNED MANY
UNCLAS SECTION 02 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
·PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
PAPERS' .ATTENTION BACK TO THE TWIN SUBJECTS OF THE
MAASTRICHT TREATY AND ERM. OF THE FIVE EDITORIALS THIS
Page
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�r ;\\..-aote\Uata
.,ource\CaOle-s\CUUU 1\l'hB93\MSGS\M0199123.html
MORNING, FOUR CATEGORICALLY STATED THAT THE ERM IN ITS
PRESENT FORM WOULD SOON COLLAPSE, AND THAT THIS WOULD BE
A SUBJECT OF CELEBRATION, NOT MOURNING. ONLY THE LIBERAL
GUARDIAN WAS MORE CAUTIOUS, STATING IN NON-SPECIFIC TERMS
THAT:
"EVERYTHING THAT HAS HAPPENED TO THE ERM SHOWS THAT MORE
UNCLASSIFIED
CO-OPERATION, NOT LESS, IS THE ONLY LONG-TERM ANSWER.
WITHOUT IT, EUROPE WILL CONTINUE TO SPLINTER UNDER THE
WEIGHT OF RECESSION INTO A SERIES OF COMPETITIVE
DEFLATIONARY NATIONAL ECONOMIES. "
THE CENTRIST INDEPENDENT LIKENED THE PRESIDENT OF THE
BUNDESBANK TO GODOT. "WAITING FOR HIM AND HIS COUNCIL TO
MAKE SOME MINIMAL REDUCTION IN GERMAN INTEREST RATES IS.
NO LONGER AN ADEQUATE SUBSTITUTE FOR SUBSTANTIVE REFORM."
2. U.S. POLITICS
HOMOSEXUALS AND HEALTHCARE STILL FEATURE AS TOPICS OF
INTEREST, AS WELL AS EVALUATIONS OF THE NEW PRESIDENT'S
POPULARITY. THE CENTRIST INDEPENDENT'S RUPERT CORNWELL
REPORTED FROM WASHINGTON, ON THE PAPER'S FRONT PAGE:
"WHATEVER HAPPENED TO THE U.S. PRESIDENTIAL HONEYMOON?
THE STANDARD PERIOD OF GRACE USED TO BE 100 DAYS, EVEN
SIX MONTHS. ON JANUARY 20, THE INAUGURATION OF THE FIRST
BABY-BOOMER IN THE WHITE HOUSE WAS HAILED AS A NEW
BEGINNING. TO JUDGE FROM THIS WEEKEND'S HEADLINES, THE
ASSEMBLED RANKS OF AMERICAN PUNDITRY ARE ALREADY SUING
FOR DIVORCE. "
3. BRITISH ARMY
ONE EDITORIAL IN THE CONSERVATIVE DAILY TELEGRAPH,
CALLING FOR A DELAY IN THE PROPOSED CUTS IN THE BRITISH
ARMY, IN THE LIGHT OF NEW DEVELOPMENTS IN BOSNIA AND
ELSEWHERE.
UNCLAS SECTION 03 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
C. HEADLINES
UNCLASSIFIED
1. ERM
"GOOD NEWS FROM DUBLIN" (TIMES EDITORIAL)
"AFTER THE PUNT DEVALUATION" (FINANCIAL TIMES EDITORIAL)
Page 3 ofl4
�r ;,~ilotc\Uala ~ource\caoies\CUUUl \FEB93\MSGS\M0f99123.html
"THE WORST OF ALL WORLDS" (INDEPENDENT EDITORIAL)
"THE PUNT TAKES A POUNDING" (GUARDIAN EDITORIAL)
"BURY TREATY WITH THE ERM" (TODAY EDITORIAL)
2. U.S. POLITICS
"FORCE OF UNREASON" (GUARDIAN COMMENTARY)
"CALLING THE PHONE-IN PRESIDENT" (GUARDIAN COMMENTARY)
"THE IMPORTANCE OF BEING HILLARY" (FINANCIAL TIMES
COMMENTARY)
3. BRITISH ARMY
"PEACE DIVIDEND DEFERRED" (DAILY TELEGRAPH COMMENTARY)
D. TEXT
1. ERM
THE CONSERVATIVE TIMES EDITORIALIZED:
"SATURDAY'S DEVALUATION OF THE IRISH PUNT WAS GOOD NEWS
FOR IRISH INDUSTRY AND FOR THE 17 PER CENT OF THE
UNCLASSIFIED
COUNTRY'S WORKFORCE WHO ARE NOW JOBLESS LARGELY BECAUSE
OF THE GOVERNMENT'S VAIN EFFORT TO CLING TO A NEEDLESSLY
HIGH EXCHANGE RATE. DEVALUATION WAS ALSO WELCOME TO THE
MANY SENSIBLE PEOPLE IN IRELAND WHO SWITCHED THEIR
UNCLAS SECTION 04 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PAS~ ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
SAVINGS INTO FOREIGN CURRENCIES BEFORE THE WEEKEND.
HOWEVER, THE FULL BENEFITS OF THE WEEKEND'S WORK BY
EUROPEAN FINANCE MINISTERS WILL GRADUALLY SPREAD ACROSS
ALL EUROPE IF THE IRISH DEVALUATION TURNS OUT TO BE THE
BEGINNING OF THE END FOR THE ENTIRE EXCHANGE-RATE
MECHANISM. FORTUNATELY, THIS IS QUITE LIKELY.
"MONETARY STRAINS IN EUROPE ARE NOT CAUSED BY SPECULATION
OR BY SMALL MISALIGNMENTS IN EXCHANGE RATES. THEY ARE
CAUSED BY A FUNDAMENTAL DIVERGENCE BETWEEN THE ECONOMIC
REQUIREMENTS OF GERMANY AND THE OTHER MEMBERS OF THE ERM.
"THE ERM, AT LEAST IN THE RIGID FORM THAT EVOLVED AFTER
Q1989 WHE/ JACQUES DELORS LAUNCHED HIS DRIVE FOR MONETARY
UNION, HAS DONE GREAT HARM TO EUROPE. NOT ONLY HAVE HIGH
INTEREST RATES AND OVERVALUED EXCHANGE RATES CONTRIBUTED
TO THE SHOCKING LEVELS OF UNEMPLOYMENT THAT HAVE TURNED
LARGE PARTS OF FRANCE, ITALY AND SPAIN, AS WEQL AS
Page 4 of14
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99123.html
IRELAND, INTO INDUSTRIAL DESERTS. JUST AS SERIOUSLY, THE
PREOCCUPATION OF EUROPEAN POLITICIANS WITH EXCHANGE RATES
HAS DISTRACTED ATTENTION FROM THE INFINITELY MORE
IMPORTANT ECONOMIC AND POLITICAL CHALLENGES THROWN UP BY
EVENTS IN THE PAST TWO YEARS -- THE THREAT TO THE WORLD
TRADING SYSTEM FROM THE BREAKDOWN OF GATT, THE CHALLENGE
OF CREATING A TRULY COMPETITIVE AND OPEN SINGLE MARKET,
THE NEED TO DEREGULATE INDUSTRIES AND LABOR MARKETS TO
IMPROVE EUROPE'S PRODUCTIVITY TO THE LEVELS PREVAILING IN
AMERICA AND JAPAN, AND THE CHALLENGE OF ASSISTING RUSSIA
UNCLASSIFIED
AND EASTERN EU~OPE AND INTEGRATING THEM INTO THE WESTERN
MARKET SYSTEM.
"AT THE START OF THIS DECADE THESE WERE THE TASKS
UNIVERSALLY ACKNOWLEDGED AS THE HISTORIC CHALLENGES OF
THE 1990S FOR EUROPE. YET THEY HAVE BEEN SHAMEFULLY
NEGLECTED BY MANY GOVERNMENTS THAT HAVE INSTEAD PUT THEIR
ENERGIES INTO FIGHTING SPECULATORS AND TRYING TO
MANIPULATE EXCHANGE RATES. THE ERM, FAR FROM TURNING
EUROPE INTO A 'ZONE OF MONETARY STABILITY' AS ITS
FOUNDING FATHERS INTENDED, HAS PRODUCED DESTABILIZING
FINANCIAL CRISES. THE BEST HOPE FOR EUROPE IS THAT THE
UNCLAS SECTION 05 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
ERM'S NEXT CRISIS WILL BE ITS LAST. "
THE INDEPENDENT FINANCIAL TIMES EDITORIALIZED:
"YET ANOTHER PUNCH-DRUNK EUROPEAN CURRENCY, THE IRISH
PUNT, HAS THROWN IN THE TOWEL . . . . EVERY COUNTRY IN
EUROPE, EXCEPT GERMANY (THOUGH MANY WOULD DISAGREE THERE
TOO), NEEDS FAR LOWER INTEREST RATES. THE QUESTION IS
WHETHER THEY WILL GET THEM.IN TIME. EVEN PARIS, THE MOST
RESOLUTE UPHOLDER OF THE 'HARD ERM', MUST RECOGNIZE·THAT
PERSISTENCE WITH 'RIGUEUR' MAY LEAD NOT TO THE SUNLIT
UPLANDS, BUT TO A BREAKDOWN WITH DAMAGING POLITICAL, AS
WELL AS ECONOMIC, CONSEQUENCES. TACTICAL FLEXIBILITY MAY
NOW BE A MORE SATISFACTORY ROUTE TO THE STRATEGIC GOAL OF
EMU THAN PERSISTENCE ALONG THE EC'~ PRESENT COURSE. THE
ONLY ESCAPE WOULD BE A LARGE REDUCTION IN GERMAN INTEREST
RATES . . . . IF THE BUNDESBANK IS NOT TO PROVIDE RELIEF,
Page 5 of14
�1':\Cable\Data Source\Cables\CDOOl\FEB93\MSGS\MO 199123.htnll
WHAT ARE THE ALTERNATIVES?
"GREATER CO-OPERATION OVER EXCHANGE RATE INTERVENTION IS
OF MODEST.HELP WHEN THE FORM OF CO-OPERATION MOST
UNCLASSIFIED
NEEDED -- LOOSER GERMAN MONETARY POLICY AND TIGHTER
GERMAN FISCAL POLICY -- IS UNAVAILABLE. REALIGNMENTS,
THOUGH INESCAPABLE UNDER SEVERE PRESSURE, ARE OF LIMITED
BENEFIT TOO, UNLESS LARGE. THE PROBLEM OF PERSISTENTLY
HIGH INTEREST RATES REMAINS, SINCE REALIGNMENT CAN HELP
HERE ONLY IF SUBSEQUENT UPWARD REALIGNMENTS AGAINST THE
D-MARK BECOME CREDIBLE.
"IT WOULD HAVE BEEN BEST TO HAVE AGREED A TEMPORARY
SUSPENSION OF THE D-MARK UPON GERMAN REUNIFICATION. IT
REMAINS THE BEST OPTION. LET THE BUNDESBANK FIGHT ITS
BATTLE FOR STABILITY UNHAMPERED BY THE MONETARY
CONSEQUENCES OF FOREIGN EXCHANGE INTERVENTION AND RELINK
EXCHANGE RATES WHEN GERMAN INFLATION IS ONCE MORE WHERE
THE BUNDESBANK WANTS IT. YET AN AGREED SUSPENSION OF
OTHER CURRENCIES NEED NOT DO THEM MUCH HARM. GIVEN THE
STRONG FUNDAMENTALS OF THE FRENCH ECONOMY, IN PARTICULAR,
THE FRANC MIGHT LOSE LITTLE VALUE, EVEN WITH LOWER
INTEREST RATES.
UNCLAS SECTION 06 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE fOR NSC-WEUROPE;
USMISSION SNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993 .
"'C'EST MAGNIFIQUE, MAIS CE N'EST PAS LAGUERRE; AND IT
IS NOT SENSIBLE MONETARY POLICY EITHER. EUROPEAN LEADERS
SHOULD ASK THEMSELVES WHETHER THEIR STRATEGIC GOAL OF
EUROPEAN UNION MIGHT NOT BE BETTER SERVED BY A TEMPORARY
RETREAT THAN BY GALLOPING ON TO GLORIOUS DEFEATS OR
PYRRHIC VQCTORIES. "
('IT'S MAGNIFICENT, BUT IT'S NOT WAR')
THE CENTRIST INDEPENDENT EDITORIALIZED:
"THANKS TO THE FOREIGN EXCHANGE DEALERS' CONTINUING
SUCCESS IN EXPLOITING THE GAP BETWEEN PRETENSIONS AND
UNCLASSIFIED
KNOWN WEAKNESSES, THE ERM IS CLOSE TO LOSING ITS LAST
SHREDS OF CREDIBILITY.
"THERE WAS NEVER ANYTHING FUNDAMENTALLY WRONG WITH ITS
CENTRAL CONCEPT : THAT PEGGING WEAKER CURRENCIES
Page 6 of14
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Page 7 of14
INCREASINGLY CLOSELY TO A CENTRAL OR ANCHOR CURRENCY
WOULD CREATE A ZONE OF STABILITY THAT WOULD BENEFIT ALL
THOSE WITHIN IT. THIS CAME TO BE SEEN AS A PRECURSOR OF
MONETARY UNION, FOR WHICH A TARGET DATE OF 1999 WAS SET.
WHAT WAS NEVER FORESEEN WAS THAT THE ANCHOR CURRENCY, THE
MARK, WOULD ITSELF COME UNDER SEVERE THREAT FROM
INFLATIONARY PRESSURES SPRINGING FROM THE HUGE COSTS OF
GERMAN REUNIFICATION.
"IN ONE MEMBER STATE AFTER ANOTHER, THE DEFLATION FORCED
ON THE ERM'S MEMBERS BY POLICIES DESIGNED FOR PURELY
GERMAN CONSUMPTION HAVE PROVED POLITICALLY UNACCEPTABLE
AND ECONOMICALLY TRAUMATIC. FIRST THE ITALIAN LIRA AND
STERLING LEFT. THEN THE SPANISH PESETA AND PORTUGUESE
ESCUDO WERE DEVALUED. NOW ONLY THE FRENCH FRANC, DANISH
KRONA AND BENELUX CURRENCIES (THE LATTER EFFECTIVELY FORM
PART OF A MARK ZONE) ARE CLINGING ON, DESPITE HEAVY AND
FREQUENT ASSAULTS ON THEIR FINGERTIPS.
"COUNTRIES STILL IN THE ERM NOW HAVE THE WORST OF ALL
POSSIBLE WORLDS, WITH AN APPALLING DEFLATIONARY SQUEEZE
ACCEPTED BY THEIR GOVERNMENTS FOR LARGELY POLITICAL
REASONS.
UNCLAS SECTION 07 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
"WHICH CURRENCY WILL BE THIS WEEK'S TARGET WILL SOON
BECOME EVIDENT. IF THE ERM IS NOT TO BE UTTERLY
DISCREDITED, ACTION TO REFORM IT CANNOT BE DELAYED MUCH
LONGER. THE MOST OBVIOUS ALTERNATIVES ARE FOR IT TO
UNCLASSIFIED
PAGE
REVERT TO ITS MORE FLEXIBLE FORM IN WHICH EXCHANGE RATE
ADJUSTMENTS, GENERALLY QUITE SMALL, WERE RELATIVELY
FREQUENT; OR FORWARDS, BY ACCELERATING THE TIMETABLE FOR
MONETARY UNION LAID DOWN IN THE MAASTRICHT TREATY. THAT
IS PROBABLY WHAT THE FRENCH AND BENELUX COUNTRIES WOULD
PREFER, ALTHOUGH LAST WEEK HELMUT SCHLESIGNER, PRESIDENT
OF THE BUNDESBANK, ADVISED AGAINST SUCH A MOVE. IN THIS
CONTEXT, MR SCHLESIGNER IS GODOT. WAITING FOR HIM AND
HIS COUNCIL TO MAKE SOME MINIMAL REDUCTION IN GERMAN
INTEREST RATES IS NO LONGER AN ADEQUATE SUBSTITUTE FOR
�F:\Cable\Data Soui'ce\Cables\CDOO 1\FEB93\MS-GS\MO 199123 .htrnl
Page 8 of 14
SUBSTANTIVE REFORM. "
THE LIBERAL GUARDIAN EDITORIALIZED:
"MORE THAN EVER, THE FATE OF THE PUNT UNDERLINES THE
DISASTROUS MISTAKE WHICH EUROPEAN FINANCE MINISTERS MADE
LAST SUMMER WHEN THEY FAILED TO PROMOTE A MANAGED GENERAL
REALIGNMENT OF ERM CURRENCIES. THAT FAILURE BY
POLITICIANS HAS LEFT THE FIELD OPEN TO BANKERS AND
SPECULATORS TO DO THE JOB THEIR WAY. THE WEAK HAVE BEEN
PICKED OFF ONE BY ONE, WITHOUT THE PROTECTION OF A MUTUAL
SUPPORT SYSTEM. FRANCE AS WELL AS DENMARK WILL BE NEXT,
AS SPECULATORS BET AGAINST THE RESULT OF THE FRENCH
ELECTION IN MARCH. SOME WILL DRAW THE CONCLUSION THAT IT
QALL PROV/S THAT CO-OPERATION CANNOT WORK. IN FACT IT
PROVES THE OPPOSITE. EVERYTHING THAT HAS HAPPENED TO THE
ERM SHOWS THAT MORE CO-OPERATION, NOT LESS, IS THE ONLY
LONG-TERM ANSWER. WITHOUT IT, EUROPE WILL CONTINUE TO
SPLINTER UNDER THE WEIGHT OF RECESSION INTO A SERIES OF
COMPETITIVE DEFLATIONARY NATILZIBZAFDFORIALIZED:
UNCLASSIFIED
PAGE
"THE QUESTION IS NO LONGER WHETHER THE EUROPEAN ERM WILL
UNCLAS SECTION 08 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
TOTALLY COLLAPSE, BUT WHEN.
"FORTUNATELY BRITAIN CAN WATCH ITS DEATH THROES
DISPASSIONATELY. SINCE BLACK WEDNESDAY WE HAVE BEEN OUT
OF ITS CLUTCHES.
"JOHN MAJOR DOES NOT HAVE TO BOTHER ABOUT WHEN TO REJOIN
THE ERM. BY THE TIME HE DECIDES TO, IT WILL NOT EXIST.
BUT THAT DOES NOT MEAN MR MAJOR CAN IGNORE WHAT IS
HAPPENING TO IT. HE IS CURRENTLY PUSHING THE
RATIFICATION OF THE MAASTRICHT TREATY THOUGH THE COMMONS,
FORCING MPS TO STAY UP ALL NIGHT, NIGHT AFTER NIGHT. AND
THE KEYSTONE OF THAT TREATY IS EUROPEAN MONETARY UNION.
"ALL THE EXPERIENCE OF THE PAST MONTHS HAS BEEN THAT THIS
CANNOT WORK. IT IS A DREAM OF THE POLITICIANS AND
BUREAUCRATS. YET THEY WILL NOT LET THE IMPOSSIBLE DREAM
GO.
"IT WOULD BE MADNESS TO TIE UP OUR CURRENCY, AND OUR
�.F:\Cable\Data Source\Cables\CDOU 1\FEB93\MSGS\MO i 99 f23.html
Page 9 of 14
ECONOMY, IN AN UNWORKABLE EUROPEAN SYSTEM AGAIN. AND
THAT MAKES IT MADNESS TO CARRY ON WITH THE MAASTRICHT
RATIFICATION.
"IF OUR MPS ARE GOING TO SPEND THEIR NIGHTS ARGUING THEY
SHOULD DO IT ABOUT THE GREAT ISSUES FACING THE COUNTRY
THE STATE OF THE HEALTH SERVICE, SCHOOLS AND
UNEMPLOYMENT. THEY SHOULD NOT BE WASTING THEIR TIME
PUSHING THROUGH AN ARRANGEMENT WHICH IS AT BEST
UNWORKABLE AND AT WORST WOULD DRAG THE ECONOMY DOWN
AGAIN. "
UNCLASSIFIED
PAGE
2. U.S. POLITICS
THE LIBERAL GUARDIAN EDITORIALIZED:
"IT IS BAD NEWS THAT ARMED FORCES WHICH WERE NOBLY IN THE
FOREFRONT OF BREAKING DOWN RACIAL DISCRIMINATION IN
AMERICA ARE NOW RESISTING MOVES TO ABOLISH DISCRIMINATION
AGAINST GAYS. THAT THE MAN LEADING THIS FIGHT TO
MAINTAIN THE PREJUDICE IS AMERICA'S FIRST BLACK CHAIRMAN
OF THE JOINT CHIEFS OF STAFF, GENERAL COLIN POWELL, .IS
UNCLAS SECTION 09 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.O.l2356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
ESPECIALLY IRONIC. TODAY, EVERY ARGUMENT ONCE USED TO
SUPPORT DISCRIMINATION AGAINST BLACK, AND THEN FEMALE
RECRUITS, IS BEING USED AGAINST HOMOSEXUALS.
"OF COURSE WOMEN AND BLACK PEOPLE STILL FACE HARASSMENT
AND DISCRIMINATION WITHIN THE ARMED SERVICES, BUT THE
IMPORTANF DISTINCTION IS THAT THESE PREJUDICES ARE NOW
UNLAWFUL.
"THE REAL ISSUE IS CLEAR ENOUGH : THOUSANDS OF AMERICANS
ARE BEING UNREASONABLY DENIED THEIR CIVIL RIGHT TO FIGHT
FOR THEIR COUNTRY . . . . THE PRESIDENT WAS UNEQUIVOCAL IN
HIS CAMPAIGN COMMITMENT. HE SHOULD BE AS RESOLUTE IN
OFFICE. TO BACK DOWN NOW WILL DESTROY HIS CREDIBILITY
ACROSS A WIDER AGENDA. HE IS BEING CLOSELY WATCHED TO
SEE IF HE IS READY TO KEEP HIS WORD, AND STAND UP FOR
UNPOPULAR CAUSES. EQUAL RIGHTS FOR GAY SOLDIERS HAS
BECOME THE TEST OF WHETHER HE INTENDS TO STICK TO HIS
GUNS. "
�F:\Cable\Data Source\Cables\CDOO 1\FEB93\MSGS\MO 199123.html
Page 10 of 14
IN THE SAME PAPER, WASHINGTON CORRESPONDENT SIMON TISDALL
REPORTED:
UNCLASSIFIED
PAGE
"FORGET THE FIRST 100 DAYS. BILL CLINTON IS ALREADY
SCREWING UP AFTER ONLY 10 DAYS IN OFFICE -- OR SO THE
POLITICIANS, PUNDITS AND POSTURERS WHO FORMULATE
WASHINGTON'S 'CONVENTIONAL WISDOM' WOULD HAVE YOU
BELIEVE.
"IT'S ALL NONSENSE, OF COURSE. CLINTON'S YOUNG
PRESIDENCY IS CERTAINLY BESIEGED. BUT THOSE COMMANDING
THE CANNON AND CATAPULTS ARE NOT CONGRESSIONAL PRIMA
DONNAS LIKE SAM NUNN, NOR THE SNEERING SABOTEURS OF THE
REPUBLICAN RIGHT, NOR EVEN THE GANG-BANGERS OF THE WHITE
HOUSE PRESS CORPS. CLINTON IS UNDER SIEGE FROM THE
AMERICAN PEOPLE. HAVING PROMISED A POPULIST PRESIDENCY
WHERE THE ORDINARY VOTER'S VOICE WOULD BE HEARD, HE IS
BEING HELD TO HIS WORD. HIS IS BECOMING THE PHONE-IN
PRESIDENCY. FOR CLINTON IS REAPING THE WHIRLWIND OF THE
POLITICS OF INCLUSION, DIVERSITY AND RENEWED HOPE WHICH
PUT HIM WHERE HE IS NOW. WHERE HE IS NOW HAS BECOME
VIRTUALLY IMPOSSIBLE TO REACH, ALTHOUGH THAT HASN'T PUT
UNCLAS SECTION 10 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
ANYONE OFF. JUST TRY CALLING THE MAIN WHITE.HOUSE
NUMBER. THE SWITCHBOARD IS CONSTANTLY ENGAGED.
"YET SO FAR, AT LEAST, DESPITE THE PREMATURE
PROGNOSTICATIONS OF THE CAPITAL'S CASSANDRAS, CLINTON
SEEMS TO BE ENJOYING EVERY MINUTE OF IT. IN FACT, THE
BOY'S DOING ALL RIGHT. AS THE NEW KID ON THE BLOCK GOES
THROUGH HIS PACES, IT'S THE WASHINGTON ESTABLISHMENT
WHICH IS CONFUSED. HONEYMOON IS THE WRONG WORD : THIS IS
A NEW ENGAGEMENT, IN THE BROADEST SENSE.
"MORE THAN ANY U.S. LEADER BEFORE HIM, CLINTON HAS THE
MEANS AND THE OPPORTUNITY TO CUT OUT THE MIDDLE MAN AND
CONNECT DIRECT. AND IT IS IN THIS CONTEXT THAT THE
UNCLASSIFIED
PAGE
REJECTION OF ZOE BAIRD'S NOMINATION CAN BE SEEN NOT AS A
�F:\Cable\Data Source\Cables\CDOO 1\FEB93\MSGS\MO 199123 .html
Page 11 of 14
DEFEAT, BUT AS A DEFT RESPONSE TO PUBLIC OPINION .
... WHEN THE PUBLIC GOT TO HEAR ABOUT IT, THE WHITE HOUSE
SWITCHBOARD LIT UP AND THE TALK-SHOWS WENT WILD. CALLERS
SOUGHT TO REMIND CLINTON THAT HE HAD PROMISED THAT THE
RICH AND PRIVILEGED WOULD NO LONGER GET PREFERENTIAL
TREATMENT, ESPECIALLY WHEN THEY BROKE THE LAW. LISTENING
CLOSELY, CLINTON THOUGHT AGAIN, AGREED, AND WITHIN A
REMARKABLY SHORT TIME SPAN, BAIRD'S NOMINATION WAS
HISTORY.
"DESPITE SENATOR NUNN'S SELF-SERVING CLAIMS TO HAVE SAVED
CLINTON FROM HIMSELF, LAST FRIDAY'S COMPROMISE OVER
ENDING THE BAN ON HOMOSEXUALS IN THE MILITARY WAS A
PRODUCT OF THE SAME PROCESS.
"FOR BEHIND-THE-CURVE WASHINGTON INSIDERS, THE DUCKING
AND WEAVING EVIDENT DURING THE BAIRD AND GAYS-IN-THE
MILITARY EPISODES SHOWED SLICK WILLIE AT HIS WORST. FOR
THE CAPITAL'S MEDIA ELITE, SUCH UNBLUSHING FLEXIBILITY
AFTER THE OH-SO-BRITTLE GEORGE BUSH TOOK THE COLLECTIVE
BREATH AWAY. FOR THE CAPITOL HILL MOB, CLINTON IS
ALREADY BECOMING A FAST-MOVING TARGET.
"WHAT ALL OF THEM HAVE SO FAR FAILED TO UNDERSTAND IS
THAT CLINTON ISN'T LISTENING TO THEM. AS BEST HE CAN
UNCLAS SECTION 11 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; roR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR OSLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
AMID THE CLAMOR, HE IS LISTENING TO THE AMERICAN PEOPLE
IN A WAY HIS PREDECESSORS HAD NEITHER THE MEANS NOR THE
INCLINATION TO DO. FOR THE 90S AMERICAN AUDIENCE, IT'S
NOT CONSISTENCY THAT MATTERS -- IT'S RESULTS, BASED ON A
QFAIR HEA/ING. AND BY THE WAY, EVERYONE 'OUT THERE' KNEW
HE'D HAVE TO RAISE TAXES, WHATEVER HE SAID IN THE
CAMPAIGN : ASK ANY VOTER. NEXT QUESTION. "
UNCLASSIFIED
PAGE
IN THE INDEPENDENT FINANCIAL TIMES, MICHAEL PROWSE
COMMENTED:
"THEY MIGHT HAVE BEEN MORE HONEST. FOR MOST OF THE
CAMPAIGN MRS HILLARY CLINTON WENT INTO 'COOKIE-BAKING'
MODE, GAZING ADORINGLY AT HER HUSBAND AND PROMISING TO BE
A TRADITIONAL FIRST LADY. BUT WITHIN HOURS OF THE
�F:\Cable\Data Source\Cables\CDOOl \FEB93\MSGS\MO 199123.html
Page 12 of 14
INAUGURATION, THE OLD ASSERTIVE HILLARY HAD REAPPEARED,
COMPLETE WITH MAIDEN NAME AND HEADBAND.
"HILLARY IS AS WELL-QUALIFIED ACADEMICALLY AS BILL AND,
AS A TOP ARKANSAS LAWYER, EARNED FIVE OR SIX TIMES BILL'S
MEAGER SALARY AS GOVERNOR. SHE ADVISED HIM THROUGHOUT
HIS CAREER, TO THE POINT OF CHAIRING THE COMMITTEE THAT
DEVISED THE EDUCATIONAL REFORMS NOW REGARDED AS HIS MAIN
ACHIEVEMENT IN ARKAt'!SAS. AS AN EQUAL PARTNER FOR SO MANY
YEARS, HER DESIRE FOR HANDS-ON RESPONSIBILITY IS
UNDERSTANDABLE.
"EVEN SO, HER NEW POSITION RAISES QUESTIONS. AFTER JOHN
F KENNEDY MADE HIS BROTHER ROBERT ATTORNEY GENERAL, ANTINEPOTISM LAWS WERE PASSED TO PREVENT THE APPOINTMENT OF
CLOSE RELATIVES TO POWERFUL POSITIONS. BY NOT PAYING HIS
WIFE, MR CLINTON HAS DODGED THESE CONSTRAINTS. YET
PEOPLE SEEM ODDLY RELUCTANT TO CRITICIZE HILLARY'S ROLE,
PERHAPS BECAUSE GREATER RESPONSIBILITY FOR WOMEN IS SEEN
AS SO OBVIOUSLY A GOOD THING. YET IF MR CLINTON HAD PUT
A BROTHER OR FAVORITE UNCLE IN CHARGE OF HEALTH-CARE
REFORM, ALL HELL WOULD HAVE BROKEN LOOSE.
"THE U.S. HAS HAD ALMOST AS MANY DIFFERENT FYPES OF
PRESIDENCIES AS THERE HAVE BEEN PRESIDENTS. IN AN AGE
WHEN POWER IS INCREASINGLY DISTRIBUTED EQUALLY BETWEEN
UNCLASSIFIED
UNCLAS SECTION 12 OF 13 LONDON 01841
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
PAGE
THE SEXES, A HUSBAND AND WIFE WORKING IN HARNESS CAN
ARGUABLY LEAD THE COUNTRY MORE EFFECTIVELY THAN EITHER
SPOUSE ALONE. THE PITY IS THAT THE ELECTORATE WAS NOT
ASKED MORE EXPLICITLY TO SUPPORT SUCH AN INT·RIGUING
INNOVATION. "
3. BRITISH ARMY
THE CONSERVATIVE DAILY TELEGRAPH EDITORIALIZED:
"THE HOUSE OF COMMONS SELECT COMMITTEE ON DEFENSE IS DUE
TO REPORT SHORTLY, AND IS WIDELY RUMORED TO BE URGING A
HALT TO THE OPTIONS FOR CHANGE SHRINKAGE (OF THE BRITISH
ARMY) WHILE THE GOVERNMENT GIVES FURTHER THOUGHT TO
BRITAIN'S MILITARY NEEDS. SUCH A CALL SHOULD BE HEEDED.
�-
F:\Cable\Data Source\Cables\CDOO 1\FEB93\MSGS\MO 199123.html
Page 13 ofi4
THOSE PARTS OF BRITAIN'S ARMED FORCES WHICH WERE DESIGNED
SPECIFICALLY FOR A NATO-WARSAW PACT CONFLAGRATION
CONTINUE TO LOOK OUT OF BALANCE WITH THE REST, NOW THAT
SUCH A SCENARIO IS HARDLY CONCEIVABLE.
"BUT BRITAIN IS TODAY ONE OFONLY TWO OR THREE WORLD
POWERS WHICH MAINTAIN THE ABILITY TO PLACE EFFICIENT
MILITARY FORCE AT THE DISPOSAL OF UN PEACEKEEPING OR
PEACEMAKING EFFORTS. BRITAIN'S STATUS AS ONE OF THE FIVE
PERMANENT MEMBERS OF THE SECURITY COUNCIL IMPLIES
ACCEPTANCE OF RESPONSIBILITIES MOST OTHER GOVERNMENTS DO
NOT NEED TO CATER FOR.
"FOR A RELATIVELY SMALL POWER WITH AILING ECONOMIC
STRENGTH, BRITAIN CAN TAKE PRIDE IN POSSESSING MORE THAN
ITS SHARE OF EXPERTISE IN THE MILITARY ARTS. THIS IS
VALUABLE NOT MERELY WHERE FULL SCALE WAR IS AT STAKE BUT
UNCLASSIFIED
PAGE
ALSO IN LOWER INTENSITY OPERATIONS DEMANDING THE CAREFUL
APPLICATION OF LIMITED FORCE. NORTHERN IRELAND, BELIZE
AND NOW BOSNIA HAVE ALL HELPED TO SHARPEN THOSE SKILLS,
WHICH ARE ESSENTIALLY INFANTRY SKILLS.
"FOR ONCE, THE ARMY'S COMPLAINT THAT IT IS FULLY
COMMITTED TO THE POINT OF OVERSTRETCH SHOULD NOT BE
UNCLAS SECTION 13 OF 13 LONDON 01841
USIA
nPERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
UNCLASSIFIED
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA (PAT NORMAN)
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
GENEVA PASS USDEL-NST; USIS; ACDA;
RAF MILDENHALL FOR PA;
BRITISH ARMY STAFF COLLEGE FOR USLO
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY FEBRUARY 1
1993
TREATED AS SPECIAL PLEADING TO PROTECT THE VESTED
INTERESTS OF FAMOUS INFANTRY REGIMENTS, BUT AS A REALITY
TO WHICH THE GOVERNMENT MUST RESPOND." COURTNEY
. BT
#1841
NNNN
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<"SECT>SECTION: 02 OF 13
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<"SECT>SECTION: 07 OF 13
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SSN:
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<ASECT>SECTION: 09 OF 13
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Page 14 of 14
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Magnetic Disk: Hard Drive
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
[02/02/1993 - 02/02/1993]
Creator
An entity primarily responsible for making the resource
NSC Cables
January 1993-December 1994
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7585710" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7585710-20060223F-006-013-2015
7585710
-
https://clinton.presidentiallibraries.us/files/original/34ff911c90f6f010ae48f6941abb493c.pdf
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RUFHFR
OATUZYUW RUFHFR 1923 0261043-UUUU--RHEHAAA.
ZNR UUUUU ZZH
0 261043Z JAN 93
FM AMEMBASSY PARIS
261043Z JAN 93
AMEMBASSY PARIS
RUEHIA/USIA WASHDC IMMEDIATE 7750
RUEAIIA/CIA WASHDC
RUEATRS/DEPARTMENT OF TREASURY
RUEKJCS/DIA WASHDC
RUEKJCS/SECDEF WASHDC//ASD/ISA//
RUEHC/SECSTATE WASHDC 9291
RHEHAAA/WHITE HOUSE
RUCPDC/USDOC WASHDC
RUEHXQ/ALLEC COLLECTIVE
RUEHGV/USMISSION GENEVA 8958
RUFHNA/USMISSION USNATO IMMEDIATE 0157
RUFHMB/USMISSION USVIENNA 7824
RUFRQJQ/COMSIXTHFLT
DAILY MEDIA REACTION REPORT
PARIS -- TUESDAY JANUARY 26, 2993
(A) SUMMARY OF TYPE OF COVERAGE:
EX-YUGOSLAVIA CONTINUES TO BE THE LEAD INTERNATIONAL
STORY IN THE FRENCH PRESS, AS FIGHTING BETWEEN SERBS AND
TEXT:
UNCLAS SECTION 01 OF 03 PARIS 01923
USIA
USIA
USIA FOR P/RC; P/P; P/FW P/FN; VOA NEWS/CA; EU; AF; P/M;
STATE FOR EUR/P/SP; EU/WE; AF; INR/P; PM; OSD !SA FOR
ILN; FOR NEA; WHITE HOUSE FOR NSC/WEUROPE; DOC FOR
ITAEUR/FR; USCINCEUR FOR PAO; NATO FOR USIS; GENEVA FOR
USIS; USDEL NST GENEVA; MOSCOW FOR P&C; ROME FOR
USIS/AIO; BRUSSELS FOR USIS AND USEC (PAO); USVIENNA FOR
USDEL CSCE.
E.O. 12356: N/A
TAGS: NONE
SUBJECT: DAILY MEDIA REACTION REPORT
PARIS -- TUESDAY JANUARY 26, 2993
(A) SUMMARY OF TYPE OF COVERAGE:
EX-YUGOSLAVIA CONTINUES TO BE THE LEAD INTERNATIONAL
STORY IN THE FRENCH PRESS, AS FIGHTING BETWEEN SERBS AND
CROATS HAS BEEN GOING ON. TWO FRENCH UN-PEACEKEEPERS
WERE KILLED AS A RESULT YESTERDAY. LIBERATION'S FOREIGN
DESK CHIEF PATRICK SABATIER FOCUSES ON THE QUESTION OF
THE INVOLVEMENT OF THE UN PEACEKEEPERS--"AN EASY TARGET
FOR THE BELLIGERENTS." (SEE PART D ~F REPORT).
THIS MORNING, ALL ELECTRONIC MEDIA REPORTED PRESIDENT
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CLINTON'S DECISION TO NAME HIS WIFE, HILLARY, AT THE
HEAD OF A NATIONAL HEALTH CARE TASK FORCE. ALL
COMMENTATORS UNDERLINED THAT SINCE THE CAMPAIGN, IT WAS
EXPECTED THAT MRS. CLINTON WOULDN'T STAY INACTIVE.
LIBERATION PUBLISHES AN OP-ED PIECE BY JEROME CHATEAU,
FROM THE UNIVERSITY OF MINNESOTA, URGING FOR REFORM OF
THE US HEALTH CARE SYSTEM: "A CLEAR POSITION FROM THE
CLINTON TEAM IS NECESSARY. THE COMING WEEKS WILL BE
CRUCIAL. ALTHOUGH THERE ARE IMPORTANT OBSTACLES, REFORM
OF THE HEALTH CARE SYSTEM IS A MUST; AMERICA IS PERHAPS
ON THE EVE OF A MAJOR IDEOLOGICAL TURN IN ITS HISTORY."
THE PRESS REPORTS ON A US-BELGIAN ATTACK AGAINST CLAN
MILITIAS IN KISMAYU, SOMALIA.
AFP, LE MONDE AND L'HUMANITE REPORT ON US REPRESENTATIVE
IN ANGOLA EDMUND DEJARNETTE'S "VERY FIRM WARNING" TO
UNITA LEADER SAVIMBI. "ON SUNDAY JANUARY 24, MR.
DEJARNETTE WAS A DETERRENT WEAPON", GEORGES MARION
REPORTS FROM CABINDA IN LE MONDE.
AFP'S MOSCOW BUREAU REPORTED THAT IN BORIS YELTSIN'S
VIEW (EXPRESSED IN THE COURSE OF A PRESS CONFERENCE
MONDAY), THE UNITED STATES "HAS RECENTLY SHOWN A
TENDENCY TO DICTATE ITS TERMS ON THE QUESTIONS OF IRAQ
AND YUGOSLAVIA".
INFLUENTIAL LE MONDE EDITOR DOMINIQUE DHOMBRES AUTHORS A
REPORT ABOUT JUSTICE THURGOOD MARSHALL. "JUSTICE
MARSHALL WAS A GREAT FIGURE," DHOMBRES WRITES.
(B) STORI~S COVERED IN REPORT:
1. HILLARY CLINTON (ELECTRONIC MEDIA ONLY)
2. EX-YUGOSLAVIA
3.
IRAQ
4.
ANGOLA
(C) HEADLINES:
EX-YUGOSLAVIA:
"CROATIA: UN BLUE HELMETS UNDER FIRE" (LIBERATION-FRONT
PAGE)
"TWO FRENCH SOLDIERS KILLED IN CROATIA" (LE FIGARO-FRONT
PAGE)
"SERBS AND CROATS CONTINUE TO NEGOTIATE IN GENEVA" (LE
MONDE-FRONT PAGE)
(D) SUPPORTING TEXT:
UNCLAS SECTION 02 OF 03 PARIS 01923
USIA
USIA
USIA FOR P/RC; P/P; P/FW P/FN; VOA NEWS/CA; EU; AF; P/M;
STATE FOR EUR/P/SP; EU/WE; AF; INR/P; PM; OSD ISA FOR
ILN; FOR NEA; WHITE HOUSE FOR NSC/WEUROPE; DOC FOR
ITAEUR/FR; USCINCEU~ FOR PAO; NATO FOR USIS; GENEVA FOR
USIS; USDEL NST GENEVA; MOSCOW FOR P&C; ROME FOR
USIS/AIO; BRUSSELS FOR USIS AND USEC (PAO); USVIENNA FOR
USDEL CSCE.
E.O. 12356: N/A
TAGS: NONE
SUBJECT: DAILY MEDIA REACTION REPORT
1. HILLARY CLINTON:
PHILIPPE RELTIN ON RADIO FRANCE INTER: " ... PRESIDENT
CLINTON OFFICIALLY NOMINATED HIS WIFE AT THE HEAD OF A
HEALTH CARE REFORM TASK FORCE. THE TASK FORCE WILL WORK
TO COUNTER THE CONSEQUENCES OF THE RECESSION IN THE AREA
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OF HEALTH CARE. FOR AMERICANS, THIS IS A TOP PRIORITY."
TV PRANCE 2 AT 8:00AM, WITH ANCHORMAN ETIENNE LEHNARDT:
"A CONSIDERABLE TASK; A DECISION WHICH PROVES THAT MRS.
CLINTON WILL NOT BE JUST A WALLFLOWER."
LUC BAZIZIN. ON TV FRANCE 2: " ... DURING THE CAMPAIGN,
HILLARY CLINTON HAD PROMISED THAT SHE WOULDN'T ONLY BAKE
COOKIES AT THE WHITE HOUSE--A PROMISE SHE KEPT. THE
UNITED STATES' FIRST LADY IS GOING TO GET DOWN TO
WORK .... SHE IS ALREADY CALLED THE PRESIDENT'S CLOSEST
ADVISOR."
2. EX-YUGOSLAVIA:
PATRICK SABATIER IN LIBERATION: " ... AS THE NUMBER OF
VICTIMS (AMONG UN FORCES) WILL INCREASE, THE QUESTION TO
MAINTAIN OR WITHDRAW THE UN BLUE HELMET FORCES ... WILL BE
POSED MORE ACUTELY .... THE PRINCIPAL--PERHAPS THE ONLY-MERIT OF THE BLUE HELMETS IS THEIR PRESENCE. INDEED,
FEW EXPERTS DOUBT THAT THEIR WITHDRAWAL WOULD LEAD TO A
NEW GENERAL CONFLAGRATION. THE CROATS HAVE NOT GIVEN UP
ON THE IDEA OF RECAPTURING THE SERB-OCCUPIED PARTS OF
THEIR TERRITORY AND HAVE BEEN PREPARING FOR THIS OVER
THE LAST YEAR; AS FOR THE SERBS--THOSE OF KRAJINA LIKE
THOSE OF BOSNIA, STILL WANT TO ATTACH THEIR SELFPROCLAIMED 'REPUBLICS' TO GREATER SERBIA. ALL KNOW THAT
THE LAW OF THE STRONGEST REMAINS THE BEST. AS LONG AS
PEACE IS NOT THE ACCEPTED ORDER, THE UN BLUE HELMET
SOLDIERS WILL UNFORTUNATELY BE NOTHING BUT ALIBIS,
HOSTAGES OR EVEN WORSE SACRIFICIAL LAMBS."
CONSERVATIVE LE FIGARO HEADLINES ON PAGE 3: "AFTER SERB
SLOBODAN MILOSEVIC, THE CROATIAN PRESIDENT HAS LEARNED
THE LESSONS OF WESTERN IMPOTENCE."
JEAN LEVALLOIS IN REGIONAL LA PRESSE DE LA MANCHE:
" ... WHAT IS AT STAKE IN THE BALKANS IS THE FUTURE OF THE
(WHOLE) WORLD, AT LEAST FOR THE NEAR TERM; BECAUSE IT IS
ALSO THE UNITED NATIONS WHOSE FORTUNES ARE AT STAKE
THERE. II
.
GILLES DAUXERRE IN REGIONAL L'YONNE REPUBLICAINE:
" ... THE IMMENSE HOPES FOR PEACE AND LIBERTY THAT EMERGED
AFTER THE COLLAPSE OF COMMUNISM AND THE FALL OF THE WALL
ARE DISAPPEARING IN THE YUGOSLAV CALDRON. WESTERN
DEMOCRACIES ARE DOING NOTHING, MAKING US BELIEVE THAT
THEY PREFER A POLITICAL SOLUTION RATHER THAN A MILITARY
'ADVENTURE'; BUT THEIR LACK OF WILL IS EVEN MORE OBVIOUS
THAN THEIR IMPOTENCE."
3.
IRAQ:
PIERRE BEYLAU IN WEEKLY LIBERAL LE POINT: "SADDAM
HUSSEIN HAS PERHAPS SCORED HIS FIRST VICTORY SINCE THE
GULF WAR--NOT IN MILITARY TERMS OBVIOUSLY .... BUT THE
UNCLAS SECTION 03 OF 03 PARIS 01923
USIA
USIA
USIA FOR P/RC; P/P; P/FW P/FN; VOA NEWS/CA; EU; AF; P/M;
STATE FOR EUR/P/SP; EU/WE; AF; INR/P; PM; OSD ISA FOR
ILN; FOR NEA; WHITE HOUSE FOR NSC/WEUROPE; DOC FOR
ITAEUR/FR; USCINCEUR FOR PAO; NATO FOR USIS; GENEVA FOR
USIS; USDEL NST GENEVA; MOSCOW FOR P&C; ROME FOR
USIS/AIO; BRUSSELS FOR USIS AND USEC (PAO); USVIENNA FOR
USDEL CSCE.
E.O. 12356: N/A
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SECT:
SSN:
TOR:
TAGS: NONE
SUBJECT: DAILY MEDIA REACTION REPORT
RECENT STEEL THUNDER OVER IRAQI SKIES SEEMED TO SOUND
THE DEATH KNOLL OF THE COALITION WHICH HAD OVERCOME
SADDAM'S LEGIONS IN FEBRUARY 1991. MOST OF THE ARAB OR
MUSLIM NATIONS WHICH HAD TAKEN PART IN THE CRUSADE
AGAINST THIS MODERN NABUCHODONOSOR HAVE BEEN VERY
CAUTIOUS; EVEN EGYPT, TRADITIONALLY ALIGNED WITH
WASHINGTON'S POSITION, HAS DISTANCED ITSELF FROM IT;
TURKEY IS ANGRY; RUSSIA, FRUSTRATED BECAUSE
MARGINALIZED, HAS EXPRESSED ITS DISPLEASURE. PRANCE,
FOR ITS PART, HAS SHOWN A NICE DIPLOMATIC MESS .... IN
HIS FINAL CONFRONTATION WITH SADDAM HUSSEIN, GEORGE BUSH
MADE PERHAPS A MISTAKE ON TIMING: WEAKENED, IRAQ IS. NO
LONGER PERCEIVED AS THE MAIN THREAT TO SECURITY IN THE
REGION--EXCEPT BY KUWAIT. IN THE FACE OF IRAN'S
AMBITIONS, THE IRAQI ARMY MAY REDISCOVER ITS ROLE AS
DEFENDER OF THE ARAB WORLD."
STEPHANE MARCHAND REPORTS IN FIGARO FROM WASHINGTON:
" ... SINCE HE CAME TO POWER, PRESIDENT CLINTON HAS
CONTINUED ... TO LAUNCH AIR RAIDS (AGAINST IRAQ) IN ORDER
TO PROVE, AT THE LOWEST COST POSSIBLE, THE CONTINUITY OF
US POLICY. HIS DETERMINATION IS STRENGTHENED BY US
OPINION (LOS ANGELES TIMES POLL) . THE DEMOCRATIC
PRESIDENT WILL PERSIST IN THIS LINE OF ACTION UNTIL THE
MOMENT WHEN HE THINKS HE CAN NO LONGER BE ACCUSED OF
WEAKNESS VIS-A-VIS SADDAM, A VIEW ALREADY HELD BY MANY
AMERICANS (39, SAME POLL). BUT THE NEW ADMINISTRATION
HAS SOME DOUBTS. IT IS TEMPTED TO SEE THE IRAQI
LEADER'S APPARENT GOOD WILL AS AN ENCOURAGING SIGN."
4. ANGOLA:
ECONOMIC LES ECHOS BACK-PAGE UNATTRIBUTED EDITORIAL:
" ... THIS WAS THE MOST SEVERE WARNING EVER ADDRESSED TO
JONAS SAVIMBI BY (THE UNITED STATES), A COUNTRY WHICH
DOESN'T USUALLY JOKE WHEN ITS CITIZENS AND ITS ECONOMIC
INTERESTS ARE AT STAKE. CEASE-FIRE NEGOTIATIONS ARE TO
TAKE PLACE LATER THIS WEEK IN ADDIS ABABA. IF THEY END
IN FAILURE, THE UNITED NATIONS HAS THREATENED IT MAY
WITHDRAW ITS TROOPS FROM ANGOLA. THIS WOULD BE A
RADICAL OUTCOME, UNACCEPTABLE TO WASHINGTON, WHICH MAY
THEN HAVE TO GET INVOLVED ALL OVER AGAIN IN THIS AFRICAN
CONFLICT." KORENGOLD
BT
#1923
NNNN
SECTION: 01 OF 03
<"SECT>SECTION: 02 OF 03
<"SECT>SECTION: 03 OF 03
1923
<"SSN>1923
<"SSN>1923
930126055230 M0187774
<"TOR>930126055232 M0187775
<"TOR>930126055333 M0187776
DIST:
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RUFHOL
OATUZYUW RUFHOL 2096 0271300-UUUU--RUEADWW.
ZNR UUUXX
0 271259Z JAN 93 ZNZ1
FM. USIS BONN
271259Z JAN 93
USIS BONN
RUEHIA/USIA WASHDC IMMEDIATE
RUEADWW/WHITE HOUSE NATIONAL SECURITY COUNCIL WASH DC
RUEHC/SECSTATE WASHDC
RUEKJCS/SECDEF WASHDC//USDP//ISA/DSAA
RUEKJCS/DIA WASHDC//DC-4A
RUEAIIA/CIA WASHDC
RUEATRS/TREASURY WASHDC
RUEAUSA/DEPT/LABOR WASHDC//MCCAFFREY
RUCNFRG/FRG COLLECTIVE
RUEHGV /USMISSION .GENEVA//NST /ACDA
RUEHBS/AMEMBASSY BRUSSELS//NESSEE
RUFHLD/AMEMBASSY LONDON
RUFHFR/AMEMBASSY PARIS
RUEHRO/AMEMBASSY ROME
RUDOGHA/USNMR SHAPE BE//PAA
RUFHMB/USMISSION USVIENNA//CSBM/PAA
RUFHNA/USMISSION USNATO
RHFQAAA/AFOSI DET 501 RAMSTEIN AB GE//EAC//
RUSNNOA/USCINCEUR VAIHINGEN GM//ECPA/POLAD/ECJ5//CJ1-HN
RUFDAAA/CINCUSAREUR HEIDELBERG GM
RUFTAKC/UDITUSAREUR HEIDELBERG GM
RXFMB/USSUPPORT ELEMENT HQ BALTAP//PIO/NA
RHFQSAF/17AF SEMBACH AB GE//CCH//
GERMAN MEDIA REACTION REPORT
FOLLOWING IS A REVIEW OF GERMAN MEDIA OF JANUARY 27, 1993
TEXT:
**************** INCOMPLETE MESSAGE ************************
UNCLAS SECTION 01 OF 07 BONN GM 02096
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR WUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD
USCINCEUR VAIHINGEN GE ALSO FOR//ECJS-E
· USCINCEUR VAIHINGEN GE ALSO FOR//CJ1-HN
CINCUSAFE RAMSTEIN AB GE ALSO FOR )/PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
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USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART TWO OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
FOLLOWING IS A REVIEW OF GERMAN MEDIA OF JANUARY 27, 1993
D. U.S.: HILLARY CLINTON TO REFORM HEALTH CARE
1. CENTRIST STUTTGARTER ZEITUNG AND CENTRIST
MITTELDEUTSCHE ZEITUNG OF HALLE CARRIES AN EDITORIAL BY
WASHINGTON CORRESPONDENT JUERGEN KOAR UNDER THE HEADLINE:
"JOB FOR THE FIRST LADY."
"SOME HAD FEARED IT, OTHERS HAD HOPED FOR IT, BUT
NOBODY HAD DOUBTED THAT HILLARY CLINTON WOULD TAKE OVER
TASKS IN HER HUSBAND'S ADMINISTRATION. SOONER THAN
EXPECTED, THE PRESIDENT HAS NOW CREATED FACTS WHICH ARE
GIVING NEW MEANING TO THE TITLE OF 'FIRST LADY'. HE HAS
COMMISSIONED HIS WIFE TO COME UP WITH A HEALTH CARE
REFORM WITHIN THE NEXT HUNDRED DAYS. THIS IS A
PATHBREAKING DECISION FOR TWO REASONS: NEVER BEFORE HAS
THE WIFE OF A PRESIDENT AS OPENLY PARTICIPATED IN THE
POLITICAL DECISION-MAKING PROCESS, AND NEVER BEFORE HAS
THIS ISSUE BEEN ASSIGNED SUCH A HIGH PRIORITY IN THE
WHITE HOUSE. IT IS A HERCULEAN TASK, A JOB CUT OUT FOR
SUPERMAN, AND IF HILLARY CLINTON SUCCEEDS, SHE WILL HAVE
QUALIFIED HERSELF AS SUPERWOMAN .....
"THE COST EXPLOSION IN THE HEALTH CARE SECTOR IS
UNCLAS SECTION 02 OF 07 BONN GM 02096
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR WUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD
USCINCEUR VAIHINGEN GE ALSO FOR//ECJ5-E
USCINCEUR VAIHINGEN GE ALSO FOR//CJ1-HN
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART TWO OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
BURDENING TO AN ALARMING EXTENT THE PRIVATE AND PUBLIC
BUDGETS, APPROXIMATELY 35 MILLION AMERICANS DO NOT CARRY
HEALTH INSURANCE. IN ORDER TO FINALLY CREATE A
WATERTIGHT SYSTEM AND KEEP THE COSTS WITHIN A REASONABLE
FRAMEWORK, LAWMAKERS, PUBLIC AGENCIES, INSURANCE
COMPANIES AND THE PHARMACEUTICAL INDUSTRY MUST BE BROUGHT
UNDER ONE ROOF. THIS - AND THE LACK OF POLITICAL WILLHAVE SO FAR CONDEMNED ALL EFFORTS TO FAILURE. HILLARY
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CLINTON OVERCAME SIMILAR RESISTANCE IN ARKANSAS AND
INITIATED A REFORM OF THE SCHOOL SYSTEM. NOW SHE WILL
WORK WITH HER HUSBAND AGAIN AT NO COST AND, IN THE END,
SHARE THE PRAISE AND CRITICISM WITH HIM. IT TAKES
COURAGE TO BREAK WITH TRADITIONS AND DARE AN EXPERIMENT
WHOSE OUTCOME HAS A LOT OF IMPLICATIONS - NOT LEAST FOR
ONE'S OWN REPUTATION."
2. LEFT-OF-CENTER (FORMER PDS YOUTH PAPER) JUNGE
WELT OF BERLIN CARRIES AN EDITORIAL BY ALMUTH NEHRING
UNDER THE HEADLINE:
"SHOCK FOR PURITANS."
"BILL CLINTON IS GIVING HIS PURI"I:AN CITIZENS A SHOCK
THERAPY. FIRST HE LOOSENS THE RESTRICTIONS ON ABORTIONS
AND NOW IT IS TO BE MADE POSSIBLE FOR HOMOSEXUAL MEN AND
WOMEN TO JOIN THE ARMY. STUPIDITY AND PRUDISHNESS ARE
COMING TO THE FORE WHEN MILITARY AND CONGRESSIONAL
REPRESENTATIVES FEAR THAT MORALE AND ORDER COULD BE
DISTURBED AT MISSILE BASES, ON TANKS, AIRCRAFT CARRIERS
AND IN THE CORRIDORS OF THE PENTAGON. IN THE PAST TEN
YEARS, 14,000 OF 1.8 MILLION SOLDIERS HAD TO RESIGN FROM
THE MILITARY BECAUSE THEY WERE HOMOSEXUAL. ONLY DURING
THE GULF WAR NONE OF THESE SOLDIERS WERE DISMISSED.
APPARENTLY HOMOSEXUALS DID NOT POSE A RISK FOR AMERICA AT
THE FRONT ....
"CLINTON WILL HAVE TO THINK ABOUT HOW HE WANTS TO
FULFILL HIS ELECTION CAMPAIGN PROMISE. OPEN
CONFRONTATION APPARENTLY DOES NOT WORK. NEW PENTAGON
CHIEF ASPIN HAS SUGGESTED HOLDING OFF THE DECISION
ANOTHER SIX MONTHS AND TO TAKE A MORE DIPLOMATIC
APPROACH. HOWEVER, THE NEW CREW IN THE WHITE HOUSE WILL
HAVE A HARD TIME STANDING UP AGAINST THE THOUSANDS OF
HOMOSEXUALS WHO SUPPORTED CLINTON IN THE ELECTION
CAMPAIGN. AFTER ALL, EVERY SEVENTH VOTE FOR THE
PRESIDENT CAME FROM A HOMOSEXUAL. CLINTON WAS THE FIRST
PRESIDENTIAL CANDIDATE TO MAKE THE DE-CRIMINALIZATION OF
HOMOSEXUALS AN ELECTION CAMPAIGN ISSUE."
E. ECONOMIC: GATT, U.S. ECONOMY
1. LEFT-OF-CENTER FRANKFURTER RUNDSCHAU CARRIES A
UNCLAS SECTION 03 OF 07 BONN GM 02096
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR WUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD
USCINCEUR VAIHINGEN GE ALSO FOR//ECJ5-E
USCINCEUR VAIHINGEN GE ALSO FOR//CJl-HN
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART TWO OF TWO
E.O. 12356: N/A
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SUBJECT: GERMAN MEDIA REACTION REPORT
REPORT UNDER THE HEADLINE:
"KINKEL CALLS UPON PARIS TO SHOW WILLINGNESS FOR
COMPROMISE."
"FOREIGN MINISTER KLAUS KINKEL DIRECTED AN URGENT
APPEAL TO THE PARIS GOVERNMENT NOT TO FOIL THE GATT
NEGOTIATIONS. DURING A SPEECH AT FREIBURG UNIVERSITY,
KINKEL SAID THAT A SUCCESS OF THE GATT TALKS IS A
'MUST.' BONN 'SHOWED ITS SOLIDARITY' (WITH FRANCE) 'WITH
A WILLINGNESS BORDERING ON SELF-DENIAL.' KINKEL DEMANDED
THAT 'FRANCE MUST NOW ALSO SHOW SOLIDARITY.' HE ADDED
THAT THE INTEREST OF NO PARTNER COUNTRY IN THE EC SHOULD
RESULT IN A TRADE WAR WITH THE OTHER BIG INDUSTRIALIZED
POWERS OF THE WORLD.
"KINKEL WARNED THAT A FAILURE OF THE GATT TALKS WOULD
STYMIE THE POWER CENTERS OF THE GLOBAL ECONOMY, I.E. THE
THREE INDUSTRIALIZED REGIONS IN EUROPE, JAPAN AND THE
U.S. IF 'THESE THREE' TURNED THEIR FORCES AGAINST EACH
OTHER, THERE WOULD HARDLY BE A CHANCE TO OVERCOME THE
GLOBAL CHALLENGES - LIKE THE VICIOUS CIRCLE OF POVERTY,
POPULATION EXPLOSION AND THE DESTRUCTION OF THE
ENVIRONMENT .... "
2. IN AN EDITORIAL ON THIS SPEECH, LEFT-OF-CENTER
FRANKFURTER RUNDSCHAU OPINES UNDER THE HEADLINE:
"EDUCATION TO WEARINESS."
"WELL ROARED, LION KINKEL. OF COURSE, FRANCE SHOULD
NOT FOIL THE GATT TALKS. IT IS SELF-EVIDENT THAT.A
SUCCESS OF THE GATT TALKS IS A 'MUST.'
NATURALLY, A
TRADE WAR WOULD BE DETRIMENTAL TO ALL PARTIES INVOLVED.
THESE ARE TRUISMS ... BUT TO BE HONEST, THEY ARE GETTING ON
OUR NERVES. POLITICS WOULD BE MORE CREDIBLE IF IT
DEMONSTRATED ITS ABILITY TO TAKE ACTION INSTEAD OF
RELYING ON GREAT WORDS.
"IN AN EXEMPLARY MANNER, THE GATT TALKS SHOW ON AN
INTERNATIONAL LEVEL HOW THE PUBLIC CAN BE EDUCATED TO
ADOPT A NOTORIOUS WEARINESS OF POLITICS, SINCE THE
POLITICIANS HAVE NOW BEEN PALAVERING FOR MORE THAN SEVEN
YEARS ABOUT A REDUCTION OF TARIFF BARRIERS .... AND THEY
ALWAYS MADE PROMISES THAT, IN HINDSIGHT, DID NOT COME
TRUE ....
"THIS IS 1993 AND A CONCLUSION OF THE GATT TALKS IS
NOT IN SIGHT. INSTEAD, THE 'TRADE PARTNERS' ARE FIGHTING
EACH OTHER WITH OLD AND PARTLY MORE WEAPONS .... THEY ALL
VIOLATE THE SPIRIT OF FREE TRADE, SOME WITH REGARD TO
CARS, SOME WITH REGARD TO RICE, AND STILL OTHERS WITH
UNCLAS SECTION 07 OF 07 BONN GM 02096
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR WUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD
USCINCEUR VAIHINGEN GE ALSO FOR//ECJ5-E
USCINCEUR VAIHINGEN GE ALSO FOR//CJl-HN ·
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
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SECT:
SSN:
TOR:
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART TWO OF 'l'WO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
DRAFT JUSTICE. AND THE SITUATION WILL PROBABLY BECOME
EVEN MORE PROBLEMATIC IN CASE OF MILITARILY .DANGEROUS
MISSIONS OUTSIDE OF NATO OR A LARGE NUMBER OF CASUALTIES.
"FOR ALL THESE REASONS, DEFENSE MINISTER RUEHE'S
DECISIONS WILL ULTIMATELY TURN OUT TO BE DECISIONS
POINTING IN THE DIRECTION OF A PROFESSIONAL ARMY. THE
PARTIES CURRENTLY STILL HOLDING ON TO THE DRAFT COULD
QUICKLY ADJUST TO THE ALTERED SITUATION AND, IN THIS
PROCESS, EVEN REFER TO A CONCLUSIVE POLITICAL ARGUMENT.
THE DRAFT IS A CHILD OF A SOVEREIGN NATIONAL STATE. ONLY
THIS STATE CREATED THE DEGREE OF COLLECTIVE IDENTITY THAT
IS THE PREREQUISITE FOR DEMANDING THAT SOMEONE RISK HIS
LIFE AS HIS DUTY AS A CITIZEN. IF THE TASK OF DEFEFE IS
PASSED ON FROM THE NATIONAL STATE TO A SUPRANATIONAL
ORGANIZATION, WHICH BONN IS TRYING TO ACHIEVE IN THE
COURSE OF EUROPEAN UNIFICATION, THE QUESTION ARISES ANEW
OF WHO SHOULD FULFILL THIS TASK AND HOW. UNDER THESE
CIRCUMSTANCES, A PROFESSIONAL ARMY COULD BY ALL MEANS
LOOK TO THE POLITICIANS AND THE PUBLIC LIKE THE MOST
SUITABLE INSTRUMENT TO ENSURE SECURITY IN EUROPE."
MILLER
BT
#2096
NNNN
SECTION: 01 OF 07
<"SECT>SECTION: 02 OF 07
<"SECT>SECTION: 03 OF 07
<"SECT>SECTION: 07 OF 07
2096
<"SSN>2096
<"SSN>2096
<"SSN>2096
930127080234 M0190409
<"TOR>930127092531 M0190546
<"TOR>930127092634 M0190549
<"TOR>930127080339 M0190413
DIST:
SIT: VAX
0
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'>-
_,
cab 1e
PREC:
CLASS:
OSRI:
LINEl:
LINE2:
LINE3:
LINE4:
DTG:
ORIG:
TO:
INFO:
SUBJ:
IMMEDIATE
UNCLASSIFIED
RUFHOL
OATUZYUW RUFHOL 2095 0271251-UUUU--RUEADWW.
ZNR UUUXX
0 271250Z JAN 93 ZNZ1
FM USIS BONN
271250Z JAN 93
USIS BONN
RUEHIA/USIA WASHDC IMMEDIATE
RUEADWW/WHITE HOUSE NATIONAL SECURITY COUNCIL WASH DC
RUEHC/SECSTATE WASHDC
RUEKJCS/SECDEF WASHDC//USDP//ISA/DSAA
RUEKJCS/DIA WASHDC//DC-4A
RUEAIIA/CIA WASHDC
RUEATRS/TREASURY WASHDC
RUEAUSA/DEPT/LABOR WASHDC//MCCAFFREY
RUCNFRG/FRG COLLECTIVE
RUEHGV/USMISSION GENEVA//NST/ACDA
RUEHBS/AMEMBASSY BRUSSELS//NESSEE
RUFHLD/AMEMBASSY LONDON
RUFHFR/AMEMBASSY PARIS
RUEHRO/AMEMBASSY ROME
RUDOGHA/USNMR SHAPE BE//PAA
RUFHMB/USMISSION USVIENNA//CSBM/PAA
RUFHNA/USMISSION USNATO
RHFQAAA/AFOSI DET 501 RAMSTEIN AB GE//EAC//
RUSNNOA/USCINCEUR VAIHINGEN GM//ECPA/POLAD/ECJ5//CJ1-HN
RUFDAAA/CINCUSAREUR HEIDELBERG GM
RUFTAKC/UDITUSAREUR HEIDELBERG GM
RXFMB/USSUPPORT ELEMENT HQ BALTAP//PIO/NA
RHFQSAF/17AF SEMBACH AB GE//CCH//
GERMAN MEDIA REACTION REPORT
FOLLMWING IS A REVIEW OF GERMAN MEDIA OF JANUARY 27, 1993
TEXT:
UNCLAS SECTION 01 OF 08 BONN GM 02095
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR EUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD
USCINCEUR VAIHI~GEN GE ALSO FOR//ECJ5-E
USCINCEUR VAIHINGEN GE ALSO FOR//CJ1-HN
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
Page 1 of 10
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VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART ONE OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
FOLLMWING IS A REVIEW OF GERMAN MEDIA OF JANUARY 27, 1993
CONTENTS:
A. LEAD STORIES SUMMARY
B. CROATIA: FRANCE TO REINFORCE TROOPS
C. MIDDLE EAST: U.N. PRESSURE ON ISRAEL
D. U.S.: HILLARY CLINTON TO REFORM HEALTH CARE
E. ECONOMIC: GATT, U.S. ECONOMY
F. GERMANY: FUTURE ROLE, PROFESSIONAL ARMY
A. LEAD STORIES SUMMARY
THE MAIN LEAD STORY IS THE DECISION OF THE PARIS
GOVERNMENT TO SEND THE AIRCRAFT CARRIER 'CLEMENCEAU' TO
THE ADRIATIC SEA. TWO PAPERS DEAL WITH THE CONTROVERSY
ABOUT THE GERMAN CREW MEMBERS ON AWACS AIRCRAFT, WHILE
GENERAL-ANZEIGER FOCUSES ON THE TALKS ON THE SOLIDARITY
PACT; STUTTGARTER ZEITUNG CENTERS ON THE CROATIAN
OFFENSIVE IN THE KRAJINA, SUEDDEUTSCHE ZEITUNG
CONCENTRATES ON NEW REVELATIONS IN THE LAPAS AFFAIR AND
WESTFAELISCHE RUNDSCHAU PUBLISHES EXCERPTS OF AN
INTERVIEW DDP CONDUCTED WITH FOP CHIEF OTTO GRAF
LAMBSDORFF. EDITORIALS CENTER ON THE SITUATION IN EX
YUGOSLAVIA AND U.N. PRESSURE ON ISRAEL.
B. CROATIA: FRANCE TO REINFORCE TROOPS
UNCLAS SECTION 02 OF 08 BONN GM 02095
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR EUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD
USCINCEUR VAIHINGEN GE ALSO FOR//ECJ5-E
USCINCEUR VAIHINGEN GE ALSO FOR//CJ1-HN
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART ONE OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
1. RIGHT-OF-CENTER DIE WELT OF BONN CARRIES A
FRONT-PAGE EDITORIAL BY JOCHEN THIES UNDER THE HEADLINE:
"GROWING PRESSURE."
"THE COMMUNITY OF NATIONS IS APPROACHING THE POINT
WHERE IT MUST MAKE A DECISION BECAUSE THE DEATH RATE OF
BLUEHELMETS IS ON THE RISE. 26 OF THEM HAVE ALREADY LOST
THEIR LIVES .... THERE ARE INDICATIONS THAT THE GULF WAR
COALITION WANTS TO PUT AN END TO THIS ENDLESS DRAMA.
LONDON AND PARIS HAVE ORDERED AIRCRAFT CARRIERS TO THE
ADRIATIC. FIGHTER PLANES ARE BEING CONVERTED AND
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PREPARED FOR A MILITARY STRIKE. IF NATO WERE TO GET
SERIOUS, THE CRISIS REGION IN FORMER YUGOSLAVIA WOULD
BASICALLY BE SURROUNDED BY AIR BASES FROM WHICH TO FLY
MISSIONS. SINCE THE GENEVA TALKS SEEM TO HAVE FAILED, IT
IS NOW UP TO CLINTON TO DETERMINE WHEN TO SEPARATE
THE ... OPPONENTS.
"IT ALMOST LOOKS AS IF THE GERMAN DEBATE, TOO, IS
BEING INCREASINGLY SHAPED BY THE INEVITABILITY OF
MILITARY ACTION. IN OTHER WORDS, WILL THE FOP CAVE IN,
IF GREAT BRITAIN~ FRANCE AND THE U.S. SOUND THE ALARM FOR
INTERVENTION?"
2. MASS-CIRCULATION RIGHT-OF-CENTER BILD ZEITUNG
CARRIES AN EDITORIAL BY KLAUS MERTES UNDER THE HEADLINE:
"THE BEAR IS GROWLING."
"THE WESTERN NATIONS COULD ONLY REMAIN INACTIVE
WITHOUT PUNISHMENT WHEN IT CAME TO THE BLOODY WAR IN
CENTRAL EUROPE AS LONG AS THE CHAOTIC RUSSIA DID NOT
EXERCISE ITS TRADITIONAL POWER INTEREST IN THE BALKANS.
"NOW, THE MOST POWERFUL COUNTRY IN EUROPE HAS
REPORTED BACK TO THE STAGE WITH ITS CRITICISM OF THE
CROATIAN MILITARY ACTION. THE BEAR IS GROWLING. AND
GERMANY IN PARTICULAR MUST WATCH OUT, BECAUSE FROM THE
VERY BEGINNING THE ISSUE IN THIS WAR WAS ALSO TO CONTAIN
THE FEARED PREDOMINANCE OF THE UNIFIED GERMANY IN
SOUTHEASTERN EUROPE. THIS, TOO, WAS A REASON WHY THE
SERBS WERE ALLOWED TO GATHER STRENGTH AND DO AS THEY
PLEASED. INITIALLY, THE RUSSIANS'S BACKING FOR THE SERBS
WAS MORE OR LESS TACIT, NOW THEY ARE OPENLY TAKING SIDES.
"WE DO NOT YET HAVE A SITUATION LIKE IN 1914 AGAIN,
UNLIKE THEN GERMANY IS NOT ISOLATED. BUT ONLY THE COMMON
PORT OF EUROPE OFFERS PERMANENT SECURITY. GERMANY MUST
GET IN THERE. - AS FAST AS POSSIBLE."
3. CENTRIST SUEDDEUTSCHE ZEITUNG OF MUNICH CARRIES
UNCLAS SECTION 03 OF 08 BONN GM 02095
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR EUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD
USCINCEUR VAIHINGEN GE ALSO FOR//ECJ5-E
USCINCEUR VAIHINGEN GE ALSO FOR//CJ1-HN
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART ONE OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
AN EDITORIAL BY JOSEF JOFFE UNDER THE HEADLINE:
"SHOOT AT WHOM, WHERE, WHEN AND WHY?"
REFERRING TO THE FRENCH DECISION TO SEND A CARRIER
FORCE TO THE ADRIATIC, JOFFE WRITES: "THE QUESTION,
Page 3 oflO
�e\Data Source\Cables\CDOO 1\JAN93\MSGS\MO 190383.html
HOWEVER, IS WHOM THE PILOTS SHOULD SHOOT AT - IF THEY
EVER GET OFF THE GROUND. THE BASIC DIFFERENTIATION - BAD
SERBS, GOOD CROATS - HAS ALWAYS BEEN SOMEWHAT TOO
SIMPLE ....
"THE CROATIAN ATTACKS DRAMATIZE SOMETHING THAT ONE
WOULD PREFER TO IGNORE IN LIGHT OF THE SERBS' UNDOUBTED
CRUELTIES: IN FORMER YUGOSLAVIA, A WAR HAS BASICALLY
BROKEN OUT IN WHICH EVERYBODY FIGHTS EVERYBODY. THE
ACTUAL TARGET IS THE SAINT GERMAN PEACE TREATY OF 1919
WHICH CREATED AN IMPOSSIBLE STATE CALLED YUGOSLAVIA FROM
THE BALKAN MULTIETHNIC MIX. NOW, VIOLENCE AND CUNNING
ARE BEING USED TO 'RE-SORT' AND 'REDISTRIBUTE' (THE
REGION) DEPENDING ON WHO HAS THE MILITARY UPPER HAND ....
"HOW DOES A FRENCH SOLDIER DIFFERENTIATE BETWEEN
SERBS, CROATS AND MUSLIMS, ALL OF WHOM LOOK ALIKE AND
SPEAK THE SAME LANGUAGE? UNFORTUNATELY, THESE GENTLEMEN
DO NOT HAVE SIGNS HANGING AROUND THEIR NECKS.
"A PEACE FORCE WORKS ONLY IF ALL (PARTIES) VALUE THE
ABSENCE OF WAR HIGHER THAN BATTLE. IF THE PEACE FORCE IS
ATTACKED, IT HAS ALREADY LOST THE GAME SINCE ITS PRESENCE
- ITS AUTHORITY- OBVIOUSLY DOES NOT COUNT MUCH. IT IS
POSSIBLE BUT NOT VERY LIKELY THAT RESPECT IS RESTORED
WITH AN AIRCRAFT CARRIER. THE SERBS AND CROATS HAVQ
CAREFULLY REGISTERED THE FACT THAT THE UN SECURITY
COUNCIL DOES NOT WANT TO PASS A MANDATE FOR COMBAT,
PARTICULARLY SINCE THE RUSSIANS ARE EVER MORE CLEARLY
JAMMING ON THE BRAKES. THEY, TOO, ARE AWARE OF THE
TACTICAL DILEMMA OF THE WOULD-BE BOMBERS: THEY DON'T
KNOW WHEN, WHERE AND AT WHOM TO SHOOT.
"IN RETALIATION FOR THE KILLING OF 241 MARINES
(1983), THE AMERICANS PLOWED UP PARTS OF LEBANON WITH
40-CM NAVAL SHELLS - AND THEN WITHDREW IN FRUSTRATION.
THE FRENCH ARE FACING THE SAME RISKS AND THE QUESTION OF
THE SENSE OF A TROOP CONTINGENT THAT SITS BETWEEN THE
FRONTS WITH ITS HANDS TIED."
4. CENTRIST KOELNER STADT-ANZEIGER CARRIES AN
EDITORIAL BY THOMAS MEYER UNDER THE HEADLINE:
"REINFORCEMENT."
"THE FACT THAT THE FRENCH UN TROOPS ARE EQUIPPED LIKE
UNCLAS SECTION 04 OF 08 BONN GM 02095
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR EUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD
USCINCEUR VAIHINGEN GE ALSO FOR//ECJS-E
USCINCEUR VAIHINGEN GE ALSO FOR//CJ1-HN
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART ONE OF TWO
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E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
AN INVASION ARMY TO 'ENSURE HUMANITARIAN TASKS' DEFIES
ALL CLASSICAL DEFINITIONS (OF UN BLUEHELMETS). BUT THE
PEACEFUL BLUEHELMET TROOPER WHOSE MERE PRESENCE
GUARANTEES THE CEASEFIRE IS NOWADAYS MOSTLY FICTION
ANYWAY - ANOTHER REASON FOR BONN TO CREATE CLARITY IN THE
BASIC LAW.
"BUT BACK TO BOSNIA: ARE THE SERBS CURRENTLY
PEACEFUL LIKE LAMBS? BY NO MEANS, THEY ARE ALREADY
TANGLING WITH THE UN TROOPS TO GET THEIR HEAVY ARTILLERY
BACK. THE MONITORING OF THE FLIGHT BAN AND THUS AN ARMED
INTERVENTION AGAINST SERBIAN TROOPS IS PART OF THE WAR
SCENARIO IN THE BALKANS. THAT IS UNLESS THE RUSSIANS PUT
IN THEIR VETO AT THE UN. COULD BONN THEN REJOICE BECAUSE
IT WOULD BE SPARED A DECISION ON THE WITHDRAWAL OF THE
GERMAN AIR FORCE FROM AWACS PLANES? CERTAINLY NOT:
THERE WOULD BE A HIGH PRICE FOR THIS. A CONFLICT BETWEEN
CLINTON'S U.S. AND YELTSIN'S RUSSIA. THIS WOULD BE A
STEP BACK TO THE COLD WAR AND, ABOVE ALL, EXPOSE THE
INNOCENT VICTIMS TO EVEN GREATER ATROCITIES BY THE
WARLORDS."
5. CENTRIST WESTDEUTSCHE ALLGEMEINE OF ESSEN CARRIES
AN EDITORIAL BY PARIS CORRESPONDENT EMIL BOELTE UNDER THE
HEADLINE:
"FLEET PROTECTION."
"FRANCE IS TOO WEAK AND ITS MILITARY NOT PROPERLY
EQUIPPED TO TAKE ANY ACTION WITHOUT THE SUPPORT OF THE
UN. DESPITE NUMEROUS DEMANDS (FOR MILITARY INTERVENTION)
THERE IS ALSO A LACK OF NATIONAL CONSENSUS FOR ANY
UNILATERAL MOVES .... MITTERRAND'S MORTARS WILL HELP THE
BLUEHELMETS TO AT LEAST DEFEND THEMSELVES IN A MORE
EFFECTIVE MANNER. BUT THAT IS ALL. IF ONE WANTS MORE,
THE SECURITY COUNCIL OF WHICH FRANCE IS A PERMANENT AND
INFLUENTIAL MEMBER WILL HAVE TO ORDER IT."
6. CENTRIST STUTTGARTER ZEITUNG CARRIES AN EDITORIAL
UNDER THE HEADLINE:
"CONDEMNATION OF CROATIA."
"THE DIPLOMATIC PROTESTS DID NOT ACCOMPLISH ANYTHING
IN BELGRADE. IT BECAME EVIDENT THESE PAST DAYS AGAIN
THAT OIL AND OTHER WAR EQUIPMENT OF IMPORTANCE TO THE
SERBS ARE STILL MAKING THEIR WAY TO THEIR DESTINATIONS
DESPITE ALL UN RESOLUTIONS. SO WHAT DO THE CROATS HAVE
TO FEAR, PARTICULARLY SINCE THEY CAN EVEN CLAIM TO HAVE
IMPLEMENTED THE UN PEACE PLAN, THOUGH WITH MILITARY
FORCE? THE CROATIAN OFFENSIVE IN THE DALMATIAN
HINTERLANDS HAS REVEALED FOR THE UMPTEENTH TIME THE UN
UNCLAS SECTION 0.5 OF 08 BONN GM 02095
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR EUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD
USCINCEUR VAIHINGEN GE ALSO FOR//ECJS-E
USCINCEUR VAIHINGEN GE ALSO FOR//CJl-HN
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
Page 5 oflO
�F:\Cable\Data Source\Cables\CDOO 1\JAN93\MSGS\MO 190383 .html
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART ONE OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
AND THE EC'S HELPLESSNESS."
C. MIDDLE EAST: UN PRESSURE ON ISRAEL
1. CENTRIST SUEDDEUTSCHE. ZEITUNG OF MUNICH CARRIES
AN EDITORIAL UNDER THE HEADLINE:
"HAMAS, ISRAEL AND DOUBLE STANDARDS."
"IN THE INTERNATIONAL COMMUNITY, THE IMPRESSION HAS
BEEN CREATED THAT SECURITY COUNCIL RESOLUTIONS ARE BEING
ENFORCED WITH DIFFERING DEGREES OF URGENCY. THIS IS THE
JUSTIFICATION UN SECRETARY GENERAL GHALI GAVE FOR CALLING
ON ISRAEL TO COMPLY WITH RESOLUTION 799 AND TAKE BACK THE
400 HAMAS ACTIVISTS IMMEDIATELY. JERUSALEM REACTED TO
THE REFERENCE TO ARAB DISPLEASURE ABOUT AMERICAN STRIKES
ON IRAQ WITH BITTERNESS.:80"
.DV ISRAEL'S DETRIMENT RATHER
THAN ITS BENEFIT.
"THE ISRAELIS REGARD THE FACT THAT THE WORLD IS
IGNORING THE TRAGIC EVENTS WHICH LED TO THE DEPORTATION
(A WAVE OF FUNDAMENTALIST KILLINGS OF SOLDIERS AND
CIVILIANS WHICH ARE ALSO SPREADING CHAOS AND FEAR IN
OTHER ARAB STATES) AS ONE-SIDED. IT IS TRUE THAT THE UN
HAS OFFERED NO PRESCRIPTION FOR DEALING WITH GROUPS LIKE
HAMAS AND THE ISLAMIC JIHAD, WHICH ARE NOT ONLY COMMITTED
TO TERRORISM BUT HAVE ALSO DECLARED THEIR INTENTION TO
FIGHT AGAINST THE MIDDLE EAST PEACE PROCESS. THIS IS ONE
SIDE OF THE COIN. THE OTHER IS THAT A CONSTITUTIONAL
STATE LIKE ISRAEL SHOULD NOT PASS HASTY JUDGMENTS (OR, TO
BE MORE EXACT, SHOULD NOT PASS ANY JUDGMENT AT ALL) EVEN
IN TIMES OF CRISIS. IF THE AUTHORITIES HAD ARRESTED THE
400 AND THEN LEFT IT TO THE JUDICIARY TO DECIDE ON THEIR
GUILT AND PUNISHMENT, RABIN'S GOVERNMENT WOULD NOT BE IN
A SITUATION WHERE IT IS BEING CONDEMNED BY BOTH THE
SECURITY COUNCIL AND THE SUPREME COURT.
"THE SECURITY COUNCIL WOULD BE WELL ADVISED TO AWAIT
THE FINDINGS OF THE SUPREME COURT. THE RABIN GOVERNMENT
WILL FIND IT EASIER TO BOW TO THE JUDGMENT OF THE COURT.
THREATS OF SANCTIONS FROM NEW YORK, ON THE OTHER HAND,
COULD HINQER ISRAEL FROM CHANGING ITS STANCE. THIS WOULD
HELP THE DEPORTED."
2. LOTHAR RUEHL WRITES IN RIGHT-OF-CENTER DIE WELT
OF BONN UNDER THE HEADLIN4:
"UN NOT MUCH HELP."
"BOUTROS GHALI'S CALL FOR THE SECURITY COUNCIL TO
FORCE ISRAEL TO UNCONDITIONALLY TAKE BACK THE HAMAS
UNCLAS SECTION 06 OF 08 BONN GM 02095
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR EUR/PA:MPEARSON
Page 6 of10
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PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD
USCINCEUR VAIHINGEN GE ALSO FOR//ECJ5-E
USCINCEUR VAIHINGEN GE ALSO FOR//CJl-HN
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M,· P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART ONE. OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
ACTIVISTS DEPORTED TO LEBANON IS PART OF THE LOGIC OF UN
POLICY. SO FAR, THE UN HAS DONE LITTLE TO SUPPORT
NEGOTIATIONS ON A COMPROMISE BETWEEN ISRAEL AND ITS ARAB
NEIGHBORS. THE PEACE PROCESS IN THE MIDDLE EAST CAME
ABOUT THROUGH AMERICAN MEDIATION BASED ON AMERICAN
INITIATIVES. BOUTROS GHALI AND THE UN REPRESENT MORE THE
OLD THINKING OF THE PAST, IN WHICH THE MAJORITY OF UN
MEMBERS USUALLY TOOK THE SIDE OF THE ARABS. SINCE THEN,
NOTHING MUCH HAS CHANGED.
"BOUTROS GHALI KNOWS PERFECTLY WELL THAT ... WEEKS AGO,
ISRAEL OFFERED TO TAKE BACK THE HAMAS ACTIVISTS IF THEY
GAVE UP THEIR RESISTANCE TO THE ISRAELI AUTHORITIES AND
PROMISED NOT TO SUPPORT 'TERRORIST ACTIVITIES' IN THE
OCCUPIED TERRITORIES. BUT THE HAMAS HAVE NOT SO FAR BEEN
PREPARED TO MAKE SUCH AN UNDERTAKING. TELEVISION
COVERAGE WARMS THEM IN THE WINTERY COLD AS WITNESSES OF
RADICAL, ANTI-ISRAELI ISLAMIC FUNDAMENTALISM WHO WILL
ALLOW NO PEACE WITH ISRAEL - IN A DEMONSTRATION INTENDED
TO PORTRAY ISRAEL AS INHUMAN, THE ARAB GOVERNMENTS AS
OPPORTUNISTIC AND ARAFAT'S PLO AS IMPOTENT. THIS SHOW ON
THE WORLD STAGE IS TO BE CARRIED ON FOR AS LONG AS
POSSIBLE. THE GOVERNMENT IN JERUSALEM WILL HAVE TIME TO
CONSIDER THE EXTENT AND CONSEQUENCES OF THE DEPORTATION,
WHICH HAS BROUGHT ISRAEL NO ADDITIONAL SECURITY. THE UN
IS NOT HELPING IT TO FIND A WAY OUT OF THE AFFAIR. ONLY
AN ISRAELI INITIATIVE CAN END THE PLAY ACTING."
3. NINA CORSTEN WRITES IN FAR-LEFT DIE TAGESZEITUNG
OF BERLIN UNDER THE HEADLINE:
"WAITING FOR THE JUDGMENT."
"THE ISRAELI GOVERNENT HAS NOT ONLY BEEN PLAYING FOR
TIME OVER THE PAST WEEK. IT HAS TRIED TO SHIFT THE
DEBATE ONTO TERRAIN WHERE IT BELIEVES 'COMPROMISES' ARE
POSSIBLE WITHOUT THE NEED TO ABANDON PRINCIPLES. IT IS
TREATING THE SITUATION OF THE DEPORTEES AS A
'HUMANITARIAN ISSUE' - THE UNANSWERED QUESTION UNDER
INTERNATIONAL LAW IS TO BE TRANSFORMED INTO A JUDICIAL
PROBLEM WHICH CAN ONLY BE RESOLVED WITHIN THE FRAMEWORK
OF THE ISRAELI LEGAL SYSTEM ....
"IN THIS HIGHLY POLITICAL TRIAL, THE SUPREME COURT
HAS A CHOICE: IT CAN SUPPORT THE HARDLY REFUTABLE
OBJECTIONS TO THE DEPORTATION UNDER INTERNATIONAL LAW.
OR IT CAN BECOME A PASSIVE INSTRUMENT OF ISRAELI
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GOVERNMENT POLICY. OVER THE COMING DAYS AND WEEKS, THE
JUDGES WILL NOT ONLY BE DECIDING ON THE FATE OF THE
DEPORTEES. THEY ALSO HAVE THE CHANCE TO DEMONSTRATE THAT
ISRAEL STILL HAS AN INDEPENDENT JUDICIARY. SHOULD THEY
DECIDE AGAINST THE POLICY OF DEPORTATION, THEY WOULD
UNCLAS SECTION 07 OF 08 BONN GM 02095
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR EUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD
USCINCEUR VAIHINGEN GE ALSO FOR//ECJ5-E
USCINCEUR VAIHINGEN GE ALSO FOR//CJl-HN
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART ONE OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
BRING ABOUT THE FIRST MAJOR DEFEAT FOR THE RABIN
GOVERNMENT, BUT MIGHT SPARE IT A SERIOUS CONFRONTATION
WITH THE UN SECURITY COUNCIL."
4. CENTRIST KOELNER STADT-ANZEIGER CARRIES AN
EDITORIAL BY FRANK ROSSOW UNDER THE HEADLINE:
"RABIN'S UNTENABLE POSITION."
"THE EMOTIONALLY UNDERSTANDABLE BUT INHUMAN,
POLITICALLY FOOLISH AND ILLEGAL DEMONSTRATION OF ISRAELI
TOUGHNESS HAS DONE SERIOUS HARM TO ISRAEL'S REPUTATION.
PRIME MINISTER RABIN, THE MAJORITY OF WHOSE CABINET ARE
AGAINST HIM, SHOULD THUS REALIZE THATTHE ONLY SOLUTION
IS TO RETURN THE DEPORTEES AND - IF THE EVIDENCE IS
SUFFICIENT - BRING THEM BEFORE A REGULAR COURT.
"SADDAM HUSSEIN'S LATEST ATTEMPT TO LINK HIS LUNATIC
LUST FOR EXPANSION WITH THE FATE OF THE PALESTINIANS
SEEMS MORE CREDIBLE THIS TIME - NOT ONLY TO THE MASSES.
OTHER ARAB GOVERNMENTS ARE ALSO COMPLAINING THAT THE
INTERNATIONAL COMMUNITY IS OBVIOUSLY APPLYING DIFFERENT
STANDARDS IN THE. CASES OF ISRAEL AND IRAQ. RABIN'S TRULY
IRRESPONSIBLE STATEMENT THAT THE UN CAN DECIDE WHATEVER
IT WANTS HAS ONCE AGAIN DEMONSTRATED TO THE ARABS THAT
THEY ARE POWERLESS IN A WESTERN-DOMINATED WORLD WHICH IS
MORE INTERESTED IN THE FLOW OF CHEAP CRUDE OIL THAN IN
ENFORCING HUMAN RIGHTS."
5. RIGHT-OF-CENTER RHEINISCHE POST OF DUESSELDORF
FEATURES A PIECE BY GODEHARD UHLEMANN UNDER THE HEADLINE:
"SOLUTION SOUGHT."
"ANYONE WHO BELIEVES THAT WASHINGTON WOULD VETO ANY
STEPS CONSIDERED AT THE SECURITY COUNCIL TO FORCE ISRAEL
TO ABANDON ITS TOUGH POSITION IS MISUNDERSTANDING THE
SITUATION. THE U.S. COULD ALSO LOSE FACE. THIS IS THE
DANGER FOR THE PALESTINIANS. SO FAR, THEY HAVE SCORED A
Page 8 of 10
�F:\Cable\Data Source\Cables\CDOO 1\JAN93\MSGS\MO 190383.html
"
SECT:
SSN:
POLITICAL VICTORY BECAUSE ISRAEL IS WRITHING IN THE
PILLORY OF WORLD OPINION. BUT THIS WILL TURN INTO A
PHYRRIC VICTORY IF THE PALESTINIANS ABANDON HIGHER AIMS
FOR THE SAKE OF QUICK SUCCESSES."
6. LEFT-OF-CENTER BERLINER ZEITUNG CARRIES AN
EDITORIAL BY FRITZ HANSEN UNDER THE HEADLINE:
"A QUESTION OF AUTHORITY."
"RABIN'S GOVERNMENT HAS QUITE UNNECESSARILY
CHALLENGED THE SECURITY COUNCIL. IT HAS PUT PRESIDENT
CLINTON IN THE UNPLEASANT POSITION OF HAVING TO DECIDE
UNCLAS SECTION 08 OF 08 BONN GM 02095
USIA
BRESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR EUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD
USCINCEUR VAIHINGEN GE ALSO FOR//ECJ5-E
USCINCEUR VAIHINGEN GE ALSO FOR//CJ1-HN
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART ONE OF TWO
E.O. 12356: ·N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
BETWEEN A POSSIBLE VETO AND A BREAK WITH ISRAEL WHICH
WOULD CAUSE CONSIDERABLE DOMESTIC PROBLEMS."
7. LEFT-OF-CENTER NUERNBERGER NACHRICHTEN MAKES THE
FOLLOWING COMMENT:
"THE QUESTION NOW IS WHETHER BILL CLINTON, LIKE
GEORGE BUSH, WILL PROVE TO BE A FRIEND OF ISRAEL OR
WHETHER HE WILL ADOPT A TOUGHER LINE. WILL HE USE HIS
VETO AS SOON AS JERUSALEM'S INTERESTS ARE IN JEOPARDY?
OR WILL HE -AS STATEMENTS MADE BY AMERICA'S AMBASSADOR
TO TEL AVIV SUGGEST - INSIST THAT ISRAEL ADHERES TO UN
RESOLUTIONS JUST·AS STRICTLY AS SADDAM HUSSEIN? ONLY
WHEN THIS HAS BEEN DETERMINED WILL A NEW CHAPTER IN THE
HISTORY OF THE MIDDLE EAST BE OPENED."
(END PART ONE OF TWO)
MILLER
BT
#2095
NNNN
SECTION: 01 OF 08
<"SECT>SECTION: 02 OF 08
<"SECT>SECTION: 03 OF 08
<"SECT>SECTION: 04 OF 08
<"SECT>SECTION: 05 OF 08
<"SECT>SECTION: 06 OF 08
<"SECT>SECTION: 07 OF 08
<"SECT>SECTION: 08 OF 08
2095
Page ':J or 10
�F:\Cable\Data_ Source\Cables\CDOO 1\JAN93\MSGS\MO 190383.html
TOR:
<ASSN>2095
<ASSN>2095
<ASSN>2095
<ASSN>'2095
<ASSN>2095
<ASSN>2095
<ASSN>2095
930127075102 M0190383
<ATOR>930127075519 M0190395
<ATOR>930127075620 M0190396
<ATOR>930127075722 M0190398
<ATOR>930127075928 M0190404
<ATOR>930127075825 M0190401
<ATOR>930127075927 M0190403
<ATOR>930127075515 M0190393
DIST:
SIT: VAX
D
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Cab 1e
PREC:
CLASS:
OSRI:
LINEl:
LINE2 :
LINE3:
LINE4:
DTG:
ORIG:
TO:
INFO:
SUBJ:
IMMEDIATE
UNCLASSIFIED
RUFHOLA
OAAUZYUW RUFHOLA3208 0391528-UUXX--RUEADWW.
ZNR UUUXX
0 081527Z FEB 93 ZNZ1
FM USIS BONN
081527Z FEB 93
USIS BONN
RUEHIA/USIA WASHDC IMMEDIATE
RUEADWW/WHITE HOUSE NATIONAL SECURITY COUNCIL WASH DC
RUEHC/SECSTATE WASHDC
RUEKJCS/SECDEF WASHDC//USDP//ISA/DSAA
RUEKJCS/DIA WASHDC//DC-4A
RUEAIIA/CIA WASHDC
RUEATRS/TREASURY WASHDC
RUEHC/DEPT/LABOR WASHDC//MCCAFFREY
RUCNFRG/FRG COLLECTIVE
RUEHGV/USMISSION GENEVA//NST/ACDA
RUEHBS/AMEMBASSY BRUSSELS//NESSEE
RUFHLD/AMEMBASSY LONDON
RUFHFR/AMEMBASSY PARIS
RUEHRO/AMEMBASSY ROME
RUDOGHA/USNMR SHAPE BE//PAA
RUFHMB/USMISSION USVIENNA//CSBM/PAA
RUFHNA/USMISSION USNATO
RHFQAAA/AFOSI DET 501 RAMSTEIN AB GE//EAC//
RUSNNOA/USCINCEUR VAIHINGEN GM//ECPA/POLAD/ECJ5//CJ1-HN
RUFDAAA/CINCUSAREUR HEIDELBERG GM
RUFTAKC/UDITUSAREUR HEIDELBERG GM
RXFMB/USSUPPORT ELEMENT HQ BALTAP//PIO/NA
RHFQSAF/17AF SEMBACH AB GE//CCH//
GERMAN MEDIA REACTION REPORT
FOLLOWING IS A REVIEW OF GERMAN MEDIA OF FEBRUARY 08, 1993
TEXT:
UNCLAS SECTION 01 OF 05 BONN GM 03208
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR WUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD/CJ1-HN/ECJ5-E
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION.-- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM.
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
Page 1 of7
�. F:\Cable\Data_ Source\Cables\CDOO 1\FEB93\MSGS\M0213894.html
PART TWO OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
FOLLOWING IS A REVIEW OF GERMAN MEDIA OF FEBRUARY 08, 1993
D. CLINTON ADMINISTRATION: EARLY DAYS
1. MONDAY'S RIGHT-OF-CENTER DIE WELT OF BONN CARRIES
A FRONT-PAGE EDITORIAL BY WASHINGTON CORRESPONDENT FRITZ
WIRTH UNDER THE HEADLINE:
"BLUNDERS ON THE POTOMAC."
"WANTED: ATTORNEY GENERAL, IF POSSIBLE FEMALE.
PREREQUISITES: GOOD UPBRINGING, PREFERABLY SINGLE WOMAN
WITHOUT PLAYBOY CONTACTS. BILL CLINTON'S SEARCH FOR AN
ADMINISTRATOR OF LAW IS GRADUALLY DEVELOPING INTO AN
EMBARRASSING FARCE ....
"CLINTON.IS STILL AN APPRENTICE AFTER JUST 18 DAYS IN
OFFICE. HOWEVER, THE MAIN CHARACTERISTIC OF A SUCCESSFUL
APPRENTICESHIP IS TO LEARN FROM ONE'S MISTAKES. HAD THIS
BEEN THE CASE, THIS LAST BLUNDER WOULD NOT HAVE
HAPPENED. AS A RESULT, THE FALSE START IS TURNING INTO A
CRISIS WHICH TOGETHER WITH THE UNFORTUNATE DEBATE ABOUT
HOMOSEXUALS WITH THE PENTAGON GENERALS LEAVES ONLY ONE
CONCLUSION: THE ROAD FROM PROVINCIAL LITTLE ROCK TO
WASHINGTON IS LONGER THAN CLINTON HAD IMAGINED. THE
ADMINISTRATION LED BY CLINTON MAY BE SHORT OF CASH, BUT
IT IS SURELY PAYING ITS DUES."
2. WASHINGTON CORRESPONDENT GUENTER DE THIER
UNCLAS SECTION 02 OF 05 BONN GM 03208
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR WUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD/CJ1-HN/ECJ5-E
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
.·"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART TWO OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
COMMENTS IN MONDAY'S RIGHT-OF-CENTER RHEINISCHE POST OF
DUESSELDORF UNDER THE HEADLINE:
"NEW VICTIM."
"THE MORALIZING KNOW-IT-ALLS ARE NOT STOPPING TO
SCRUTINIZE APPLICANTS FOR PUBLIC OFFICE UNDER A
MICROSCOPE AND THUS PREVENTING THE NOMINATION OF
QUALIFIED CANDIDATES."
3. MONDAY'S CENTRIST STUTTGARTER ZEITUNG AND
CENTRIST KOELNER STADT-ANZEIGER CARRY AN EDITORIAL BY
WASHINGTON CORRESPONDENT JUERGEN KOAR UNDER THE HEADLINE:
"BLUNDER NUMBER TWO."
"BILL AND HILLARY CLINTON WANTED TO SEND A SIGNAL AND
GIVE THIS IMPORTANT POST TO A WOMAN. THIS NARROWS DOWN
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�F:\Cable\Data Source\Cables\CDOO 1\FEB93\MSGS\M0213894.html
THE CHOICE. A LOT FEWER WOMEN THAN MEN CAN DECIDE TO
PURSUE A CAREER THAT WOULD QUALIFY THEM FOR SUCH A POST.
IT IS OFTEN DIFFICULT TO COMBINE A CAREER AND CHILDREN.
CLINTON'S DIFFICULTIES ARE PUTTING THE SPOTLIGHT ON A
PROBLEM OF SOCIETY. A SYMBOLIC DECISION WAS INTENDED TO
PROVE THAT WOMEN CAN BY ALL MEANS MAKE IT TO THE TOP
WITHOUT HAVING TO GIVE UP CHILDREN. THIS GOOD INTENTION
HAS NOW LED TO THE SECOND BLUNDER .... CLINTON IS DOING
CAREER WOMEN A DISSERVICE."
4. MONDAY'S RIGHT-OF-CENTER MUENCHENER MERKUR
COMMENTS: "(CLINTON) SHOULD NOT FORGET THAT A SPOILED
REPUTATION IS, IF AT ALL, DIFFICULT TO RESTORE. THE
FIRST BLEMISHES ARE ALREADY TARNISHING CLINTON'S IMAGE OF
SUCCESS."
5. MONDAY'S CENTRIST GENERAL-ANZEIGER OF BONN
CARRIES AN EDITORIAL BY WASHINGTON CORRESPONDENT UWE
KNUEPFER COMMENTING ON THE ZOE BAIRD/KIMBA WOOD AFFAIR:
"IT WAS, FOR ONE, CL-INTON'S FIRST DEFEAT, BUT SECONDLY IT
ENTAILS AN AMAZING LESSON: UNTIL JUST A SHORT TIME AGO,
IT WAS FATAL FOR A CAREER IN U.S. POLITICS TO HAVE AN
EXTRAMARITAL AFFAIR. NOW, IT IS DANGEROUS TO VIOLATE THE
LAW AND NOT PAY ONE'S TAXES ON TIME .... "
KNUEPFER, HOWEVER, POINTS OUT CLINTON'S ACHIEVEMENTS,
SAYING: "CLINTON SEEMS TO BE SERIOUS ABOUT REDUCING THE
GIGANTIC BUDGET DEFICIT ... AND INTRODUCING AN ENERGY TAX.
THIS WOULD MEAN NOTHING LESS THAN AN ACCELERATED FAREWELL
TO THE AMERICAN WAY OF LIFE. CHEAP GAS, CHEAP OIL, CHEAP
ELECTRICITY ARE THE ELIXIRS OF LIFE OF THE DISPOSAL AND
AUTOMOBILE SOCIETY .... CLINTON HAS COMMISSIONED HIS WIFE
TO FORMULATE A HEALTH CARE REFORM WITHIN 100 DAYS, AND
THIS REFORM WILL BE RATHER RADICAL .... THE 'FAMILY
UNCLAS SECTION 03 OF 05 BONN GM 03208
US;IA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR WUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD/CJ1-HN/ECJ5-E
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART TWO OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
LEAVE' BILL WILL ALLOW U.S. EMPLOYEES FOR THE FIRST TIME
TO TAKE LEAVE TO CARE FOR A SICK CHILD, A FURTHER STEP IN
THE DIRECTION OF A SOCIAL STATE. BILL CLINTON WANTS TO
INTRODUCE HIS ECONOMIC PROGRAM IN TEN DAYS. IT WILL
INCLUDE MASSIVE INVESTMENTS IN INFRASTRUCTURE, SCHOOLS,
AND THE COMMUNICATIONS NETWORK .... ALL IN ALL, THIS IS
NOTHING TO LAUGH AT FOR THE FIRST WEEKS OF A NEW
PRESIDENT."
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6. MONDAY'S CENTRIST MUENCHENER ABENDZEITUNG CARRIES
A COMMENTARY BY HELMUT LINDEMANN UNDER THE HEADLINE:
"AMATEUR CLINTON."
"THE NEW U.S. PRESIDENT IS RUNNING THE RISK OF BEING
LABELED AN AMATEUR. THIS WAS ALREADY HIS SECOND ATTEMPT
TO WIN A WOMAN AS ATTORNEY GENERAL WHICH FAILED BECAUSE
HIS CANDIDATE WITHDREW .... THE SUPERFICIAL IMPRESSION OF
HAVING VOTED AN AMATEUR INTO THE WHITE HOUSE IS
STRENGTHENED BY CLINTON'S HESITANCY IN MATTERS OF FOREIGN
POLICY. CLINTON MAY HAVE GOOD REASONS NOT TO WANT TO
TREAT THE YUGOSLAVIA CRISIS WITH THE VANCE/OWEN
PRESCRIPTION. HOWEVER, SINCE THE ISSUE HAS BEEN ON THE
AGENDA FOR MORE THAN A YEAR, ONE COULD EXPECT THE
PRESIDENT OR HIS SECRETARY OF STATE TO OFFER AN
ALTERNATIVE SOON. INSTEAD THEY ASK FOR MORE TIME TO
PONDER THE ISSUE. IT COULD PROVE FATAL FOR CLINTON THAT
HE IS ALREADY BEING COMPARED TO JIMMY CARTER. - A
PRESIDENT WITH HIGH MORALS, BUT LITTLE ASSERTIVENESS: AN
AMATEUR. IN ANY CASE, A LUCKLESS AMATEUR."
E. U.S.-RUSSIA: RELATIONS
SATURDAY'S RIGHT-OF-CENTER FRANKFURTER ALLGEMEINE
CARRIED AN EDITORIAL UNDER THE HEADLINE:
"CLINTON AND YELTSIN."
"FOREIGN POLICY IS TAKING UP A LOT MORE OF CLINTON'S
ATTENTION THAN HE HAD THOUGHT WHEN ASSUMING OFFICE. THAT
CLINTON'S WORK SCHEDULE IS DE.TERMINED MORE BY
INTERNATIONAL RESTRAINTS THAN HE WOULD WISH IS DUE FIRST
AND FOREMOST TO THE WAR IN THE BALKANS, THE STILL
PRECARIOUS SITUATION IN THE GULF AND THE ONCE AGAIN
STALLING ISRAELI-ARAB PEACE NEGOTIATIONS. BEFORE THIS
BACKGROUND, THE MEETING BETWEEN THE U.S. AND RUSSIAN
FOREIGN MINISTERS SCHEDULED FOR THIS MONTH IN GENEVA IS
GAINING SIGNIFICANCE PARTICULARLY SINCE IT IS MEANT TO
PREPARE A RAPID MEETING BETWEEN CLINTON AND YELTSIN.
WHILE THERE SEEMED TO BE HARDLY ANY DIFFERENCES OF
OPINION BETWEEN WASHINGTON AND MOSCOW WHEN IT CAME TO
ASSESSING AND DEALING WITH SO-CALLED REGIONAL CONFLICTS
UNCLAS SECTION 04 OF 05 BONN GM 03208
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
SfATE FOR WUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR. VAIHINGEN GE ALSO FOR//ERPAO/POLAD/CJ1-HN/ECJ5-E
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART TWO OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
UNTIL RECENTLY, RUSSIA IS MEANWHILE INCREASINGLY TAKING
SIDES WITH SERBIA AND DISTANCING ITSELF FROM U.S. POLICY
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�F:\Cable\Data Source\Cables\CDOOI \FEB93\MSGS\M0213894.html
IN THE GULF. FROM CLINTON'S VIEW, CLARIFYING TALKS HAVE
BECOME ALL THE MORE URGENT BECAUSE YELTSIN IS HAVING TO
DEAL INCREASINGLY WITH PAN-SLAVIC FORCES, WHICH HARBOR NO
SYMPATHIES FOR THE WEST."
F. ECONOMIC: NAFTA, EC-U.S. TRADE TENSIONS
1. MONDAY'S CENTRIST GENERAL-ANZEIGER OF BONN AND
CENTRIST SUEDDEUTSCHE ZEITUNG OF MUNICH CARRY A REPORT BY
WASHINGTON CORRESPONDENT PETER DE THIER UNDER THE
HEADLINE:
"U.S. IS PINNING ITS HOPES ON NAFTA RATHER THAN GATT
- DISAPPOINTMENT ABOUT FOREIGN MINISTER KINKEL'S VISITS 'FRONTS MORE HARDENED THAN EVER.'"
"THE U~S. ADMINISTRATION WAS PARTICULARLY
DISAPPOINTED ABOUT THE FACT THAT GERMAN MINISTER (KINKEL)
DID NOT EVEN TAKE THE TROUBLE TO INFORM HIMSELF ABOUT THE
CURRENT PROBLEMS (IN U.S.-EC RELATIONS) IN THE RUN-UP TO
THE VISIT. EVEN BEFORE HIS MEETING WITH SECRETARY OF
STATE CHRISTOPHER AND PRESIDENT CLINTON, KINKEL ADMITTED
TO JOURNALISTS IN WASHINGTON TO NOT KNOWING ANYTHING
ABOUT THE TELECOMMUNICATIONS DISPUTE BETWEEN THE EC AND
THE U.S ....
"THE REACTIONS FROM LEADING ECONOMIC ADVISORS
UNDERLINE JUST HOW DISILLUSIONED THE AMERICANS ARE ABOUT
THE SLOW PROGRESS IN THE URUGUAY ROUND.
'THE SUBSEQUENT
MEETING WITH MULRONEY (ON THE DAY AFTER KINKEL'S
DEPARTURE) WAS A DIRECT SIGNAL TO THE GERMANS, ' OPINED
NATIONAL ECONOMIST ROBERT HARRIS ..... A SHIFT IN
PRIORITIES IS INDEED TAKING SHAPE IN WASHINGTON. SINCE
THE INTERNATIONALLY INEXPERIENCED PRESIDENT CANNOT AFFORD
RISKING ISOLATION AND MUST DEMONSTRATE GOOD WILL WHEN IT
COMES TO LIBERALIZING GLOBAL TRADE, THE WHITE HOUSE
CANNOT SIMPLY TURN ITS BACK ON THE URUGUAY ROUND. ON THE
OTHER HAND, THE ADMINISTRATION'S FOCUS IS ON AN EXPANSION
OF NAFTA MORE THAN ON GATT ....
"THE CLINTON ADMINISTRATION IS BY ALL MEANS AWARE OF
THE FACT THAT IT HAS TO SEIZE THE INITIATIVE TO GET THE
URUGUAY ROUND GOING AGAIN AND BRING ABOUT A SUCCESSFUL
CONCLUSION. BUT TRADE REPRESENTATIVE MICKEY KANTOR HAS
ALREADY POSTPONED ONCE THE PLANNED MEETING WITH EC
COMMISSIONER LEON BRITTAN BECAUSE HE, IN HIS OWN WORDS,
'DOES NOT WANT TO BE RAILROADED.' ON THE OTHER HAND, THE
WHITE HOUSE STILL HAS UNTIL MARCH 2 TO PRESENT A GATT
PACKAGE TO CONGRESS TO BE DECIDED UPON WITH THE SO-CALLED
'FAST TRACK' PROCEDURE. HOWEVER, IT IS UNLIKELY THAT THE
UNCLAS SECTION 05 OF 05 BONN GM 03208
USIA
BRUESSELS ALSO FOR USIS AND USEC
USNATO ALSO FOR USDELMC
STATE FOR WUR/PA:MPEARSON
PASS FSI/CSFA
USCINCEUR VAIHINGEN GE ALSO FOR//ECPAO/POLAD/CJ1-HN/ECJ5-E
CINCUSAFE RAMSTEIN AB GE ALSO FOR //PA/POLAD
USSUPPORT ELEMENT HQ BALTAP ALSO FOR //PIO/NATO
HQUSAF WASHDC ALSO FOR //XOXX//
"PERISHABLE INFORMATION -- DO NOT SERVICE"
USIA EU, P/M, P/RM, P/FW, P/FN, P/R, P/RWE, P/GR,
VOA/BRE, P/P, MBFR - STATE
EUR/CE;EUR:P/M.PEARSON;PM;INR/RWE;S/CSCE/J.KORNBLUM
Page 5 of7
�F:\Cable\Data Source\Cables\CDOOI \FEB93\MSGS\M0213894.html
VAIHINGEN FOR ECPA-O:CDR MCCURDY
LONDON FOR POL
PART TWO OF TWO
E.O. 12356: N/A
SUBJECT: GERMAN MEDIA REACTION REPORT
ADMINISTRATION WILL BE ABLE TO ADHERE TO THIS DATE.
OBSERVERS IN WASHINGTON RATHER BELIEVE THAT THE CLINTON
ADMINISTRATION WILL SHOW A TENDENCY TO APPLY ITS OWN
TRADE LAWS ALSO TO THE EUROPEANS IN THE FUTURE AND TO
INCREASINGLY MILK FOREIGN COMPANIES, ANOTHER ISSUE THAT
IS HIGHLY CONTROVERSIAL WITHIN GATT."
2. MONDAY'S LEFT-OF-CENTER (FORMER SED PAPER) NEUES
DEUTSCHLAND OF BERLIN CARRIES AN EDITORIAL BY WERNER
GOLDSTEIN UNDER THE HEADLINE:
"AN EYE FOR AN EYE."
COMMENTING ON EC PROTESTS AGAINST THE U.S. THREAT TO
IMPOSE PUNITIVE TARIFFS ON STEEL AND OTHER DUMPING GOODS
AND OF EXCLUDING EC TELECOMMUNICATIONS COMPANIES FROM
BIDS FOR U.S. GOVERNMENT CONTRACTS, GOLDSTEIN WRITES:
"BILLIONS ARE AT STAKE AND THE 'PROTEST' FROM BRUSSE-LS IS
THUS CORRESPONDINGLY LOUD. AFTER ALL, THIS IS PART OF
THE POKER GAME ON THE GLOBAL MARKET. THE COMPETITORS ARE
SPARRING ACCORDING TO THE MOTTO 'AN EYE FOR AN EYE.'
"BUT BRUSSELS' OUTRAGE IS HYPOCRITICAL. AFTER ALL,
IT HAS KNOWN FOR A LONG TIME ABOUT THE U.S. DUMPING
COMPLAINT IN THE STEEL SECTOR. AND BRUSSELS ITSELF JUST
RECENTLY ORDERED THAT EC BIDDERS BE GIVEN PREFERENCE IN
PUBLIC CONTRACTS, THUS LEAVING THE AMERICANS OUT IN THE
COLD.
"THE ONLY THING NEW IS THAT A NEW BOSS IS OCCUPYING
THE WHITE HOUSE WHO HAS SENT HIS NEW TRADE
·REPRESENTATIVE, A LEGAL SPOKESMAN OF POWERFUL U.S.
INDUSTRIAL FIRMS AND ARMS MANUFACTURERS, INTO THE RING.
AS YET, THIS IS AS IN MANY PREVIOUS INSTANCES MERELY
VERBAL SPARRING. AND - AS USUALLY - ONE WILL PROBABLY
REACH AN AGREEMENT THIS TIME AROUND TO KEEP THE COMPANY
COFFERS ON BOTH SIDES OF THE ATLANTIC FULL. THE TRAGIC
PART IS THAT REAL VICTIMS COME OUT OF THIS
SHADOW-BOXING. THE 'TRADE WAR' IS AN EXCUSE TO CUT BACK
JOBS, BE IT AT BETHLEHEM STEEL OR THYSSEN, AT
WESTINGHOUSE OR SIEMENS."
MILLER
BT
#3208
NNNN
SECT: SECTION: 01 OF 05
<"SECT>SECTION: 02 OF 05
<"SECT>SECTION: 03 OF 05
<"SECT>SECTION: 04 OF 05
<"SECT>SECTION: 05 OF 05
SSN: 3208
<"SSN>3208
<"SSN>3208
<"SSN>3208
<"SSN>3208
TOR: 930208102826 M0213894
<"TOR>930208103035 M0213899
<"TOR>930208103137 M0213900
Page 6 of/
�.
F:\Cable\Data Source\Cables\CDOOI \FEB93\MSGS\M0213894.html
..
<ATOR>930208103240 M0213902
<ATOR>930208103241 M0213903
DIST:
SIT: VAX
D
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�F:\Cable\Data Source\Cables\CDOO 1\FEB93\MSGS\M0240606.html
...
..__
Cab 1e
PREC:
CLASS:
OSRI:
LINEl:
LINE2:
LINE3:
LINE4:
DTG:
ORIG:
TO:
INFO:
SUBJ:
PRIORITY
UNCLASSIFIED
RUEHBYA
PAAUZYUW RUEHBYA1279 0540613-UUUU~-RHEHAAA.
ZNR UUUUU ZZH
P 230613Z FEB 93
FM AMEMBASSY CANBERRA
230613Z FEB 93
AMEMBASSY CANBERRA
RUEHIA/USIA WASHDC PRIORITY 8640
RHEHAAA/WHITEHOUSE WASHDC PRIORITY
RUEHC/SECSTATE WASHDC PRIORITY 7410
RUEKJCS/SECDEF WASHDC PRIORITY
RUEHDN/AMCONSUL SYDNEY PRIORITY 4228
RUEHBN/AMCONSUL MELBOURNE PRIORITY 3758
RUEHPT/AMCONSUL PERTH PRIORITY 0586
RUEHBI/AMCONSUL BRISBANE PRIORITY 0096
RUEHUL/AMEMBASSY SEOUL PRIORITY 4115
RUEHKO/AMEMBASSY TOKYO PRIORITY 0607
RUEHWL/AMEMBASSY WELLINGTON PRIORITY 2109
RUEHPM/AMEMBASSY PORT MORESBY PRIORITY 4016
RUEHVA/AMEMBASSY SUVA PRIORITY 2081
RUEHML/AMEMBASSY MANILA PRIORITY 2479
RUHVPAC/CINCPACAF HICKAM AFB HI PRIORITY
RUWTNOL/USCINCSPACE PETERSON AFB CO//POLAD// PRIORITY
RUHVPAC/HQPACAF HICKAM AFB HI//XP// PRIORITY
RULNEAA/PMCMIDEMII ABERDEEN PROVING GROUND MD PRIORITY
RUHQHQB/USCINCPAC HONOLULU HI//USIA// PRIORITY
RUHVPAC/HQPACAF HICKAM.AFB HI //PAI// PRIORITY
****
USIA-MEDIA REACTION REPORT FEBRUARY 23, 1993
PROGRESS OF THE CLINTON PROGRAM
TEXT:
UNCLAS SECTION 01 OF 02 CANBERRA 01279
USIA
USIA FOR P/M, EA, R, P/P, P/PFF, P/F, P/G, NEA; STATE
FOR EAP/ANZ; SECDEF FOR USDP/ISA
E.O. 12356: N/A
SUBJECT: USIA-MEDIA REACTION REPORT FEBRUARY 23, 1993
PROGRESS OF THE CLINTON PROGRAM
1. MELBOURNE'S LIBERAL AGE TODAY FEATURED A STORY BY
ITS U.S. ~ORRESPONDENT HEADED, 'THE COST OF CLINTON'S
VISION' THAT READ, "MR. CLINTON'S VIGOROUS
CAMPAIGNING IN OHIO, MISSOURI AND CALIFORNIA IN
RECENT DAYS SHOWS THAT EVEN HE IS UNSURE OF HIS
MANDATE AND OF HIS SUPPORT IN CONGRESS. LIKE MR.
REAGAN 12 YEARS AGO, HE HOPES TO BUILD A BASE OF
PUBLIC SUPPORT THAT WILL BEND CONGRESS TO HIS
WILL .... MR. CLINTON APPEARS TO BE ACHIEVING HIS
GOAL .... THE CHALLENGE FOR CLINTON IS TO KEEP
AMERICAN EYES ON THE BROAD AIMS AND OFF THE DETAILS."
Page i ofj
�F:\Cable\Data Source\Cables\CD001\FEB93\MSGS\M0240606.html
2. CONSERVATIVE AUSTRALIAN TODAY CARRIED THIS FROM
ITS WASHINGTON CORRESPONDENT, "A COUNTRY GROWN
.
ACCUSTOMED TO A BONE LAZY LEADER HAS BEEN STRUCK BY
CLINTON'S ENTHUSIASM, THE LONG HOURS HE DEVOTES TO
THE JOB AND HIS WILLINGNESS TO TRAVEL EXTENSIVELY AS
HE REACHES OUT FOR PUBLIC SUPPORT .... CLINTON WENT
OVER EVERY LINE OF THE BUDGET FOUR TIMES .... WHEN HE
WASN'T CROUCHED OVER THE FIGURES, CLINTON WAS ON
CAPITOL HILL WORKING THE CONGRESSMEN OR OUT IN THE
COUNTRY SOFTENING UP THE PUBLIC. PUT SIMPLY, BILL
CLINTON CONNECTS .... IN A BUSY FOUR WEEKS THOUGH,
CLINTON'S MOST COURAGEOUS--SOME WOULD SAY FOOLISH-DECISION HAS TO HAND OVER THE REFORM OF THE NATION'S
GIGANTIC HEALTH INDUSTRY TO HIS WIFE .... NOTHING
CLINTON DOES ON ECONOMIC REFORM WILL SUCCEED IF
HILLARY FAILS. THE INITIAL SIGNS ARE POSITIVE WITH
POLITICAL FOES AND FRIENDS ALIKE SAYING SHE HAS MADE
AN IMPRESSIVE START."
3. BOTH MELBOURNE'S LIBERAL AGE AND LIBERAL SYDNEY
MORNING HERALD TODAY HAD AN OP-ED ARTICLE BY THE HEAD
OF THE SYDNEY INSTITUTE WHO COMMENTED, "IN HIS STATE
OF THE UNION ADDRESS BILL CLINTON CAME UP WITH A
COURAGEOUS PLAN TO HALVE THE DEFICIT AS A PERCENTAGE
OF GOP OVER FOUR YEARS. HOWEVER, THIS PROPOSAL DOES
NOT TAKE INTO ACCOUNT ANY INCREASE IN EXPENDITURE
CONSEQUENT UPON THE REPORT OF THE HEALTH-CARE TASK
FORCE .... IF REPORTS ARE ACCURATE, WHAT HILLARY
CLINTON HAS IN MIND IS THE BIGGEST GOVERNMENT-FUNDED
PROGRAM SINCE THE NEW DEAL OF THE 1930S .... HILLARY
CLINTON'S RECORD SUGGESTS THAT, FROM TIME TO TIME,
SHE MIXES A HEALTHY DEGREE OF PRAGMATISM WITH HER
ON~OING IDEOLOGY ....
THE JURY IS VERY MUCH OUT ON
HILLARY CLINTON. IF SHE ACHIEVES REFORM OF THE
EXPENSIVE U.S. HEALTH-CARE SYSTEM, THE (CLINTON)
PARTNERSHIP WILL GO MARCHING ON. BUT IF SHE FAILS,
BOTH BILL AND HILLARY WILL BE DIMINISHED."
THE FALLING DOLLAR -- GOOD NEWS
4. BUSINESS-ORIENTED AUSTRALIAN FINANCIAL REVIEW'S
ECONOMIC EDITOR TODAY NOTED, "THE U.S. DOLLAR IS
FALLING BECAUSE THE CLINTON ADMINISTRATION HAS
SIGNALLED THAT THE UNITED STATES WILL AT LEAST MOVE
TO REDUCE ITS FED.ERAL BUDGET DEFICIT. . . . THE U.S.
BUDGET TIGHTENING IS AIMED AT CLIPPING GOVERNMENT
CONSUMPTION, WHILE A WEAKER U.S. DOLLAR WILL MAKE
AMERICAN INDUSTRY MORE COMPETITIVE ON WORLD
UNCLAS SECTION 02 OF 02 CANBERRA 01279
USIA
USIA FOR P/M, EA, R, P/P, P/PFF, P/F, P/G, NEA; STATE
FOR EAP/ANZ; SECDEF FOR USDP/ISA
E.O. 12356: N/A
SUBJECT: USIA-MEDIA REACTION REPORT FEBRUARY 23, 1993
MARKETS--AND THUS ABLE TO MAKE INROADS INTO THE
JAPANESE TRADE SURPLUS. THIS IN TURN, WILL EASE
PROTECTIONIST PRESSURES AT HOME FOR CLINTON, HELPING
HIM TO MAINTAIN A FREE TRADE OUTLOOK." FARMER
BT
#1279
NNNN
Page 2 of3
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"·
SECT:
SSN:
TOR:
SECTION: 01 OF 02
<ASECT>SECTION: 02 OF 02
1279
<ASSN>1279
930223011914 M0240606
<ATOR>930223011917 M0240607
DIST:
SIT: VAX
D
Page 3 of3
�F:\Cable\Data_Source\Cables\CD003\SEP93\MSGS\M0612861.html
__,
Cab 1e
PREC:· IMMEDIATE
CLASS: UNCLASSIFIED
LINEl: OAAUZYUW RUFHLDA7066 2631229-UUUU--RHEHAAA.
LINE2: ZNR UUUUU ZZH
LINE3: 0 2012252 SEP 93
LINE4: FM AMEMBASSY LONDON
OSRI: RUFHLD
DTG: 2012252 SEP 93
ORIG: AMEMBASSY LONDON
TO: RUEHIA/USIA WASHDC IMMEDIATE 8007
INFO: RUEAIIA/CIA WASHDC
RUEATRS/DEPTTREAS WASHDC
RUCPDC/USDOC WASHDC
RUEKJCS/DIA WASHDC
RUEKJCS/SECDEF WASHDC
RUEHC/SECSTATE WASHDC'9557
RHEHAAA/WHITEHOUSE WASHDC
RUFHBE/AMEMBASSY BELGRADE 7073
RUFHOL/AMEMBASSY BONN 0739
RUEHBS/AMEMBASSY BRUSSELS 0163
RUFHFR/AMEMBASSY PARIS 5465
RUEHBJ/AMEMBASSY BEIJING 3173
RUEHRO/AMEMBASSY ROME 7651
RUEHKO/AMEMBASSY TOKYO 2123
RUFHZG/AMEMBASSY ZAGREB 3230
RUCNDT/USMISSION USUN NEW YORK 2682
RUFHMB/USMISSION USVIENNA 3690
RUFHNA/USMISSION USNATO 2185
RUSNNOA/USCINCEUR VAIHINGEN
RUDOVFA/3AF RAF MILDENHALL UK
SUBJ:
MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
BROADCAST MEDIA
CHINA OLYMPIC BID
ON BBC TV'S BREAKFAST NEWS THIS MORNING, REPORTER BRIAN
TEXT:
UNCLAS SECTION 01 OF 10 LONDON 17066
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
Page 1 of 12
�F:\Cable\Data Source\Cables\CD003\SEP93\MSGS\M0612861.html
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
BROADCAST MEDIA
CHINA OLYMPIC BID
ON BBC TV'S BREAKFAST NEWS THIS MORNING, REPORTER BRIAN
BARRON SAID FROM CHINA:
"BEHIND THE MAWKISH VIDEO PROMOTION IS POLITBURO
WILLPOWER. THE QUEST FOR THE 2,000 OLYMPICS IS A MAJOR
FOREIGN POLICY GOAL. SO FAR THE PROMISE OF A MORE OPEN
CHINA IS NOTHING MORE THAN A PROPAGANDA STATEMENT. THE
RELEASE OF SEVERAL PROMINENT POLITICAL PRISONERS IS A
CLUMSY ATTEMPT TO CARRY SUPPORT AT MONTE CARLO.
BEIJING'S MOST OBVIOUS SHORTCOMINGS, LIKE THE INADEQUATE
AIRPORT, HAVE LED TO AN ADVERSE IOC TECHNICAL ASSESSMENT.
CHINA'S ANSWER IS TO FORGE AHEAD WITH OLYMPIC-RELATED
CONSTRUCTION.
"PERHAPS THE BEST POLITICAL ARGUMENT FOR BEIJING IS WHAT
HAPPENED AT SEOUL, SOUTH KOREA'S CAPITAL, WHICH HOSTED
THE 1988 GAMES. IN THE LENGTHY RUN-UP TO THOSE OLYMPICS,
THE REPRESSIVE MILITARY REGIME WAS FORCED BY POPULAR
PRESSURE TO MAKE DEMOCRATIC REFORMS. THE OLYMPICS COULD
BE A SIMILAR ENGINE FOR CHANGE FOR CHINA TOO.·"
A. TODAY'S MAJOR NEWS STORIES
1 . WORLD TRADE
2. U.S. POLITICS/ HEALTHCARE REFORMS
3. BOSNIA
4. CHINA OLYMPIC BID
B. SUMMARY
1. WORLD TRADE
THIS HAS ONCE AGAIN COME TO THE FOREFRONT OF THE NEWS
AGENDA. THE LIBERAL GUARDIAN REPORTED:
"FRANTIC DIPLOMATIC EFFORTS WERE UNDER WAY IN BRUSSELS
LAST NIGHT TO AVERT A FRENCH VETO TODAY OF A KEY PILLAR
OF THE GATT WORLD TRADE AGREEMENT -- THE BLAIR HOUSE
ACCORD SLASHING EC FARM TRADE SUBSIDIES. A VETO OF THE
U.S.-EC FARM TRADE AGREEMENT WOULD PRECIPITATE A SPLIT IN
THE EC AND MIGHT TRIGGER THE COLLAPSE OF THE ENTIRE GATT
URUGUAY ROUND TRADE DEAL."
UNCLAS SECTION 02 OF 10 LONDON 17066
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PW
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL~CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
2. U.S. POLITICS/ HEALTHCARE REFORMS
Page 2 of12
�F:\Cable\Data Source\Cables\CD003\SEP93\MSGS\M061286l.html
ALL OF THE SERIOUS PAPERS TODAY PREVIEW THIS WEEK'S
ANNOUNCEMENT BY PRESIDENT CLINTON ON HEALTHCARE, LOOKING
AT THE LIKELY CHANGES AND THEIR CHANCES OF BECOMING LAW.
PAPERS AGREE THAT THERE IS A MUCH WIDER POLITICAL
CONSENSUS ON HEALTHCARE REFORM THAN FOR, SAY, THE
PRESIDENTIAL BUDGET CHANGES .. HOWEVER, COMMENTATORS ALSO
STRESS THE SCALE AND RADICAL NATURE OF THE REFORM,
CALLING IT A 'GAMBLE' FOR THE PRESIDENT AND THE COUNTRY.
THE INDEPENDENT FINANCIAL TIMES EXPLAINED TO ITS READERS:
"THE BEST WAY FOR NON-AMERICANS TO UNDERSTAND WHY REFORM
HAS BECOME A POLITICAL IMPERATIVE IS TO IMAGINE WHAT THE
HEALTH SYSTEM IN THE UK, SAY, MIGHT LOOK LIKE IF THE
NATIONAL HEALTH SERVICE HAD NOT BEEN CREATED IN THE LATE
1940S."
3. BOSNIA
THE LIBERAL GUARDIAN EDITORIALIZED:
"MORE NEW INITIATIVES, MORE NEW IDEAS, ARE URGENTLY
NEEDED. BOSNIA WILL SOON BE BACK ON OUR FRONT PAGES AND
THE WINTER IS LESS THAN A MONTH AWAY. "
4. CHINA OLYMPIC BID
THE INDEPENDENT FINANCIAL TIMES EDITORIALIZED:
"TRADE SANCTIONS ARE NOT AN APPROPRIATE WAY TO ADVANCE
THE CAUSE OF HUMAN RIGHTS IN CHINA. BUT TO COMMIT THE
WORLD TO HOLDING ITS TOP SPORTING EVENT IN BEIJING IN
SEVEN YEARS WOULD AMOUNT TO A VOTE OF CONFIDENCE IN
CHINA'S RULERS WHICH THEY CANNOT BE SAID TO HAVE EARNED .
... BEIJING SHOULD BE TOLD THAT IT CAN STAGE THE GAMES
ONLY WHEN ITS OWN PEOPLE ARE AT LIBERTY TO ENJOY THEM."
C. HEADLINES
1. WORLD TRADE
"PARIS THREATENS TO VETO GATT DEAL" (GUARDIAN REPORT)
"FRENCH BRINKMANSHIP THREAT TO GATT" (GUARDIAN REPORT)
"BALLADUR STANDS HIS GROUND AGAINST CUT IN FARM
SUBSIDIES" (INDEPENDENT FRONT PAGE REPORT)
"MAJOR TELLS FRANCE TO BACK DOWN OVER WORLD TRADE TALKS"
(TIMES REPORT)
UNCLAS SECTION 03 OF 10 LONDON 17066
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE. "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
2. U.S. POLITICS/ HEALTHCARE REFORMS
"POLITICAL IMPERATIVE TO END COSTLY HODGE-PODGE" (F.T.
COMMENTARY)
"CONGRESSIONAL ADVERSARIES FIND COMMON GROUND IN PLAN"
Page 3 of12
�F:\Cable\Data Source\Cables\CD003\SEP93\MSGS\M0612861.html
(F.T. COMMENTARY)
"CLINTONS GAMBLE ON THE NATION'S HEALTH" (DAILY TELEGRAPH
COMMENTARY)
"CLINTON TO FULFIL HEALTH PLEDGE" (INDEPENDENT REPORT)
"CLINTON GAMBLES ON UTOPIAN DESIGNER'S HEALTH REFORMS"
(TIMES REPORT)
"BACK FROM THE WILDERNESS" (GUARDIAN PROFILE, CARTER)
3. BOSNIA
"BOSNIA AND THE 'PROBLEM' OF PEACE" (GUARDIAN EDITORIAL)
4. CHINA OLYMPIC BID
"SITING THE GAMES" (F.T. EDITORIAL)
D. TEXT
1. WORLD TRADE
THE LIBERAL GUARDIAN COMMENTED:
"FOREIGN AND FARM MINISTERS FROM THE 12 EC COUNTRIES
GATHER IN BRUSSELS TODAY, IN A MEETING WHICH COULD MAKE
OR BREAK THE SEVEN YEAR OLD TALKS TAKING PLACE UNDER THE
AUSPICES OF THE GATT.
"THERE CAN BE NO DOUBT OF THE IMPORTANCE OF DECISIONS
TAKEN TODAY: INSIDERS SAY IF THE COMMISSION CAN RESIST
FRENCH PRESSURE, THE GATT PROCESS WILL BE GALVANIZED AND
A FINAL AGREEMENT BY DECEMBER 15 WILL LOOK VERY LIKELY ;
IF THE FRENCH PERSUADE THE EC TO ATTEMPT TO RENEGOTIATE
THE BLAIR HOUSE DEAL, OR EVEN TO ASK FOR ANYTHING MORE
THAN COSMETIC CONCESSIONS FROM THE U.S., THE LIKELY
HOSTILE REACTION FROM THE U.S. WOULD FREEZE THE GATT
PROCESS AND BLOW THE WORLD'S CHANCES OF A FREE TRADE
AGREEMENT.
"THE HOPE IS THAT THE BALLADUR GOVERNMENT, WHILE MAKING
THE RIGHT NOISES TO PLACATE THE MILITANT FRENCH FARMING
LOBBY, WILL SETTLE FOR SOME FORMULA WHICH ALLOWS BOTH
SIDES TO CLAIM THE VICTORY WHILE LEAVING THE SUBSTANCE OF
UNCLAS SECTION 04 OF 10 LONDON 17066
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
BLAIR HOUSE UNCHANGED.
"BUT THE FEAR IS THAT THE FRENCH WILL GO TOO FAR WITH
THEIR BRINKMANSHIP -- THE RIGHT WORD FOR FRANCE'S
BEHAVIOR, MANY BELIEVE -- AND PUT THE CHANCES OF A WORLD
TRADE DEAL BACK ANOTHER SEVEN YEARS."
THE CENTRIST INDEPENDENT REPORTED ON ITS FRONT PAGE:
"THE FRENCH GOVERNMENT WAS TOLD TODAY BY JOHN MAJOR THAT
IT WOULD BE 'WRONG AND DANGEROUS' TO BLOCK A WORLD TRADE
Page 4 of12
�F:\Cable\Data Source\Cables\CD003\SEP93\MSGS\M0612861.html
AGREEMENT. THE PRIME MINISTER, ADDRESSING JAPANESE
BUSINESSMEN IN TOKYO, ALSO WARNED FRANCE THAT IT COULD
THREATEN PROGRESS ON THE MAASTRICHT TREATY.
"BRITISH OFFICIALS SAID THE U.S. COULD REIMPOSE DUTIES ON
FRENCH GOODS, SUCH AS WINE, WHICH WERE THREATENED WHEN
GATT TALKS LAST BROKE DOWN, IF THE FRENCH REFUSED TO CUT
SUBSIDIES ON FARM EXPORTS. MR BALLADUR SHOWED NO SIGNS
OF BACKING DOWN . . . . MR MAJOR LAST N+GHT DENIED BRITAIN
·WOULD BE SEEKING TO GIVE FRANCE A 'BLOODY NOSE' AT A
MEETING, DUBBED 'LE JUMBO' TODAY IN BRUSSELS.
'WHAT I
WANT TO HAPPEN IN THE MEETING IS FOR THE COMMISSION TO
HAVE AN UNFETTERED RIGHT TO CONTINUE THE NEGOTIATIONS.
WE ARE RUNNING OUT OF TIME. I KNOW SOME PEOPLE ARE
SAYING THAT THE DEADLINE IS NOT A REAL DEADLINE AND IT
CAN BE EXTENDED, BUT FRANKLY I DOUBT THAT VERY MUCH.'"
THE CONSERVATIVE TIMES REPORTED:
"JOHN MAJOR IS THREATENING TO BRING THE EC TO A VIRTUAL
HALT IF FRANCE DOES NOT ACCEPT A GATT DEAL ON WORLD
TRADE. THE PRIME MINISTER WILL BLOCK NEW INITIATIVES
FROM BRUSSELS IN AREAS SUCH AS SOCIAL AND ENVIRONMENTAL
POLICY UNLESS PARIS DROPS ITS DEMAND FOR A RENEGOTIATION
OF AN EC-U.S. DEAL ON AGRICULTURE SUBSIDIES AND ACCESS TO
MARKETS. THE TOUGH LINE SHOULD ALSO HELP HIM IN HIS
EFFORTS TO CALM REBELLIOUS TORY MPS.
"BRITAIN'S DIPLOMATIC OFFENSIVE INSIDE THE EC WOULD BE
BACKED UP BY DIRECT RETALIATION BY AMERICAN AND JAPAN, MR
MAJOR BELIEVES. SELECTED FRENCH EXPORTS WOULD BE THE
TARGET OF PUNITIVE TARIFFS AS THE WORLD SLID INTO A TRADE
WAR. THE THREAT OF BRITISH OBSTRUCTION INSIDE THE EC
EMERGED AS THE PRIME MINISTER PREPARED FOR A MEETING
TODAY WITH MORIHIRO HOSOKAWA, THE JAPANESE PRIME
MINISTER, TO DISCUSS THE GATT DEADLOCK. IT ALSO CAME ON
THE EVE OF TODAY'S 'JUMBO' MEETING OF EC FOREIGN,
FINANCE AND TRADE MINISTERS IN BRUSSELS THAT IS SEEN AS
CRITICAL IN RESOLVING THE DISPUTE."
2. U.S. POLITICS/ HEALTHCARE REFORMS
UNCLAS SECTION 05 OF 10 LONDON 17066
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;.
USMISSION USNATO FOR USlS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
THE INDEPENDENT FINANCIAL TIMES COMMENTED:
"THE DEBATE OVER HEALTHCARE REFORM HAS CARRIED NONE OF
THE POLITICAL SAVAGERY THAT ACCOMPANIED THE BATTLE OVER
PRESIDENT BILL CLINTON'S BUDGET. U.S. POLITICIANS ON ALL
Page 5 of12
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SIDES HAVE EXPRESSED RESPECT FOR THE EFFORTS IT PUT IN ON
THE ISSUE AND HAVE DECLARED THEIR WILLINGNESS TO WORK
TOGETHER TO CRAFT A BIPARTISAN REFORM . . . . THIS
GENTLEMANLINESS REFLECTS, IN PART, A GROWING CONSENSUS
THAT THE U.S. HEALTH SYSTEM MUST BE REFORMED -- A VIEW
THAT, JUST TWO YEARS AGO, WAS HELD BY ONLY A HANDFUL IN
WASHINGTON, MOSTLY BUDGET SPECIALISTS WHO SAW THE LONGTERM EFFECTS OF MEDICAL INFLATION ON THE GOVERNMENT
DEFICIT.
"BUT IT ALSO REVEALS A FEELING OF VULNERABILITY AND
UNCERTAINTY THROUGHOUT THE POLITICAL SPECTRUM. IT IS
EASY TO SUPPORT HEALTHCARE REFORM -- ALONG WITH MORE THAN
THREE QUARTERS OF THE POPULATION -- BUT LESS EASY TO
DETERMINE THE POLITICAL PLUSES AND MINUSES OF SPECIFIC
ELEMENTS OF HEALTHCARE POLICY.
"CONGRESSIONAL LEADERS HAVE BEGUN TO TAKE HEART AT THE
SIGHT OF SO MUCH POTENTIAL COMMON GROUND. NO ONE
RELISHES PASSING SUCH A FUNDAMENTAL REFORM BY THE SINGLEVOTE MARGINS WITH WHICH MR CLINTON PREVAILED ON HIS
BUDGET. BUT THE TASK MAY GROW HARDER AS NEXT YEAR'S
CONGRESSIONAL ELECTIONS GET CLOSER. THE WHITE HOUSE
PLANS TO SEND THE LEGISLATIVE LANGUAGE FOR ITS PROPOSAL
TO CONGRESS IN THE FIRST WEEK OF OCTOBER, AND HOPES IT
MAY PASS EARLY NEXT YEAR, BY SPRING AT THE LATEST. SOME
MEMBERS BELIEVE IT MAY TAKE LONGER THAN THAT."
THE CONSERVATIVE DAILY TELEGRAPH COMMENTED:
"WHEN PRESIDENT CLINTON CAME TO THE POINT IN JANUARY WHEN
HE HAD TO HONOR A CAMPAIGN PLEDGE TO UNTANGLE THE MULTI
BILLION DOLLAR MESS THAT IS THE AMERICAN HEALTH CARE
INDUSTRY, HE DECIDED IT WAS SUCH A MASSIVE UNDERTAKING
THAT IT COULD BE ENTRUSTED TO ONLY ONE PERSON, HIS WIFE.
"FEMINISTS CHEERED AND TRADITIONALISTS GROANED WHEN MRS
HILLARY CLINTON STEPPED FORWARD TO TAKE COMMAND OF THE
TASK FORCE ON REFORM. SHE WAS NOT TO BE A CONVENTIONAL
FIRST LADY. MRS CLINTON ACKNOWLEDGED AT THE TIME THAT
SHE KNEW LITTLE ABOUT MEDICINE OR HEALTH ADMINISTRATION.
"SHE GAVE SPEECH AFTER SPEECH, REASSURING DOCTORS THAT
THEY WOULD NOT LOSE STATUS OR TOO MUCH INCOME UNDER THE
UNCLAS SECTION 06 OF 10 LONDON 17066
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
REFORMS SHE WAS CONSIDERING. THEN SHE WENT TO CAPITOL
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HILL, AN EXPLOSION OF ENERGY IN HER WASHINGTON POWER
SUIT, TO FLATTER, ~H~N BULLY, THE CONGRESSIONAL
LEADERSHIP. MRS CLINTON IS NOT AFRAID TO EXPLOIT HER
REPUTATION AS A TOUGH CUSTOMER WITH A SAVAGE TONGUE.
MOST MEN ARE TERRIFIED OF HER, BUT MOST PEOPLE WHO MEET
HER IN PERSON ARE SURPRISED BY HER CHARM. IT IS A POTENT
COMBINATION.
"AMERICA'S TELEVISION SCREENS ARE ALREADY SWAMPED BY
ADVERTISEMENTS DENOUNCING THE PLAN IN SUBTLE AND NOT SO
SUBTLE TERMS. THE IMPLIED MESSAGE IS : WATCH OUT, THE
CLINTONS ARE BAD FOR YOUR HEALTH. THE PROBLEM THE
CLINTONS HAVE IS THAT, THOUGH AMERICANS DO WORRY ABOUT
THE OVERALL SYSTEM, HEALTH CARE IN THE U.S. IS
EXCEPTIONALLY GOOD, IF YOU ARE WELL INSURED AND CAN
AFFORD THE BEST. MANY AMERICANS LACK A PERSONAL MOTIVE
FOR WANTING TO SEE RADICAL CHANGE.
"THE PLAN WILL INEVITABLY BE REVISED BETWEEN THE MOMENT
MR CLINTON FORMALLY UNVEILS IT ON WEDNESDAY NIGHT AND
WHEN IT FINALLY PASSES CONGRESS. BUT IT IS EQUALLY CLEAR
NOW THAT SOME FORM OF FUNDAMENTAL REFORM WILL BE ENACTED.
A REPUBLICAN COUNTER-PROPOSAL ANNOUNCED LAST WEEK WAS IN
MANY RESPECTS SIMILAR TO THE CLINTON PLAN. WHATEVER THE
SHORT-COMINGS OF THEIR PLAN, THE CLINTONS HAVE BEEN
SUCCESSFUL IN CREATING A POLITICAL CONSENSUS IN FAVOR OF
RADICAL CHANGE."
THE CENTRIST INDEPENDENT COMMENTED: ·
"ONE PROMISE, AT LEAST, BILL CLINTON IS KEEPING.
'I
PLEDGE THAT IN THE FIRST YEAR OF MY ADMINISTRATION,' HE
TOLD HUNDREDS OF CHEERING SUPPORTERS IN OCTOBER 1991 AS
HE ANNOUNCED HIS CANDIDACY FROM THE STEPS OF THE OLD
STATE HOUSE IN LITTLE ROCK, ' WE WILL PRESENT A PLAN TO
CONGRESS AND THE AMERICAN PEOPLE TO PROVIDE AFFORDABLE,
QUALITY HEALTH CARE FOR ALL.' THIS WEDNESDAY, HE IS
DOING PRECISELY THAT.
"THE SETTING IS WORTHY OF THE TASK. TO A SPECIALLY
CONVENED JOINT SESSION OF CONGRESS, THAT MOST SOLEMN
OCCASION OF AMERICAN PUBLIC LIFE, THE 42ND PRESIDENT WILL
UNVEIL THE MOST MOMENTOUS SOCIAL INITIATIVE SINCE LYNDON
JOHNSON'S GREAT SOCIETY -- SOME SAY SINCE ROOSEVELT'S NEW
DEAL IN THE 1930S ; A REFORM THAT WILL BRING THE U.S. IN
LINE WITH EVERY OTHER ADVANCED INDUSTRIAL COUNTRY AND
GUARANTEE HEALTH COVERAGE FOR EVERY CITIZEN.
"THE VENTURE IS COLOSSAL. AT A MOMENT WHEN FAITH IN
GOVERNMENT HAS NEVER .BEEN LOWER, HE IS PROPOSING
UNCLAS SECTION 07 OF 10 LONDON 17066
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
Page 7 of12
�F:\Cable\Data Source\Cables\CD003\SEP93\MSGS\M0612861.html
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
GOVE-RNMENT INTERVENTION TO OVERHAUL FROM TOP TO BOTTOM AN
INDUSTRY THAT CONSUMED 15 CENTS OF EVERY DOLLAR OF WEALTH
CREATED IN THE U.S. EVERY INDIVIDUAL AND EVERY COMPANY
WILL BE AFFECTED. SUCCESS WILL ASSURE .MR CLINTON'S PLACE
IN HISTORY. FAILURE WOULD DEAL THE NATIONAL ECONOMY, A
DISCREDITED CONGRESS AND HIS OWN PRESIDENCY, IMMEASURABLE
BLOWS.
"HARRY TRUMAN, RICHARD NIXON, JIMMY CARTER, EVEN (HALF
HEARTEDLY) GEORGE BUSH TRIED TO TACKLE IT. NEVER THOUGH
HAVE THE STARS BEEN AS FAVORABLY SET. BIG BUSINESS,
ORDINARY WORKERS, NOT TO MENTION THE UNINSURED, ALL SEEK
CHANGE. DESPITE TODAY'S RUMBLES OF THUNDER, THE ODDS ARE
THAT SOME FORM OF THE CLINTON PACKAGE WILL BE VOTED INTO
LAW SOMETIME NEXT YEAR.
"MAYBE, AS CRITICS CHARGE, IT WOULD SIMPLY 'REPLACE ONE
MESS WITH ANOTHER'. IN ESSENCE, THROUGH, THE SYSTEM IS
BEING GIVEN ONE LAST CHANCE AT SURVIVAL BY ADJUSTMENT.
IF NOT, INEXORABLE ECONOMIC AND SOCIAL PRESSURES WILL
FORCE MORE RADICAL THERAPY : EITHER A CANADIAN SINGLEPAYER SYSTEM OR A MULTI-PAYER SYSTEM WITH RIGID
GOVERNMENT CONTROLS ALONG GERMAN LINES."
THE CONSERVATIVE TIMES COMMENTED:
"THIS IS THE WEEK THAT WILL SEE THE UNVEILING OF A
CENTERPIECE OF THE CLINTON PRESIDENCY, THE CULMINATION OF
EIGHT MONTHS' WORK BY HILLARY CLINTON DESIGNED TO SHAKE
UP THE AMERICAN HEALTH CARE SYSTEM. IT IS ALSO THE
BIGGEST WEEK IN THE LIFE OF A LESS HIGH-PROFILE FIGURE
THAN THE DAZZLING FIRST LADY : IRA MAGAZINER, AN
UNSHAKABLE IDEALIST AND VISIONARY WHO HAS DEVOTED MOST OF
HIS 45 YEARS TO TRYING TO IMPROVE THE HUMAN LOT.
"HE HAS STRIPPED THE HEALTH CARE SYSTEM DOWN TO ITS NUTS
AND BOLTS AND REASSEMBLED THE PARTS INTO THE UTTERLY
DIFFERENT CREATURE THAT MR CLINTON WILL UNVEIL FORMALLY
ON WEDNESDAY. MRS CLINTON IS THE PLAN'S MIDWIFE, CHARGED
WITH EASING ITS POLITICAL PASSAGE AND PRESENTING IT TO
THE WORLD, BUT IT IS UNQUESTIONABLY MR MAGAZINER'S BABY.
"MR MAGAZINER CAN NEVER BE ACCUSED OF THINKING SMALL. IF
IMPLEMENTED, HIS PLAN WILL AFFECT DIRECTLY EVERY AMERICAN
AND REPRESENT THE BIGGEST SOCIAL CHANGE SINCE FRANKLIN
ROOSEVELT'S NEW DEAL. IT IS SO COMPLEX AND RADICAL THAT
IT HAS ACHIEVED THE RARE FEAT IN WASHINGTON OF RENDERING
POTENTIAL ENEMIES ALMOST SPEECHLESS. IT IS THE WORK OF A·
BRILLIANT THEORETICIAN, BUT WHETHER IT WILL WORK IS
ANYBODY'S GUESS. ESSENTIALLY, WHAT MR CLINTON WILL BE
ASKING AMERICA TO DO IS TAKE A HUGE GAMBLE ON A PLAN THAT
ONE CONGRESSMAN DESCRIBED AS A 'BEAUTIFUL ANIMAL IN
FAIRYLAND, BUT UNSEEN ON EARTH.'"
UNCLAS SECTION 08 OF 10 LONDON 17066
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
Page 8 of 12
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EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
THE LIBERAL GUARDIAN PROFILED FORMER PRESIDENT JIMMY
CARTER:
"AS THE MAN WHO ALWAYS MAINTAINED THAT 'TRUST' WAS THE
FUNDAMENTAL MEASURE OF ANY PRESIDENCY, CARTER IS RIGHT
BACK IN FASHION -- GIVEN THAT THE REPUBLICANS WHO
SUCCEEDED HIM ARE NOW PERCEIVED TO HAVE ALMOST RUINED THE
COUNTRY THROUGH THE DEFNCIT-FINANCED SPENDING SPREES AND
CORPORATE VANDALISM OF THE 1980S. BUT MOST SURPRISINGLY
OF ALL, CARTER'S ONCE VILIFIED RECORD AS 39TH PRESIDENT
OF THE UNITED STATES IS GAINING RESPECT. AMONG A
STRENGTHENING BAND OF HISTORIANS AND PRESIDENTIAL
BIOGRAPHERS, HE IS NOW VIEWED AS THE MOST FAR SIGHTED OF
AMERICA'S RECENT LEADERS.
"CARTER'S POLICY AGENDA LOOKED, IN FACT, VERY MUCH LIKE
BILL CLINTON'S DOES NOW. HE INITIATED GROUND-BREAKING
ENVIRONMENTAL AND CONSERVATION POLICIES. HE TRIED TO
REIN IN HOSPITAL COSTS ; AND STRONGLY SUPPORTED MEASURES
TO ENHANCE THE RIGHTS OF WOMEN AND MINORITIES.
"AS PRESIDENT, HE RAILED AGAINST GOVERNMENT WASTE AND
INEFFICIENCY. BUT IN CONTRAST TO JACK KENNEDY AND LYNDON
JOHNSON, HIS ANTI-POVERTY PROGRAMS STRESSED FISCAL
RESPONSIBILITY. ABORAD, CARTER MADE HUMAN RIGHTS AND
SUPPORT FOR DEMOCRACY A CENTRAL TENET OF HIS POLICY.
"JUST AS CLINTON NOW SEEKS ANTI-PROLIFERATION CONTROLS,
CARTER SOUGHT, UNSUCCESSFULLY AS IT HAPPENED, TO SLOW THE
COLD WAR ARMS RACE.
HIS BIGGEST CRISIS -- WITH IRAN IN
1980 -- WAS PRECIPITATED, TYPICALLY, BY A HUMANITARIAN
GESTURE : HE ALLOWED THE EXILED AND DYING SHAH TO SEEK
MEDICAL TREATMENT IN THE U.S.
"LAST TUESDAY MARKED THE HIGH POINT OF ONE OF THE LONGEST
COMEBACKS IN HISTORY. YET IN A FUNDAMENTAL SENSE, CARTER
IS STILL BOTH TOO. GOOD AND TOO AND FOR THE CLINTON ERA IN
WHICH PROMISES DON'T COUNT BUT WINNING DOES."
3. BOSNIA
THE LIBERAL GUARDIAN EDITORIALIZED:
"BOSNIA MAY GET A PEACE AGREEMENT SIGNED IN SARAJEVO
TOMORROW, IN A LAST DESPERATE EFFORT TO STOP THE WAR. OR
IT MAY NOT. EITHER WAY THIS IS NOT GOING TO STUN THE
WORLD. THERE HAVE BEEN TOO MANY NEGOTIATIONS, TOO MANY
AGREEMENTS, AND NOW THE POLE POSITION WHICH BOSNIA USED
TO OCCUPY HAS BEEN SEIZED BY YASSER ARAFAT AND YITZHAK
RABIN.
UNCLAS SECTION 09 OF 10 LONDON 17066
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; R/C; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
Page 9 of12
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(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
"MR IZETBEGOVIC'S GOVERNMENT MAY STILL HAVE TO SETTLE IN
THE END UNDER BRUTAL AND UNSUBTLE PRESSURE. AS ONE
OFFICIAL CLOSE TO THE TALKS PUTS IT, 'THERE'S BEEN AN
ACKNOWLEDGEMENT OF THE NEED FOR SPEED, TO GET A
SETTLEMENT QUICKLY ... BEFORE WINTER.' DECODED, THIS
MEANS : BEFORE THOUSANDS MORE BOSNIANS FREEZE TO DEATH.
MR IZETBEGOVIC'S HOPES OF A MORE ASSERTIVE U.S. POSITION
APPEAR TO HAVE BEEN DASHED. THIS WEEKEND THE U.S. MEDIA
WAS ENUMERATING MR CLINTON'S DOMESTIC PREOCCUPATIONS
PLUS THE NEGATIVE FALLOUT FROM SOMALIA -- WHICH MADE HIM
WARY OF AN OPEN-ENDED ENTANGLEMENT IN BOSNIA.
"A COALITION OF SARAJEVO CIVILIANS HAS NOW LAUNCHED A
CAMPAIGN TO ESTABLISH A UN PROTECTORATE OVER THE CITY,
AND FOR A SIMILAR EC ADMINISTRATION IN MOSTAR. THE IDEA
WOULD TRANSLATE AT LEAST A SMALL BIT OF THE UN
RESOLUTIONS INTO REALITY. IT SHOULD NOT HAVE TO WAIT FOR
A WIDER AGREEMENT. MORE NEW INITIATIVES, MORE NEW IDEAS,
ARE URGENTLY NEEDED. BOSNIA WILL SOON BE BACK ON OUR
FRONT PAGES AND THE WINTER IS LESS THAN A MONTH AWAY.
MEANWHILE IN EAST MOSTAR, REUTERS REPORTED YESTERDAY, THE
LAST UNDERTAKER IN THE MUSLIM QUARTER HAS JUST BEEN
KILLED."
4. · CHINA OLYMPIC BID
THE INDEPENDENT FINANCIAL TIMES EDITORIALIZED:
"IT WOULD SURELY BE IMPRUDENT, AS WELL AS UNJUST, TO LET
MEMORIES OF 1936 COUNT AGAINST BERLIN WHILE GIVING
BEIJING THE BENEFIT OF THE DOUBT. IF 1936 LOOMS LARGE IN
BERLIN'S CASE, IT IS BECAUSE A MINORITY OF THE CITY'S OW~
INHABITANTS IS DEEPLY TROUBLED BY THOSE MEMORIES, AND IS
FREE TO DRAW ATTENTION TO THEM. THE MEMORY OF WHAT
HAPPENED IN BEIJING IN 1989 -- THE TIANENMEN SQUARE
MASSACRE -- MAY NOT HAVE BEEN DRAWN SO DIRECTLY TO THE
IOC'S ATTENTION, BUT IT SHOULD BE MUCH FRESHER.
"NO DOUBT THINGS HAVE IMPROVED IN CHINA SINCE THEN, AND
WITH LUCK BY 2000 THEY WILL HAVE IMPROVED EVEN MORE. BUT
WHO CAN POSSIBLY TELL? THE IOC SHOULD NOT RISK
INFLICTING ON THE WORLD ANOTHER DRAMA LIKE THAT OF MEXICO
IN 1968, WHEN THE GAMES WERE HELD IN A CITY FROM WHICH
THE BLOOD OF HUNDREDS OF STUDENT RIOTERS HAD SCARCELY
BEEN CLEANED ; NOR YET ANOTHER DILEMMA LIKE THAT OF
MOSCOW IN 1980, WHEN THOSE WHO COMPETED, IN DEFIANCE OF A
U.S.-LED BOYCOTT, FOUND THEMSELVES IMPLICITLY CONDONING
THE SOVIET INVASION OF AFGHANISTAN.
"TRADE SANCTIONS ARE NOT AN APPROPRIATE WAY TO ADVANCE
THE CAUSE OF HUMAN RIGHTS IN CHINA. BUT TO COMMIT THE
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..
SECT:
SSN:
TOR:
UNCLAS SECTION 10 OF 10 LONDON 17066
USIA
"PERISHABLE INFORMATION - DO NOT SERVICE "
USIA FOR P/M; RC; R/M; P/P; P/G; (RMCLELLAN); P/F; P/FW;
P/FN; P/PFN; P/PPE; P/PFE; P; EU; NEA; VOA NEWS/CA; PL
(LSECREST); B/TV/WP;
STATE FOR EUR/P AND PLS PASS ACDA/PA; EUR/PA; EUR/P/SP;
EUR/WE; EUR/NE; IO/CU; NEA/P; EB/TT; INR/P; PM;
CSD ISA FOR ILN; FOR NEA; OASD/PA;
USDOC PASS USTR/PA
WHITEHOUSE FOR NSC-WEUROPE;
USMISSION USNATO FOR USIS;
PARIS FOR USIS; UNESCO; OECD;
VIENNA PASS USDEL-CSCE;
RAF MILDENHALL FOR PA;
E.0.12356:N/A
SUBJECT: MEDIA REACTION REPORT, LONDON, MONDAY SEPTEMBER
20 1993
WORLD TO HOLDING ITS TOP SPORTING EVENT IN BEIJING IN
SEVEN YEARS WOULD AMOUNT TO A VOTE OF CONFIDENCE IN
CHINA'S RULERS WHICH THEY CANNOT BE SAID TO HAVE EARNED.
THE CHINESE AUTHORITIES HAVE IN RECENT WEEKS SOUGHT TO
BOOST THEIR CHANCES BY TAKING STEPS TO IMPROVE THEIR
IMAGE ON HUMAN RIGHTS. BUT THEY HAVE ALSO CORRALLED
THEIR CITIZENS INTO ASSISTING THEIR BID IN TYPICALLY
REPRESSIVE FASHION, AND WOULD ALMOST CERTAINLY DO
LIKEWISE DURING THE EVENT ITSELF. BEIJING SHOULD BE TOLD
THAT IT CAN STAGE THE GAMES ONLY WHEN ITS OWN PEOPLE ARE
AT LIBERTY TO ENJOY THEM." O'BRIEN
BT
#7066
NNNN
SECTION: 01 OF 10
<"SECT>SECTION: 02 OF 10
<"SECT>SECTION: 03 OF 10
<"SECT>SECTION: 04 OF 10
<"SECT>SECTION: 05 OF 10
<"SECT>SECTION: 06 OF 10
<"SECT>SECTION: 07 OF 10
<"SECT>SECTION: 08 OF 10
<"SECT>SECTION: 09 OF 10
<"SECT>SECTION: 10 OF 10
7066
<"SSN>7066
<"SSN>7066
<"SSN>7066
<"SSN>7066
<"SSN>7066
<"SSN>7066
<"SSN>7066
<"SSN>7066
<"SSN>7066
930920083138 M0612861
<"TOR>930920083239 M0612862
<"TOR>930920083240 M0612863
<"TOR>930920083343 M0612865
<"TOR>930920083444 M0612866
<"TOR>930920085053 M0612911
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,.
<ATOR>930920085155
<ATOR>930920083648
<ATOR>930920083752
<ATOR>930920083900
DIST:
SIT: VAX
0
M0612912
M0612869
M0612872
M0612875
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..
Cab 1e
PREC:
CLASS:
LINEl:
LINE2:
LINE3:
LINE4:
OSRI:
DTG:
ORIG:
TO:
INFO:
SUBJ:
IMMEDIATE
UNCLASSIFIED
OAAUZYUW RUFHFRA5470 2671047-UUUU--RHEHAAA.
ZNR UUUUU ZZH
0 241047Z SEP 93
FM AMEMBASSY PARIS
RUFHFR
241047Z SEP 93
AMEMBASSY PARIS
RUEHIA/USIA WASHDC IMMEDIATE 0963
RUFHNA/USMISSION USNATO IMMEDIATE 1128
RUEAIIA/CIA WASHDC
RUEATRS/DEPARTMENT'OF TREASURY
RUEKJCS/DIA WASHDC
RUEKJCS/SECDEF WASHDC//ASD/ISA//
RUEHC/SECSTATE WASHDC 2015
RHEHAAA/WHITE HOUSE
RUCPDC/USDOC WASHDC
RUEHXQ/ALL EUROPEAN COMMUNITY POST COLLECTIVE
RUEHMO/AMEMBASSY MOSCOW 3994
RUFHMB/USMISSION USVIENNA 8798
RUFRQJQ/COMSIXTHFLT
DAILY MEDIA REACTION REPORT
PARIS -- FRIDAY SEPTEMBER 24, 1993
(A) SUMMARY OF TYPE OF COVERAGE:
THE 1994 BUDGET, PRESENTED WEDNESDAY BY THE GOVERNMENT,
CONTINUES TO DOMINATE THE FRENCH PRESS.
TEXT:
UNCLAS SECTION 01 OF 05 PARIS 25470
USIA
USIA FOR P/RC; P/P; P/FW P/FN; VOA NEWS/CA; EU; AF; P/M;
STATE FOR EUR/P/SP; EP/WE; AF; INR/P; PM; OSD ISA FOR
ILN; FOR NEA; WHITE HOUSE FOR NSC/WEUROPE; DOC FOR
ITA/EUR/FR AND PASS USTR/PA (ANN LUZZATO) ; USCINCEUR FOR
PAO; NATO FOR USIS; MOSCOW FOR P&C; ROME FOR USIS/AIO;
BRUSSELS FOR USIS AND USEC (PAO); USVIENNA FOR USDEL
CSCE.
E.O. 12356: N/A
TAGS: NONE
SUBJECT: DAILY MEDIA REACTION REPORT
PARIS -- FRIDAY SEPTEMBER 24, 1993
(A) SUMMARY OF TYPE OF COVERAGE:
THE 1994 BUDGET, PRESENTED WEDNESDAY BY THE GOVERNMENT,
CONTINUES TO DOMINATE THE FRENCH PRESS.
THE POLITICAL SITUATION IN RUSSIA IS STILL THE NUMBERONE FOREIGN STORY, WITH THE PRESS REPORTING THAT THE
CONSERVATIVES ARE LOSING GROUND. THE PRESIDENT
"CONTROLS ALL, OR ALMOST ALL LEVERS AND THE COUNTERPOWER IS (ONLY) GESTICULATING", PIERRE BOCEV REPORTS
BELIEVES IN YELSTIN'S VICTORY"~ "THE UNITED STATES IS
CONVINCED THAT RUSSIAN PRESIDENT BORIS YELTSIN HAS
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PREVAILED IN HIS FIGHT AGAINST THE CONSERVATIVES IN
MOSCOW, AND WASHINGTON INTENDS TO PURSUE, EVEN INTENSIFY
ITS SUPPORT FOR REFORMS IN RUSSIA, TWO CLINTON
ADMINISTRATION OFFICIALS SAID ON CONDITION OF
ANONYMITY."
ALL MEDIA COVER PRESIDENT CLINTON'S HEALTH CARE REFORM
PLAN. SEVERAL SPEAK OF AN "AMBITIOUS" PLAN. LE MONDE'S
ALAIN FRACHON SAYS THAT THE U.S. PRESIDENT "HAS RAISED
THE STANDARD VERY HIGH". LA TRIBUNE'S JEAN-MARIE
MACABREY SAYS THAT BILL CLINTON'S SPEECH ON WEDNESDAY
WAS "PROBABLY THE MOST IMPORTANT ONE IN HIS PRESIDENCY".
SEVERAL COMMENTATORS REPORT THAT HE REMAINED "VAGUE" ON
DETAILS ABOUT THE FINANCIAL ASPECTS OF THE PLAN.
FINANCIAL LA TRIBUNE PUBLISHES A TWO-PAGE PORTRAIT OF
TREASURY SECRETARY LLOYD BENTSEN, "THE ARISTOCRAT IN THE
CLINTON TEAM": "CLINTON SUFFERED FROM A LACK OF
EXPERIENCE 'AND A PROBLEM OF CREDIBILITY IN THE BUSINESS
CIRCLES. BY APPOINTING BENTSEN TO THE TREASURY, THE
YOUNG PRESIDENT WANTED TO REASSURE THE PUBLIC." BIANCA
RIEMER SAYS THAT "THE EUROPEANS ARE UNDER (BENTSEN'S)
CHARM".
THE MOST SIGNIFICANT COVERAGE OF GATT STORIES IS TO BE
FOUND IN THE WEEKLIES (SEE PART D OF REPORT) .
THE PRESS REPORTS THAT AUSTRALIAN PRIME MINISTER PAUL
KEATING, WHO IS ON A VISIT IN FRANCE, CRITICIZED THE
FRENCH POSITION ON GATT BY DENOUNCJNG FRANCE'S
"SELFISHNESS". THE FRENCH SHOULD "REALIZE THAT THEY ARE
PART OF THE WORLD", KEATING IS QUOTED AS SAYING (LE FIGECO) . FRENCH AGRICULTURE MINISTER JEAN PUECH REACTED BY
SAYING THAT "FRANCE DOES NOT NEED TO ANSWER TO THAT KIND
OF CRITICISM" WHICH "DOESN'T CONTRIBUTE TO PROGRESS IN
THE NEGOTIATIONS". "THAT KIND OF ARGUMENT PUTS (THE
AUSTRALIAN PRIME MINISTER) IN A WEAK POSITION", PUECH
ADDED, SAYING THAT "WE HAVE EXPORTS TO PROTECT AND WE
WANT TO PARTICIPATE IN THE DEVELOPMENT OF THE WORLD
ECONOMY."
AFP REPORTS T~AT AGRICULTURE MINISTER PUECH'S OFFICE HAS
ANNOUNCED THAT THE MINISTER WOULD MEET WITH U.S.
AMBASSADOR PAMELA HARRIMAN ON THURSDAY SEPTEMBER 30.
EUROPEAN AFFAIRS MINISTER ALAIN LAMASSOURE SAID
YESTERDAY: "WE MUST, WITH THE AMERICANS, HAVE A VERY
FIRM, VERY HARD, UNSHAKEABLE POSITION IN DEFENSE OF OUR
INTERESTS." (AFP QOUTES)
AFP ALSO REPORTS THAT SWISS PRESIDENT ADOLPHE OGI SAID
YESTERDAY, AFTER HE MET WITH PM BALLADUR THAT IT WAS
"ABSOLUTELY" NECESSARY TO "RENEGOTIATE BLAIR HOUSE".
ON THE AUDIOVISUAL QUESTION, PATRICK WASJMAN AUTHORS AN
UNCLAS SECTION 02 OF OS PARIS 25470
USIA
USIA FOR P/RC; P/P; P/FW P/FN; VOA NEWS/CA; EU; AF; P/M;
STATE FOR EUR/P/SP; EU/WE; AF; INR/P; PM; OSD ISA FOR
ILN; FOR NEA; WHITE HOUSE FOR NSC/WEUROPE; DOC FOR
ITA/EUR/FR AND PASS USTR/PA (ANN LUZZATO); USCINCEUR FOR
PAO; NATO FOR USIS; MOSCOW FOR P&C; ROME FOR USIS/AIO;
BRUSSELS FOR USIS AND USEC (PAO); USVIENNA FOR USDEL
CSCE.
E.O. 12356: N/A
TAGS: NONE
Page 2 of7
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SUBJECT: DAILY MEDIA REACTION REPORT
OP-ED PIECE TITLED "MARIANNE VS. THE DINOSAURS" IN LE
FIGARO WHICH DENOUNCES THE "AGGRESSIVE CHAUVINISM" AND
ALLEGATIONS OF "AMERICAN CULTURAL IMPERIALISM": "IT IS
NOT BY DENCOUNCING THE 'AMERICAN CULTURAL IMPERIALISM'
THAT WE WILL SAVE THE FRENCH MOVIE INDUSTRY", WASJMAN
SAYS. WEEKLY LE NOUVEL OBSERVATEUR WONDERS "ARE WE
REALLY INVADED BY THE YANKEE CINEMA?" AND RIDICULES
CULTURE MINISTER JACQUES TOUBON FOR SAYING THAT STEVEN
SPIELBERG'S JURASSIC PARK THREATENS "FRENCH IDENTITY"--A
WARNING WHICH LE NOUVEL OBSERVATEUR CALLS "DELIRIUM".
THE ECONOMIC PRESS REPORTS THAT THE G-7 FINANCE
MINISTERS WILL BE CONVENING IN WASHINGTON TOMORROW.
"THE STAKES (IN THE MEETING) MAY GO BEYOND THE
COMPETENCE OF FINANCE MINISTERS", ECONOMIC LES ECHOS
SAYS, "BECAUSE FUELING GROWTH--WHICH WILL BE AT THE
HEART OF THE DEBATE--NO LONGER DEPENDS ON CUTS IN
INTEREST RATES OR BUDGETARY ADJUSTMENTS, BUT ON
POLITICAL INITIATIVES CAPABLE OF RESTORING CONFIDENCE."
THE CHOICE OF SYDNEY AS THE 2,000 OLYMPIC GAMES SITE,
DEVELOPMENTS IN THE REPUBLIC OF GEORGIA AND THE APPROVAL
OF THE ISRAEL-PLO ACCORD BY THE ISRAELI KNESSET ARE
AMONG THE OTHER MOST IMPORTANT STORIES IN THE FRENCH
PRESS THIS MORNING.
(B) STORIES COVERED IN REPORT:
1. U.S. HEALTH CARE REFORM
2. GATT
(C) HEADLINES:
U.S. HEALTH CARE REFORM:
"CLINTON PROPOSES HEALTH CARE FOR ALL" (LA TRIBUNE-FRONT
PAGE)
"CLINTON 'SELLS' ·HIS SOCIAL REVOLUTION" (LE FIGARO-PAGE
6)
"BILL CLINTON LAUNCHES AN AMBITIOUS HEALTH CARE REFORM
IN THE U.S" (LE MONDE-PAGE 26)
"HEALTH: CLINTON COVERS ALL AMERICANS" (LIBERATION-PAGE
13)
(D) SUPPORTING TEXT:
1. THE NEW U.S. HEALTH CARE PLAN:
LAURENT BAZIN SAID ON TV TF-1 LAST EVENING: " ... FOR THE
TIME BEING, THE U.S. HEALTH CARE SYSTEM HAS ONLY ONE
LOGIC--THAT OF PROFIT. WE NEED A MEDICINE THAT IS EQUAL
FOR ALL, THEY (CLINTONS) HAVE BEEN REPEATING. IT
REMAINS TO BE SEEN HOW THEY ARE GOING TO FUND. THIS
DREAM--AND THAT IS AT THE HEART OF THE FIGHT THAT IS
GOING TO START IN CONGRESS."
ECONOMIC LES ECHOS ON PAGE 4: "PRESENTING HIS HEALTH
CARE PLAN, THE U.S. PRESIDENT PROMISED A REAL REVOLUTION
TO THE AMERICANS. HE HOWEVER REMAINED VAGUE ON THE
DETAILS OF ITS FINANCING."
JEAN-MARIE MACABREY REPORTS FROM WASHINGTON IN FINANCIAL
LA TRIBUNE: "BILL CLINTON PROBABLY JUST MADE THE MOST
IMPORTANT SPEECH IN HIS PRESIDENCY .... THE CLINTON PLAN
WILL INEVITABLY BE MODIFIED BY CONGRESS. BUT THE
GENERAL FEELING IS THAT CAPITOL HILL WILL APPROVE
UNCLAS SECTION 03 OF 05 PARIS 25470
USIA
USIA FOR P/RC; P/P; P/FW P/FN; VOA NEWS/CA; EU; AF; P/M;
Page 3 of7
�F:\Cable\Data Source\Cables\CD003\SEP93\MSGS\M0622703.html
STATE FOR EUR/P/SP; EU/WE; AF; INR/P; PM; OSD ISA FOR
ILN; FOR NEA; WHITE HOUSE FOR NSC/WEUROPE; DOC FOR
ITA/EUR/FR AND PASS USTR/PA (ANN LUZZATO); USCINCEUR FOR
PAO; NATO FOR USIS; MOSCOW FOR P&C; ROME FOR USIS/AIO;
BRUSSELS FOR USIS AND USEC (PAO); USVIENNA FOR USDEL
CSCE.
E.O. 12356: N/A
TAGS: NONE
SUBJECT: DAILY MEDIA REACTION REPORT
UNIVERSAL HEALTH CARE INSURANCE BEFORE THE 1996
PRESIDENTIAL ELECTION. THIS ACCOMPLISHMENT ALONE IS
ENOUGH TO ENSURE BILL CLINTON A FIST PLACE IN THE
HISTORY OF THE UNITED STATES .... BUT THE TOUGHEST
REMAINS TO BE DONE (FIGHT WITH CONGRESS)."
PHILIPPE LABARDE AUTHORS THE BACK-PAGE EDITORIAL OF LA
TRIBUNE: " ... THE U.S. PRESIDENT'S INITIATIVE (HEALTH
CARE REFORM) IS NOT A SURPRISE. THIS CONSIDERABLE
REFORM WAS ON HIS PLATFORM. MANY VIEWED IT AS A VOTESEEKING DEMARCHE, WHICH IS NOT DOUBTFUL. HOWEVER, ONE
(SHOULD NOT) DRAW THE CONCLUSION THAT BILL CLINTON WAS
ONLY MOTIVATED BY POLITICAL OR·MORAL CONSIDERATIONS ....
IF BILL CLINTON HAS MADE THIS PROPOSAL (NEW PLAN), IT IS
UNDOUBTEDLY BECAUSE HE THINKS THAT, THANKS TO A REFORM
OF THE HEALTH CARE SYSTEM, THE U.S. ECONOMY WILL DO
BETTER IN THE LONG RUN. BESIDES, HE SAID IT. THIS IS
FOOD FOR THOUGHT FOR THOSE IN EUROPE AND ESPECIALLY
FRANCE, WHO REJECT SOCIAL PROTECTION AS AN OBSTACLE TO
FREE COMPETITION."
INFLUENTIAL LE MONDE FRONT-PAGE UNATTRIBUTED EDITORIAL:
" ... FOR THE FIRST BIGGEST ECONOMIC POWER IN THE WORLD
(THE U.S), THIS SA FORMIDABLE CONFESSION. PER CAPITA
HEALTH COSTS ARE THE HIGHEST, BUT HEALTH CARE
DISTRIBUTION IS THE WORST. U.S. INDEXES SUM UP THIS SAD
REALITY: THE U.S. RANKS 16TH IN THE WORLD FOR LIFE
EXPECTANCY, 23TH FOR CHILD MORTALITY .... ALTHOUGH THE
GIGANTIC TASK TO WHICH BILL CLINTON IS COMMITTING
HIMSELF GIVES NEW LEGITIMACY TO THE VALUES ON WHICH
EUROPEAN SOCIAL PROTECTION SYSTEMS ARE FOUNDED, IT MUST
NOT MAKE US FORGET THAT THESE VERY SYSTMES ARE IN
CRISIS."
ALAIN FRACHON WRITES IN LE MONDE: " ... HILLARY CLINTON
HAS WON THE FIRST SET. SHE HAS WON OVER CONGRESS THANKS
TO A NON-PARTISAN APPROACH, WON OVER EXPERTS THANKS TO
HER COMPETENCE AND WON OVER THE PUBLIC THANKS TO HER
TALENT FOR COMMUNICATION. IF THERE IS A NEW, REAGANSTYLE 'GREAT COMMUNICATOR' AT THE WHITE HOUSE, IT MAY
NOT BE THE ONE ONE THINKS .... UP TO NOW, THE AMERICANS
SEEM TO ACCEPT THE ROLE THAT HILLARY CLINTON HAS BEEN
PLAYING. BUT IF SHE FAILS, IT WOULD IMPACT HER
HUSBAND."
PIERRE BRIANCON REPORTS FROM WASHINGTON IN INFLUENTIAL
LIBERATION: " ... POLITICALLY, CL.INTON SHOWED OPENESS BY
ASKING THE REPUBLICANS TO PARTICIPATE IN HIS GREAT
REFORM .... BUT THINGS ARE GETTING WORSE ON THE ECONOMIC
LEVEL. FIRST, ALL EXPERTS DOUBT IT IS POSSIBLE TO
ACHIEVE THE SAVINGS THAT CLINTON IS PROJECTING ....
AFTER WEDNESDAY'S GLORIOUS SPEECH--WHERE BOTH CAMPS IN
CONGRESS GAVE HIM SEVERAL STANDING OVATIONS--THE PLAN IS
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GOING TO MOVE INTO PUBLIC DEBATE AND CONGRESSIONAL
CRITICISM. THE MOST CONSERVATIVE REPUBLICANS HAVE
ALREADY DENOUNCED THE EXTENSION OF BIG BROTHER'S CONTROL
OVER THE ECONOMY APD SOCIETY. BUT IT IS ON THE
FINANCIAL QUESTION THAT BILL CLINTON WILL BE JUDGED."
JEAN-LOUIS TURLIN REPORTS FROM NEW YORK IN LE FIGARO:
"TAKEN FOR GRANTED IN EUROPE, A NATIONAL HEALTH CARE
SYSTEM STILL LOOKS LIKE A REVOLUTIONARY PLAN IN THE
U.S .... BILL CLINTON RELIES ON TWO FACTORS WHICH WILL
DETERMINE THE SUCCESS OF HIS PLAN AND, THEREFORE, THAT
OF HIS PRESIDENCY--A CHANGE OF MENTALITY OVER THE PAST
FIFTY YEARS ... AND HIS POLITICAL SKILL .... THE 'CHARM
UNCLAS SECTION 04 OF 05 PARIS 25470
USIA
USIA FOR P/RC; P/P; P/FW P/FN; VOA NEWS/CA; EU; AF; P/M;
STATE FOR EUR/P/SP; EU/WE; AF; INR/P; PM; OSD ISA FOR
ILN; FOR NEA; WHITE HOUSE FOR NSC/WEUROPE; DOC FOR
ITA/EUR/FR AND PASS USTR/PA (ANN LUZZATO); USCINCEUR FOR
PAO; NATO FOR USIS; MOSCOW FOR P&C; ROME FOR USIS/AIO;
BRUSSELS FOR USIS AND USEC (PAO); USVIENNA FOR USDEL
CSCE.
E.O. 12356: N/A
TAGS: NONE
SUBJECT: DAILY MEDIA REACTION REPORT
OFFENSIVE' (WEDNESDAY SPEECH) WORKED PERFECTLY WELL."
JEAN LESIEUR SAYS IN WEEKLY L'EXPRESS: " ... THE MAN OF
THE WHITE HOUSE IS GAMBLING BIG .... NOW, ON THIS TOUGH
QUESTION, (CLINTON) MUST PROVE THAT 'THE CLINTON
REVOLUTION' DOES EXIST. ALMOST A YEAR AFTER HIS
ELECTION, BUSH'S SUCCESSOR HAS NOT ERASED DOUBTS. HE
HAS BEEN WAVERING ON FOREIGN ISSUES--AND NO ONE
SERIOUSLY BELIEVES THAT HE PLAYED AN IMPORTANT PART IN
THE MIDDLE EASTERN MIRACLE (ISRAELI-PLO ACCORD).
CONFRONTED WITH ... CONGRESS, HE HAD TO STEP BACK ON ALL
THE KEY-POINTS OF HIS ECONOMIC PROGRAM. LASTLY, HE IS
ABOUT TO FEEL THE WRATH OF MANY CONGRESSMEN IN THE TOUGH
BATTLE FOR THE RATIFICATION OF NAFTA .... BILL CLINTON
IS NOW WITH HIS BACK TO THE WALL."
2. GATT:
ALAIN DUHAMEL SAYS IN INFLUENTIAL LIBERATION: " ... ON A
TECHNICAL LEVEL, THE (BLAIR HOUSE) PRE-ACCORD IS FOR THE
TIME BEING NOT FAIR. THE EUROPEANS ARE ACCEPTING TO DO
MORE SACRIFICES THAN THE AMERICANS, AND FRANCE MORE THAN
ITS PARTNERS. BLAIR HOUSE IS NEITHER A FAIR COMPROMISE,
NOR SOMETHING THAT IS ENTIRELY COMPATIBLE WITH THE
REFORM OF THE CAP (EC COMMON AGRICULTURAL POLICY) . IN
BRUSSELS, LEON BRITTAN HAS NEVER ACCEPTED THESE TWO
THESES .... FURTHERMORE--AND THAT IS THE HEART OF THE
DISPUTE, SIR LEON HAS A DANGEROUS. PERCEPTION OF HIS
ROLE. COMMISSIONERS MUST PREPARE THE DECISIONS OF EC
COUNCILS OF MINISTERS, AND THEN IMPLEMENT THEM. IT IS
NOT UP TO THEM (COMMISSIONERS) TO MAKE DECISIONS. BUT
SIR LEON OFTEN ACTS AS IF HE WERE VESTED WITH A
LEGITIMACY COMPARABLE TO THAT OF GOVERNMENT
REPRESENTATIVES. FOR THIS, HE IS THE COMMISSIONER OF
ALL DANGERS."
DIDIER PAVY SAYS IN WEEKLY LE NOUVEL OBSERVATEUR:
" ... EVERYONE KNOWS IN EUROPE THAT ASKING FOR A BLAIR
Page 5 of7
�-
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SECT:
HOUSE RENEGOTIATION IS LIKE OPENING A PANDORA'S BOX.
THE PROTECTIONIST DEVIL OF THE DEMOCRATIC ADMINISTRATION
NOW IN POWER IN WASHINGTON MAY SPRING OUT OF IT AND
DEMAND COMPENSATIONS THAT WOULD BE MUCH TOUGHER ON EC
AGRICULTURE .... NOTHING IS SET FOR FRENCH FARMERS.
EVERYTHING DEPENDS ON LEON BRITTAN AND THE SUPPORT HE
WILL RECEIVE FROM THE MOST LIBERAL EC MEMBERS. A
COMMISSION OFFICIAL SAYS: 'WE CAN DISCUSS ANYTHING WITH
THE AMERICANS, AS LONG AS THE PROBLEMS RAISED DON'T
QUESTION BLAIR HOUSE'."
SABINE DELANGLADE AND GEORGES VALANCE SAY IN WEEKLY
L'EXPRESS: " ... ALTHOUGH THE TWELVE ARE UNITED AGAIN,
NOTHING IS WON YET .... IT IS THE AMERICANS WHO WILL
DECIDE IN THE END. THEIR FIRST REACTION, ON TUESDAY
SEPT 21, WAS PARTICULARLY NEGATIVE .... THAT IS
ANNOYING, BUT NOT CATASTROPHIC FOR EDOUARD BALLADUR.
HIS FIGHT IS ABOVE ALL A POLITICAL ONE .... THE FINAL
AIM OF ALL THESE (BALLADUR'S) EFFORTS IS TO GIVE
CONFIDENCE BACK TO THE FRENCH, IN ORDER TO BREAK THE
DEFLATIONARY SPIRAL THAT FUELS THE CRISIS. FOR IT IS
HIS CAPACITY TO FIGHT RISING UNEMPLOYMENT THAT WILL
DETERMINE EDOUARD BALLADUR'S POLITICAL DESTINY."
WRITER PATRICK WASJMAN SAYS ON LE FIGARO'S OP-ED PAGE:
" ... IS IT NECESSARY THAT THE FRENCH MOVIE WORLD FALLS
INTO AGGRESSIVE CHAUVINISM AND LOSES ITS SANG-FROID,
UNCLAS SECTION 05 OF 05 PARIS 25470
USIA
USIA FOR P/RC; P/P; P/FW P/FN; VOA NEWS/CA; EU; AF; P/M;
STATE FOR EUR/P/SP; EU/WE; AF; INR/P; PM; OSD ISA FOR
ILN; FOR NEA; WHITE HOUSE FOR NSC/WEUROPE; DOC FOR
ITA/EUR/FR AND PASS USTR/PA (ANN LUZZATO); USCINCEUR FOR
PAO; NATO FOR USIS; MOSCOW FOR P&C; ROME FOR USIS/AIO;
BRUSSELS FOR USIS AND USEC (PAO); USVIENNA FOR USDEL
CSCE.
E.O. 12356: N/A
TAGS: NONE
SUBJECT: DAILY MEDIA REACTION REPORT
GOING AS FAR AS TO DENOUNCE, ONCE AGAIN, 'AMERICAN
CULTURAL IMPERIALISM'? I DON'T THINK SO .... WHEN WILL
WE STOP BEING IMMATURE? HASN'T FRANCE, OVER THE LAST
FIVE CENTURIES, REMARKABLY ASSIMILATED SEVERAL FOREIGN
CULTURES WITHOUT LOSIGN ITS SPECIFICITY? .... IN
REALITY, THIS CONTROVERSY COVERS AT LEAST TWO
EMBARRASSING TRUTHS: L/OUR CINEMA HAS REMAINED
FUNDAMENTALLY A CRAFT WHILE THAT OF THE U.S.-~EVERY ONE
KNOWS IT--IS A FORMIDABLE INDUSTRY .... 2/THE FRENCH
MOVIE SECTOR HAS PRODUCED COUNTLESS MASTERPIECES. BUT
IN MOST CASES, THE THEME, TONES OR SENSITIVITY OF THESE
FILMS IS TOO FRENCH ... HOW, UNDER SUCH CIRCUMSTANCES,
TO MOBILIZE ... AND RAISE ENTHUSIASM FROM MILLIONS OF
VIEWERS, FROM SARCELLES (PARIS SUBURB) TO LAS VEGAS?"
KORENGOLD
BT
#5470
NNNN
SECTION: 01 OF 05
<ASECT>SECTION: 02 OF 05
<ASECT>SECTION: 03 OF 05
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•
SSN:
TOR:
<ASECT>SECTION: 04 OF 05
<ASECT>SECTION: 05 OF 05
5470
<ASSN>5470
<ASSN>5470
<ASSN>5470
<ASSN>5470
930924070041 M0622703
<ATOR>930924070049 M0622704
<ATOR>930924070052 M0622705
<ATOR>930924070256 M0622708
<ATOR>930924070054 M0622706
DIST:
SIT: VAX
D
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�F:\Cable\Data Source\Cables\CD003\SEP93\MSGS\M0622314.html
Cab 1e
PREC:
CLASS:
LINEl:
LINE2:
LINE3:
LINE4:
OSRI:
DTG:
ORIG:
TO:
INFO:
SUBJ:
PRIORITY
UNCLASSIFIED
PAAU2YUW RUEHBYA6754 2670713-UUUU--RHEHAAA.
2NR UUUUU 22H
P 2407132 SEP 93
FM AMEMBASSY CANBERRA
RUEHBY
2407132 SEP 93
AMEMBASSY CANBERRA
RUEHIA/USIA WASHDC PRIORITY 9726
RHEHAAA/WHITEHOUSE WASHDC PRIORITY
RUEHC/SECSTATE WASHDC PRIORITY 0937
RUEKJCS/SECDEF WASHDC PRIORITY
RUEHDN/AMCONSUL SYDNEY PRIORITY 6231
RUEHBN/AMCONSUL MELBOURNE PRIORITY 5613
RUEHPT/AMCONSUL PERTH PRIORITY 1823
RUEHBI/AMCONSUL BRISBANE PRIORITY 0797
RUEHKO/AMEMBASSY TOKYO PRIORITY 1375
RUEHWL/AMEMBASSY WELLINGTON PRIORITY 3296
RUEHPM/AMEMBASSY PORT MORESBY PRIORITY 4847
RUFHFR/AMEMBASSY PARIS PRIORITY 8411
RUEHVA/AMEMBASSY SUVA PRIORITY 2785
RUWTNOL/USCINCSPACE PETERSON AFB CO//POLAD// PRIORITY
RUHVPAC/HQPACAF HICKAM AFB HI//CC/XP/PAI// PRIORITY
RUEPAPG/PMCMIDEMII ABERDEEN PROVING GROUND MD PRIORITY
RUHQHQB/USCINCPAC HONOLULU HI//USIA// PRIORITY
****
USIA-MEDIA REACTION REPORT SEPTEMBER 24, 1993
AUSTRALIAN PRIME MINISTER SLAMS FRENCH ON TRADE
TEXT:
UNCLA$ SECTION 01 OF 02 CANBERRA 06754
USIA
USIA FOR P/M, EA, R, P/P, P/PFF, P/F, P/FW, P/G, EU,
B/TV, NEA; STATE FOR EAP/AN2; STATE PLEASE PASS USTR;
SECDEF FOR USDP/ISA
E.O. 12356: N/A
SUBJECT: USIA-MEDIA REACTION REPORT SEPTEMBER 24, 1993
AUSTRALIAN PRIME MINISTER SLAMS FRENCH ON TRADE
1. THE LIBERAL SYDNEY MORNING HERALD TODAY REPORTED,
"FRENCH OFFICIALS HAVE DENOUNCED THE AUSTRALIAN PRIME
MINISTER AFTER BEING BRIEFED ON THE DETAILS OF HIS
SCATHING ATTACK ON ITS AGRICULTURAL SUBSIDIES, IN
WHICH HE EFFECTIVELY ACCUSED FRANCE OF DISHONORING
THE MEMORY OF AUSTRALIAN SOLDIERS KILLED ON FRENCH
SOIL .... BUT MR. KEATING WAS UNREPENTANT, SAYING
THAT HE INTENDED TO ENCOURAGE OTHER COUNTRIES TO STEP
UP THE PRESSURE ON FRANCE AND THE EUROPEAN COMMUNITY
TO TRY TO FORCE THEM TO BACK OFF MOVES WHICH THREATEN
TO WRECK WORLD TRADE TALKS .... MR. KEATING'S ATTACK
ON FRANCE WAS MADE AFTER AN EMOTIONAL VISIT TO THE
AUSTRALIAN WAR MEMORIAL AT VILLERS-BRETONNEUX WHERE
Page 1 of3
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·"
THE NAMES OF MORE THAN 45,000 AUSTRALIANS WHO DIED ON
THE WESTERN FRONT ARE RECORDED."
2. A BYLINER IN THE BUSINESS-ORIENTED AUSTRALIAN
FINANCIAL REVIEW ASSERTED, "(PM) KEATING WAS ANGRY AT
THE COMPLACENCY OF THE FRENCH AND THEIR INDIFFERENCE
TO ACHIEVING A GLOBAL FREE-TRADE SYSTEM. HE EVEN
ASKED THE UNFORTUNATE LOCAL FRENCH MP ACCOMPANYING
HIM WHAT FRANCE'S RESPONSE WOULD HAVE BEEN IF
AUSTRALIA HAD SAID DURING THE WAR THAT IT WOULD GIVE
45,000 OF ITS YOUTH FOR FRANCE'S LIBERTY, IN RETURN
FOR A WINDING BACK OF AGRICULTURE TRADE BARRIERS.
ACCORDING TO KEATING, THE MP SIMPLY SHRUGGED HIS
SHOULDERS, DISSEMBLING WITH THE USUAL STOCK RESPONSE
ABOUT FARMERS HAVING CULTURAL ROOTS THAT HAD TO BE
PROTECTED."
3. MELBOURNE'S LIBERAL AGE TODAY FEATURED AN
EDITORIAL HEADED, "TELLING THE FRENCH" THAT READ,
"CONTINUED RESISTANCE BY THE FRENCH TO LOWERING
AGRICULTURAL SUBSIDIES COULD WELL MEAN THAT THERE
WILL BE NO GATT.AGREEMENT AND THAT THE WORLD COULD
WELL END UP BEING DIVIDED .INTO WARRING TRADE BLOCS.
THAT WOULD BE A RECIPE FOR A PROLONGED INTERNATIONAL
ECONOMIC DOWNTURN."
4. MELBOURNE'S CONSERVATIVE TABLOID THE HERALD-SUN
TODAY EDITORIALIZED, "AUSTRALIA STANDS TO LOSE 2.5
BILLION DOLLARS A YEAR IN EXTRA EXPORTS IF THE
FRENCH, BY RESISTING RURAL REFORM, SUCCEED IN
SCUTTLING THE ENTIRE GATT DEAL. ABOUT ONE BILLION OF
THIS LOSS WOULD BE IN RURAL EXPORTS. AS THE NATIONAL
BANK REMINDS US, THIS WOULD BE A SERIOUS BLOW TO OUR
PROSPECTS OF RECOVERY."
SYDNEY 2000
5. BROADCAST MEDIA THROUGHOUT THE NIGHT WERE
DOMINATED BY SPECIAL REPORTS ON THE ANNOUNCEMENT OF
THE CITY TO HOST THE YEAR 2000 OLYMPIC GAMES. LIVE
FEEDS FROM SYDNEY HARBOR AND MONACO (AT 4:00A.M.
AUSTRALIAN EASTERN TIME) BROUGHT SCENES OF JUBILATION
AS SYDNEY WAS ANNOUNCED THE WINNER (WITH NEW SOUTH
WALES PREMIER JOHN FAHEY MAKING A MEMORABLE LEAP FROM
HIS CHAIR.) SOME MORNING PAPERS WERE ABLE TO BANNER
THE NEWS AND THE SYDNEY MORNING HERALD ALSO CARRIED A
UNCLAS SECTION 02 OF 02 CANBERRA 06754
USIA
USIA FOR P/M, EA, R, P/P, P/PFF, P/F, P/FW, P/G, EU,
B/TV, NEA; STATE FOR EAP/ANZ; STATE PLEASE PASS USTR;
SECDEF FOR USDP/ISA
E.O. 12356: N/A
SUBJECT: USIA-MEDIA REACTION REPORT SEPTEMBER 24, 1993
COLOR WRAPAROUND EMBLAZONED "OLYMPICS 2000 IT'S
OURS." THERE HAS BEEN NO COMMENTARY AS YET
CONCERNING POLITICAL FACTORS OR FALLOUT IN THE
FAILURE OF BEIJING'S BID.
CLINTON'S HEALTH PACKAGE
6. THE CONSERVATIVE AUSTRALIAN TODAY FRONT-PAGED A
REPORT ON CLINTON'S HEALTH CARE PROPOSAL AND CARRIED
INSIDE A COMMENTARY BY ITS WASHINGTON CORRESPONDENT
WHO HELD, "PRESIDENT CLINTON'S HEALTH REFORM PLAN
DEMONSTRATES HIS TENACITY, HIS WILLINGNESS TO TAKE ON
Page 2 o(3 - - -- - ---
�,.
.
F:\Cable\Data Source\Cables\CD003\SEP93\MSGS\M0622314.html
SECT:
SSN:
TOR:
POWERFUL LOBBY GROUPS AND HIS COMMITMENT TO FOLLOW
THROUGH ON A CENTRAL CAMPAIGN PLEDGE. ALMOST EVERY
PRESIDENT SINCE WORLD WAR II HAS WANTED TO DO WHAT
BILL CLINTON DID LAST NIGHT -- PRESENT A PLAN FOR
UNIVERSAL HEALTH COVERAGE TO THE U.S. CONGRESS. LAST
NIGHT'S SPEECH WAS VINTAGE CLINTON -- SHOWING YET
AGAIN HE IS NOT AFRAID TO TAKE ON SOME OF THE
WEALTHIEST GROUPS IN THE NATION INCLUDING THE
POWERFUL HEALTH INSURANCE INDUSTRY."
7. AN OP-ED ARTICLE IN TODAY'S LIBERAL SYDNEY
MORNING HERALD FROM ITS WASHINGTON CORRESPONDENT
READ, "EVEN AS PRESIDENT CLINTON FORMALLY UNVEILED
HILLARY CLINTON'S WIDELY-LEAKED BLUEPRINT FOR HEALTH
REFORM IN CONGRESS ON WEDNESDAY NIGHT, CRITICISM OF
THE PLAN'S KEY ELEMENTS WAS ALREADY THREATENING TO
ENGULF IT .... WIDE-RANGING SOCIAL AND FINANCIAL
REFORMS ARE HARD ENOUGH IN ANY COUNTRY. THEY ARE
ESPECIALLY TRICKY IN THE UNITED STATES WITH ITS
CONSTITUTIONAL SEPARATION OF POWERS AND THE INFLUENCE
OF WEALTHY LOBBY GROUPS OVER BEHOLDEN CONGRESSIONAL
MEMBERS. BUT THE SADDEST ASPECT OF THE CLINTONS'
UNIQUELY MADE-IN-AMERICA PLAN IS THAT IT HAS
ACKNOWLEDGED ALL THESE OBSTACLES TO REFORM BY
PRODUCING A HEAVILY COMPROMISED PROPOSAL FROM THE
START. IN ESSENCE IT WOULD TONE UP, RATHER THAN
SURGICALLY ALTER; THE LARGELY UNREGULATED,
PRIVATELY-RUN U.S. HEALTH SYSTEM."
NAFTA
8. THE BUSINESS-ORIENTED AUSTRALIAN FINANCIAL REVIEW
HAD AN OP-ED PAGE REPORT FROM ITS WASHINGTON
CORRESPONDENT WHICH READ, "IN WASHINGTON LAST WEEK,
PAUL KEATING URGED BILL CLINTON TO HELP PUT 'FLESH ON
THE BONES' OF THE APEC INITIATIVE BEFORE EXTENDING
THE NAFTA SOUTH OF MEXICO. YET ONLY HOURS BEFORE
CLINTON HOSTED A PRO-NAFTA PEP TALK WHERE HE WAXED
ABOUT ANNEXING MOST OF SOUTH AMERICA TO THE
FREE-TRADE DEAL .... WHILE AUSTRALIA HAS DECIDED TO
LIVE WITH NAFTA, IT NOW FEARS A BIGGER WESTERN
HEMISPHERE FREE-TRADE ZONE --- A WHFTA -- STRETCHING
FROM ANCHORAGE TO PATAGONIA."FARMER
BT
#6754
NNNN
SECTION: 01 OF 02
<"SECT>SECTION: 02 OF 02
6754
<"SSN>6754
930924031537 M0622314
<"TOR>930924031737 M0622315
DIST:
SIT: VAX
0
Page 3 of3
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Magnetic Disk: Hard Drive
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
[01/22/1993 - 09/24/1993]
Creator
An entity primarily responsible for making the resource
NSC Cables
January 1993-December 1994
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7585710" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7585710-20060223F-006-012-2015
7585710
-
https://clinton.presidentiallibraries.us/files/original/cafcdc33f6a34038bf2e3713003c9f01.pdf
4fa6dab02f69c55eb080ba8be691c45c
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
National Security Council
Series/Staff Member:
Subseries:
1378
OA/ID Number:
Scan ID:
Document Number:
9306139
Folder Title:
[NSCURMS]
Stack:
Row:
Section:
Shelf:
Position:
s
45
3
4
3
�UNCLASSIFIED
NSC/RMO PROFILE
RECORD ID: 9306139
RECEIVED: 13 AUG 93 11
TO: CLINTON, H
FROM: RATHBONE, TIM
DOC DATE: 09 MAR 93
SOURCE REF:
KEYWORDS: GREAT BRITAIN
PERSONS:
SUBJECT:
LTR FM RATHBONE OF HOUSE OF COMMONS TO FIRST LADY RE NATL TASK FORCE
ON HEALTH CARE
ACTION: NFAR PER LOWENKRON
DUE DATE: 17 AUG 93
STAFF OFFICER: LOWENKRON
FILES: WH
LOGREF:
NSCP:
CODES:
D 0 C U ME N T
FOR ACTION
STATUS: C
D I S T R I BUT I 0 N
FOR CONCURRENCE
FOR INFO
SOLIS, P
COMMENTS:
DISPATCHED B Y - - - - - - - - - - DATE----- BY HAND
OPENED BY: NSJDA
CLOSED
~y:
NSWEA
UNCLASSIFIED
DOC
1 OF
W/ATTCH
1
�UNCLASSIFIED
ACTION DATA SUMMARY REPORT
DOC ACTION OFFICER
001 LOWENKRON
001
RECORD ID: 9306139
CAO ASSIGNED ACTION REQUIRED
Z 93081311 PREPARE MEMO FOR ITOH
X 93081316 NFAR PER LOWENKRON
UNCLASSIFIED
�UNCLAESIFIJtD
NSC/RMO PROFILE
RECORD ID: 9306139
RECEIVED: 13 AUG 93 11
TO: CLINTON, H
DOC DATE: 09 MAR 93
SOURCE REF:
FROM: RATHBONE, TIM
KEYWORDS: GREAT BRITAIN
PERSONS:
SUBJECT:
LTR FM RATHBONE OF HOUSE OF COMMONS TO FIRST LADY RE NATL TASK FORCE
ON HEALTH CARE
DUE DATE: 17 AUG 93
ACTION: PREPARE MEMO FOR ITOH
LOGREF:
STAFF OFFICER: LOWENKRON
FILES: WH
STATUS: S
CODES:
NSCP:
D 0 C U ME N T
D I S T R I BUT I 0 N
FOR INFO
KUPCHAN
WALKER
COMMENTS:
DISPATCHED B Y - - - - - - - - - - DATE----- BY HAND
OPENED BY: NSJDA
CLOSED 'IY:
DOC
1 OF
W/ATTCH
1
...
UNCLASSIFIED
�Tim Rathbone, M.P .
••
HOUSE OF COMMONS
LONDON SWlA OAA
9th March 1993
May I from this great distance wish you extremely well in
your role as head of the National Task Force on Health
Care Reform. My particular interest in your plans, as in
the Government's activities here in Great Britain, has to
do with the continuing awful problems of drugs misuse. It
is my belief that we shall never get on top of that
problem until we have vastly improved health education ~
order to reduce demand.
To that end I have written jointly with a British Member
of the European Parliament a book of guidance about drugs
prevention and health education titled "It's My Problem As
Well ... ". This draws upon exper~ence of some United
States programmes and discussions we had with Governor
Martinez and Secretary Sullivan. I hope th~t it might be
of interest to you and a copy is enclosed.
More strength to your elbow in your important endeavours.
\
Enc:
Mrs Hillary Clinton
The White House
WASHINGTON D C
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
9306139
Creator
An entity primarily responsible for making the resource
National Security Council
Unclassified Records Management System
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7388808" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7388808-20060223F-006-011-2015
7388808
-
https://clinton.presidentiallibraries.us/files/original/ec640dd8018d9d0ad1ce4c274194edfa.pdf
8d3aa19c0aa6edd81d2cce57a521cbce
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
National Security Council
Series/Staff Member:
Subseries:
1376
OA/ID Number:
Scan ID:
Document Number:
9305325
Folder Title:
[NSCURMS]
Stack:
Row:
Section:
Shelf:
Position:
s
45
3
4
2
�UNCLASSIFIED
NSC/RMO PROFILE
..
RECORD ID: 9305325
RECEIVED:--2t· JUL· 93-11 _,
TO: SOLIS, P
DOC DATE: 24 JUL 93
SOURCE REF:
FROM: ITOH
KEYWORDS: DENMARK
PERSONS:
LANDMAN, LAWRENCE B ·
SUBJECT:
REQUEST FIRST LADY SPEAK AT CONF BY_DENMARK_ SHCOOL OF PUBLIC
ADMINISTRATION
ACTION: KENNEY SGD MEMO
DUE DATE: 24 JUL 93
STAFF OFFICER: KELLY, C
;/
LOGREF:
NSCP:
CODES:
D 0 C U M.E NT
FOR ACTION
STATUS: C
DIS T RIB UTI 0 N
FOR CONCURRENCE
FOR INFO
EXEC SEC
KELLY, C
COMMENTS: --------------------------------------------------------
\8_~--~----- DATE
DISPATCHED BY _ _ _ _ _
or· :NED BY: NSJDA
CLOSED BY.: NSWEA
UNCLASSIFIED
------------------------ - - - - - - - - - -
.
lf''()
BY HAND
. DOC
2 OF
W/ATTCH
2
�UNCLASSIFIED
ACTION DATA SUMMARY REPORT
DOC ACTION OFFICER
RECORD ID: 9305325
CAO ASSIGNED ACTION REQUIRED
001 KELLY, C
OOi ITOH
002
Z 93072111 PREPARE MEMO FOR ITOH
Z 93072321 FOR SIGNATURE
X 93072413 KENNEY SGD MEMO
DISPATCH DATA SUMMARY REPORT
DISPATCH FOR ACTION
002
DISPATCH FOR INFO
930724 SOLIS, P
UNCLASSIFIED
-------
- - - - - - - - - - - - - '
�·•.:
National Security Council
The White House
5?:>Z..t;"
PROOFED BY: _ _ _ _ _ __
LOG#
URGENT NOT PROOFED: _ __
SYSTEM
~
BYPASSED WW DESK: _ _ __
DOCLOG
~
HAS SEEN
SEQUENCE TO
NSC
/NT
A/0 _ _ __
DISPOSITION
\ltnepExecSec
ExecSec
Staff Director
D/APNSA
APNSA
Situation Room
West Wing Desk
NSC Secretariat
I = Information
cc:
VP
D =Dispatch
Mclarty
R =Retain
N = No Further Action
Other _ _ _ _ _ __
Should be seen by: _ _ _ _ _ _ __
(Date/Time)
COMMENTS:
¥.:::..;:.,_·.,-. ....::~'~··
.- .. , .. -·-- -....
DISPATCH INSTRUCTIONS:
�..c:
_.,., (. ;:•F;
.:,...· ....
THE WHITE HOUSE
WASHINGTON
July 19, 1993
MEMORANDUM FOR WILLIAN ITOB
PROM:
PATTI SOLIS
DIRECTOR OF SCHEDULING FOR THE FIRST LADY
RBI
SCHEDQLING REQUESTS
The enclosed letter from Lawrence
invitation for the First Lady to speak
at a conference sponsored by Denmark's
Administration on October 25th, 1993.
action.
MEMORANDUM FOR PATTI SOLIS
I .. ll~
FROM:
July 23, 1993
WILLIAM H. ITO~-
SUBJECT:
B. Landman, Esquire, is an
about health care reform
School of Public
Please advise on course of
Scheduling Request
The NSC staff recommends that the First Lady decline the
Scheduling Request as stated above. Given the demands on the
First Lady's time, this venue is not a high priority, unless it
is one stop on a broader trip.
---------~--
�LANDMAN & CHRISTENSEN
\
\
"
NygArdterrasseme 254F
3520 Farum - Denmark
Tlf. +45 42 95 13 68
Fax +45 42 95 69 83
Lawrence B. Landman
Juris Doctor*, M.B.A
Helle Lind Christensen
Cand. mere., M.B.A
June 14, 1993
Ms. Hillary Rodham Clinton
The White House
1600 Pennsylvania Ave.
Washington, D.C.
USA
Dear Ms. Clinton:
I write to invite you to speak at a conference on the United States.
Danmarks Forvaltningshojskole (Denmark's School of Public
Administration) is arranging this conference, and I am helping the
school in this effort. The conference will take place on October 25,
1993. A program of the conference is enclosed.
We would very much like you to talk about the administration's health
care reform proposals. You have in the past expressed admiration for
the Danish social system, particularly the educational system and
medical system. We also invite to express your thoughts on these and
similar subjects. '
On September 3, 1992, in Rockville, Maryland, your husband said that
the United States must learn to compete against, among other
countries, Denmark. As an American living in Denmark I know how
emphatically true that is. To draw attention to this fact, you may
want to consider attending this conference.
If you can not attend the conference personally, the school and I are
very happy to extend this invitation to a member of your staff, the
health care task force's staff, or another person whom you consider
appropriate, whether or not that person attends formally on your
behalf.
The honorarium is 2,000 Danish Kroner (approximately $350.00). I
could, however, arrange for the speaker to instead receive round-trip
airfare to Copenhagen.
I look forward to hearing from you at your earliest convenience.
\
.
'\
\
�Danmarks
Forvaltningsht?Jjsko/e
Program
Dealing with Bill Clinton's America
The New President, Social Conditions, and Economic Growth
Monday 25th October 1993
Conference Center:
Schrefferga rden
Jregersborg Aile 166
2820 Gentofte
Phone no. 31 65 60 65
Co-ordinator:
Jur.Dr., MBA.
Lawrence B. Landman
Public Admini~tration Training Center
Danish School of Public Administration
Lindevangs Aile 6-12
2000 Frederiksberg
Phone no. 31 86 18 70
Lecturer Jytte Clausen
�8.30
Arrival and coffee
9.00
Introduction
a. Overview of American Society
9.30
America's International Role
a. International Responsibilities
b. Turning Inward After The Cold War
10.00
Economic Performance since 1973
a. Internationalization
b. Productivity and Growth
c. The Service Economy
11.00
Social Conditions
a. Crime
b. Income and Job Growth
c. Education
12.00
Lunch
13.30
Health Care
a.
b.
c.
d.
The Extent of Coverage
Business' Costs and Obligations
Public Expenditures
Tort System and Product Liability
�14.00
The Deficit
a. The Problem
1. Benefits and the Explosion of Borrowing During the 1980's
2. The Economic and Social Implications
b. Clinton's Proposals (or, by October, Enactments)
1. What They Are
2. What They \Vill Do
15.00
Co.ffeebrake
15.15
Business Environment, Industrial Policy, and Foreign Economic Policy
a. "Strategic" Business Subsidies and Public Investment
b. "Fair-Trade" Policy, Especially Regarding the EC
c. Current Business Conditions
1. Productivity Is Increasing
2. The Recession Is Ending
16.15
End of Conference
16.30
Refreshments
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
9305325
Creator
An entity primarily responsible for making the resource
National Security Council
Unclassified Records Management System
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7388808" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7388808-20060223F-006-010-2015
7388808
-
https://clinton.presidentiallibraries.us/files/original/345750472af6cbd4ef6f577e64f0d4d8.pdf
76595f0ba336060397881af0ef191ac4
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
National Security Council
Series/Staff Member:
Subseries:
1376
OA/ID Number:
Scan ID:
Document Number:
9305320
Folder Title:
[NSCURMS]
Stack:
Row:
Section:
Shelf:
Position:
s
45
3
4
2
�.UNCLASSIFIED
NSC/RMO PROFILE
TO: SOLIS, .P
FROM: ITOH
DOC DATE: 19 JUL 93
SOURCE REF:
KEYWORDS: ISRAEL
PERSONS:
ZILONY, EPHRAIM
SUBJECT:
SCHEDULING REQUEST FOR ZILONY OF HISTADRUT GRN FEDERATION OF LABOUR
IN ISRAEL
.
ACTION: KENNEY SGD MEMO
STAFF OFFICER: INDYK
'//·,;;~~·,
FILES: WH ! i
(
'--.._
/J
I
·,I\__.--/
DUE DATE: 24 JUL 93
STATUS: C
LOGREF:
NSCP:
CODES:
)
--
FOR ACTION
D 0 C U ME N T
DI S T R I BUT I 0 N
FOR CONCURRENCE
FOR INFO
EXECSE.C
INDYK
COMMENTS:
DISPATCHED B Y - - - - - - - - - - DATE----- BY HAND
or· :NED BY: NSJDA
CLOSED BY: NSMEM ·
UNCLASSIFIED
DOC
2 OF
W/ATTCH
2
�UNCLASSIFIED
ACTION DATA SUMMARY REPORT ·
DOC ACTION OFFICER
RECORD ID: 9305320
CAb ASSIGNED ACTION REQUIRED
001 INDYK
001 ITOH
002
Z 93072111 P~EPARE MEMO FOR ITOH
Z 93072118 FOR SIGNATURE
X 93072208 KENNEY SGD MEMO
DISPATCH DATA SUMMARY REPOR:I .
DISPATCH FOR ACTION
002
930719
DISPATCH FOR INFO
SOLIS, P
UNCLASSIFIED
�National Security Council
The White House
___.,@)~-. ,_.__
....
5-;)2.0
PROOFED BY: _ _
LOG#
URGENT NOT PROOFED: _ __
SYSTEM
BYPASSED WW DESK: _ _ __
DOCLOG~
~
pi)
NSC
/NT
A/0 _ _ __
DISPOSITION
SEQUENCE TO
(
DepExecSec
ExecSec
Staff Director
D/APNSA
APNSA
Situation Room
West Wing Desk
NSC Secretariat
A= Action
cc:
I = Information
VP
D =Dispatch
Mclarty
R =Retain
N = No Further Action
Other _ _ _ _ _ __
Should be seen by: _ _ _ _ _ _ __
(Date/Time)
COMMENTS:
DISPATCH INSTRUCTIONS:
�"(
.,.., .
I
THE WHITE HOUSE
WASHINGTON
July 19, 1993
MEMORANDUM FOR WILLIAM ITOB
FROM:
PATTI SOLIS
DIRECTOR OF SCHEDULING FOR THE FIRST LADY
RE:
SCHEDULING REQUESTS
The enclosed letter from Ephraim Zilony of the Histadrut,
General Federation of Labour in Israel is an invitation for the
First Lady to lead a delegation to examine the Israeli health
care system on a date of the First Lady's convenience. Please
advise on course of action.
---------------------~----------------------------------------
July 21, 1993
MEMORANDUM FOR PATTI SOLI'~
I
, /
FROM:
WILLIM-1 IT~
SUBJ:
Scheduling Request from Ephraim Zilony of the
Histadrut, General Federation of Labour in Israel
The NSC does not recommend a meeting at this time.
�I 1 1 0
I K
U
i'i U
I
• UEilllilldl r8UtirdUUII Or LdUOQi
Ill 1Sid81
February 17, 1993
Mrs. Hillary Clinton,
The White House,
MAA 19 19m
Washington D.C.
U.S.A.
Dear Mrs. Clinton,
I must declare, at the outset, that I was among the many who expectantly
anticipated the election of Bill Clinton to the position of President of the United States. This
was because of the hope that he would succeed in arousing the majority of the American
people to the awarenes..c;; that it is possible to create a society based on principles of
responsibility and achievement, while ensuring the commitment to fundamental social justice,
in which the administration does not confine its concern to guidance and supervision but takes
a leading active role in the moulding and consummation of policy.
The announcement that the President has appointed you Head of the Task Force
for Health-Care Reform, charged with finding the solutions to the problems of the health care
system in the States, has been received by many both in the U.S. and abroad with great
pleasure, as we are conscious of your social awareness and professional abilities.
Histadrut, the General Federation of Labour in Israel, which is not solely a
trade union, has created since its foundation in the early twenties of this century, a
comprehensive system of services. These include the Kupat Holim, Health Fund, which
provides health services to the clear majority of the population of the country. In spite of the
fact that for the last few years the institution has been contending with difficult financial
restraints, stemming mainly from political policies of previous conservative governments, we
believe that it is able to demonstrate to you a model of the operation of a public health-care
system, which can be studied and adapted for use elsewhere.
I would like to invite you to visit Israel, as guest of the Histadrut, General
Federation of Labour at the head of a delegation, to examine the structure of the Israeli health
care system, at first hand. To appreciate its achievements and its problems.
93, Arlosoroff St.
62 098 Tel-Aviv
ISRAEL
Phone: (03) 431 111
Cables : OVDIM TEL-AVIV
Telex : 342488 HISTD IL
�A I S I A D R U I - Gener81 Fed8rat1on of LabOur 1n Israel
EXE"CU liVE CUMMII TEE
2
Our opinion is that the Israeli model, in spite of its present problems, can be
a source of inspiration, ideas and lessons for you to utilize while constructing a new American
model.
Based on our observation, through the media, of the President's views and
commitment to a new, audacious social move, we believe that the new Democratic
Administration will indeed succeed in bringing about a genuine reformation in U.S. society
and health and religion are important turning points in the new social design.
The dominant and responsible role which has been assigned to you is the initial
establishing stride on the road which I and my colleagues in the Histadrut believe to be the
correct one:
I hope that you will accept my invitation and agree to be the guest of the
Histadrut for a working visit to investigate our health care system, which may be able to
make a positive contribution for the welfare of the American People.
I believe that the new team in the White House, towards whose election you
contributed so much thanks to your personality, your abilities and your dynamism, will
succeed in confronting and prevailing over the challenge of creating a health care system
which will be appropriate not only to the needs of the citizens of America, but will be a
positive example for other nations.
With respect,
You . sincerely,
'Lu
ony
irman,
93, Arlosoroft St.
62 098 Tel-Aviv
ISRAEL
a
~ de Union Department
Phone: (03) 431 111
Cables : OVDIM TEL-AVIV
Telex : 342488 HISTD IL
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
9305320
Creator
An entity primarily responsible for making the resource
National Security Council
Unclassified Records Management System
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7388808" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7388808-20060223F-006-009-2015
7388808
-
https://clinton.presidentiallibraries.us/files/original/bf679abedf413911d2c9bc02bfb578ec.pdf
e03d664947159a0d2c68899b3e3771e7
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
National Security Council
Series/Staff Member:
Subseries:
1375
OAIID Number:
Scan ID:
Document Number:
9304749
Folder Title:
[NSCURMS]
Stack:
Row:
Section:
Shelf:
Position:
s
45
3
3
2
�UNCLASSIFIED
NSC/RMO PROFILE
RECORD ID: 9304749-- -- --RECEIVED:~28 JUN 93 11
TO: SOLIS, P
DOC DATE: 08 JUL 93
SOURCE REF:
FROM: ITOH
KEYWORDS: AUSTRALIA
PERSONS:
SUBJECT:
REQUEST FIRST LADY VISIT AUSTRALIA TO DISCUSS HEALTH CARE ISSUES
ACTION: KENNEY SGD MEMO
DUE DATE: 01 JUL 93
STAFF OFFICER: ZEGART
/
''.
FILES : rWH / .
NSCP:
.
LOGREF:
CODES:
.
D 0 C U ME N T
FOR ACTION
STATUS: C
DI S T R I BUT I 0 N
FOR CONCURRENCE
FOR INFO
EXEC SEC
ZEGART
COMMENTS:
DISPATCHED BY - - - - - - - - - - DATE - - - - - BY HAND
OPENED BY: NSJDA
CLOSED BY NSWEA
UNCLASSIFIED
DOC
3 OF
W/ATTCH
3
�UNCLASSIFIED
ACTION DATA SUMMARY REPORT
DOC ACTION OFFICER
RECORD ID: 9304749
CAD ASSIGNED ACTION REQUIRED
001 KRISTOFF
002 ITOH
003
Z 93062811 PREPARE MEMO ITOH TO SOLIS
Z 93070918 FOR .SIGNATURE
X 93070919 KENNEY SGD MEMO
DISPATCH DATA SUMMARY REPORT
DISPATCH FOR ACTION
003
DISPATCH FOR INFO
930708 SOLIS, P
UNCLASSIFIED
�National Security Council
The White House
PROOFED BY:
~
LOG#
URGENT NOT PROOFED:
SYSTEM
BYPASSED WW DESK:
DOCLOG
/NT
DISPOSITION
HAS SEEN
SEQUENCE TO
\Lb#-!
DepExecSec
ExecSec
It
Staff Director
D/APNSA
APNSA
Situation Room
West Wing Desk
NSC Secretariat
@;
J.,
i/~
3
I = Information
cc:
VP
~
D
D =Dispatch
Mclarty
R =Retain
N = No Further Action
Other _ _ _ _ _ __
Should be seen by: _ _ _ _ _ _ __
(DatefTime)
1)0T&aoi~LA
(b'#
DISPATCH INSTRUCTIONS:
MEMO WAS>
~T/ff'F OfP.tc..£(L .
fR£_ ... CATE.O
�4749
NATIONAL SECURITY COUNCIL
WASHINGTON, D.C. 20508
July 8, 1993
MEMORANDUM FOR PATTI SOLIS
ITO~
FROM:
WILLIAM H.
SUBJECT:
Request for Mrs. Clinton to Visit Australia to
Discuss Health Care Issues.
Sir Gustav Nossal, Director of the Walter and Eliza Hall
Institute of Medical Research in Melbourne Australia, has written
inviting Mrs. Clinton to visit Australia and discuss health care
issues.
The NSC staff recommends declining the invitation. Australia's
health care system has not provided a prominent model for U.S.
health care reform and does not appear on the agenda for
Secretary Christopher's upcoming trip to Australia.
Attachments
Tab A
Incoming Material
�:.··.
4749.
NATIONAL SECURITY COUNCIL
WASHINGTON. D.C. 20506
July B, 1993
ACTION
MEMORANDUM FOR WILLIAM H. ITO~~ ~~
THROUGH:
KENT WIEDEMAN~
FROM:
AMY ZEGART
SUBJECT:
Invitation for Mrs. Clinton Visit to Australia
~
Sir Gustav Nossal, Director of the Walter and Eliza Hall
Institute of Medical Research in Melbourne Australia, has invited
Mrs. Clinton to visit the Institute, study Australian health care
reforms and discuss health care issues.
The NSC Asia staff recommends declining this invitation.
Australia's health care system has not provided a prominent model
for U.S. health care reform.
RECOMMENDATION
That you sign the memo to Patti Solis at Tab I.
Attachments
Tab I
Memo to Solis
Tab A
Incoming Material
�THE WHITE HOUSE
WASHINGTON
June 22, 1993
MEMORANDUM FOR WILLIAM ITOR
FROM:
PATTI SOLIS
DIRECTOR OF SCHEDULING FOR THE FIRST LADY
RE:
SCHEDULING REQUESTS
The enclosed letter from G. J. v. Nossal is an invitation
for the First Lady to join health care leaders in Australia to
discuss health care reform on a date of Mrs. Clinton's
convenience. Please advise on course of action.
�THE WALTER AND ELIZA HALL INSTITUTE OF MEDICAL RESEARCH
A.C.N. 004 251 423
Affiliated with
THE UNIVERSITY OF MELBOURNE
THE ROYAL MELBOURNE HOSPITAL
DIRECTOR
SIR GUSTAV NOSSAL
19th February, 1993.
Mrs Hillary Clinton
The White House
1600 Pennsylvania Avenue, NW
WASHINGTON D.C. 20500
U S A
Dear Mrs Clinton,
Permit me to join other health leaders in Australia in urging:,~you
to visit this country as part of your investigation into the
revamping of the United States health care system. In making
this plea, I wear three hats. First, I have the honour of being
the Director of Australia's oldest and largest medical research
institute, which is very well known in your country and which
leads the world in many aspects of immunology and oncology. It
would be an enormous pleasure to introduce you to the leaders of
Australian medical research within and outside the Institute, to
show you some of our work and, in particular, to highlight the
importance of medical research within an overall health care
system.
Secondly, I am the Chairman of the Victorian Health Promotion
Foundation and I wanted to follow-up on the letter which our
Chief Executive, Ms Rhonda Galbally, has already written to you.
We believe this Foundation, financed by a hypothecated tax on
cigarettes, has developed into a fine model which is being copied
in many parts of the world. It is far from being purely an antismoking lobby. Indeed, it is promoting health in a wide variety
of ways involving networks at many levels. We are particularly
proud of the way that we have been able to involve personalities
both from the sports and from the arts in our health promotion
programmes. Furthermore, we would like to be able to point out
to you the essential role of health promotion and preventive
medicine in an overall health care framework. We have been
particularly successful in setting up a three-way conversation
between the leaders of the practicing medical profession, public
health specialists and the political/government sector which has
got a new spirit of partnership moving in this area.
In passing, I might mention that we had several productive
interactions with Michael Dukakis while he was visiting here
studying the Australian health care system. He seemed
enthusiastic about some of our models.
Continued/
�I N v ! -r f) 7
. ,_- h__
THE WALTER AND ELIZA HALL INSTITUTE OF MEDICAL RESEARCH
A.C.N. 004 251 423
Affiliated with
THE UNIVERSITY OF MELBOURNE
THE ROYAL MELBOURNE HOSPITAL
DIRECTOR
SIR GUSTAV NOSSAL
19th February, 1993.
Mrs Hillary Clinton
The White House
1600 Pennsylvania Avenue, NW
WASHINGTON D.C. 20500
tJ S A
Dear Mrs Clinton,
Permit me to join other health leaders in Australia in urging you
to visit this country as part of your investigation into the
revamping of the United States health care system. In making
this plea, I wear three hats. First, I have the honour of being
the Director. of Australia's oldest and largest medical research
institute, which is very well known in your country and which
leads the world in many aspects of immunology and oncology. It
would be an enormous pleasure to introduce you to the leader~ of
Australian medical research within and outside the Institute, to
show you some of our work and, in particular, to highlight the
importance of medical research within an overall health care
system.
I
Secondly, I am the Chairman of the Victorian Health Promotion
Foundation and I wanted to follow-up on the letter which our
Chief Executive, Ms Rhonda Galbally, has already written to you.
we believe this Foundation, financed by a hypothecated tax on
cigarettes, has developed into a fine model which is being copied
in many parts of the world. It is far from being purely an antismoking lobby. Indeed, it is promoting health in a wide variety
of ways involving networks at many levels. we ~re particularly
proud of the way that we have been able to involve personalities
both from the sports and from the arts in our health promotion
programmes. Furthermore, we would like to be able to point out
to you the essential role of health promotion and preventive
medicine in an overall health care framework. We have been
particularly successful in setting up a three-way conversation
between the leaders of the practicing medical profession, public
health specialists and the political/government sector which has
got a new spirit of partnership moving in this area.
In passing, I might mention that we had several
~r~d~ctive
�. I
..
Mrs Hillary Clinton
- 2 -
19th February, 1993.
Finally, I am the Chairman of the World Health Organization's
Scientific Advisory Group of Experts advising on WHO's Programme
for vaccine Development. I am, therefore, very familiar with all
the problems surrounding the delivery of immunisation programmes.
In closing, I need hardly add what a "shot in the arm" it would
be for Australian medical science if you could make such a visit.
Yours sincerely,
G. J. v. Nossal
Director.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
9304794
Creator
An entity primarily responsible for making the resource
National Security Council
Unclassified Records Management System
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7388808" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7388808-20060223F-006-008-2015
7388808
-
https://clinton.presidentiallibraries.us/files/original/e68ae7ab2673d37ffce41c0411d361a9.pdf
d3cf6f6a7ecd3e7a87d949842c1710e6
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
National Economic Council
Series/Staff Member:
Gene Sperling
Subseries:
6707
OA/ID Number:
FolderiD:
Folder Title:
Preliminary Health Care Decisions APR 13 93
Stack:
Row:
Section:
Shelf:
Position:
s
17
5
4
3
�PRELIMINARY
HEALTH CARE DECISIONS
�'!I'
I
I
THE WHITE HOUSE
WASHINGTON
April 13, 1993
MEMORANDUM FOR HILLARY RODHAM CLINTON, CAROL RASCO
FROM:
IRA MAGAZ INER
SUBJECT:
PRELIMINARY HEALTH CARE PLAN -- OUTLINE AND
DECISIONS
J
)/
1'{11'
Enclosed is an overview and outline of the preliminary construct
for national health reform. This book describes key decisions
which now must be made.
Information and options related to investments, savings and
financing for the new health care system will be inserted into
the book over the weekend.
�TABLE OF CONTENTS
OVERVIEW OF HEALTH REFORM
PRELIMINARY PLAN FOR NATIONAL
HEALTH REFORM
DECISIONS
�OVERVIEW OF HEALTH REFORM
�WHAT IS RIGHT WITH AMERICA'S HEALTH CARE SYSTEM?
MOST AMERICANS ARE HAPPY WITH THE QUALITY OF CARE
THEY RECEIVE FROM THEIR DOCTORS.
MOST AMERICANS HAVE ADEQUATE CHOICE OF DOCTORS
AND TYPES OF CARE (THOUGH NOT IN UNDERSERVED
AREAS).
MOST AMERICANS HAVE NEGOTIATED HEALTH CARE
BENEFITS WHICH THEY FEEL ARE ADEQUATE (THOUGH THEY
FEAR LOSING THEM).
JM/PRIVJLEGED 6: CONFIDEN'11A114-11-83 - 1
�MAJOR PROBLEMS WITH TODAY'S HEALTH SYSTEM
COSTS ARE HIGH AND RISING TOO FAST -- OVER 14% OF GDP
VS. LESS THAN 9% IN GERMANY AND LESS THAN 8% IN
JAPAN.
LACK OF SECURITY -- ONE IN FOUR AMERICANS LOSES
COVERAGE EVERY TWO YEARS.
NOT USER OR PROVIDER FRIENDLY -- IN SURVEYS, MOST
CONSUMERS AND PROVIDERS FIND THE SYSTEM TO BE
BUREAUCRATIC, CONFUSING AND FRUSTRATING.
MANY AMERICANS ARE UNDERSERVED -- 37 MILLION LACK
COVERAGE; 22 MILLION HAVE ONLY "BARE BONES"
COVERAGE; MANY RURAL AND POOR URBAN AREAS LACK AN
ADEQUATE MEDICAL INFRASTRUCTURE.
INADEQUATE LONG-TERM CARE -- AN INCREASING NUMBER
OF PEOPLE REQUIRE LONG-TERM CARE.
DIIPBJVILEGED A CONPIDBN'I1AJJ4-11-83- 2
�WHY COSTS ARE RISING IN HEALTH CARE
HIGH ADMINISTRATIVE AND TRANSACTION COSTS
•
INSURANCE UNDERWRITING AND CLAIMS
PROCEDURES
•
INEFFICIENT REIMBURSEMENT AND QUALITY
SYSTEMS
INCENTIVES FOR UNNECESSARY CARE
•
PROVIDERS PAID BY THE TEST OR PROCEPURE
ENCOURAGING MORE TESTS AND PROCEDURES TO
BE PERFORMED
•
CONSUMERS ABLE TO ACCESS THE SYSTEM AS
i
· THEY WISH WITH FEW INCENTIVES TO LIMIT USE
TO NECESSARY OCCASIONS
•
FEW INCENTIVES TO EVALUATE NEW TECHNOLOGY USAGE AND CAPITAL INVESTMENTS FOR
COST EFFECTIVENESS
•
TO A LESSER EXTENT, DEFENSIVE MEDICINE
PRACTICED TO AVOID LAWSUITS
IMIPBMLEGED • CONFIDEN'l1All4-11·88- a
�WHY THERE IS LACK OF SECURITY
THE ORGANIZATION OF THE U.S. INSURANCE MARKET
•
INSURANCE COMPANIES COMPETE BY RISK
SELECTION --TRYING TO INSURE ONLY THOSE
WHO ARE UNLIKELY TO BECOME ILL AND
DROPPING THOSE WHO DO BECOME ILL -- IF YOU
ARE LIKELY TO NEED CARE, YOU HAVE DIFFICULTY
BEING COVERED
•
HEALTH CARE BENEFITS FOR MOST AMERICANS
(THOSE WHO ARE NOT OVER 65 YEARS OLD OR WHO
ARE NOT POOR OR SEVERELY DISABLED) ARE TIED
TO EMPLOYMENT
NOT ALL EMPLOYERS PAY TO COVER THEIR
EMPLOYEES
WSING OR CHANGING JOBS CAN MEAN WSS
OF COVERAGE
AS COSTS RISE, MORE EMPLOYERS ARE
DROPPING COVERAGE AS A COMPANY PAID
BENEFIT OR INCREASING THE EMPLOYEE
REQillRED PAYMENTS WHICH CAUSES SOME
EMPLOYEESTOCANCELCOVERAGE
�WHY THERE IS LACK OF SECURITY (CONT'D)
•
AS A RESULT, 37 MILLION AMERICANS ARE
UNINSURED AND ANOTHER 22 MILLION LACK
ADEQUATE INSURANCE. MANY ADDITIONAL
AMERICANS LIVE IN FEAR OF LOSING THEIR
COVERAGE IF THEY LOSE THEIR JOB, THEIR
EMPLOYER CUTS BACK ON HEALTH CARE
PAYMENTS OR THEY OR A FAMILY MEMBER
BECOME ILL
JM/PRI\'IIEGED lc CONFIDENTIAII4-11-83 -1
- - - - - - - - - - - -
- - - - - - - - - - - - - -
�THE SYSTEM IS NOT USER OR PROVIDER FRIENDLY
THOUGH MOST AMERICANS FEEL OKAY ABOUT THE QUALITY
OF CARE TH_EY RECEIVE, THEY ARE FRUSTRATED BY:
•
. THE COMPLEXITY OF THE CLAIMS AND
REIMBURSEMENT PROCESS
•
UNCERTAINTIES ABOUT WHAT IS OR IS NOT
COVERED IN THEIR INSURANCE POLICY
HEALTH CARE PROVIDERS ARE ALSO FRUSTRATED BY THE
BUREAUCRACY THEY MUST ENDURE AND THE MICROMANAGEMENT BY GOVERNMENT AND INSURANCE
COMPANIES OF THEIR DAILY ACTIVITIES.
•
DRG AND RBRVS REQUIREMENTS
•
MULTIPLE UTILIZATION REVIEWS
•
CLIA
•
PRO'S
•
MULTIPLE REGULATING AUTHORITIES
1M/PRIVILEGED • CONPIDEN'nA114-ll-88 -8
�WHY MANY AMERICANS ARE UNDERSERVED
PROVIDING COMPREHENSIVE HEALTH BENEFITS FOR
UNINSURED AND UNDERINSURED AMERICANS WILL STILL
LEAVE MANY AMERICANS WITHOUT ADEQUATE HEALTH
CARE.
•
INADEQUATE INFRASTRUCTURE-- DOCTORS,
HOSPITALS, ETC. -- IN MANY RURAL AND POOR
URBAN AREAS
•
POOR HEALTH EDUCATION AND INADEQUATE
PREVENTIVE SERVICES
IM/PBIVILEGED & CONPIDEN'l1AIJ4-11-83- '1
�INADEQUATE LONG-TERM CARE
AN INCREASING NUMBER OF AMERICANS WILL REQUIRE
WNG-TERM CARE AT SOME TIME DURING THEIR LIVES
•
AGING OF THE POPULATION
•
INCREASING ABILITY TO MAINTAIN LIFE AFTER
SEVERE ACCIDENTS, BIRTH DEFECTS, SEVERE
ACUTE ILLNESSES
THE FAMILY IS LESS ABLE TO PROVIDE CARE AT HOME
•
•
MOBILITY OF POPULATION
. AGING OF POPULATION MEANS CHILDREN OF OLD
ELDERLY MAY THEMSELVES BE ELDERLY
•
INCREASED PARTICIPATION OF WOMEN IN THE
WORKFORCE
•
DECLINING REAL INCOMES OF MANY FAMILIES
THE PROBLEM GROWS DRAMATICALLY IN 20-30 YEARS
1M/PRIVILEGED • CONPIDE!mAII4-11-83 - 8
�ADDRESSING THE PROBLEMS: THE WORK TEAM PROPOSALS
PROBLEM
IDGH ADMINISTRATIVE COSTS
SOLUTION
• ELIMINATION OF INSURANCE UNDERWRITING AND
MULTIPLE RISK PRODUCTS
• SIMPLIFICATION OF CLAIMS AND REIMBURSEMENT
-MOVE TOWARDS CAPITATED PAYMENT SYSTEMS
- SIMPLE UNIVERSAL CLAIMS AND REIMBURSEMENT
FORMS DRIVEN BY UNIVERSAL ENCOUNTER FORMS
• ELIMINATION OF DUAL COVERAGE AND COVERAGE
DETERMINATION PRACTICES
• SIMPLIFICATION OF PRODUCT REDUCES NEED FOR
AGENT TO ASSIST CONSUMERS
• REDUCTION IN COSTS OF SMALL GROUP
ADMINISTRATION
• REDUCTION IN REGULATORY REQUIREMENTS -- FORM
FILLING -- FOR CLIA, PRO'S, ETC.
• REDUCTION IN MALPRACTICE PREMIUMS
• REDUCTION IN TIME SPENT BY PROVIDERS AND
INSURERS INVESTIGATING OR DEBATING
REIMBURSABILITY
�ADDRESSING THE PROBLEMS: THE WORK TEAM PROPOSALS (CONT'D)
SOLUTION
PROBLEM
UNNECESSARY TESTS AND
PROCEDURES
• BUDGETED/CAPITATED SYSTEMS DISCOURAGE
UNNECESSARY UTILIZATION AND INTENSITY OF SERVICE
BY PROVIDERS
.
.
• GATEKEEPERS aN HMOs OR PROs), SOME USE OF COPAYS
IN FEE FOR SERVICE PLANS AND PRICE COMPETITION
WILL DISCOURAGE UNNECESSARY CONSUMER USAGE
• NATIONAL TECHNOLOGY ASSESSMENT AND BETrER
INFORMATION ON PRACTICE PATrERN DIFFERENCES AND
EFFECTIVENESS OF TREATMENT WILL ENHANCE COST
CONSCIOUS/HIGH QUALITY PRACTICE
• BUDGETED/CAPITATED SYSTEMS ENCOURAGE MORE
PRUDENT USE OF TECHNOLOGY AND MORE COST
EFFECTIVE CAPITAL INVESTMENT
• MALPRACTICE REFORMS WILL CUT THE COSTS OF
MALPRACTICE INSURANCE AND DEFENSIVE MEDICINE
LACK OF SECURITY
• ALL AMERICANS ARE INSURED
• INSURANCE CANNOT BE DENIED OR TAKEN AWAY
REGARDLESS OF HEALTH STATUS
JMIPBIVILEGED 6 OONPIDEN'l1AU4-ll-83 - 10
�ADDRESSING THE PROBLEMS: THE WORK TEAM PROPOSALS (CONT'D)
PROBLEM
LACK OF SECURITY (CONT'D)
SOLUTION
• BENEFITS AT A COMPARABLE LEVEL CONTINUE
REGARDLESS OF EMPLOYMENT OR INCOME STATUS
• ALL AMERICANS AND THEm EMPLOYERS PAY INTO THE
SYSTEM AT THE SAME RATE REGARDLESS OF THEm
HEALTH STATUS
NOT USER FRIENDLY
• GREATER CHOICE OF PLANS FOR MANY AMERICANS
• SIMPLE UNDERSTANDABLE BENEFITS PACKAGE
• ONE COVERAGE PACKAGE FOR A FAMILY
• NO COVERAGE BATrLES AMONG INSURERS
• GUARANTEED ACCESS TO PLANS
• CONSUMER COMPLAINT MECHANISM IN PLANS AND
ALLIANCE
• SIMPLE REIMBURSEMENT AND CLAIMS FORMS
• PUBLISHED QUALITY INFORMATION
PROVIDER FRIENDLY
• CLIA SIMPLIFICATION
• PRO SIMPLIFICATION
• STANDARD REIMBURSEMENT AND ENCOUNTER FORM
IM/PRIVILEGED 6 CONPIDEN'nAII4-ll-88- 11
�ADDRESSING THE PROBLEMS: THE WORK TEAM PROPOSALS (CONT'D)
PROBLEM
UNDERSERVEDPOPULATIONS
SOLUTION
• UNIVERSAL COVERAGE
• INCREASED INVESTMENTS IN INFRASTRUCTURE IN
POOR URBAN AND RURAL AREAS AND IN PUBLIC HEALTH
• PREVENTION OF "RED LINING" OF HEALTH ALLIANCES
• RISK ADJUSTMENT OF POOR POPULATIONS
• HEALTH ALLIANCE RESPONSffiiLITY FOR BUILDING
HEALTH NETWORKS WHERE NONE EXIST
INADEQUATE LONG-TERM CARE
• EXPANDED OPPORTUNITIES FOR HOME CARE
• RAISING MEDICAID SPEND DOWN LIMITS
• BEGINNING OF SOCIAL INSURANCE PLAN
• INCENTIVES FOR PRIVATE INSURANCE MARKET
�HOW THE NEW SYSTEM MAINTAINS WHAT
PEOPLE LIKE IN THE CURRENT SYSTEM
MAINTAIN NEGOTIATED BENEFITS
• LARGE EMPLOYERS AND EMPLOYEES CAN MAINTAIN
THEIR CURRENT PLANS AS LONG AS THEY MEET
FEDERAL STANDARDS
-EMPLOYERS CAN CONTINUE TO PAY MORE GENEROUS
CO-PREMIUM, COPAY AND DEDUCTIBLE FOR
NATIONALLY GUARANTEED BENEFITS PACKAGE IN A
TAX SUBSIDIZED MANNER
MAINTAIN InGH QUALITY SYSTEM
• QUALITY OF SYSTEM WILL IMPROVE WITH BETTER
PRACTICE GUIDELINE INFORMATION, QUALITY REPORT
CARD, CONSUMER SURVEYING
• QUALITY INFORMATION WILL BE MORE AVAILABLE TO
CONSUMERS
MAINTAIN CHOICE OF DOCTOR
• BUDGETED FEE FOR SERVICE NETWORK ALLOWS ALL
AMERICANS TO CHOOSE THEIR DOCTORS AS THEY CAN
TODAY
• AVAILABILITY OF MULTIPLE PLANS OF DIFFERENT
TYPES ALLOWS CONSUMERS GREATER CHOICE OF TYPE
OF CARE THAN MANY HAVE TODAY
JWPIIIYILBGED A CONPIDBN'I1AII4-11-113- 18
�WHAT COULD GO WRONG?
WHAT COULD GO WRONG
A LARGE NUMBER OF SMALL
BUSINESSES GO BANKRUPT
SAFEGUARDS
• PHASE IN OF MANDATE
• SUBSIDIES TO SMALL BUSINESS
A TWO-TIERED SYSTEM DEVEWPS
• THE HEALTH ALLIANCES
BECOME SUPER MEDICAID AND
THE SELF-INSURED PLANS ARE
FIRST CLASS
• HEALTH CARE PLANS
SELECT BY INCOME OR
REDLINE
• LARGE HEALTH ALLIANCES
DRAWN ACROSS CONTIGUOUS
BOUNDARIES WITH INCOMEDIVERSITY REQUIREMENTS
• REQUIREMENTS ON SELFINSURED PLANS TO CONFORM TO
NATIONAL GOALS AND TO
CONTRIBUTE TO POOL FOR
DISABLED
• RISK ADJUSTMENT FOR PLANS IN
POOR AREAS
• UNIFORM QUALITY
REQUIREMENTS FOR PLANS
• HEALTH ALLIANCE
RESPONSffiiLITY TO BOLSTER
PLANS IN UNDERSERVED AREAS
• SOME LIMIT ON PRICE
COMPETITION
�WHAT COULD GO WRONG
THE WORST OF MANAGED CARE
COMPANIES ARE VICTORIOUS IN THE
COMPETITION
SAFEGUARDS
• ALLOW PROVIDERS TO JOIN MORE
THAN ONE PLAN
• REMOVE ANTI-TRUST
RESTRICTIONS ON PROVIDER
NEGOTIATIONS WITH INSURERS
• ALLOW PLANS TO SERVE AREAS
OF A REGION AS LONG AS THEY
ARE NOT "REDLINING"
• ESTABLISH REINSURANCE POOL
• ESTABLISH UNIFORM QUALITY
REQillREMENTS TO PREVENT
ABUSE
STATES CANNOT MEET OR ENFORCE
THE BUDGET
• STATES GIVEN FULL SET "TOOLS"
TO ENFORCE
• FEDERAL BACK-UP
• TWO-YEAR BUDGET
�WHAT COULD GO WRONG?
WHAT COULD GO WRONG
HEALTH CARE PLANS RATION INSTEAD
OF LOWERING ADMINISTRATIVE COSTS
OR ELIMINATING UNNECESSARY
TREATMENTS AND PROCEDURES
SAFEGUARDS
• UNIFORM QUALITY SYSTEM
• HEALTH ALLIANCE CAN DROP
PLAN
• STATE AND FEDERAL OVERSIGHT
MANAGED COMPETITION DOES NOT
WORK TO REDUCE COSTS
BENEFIT PACKAGE IS MORE EXPENSIVE
THAN ANTICIPATED
SYSTEM IS NEW AND UNTESTED AND IS
A MASSIVE CHANGE -- WHAT ABOUT
ALL OF THE UNINTENDED
CONSEQUENCES?
eBUDGET
• BASELINE FORMULA ON CO-PAYS
AND DEDUCTffiLES CAN BE
ADJUSTED DURING PHASE-IN
PERIOD
• STATE FLEXIBILITY PROVIDES
LEARNING
• GRADUAL PHASE-IN
�THE PLAN
�April 13, 1993
The attached memorandum lays out a set of preliminary,
illustrative proposals for national health reform.
These proposals are intended only to stimulate
discussion.
- - - - - - - -
�ILLUSTRATIVE OUTLINE FOR NATIONAL HEALTH REFORM
I. COMMITMENTS UNDER NATIONAL HEALTH REFORM:
A.
All Americans will gain the security of guaranteed
access to comprehensive health care
B.
No lapses or gaps in coverage will occur as Americans
move, change jobs, develop illnesses or experience
other changes in their lives
c.
Cost containment will m~coverage more affordable
D.
Consumers will choose th1r~ doctors and health plans
E.
Health professionals will choose the health plans in
which they participate
F.
To ensure that choice is meaningful for all consumers,
health reform will address shortages of health
professionals and inadequate infrastructure in rural
and urban underserved areas
G.
Built-in flexibility will allow American communities to
tailor health care to local needs and preferences
H.
Health reform will reduce the burden of paperwork on
consumers and providers
I.
A renewed emphasis on primary care and new approaches
to resolving consumer problems will make health care
delivery more consumer friendly
J.
Health reform will eliminate abusive insurance
practices, returning to the concept of insurance as the
community sharing the risk of illness and disability
K.
Although health care in America will change
significantly, those changes will proceed in an orderly
fashion over a defined period of time to minimize
unnecessary disruptions
PRIVILEGED AND ...OONFIBEN'fiAL
DETER:\1JSED TO BE AS ADMISISTRATIVE
:\1ARKI:'<I'G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
Date: 0 Lj I 075 I II
ctc'3
�2
II. SYSTEM ORGANIZATION
A.
Under national health reform, the federal government
will:
1.
Establish guarantees for health-care coverage
and delivery to be carried out by the states
2.
Ensure protection of citizens if states fail
to meet federal standards
DECISION 1: WHAT REMEDIES
SHOULD THE ·FEDERAL
GOVERNMENT USE II' STATES
DO NOT FULFILL THE
REQUIREMENTS 01' HEALTH
REFORM?
3.
Establish an employer and individual
responsibility to contribute to health
insurance costs
4.
Enforce a national health budget, holding
states accountable for spending to meet the
budget
DECISION 2: WHAT DEGREE
01' FLEXIBILITY DO STATES
HAVE TO EXCEED THE
NATIONAL HEALTH CARE
BUDGET?
.~-·
.....
5.
Determine the annual increase in the national
health budget
DECISION 3: SHOULD THE
NATIONAL BUDGET BE SET TO
REDUCE DISPARITIES IN
SPENDING LEVELS DUE TO
PRACTICE PATTERN
DIFFERENCES ACROSS
STATES?
6.
Establish and oversee formulas for adjusting
payments to health plans based on demographic
and clinical characteristics of enrolled
patients
PRIVILEGED AND CONFIQEN'I'IAfr
DETER:\11:"ED TO BE A:" AD!\'tl~ISTRATIVE
MARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: A~
Date: vj /CJ8 1 II
�3
7.
Update and refine the comprehensive benefit
package
8.
Establish and oversee federal subsidies for
low-income persons and eligible small
employers
9.
Establish and implement national quality and
access standards
10.
Manage and analyze national collection of
information related to health care access,
quality and coverage
11.
Establish a mechanism for assessment of
health technology and emerging treatments
12.
Oversee federal funding for training of
health professionals
13.
Provide technical assistance and start-up
grants to support the development of consumer
health alliances and health plans
14.
Administer any limits placed on taxdeductibility of employer contributions to
premiums in excess of locally established
benchmark premium
DECISION 4: SHOULD TAX
INCENTIVES BE USED TO
PROMOTE CHOICE OF LOWERCOST HEALTH PLANS?
15.
Override state anti-managed competition laws
and other statutes inconsistent with the
principles of the new health care system
16.
Delegate these functions variously to a
national health board and an executive branch
agency
PRIVILEGED
AND~ONFIBBNTIAt
UF.TER~11~ED
\1:\RKI~G
Initials:
TO BE A~ AD:\1I~ISTRATIVE
Per E.O. 12958 as amended, Sec. 3.3 (c)
A£()
Date:
0
~
I o"& I 'jl..D (\
�4
B.
Under national health reform, the states will:
1.
Establish at least one consumer health alliance
2.
If they choose, opt out of the consumer
health alliance structure and operate as a
single payer that negotiates directly with
providers or sets all-payer rates
3.
Set boundaries for consumer health alliances
to ensure:
a.
Minimum population of one million,
or entire state population if less
than one million
b.
No discrimination against lowincome or high-risk populations
c.
Contiguous boundaries
4.
Administer and assure compliance with
national health budget
5.
Establish and enforce performance standards
for consumer health alliances under federal
rules, including:
a.
Enrollment in health plans of all
persons residing in assigned
geographic area
b.
Inclusion of a range of health
plans within budget targets
c.
Solvency requirements
d.
Appointments to, composition of,
and membership on policy-making
boards
e.
Administrative expenses
6.
Protect people enrolled in health plans or
health alliances in case of financial failure
7.
Operate a state health plan if necessary to
correct gaps in the market
PRIVILEGED AND OONFIDENTIAL
DETER:\fi~ED TO BE A~ AD:'\fi~ISTR~TIVE
MARKJ:\G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: A.C'!>.
Date: 0\...1/"fO lAD 1\
I
�5
c.
Under national health reform, Consumer Health
Alliances, established by the states and representing
consumers, will:
1.
Negotiate prices for health plans
DECISION 5: BOW MUCH
PRICE COMPETITION IS
DESIRABLE?
2.
Provide health coverage for employees of
public and private organizations with fewer
than [100, 500, 1000 or more] workers
a.
Depending on size of groups
integrated into the new system, the
Federal Employee Health Benefit
Plan may be integrated or allowed
to continue as a stand-alone plan
DECISION 6: WHICH PRIVATE
AND PUBLIC EMPLOYER
GROUPS WILL BE REQUIRED
TO OBTAIN HEALTH COVERAGE
THROUGH THE HEALTH
ALLIANCES?
3.
Provide health coverage for larger employers
that exercise the option of buying into the
consumer health alliance
4.
Enroll all eligible individuals in
accountable health plans
5.
Oversee and stimulate the establishment of an
adequate selection of health plans
6.
Select health plans to offer to consumers,
enforcing national requirements for their
operation and terminating their participation
if necessary
7.
Offer a variety of health plans sufficient to
provide both consumers and providers (who may
participate in more than one plan) a range of
choice in organization and delivery system
including:
a. Health maintenance organizations
PRIVILEGED AND -GONPIBEN'PIAL
DETER:\11~F.D TO BE A~ AD~11~1STRATIVE
!\1:\RKI~G J>(lr E.O. 12958 as amended, Sec. 3.3 (c)
lnlthlls: At~
Date:
0'1 I D'Z /60\\
�6
b. Preferred provider networks
c. Fee-for-service
8.
Negotiate community rates for premiums and
capitated payments to all health plans,
including fee-for-service plans
9.
Negotiate service areas for plans to prevent
discrimination against low-income people and
high-risk populations
10.
Administer consumer plan selection, billing,
payments and marketing (including outreach
for high-risk populations)
11.
Institute plan-based alternatives to
litigation
12.
Calculate and administer risk adjustments to
payments as defined under federal guidelines
13.
Ensure access to tertiary or other
specialized services through contracts or
other arrangements
14.
Ensure the quality of care delivered through
health plans
15.
Protect the rights of consumers, including
resolving complaints through an ombudsman
structure
16.
Collect and report required information
17.
Set aside and administer premium revenue for
infrastructure development, public health
activities and services that ensure access
for high-risk and underserved populations
18.
Require health plans to contract with
community-based providers when necessary to
ensure access for underserved and vulnerable
populations
19.
Monitor trends in enrollment, particularly
disenrollment by high-risk populations and
persons with serious illnesses
PRIVILEGED AND- CONFIBE.I'l'IAJ:I
DF:TF.R:\11\F.O TO BE A\ A0!\11\ISTRATIVE
!\1ARKI\G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: AU)
Date: OL-1 / o'j fa.p !I
�groups of
care, will
D.
1.
Deliver the nationally defined comprehensive
benefit package
2.
Provide coverage to every applicant (subject
to capacity limits) who chooses the health
plan, regardless of health status or any
other personal factors, without waiting
periods, exclusions or terminations for any
reason
3.
Establish consistent rates without regard to
health status, gender and age
DECISION 7: SHOULD
COMMUNITY RATING BE
MODIFIED TO ACCOUNT FOR
AGE?
4.
Secure an adequate number, mix, availability
and distribution of qualified providers
5.
Collect and report required data related to
access, service and quality of care
6.
Meet state requirements related to financial
solvency
7.
Establish and administer consumer grievance
and dispute resolution procedures
8.
Provide a core of support services when
necessary to assure access for all patients
enrolled
9.
Designate and contract with providers of
highly specialized services, such as tertiary
care
PRIVILEGED AND eE)NFI9EN'fiAL
DETER:\11~F.D TO BE A~ AD:\ofi~ISTRATIVE
MARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: AC\\
Date:
0 L-f /
bt' /
CW\ \
�8
E.
Large employers that elect to manage their own plans
assume obligations similar to accountable health plans
including the responsibility to:
1.
Deliver the comprehensive benefit package
2.
Ensure equal coverage for all employees
3.
Establish consistent premium rates,
regardless of health status or other
characteristics of the individual
4.
Share in paying national costs of high-risk
or chronically ill populations
5.
Meet quality, access and financial
performance standards that apply to health
plans within consumer health alliances
6.
Offer employees choice of plans or allow them
to choose coverage from plans offered through
a consumer health alliance
7.
Establish community-rated premiums
DECISION 8: WHAT RATING
AND CHOICE RULES GOVERN
STAND-ALONE PLANS?
F.
The state and federal governments will limit private
insurance markets for supplemental insurance in the
following ways:
1.
Insurance coverage for cost-sharing and
services covered in the comprehensive benefit
package will be prohibited
2.
Federal regulations will prohibit:
a.
Tying sale of supplemental
insurance to purchase of
comprehensive benefit package
b.
Obtaining or disclosing information
about the health status of any
individual for the purpose of
marketing insurance
PRIVILEGED AND €0NFIDEN'l'IAL---'
DETER:\11SED TO BE AS AD:\11SISTR.\TIVE
MARKISG Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: Nf;>
Date: oLj { <' R/2§1 \
�9
c.
3.
Compensating agents for encouraging
a person to choose a particular
health plan
State laws will regulate other supplemental
insurance policies
III. BUDGET
A.
National health reform will establish a budget for
health care spending consisting of two parts:
1.
The federal government will enforce an annual
budget for spending through consumer health
alliances
a.
Determined by the average premium
(weighted by enrollment in each
plan) for the comprehensive benefit
package
b.
Enforced at the state level
c.
States held accountable for
spending in excess of the budget
d.
States and health alliances will
meet budget limits through:
(1)
(2)
Authority to freeze
enrollment in plans
(3)
Authority to set and
regulate payments to
providers
(4)
2.
Authority to negotiate
and regulate premiums
Authority to approve
investments in health
resources and technology
Self-insured plans also will be required to
meet state budgets
PRIVILEGED AND eoNFIBENTIAL='
DETER:\11~ED TO BE A~ AD!\U!'ilSTRATIVE
MARKI~G Per E.O. 11958 as amended, Sec. 3.3 (c)
Initials:
Axe/~
Date:
Oj fc::,?::, I M 1\
---------
~------~
�10
B.
The federal government will enforce budget limits
through the following mechanisms:
1.
Allow states to share in savings for federal
subsidies if costs increase less than
budgeted
2.
Require states that exceed budget to submit
plans for correction
3.
Require states to finance additional cost of
subsidies to small employers, individuals and
families if budget exceeded
4.
If budget exceeded in successive years:
a.
Impose a penalty tax on providers,
with revenues to pay for federal
·subsidies
b.
c.
c.
Implement rate setting
Operate consumer health alliance
Consistent with the national health budget, the federal
government will constrain payments to providers to
limit spending for its programs
IV. COVERAGE
A.
All Americans are entitled to obtain health services
specified in a national, comprehensive benefit package
guaranteed by the federal government
1.
All Americans and legal residents will receive a
Health Security Card that permits them to choose a
health plan through a local consumer health
alliance or from their employer (if the employer
offers its own plans)
2.
Consumers will have access to all health
plans offered by the consumer health alliance
in their area
3.
Plans offered through consumer health
alliances must agree to enroll every eligible
person who seeks coverage
PRIVILEGED AND CONFIDEiof'flAL
DF.TER.\1J~F.n TO BE A~ AD~fi~ISTRATIVE
"IAHKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: Ac~
Date:
Oj ( ~ (~oq
�11
4.
All individuals and families will pay a
portion -- perhaps 20 percent -- of the cost
of the health plan they choose but can
receive subsidies to cover that cost if they
are poor or earn a low income.
5.
Medicaid beneficiaries will enroll in health
plans through consumer health alliances
a.
b.
6.
Medicaid beneficiaries will receive
subsidies toward the cost of
premiums and co-payments on the
same basis as other low-income
people
Health plans will provide
supplemental services such as
transportation and clinical case
management as appropriate to ensure
access to care
Disabled and elderly Medicare beneficiaries
will continue receiving coverage through an
enhanced Medicare program, which may or may
not be integrated with the new health care
system
DECISION 9: SHOULD
MEDICARE BE INTEGRATED
INTO THE NEW SYSTEM?
7.
Individuals who obtain medical care through
the Veterans Administration, the Department
of Defense and the Indian Health Service will
remain eligible for those programs
8.
Illegal aliens are not covered but may
receive emergency or other care as now occurs
DECISION 10: BOW WILL
CARE FOR UNDOCUMENTED
PERSONS BE FUNDED?
9.
For families with multiple employers, one
employer will be designated primary, and
financial obligations may be re-distributed
in an annual reconciliation
PRIVILEGED AND -€9NFIBBN'fiAL
DETER:\fl:'tiEO TO BE AS AD!\1ISISTRATIVE
MARI<ISG Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: 4c ~
Date: Ot:/ (CJr:t /MI)
�12
10.
Unemployed workers will continue their
coverage without interruption, and some will
receive a subsidy based on income
11.
Small companies -- perhaps those with fewer
than 25 workers -- will receive a federal
subsidy toward the cost of the benchmark
premium for low-wage workers if their total
premium exceeds a threshold percentage of
payroll
V. BENEFITS
A.
All Americans are guaranteed a nationally established
comprehensive benefit package
B.
The comprehensive benefit package will cover:
1.
2.
3.
4.
5.
6.
7.
Inpatient hospital services
Clinic and outpatient-hospital services
Professional services
Preventive health services
Emergency care
Laboratory and diagnostic services
Reproductive health services
DECISION 11: TO WHAT
EXTENT IS THE RANGE OF
REPRODUCTIVE HEALTH
SERVICES DEFINED IN THE
BENEFIT PACKAGE?
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
C.
Emergency ambulance services
Prescription drugs and biologicals
Durable medical equipment, including hearing
aids
Prosthetic and orthotic devices
Hospice services
Post-acute adult rehabilitation services
Post-acute nursing home and home care
Mental health services
Substance abuse treatment
Hearing and vision care for children
Chronic care for children
Dental services for children
Other services, such as vision and dental care for
adults, are desirable but may not be covered in the
guaranteed benefit package because of cost constraints
PRIVILEGED AND ...e6NFI9BN'fiAL
llETER\11\f.D TO BE A\ AD~l~ISTRATIVE
\1AH.KI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
L ---------------------------------
A;t~
Date:
0'-1
(o~ I '?C\\
�13
D.
The benefit package will provide primary coverage for
medical claims also covered by workers' compensation
and automobile insurance
E.
The listed benefits are covered unless they are not
considered medically necessary or appropriate, within
federal guidelines
F.
Health plans will provide supplemental services -- such
as transportation, outreach and case management -- as
necessary to ensure access for underserved and highrisk populations
G.
All health plans will include specified cost-sharing
arrangements defined by category of plan, such as
health maintenance organizations and fee-for-service
VI. BENEFITS -- MENTAL HEALTH AND SUBSTANCE ABUSE
A.
The comprehensive benefit package will cover mental
health and substance-abuse treatment, services and
providers on the same terms and conditions as other
medical and health services
1.
The benefit structure will ensure that
persons with mental illness and substanceabuse disorders have access to a
comprehensive array of services
2.
Except for screening services, health plans
will impose cost sharing for mental health
and substance abuse services based on the
same principles as cost sharing for other
health services
3.
Health reform will encourage the use of home
and community-based treatment and
alternatives to hospitalization
4.
Health plans will deliver services with
flexibility to provide the appropriate types,
mix and duration of services
PRIVILEGED AND CONFIDENTIAL
DF:Tf.R:\11~F.D TO BE A:\ AD:\11:\ISTRATIVE
:\1:\I~KI\G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
N~
Date:
0'-\ I
I
oR
/IMI\
�14
5.
To protect against inappropriate use of
services and target resources, consumer
health alliances and accountable health plans
will adopt eligibility criteria:
a.
.b.
Patients will be eligible for
mental health and substance-abuse
services for diagnosable disorders
specified under DSM-III-R and that
create a serious risk for
functional impairment
c.
6.
All persons will be eligible for
screening, assessment and 24-hour
crisis service
Patients' family members may
receive necessary related services
(collateral treatment)
All accountable health plans will provide
qualified mental health screeners to
determine eligibility
• QUALITY ASSURANCE
A.
A National Quality Management Program will create and
update a national consumer "report card" that includes
standard measures of:
1.
2.
Access to care
3.
Appropriateness of care
4.
B.
Patient satisfaction
Health outcomes
States will monitor the quality of health care using
federal guidelines:
1.
Each level of the health care system will
collect appropriate, uniform data
2.
Specific national measures will assess
performance at the state level
PRIVILEGED AND
09NPIBBtf'I'IAL
DETERMI~ED TO BE A~ AD:\ii~ISTRATIVE
MARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: frt.&
Date:
OLj / 0~ /WI\
�15
3.
All levels of the system will develop
information systems that enhance the ability
to compare data collected for a variety of
purposes
C.
The federal government will support development and
dissemination of practice guidelines
D.
The quality system will minimize retrospective, chartbased quality-assurance measures, replacing them with
performance-based outcomes
E.
Additional changes in the approach to quality assurance
involve:
1.
Simplification of peer review
2.
Simplification of requirements under the
Clinical Laboratories Improvement Act of 1988
3.
Simplification of survey and certification of
health care institutions
II. ADMINISTRATIVE SIMPLIFICATION
A.
National health reform will establish rules intended to
reduce burdensome data collection and information
processing while assuring privacy and security of
personal health information:
1.
Simplify information collection requirements
for billing and enrollment purposes
2.
Require use of national, standard forms
3.
Require use of national, standard data sets
for financial, clinical, quality and other
information
4.
Develop national procedures for coordination
of benefits until new health system fully
implemented
5.
Develop and adopt unique provider, patient,
plan and employer-identification numbers
6.
Set national communication standards for
electronic data interchange
PRIVILEGED AND CONFIBBNTIAL
DETER:\1J~ED TO
BE A~ AD~I~ISTRATIVE
Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: ~
Date: oy( 0~
I
MARKI~G
/ao\
�16
7.
B.
Set uniform national rules regarding privacy
and security
Simplify utilization review
IX. DELIVERY SYSTEM DEVELOPMENT
A.
The federal government will provide grants, loans and
loan guarantees to invest in health-care delivery sites
in rural and urban underserved areas
B.
Federal funds also will support the development of
alternative delivery sites, including school-based
clinics
c.
Federal policies that restrict conversion of rural
hospitals to multiple uses will be modified
X. PREVENTION AND PUBLZC HEALTH
A.
The public health system will:
1.
Continue traditional measures to monitor and
promote public health
2.
Coordinate public health and prevention with
personal preventive health services provided
through health plans
B.
A fixed portion of total health expenditures will
create stable funding for population-based public
health and prevention activities
c.
The federal government will streamline the
administration of existing categorical health programs
XI. WORKFORCE DEVELOPMENT
A.
The federal government will support the provision of an
appropriate mix of primary care physicians, nurse
practitioners, nurse midwives, physician assistants and
community health workers in rural and urban areas by:
1.
Redirecting federal spending on graduate
medical education to emphasize training of
primary care health professionals rather than
medical specialists
2.
Promoting the use of inter-disciplinary teams
PRIVILEGED
AND~
DETER:\fi~ED TO BE A~ AD:vti~ISTRATIVE
MARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: 1\t~
Date: O'j fog/ d.o\ \
I
�17
3.
4.
Including non-professional health workers in
a national service initiative
5.
B.
Retraining specialists in the use of most
current primary care approaches and knowledge
Providing incentives for health professionals
to locate in underserved areas, including
expansion of the National Health Service
Corps
The federal government will remove legal, regulatory
and institutional barriers that inappropriately
restrict the practices of health professionals
XII. MEDICAL MALPRACTICE AND TORT REFORM
A.
The federal government will institute a system of
medical malpractice and tort reform based on enterprise
liability and plan-based alternatives to litigation
B.
Consumer health alliances will require accountable
health plans to adopt non-binding alternatives to
litigation chosen from a menu of options identified by
the federal government, such as:
1.
2.
Mediation
3.
c.
Arbitration
Early settlement offers
Enterprise liability provisions include:
1.
Federal rules will require health plans to
assume sole legal liability for care they
finance
2.
Direct providers of care, such as physicians,
will be exempt from legal liability except in
cases of gross negligence, willful wanton and
malicious conduct
3.
Health plans will obtain insurance or selfinsure against liability in order to create a
clear and direct incentive to sustain high
quality, deter malpractice and resolve
disputes
PRIVILEGED AND CONFIBBN'fiAL
DETER:\11~ED TO BE A~ AD:\'ti~ISTRATIVE
MARKI~G Per £.0. l2958 as amended, Sec. 3.3 (c)
Initials: (')l{ Jo1fao\\ Date:_..;..Af~3:~.-_ __
�18
4.
5.
Certain institutional providers such as major
hospitals will retain their current duty to
oversee the quality of care
6.
When a health plan makes a payment on a claim
of negligent care by a physician, the health
plan will provide the name of the physician
to the National Practitioner Data Bank
7.
D.
Health plans will be forbidden to require
providers to indemnify plans for any
liability
Plans must disclose to consumers the
availability of procedures for the resolution
of grievances
The federal government will establish uniform standards
in medical malpractice cases for:
1.
Non-economic damages
2.
Double recovery from collateral sources
3.
Contingency fees
4.
Periodic payment of large awards
DECISION 12: SHOULD THE
FEDERAL GOVERNMENT CAP
NON-ECONOMIC DAMAGES AND
IMPOSE OTHER UNIFORM
RULES FOR MEDICAL
MALPRACTICE CLAIMS?
E.
Substantive rights, such as the applicable standard of
care, will remain as under current law
XIII. ANTITRUST CONSIDERATIONS
Implementing health reform will require strategies to
minimize conflicts between the operation of the new
system and antitrust laws without undermining their
legitimate purposes
PRIVILEGED AND"CONPIBBN'fiAL
DETER:\11~ED TO BE A~ AD~I~ISTR.\TI\'E
MARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
In ltials:
A-t6
Date:
0
'1/ Og /WI t
�19
• XNDXAN HEALTH SERVXCE
A.
At the election of tribes and depending on location, the
Indian Health Service (including tribal health programs)
will have three options for participation in health reform:
1.
As a provider paid through accountable health
plans
2.
As an accountable health plan
3.
As an independent program, to accommodate
some tribes' objections to state control
B.
Where appropriate, Indian Health Service will provide
care to non-Indians
C.
All options will require improving and augmenting
Indian Health Service capacity in areas such as:
1.
Primary care including maternal and child
health
2.
Emergency services
3.
Mental health
4.
Specialty services
D.
Under all options, the federal government will pay the
full cost of care for American Indians and Alaska
Natives and continue supplemental public health and
environmental improvements
E.
To compete in the new health system, Indian Health
Service must address legal, organizational and
regulatory barriers including:
1.
Restrictions on hiring and assigning staff
2.
Federal procurement rules
3.
Financial systems not designed to bill for
services
4.
Re~trictions
on providing services to non-
Indians
PRIVILEGED AND CONFIDEN'tiAL
DETER:\11~ED TO BE A~ AD:WI~ISTRATIVE
MARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: A/~
Date: QL{ .{
()()j WI \
�20
F.
Any change in operations of the Indian Health Service must
accommodate the rights of sovereign tribal governments to
act on behalf of their people
XV. DEPARTMENT OF DEFENSE
A.
The Department of Defense will provide health care
services and capacity necessary to maintain military
readiness
B.
The Department of Defense will make accountable health plans
available in selected geographic areas within the structure
of the consumer health alliances:
1.
2.
C.
In areas with military health plans, beneficiaries
will have the option of choosing a civilian health
plan or a military plan
In areas that do not have a military plan,
beneficiaries will choose among civilian
accountable health plans
Benefits and Eligibility
1.
2.
The Department of Defense will pay premium
costs for all dependents of active-duty
personnel and retirees
3.
D.
Active-duty personnel will continue to receive free and
comprehensive health care services through military
facilities, supplemented by local providers
After implementation of health reform, the
department will cover a portion of premiums
(like other employers) for dependents of new
active-duty personnel
Competing in the new health system will require changes
in the Department of Defense health system, including:
1.
Adjusting resource allocation and cost-accounting
systems
2.
Establishing uniform employment and compensation
systems for federal health care workers
3.
Closing military health plans that fail to compete,
unless required for military readiness
PRIVILEGED AND eoNF'IOENTIAf:r
DF.Tf.R\ti.":F.D TORE A~ AD:\H~ISTRATIVE
\1.-\Rh:I\G Per F..O. 1295R as amended, Sec. 3,3 (c)
lnitiai~: A;C£>
Date: Dj / 6~ I aoq
�21
• VETERANS ADMINISTRATION
A.
The Veterans Administration will develop regional health
plans for veterans
1.
Benefits and Eligibility
a.
Low-income veterans and those with serviceconnected disabilities will receive the
comprehensive benefits package plus supplemental
benefits at no cost
b.
Other veterans may purchase the Veterans
Administration health plan through consumer health
alliances or use Veterans Administration centers
on a fee-for-service basis
B.
The Veterans Administration will compete for veterans
not now using VA services, who will be allowed to take
their employer contributions to the VA health plan in
their area if they choose
c.
Competing in the new health system will require
management and regulatory changes in the Veterans
Administration health system, including:
1.
Eliminating procurement regulations that restrict the
ability to take advantage of competitive pricing
2.
Increasing flexibility in hiring and personnel
management
3.
Altering budget process to enable VA centers to retain
a portion of their "earnings"
XVII. LONG-TERM CARE
A.
National health reform will require adaptation of longterm care components of the current Medicaid program
B.
National health reform will expand the public
commitment to provide long-term care
DECISION 13: HOW MUCH
SHOULD BE INVESTED IN
LONG-TERM CARE?
PRIVILEGED AND -GONFI9:SN'i'IAL
DETEit\11~ED TO
~1ARKI:\'G
BE A~ AD~I~ISTRATIVE
Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: AC..~
Date: QLj /O~ ,1~0 \\
�22
DECISION 14: WHAT'S THE
PREFERRED SCOPE OF HEALTH
REFORM: WHAT'S THE
MINIMUM WORTH DOING?
XIX. FINANCING
A.
Under health reform, employers will assume the
following responsibilities:
1.
Assure health coverage for their employees
and their employees' families
a.
b.
2.
B.
Pay a substantial portion
perhaps 80 percent -- of the
premium for full-time and a prorated portion for part-time
employees, although they may
receive a partial subsidy for lowwage workers
Deduct the employee share of the
premium from payroll
Employees will pay the remainder of the
premium -- perhaps 20 percent -- although
low-income workers may receive a subsidy
States will continue to contribute to the cost of care
for low-income people:
1.
Initially under a requirement for maintenance
of effort and later subject to a new formula
determined by a commission and adopted by
Congress through an expedited procedure
2.
Requirements for maintenance of effort could
include all state health expenditures, not
just Medicaid
PRIVILEGED AND e9NFIDBN'fiAJ:J
DETER~fl~ED TO BE AN AD!WINISTRATIVE
MARKING Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: AC-3Date:
o& ~ot\
oy ( I
�23
C.
Depending on decisions that shape the delivery and
financing of the health system, prospective sources of
new federal revenue include:
1.
General tax revenues
2.
"Sin" taxes
3.
Premium tax-cap revenues
4.
Provider or insurance tax
5.
Community rating for Medicare and/or Medicaid
disabled population
DECISION 15: HOW WILL HEALTH REFORM
BE FINANCED?
DECISION 16: WHO WILL PAY FOR
HEALTH REFORM?
DECISION 17: HOW MUCH NEW
INVESTMENT WILL BE MADE IN TOTAL
HEALTH-CARE SPENDING?
• TRANSITION AND SHORT-TERM COST CONTROLS
A.
Managing the transition to the new health system will
involve:
1.
Implementation of reform:
a.
Establish state consumer health
alliances
b.
Enroll consumers in health
alliances
c.
Develop delivery system capacity
d.
Remove statutory and regulatory
barriers, including provisions of
ERISA
PRIVILEGED
DETER:\11~ED
MARKI~G Per
Initials:
Ac B.
AND~ONPIBENTI~
TO 13E A~ AD:\ii~ISTR.\TIVE
E.o. 12958 as amended, Sec. 3.3 (c)
Date: CJ'j I G<j? h o'l\
'
.
�24
2.
Protection of consumers from insurance market
dislocation to preserve existing coverage
and/or market failure through:
a.
Negotiating voluntary commitments
from insurers to continue to serve
policyholders and new applicants
during transition with commitments
related to:
(1)
(2)
Termination of coverage
(3)
Treatment of new
applicants
(4)
b.
Rate increases
Procedures for market
exit
Imposing emergency regulations
requiring maintenance of insurance
existing coverage at fair prices
with provisions that:
(1)
(2)
Prohibit insurers from
terminating coverage
except for good cause
(3)
Restrict exits from the
market
(4)
c.
Prohibit insurers from
targeting large rate
increases to specific
groups or individuals
Require acceptance of new
full-time employees to
currently insured groups
Create voluntary federal or state
insurance pools to cover displaced
or uninsured groups or individuals
PRIVILEGED AND .SONFIBBN'I'IAL
DETER:\ffSED TO BE AS AD!\11SISTRATIVE
MARKISG Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: 4C?>
Date: o'j loS /~oq
t
f
�25
3.
Implementation of comprehensive insurance
market reform to:
a.
b.
Require acceptance of all
applicants
c.
Move toward community rating
d.
Enact guaranty renewability
e.
4.
Stabilize premiums
Guarantee portability of coverage
Imposition of short-term cost controls
DECISION 18: HOW WILL COSTS BE
CONTROLLED WHILE HEALTH REFORM IS
IMPLEMENTED?
XXI. ACCELERATING NEW SYSTEM DEVELOPMENT
A.
The implementation of national health reform will occur
in phases:
1.
On a state-by-state basis, allowing broad
flexibility for the pace of state action,
with the goal of covering all Americans by
mid-1995
2.
Or, on a more gradual schedule with the goal
of covering all Americans by the year 2000
DECISION 19: BY WHAT METHOD WILL
THE TRANSITION TO THE NEW SYSTEM
TAKE PLACE?
DECISION 20: HOW FAST WILL THE NEW
SYSTEM BE IMPLEMENTED?
PRIVILEGED AND -GQNFXDBN'I'IAL
DETER\11\F.D TO BE A\ AD:\11\ISTRATIVE
\1ARKI\G Per E.O. 12958 as amended, Sec. 3.3 (c)
lnitials:Ac.&
Date: C9Lj, /08/?P\\
�DECISIONS
�DECISION 1:
WHAT REMEDIES SHOULD THE FEDERAL GOVERNMENT USE IF
STATES DO NOT FULFILL THE REQUIREMENTS OF HEALTH
REFORM?
DECISION 2:
WHAT DEGREE OF FLEXIBILITY DO STATES HAVE TO
EXCEED THE NATIONAL HEALTH CARE BUDGET?
DECISION 3:
SHOULD THE NATIONAL BUDGET BE SET TO REDUCE
DISPARITIES IN SPENDING LEVELS DUE TO PRACTICE
PATTERN DIFFERENCES ACROSS STATES?
DECISION 4:
SHOULD TAX INCENTIVES BE USED TO PROMOTE CHOICE OF
LOWER-COST HEALTH PLANS?
DECISION 5:
HOW MUCH PRICE COMPETITION IS DESIRABLE?
DECISION 6:
WHICH PRIVATE AND PUBLIC EMPLOYER GROUPS WILL BE
REQUIRED TO OBTAIN HEALTH COVERAGE THROUGH THE
HEALTH ALLIANCES?
DECISION 7:
SHOULD COMMUNITY RATING BE MODIFIED TO ACCOUNT FOR
AGE?
DECISION 8:
WHAT RATING AND CHOICE RULES GOVERN STAND-ALONE
PLANS?
DECISION 9:
SHOULD MEDICARE BE INTEGRATED INTO THE NEW SYSTEM?
DECISION 10:
HOW WILL CARE FOR UNDOCUMENTED PERSONS BE FUNDED?
DECISION 11:
TO WHAT EXTENT IS THE RANGE OF REPRODUCTIVE HEALTH
SERVICES DEFINED IN THE BENEFIT PACKAGE?
DECISION 12:
SHOULD THE FEDERAL GOVERNMENT CAP NON-ECONOMIC
DAMAGES AND IMPOSE OTHER UNIFORM RULES FOR MEDICAL
MALPRACTICE CLAIMS?
DECISION 13:
HOW MUCH SHOULD BE INVESTED IN LONG-TERM CARE?
DECISION 14:
WHAT'S THE PREFERRED SCOPE OF HEALTH REFORM;
WHAT'S THE MINIMUM WORTH DOING?
DECISION 15:
HOW WILL HEALTH REFORM BE FINANCED?
DECISION 16:
WHO WILL PAY FOR HEALTH REFORM?
DECISION 17:
HOW MUCH NEW INVESTMENT WILL BE MADE IN TOTAL
HEALTH-CARE SPENDING?
DECISION 18:
HOW WILL COSTS BE CONTROLLED WHILE HEALTH REFORM
IS IMPLEMENTED?
DECISION 19:
BY WHAT METHOD WILL THE TRANSITION TO THE NEW
SYSTEM TAKE PLACE?
DECISION 20:
HOW FAST WILL THE NEW SYSTEM BE IMPLEMENTED?
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
J_·
Divider Title:
---------------------------
�DECISION 1
FEDERAL REMEDIES IN CASE OF STATE FAILURE
BACKGROUND
WHAT REMEDIES SHOULD THE FEDERAL GOVERNMENT
USE IF STATES DO NOT FULFILL REQum.EMENTS OF
HEALTH REFORM?
FEDERAL LEGISLATION WILL REQUIRE STATES TO:
•
CREATE HEALTH ALLIANCES AND HEALTH PLANS
(OR EXERCISE OPTION FOR STATE-BASED PLAN),
ACCORDING TO FEDERAL RULES
•
ENSURE THAT ALLIANCES AND PLANS PROVIDE ALL
AMERICANS THE GUARANTEED BENEFIT PACKAGE
•
MEET A FEDERALLY-SET BUDGET
LEGISLATION MUST SPECIFY FEDERAL REMEDIES IF STATES
DO NOT CONFORM TO REQUIREMENTS.
Df.-:-ER:\11~F.D TO BE A~ AD!\11~1STRATIVE
\1:\RKI\G Per E.O. 12958 as amended, Sec:. 3.3 (c)
Initials: !JC $
Date: c,Y ( C> Yi J Ac.~
�DECISION 1
FEDERAL REMEDIES IN CASE OF STATE FAILURE
STATEMENT OF OPTIONS
OPTION 1:
FINANCIAL SANCTIONS TO INDUCE STATE
ACTION
OPTION 2:
DIRECT FEDERAL ACTION TO ACHIEVE
PERFORMANCE
UIIPRIVELBDGED a c:I9NPIBBNTWJ.fll-ta
DF.TER:\11~ED TO BE A~ AD!\-1l~ISTRATIVE
:\1ARKI:'\G Per E.O. 12958 as amended, See. 3.3 (c)
Initials: AC.~
Date: C> j { 0~ / ?-.o \\ ,
~~
-
~~~--
-~----~
�DECISION 1
FEDERAL REMEDIES IN CASE OF STATE FAILURE
OPTION 1:
FINANCIAL SANCTIONS
THE FEDERAL GOVERNMENT IMPOSES FINANCIAL
SANCTIONS TO INDUCE STATE ACTION, WITHHOLDING, FOR
EXAMPLE:
•
TAX DEDUCTIONS FOR HEALTH INSURANCE
PREMIUMS
•
MEDICAL EDUCATION, PUBLIC HEALTH AND
MEDICAL RESEARCH FUNDS
•
LOW-INCOME SUBSIDIES
THESE SANCTIONS COULD BE APPLIED ON A GRADUATED
BASIS.
PROS:
•
SEVERE PENALTIES MAKE COMPLIANCE LIKELY
•
PRESERVES STATE-BASED SYSTEM
CONS:
•
IF SANCTIONS ARE MILD, THEY MAY BE
INEFFECTIVE; IF THEY ARE TOO SEVERE, THEY MAY
NEVER BE IMPOSED
•
IF IMPOSED, THEY PENALIZE CITIZENS
DETER~fi~ED TO BE AS AD.\11SISTR4.TI\'E
MARI<ISG Per E.O. 12.958 as amended, Sec. 3.3 (c)
Initials: A,c.r~
Date: 6 Lf I oS ho l!
�DECISION 1
FEDERAL REMEDIES IN CASE OF STATE FAILURE
OPTION 2:
Dm.ECT FEDERAL ACTION
DIRECT FEDERAL ACTION TO ACHIEVE PERFORMANCE TO
INCLUDE:
•
CONTRACT WITH ANOTHER ORGANIZATION OR
STATE TO MANAGE THE HEALTH ALLIANCE
•
DIRECTLY MANAGE THE HEALTH ALLIANCE
•
OFFER A FEDERAL HEALTH PLAN TO STATE
RESIDENTS
PROS:
•
GUARANTEES PERFORMANCE UNDER THE LAW
CONS:
•
.COULD BECOME A FEDERAL PROGRAM
DETER:\fl~ED TO BE A~ AD~I~JSTR<\TIVE
MARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: At'3
Date: 0'--1/ 8$/:l. ol!
I
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
---------------------------
�DECISION 2
STATE BUDGET FI.EXIBILITY
BACKGROUND
WHAT DEGREE OF FI.EXIBILITY DO STATES HAVE TO
EXCEED THE NATIONAL HEALTH CARE BUDGET?
HEALTH REFORM WILL BUDGET THE ANNUAL RATE OF
GROWTH IN SPENDING ON HEALTH PLAN PREMIUMS IN
ORDER TO CONSTRAIN EXPENDITURES (FOR EXAMPLE, GNP
PLUS TWO PERCENT).
STATES WANT FLEXIBILITY TO EXCEED BUDGETS IF:
•
NATIONAL BUDGET IS ARBITRARILY TIGHT
RELATIVE TO COVERAGE GUARANTEES
•
STATE WANTS OR NEEDS TO SPEND MORE (AT ITS
OWN EXPENSE)
FEDERAL GOVERNMENT WANTS:
•
GUARANTEE EXPENDITURE CONSTRAINT FOR
PUBLIC AND PRIVATE PAYERS
•
TO LIMIT EXPOSURE OF EMPLOYERS AND
INDMDUALS UNDER MANDATED HEALTH
INSURANCE
DETER:\11~ED TO
BE AS AD~l~ISTRATIVE
MARKI:\G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: OLt/ba}?el\ Datc:-~~:S_ __
�DECISION 2
STATE BUDGET FlEXIBILITY
STATEMENT OF OPTIONS
OPTION 1:
HOLD STATES ACCOUNTABLE F'OR ANNUAL
BUDGETS
OPTION 2:
HOLD STATES ACCOUNTABLE FOR MULTI-YEAR
BUDGETS
OPTION 3:
ALLOW A "BAND" OF EXCESS SPENDING WITH
SOME PENALTIES
DETER~11SED TO BE AS AD~11SISTRATIVE
MARKI:\G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
'3
Date: D 'f /08 /d§..t I
Af
�DECISION 2
STATE BUDGET FI..EXmiLITY
OPTION 1:
ANNUAL BUDGET
HOLDING STATES ACCOUNTABLE FOR ANNUAL
BUDGETS REQUIRES STATES TO USE TOOLS TO PREVENT
EXCESS SPENDING, FOR EXAMPLE:
•
REGULATING PROVIDER RATES
•
OFFSET VOLUME INCREASES BY LIMITING RATES
•
FREEZING ENROLLMENT IN HIGH-COST PLANS
IN THE EVENT OF STATE FAILURE, REQUIRES THAT FEDERAL
GOVERNMENT EITHER:
•
INTERVENE TO CONTROL SPENDING
•
IMPOSE FINANCIAL SANCTIONS
WITHHOLD SUBSTANTIAL FEDERAL FUNDS
REQUIRE STATES TO OFFSET OVERAGES
THROUGH GENERAL REVENUES
FEDERAL GOVERNMENT COULD OFFER FINANCIAL
INCENTIVES TO MEET BUDGET (FOR EXAMPLE, PAY STATES
PORTION OF UNSPENT FEDERAL SUBSIDY DOLLARS)
PROS:
•
PREDICTABLE, SCOREABLE SAVINGS
DETERMIXED TO BE A~ AD:\fl~ISTRATIVE
MARKIXC Per E.O. 12958 as amended, Sec. 3.3 (cl
Initials: 4<'.:>
Date: 0'-l I 0 t I ll,O!t{
r
1
�CONS:
•
MAY NEVER HAPPEN BECAUSE THE PENALTIES ARE
TOO SEVERE
•
LEAVES LITTLE ROOM FOR UNFORESEEN YEAR-TOYEAR VARIATION
DETERMINED TO BE A~ AD,1I\JSTR-\TI\'E
MARKI:\'G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
Date: o~/o&/dW:II,
rtc;$
�DECISION 2
STATE BUDGET FLEXIBILITY
OPI'ION 2:
MULTI-YEAR BUDGET
BUDGET BASED ON MULTI-YEAR CALCULATION ALLOWS
STATES TO TAKE CORRECTIVE MID-COURSE ACTION.
•
SPECIFY ALLOWABLE PERCENTAGE INCREASE IN
TWO OR MORE YEARS
PROS:
•
PREDICTABLE, SCOREABLE SAVINGS
•
STATE FLEXIBILITY
CONS:
•
FLEXIBILITY MAY UNDERMINE PERFORMANCE
DETER:\11SED TO BE A~ AD:\11~1STRATIVE
MARJ<ISG Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: A(.~
Date: Gtj I Q{? I ac!(
I
�DECISION 2
STATEBUDGETF~~
OPTION 3:
"BAND"
STATES COULD SPEND ABOVE BUDGETS UP TO A CEILING. IF
SPENDING IS BETWEEN THE BUDGET AND THE CEILING,
THAT IS, WITHIN THE "BAND,":
•
FEDERAL SUBSIDIES CAPPED AT BUDGETED LEVEL
OR REDUCED WITHIN THE BAND
•
STATE RESPONSffiLE FOR ANY EXCESS
•
FEDERAL GOVERNMENT DOES NOT INTERVENE
IF STATE SPENDING EXCEEDS THE BAND, FULL FINANCIAL
PENALTIES APPLY AND FEDERAL GOVERNMENT INTERVENES.
PROS:
•
ALLOWS STATES GREATER FLEXffiiLITY WITH NO
·(OR LIMITED) FEDERAL COST CONSEQUENCES
•
PREDICTABLE OBLIGATIONS FOR PRIVATE PAYERS
•
MITIGATES ADVERSARIAL RELATIONSHIP BETWEEN
STATES AND FEDERAL GOVERNMENT
CONS:
•
REDUCES PREDICTABILITY OF PUBLIC AND PRIVATE
SAVINGS
•
CEILING COULD BECOME THE BUDGET
IMIPRIVELEDGED ·~ 11-113
DET.F.R:\fiSED TO BE AS ADMISISTRATIVE
MARI<l~G Per E.O. 12958 as amended, See. 3.3 (c)
Initials: ~V-S
Date: o Ll r o8> ;I ?:.-0 11
I
�Clinton Presidential Records
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This marker identifies the place of a tabbed divider. Given our
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indicated below.
Divider Title:
---------------------------
�DECISION 3
STATE SPENDING DISCREPANCIES
BACKGROUND
SHOULD THE NATIONAL BUDGET BE SET TO REDUCE
DISPARITIES IN SPENDING LEVELS DUE TO PRACTICE
PATTERN DIFFERENCES ACROSS STATES?
IN SEITING BUDGETS FOR STATES, ALLOWANCES WILL HAVE
TO BE MADE FOR DIFFERENTIALS IN CURRENT INSURANCE
COVERAGE, DEMOGRAPHICS AND GENERAL PRICE LEVELS.
EVEN AFTER ADJUSTING FOR THESE DIFFERENCES, PER
CAPITA HEALTH EXPENDITURES VARY WIDELY BY STATE.
•
SPENDING IN THE HIGHEST-COST STATE IS $3031
PER CAPITA WHILE SPENDING IN THE LOWESTCOST STATE IS $1689 PER CAPITA (ADJUSTING FOR
AGE AND INPUT COSTS)
1
A SIGNIFICANT SHARE OF THE DIFFERENCE REFLECT0
UNEXPLAINED VARIATION IN PRACTICE PAITERNS. - /
INITIALLY, HISTORICAL SPENDING MUST BE USED AS BASIS
FOR BUDGETS.
SETTING PROPER LEVELS OF SPENDING BASED ON PRACTICE
PATTERNS IS DIFFICULT BECAUSE OF INADEQUATE
KNOWLEDGE ABOUT OUTCOMES OF DIFFERENT PAITERNS
OF CARE.
LM/PRIVELEDGED 6: 881fPIBBiPI'UJhl4 11-83
DETERMISED TO BE AS AD!\1I~ISTRATl\'E
MARI<I:\G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: Ate,
Date: -&~ {6%1').01\
�DECISION 3
STATE SPENDING DISCREPANCIES
STATEMENT OF OPTIONS
OPTION 1:
PROVIDE INFORMATION ON PRACTICE
PATTERNS AND INCENTIVES TO STIMULATE
ADJUSTMENTS TO PRACTICE PATTERNS
OPTION 2:
SET A MULTI-YEAR FORMULA IN REFORM THAT
PEGS STATE SPENDING TO A COMBINATION OF
HISTORICAL SPENDING AND A NATIONAL
NORM
OPTION 3:
CREATE A "BASE-CLOSING" COMMISSION TO
RECOMMEND FUTURE BUDGET ADJUSTMENTS
DETER:\~I~ED TO BE A~ AD:WI~JSTRATIVE
M~RI<I:"\G Per E.O. 12958 as amended, Sec. 3.3 (c)
IDJtfals: '\t:?
Date: 61{ / G~ /,a o [J
l
�DECISION 3
STATE SPENDING DISCREPANCIES
OPTION 1:
INFORMATION AND INCENTIVES
A SINGLE NATIONAL GROWTH RATE (ADJUSTED FOR
INSURANCE COVERAGE, OTHER DEMOGRAPHICS AND INPUT
COSTS) WILL BE APPLIED TO STATE HISTORICAL PER CAPITA
SPENDING LEVELS.
THE FEDERAL GOVERNMENT:
•
WILL DEVELOP SCIENTIFICALLY-BASED
GUIDELINES AND DISSEMINATE RESEARCH ON
OUTCOMES
•
WILL PUBLISH INFORMATION ABOUT VARIATIONS
IN STATE PRACTICE PATTERNS
•
MAY APPLY FINANCIAL INCENTIVES (ALLOWING
STATES TO SHARE IN UNSPENT FEDERAL SUBSIDY
DOLLARS) TO ENCOURAGE MORE APPROPRIATE
VOLUME AND INTENSITY
PROS
•
ALLOWS MAXIMUM STATE FLEXIBILITY
•
PROMOTES EFFICIENCY WITHOUT DISLOCATIONS
•
AVOIDS MAJOR POLITICAL CONFLICT OVER
ALLOCATION
CONS
•
DETER:\11~ED
MAY PERPETUATE UNJUSTIFIED DIFFERENTIALS
TO BE A~ AD!\11~1STRATIVE
MARKI:'<iG Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: tit~
Date: Olf [a& /ao11
�DECISION 3
STATE SPENDING DISCREPANCIES
OPI'ION 2:
NATIONAL FORMULA
NATIONAL FORMULA WILL REDUCE STATE VARIATION OVER
TIME.
•
A STATE'S FIRST-YEAR BUDGET WILL REFLECT
HISTORICAL SPENDING
•
IN SUBSEQUENT YEARS, FORMULA AUTOMATICALLY
ADJUSTS ALLOWABLE INCREASE TO MOVE TOWARD
A NATIONAL NORM
THIS FORMULA COULD BE PHASED IN OVER AN EXTENDED
PERIOD OF TIME TO AVOID SEVERE DISRUPTIONS.
PROS:
•
REDUCES PRACTICE PATTERN VARIATION
•
FAVORED BY WWEST-COST STATES
INVITES OPPOSITION TO HEALTH REFORM FROM
CURRENT HIGH-COST STATES LIKE
MASSACHUSETTS AND NEW YORK
CAUSES PROVIDER DISLOCATIONS IN STATES
RTHEST FROM THE NORM
•
WOULD BE DIFFICULT TO ADJUST AND WOULD
TAKE YEARS TO SHOW PROGRESS·
DETERMI~ED TO BE AN AD!\11SISTRATIVE
MARKI~G
Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: Aw
Date: O'j (t$ Ja,O ll
�DECISION 3
STATE SPENDING DISCREPANCIES
OPTION 3:
CREATE A "BASE-CLOSING"
COMMISSION
PLAN WILL CREATE A "BASE-CLOSING" COMMISSION THAT
WILL MAKE A RECOMMENDATION TO CONGRESS ON A
FORMULA FOR THE BUDGET ALLOCATION TO STATES.
THE CONGRESS WILL TAKE AN UP-OR-DOWN VOTE ON THE
FORMULA. IF CONGRESS REJECTS THE COMMISSION'S
RECOMMENDATIONS, THE ALLOCATION DEFAULTS TO
HISTORICAL SPENDING LEVELS.
PROS
•
REMOVES A DIFFICULT POLITICAL DECISION TO AN
IMPARTIAL ENTITY
•
ALLOWS SOME STATE FLEXIBILITY
CONS
•
DOES NOT ENSURE THAT VARIATIONS WILL BE
MINIMIZED
•
PUTS PRESSURE ON THE CONGRESS
LM/PRIVILEGED A ~11-83
DETER:\ff~ED TO BE A~ AD:\11~1STRATIVE
:\1..\RKI~(; Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: 4C.~
Date: 04/tJ[/afll
�Clinton Presidential Records
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digitization capabilities, we are sometimes unable to adequately
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indicated below.
Divider Title:
---------------------------
�I>ECISI9N 4
TAX CAP
BACKGR9UNB
SHOULD TAX INCENTIVES BE USED TO PROMOTE CHOICE
OF LOWER-COST HEALTH PLANS?
CURRENT TAX EXPENDITURE FOR HEALTH BENEFITS IS
ESTIMATED AT $75 BILLION.
•
ANY REDUCTIONS WOULD PRINCIPALLY AFFECT
MIDDLE- AND HIGHER-INCOME INDIVIDUALS
TAX-FREE BENEFITS MAY ENCOURAGE WORKERS TO:
•
ACCEPT MORE IN BENEFITS THAN THEY MIGHT
NEED
•
PREFER HEALTH BENEFITS TO WAGES
•
BE LESS PRICE SENSITIVE THAN DESIRED UNDER
.MANAGED COMPETITIO
DETER:\11~ED TO BE A~ AD:\11~1STRATIVE
~tARKI~G Per E.O. 12958 as amended, Sec. 3.3 {c)
Initials:
A( \3
Date:
oj / 0~ I f).,() II
�DECISION 4
TAX CAP
STATEMENT OF OPI'IONS
OPTION 1:
LEAVE BENEFITS TAX-FREE, AS IN CURRENT
LAW
OPTION 2:
TREAT AS TAXABLE INCOME EMPLOYER
CONTRIBUTIONS TO PREMIUMS FOR BENEFITS
BEYOND THE GUARANTEED BENEFITS
PACKAGE
OPTION 3:
TREAT AS TAXABLE INCOME EMPLOYER
CONTRmUTIONS TO PREMIUMS ABOVE THE
LOWEST-PREMIUM PLAN OR ABOVE SOME
SPECIFIED HIGHER LEVEL
OPTION 4:
FOR UPPER INCOME ONLY, TREAT AS TAXABLE
INCOME EMPLOYER CONTRmUTIONS TO
PREMIUMS ABOVE THE LOWEST-PREMIUM
PLAN OR ABOVE SOME SPECIFIED HIGHER
LEVEL
DETF.R:\H:\"ED TO BE A~ AD:\11~1STRATIVE
' 1:-\.RKI:\G Per E.O. 12958 as amended, Sec. 3.3 (c)
lmt1als:..B C~
Date: C>L{ (0"6 /Poll
�DECISION 4
TAX CAP
OPTION 1:
NO CHANGE FROM CURRENT LAW
LEAVE HEALTH BENEFITS TAX-FREE, AS IN CURRENT LAW.
PROS:
•
AVOIDS A TOUGH POLITICAL ISSUE
•
ASSURES THOSE WITH GOOD BENEFITS PACKAGES
THAT GOVERNMENT WILL NOT IMPOSE A NEW TAX
ON THOSE BENEFITS
CONS:
•
LEAVES IN PLACE THE CURRENT INCENTIVES FOR
EMPLOYERS TO PAY FOR BOTH MORE BENEFITS
AND MORE COSTLY PLANS
•
RETAINS INEQUITIES IN COVERAGE UNLESS
COMPREHENSIVE BENEFIT PACKAGE SET AT VERY
HIGH LEVEL
•
DOES NOT REDUCE CURRENT TAX EXPENDITURE
DETER:\11~ED TO BE A~ AD:\11~JSTR<\TIVE
MARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
4\'3
Date:
0
lf I o8 b.ctt
-------
_ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ j
�DECISION 4
TAX CAP
OPTION 2:
TAX BENEFITS ABOVE GUARANTEED
PACKAGE
TREAT AS TAXABLE INCOME EMPLOYER CONTRmUTIONS TO
PREMIUMS FOR BENEFITS BEYOND THE GUARANTEED
BENEFITS PACKAGE.
•
FOR EXAMPLE, TAXES WOULD APPLY TO COSMETIC
SURGERY BUT NOT TO HIGHER PREMIUMS FOR
GUARANTEED PACKAGE.
PROS:
•
WOULD MODESTLY LIMIT FUTURE GROWTH IN TAXFREE HEALTH CARE SPENDING
•
PERMITS INTRODUCTION OF "TAX-CAP" CONCEPT
WITH MINIMAL OPPOSITION, ASSUMING A
COMPREHENSIVE BENEFITS PACKAGE
CONS:
•
WILL NOT SIGNIFICANTLY REDUCE CURRENT TAX
EXPENDITURES
•
DOES LITTLE TO PROMOTE COST-CONSCIOUS
CONSUMER BEHAVIOR
•
IF BENEFITS PACKAGE NOT COMPREHENSIVE,
WOULD CONSTITUTE TAX INCREASE ON MIDDLE
CLASS
DF.TER:\1l~ED TO BEA~ AD~l~ISTRATIVE
MARKI:\G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: 1\\..'l)
Date: 0 Y /o~ Ja.c '0
�DECISION 4
TAX CAP
OPTION 3:
TAX PREMIUMS ABOVE LOW-COST PLAN
TREAT AS TAXABLE INCOME EMPLOYER CONTRmUTIONS TO
PREMIUMS ABOVE THE LOWEST-PREMIUM PLAN OR ABOVE
SOME SPECIFIED HIGHER LEVEL.
PROS:
•
WOULD ENCOURAGE CONSUMERS TO CHOOSE
LOWER-COST PLANS
•
WOULD REDUCE CURRENT TAX EXPENDITURES
CONS:
•
WOULD BE VIEWED BY MANY AS A TAX ON THEIR
BENEFITS AND A TAKEAWAY
•
WOULD LIMIT CHOICE BASED ON INCOME
DF.TER,fiSED TO BE AS AD:\'IISISTRATIVE
.\lARKISG Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
Date: QLj I Q9. / 'J.G\1
Af..'h
i
I
�DECISION 4
TAX CAP
OPTION 4:
SAME AS OPI'ION 3, BUT FOR UPPERINCOME ONLY
FOR UPPER INCOME ONLY, TREAT AS TAXABLE INCOME
EMPLOYER CONTRffiUTION TO PREMIUMS ABOVE THE
LOWEST-PREMIUM PLAN OR ABOVE SOME SPECIFIED HIGHER
LEVEL.
PROS:
•
GENERATES REVENUE WITHOUT HARMING
MIDDLE-INCOME PERSONS
•
REDUCES DISPARITY IN PLANS BASED ON INCOME
•
MAY BE ACCEPTABLE TO GROUPS THAT HAVE
HISTORICALLY OPPOSED TAX CAP
CONS:
•
DETER:\11~ED
REVENUE RAISED MAY NOT BE WORTH POLITICAL
CONTROVERSY OR ADDITIONAL ADMINISTRATIVE
BURDEN
TO BE A~ AD:\1J~ISTRATIVE
Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: A-t.~
Date: 0 '1 / oY> /?.UJ'-1
MARKI~G
�Clinton Presidential Records
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marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
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indicated below.
Divider Title:
----------------------------
�DECISION 5
PRICE COMPETITION
BACKGROUND
HOW MUCH PRICE COMPETh'ION IS DESm.ABLE?
PRICE COMPETITION ALLOWS DISPARITY IN PREMIUMS.
DISPARITY IN PREMIUMS MAY CAUSE:
•
GROUPING OF LOW-INCOME INDIVIDUALS IN LOWCOST PLANS; OR
•
HIGHER SUBSIDY COSTS IF LOW-INCOME
INDIVIDUALS HAVE BROAD CHOICE OF PLAN
DILEMMA OF PRICE COMPETITION:
•
ENCOURAGES EFFICIENTLY-DELIVERED CARE AND
ALLOWS CONSUMER CHOICE REFLECTING
PREFERENCES REGARDING VALUE FOR DOLLAR
BUT
•
SUBSIDIES DETERMINE WHETHER LOW-INCOME
CONSUMERS HAVE WIDE CHOICE OF HEALTH PLANS
OR ARE SEGREGATED IN LOW COST PLANS
•
WW COST MAY MEAN POOR SERVICE
DETERMI~ED
TO BE A~ AD:vti~ISTR.\TIVE
Per E.O. 12958 as amended, Sec. 3.3 (c)
lnitiais: A-t~
Date:. 0'-'\.{ 0 c:g /?pt \
MARKI~G
�DECISION 5
PRICE COMPETITION
STATEMENT OF OPTIONS
..
OPTION 1:
FULL PRICE COMPETITION; SUBSIDY AMOUNT
TIED TO LOWEST PREMIUM(S)
OPTION 2:
FULL PRICE COMPETITION; SUBSIDY AMOUNT
NOT TIED TO LOWEST PREMIUM(S)
OPTION 3:
CONSTRAIN PRICE COMPETITION BY LIMITING
PREMIUM VARIATION; SUBSIDY AMOUNT NOT
TIED TO LOWEST PREMIUM(S)
OPTION 4:
ELIMINATE PRICE COMPETITION; SUBSIDY
AMOUNT DOES NOT VARY
DETER:\fi:\ED TO BE A~ ADMI''ISTRATIVE
\1ARI<I:\G
. .~
· : . . · Per E.O. 12958 as amended, Sec. 3.3 (c)
lmtaals: A-t~
Date: Ql:( (ot lao\\
:
�DECISION 5
PRICE COMPETffiON
OPTION 1:
FULL PRICE COMPETITION; SUBSIDY
AMOUNT TIED TO LOWEST PREMIUM(S)
EACH PLAN NEGOTIATES A PREMIUM WITH HEALTH
ALLIANCE.
FEDERAL SUBSIDY TIED TO INDMDUAL SHARE OF PREMIUM
FOR LOWEST-PRICED PLAN(S).
PROS:
•
PRICE COMPETITION:
MAXIMIZES INCENTIVES TO KEEP COSTS LOW
ENHANCES CHOICE FOR MIDDLE AND UPPER
INCOME
MINIMIZES EMPLOYER COSTS
•
LIMITED SUBSIDIES MINIMIZE COST TO
GOVERNMENT
CONS:
•
LIMITS CHOICE FOR POOR/NEAR-POOR
•
CONCENTRATES POOR IN LOWEST-COST PLANS
CAPTIVE POPULATION CANNOT EXERCISE
CHOICE
MAY RESULT IN OVERCROWDING AND POOR
SERVICE
DETER:\1l~ED TO BE A~ AD:\tl~lSTRATl\'E
MARKI:\G Per E.O. 12958 as amended, Sec. 3.3 {c)
Initials: Af'b
Date: Ot...t lo$ /1 QL\
I
�DECISION 5
PRICE COMPETITION
OPTION 2:
FULL PRICE COMPETITION; SUBSIDY
AMOUNT NOT TIED TO LOWEST
PREMIUM(S)
EACH PLAN NEGOTIATES A PREMIUM WITH HEALTH
ALLIANCE.
FEDERAL SUBSIDY NOT TIED TO LOWEST PREMIUM. FOR
EXAMPLE, SUBSIDY SET AT:
•
110% OF LOWEST PREMIUM
•
MEDIAN PLAN PREMIUM
•
ACTUAL PREMIUM, REGARDLESS OF LEVEL
PROS:
•
MAINTAINS THE BENEFITS OF PRICE COMPETITION
•
HIGHER SUBSIDIES REDUCE CONCENTRATION OF
POOR IN LOWEST-COST PLANS
CONS:
•
MAY ALLOW THE VERY POOR BROADER CHOICE
THAN THE NEAR POOR
•
INCREASES PUBLIC SUBSIDY COSTS
DF.TER:\11~ED TO BE A~ AD:\11~1STRATIVE
:\1.-\RKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: ~c.f~
Date: o'--\. (o} faoy.
�DECISION 5
PRICE COMPETITION
OPTION 3:
LIMIT PREMIUM VARIATION; SUBSIDY
AMOUNT NOT TIED TO LOWEST
PREMIUM(S)
ALLIANCE NEGOTIATES WITH PLANS TO LIMIT PREMIUM
VARIATION. FOR EXAMPLE, HIGHEST PREMIUM CANNOT
EXCEED LOWEST PREMIUM BY MORE THAN 20%-30%.
FEDERAL SUBSIDY NOT TIED TO LOWEST PREMIUM. FOR
EXAMPLE, SUBSIDY SET AT:
•
110% OF LOWEST PREMIUM
•
MEDIAN PLAN PREMIUM
•
ACTUAL PREMIUM, REGARDLESS OF LEVEL
PROS:
•
LIMITS PREMIUM COSTS FOR ALL INCOME GROUPS
•
CHOICE WITHOUT MARKET SEGMENTATION
•
MAY FACILITATE MEETING BUDGET
CONS:
•
CAPPING PREMIUMS LIMITS INCENTIVE TO
INNOVATE AT THE HIGH END OF COST
NARROWS RANGE OF PLAN OFFERINGS
•
DETER:\1l~ED
MOVES SERVICE TOWARD LOWEST COMMON
DENOMINATOR
INCREASES PUBLIC SUBSIDY COSTS
TO BE A~ AD:\1l~ISTRATIVE
Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: ~
Date: 0:1 / o~ 1
:e,,O'\\ ..
:\1ARKI~G
�DECISION 5
PRICE COMPETITION
OPTION 4:
ELIMINATE PRICE COMPETITION
SUBSIDY AMOUNT DOES NOT VARY
HEALTH ALLIANCE NEGOTIATES ONE PRICE FOR ALL PLANS.
FEDERAL SUBSIDY DOES NOT VARY.
PROS:
•
LIMITS PREMIUM EXPENSES FOR INDIVIDUALS TO
20% SHARE
•
PEOPLE HAVE SAME CHOICE REGARDLESS OF
INCOME
CONS:
•
SINGLE PREMIUM LIMITS INCENTIVE TO INNOVATE
NARROWS RANGE OF PLAN OFFERINGS
MOVES SERVICE TOWARD LOWEST COMMON
DENOMINATOR
•
SINGLE PREMIUM MAY RAISE GOVERNMENT AND
EMPLOYER COSTS
DETER:\1J~ED TO BE A~ AD:\'ti~ISTR-\TI\'E
MARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: A!-~
Date: C\Y
fat,
/'rl>C\\
.
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
(o__;__·_ _ _ _ _ _ __
Divider Title: _ _ _ _ _
L _ _ _ _ _ _ _ _ __
I
�DECISION 8
POPULATION GROUPS IN HEALTH ALLIANCES
BACKGROUND
WIUCH PRIVATE AND PUBLIC EMPLOYER GROUPS WILL
BE REQumED TO OBTAIN HEALTH COVERAGE THROUGH
THE HEALTH ALLIANCES?
FOR ALLIANCES TO WORK, THEY MUST BE OF SUFFICIENT
SIZE.
•
THEY MUST BE LARGE ENOUGH TO HAVE
PURCHASING POWER
•
IF THEY ARE TOO SMALL AND INCLUDE THE POOR,
THEY WILL BECOME KNOWN AS "SUPER-MEDICAID"
PLANS AND BE SHUNNED BY THE MIDDLE CLASS
•
SMALL ALLIANCES WOULD BE UNABLE TO CARRY
OUT FUNCTIONS OF QUALITY ASSURANCE, ENSURE
ADEQUATE SERVICE AND CHOICE FOR THE POOR,
ENFORCE BUDGET
FOR THESE REASONS, THE AFL-CIO AND MANY SINGLEPAYER ADVOCATES FAVOR MOVING EVERYONE INTO THE
ALLIANCE.
MANY BUSINESS GROUPS AND THEIR EMPLOYEES WANT TO
LIMIT ALLIANCE SIZE.
•
MOVING PEOPLE INTO LARGE ALLIANCES MAY
CAUSE DISRUPTIONS FOR PEOPLE WHO ARE
CURRENTLY SATISFIED WITH THEIR COVERAGE
•
MANY LARGER FIRMS -- ESPECIALLY MULTI-STATE
EMPLOYERS -- PREFER TO FINANCE AND OPERATE
THEIR OWN PLANS
DETER:\fJ~ED TO BE A~ AD:\'li~ISTRATIVE
MAU.Kl~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
Date:
----
�DECISION 6
POPULATION GROUPS IN HEALTH ALLIANCES
BACKGROUND (CONT)
SPECIAL ISSUES EXIST FOR PUBLIC EMPLOYEES:
•
FEDERAL EMPLOYEES MAY BE PARTICULARLY
RESISTANT TO MOVING INTO ALLIANCES
•
SPECIAL EXEMPTIONS FOR FEDERAL AND OTHER
PUBLIC EMPLOYEES WOULD SEND A NEGATIVE
MESSAGE TO SMALL EMPLOYERS
NOTE:
RULES ABOUT FIRM SIZE PARTICIPATION WILL
HAVE DIFFERENT IMPACTS IN DIFFERENT STATES.
LMIPRMLEGED wetJNfwEN i1JW4-11-83
DETER:\1Jl'iED TO BE AS AD.\'fiSISTRATIVE
MARKii\G Per E.O. 12958 as amended, Sec. 3.3 (Q)
lnitiais:Ase~
Date: oLf{o?;/?-011 ·
�DECISION 8
POPULATION GROUPS IN HEALTH ALLIANCES
STATEMENT OF OPTIONS
OPTION 1:
REQUIRE PARTICIPATION OF FIRMS WITH 100
OR FEWER EMPLOYEES
OPTION 2:
REQUIRE PARTICIPATION OF
FIRMS WITH 500 OR FEWER
EMPLOYEES
OPTION 3:
REQUIRE PARTICIPATION OF
FIRMS WITH 1,000 OR FEWER
EMPLOYEES
OPTION 4:
REQUIRE PARTICIPATION OF ALL FIRMS,
REGARDLESS OF SIZE
OPTION 5:
SPECIAL RULES FOR PUBLIC EMPLOYERS
DETER:\11~ED TO BE A~ AD:\11~1STRATin:
MARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: Ae~
Date: Qj I{o8 f?£:1\
�DECISION 6
POPULATION GROUPS IN HEALTH ALLIANCES
OPTION 1:
REQum.E PARTICIPATION OF FIRMS
WITH 100 OR FEWER EMPLOYEES
PROS:
•
POOLING SMALL EMPLOYERS WILL ADDRESS MOST
EGREGIOUS PROBLEMS IN INSURANCE MARKET:
REDUCE ADMINISTRATIVE COSTS
OFFER EMPLOYEES A WIDER CHOICE OF
HEALTH PLANS
CONS:
•
THESE ALLIANCES WOULD HAVE A
DISPROPORTIONATE SHARE OF POOR AND NEARPOOR MEMBERS
•
GOVERNMENT MUST REGULATE LARGE NUMBER OF
EMPLOYERS OUTSIDE THE ALLIANCE
DF.Tf.R:\11:-;ED TO BE A~ AD:\11:-;ISTRATIVE
MARKJ:-;G Per E.O. 129S8 as amended, Sec. 3.3 (c)
Initilllli: J\t_'}.
Date: c,L.f f 08 1?(I\\
�DECISION 8
POPULATION GROUPS IN HEALTH ALLIANCES
OPTION 2:
REQum.E PARTICIPATION OF Fm.MS
WITH 500 OR FEWER EMPLOYEES
118 MILLION NON-ELDERLY PEOPLE (OUT OF 230 MILLION)
WILL BE IN ALLIANCES IF FIRMS WITH 500 OR FEWER
EMPLOYEES ARE REQUIRED TO JOIN. THE NUMBER WILL BE
HIGHER IF ALL PUBLIC EMPLOYEES NOT INCLUDED IN THIS
CATEGORY (ABOUT 15 MILLION WORKERS PLUS THEIR
DEPENDENTS) ARE REQUIRED TO JOIN.
PROS:
•
REDUCES THE NEED FOR AN ADDITIONAL LAYER OF
SMALL-GROUP INSURANCE MARKET REGULATION
OUTSIDE THE ALLIANCES
•
SPREADS RISK AND ATTRACTS LEADERSHIP
BEYOND SMALL EMPLOYERS
•
INCREASES ALLIANCE PURCHASING POWER
CONS:
•
APPROXIMATELY 27% OF THE ENROLLED
POPULATION (NOT INCLUDING ALL PUBLIC
EMPLOYEES) WILL BE BELOW POVERTY COMPARED
TO 17% FOR THE POPULATION AS A WHOLE
DETER\11~ED TORE A~ AD\H~ISTRL\.TIVE
'
MARKI~G
Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: (\(,_{~
Date: C>=t (o 0 / ? o\\
�DECISION 6
POPULATION GROUPS IN HEALTH ALLIANCES
OPTION 3:
REQumE PARTICIPATION OF
COMPANIES WITH 1,000 OR FEWER
EMPLOYEES
131 MILLION NON-ELDERLY PEOPLE (OUT OF 230 MILLION)
WILL BE IN ALLIANCES IF FIRMS WITH 1,000 OR FEWER
EMPLOYEES ARE REQUIRED TO JOIN. THE NUMBER WILL BE
HIGHER IF ALL PUBLIC EMPLOYEES WHO ARE NOT INCLUDED
IN THIS CATEGORY (ABOUT 13 MILLION WORKERS PLUS
THEIR DEPENDENTS) ARE REQUIRED TO JOIN.
PROS:
•
FURTHER STRENGTHENS PURCHASING POWER
•
FURTHER SPREADS RISK
•
REDUCES THE NUMBER OF FIRMS TO REGULATE
OUTSIDE THE ALLIANCE
CONS:
•
APPROXIMATELY 25% OF THE ENROLLED
POPULATION (NOT INCLUDING ALL PUBLIC
EMPLOYEES) WILL BE BELOW POVERTY COMPARED
TO 17% FOR THE POPULATION AS A WHOLE
LMIPBIVILEGED A eeNPIM!f'l'h\JI4-11-18
llf.TF.R:\11\EO TO BE A\ AD:\11\ISTRATIVE
:\1ARKI\G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
A(':s
Date: 0
':t I/68/?>.0!!
�DECISION 8
POPULATION GROUPS IN HEALTH ALLIANCES
OPTION 4:
REQUIRE PARTICIPATION OF ALL Fm.MS
PROS:
•
FACILITATES BUDGETARY CONTROL AND
NEGOTIATING POWER
•
CREATES THE BROADEST POOLING OF RISKS
•
BRINGS THE LEADERSHIP OF LARGE
CORPORATIONS INTO HEALTH ALLIANCE
•
EMPLOYERS WITH OLDER THAN AVERAGE WORKERS
WILL WIN
CONS:
•
CHANGES EXISTING COVERAGE THAT MANY
EMPLOYEES BELIEVE IS SATISFACTORY
•
ELIMINATES SELF INSURANCE THAT MANY LARGE
EMPLOYERS PREFER
1M/PRIVILEGED a. ~11-88
DETF.R\11\F.D TO BE A\ AD:\'IINISTRATIVE
MARKI\G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: 6K ~
Date: o"'-\ / Cl ~ I OCl\
�DECISION 8
POPULATION GROUPS IN HEALTH ALLIANCES
OPTION 5:
SPECIAL RULES FOR PUBLIC
EMPLOYERS
REQillRING PARTICIPATION BY FIRMS OF 1,000 EMPLOYEES
WOULD NOT ENCOMPASS EMPLOYEES IN URBAN AND
SUBURBAN COUNTIES, LARGE CITIES AND SCHOOL
DISTRICTS, OR FEDERAL AND STATE EMPLOYEES.
IF REQillREMENTS APPLY TO BARGAINING UNITS, MORE
PUBLIC EMPLOYEES WILL BE INCLUDED.
SPECIAL RULES TO REQUIRE PUBLIC EMPLOYEE
PARTICIPATION WOULD:
•
ACCELERATE TRANSITION BY USING PUBLIC
EMPLOYEE HEALTH BENEFIT PLANS AS A
SPRINGBOARD
•
BillLD ON THE EXPERTISE OF STATE PUBLIC
EMPLOYEE GROUPS IN OPERATING HEALTH
ALLIANCES
•
EXPAND SIZE OF ALLIANCE
PUBLIC-SECTOR UNIONS MAY:
•
REGARD SPECIAL REQillREMENTS AS AN UNFAIR
DISRUPTION OF BARGAINING AGREEMENTS
•
RESIST PARTICIPATION IN ANY POOL THAT IS
DISPROPORTIONATELY UJW-INCOME
DETER!\11~ED TO BE A~ AD:\1l~ISTRATI\'E
MARKI:\G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials; 01 [u"b / ~\\ Date: __..;..j?r(..;;;_j3"-----
�Clinton Presidential Records
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marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
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indicated below.
Divider Title:
---------------------------
�DECISION 7
AGE ADJUSTMENT TO COMMUNITY RATE
BACKGROUND
SHOULD COMMUNITY RATING BE MODIFIED TO ACCOUNT
FORAGE?
UNDER EXPERIENCE RATING, HEALTHIEST GROUPS PAY
BELOW-AVERAGE PREMIUMS REFLECTING:
•
HEALTH STATUS
•
CLAIMS HISTORY
•
DEMOGRAPHIC CHARACTERISTICS
COMMUNITY RATING SPREADS RISK BY REQUIRING ALL
GROUPS TO PAY THE SAME PREMIUM.
A MOVE TO PURE COMM:UNITY RATING WILL:
•
PRODUCE IMMEDIATE PREMIUM INCREASES FOR
HEALTHIER, YOUNGER GROUPS
•
PREVENT RATE SWINGS AS EXPERIENCE IN SMALL
GROUPS CHANGES
•
ALLOW OLDER, SICKER INDMDUALS AND GROUPS
TO PAY LESS
ADJUSTING COMMUNITY RATES FOR AGE WILL RESULT IN
FEWER EMPLOYERS AND INDMDUALS EXPERIENCING LARGE
INCREASES OR LARGE REDUCTIONS.
DETERMISED TO BE AS AD!\11:SISTRo\TI\'E
MARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: At~
Date: CH fg.pq
�DECISION 7
AGE ADJUSTMENT TO COMMUNITY RATE
STATEMENT OF OPTIONS
OPTION 1:
AGE-RATE PREMIUMS
OPTION 2:
DO NOT AGE-RATE PREMIUMS
DF.TEit\11\ED TO RF. A\ AD:\11\ISTRATIVE
:\1:\RKI\G l'cr E.O. 12958 as amended, Sec. 3.3 (c)
Initials: A$-~
Date: if1 hx 1'M ll
L _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
-
�DECISION 7
AGE ADJUSTMENT TO COMMUNITY RATE
OPTIONS 1 & 2:
AGE-RATING PREMIUMS
PROS:
•
AGE RATING WILL MINIMIZE SHIFT IN
PREMIUM COSTS FROM MIDDLE-AGED
HIGHER EARNERS TO YOUNGER, LOWER
EARNERS
•
BECAUSE AGE IS CORRELATED WITH
INCOME, AGE RATING WILL REDUCE
GOVERNMENT SUBSIDY COSTS
•
AGE RATING WILL REDUCE COSTS FOR
SMALL EMPLOYERS WITH A
PREDOMINANTLY YOUNG WORK FORCE
CONS:
•
MAY CAUSE JOB DISCRIMINATION BASED
ON AGE
•
WILL BE ATTACKED AS INEQUITABLE
•
ADDS ADMINISTRATIVE COMPLEXITY (THE
BENCHMARK PREMIUM AND THE TAX CAP
WOULD ALSO HAVE TO BE AGE-RATED)
•
ALLOWING ONE EXCEPTION TO COMMUNITY
RATING COULD OPEN DOOR TO OTHERS
DETER:'\fi~ED TO BE AS AD\11SISTRATIVE
MARKI\G Per F..O. 12958 as amended, Sec. 3.3 (c)
Initials: At!-,
Date: 68 (o~ (?..CI \
�Clinton Presidential Records
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Divider Title:
---------------------------
�DECISION 8
STAND-ALONE PLANS
B~CKGROUND
WHAT RATING AND CHOICE RULES GOVERN STANDALONE PLANS?
PLANS OUTSIDE THE HEALTH ALLIANCE MUST AT LEAST:
•
PROVIDE THE COMPREHENSIVE BENEFIT PACKAGE
•
PAY SAME PREMIUM SHARE AS EMPLOYERS
PARTICIPATING IN THE ALLIANCE
•
COMPLY WITH FEDERAL QUALITY STANDARDS
.•
COMPLY WITH BUDGET
•
PAY ASSESSMENT FOR NATIONAL DISABLED POOL
(IF ESTABLISHED)
•
COMPLY WITH SOLVENCY AND REPORTING
REQUIREMENTS
UNLESS RULES ABOUT RATING AND CHOICE ARE
ESTABLISHED, ALLIANCES MAY BE SUBJECT TO ADVERSE
SELECTION AND EMPLOYEE CHOICE WILL BE LIMITED.
DETERMISED TO BE AS AD:\fiSISTR-\ TI\T
MARKISG Per E.O. 12958 as amended, Sec. 3.3 (c
Initials: Af.- ~
Date: 0j (c '?5 I ?P \l
�DECISION 8
STAND-ALONE PLANS
STATEMENT OF OPTIONS
OPTION 1:
RETAIN SELF INSURANCE BUT ALLOW
EMPLOYERS TO JOIN ALLIANCE
OPTION 2:
ELIMINATE SELF INSURANCE BUT ALLOW
EMPLOYERS TO MANAGE OWN PLANS
OPTION 3:
RETAIN SELF INSURANCE OUTSIDE THE
ALLIANCE; BUT HAVE SPECIAL RULES FOR
EMPLOYEE CHOICE
DB/PRIVILEGED • fl8NIIIBB!ft'b\tl4-11-83
DETER:\1I:'tED TO BE A~ AD~l~ISTRATIVE
MARI<l:'tG Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
Date: rt\ /6 '6 / '44 V1
A.c-1
�DECISION 8
STAND-ALONE PLANS
OPTION 1:
RETAIN SELF INSURANCE BUT ALLOW
EMPLOYERS TO JOIN ALLIANCE
PERIODICALLY, LARGE FIRMS WOULD HAVE THE
OPPORTUNITY TO JOIN THE ALLIANCE.
THESE FIRMS WOULD PAY AN EXPERIENCE-RATED PREMIUM
TO THE ALLIANCE.
•
NECESSARY TO PROTECT ALLIANCE AGAINST AN
INFLUX OF HIGHER-COST, LARGE FIRMS.
•
EVENTUALLY <PERHAPS AFrER 10 YEARS), THESE
FIRMS COULD PAY ON A COMl\WNITY RATE.
PROS:
•
MANY LARGE FIRMS LIKELY TO FAVOR THIS OPTION
BECAUSE IT EXPANDS CHOICE BUT DOES NOT
REQUIRE CHANGE
CONS:
•
LARGE FIRMS WITH OLDER OR LESS HEALTHY
WORKERS WILL OBJECT TO CONTINUED HIGHER
COSTS
DETER~H\'ED TO BE A\' AD:WI:"iiSTRATIVE
MARKI\'G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: 1\U~
Date: o':t (o~ 1M l\
�DECISION 8
STAND-ALONE PLANS
OPTION 2:
ELIMINATE SELF INSURANCE BUT
ALLOW EMPLOYERS TO MANAGE OWN
PLANS
INSTEAD OF ALLOWING PLANS TO SELF INSURE, LARGE
EMPLOYERS MANAGING OWN PLANS WOULD PAY SAME
COMMUNITY RATE TO ALLIANCE AS OTHER EMPLOYERS.
THESE EMPLOYERS COULD LIMIT THEIR PLAN TO THEIR OWN
EMPLOYEES.
EMPLOYEES MAY CHOOSE ANY PLAN IN THE ALLIANCE OR
THEIR EMPLOYER'S PLAN.
THESE EMPLOYER PLANS, LIKE ANY OTHER PLAN, WILL
RECEIVE A RISK-ADJUSTED PAYMENT FOR THEIR
EMPLOYEES THAT CHOOSE IT.
PROS:
•
PREVENTS ADVERSE SELECTION AGAINST THE
HEALTH ALLIANCE
•
SELF-FUNDED HEALTH PLANS FORCED TO
COMPETE ON EFFICIENCY, NOT RISK-SELECTION
•
REDUCES COSTS FOR FIRMS WITH OLDER AND/OR
LESS HEALTHY WORKERS
CONS:
•
MOST LARGE FIRMS WILL SEE THIS OPTION AS
TANTAMOUNT TO JOINING THE ALLIANCE
•
RAISES COSTS FOR FIRMS WITH YOUNGER
WORKERS
DR/PRIVILEGED 6~11-IS
DETER!\H~ED TO BE A~ AD~11~1STR4.TIVE
MARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: A(!Z
Date: (b4 /o t/7o r (
�DECISION 8
STAND-ALONE PLANS
OPTION 3:
RETAIN SELF INSURANCE OUTSIDE THE
ALLIANCE BUT HAVE SPECIAL RULES
TO EXPAND EMPLOYEE CHOICE
POSSffiLE APPROACHES TO EXPAND EMPLOYEE CHOICE:
•
REQUIRE LARGE FIRMS TO ALLOW EMPLOYEES TO
CHOOSE ALLIANCE PLANS
•
REQUIRE LARGE FIRMS TO OFFER TWO OR MORE
HEALTH PLANS IN ADDITION TO THE FIRM'S
PRIMARY PLAN
PROS:
•
GIVES THESE EMPLOYEES BROADER CHOICE OF
HEALTH PLANS
CONS:
•
IMPOSES NEW REQUIREMENTS ON LARGE
EMPLOYERS
FOR INDIVIDUAL OPT-IN:
•
DIFFICULT TO ADMINISTER INDIVIDUAL OPT-IN
EMPLOYERS MAY SELECTIVELY ENCOURAGE
HIGHER-COST EMPLOYEES TO JOIN THE
ALLIANCE'S PLANS
•
MANY EMPLOYERS WILL FIND IT DIFFICULT TO
SUSTAIN A SELF-FUNDED PLAN DUE TO
UNPREDICTABILITY OF VOLUME
DETER:\1f'"ED TO BE AN AD~I'"ISTRATIVE
MARKI~G Per E.O. 12958 as amended, Sec. 3.3 {c)
Initials:
At'S.
Date: 0~1 (o8j~ol\
--------------------------
�Clinton Presidential Records
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Divider Title:
---------------------------
�DECISION 9
MEDICARE INTEGRATION
BACKGROUND
SHOULD MEDICARE BE INTEGRATED INTO THE NEW
SYSTEM?
MEDICARE COVERS 13% OF THE POPULATION:
•
31 MILLION ELDERLY
•
3 MILLION NON-ELDERLY DISABLED
MEDICARE HAS SUBSTANTIAL MARKET SHARE:
•
17 PERCENT OF TOTAL HEALTH SPENDING
•
27 PERCENT OF ALL HOSPITAL SPENDING AND 24
PERCENT OF PHYSICIAN SPENDING
MEDICARE HAS STRONG SUPPORT AMONG BOTH ELDERLY
AND NON-ELDERLY AMERICANS.
MEDICARE HAS NATIONWIDE ADMINISTRATIVE CAPACITY
THROUGH ITS CARRIERS AND INTERMEDIARIES IN .EACH
STATE.
1.5 MILLION BENEFICIARIES ARE IN RISK-BASED HMOS.
MEDICARE HAS A NATIONAL PAYMENT SYSTEM FOR
HOSPITALS AND PHYSICIANS.
DB/PRIVILEGED
~4-11-83
DETER:\1l~ED TO BE A~ AD~ISISTRATIVE
MARI<l:'liG Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
Date: OLf (o'6 /flGI I
ftL&
�DECISION 9
MEDICARE INTEGRATION
STATEMENT OF OPTIONS
OPTION 1:
LEAVE MEDICARE PROGRAM ALONE EXCEPT TO
EXPAND BENEFITS
OPTION 2:
PARTIAL INTEGRATION OF MEDICARE
OPTION 3:
FULL INTEGRATION OF MEDICARE INTO THE
NEW SYSTEM
DETER!\11~ED TO BE AS AD:WI~ISTRATIVE
MARKISG Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
Date: 0=-t_ {of'/ 00tl
Af'3
�DECISION 9
MEDICARE INTEGRATION
OPTION 1:
LEAVE PROGRAM ALONE; EXPAND
BENEFITS
MEDICARE REMAINS A SEPARATE PROGRAM FOR ELDERLY
AND DISABLED BENEFICIARIES.
BENEFITS COULD BE IMPROVED TO INCLUDE PRESCRIPTION
DRUGS AND REDUCE COST-SHARING.
INCENTIVES COULD BE PROVIDED TO ENCOURAGE
BENEFICIARIES TO ENROLL IN MANAGED CARE PLANS.
PROS:
•
AVOIDS DISRUPTION FOR MEDICARE
BENEFICIARIES
•
MEDICARE COULD BE USED AS TRANSITIONAL FEEFOR-SERVICE OPTION OR IF NEW SYSTEM NOT
-OPERATIONAL IN ALL AREAS
•
RATE-SETTING METHODS COULD BE APPLIED TO
OTHER PAYERS OR USED BY STATES
CONS:
•
CURRENT MEDICARE POLICIES IMPEDE MOVE
TOWARD CARE MANAGEMENT
•
KEEPS IN PLACE SEPARATE ADMINISTRATIVE
REQIDREMENTS WHICH MAY BURDEN PROVIDERS
•
SEPARATE COST CONTAINMENT MEASURES
DETER:\11\F.D TO BE AS AD~I~ISTRATIVE
MARKI\G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: &-~
Date: C3'i { ot>
l\
/Q.P
�•
LOW MEDICARE PAYMENT LEVELS COULD RESULT
IN COST-SHIFTING TO OTHER PLANS
DR/PRIVILEGED lre6NPID2!~-11-9S
DETERMINED TO BE AN ADMINISTRATIVE
MARKING Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
Date: 6Lf / 0 l>
M
/<U
�DECISION 9
· MEDICARE INTEGRATION
OPTION 2:
PARTIAL INTEGRATION
RETAIN SEPARATE MEDICARE PROGRAM AND BENEFITS FOR
THE ELDERLY AND DISABLED, BUT INTEGRATE MEDICARE
PAYMENTS WITH THE NEW SYSTEM.
MEDICARE BENEFICIARIES WOULD CONTINUE TO RECEIVE
CARE FROM PHYSICIAN OF CHOICE.
PROVIDERS WOULD BE PAID THROUGH ALLIANCE FEE-FORSERVICE NETWORK:
•
INSTEAD OF NATIONAL FEE SCHEDULE, PHYSICIANS
IN THE NETWORK WOULD NEGOTIATE FEES UNDER
THE STATE BUDGET
•
MEDICARE BENEFICIARIES WOULD OBTAIN
PRESCRIPTION DRUG COVERAGE AND MEDIGAP
COVERAGE THROUGH THE ALLIANCE
PROS:
•
ELDERLY RETAIN DISTINCT PROGRAM WITH
MINIMAL DISRUPTION
•
OPEN-ENDED FEE-FOR-SERVICE PAYMENT UNDER
MEDICARE REPLACED WITH PHYSICIAN
NEGOTIATED FEES UNDER A BUDGET
•
BRINGS MEDICARE PAYMENTS UNDER EACH
STATE'S BUDGET; PROVIDES STATE WITH GREATER
CONTROL OVER TOTAL SPENDING IN STATE
•
REGULATORY BUREAUCRACY WILL BE REDUCED
DETER\fl:'\'ED TO B£ AN AD'"I''IST
MARKI:\"G
.Y, n RATIVE
In' .
Per E.O. 12958 as amended, Sec. 3.3 (c)
ltlals: ( 3
Date: <?-f /o "6 ll (
A.
�DECISION 9
MEDICARE INTEGRATION
OPTION 2:
•
PARTIAL INTEGRATION (CONT)
FAVORED BY STATE OFFICIALS
CONS:
•
UNDERMINES NATIONAL POLITICAL POWER BASE
OF ELDERLY
•
RESTRUCTURES RELATIONSHIP OF BENEFICIARY
AND PROVIDER WITH NEW FISCAL INCENTIVES
•
MAY BE VIEWED BY ELDERLY AS DISMANTLING
MEDICARE AS A NATIONAL SOCIAL INSURANCE
PROGRAM AND ENTITLEMENT
•
DIFFICULTIES IN SETTING CAPITATION RATES AND
RISK ADJUSTERS FOR THE ELDERLY COULD
UNDERMINE QUALITY AND ACCESS
DETER~fi~ED TO BE AS ADMINISTRATIVE
MARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
P{.:s
Date:
ay (6 ca
I ~1\
�DECISION 9
MEDICARE INTEGRATION
OPTION 3:
FULL INTEGRATION
MEDICARE BENEFICIARIES RECEIVE COVERAGE THROUGH
ALLIANCE HEALTH PLANS.
•
MEDICARE PAYS PLANS USING AGE- AND RISKADJUSTED PREMIUMS
•
MEDICARE BENEFITS SAME AS FOR UNDER-65
•
COULD BE PHASED IN AS PEOPLE TURN 65 BY
GMNG THEM OPTION TO RETAIN EXISTING
COVERAGE WITH MEDICARE PAYING FOR PREMIUMS
PROS:
•
THE ELDERLY WOULD BE TREATED LIKE ALL
. OTHER AMERICANS RESULTING IN A SINGLE
SYSTEM FOR THE NATION
•
PURCHASING POWER OF THE ALLIANCE WOULD BE
INCREASED BY 34 MILLION AMERICANS
•
MEDICARE SPENDING WOULD BE INCLUDED IN THE
STATE BUDGETS PROVIDING STATES WITH
BROADER COST CONTROL AUTHORITY
•
ELDERLY WOULD RECEIVE THE COMPREHENSIVE
BENEFIT PACKAGE PROVIDING MORE PROTECTION
THAN CURRENT MEDICARE PACKAGE
•
INTEGRATION ALLOWS FOR GAINS IN SIMPLIFYING
THE ADMINISTRATION OF THE HEALTH SYSTEM
AND REDUCING BURDENS ON PROVIDERS
DETERMINED TO BE A~ AD:\11~1STRATI\'E
MARKING Per E.O. 12958 as amended,
3.3 (c)
Initials: A<.~
Date: oY.
'IfI '\
/o
f;g
�DECISION 9
MEDICARE INTEGRATION
OPTION 3:
FULL INTEGRATION (CONT)
CONS:
•
ELDERLY AND THEIR ADVOCATES WILL SEE THIS AS
TAKING AWAY A CURRENT ENTITLEMENT AND
PU'ITING THE ELDERLY IN A NEW AND UNTRIED
SYSTEM
•
REQUIRES SUBSTANTIAL ADDITIONAL FEDERAL
SPENDING TO UPGRADE MEDICARE BENEFITS
•
REQUIRES SEPARATE PREMIUM STRUCTURE WITHIN
THE ALLIANCE
•
RAPID TRANSITION COULD DISRUPT CARE FOR THE
ELDERLY AND COMPLICATE EXISTING PROVIDER
RELATIONSHIPS
DB/PRIVILEGED &•eeNPIBBJIRUirt 11-83
DETER:\11~ED TO BE A~ AD!\1I~ISTRATI\'E
MARKI:\G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: &t'!>
Date: oLf / 6~ 01 \
?-
�Clinton Presidential Records
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marker by the William J. Clinton Presidential Library Staff.
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digitization capabilities, we are sometimes unable to adequately
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indicated below.
Divider Title:
----------------------------
�DECISION 10
.UNDOCUMENTED PERSONS
BACKGROUND
HOW WILL CARE FOR UNDOCUMENTED PERSONS BE
FUNDED?
AS MANY AS 12 MILLION UNDOCUMENTED PERSONS RESIDE
IN THE UNITED STATES, HIGHLY CONCENTRATED IN A FEW
AREAS.
PUBLIC HOSPITALS, SELECT TEACHING HOSPITALS AND
COMMUNITY AND MIGRANT HEALTH CENTERS RECEIVE
COMPENSATION FOR THESE PERSONS THROUGH
UNCOMPENSATED CARE AND OTHER APPROPRIATED FUNDS.
UNDOCUMENTED PERSONS MAY CARRY COMMUNICABLE
DISEASES SUCH AS TUBERCULOSIS. WITHOUT A STABLE AND
ACCESSIDLE CARE DELIVERY SYSTEM FOR THIS POPULATION,
THESE DISEASES MAY GO UNIDENTIFIED AND UNTREATED,
AND INCREASE THE RISK OF TRANSMISSION TO OTHERS.
WITHOUT FINANCIAL SUPPORT IN ONE FORM OR ANOTHER,
INSTITUTIONS TREATING UNDOCUMENTED PERSONS MAY NO
LONGER BE ABLE TO PROVIDE CARE, OR WILL HAVE
DIFFICULTY COMPETING ON THE BASIS OF PRICE ..
DETERMISED TO BE AN AD~I~ISTRATIVE
MARKIJ\G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: fiLlS
Date: 0'-\ / o8 I?.G 11
�DECISION 10
. UNDOCUMENTED PERSONS
STATEMENT OF OPTIONS
OPTION 1:
UNDOCUMENTED PERSONS ELIGmLE FOR THE
COMPREHENSIVE BENEFITS PACKAGE AND ALL
SUBSIDIES
OPTION 2:
INSTITUTIONS TREATING UNDOCUMENTED
PERSONS RECEIVE DEDICATED FUNDS
OPTION 3:
NO EXPLICIT FUNDING FOR CARE
DETf.R,11:\"ED TO BE A~ AD:\11~1STRATIVE
MAlU(J:\"G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
4C1>
Date:
Oj ( 0~ / ~o~
�DECISION 10
. UNDOCUMENTED PERSONS
OPI'ION 1:
NO COVERAGE DISTINCTION
NO COVERAGE DISTINCTION IS MADE AMONG AMERICAN
CITIZENS, LEGAL RESIDENTS AND UNDOCUMENTED
PERSONS. ALL WOULD BE ELIGffiLE FOR THE
COMPREHENSIVE BENEFITS PACKAGE AND ALL SUBSIDIES.
PROS:
•
ALLEVIATES UNCOMPENSATED CARE FOR
UNDOCUMENTED PERSONS
•
SIMPLIFIES ADMINISTRATION FOR PROVIDERS
CONS:
•
MAY ENCOURAGE ILLEGAL IMMIGRATION TO THE
UNITED STATES
•
AMERICAN CITIZENS MAY PROTEST A BENEFIT
THEY FEEL TO BE UNFAIR
•
FURTHER COMPLICATES ENFORCEMENT OF
IMMIGRATION LAWS
DETER:\11~ED TO BE A~ AD~I~ISTRATIVE
\1ARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: AC.'3.
Date:
Oj
(o8 /?,91.\
�DECISION 10
. UNDOCUMENTED PERSONS
OPI'ION 2:
DEDICATED FUNDS
UNDOCUMENTED PERSONS WOULD NOT BE ENROLLED IN
HEALTH PLANS. A DIRECT GRANT OR SET-ASIDE
ARRANGEMENTS WOULD BE PROVIDED TO SUPPORT
INSTITUTIONS WITH A DISPROPORTIONATE SHARE OF
UNDOCUMENTED PERSONS.
PROS:
•
ASSURES THAT FUNDS GO DIRECTLY TO THE
PROVIDERS THAT CARE FOR THIS POPULATION
CONS:
•
MAY ENCOURAGE ILLEGAL IMMIGRATION TO THE
UNITED STATES
•
AMERICAN CITIZENS MAY PROTEST A BENEFIT
THEY FEEL TO BE UNFAIR
DETER:\11~ED TO BE A~ AD:\'II~ISTRATIVE
MARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: Ac--~
Date: GY (o~ 0..0 II
/
�DECISION 10
. UNDOCUMENTED PERSONS
OPTION 3:
NO EXPLICIT FUNDING
UNDOCUMENTED PERSONS WOULD CONTINUE TO RECEIVE
UNCOMPENSATED EMERGENT CARE OR PAY FOR OWN CARE
OUT-OF-POCKET AS UNDER CURRENT SYSTEM.
PROS:
•
NO VISffiLE PUBLIC FUNDS GOING TO
CONTROVERSIAL GROUP
CONS:
•
CONTINUES INCENTIVES FOR COST-SHIFTING
•
UNDULY BURDEN SOME PROVIDERS
•
UNDOCUMENTED PERSONS MAY NOT RECEIVE
NECESSARY TREATMENT
DETER!\flNED TO BE AN ADMINISTRATIVE
MA.RKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
lnit•als: t\93
Date: 6Lf (oX (2PLI
�Clinton Presidential Records
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marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
---------------------------
�DECISION 11
· REPRODUCTIVE SERVICES
BACKGROUND
TO WHAT EXTENT ARE THE RANGE OF REPRODUCTIVE
HEALTH SERVICES DEFINED IN THE BENEFITS PACKAGE?
THE BENEFIT PACKAGE WILL COVER REPRODUCTIVE HEALTH
SERVICES, FOR EXAMPLE:
•
PREGNANCY TESTING
•
PRE-NATAL CARE
•
· LABOR AND DELIVERY
AT ISSUE IS WHETHER "REPRODUCTIVE HEALTH SERVICES"
INCLUDES ABORTION SERVICES.
COVERAGE OF ABORTION SERVICES COULD BE THE MOST
POLITICALLY DIVISIVE ISSUE IN THE HEALTH REFORM
DEBATE.
•
WOMEN'S GROUPS AND OTHER PRO-CHOICE
ADVOCATES WANT ABORTION SERVICES CLEARLY
SPELLED OUT, NOT LEFT TO STATES OR HEALTH
PLANS TO DETERMINE
•
ANTI-ABORTION ADVOCATES WILL FIGHT EXPLICIT
COVERAGE OF ABORTIONS AND SEEK TO PROHffiiT
THEM
LM/PBJVJLEGED &-eet!J'JDI:Jlll'fllll/4-11-83
DETER\ffSED TO BE AS AD~ISISTRATIVE
MARK IS • Per E.Q. 12958 as amended, Sec. 3.3 (c)
Initials:
fS
Date: 0'-l
/G ~ / 'd..ou
�DECISION 11
. REPRODUCTIVE SERVICES
BACKGROUND (CONT)
CURRENT COVERAGE FOR ABORTION VARIES:
•
MOST EUROPEAN COUNTRIES COVER ABORTIONS
UNDER CERTAIN CONDITIONS
•
MANY PRIVATE HEALTH PLANS AND HMOS IN THE
U.S. IMPLICITLY COVER ABORTION UNDER
"PREGNANCY-RELATED CARE" OR COVER THEM
SUBJECT TO "MEDICAL NECESSITY"
•
HAWAII'S COMPREHENSIVE HEALTH PLAN COVERS
ABORTION AS "CHILDBIRTH OR OTHER
TERMINATION OF PREGNANCY"
•
TEN STATES CURRENTLY RESTRICT COVERAGE OF
ABORTION IN PRIVATE PLANS, TWELVE STATES
ALLOW STATE-ONLY MEDICAID FUNDS TO PAY FOR
.ABORTIONS FOR LOW-INCOME WOMEN
DETER!\11~ED TO BE A~ AD!\'ti~ISTRATIVE
MARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
f\c£
Date: G'-! / o ~
/W U
�DECISION 11
REPRODUCTIVE SERVICES
STATEMENT OF OPTIONS
OPTION 1:
EXPLICITLY INCLUDE ABORTION SERVICES IN
BENEFITS PACKAGE, WITHOUT RESTRICTIONS
OPTION 2:
EXPLICITLY COVER ABORTION, BUT INCLUDE
RESTRICTIONS
OPTION 3:
COVER "REPRODUCTIVE HEALTH SERVICES",
LEAVING INTERPRETATION TO THE STATES
OPTION 4:
EXCLUDE ABORTION FROM THE
COMPREHENSIVE BENEFITS PACKAGE
DETER:\H:"iF.D TO BE AN AD!\UNISTRATIVE
MARI<I\G Per E.O. 129S8 as amended, Sec. 3.3 (c)
Initials:
ACA
Date: Qj /
F
GgI/ 1,0 11
�DECISION 11
. REPRODUCTIVE SERVICES
OPTION 1:
EXPLICIT COVERAGE, NO RESTRICTIONS
PROS:
•
GUARANTEES ALL WOMEN FREEDOM OF
CHOICE
•
FREES STATES FROM PRO-CHOICE/PRO-LIFE
BATrLES AND PREEMPTS STATE LAWS
RESTRICTING ABORTIONS
•
COULD ENCOURAGE OVERUSE OR
INAPPROPRIATE USE
•
WILL MEET WITH SIGNIFICANT OPPOSITION
•
MAKES HEALTH CARE BILL OR NATIONAL
BOARD FOCAL POINT FOR PRO-CHOICE/PROLIFE BATrLES
CONS:
DETERMINED TO BE AN ADMINISTRATIVE
MARKING Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
Date: Oj (6S fa,o11
¥-%
�DECISION 11
. REPRODUCTIVE SERVICES
OPTION 2:
EXPLICIT COVERAGE, WITH
RESTRICTIONS
COVERAGE SUBJECT TO LIMITATIONS, SUCH AS "MEDICALLY
NECESSARY OR APPROPRIATE", PARENTAL CONSENT OR A
WAITING PERIOD.
PROS:
•
RESTRICTIONS BASED ON MEDICAL NEED ARE
CONSISTENT WITH CURRENT COVERAGE UNDER
MANY PRIVATE PLANS
CONS:
•
•
ABORTION COVERAGE AND AVAILABILITY OF
SERVICE COULD VARY BY STATE OR PLAN
LITIGATION OR FEDERAL REGULATIONS COULD
. CLARIFY AND ACHIEVE NATIONAL UNIFORMITY
LMIPRMLEGED A 88NPIBJDPPWJ4-11-83
Df:TER:\fiXED TO BE AX AD:WIXISTRATIVE
\1ARKIXG Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
tkC>
Date:
cY I a~ (am~
�DECISION 11
. REPRODUCTIVE SERVICES
OPTION 3:
IMPLICIT COVERAGE, STATE
INTERPRETATION
FEDERAL LEGISLATION IS SILENT ON ABORTION SERVICES.
STATES OR PLANS DECIDE WHETHER TO COVER ABORTION.
PROS:
•
PERMITS STATE RESTRICTIONS SUCH AS PARENTAL
CONSENT OR WAITING PERIODS THAT ENJOY
PUBLIC SUPPORT AND ARE CONSISTENT WITH PAST
POLICY
•
DEFERS A DIFFICULT POLITICAL DECISION TO THE
STATES
CONS:
•
THREATENS CONCEPT OF NATIONAL BENEFIT
PACKAGE BY ESTABLISHING PRECEDENT FOR
STATES TO INTERPRET COMPONENTS DIFFERENTLY
•
COULD RESULT IN A "NO-WIN" SITUATION
PRO-CHOICE GROUPS ANGERED BY PERCEIVED
LACK OF PRESIDENTIAL LEADERSHIP ON
ABORTION RIGHTS
PROTRACTED CONGRESSIONAL DEBATE ON
ABORTION
•
COULD RESULT IN WIDELY VARIED ACCESS AND
SERVICES ACROSS STATES
1M/PRIVILEGED &~4-11-83
DETER\1I~ED TO BE AN ADMINISTRATIVE
' 1 :.\.RKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
lmt•als:
flc:s
Date:
6Lf jc8J?.a If
�DECISION 11
. REPRODUCTIVE SERVICES
OPTION 4:
EXCLUDE COVERAGE OF ABORTION
SERVICES
PROS:
•
AITEMPTS TO FOCUS DEBATE ON OVERALL HEALTH
REFORM, NOT ON ONE DMSIVE ISSUE
CONS:
•
RESTRICTS ACCESS TO ABORTION FOR ALL WOMEN,
PARTICULARLY POOR WOMEN
•
REDUCES BENEFITS FOR WOMEN FOR WHOM
ABORTION SERVICES ARE CURRENTLY COVERED
•
ANGERS PRO-CHOICE CONSTITUENCIES AND
COMPROMISES SUPPORT FOR PLAN
LMIPRIVILEGED 6 il9NPIBIHI'I'IAII4-11-83
DETER:\11~ED TO BE A~ AD~I~ISTRATIVE
MARKI~G Per £.0. 12958 as amended, Sec. 3.3 (c)
Initials:
Date: O'=f / OS( /')JJ II
4CJ3.,
�Clinton Presidential Records
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indicated below.
Divider Title:
----------------------------
�DECISION 12
CAPS AND OTHER FEDERAL MALPRACTICE RULES
BACKGROUND
SHOULD FEDERAL GOVERNMENT CAP NON-ECONOMIC
DAMAGES AND IMPOSE OTHER UNIFORM RULES FOR
MEDICAL MALPRACTICE CLAIMS?
PHYSICIANS ARGUE THAT THE CURRENT TORT SYSTEM:
•
UNFAIRLY STIGMATIZES PHYSICIANS
•
INCREASES HEALTH COSTS BY STIMULATING
DEFENSIVE MEDICINE
CONSUMER ADVOCATES ARGUE:
•
SEVERELY INJURED PLAINTIFFS RECEIVE TOO
LITTLE COMPENSATION
•
THREAT OF MALPRACTICE SUITS DOES NOT
SIGNIFICANTLY INCREASE HEALTH COSTS
REFORM WILL IMPROVE SYSTEM FOR DISPUTE RESOLUTION:
•
PLANS WILL PROVIDE ALTERNATIVE DISPUTE
RESOLUTION MECHANISMS
•
UNDER "ENTERPRISE LIABILITY," PLANS, NOT
PHYSICIANS, FACE THREAT OF LIABILITY
•
UNIVERSAL COVERAGE OF CATASTROPHIC MEDICAL
EXPENSES MAY LIMIT SUITS SEEKING MEDICAL
EXPENSES
DETER~111\"ED TO BE AN ADMINISTRATIVE
~1ARI<I~G Per £.0. 12958 as amended, Sec. 3.3 (c)
Initials:
Ap'&
Date: oL(
(a W{~ Ofl
�DECISION 12
CAPS AND OTHER FEDERAL MALPRACTICE RULES
BACKGROUND (CONT)
STATE EXPERIENCE WITH CAPS ON NON-ECONOMIC
DAMAGES:
APPROXIMATELY 28 STATES CURRENTLY ENFORCE LIMITS ON
TORT AWARDS, MOSTLY LIMITS ON NON-ECONOMIC
DAMAGES.
SOME STATE COURTS HAVE REJECTED LIMITS ON STATE
CONSTITUTIONAL GROUNDS.
LIMITS VARY WIDELY, FROM A $200,000 NON-ECONOMIC
DAMAGE CAP WITH NO INFLATION INDEX IN CALIFORNIA, TO
MUCH HIGHER CAPS WITH INFLATION INDEX IN OTHER
STATES.
STATE EXPERIENCE WITH OTHER TORT REFORMS:
TWO-THIRDS OF STATES HAVE PROHmiTION AGAINST
DOUBLE RECOVERY FROM COLLATERAL SOURCES.
TWO-THIRDS OF STATES HAVE ENACTED PERIODIC PAYMENT
RULES; SOME ARE MANDATORY, OTHERS VOLUNTARY.
ABOUT HALF OF STATES LIMIT CONTINGENCY FEES; SOME
HAVE SLIDING SCALE BASED ON AMOUNT OF AWARD;
OTHERS HAVE SINGLE UPPER LIMIT.
DETERMINED TO BE AN AD!\11l'iiSTRATIVE
MARKISG Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: A{'?..
Date: 6'{ / G'l> I 'f-.01{
�DECISION 12
CAPS AND OTHER FEDERAL MALPRACTICE RULES
STATEMENT OF OPTIONS
OPTION 1:
CAP NON-ECONOMIC DAMAGES AND IMPOSE
OTHER UNIFORM FEDERAL RULES
OPTION 2:
IMPOSE OTHER UNIFORM FEDERAL RULES
•
•
PERIODIC PAYMENTS OF LARGE AWARDS
•
OPTION 3:
PROHWITIONS AGAINST DOUBLE
RECOVERY FROM COLLATERAL SOURCES
LIMITS ON CONTINGENCY FEES
NO TORT REFORM
LMIPRIVILEOED 6 CONPW&CIWI4-ll-IS
DETERMISED TO BE A~ AD)11~1STRATIVE
MARKI~G Per E.O. 12958 as a~ended, Sec. 3.3 (c)
Initials:
Date: ot:;.fo'K ,/2Pt(
Acrs
�DECISION 12
CAPS AND OTHER FEDERAL MALPRACTICE RULES
OPTION 1:
CAP NON-ECONOMIC DAMAGES AND
IMPOSE OTHER UNIFORM FEDERAL
RULES
A NATIONAL CAP ON NON-ECONOMIC DAMAGES COULD
OPERATE AS A FIXED CAP OR ON A SLIDING SCALE.
PROS:
•
. PROVIDES NATIONAL CONSISTENCY
•
REDUCES OR LIMITS COST OF MALPRACTICE
PREMIUMS
•
WINS STRONG SUPPORT FROM PHYSICIANS
CONS:
•
REDUCES AWARDS TO THOSE MOST SEVERELY
.INJURED
•
LAWYERS MAY BE LESS WILLING TO TAKE
MERITORIOUS CASES
•
MAY RAISE CAP IN SOME STATES
•
TRIAL LAWYERS AND SOME CONSUMER GROUPS
WILL OPPOSE PROVISION
IN ADDITION, THE DISCUSSION OF OPTION 2 (ADDITIONAL
UNIFORM FEDERAL RULES) ALSO APPLIES HERE.
DETF.R:\fJ~F.O TO BE AN ADMINISTRATIVE
:\1,\JUO'G Per E.O. 12958 as amended, Sec. 3.3 (c)
!nilials:
ftC..&
Dutc:
CH fog /a, a 1 (
�DECISION 12
CAPS AND OTHER FEDERAL MALPRACTICE RULES
OPTION 2:
IMPOSE OTHER UNIFORM FEDERAL
RULES
PROHffiiTIONS AGAINST DOUBLE RECOVERY FROM
COLLATERAL SOURCES
PROS:
•
REDUCE TOTAL AMOUNT OF AWARD BY
ELIMINATING COMPENSATION FOR AMOUNTS
ALREADY COVERED BY UNIVERSAL COVERAGE
CONS:
•
LEGAL FEES MAY CUT INTO RECOVERY FOR
ECONOMIC LOSS TO INJURED PLAINTIFFS
PERIODIC PAYMENTS OF LARGE AWARDS
PROS:
•
MAY REDUCE PAYOUTS OF LARGE DAMAGE AWARDS
•
MAY BE MORE EQUITABLE TO BOTH PARTIES
CONS:
•
IF DESIGNED TO REDUCE VALUE OF AWARDS, TRIAL
LAWYERS AND SOME CONSUMERS WILL OPPOSE
DETERMINED TO BE A!'i ADMI!'iiSTRATIVE
MARKING Per E.O. 12958 as amended. Sec. 3.3 (c)
Initials:
f1·US
Date:
0Lf (6 g Igp r(
�DECISION 12
CAPS AND OTHER FEDERAL MALPRACTICE RULES
OPTION 2:
IMPOSE OTHER UNIFORM FEDERAL
RULES (CONT)
LIMITS ON CONTINGENCY FEES
PROS:
•
PROVIDES GREATER SHARE OF AWARD TO INJURED
PARTY
CONS:
•
REDUCES FINANCIAL INCENTIVES FOR LAWYERS TO
BRING MALPRACTICE CLAIMS, EVEN FOR
MERITORIOUS PLAINTIFFS
llF.TF.R:\fJ~ED TO BE AN AD!\11NISTRATIVE
:\1:\RKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: ~>
Date:
O':f
(aa Jgp 11
�Clinton Presidential Records
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marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
13
---------------------------
�DECISION 13
LONG-TERM CARE
BACKGROUND
HOW MUCH SHOULD BE INVESTED IN LONG-TERM CARE?
THERE ARE ABOUT 10 MILLION DISABLED PEOPLE LIVING IN
THE COMMUNITY AND ANOTHER 2 MILLION IN INSTITUTIONS.
PUBLIC ASSISTANCE FOR LONG-TERM CARE IS AVAILABLE
PRIMARILY THROUGH A MEANS-TESTED PROGRAM - MEDICAID.
MEDICAID PAYS DISPROPORTIONATELY FOR INSTITUTIONAL
CARE.
ELIGffiiLITY FOR MEDICAID NURSING HOME COVERAGE
REQillRES THAT PEOPLE EXHAUST MOST OF THEIR
PERSONAL SAVINGS AND ALMOST ALL THEIR MONTHLY
INCOME.
ALTHOUGH MEDICAID OFFERS LIMITED ACCESS TO HOME
AND COMMUNITY-BASED CARE, THIS ACCESS IS HIGHLY
UNEVEN ACROSS STATES.
MEDICAID HAS DISCOURAGED FLEXIBILITY IN THE DESIGN
OF BENEFITS TO MEET THE NEEDS OF DIVERSE DISABLED
POPULATIONS.
DILEMMA IN DESIGNING SOLUTION:
•
LONG-TERM CARE ENTITLEMENT SENIORS AND
WORKING-AGED DISABLED WANT IS VERY COSTLY
•
GROUPS MAY OPPOSE HEALTH REFORM WITHOUT
SIGNIFICANT LONG-TERM CARE COMPONENT
DETERMI~ED TO BE AN ADMI~ISTRATIVE
MARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
ttc..t5
Date:
Oi I a.g I ao l/
._____ _ _ _ _ _ _ _ _ _
--------~-----------------
�DECISION 13
LONG-TERM CARE
STATEMENT OF OPTIONS
OPTION 1:
MEDICAID REFORM THROUGH BLOCK GRANT
OR INCREMENTAL CHANGES TO HOME CARE
AND NURSING HOME SERVICES
OPTION 2:
FEDERAL HOME CARE PROGRAM FOR LOWINCOME SEVERELY DISABLED
OPTION 3:
FEDERAL SOCIAL INSURANCE FOR HOME CARE
FOR SEVERELY DISABLED, REGARDLESS OF
INCOME
OPTION 4:
FULL SOCIAL INSURANCE FOR HOME AND
NURSING HOME CARE, PHASED IN OVER TIME
IJIIPBlVILEGED ~~~· 11-IS
DETERMINED TO BE A~ AD.\11~1STRATI\'E
MARKING Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: 4U3
Date: (? t..f/61? ; 12 01 /
I
�DECISION 13
LONG-TERM CARE
OPTION 1:
INCREMENTAL MEDICAID REFORM
REPLACE MEDICAID WITH:
•
A BLOCK GRANT FOR NURSING HOME AND HOME
CARE, WITH NO STRINGS ATrACHED; OR
•
CAPPED MATCHING GRANTS FOR HOME CARE, AND
. INCREASED ASSET PROTECTION IN NURSING
HOMES
PROMOTE/REGULATE PRIVATE LONG-TERM CARE INSURANCE
•
TAX PREFERENCES
PROS:
BLOCK GRANTS AND CAPPED MATCHING GRANTS:
•
PROVIDES FLEXIBILITY TO PROMOTE HOME CARE
•
LIMIT FEDERAL LIABILITIES
INCREASED ASSET PROTECTION:
•
REDUCES IMPOVERISHMENT IN NURSING HOMES
CONS:
•
STRONG STATE OPPOSITION TO BLOCK GRANTS
UNLESS FUNDS ARE SIGNIFICANTLY EXPANDED
•
FUNDING LIMITS RESTRICT SERVICE
•
MAY BE SEEN AS PERPETUATION OF WELFARE
DETERMINED TO BE AN AD~I~ISTRATIVE
MARKING Per E.O. 129S8 as amended, Sec. 3.3 (c)
Initials: tti.C!.S
Date: 0'--( /G~ /QGI{
�DECISION 13
LONG-TERM CARE
OPTION 2:
FEDERAL HOME CARE PROGRAM FOR
LOW-INCOME
REPLACE MEDICAID WITH FEDERAL HOME CARE PROGRAM
•
FEDERAL FUNDING FOR ALL SEVERELY DISABLED
WITH INCOMES BELOW 100% POVERTY
•
FEDERAL/STATE MATCHING PROGRAM FOR NEARPOOR, LESS SEVERELY DISABLED
TAX EXEMPTIONS TO OFFSET PERSONAL ASSISTANCE COSTS
FOR WORKING-AGE DISABLED
PROS:
•
FEDERAL FUNDING ESTABLISHES HOME CARE IN
ALL STATES AND FREES UP STATE RESOURCES FOR
OTHER PURPOSES
•
TAX EXEMPTIONS ENABLE WORKING-AGED
DISABLED TO ENTER OR REMAIN IN THE WORK
FORCE
CONS:
•
LMIPRIVILEGED
INCOME-TESTED HOME CARE PERCEIVED BY
SENIORS AND DISABLED AS PROGRAM FOR THE
POOR
11:~4-11-83
OETER\11XED TO BE A~ ADMII'<iiSTRATIVE
\1ARKI\G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: 4<!..13
Date:
I0 g 1?. Q l/
ott I
�DECISION 13
LONG-TERM CARE
OPTION 3:
. SOCIAL INSURANCE HOME CARE FOR
ALL SEVERELY DISABLED
FEDERAL PROGRAM TO PROVIDE HOME AND COMMUNITYBASED CARE TO ALL SEVERELY DISABLED, WITHOUT REGARD
TO INCOME
LIMIT PER CAPITA SPENDING
FINANCE THROUGH TAXES AND PREMIUMS (SUBSIDIZED
BASED ON INCOME)
INCLUDE COST-SHARING, WITH INCOME-RELATED SLIDING
SCALE
PROS:
•
•
GUARANTEES HOME CARE IN ALL STATES
· OFFERS COMMITMENT SENIORS AND DISABLED ARE
SEEKING
CONS:
•
ESTABLISHES NEW ENTITLEMENT PROGRAM WITH
SUBSTANTIAL COSTS
•
DOES NOT PROTECT AGAINST NURSING HOME
COSTS
l>ETER\U:\ED TO BE AS ADMINISTRATIVE
.\1:\RKI:\G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
1Ct<
Date:
OL( (0~/Ml{
�DECISION 13
LONG-TERM CARE
OPTION 4:
FULL SOCIAL INSURANCE FOR HOME
AND NURSING HOME CARE, PHASED IN
OVERTIME
ESTABLISH SCHEDULE FOR IMPLEMENTING FULL SOCIAL
INSURANCE IN REFORM LEGISLATION (SEE EXAMPLE BELOW)
MAKE EXPANSIONS AUTOMATIC, ONLY IF NATIONAL BUDGET
IS MET
IF BUDGET NOT MET, SPECIFY THAT CONGRESS REVIEW AND
ADJUST SCHEDULE
PROS:
•
LEGISLATIVE COMMITMENT TO SOCIAL INSURANCE
MAY WIN SUPPORT FROM SENIOR AND DISABLED
GROUPS
CONS:
•
ESTABLISHES NEW ENTITLEMENT AT SIGNIFICANT
EXPENSE
THE FOLLOWING OFFERS ONE POSSffiLE PHASE-IN
SCHEDULE:
1994
ESTABLISH FEDERAL HOME CARE FOR
SEVERELY DISABLED POOR AND RAISE
NURSING HOME RESOURCE PROTECTIONS
(OPTION 2)
UliPRJVILEGED A: OONtWbi'Ritb'4 11-83
DETERMI~ED TO BE A~ AD!\11~1STRATIVE
MARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
¥
f5
Date:
Gc.J r/Q kt/:;20 l{
�DECISION 13
LONG-TERM CARE
OPTION 4:
FULL SOCIAL INSURANCE FOR HOME
AND NURSING HOME CARE, PHASED IN
OVER TIME (CONT)
1997
EXTEND HOME CARE PROGRAM TO INCOMES
UP TO 150% POVERTY
2000
EXTEND HOME CARE PROGRAM TO INCOMES
UP TO 200% POVERTY
COVER FIRST SIX MONTHS IN NURSING HOMES
FOR ALL SEVERELY DISABLED, WITHOUT
REGARD TO INCOME
2005
EXTEND HOME CARE PROGRAM TO INCOMES
UP TO 300% POVERTY
INCREASE NURSING HOME RESOURCE
PROTECTION FOR STAYS BEYOND SIX MONTHS
TO PROTECT FULL ASSETS OF AVERAGE
SENIOR
2010
PROVIDE FULL COVERAGE OF HOME CARE AND
NURSING HOME CARE WITHOUT REGARD TO
INCOME
(ELIGffiiLITY BY DISABILITY LEVEL AND SCOPE OF HOME
CARE BENEFITS COULD ALSO BE MODIFIED OR PHASED IN
OVER THE PERIOD)
UIJPRIVILEGED 6 c:9NPJBBNIIIIIW4-11-9S
DETER:\11NED TO BE AN ADMINISTRATIVE
Per E.O. 12958 as amended, Sec. 3.3 (c)
lnltlall: ,4-CZ
Date: Ol£ I/o}l:/g,_o !(
a
~1ARKI!'iG
�Clinton Presidential Records
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marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
---------------------------
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our
digitization capabilities, we are sometimes unable to adequately
scan such dividers. The title from the original document is
indicated below.
Divider Title:
1-9
----------------------------
�DECISION 19
METHOD OF TRANSITION
STATEMENT OF OPTIONS
BY WHAT METHOD SHOULD THE TRANSITION TO THE NEW
SYSTEM TAKE PLACE?
THE TRANSITION TO UNIVERSAL COVERAGE AND THE NEW
SYSTEM OF HEALTH ALLIANCES COULD PROCEED BY:
•
STATE
•
POPULATION GROUP
•
BENEFIT LEVEL
ALL OPTIONS ASSUME RAPID:
•
INSURANCE REFORM
•
ERISA REFORM
PSIPBlVJJ..EGED • eettPIBIIUW/d/4-11-83
DETERMI~ED TO BE AN AD!\1INISTRATIVE
MARI<I~G Per E.O. 12958 as amended, See. J.J (c)
Initials: ftC!3
Date:
Oi..f /6R/20l(
�DECISION 19
METHOD OF TRANSITION
OPTION 1:
PHASE-IN STATE-BY-STATE
A STATE-BY-STATE PHASE-IN SETS A TARGET DATE FOR
STATES TO INSTITUTE THE NEW SYSTEM FOR ALL ELIGIBLE
CONSUMERS AND ALLOWS STATES A GRACE PERIOD OF ONE
OR MORE YEARS BEFORE ANY PENALTIES ARE IMPOSED.
STATES COULD RECEIVE SUBSIDIES TO ESTABLISH THE
HEALTH ALLIANCES FOR ALL ELIGIBLE CONSUMERS AND
EMPLOYERS AS OF TARGET DATE.
STATES WOULD BE ALLOWED ONE OR MORE YEARS BEFORE
THEY FACE PENALTIES FOR FAILING TO COMPLY.
THE TARGET DATE AND GRACE PERIOD COULD BE ADJUSTED
FOR A RAPID OR SLOW PHASE-IN.
PROS:
•
SETS A NATIONAL GOAL FOR UNIVERSAL
COVERAGE BUT PROVIDES STATES
FLEXIBILITY TO MOVE AT DIFFERENT
SPEEDS
•
FITS THE STATE-BASED STRUCTURE OF
THE ALLIANCES AND BUDGETING SYSTEM
•
STATES THAT IMPLEMENTED LATER
COULD LEARN FROM THE EXPERIENCE OF
FASTER-MOVING STATES
CONS:
•
SOME STATES MAY HOLD BACK FOR FEAR
OF A'ITRACTING UNINSURED AND LOSING
JOBS TO OTHER STATES
DETER~II~ED TO BE A~ AD!\11NISTRATIVE
~1ARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials:
d-C";s
Date:
O'i (of< /r?>P~
�DECISION 19
METHOD OF TRANSITION
OPTION 2:
PHASE-IN BY POPULATION
A PHASE~ IN BY POPULATION GROUP WOULD
SIMULTANEOUSLY EXTEND COVERAGE IN ALL STATES TO
THE SAME GROUPS (FOR EXAMPLE, CHILDREN, EMPLOYEES
OF VARYING FIRM SIZES).
A POSSmLE SCHEDULE WOULD:
•
START WITH CHILDREN
•
APPLY MANDATE TO LARGE, THEN SMALL, FIRMS
•
APPLY INDIVIDUAL MANDATE AND SUBSIDIES FOR
NONWORKERS
•
FOLD IN MEDICAID
PROS:
•
FAST IMPLEMENTATION, WHILE LIMITING
NEAR-TERM FEDERAL BUDGET COSTS
•
MANY UNINSURED GAIN COVERAGE BEFORE
STARTUP OF THE ALLIANCES
•
ADVANCES COVERAGE FOR LOWEST-COST
GROUPS THAT ARE EASIEST TO ABSORB
CONS:
•
DELAYS POOLED PURCHASING THAT
REMEDIES PROBLEMS IN THE SMALLGROUP AND INDIVIDUAL INSURANCE
PS/PBlVILEGED A eeNPID!N'I'b\flll-83
DETERMINED TO BE AN ADMII'iiSTRATIVE
MARKII'iG Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: d('S
Date: Olf /Gt I -:<au
I
�MARKETS
•
INEVITABLE TRANSITIONAL INEQUITIES
DETER.\11\£() TO BE A\ ADMINISTRATIVE
:\1ARKI\G Per E.O. 12958 as amended, See. 3.3 (c)
Initials: A-C3
Date: OL{ /ot /u td
�DECISION 19
METHOD OF TRANSITION
OPI'ION 3:
PHASE-IN BY BENEFIT
ESTABLISH AN INITIAL BENEFIT WITH HIGHER COST
SHARING (UNSUBSIDIZED) AND PERHAPS FEWER BENEFITS
THAN ULTIMATELY DESIRED.
REDUCE COST SHARING AND EXPAND BENEFITS OVER TIME.
PROS:
•
•
PUTS STRUCTURE IN PLACE WHILE REDUCING
INITIAL COSTS FOR GOVERNMENT AND EMPLOYERS
PROVIDES SECURITY TO PEOPLE WHO LOSE
·coVERAGE
CONS:
•
DOES NOT OFFER MUCH TO PEOPLE WHO
MAY NOW HAVE BE'ITER BENEFITS
PS/PRMLEGED ~11-83
DETERMINED TO BE AN ADMINISTRATIVE
.\1ARKI:\G Per E.O. 12958 as amended, Sec. 3.3 (c)
lnitialli: $-C~
Date: OL{ ( C8) 6-6 ({
-
----------
- - - -
�Clinton Presidential Records
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Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
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White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
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1993
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2006-0223-F
Description
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This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
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72 files in 6 boxes
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Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
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William J. Clinton Presidential Library & Museum
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<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
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Title
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Preliminary Health Care Decisions Apr 13 93
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National Economic Council
Gene Sperling
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2006-0223-F
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Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/4212804" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
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William J. Clinton Presidential Library & Museum
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1/8/2015
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42-t-4212804-20060223F-006-007-2015
4212804
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https://clinton.presidentiallibraries.us/files/original/54740df4a709f3430c6b3423535bccb2.pdf
8ba7cf506c9778af71f71d7372b7ed31
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
First Lady's Office
Series/Staff Member:
Maggie Williams; Evan Ryan; Melanne Verveer
Subseries:
Misc. Subject Files
OA/ID Number:
12822
FolderiD:
Folder Title:
American Physicians Lawsuit-HCTF (Health Care Task Force); March 22, 1994
Stack:
Row:
Section:
Shelf:
Position:
s
59
4
7
2
�UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS,
INC. , et al . ,
Plaintiffs,
v.
HILLARY RODHAM CLINTON, et al.,
Defendants.
)
)
)
)
)
)
)
)
)
)
)
)
)
)
Civil Action
No. 93-399
(Judge Lamberth)
.
,
ORDER
This
matter
having
come
before
the
Court
pursuant
to
plaintiffs' Motion for summary Judgment, the court having read and
considered the same along with the memorandum of points and
authorities in support thereof and in opposition thereto and the
exhibits submitted therewith,
and the Court having heard oral
argument, it is
ORDERED that the plaintiffs' Motion for Summary Judgment be,
and the same hereby is, granted, and it is further
ORDERED that judgment be, and the same hereby is, granted in
favor of plaintiffs for the relief sought in. plaintiffs' Second
Amended complaint.
Date ---------------
JUDGE, UNITED STATES DISTRICT COURT
�UNITED STAT&S DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS,
INC., et al.,
)
)
)
)
Plaintiffs,
)
)
)
)
v.
Civil Action
No. 93-399
(Judge Lamberth)
)
HILLARY RODHAM CLINTON, et al., )
)
Defendants.
)
)
)
AFFIQAVIT OF KENT MASTERSON BRQWN
NOW COMES the Affiant, Kent Master·son Brown, Counsel for the
Plaintiffs herein, and after being duly sworn, deposes and says:
1.
This Affiant telephoned counsel for the Defendants, Hon.
Jeffrey
s. Gutman, on February 28, 1994, and informed him that he
would like to take the deposition of the Defendant, IRA MAGAZINER.
This Affiant informed Mr. Gutman that he would like to depose the
said Defendant on March 16, 17 or 18, 1994, or, on any days during
the week thereafter, March 21 through 25.
2.
This Affiant, on February 28, 1994, by fax and first
class mail, forwarded to Mr. Gutman a letter setting forth the
above request.
A true and correct copy of the aforementioned
letter from this Affiant to Hon. Jeffrey
s. Gutman, dated February
·28, 1994, is attached hereto and made a part hereof, and marked,
for
purpo~es
of identification, as Exhibit A.
3. ·· As of this date, this Affiant has never received a
response from Mr. Gutman either by telephone, letter, fax or otherwise.
�Under penalties of perjury, the foregoing statements of the
Affiant are true and correct.
c_ : : =: . :.A-: .-:g~.==-..::~~':L_;}_!:!:::=-~ .
..
.:...;::/
KENT MASTERSON BROWN
Subscribed and sworn to before me
1994.
this~;r~ay
of March,
~~~.~
Na}' Public
My Commission Expires:
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�~<()UI??/ & ~/}4()UHI/,
fJl/.~
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(6'()6'/ .!33-747.9
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February 28, 1994
Mr. Jeffrey s. Gutman
Federal Proqrams Branch
Civil Division
u.s. Department of Justice
Washinqton, D.C. 20530
RE:
AAPS
v.
Clinton
Dear Mr. Gutman:
Please be advised that I wish to take the deposition of Ira
Maqaziner.
As we are under an expedited discovery schedule--and I would
like to move this case alonq--I would like to take the deposition
on March 16, 17 or 18, 1994, or on any of the days durinq the week
thereafter (March 21 throuqh 25).
·
Obviously, we would need to schedule more than one day.
Please advise.
tc;~·---.4
KENT MASTERSON BROWN
KMB/jp
cc:
Frank Northam
..
.......................
EXHIBIT A
�DECLARATION OF GENEVIEVE M. YOUNG
I, Genevieve M. Young ("Declarant"), do come forth and say:
1.
That Declarant has personally reviewed every non-privileged document and was .,
neither given access to nor reviewed any material subject to the Protective Order produced by
defendants through their attorneys in the matter of Association of American Physicians and
Sur&eons et al., y. Hillary Rodham Clinton et al., Civ. No. 93-399 (D.D.C.).
2.
That Declarant has attempted to independently verify the employment status of
every identified member of the Interdepartmental Working Group, and every Cluster Group,
Working Group, and Subgroup thereof, of the President's Task Force on National Health Care
Reform.
3. . That in conducting these verification activities, Declarant was unable to locate
independent evidence establishing that each and every member of the Interdepartmental Woiidng
Group, and every Cluster Group, Working Group, and Subgroup thereof, was a federal
government employee as represented to the plaintiffs by the defendants, and that independent
evidence contradicted defendants' claims that each and every member of the above groups was
a federal employee, full-time or part-time, or a special government employee, or consultant in
accordance with the governing federal law, 5 USC App. §§ 1-14.
4.
In order to verify the employment status of each and every member of the
Interdepartmental Working Group, and every Cluster Group, Working Group, and Subgroup
thereof was indeed a Congressional employee as averred by the defendants, Declarant consulted
1993 ConKiessional Staff Directocy (Vol. 1) (ed. Brownson, A.), the title page of which is
attached as Exhibit 1. Searching the Congressional Directory revealed that although defendants
represented that the following were full-time government employees ("FTE's") employed as
members of the Congressional staff, their names did not appear in this directory:
Altman, David
Baily, Sarah
Clark, William
Davies, Monica
Eckart, Kevin ··
Sen.
Sen.
Sen.
Sen.
Sen.
Jay Rockefeller (D-WV) ·
Donald Riegle (D-MI) 1
Dale Bumpers (D-AR)
Bingaman (D-NM)
Wofford (D-PA)
1
Pursuant to a telephone call made by Declarant on January 27,
1994, at 18:58 a.m., the Office of Sen. Rieqle stated it had "never
heard of her."
1
�Goldstein, Elaina
Gust, Steven
Miller, Melanie
Powell, Keith
Rickel, Annette
Sandler, David
Schuster, James
Sochalski, Julie
House Select Committee on Agingl
Sen. Wefistone (D-MN)l
Rep. Andrews (D-TX)
Sen. Labor and Human Resources Comm.
Sen. Riegle (D-Mit
Sen. Akaka (D-HI)
Rep. Strickland (D-OH)'
Sen. Bradley (D-NJ)
Because the aforementioned source is considered authoritative, Declarant's conclusion was that
the above were not full-time government employees serving as Congressional staff, paid by
public monies.
S.
That Declarant personally traveled to The Foundation Center, an independent,
nonprofit organization established by foundations to provide information for the public, described
in its own .published and public brochure, attached hereto as Exhibit 2, and discovered
documents naming Task Force members as grantees of private, not-for-profit foundations. For
example, the published and public brochure entitled, "Directory: Robert Wood Johnson H~th
Policy Fellowships 1974-1993," attached hereto as Exhibit 3 states that the for the period
December 1992 to August 1993, the following individuals, all listed as FTE's by defendants,
with the exception of Arnold Epstein, who was listed as a Special Government Employee
("SGE"), were Robert Wood Johnson Foundation Fellows:
David F. Altman, MD
According to Rep. Hughes office, confirmed by telephone on
January 27, 1994 with Declarant, the House Select Committee on
Aging lost its appropriations as of March 31, 1993. Ms. Goldstein
began working on the Health Care Task Force at that time. Richard
Veloz was formerly the Staff Director of the House Select Committee
on Aging, and began working for the Task Force in February 1993.
Declarations of Marjorie Tarmey, Richard Veloz SF278. According to
Rep. Hughes' office, Ms. Goldstein now works for Sen. Jeffords (RVT), distinguished as the only Senate Republican co-sponsor of the
Clinton Plan.
2
In Task Force documents, Steve Gust is listed as being an FTE
from NIH, from Rep. Strickland's office, and from Sen. Wellstone's
office.
3
•According to telephone conversation with Declarant on January
27, 1994, Sen. Riegle's office never heard of her.
•According to telephone conversation on January 27, 1994 with
Declarant, James Schuster was a law student from George Washington
Universit~ when
he served on the Task Force through this
congressional office.
2
�Center for the Health Professions
University of California, San Francisco, School of Medicine
Office of Senator John D. Rockefeller IV, D-WV
William B. Clark, DDS, DMS
Professor of Oral Biology and Director
Periodontal Disease Research Center
University of Florida College of Dentistry
Office of Senator Dale Bumpers, D-AR
J. Kevin Eckart, PhD
Professor, Sociology, Anthropology, and Policy Studies
Associate Dean, Arts and Sciences
University of Maryland - Baltimore County
Office of Senator Harris Wofford, D-PA
Arnold M. Epstein, MD, MA
Associate Professor of Medicine and Health Care Policy
Harvard Medical School
Office of Senator Edward Kennedy, D-MA
Committee on Labor and Human Resources
Co-Chair, Quality of Care Committee
White House Interagency Task Force on Health Care Reform
Keith R. Powell, MD
Professor and Associate Chair for Clinical Affairs
Department of Pediatrics
Chief, Division of Infectious Diseases
University of Rochester Medical Center
Office of Senator Edward Kennedy, D-MA
Committee on Labor and Human Resources
Julie Sochalski, PhD
Assistant Professor
School of Nursing
College of Physicians and Surgeons
Columbia University
Office of Senator Bill Bradley, D-NJ
6.
That Declarant reviewed the published and public 1992 Annual Report of the
Robert Wood Johnson Foundation, attached hereto as Exhibit 4, and obtained from the files of
The Foundation Center, the Robert Wood Johnson Foundation IRS Form 990-PF 1992, attached
hereto as Bxl:libit S, which publicly discloses the investments and holdings of the $4 billion
3
�dollars in assets owned by the Robert Wood Johnson Foundation. The Foundation invests nearly
$3.5 billion in stocks. The Foundation in 1992 owned approximately 45,491,400 shares of
Johnson & Johnson stock, accounting for approximately $2,297,315,700.00 of its total holdings.
See Monthly Equity Portfolio Report, Page 3 of 3, IRS FORM 990PF. Many health care stocks
such as Humana, Inc. (IRS FORM 990-PF 1992, Part IV, Line 1, page 1), Merck & Co., Inc.
(IRS FORM 990-PF 1992, Part IV, Line 1, page 4), Unilab Corporation (IRS FORM 990-PF ,
1992, Part IV, Line 2, page 44), Chemical Waste Management (id.), U.S. Bioscience (id.), ·.
Bristol-Myers (id. at 48), are also listed as investments.
'
7.
That Declarant reviewed the published and public News Release dated May 12,
1993 entitled "Public cautious About Giving States Flexibility in Health Reform," from the
Henry J. Kaiser Family Foundation files at the Foundation Center, attached hereto as Exhibit
6.
8.
That Declarant reviewed the published and public News Release dated March 23,
1993, entitled, "Strong Public Support For Potential Elements of the Clinton Health Reform
Plan" and the accompanying poll, attached hereto as Exhibit 7, from Henry J. Kaiser Family
Foundation files at the Foundation Center.
9.
That Declarant reviewed the published and public brochure attached hereto as
Exhibit 8, entitled, "can for Proposals: State Initiatives in Health Care Reform, State Initiatives
in Long Term Care" located the files on the Robert Wood Johnson Foundation at the Foundation
Center.
10.
That Declarant copied the published and public Robert Wood Johnson Foundation
Newsletter, Advances, dated Summer 1993, attached hereto as Exhibit 9, from the files at the
Foundation Center.
11.
That Declarant copied the published and public 1992 Annual Report of the Henry
J. Kaiser Family Foundation, attached hereto as Exhibit 10, from files at the Foundation Center.
12.
That Declarant copied the public and public Robert Wood Johnson Foundation
brochure entitled, "can for Proposals: Changes in Health Care Financing and Organization
1993," attached hereto as Exhibit 11, from files at the Foundation Center.
13.
That Declarant copied the public and published Robert Wood Johnson FoundationHenry J. Kaiser Family Foundation program brochure, attached hereto as Exhibit 12, entitled,
"can for Proposals: Opening Doors: A Program To Reduce Sociocultural Barriers to Health
Care," from files at the Foundation Center.
14.
That Declarant copied the published and public Robert Wood Johnson Foundation
brochure entitled, "Call for Nominations: Robert Wood Johnson Health Policy Fellowships
1994," attached hereto as Exhibit 13, from files at the Foundation Center.
4
�15.
That Declarant researched, read and copied the GrantWatch Section from the
published and public Summer 1993 edition of Health Affairs, attached hereto as Exhibit 14,
which included an essay by Dennis F. Beatrice, Vice President of the Henry J. Kaiser Family
Foundation, entitled, "The Role of Philanthropy in Health Care Reform," at the Foundation
Center.
.,
16.
That Declarant reviewed the Henry J. Kaiser Family Foundation files at' the ·
Foundation Center and copied the published and public news release dated January 31, 1994,
entitled, "Straight Facts on Health Reform," at the Foundation Center, attached as Exhibit IS.
17~
That Declarant read and copied from the published and public newspaper, IG
Washin~on Times, two editorials, dated 2/14/94 and 2/28/94, along with the Letter to the Editor
from Becky Cain, President, League of Women Voters Education Fund, dated 2/28/94, attached
hereto as Exhibit 16.
18.. · That Declarant read and copied from the public and published newspaper, IG
Washin• Post, the column entitled "The Patient's Advocate," dated 1217/93, 12114/93, 12/2128/93, 2/1/94, 2/8/94, and 2115/94, attached as Exhibit 17.
19.
That Declarant obtained on May 6, 1993, from the Offices of The Honorable
Robert Dole, Senate Republican Leader, the letter dated March 15, 1993, from Senator Dole and
Representative Michel, to Steven Schroeder, President of the Robert Wood Johnson Foundation,
attached hereto as a true copy as Exhibit 18.
20.
That Declarant obtained on May 6, 1993, from the Offices of The Honorable
Robert Dole, Senate Republican Leader, the letter dated March 16, 1993, to Senator Dole and
Representative Michel, from Steven Schroeder, President of the Robert Wood Johnson
Foundation, attached hereto as a true copy as Exhibit 19.
21.
That Declarant copied the published and public Spring 1993 Advances, the
newsletter of the Robert Wood Johnson Foundation at the Founda~on Center (attached hereto as
Exhibit 20).
22.
That Declarant copied from the published and public Summer 1993 Health Affairs,
the pages attached hereto as Exhibit 21, listing the editorial board, from the Foundation Center.
23.
That Declarant copied from the published and public Spring 1993 Health Affairs,
the pages attached hereto as Exhibit 22, listing the articles and editorial board, from the
Foundation Center.
24.
That Declarant copied from the published and public Wall Street Journal on
February 28, 1994, the announcement relating to the published and public Spring (I) 1994 edition
of Health Affairs and copied the cover page of that edition from the Foundation Center, attached
hereto as Exhibit 23.
5
�25.
That Declarant copied the published and public News Release dated March 30,
1993, announcing that Mark Smith was named Executive Vice President of the Kaiser Family
Foundation, from the files at the Foundation Center (attached hereto as Exhibit 24).
26.
That Declarant copied the published and public News Release dated May 13, 1993,
announcing that Diane Rowland was named Senior Vice President of the Kaiser Family ,
Foundation, attached hereto as Exhibit 2S, from the files at the Foundation Center.
'
27.
That the Declarant obtained from the office of Rep. Robert livingston a copy of
President William J. Clinton's Public Financial Disclosure Form SF 278, filed May 14, 1993,
attached hereto as Exhibit 26. According the Form's instructions, Schedule A appended to the
form must reflect the value of the assets in the calendar year preceding and the ~t calendar
year up to the date of filing, using any date within 31 days of the date of filing. Thus, the
President's and the First Lady's form should reflect the value of their holdings during calendar
year 1992, .W up to May 14, 1993, on any date between Apri112 and May 14, 1993.
•.
The President and the First Lady had about $100,000 invested as limited partners in
Valuepartners I, managed by Smith Capital Management in Little Rock, Arkansas. Many of the
investments were health care stocks. The list of stocks appended to Schedule A of the
President's SF 278 is list of the stocks held by Smith Capital Management as of December 1992.
The form is not technically correct, then, as the form does not say exactly what the President
and the First Lady were invested in during calendar year 1992 and as of Apri113, 1993 at the
earliest. There is only a snapshot of how the monies were invested. The Clintons were running
the Presidential campaign all throughout 1992 with a focus on health care reform, they had a
Health Care Policy Transition Team from at least November 4, 1992 to January 21, 1993~ and
it should be noted that the President's Task Force on National Health Care Reform, .chaired by
the First Lady, formally began on January 21, 1993, and its cbarter expired May 30, 1993.
United Health Care is the only H.M.O. stock listed in which a "long• position was held,
according to the President's SF278 and the form dated December 1992. An exact list of the
stocks in which the fund invested in the first quarter of 1993 bas not been made publicly
available.
Mr. Smith told The Wall Street Journal on March 11, 1994, that in the first quarter of
1993, the Clintons were invested "long" on two health maintenance organizations. See Exhibit
27. The New York Times reported on Wednesday, December 29, 1993, that "H.M.O.'s had
'the highest overall profit gains' in the first quarter of 1993. • See Exhibit 28.
28.
That Declarant has knowledge that Lois Quam, Working Group Leader for Groups
2 (Managed Care/Toward & Beyond) and 18 (Accelerating New System Development), had the
corporate tide of Vice President of United Health Care during the time worked on the Task
Force. Declarations of Marjorie Tarmey, Documents Nos. 7, 11.
29.
Cfhat Declarant has knowledge that in the time when Mrs. Clinton chaired the Task
6
�Force, an officer of a corporation in which she was invested played a key role on the Task
Force, and a corporate employee of the another corporation in which she was invested played
a key role.
The December 1992 list shows many health care stocks in which a long position was held,
including Columbia Hospital, Grancare, Health Care and Retirement, Lincare, National ·,
Rehabilitation Centers, and Phycor, Inc. Thus, a full range of companies- whose products ·
were being considered for inclusion in the benefits package- was represented by Valuepartners
I. "Short" positions were held in Bioplasty, Inc., Cryomedical Sciences, HealthPro, and
Kentucky Life.
30.
That the Declarant reviewed the dramatic effect that political rhetoric and policymaking can have on the stock market, documented by The Catalyst Institute in study called,
Political Rhetoric and Stock Price Yolatilizy: A Case Study by Craig S. Pirrong, University of
Michigan. See Exhibit 29. In broad terms, the outcome of the study was that between January
1, 1993 and· September 9, 1993, stock prices for selected pharmaceutical companies fell over
27% relative to the rest of the stock market, resulting in $67 billion in losses for investors in
these stocks.
31.
That the Declarant personally dialed the phone numbers that appeared on sign-in
lists and telephone lists of Working Group members, and thereby identified the organizations by
which the following individuals were employed. Pages from the relevant local telephone
directories are appended as Exhibit 30.
32.
That the Declarant fmds, based on a review of the documents, the following facts
concerning the leadership and composition of the Ouster Groups and Working Groups:
Cluster Group I - New System Organization
Cluster Group I, and its Working Groups (1, lA, 2, 3, 4, and 5), are led by
individuals from the private sector. Cluster Group l's leacler is Walter Zelman,
Chairman of the Health Care Advisory Commission, from the California
Department of Insurance (Declarations of Marjorie Tarmey, Documents Nos. 864868), headed by Insurance Commissioner John Garamendi.6 Rick Kronick,
Working Group 1's leader, is from the University of California School of Public
Health, and also works as a Senior Policy Analyst for RAND. Declarations of
Marjorie Tarmey SF278 Richard Kronick. Group lA 's leader is Robert Berenson,
M.D., the President of National Capital Preferred Provider Organization, a
managed care entity. Declarations of Marjorie Tarmey, SF278 Robert Berenson.
Working Group 2 was led by Lois Quam, Vice President of United Health Care
•John Garamendi 's name and telephone number appear on the
telephone list produced 1 Declarations of Marjorie Tarmey 1 Documents
Nos. 1680-1692.
7
�Corporation, one of the largest publicly-traded managed care companies in the
United States. Declarations of Marjoiie Tanney, SF278 Lois Quam. Group 3
was led by Richard Curtis, President, Institute for Health Policy Solutions, a
health policy consulting group in Washington, DC that performed a study starting
in October 1992 of the so-called "Garamendi Plan, • named after Insurance
Commissioner of California, John Garamendi. 7 His organization also performed
studies with grant money from the Robert Wood Johnson Foundation and the
Hartford Foundation in the same period of time. Declarations of Marjorie
Tanney, SF278 Richard Curtis. Group 4 was led by Lany Levitt, a staff
member from the California Department of Insurance, Commissioner's Health
•
Care Advisory Commission. Declarations of Matjorie Tanney, SF278 Lawrence
Levitt. In other words, he also worked with Zelman and Garamendi and possibly
consulted with Curtis. prior to being a part of the Task Force. The leader of
Working Group 5 was Gary Claxton, from the National Association of Insurance
Co•ssioners (Declarations of Marjorie Tanney, SF278 Gary Claxton), who
undoubtedly knew from his professional life all the other leaders of the Working
Groups in Cluster I.
Cluster Group II - New System Coverage
The nominal leader of Cluster II is Atul Gawande, Department of Health and
Human Services, but he appears only to the nominal head, as all the lists of
Cluster Group II members begin with Diane Rowland's name. Declarations of
Marjorie Tanney, Documents Nos. 180, 1525). Even many of the sign-in lists
for Cluster Group II begin with Diane Rowland's name at the top (Declarations
of Marjorie Tanney, Documents Nos. 30117, 30098), possibly indicating also that
she is the Cluster Group Leader. Diane Rowland is currently Senior Vice
President of the Henry J. Kaiser Family Foundation (See News Release, dated
May 13, 1993, attached as Exhibit 25), and while she was on the Task Force,
was the head of the Kaiser Commission on the Future of Medicaid at Johns
Hopkins University (see id.), a program which received $1.3 million dollars from
the Henry J. Kaiser Family Foundation in 1992. See 1992 Annual Report of the
Henry J. Kaiser Family Foundation. Another prominent member of Cluster II
was David Eddy, a Senior Policy Advisor to Kaiser Permanente (Declarations of
Matjorie Tanney, Documents Nos. 864-869), a not-for-profit managed care
company.
Working Group 6 of Cluster Group II was led by Linda Bergthold, an employee
benefits consultant to W.H. Mercer, Inc., an employee benefits consulting firm
in San Francisco, California. Declarations of Marjorie Tanney, SF278 Linda
7
14,
FOr an explanation of the Garamendi Plan, see Forbes, March
attached hereto as Exhibit 31.
~·~94,
8
\
�Bergthold. The co-leaders of Group 8 were also both from the private sector,
Shoshanna Sofaer, from George Washington University Medical Center, and Rick
Brown, from University of California School of Public Health. Declarations of
Marjorie Tanney, Documents Nos. 176, 178.
Cluster Group III - New System Infrastructure
The Cluster Leader, or Chair, of Cluster Group III was Thomas Pyle, from the
Boston Consulting Group and the Harvard Community Health Plan. Declarations
of Marjorie Tarmey, Documents Nos. 864-869. Harvard Community Health
Plan received well over $1 million dollars in 1992 from the Robert Wood Johnson
Foundation. See 1992 Annual Report of the Robert Wood Johnson Foundation.
Working Group 9 was led by Arnold Epstein, M.D., a Robert Wood Johnson
Fellow working in Sen. Kennedy's office, sponsored by Harvard Medical School.
Members of Group 9 included Thomas Chapman, a Program Director for the
Robert Wood Johnson Foundation program, "Opening Doors, • David and Judy
Eddy of Duke University (Reference to David Eddy, SJ.Qml), David Jackson, the
CEO of Assurqual, a quality assurance consulting firm in Ohio (Declarations of
Marjorie Tarmey, Documents Nos. 864-869), and David Satcher, a pediatrician
from Memphis, Tennessee, and the President of Meharry Medical College, a
recipient of Robert Wood Johnson funds in 1992.
Working Group 10 was led by David Eddy, who, as noted, is a Senior Policy
Advisor to Kaiser Permanente, and a professor of Health Policy and Management
at Duke University. Working Group 10 members appear to have met with many
private sector representatives, including individuals from Travelers (Declarations
of Marjorie Tanney, Documents Nos. 30094, 30122), the Cooperative Health
Care Network (id.), and PCS Health Systems, among others (id.). 1n addition,
it appears that Mike McDonald, an employee of Communications and Computer
Applications in Public Health ("CCAPH•), wrote a memorandum to Task Force
member Shannah Koss, a federal employee, to arrange the time, place, and
participants of a Working Group meeting at the White House. Declarations of
Marjorie Tarmey, Documents Nos. 1232, 1233, 1231, 1284, 1283, and 3008630088). Other private sector participants in that meeting, which apparently was
arranged by CCAPH, a possible federal government contractor for health
information systems, and very likely, a State of California government contractor
for California's health information systems, included Warner Slack, Director
Harvard Center for Clinical Computing (another possible contractor), Steven
Locke, Director, Harvard Center for Psychiatric Computing, C. Everett Koop,
and others.
The leader for Working Group 11, on malpractice reform, was Robert Berenson,
M.D., 'President, National Capital Preferred Provider Organization. Declarations
9
�of Marjorie Tanney, SF278 Robert Berenson. On White House stationery, he and
his co-chair, Kathleen Hastings, an HHS employee, invited a select group of
about 25 individuals to a meeting to discuss malpractice reform. Declarations of
Marjorie Tanney, Documents Nos. 1330, 1331, 30026. The participants were all
from the private sector, from places such as The Urban Institute, Duke
University, Alice Gosfield, a health lawyer in private practice in Philadephia, and
the President of a Risk Management Foundation, Harvard Medical Institution.
Cluster Group V, Working Group 17- Bioethics or Ethical Foundations of the New System
Cluster Group V was composed entirely of members from the private sector,
including individuals recommended by Rep. Daniel Rostenkowski (D-IL)
(Declarations of Marjorie Tarmey, Documents Nos. 463, 464), and by Thomas
Pyle (see id.).
Cluster Group VI - Transition to the New System
Cluster VI met as early as February 10, 1993, according to one sign-in sheet.
Declarations of Marjorie Tarmey, Document No. 30052. Paul Starr, a professor
from Princeton University, was the Cluster Leader. Declarations of Marjorie
Tarmey, Document No. 1763. Group 18 was led by Lois Quam, Vice President
of United Health Care. Declarations of Marjorie Tanney, Documents Nos. 1760.
Others from the State of Minnesota were Ellen Benavides, Dan McLaughlin, both
affiliated with the Hennepin County Medical Center, Minnesota Bureau of Health,
and Mary Jo O'Brien, Chair of the Minnesota Health Care Commission, who,
according to Task Force documents, was representing the Governor of Minnesota
(1786-1787).
Group 19, Administrative Simplification, was composed of a number of private
sector individuals. Two were from Telesis, a consulting group that specializes in
consulting for government on public policy issues (Boston Globe, Nov. 24,
1992), which according to Rhode Island Corporate Records, is an entity whose
President is Ira Magaziner, a member of the Task Force, and it merged in 1986
with Towers Perrin, a financial consulting group which served on Group 34.
Declaration of Marjorie Tarmey, List, Administrative Simplification. This group
even held a so-called "Vendor Meeting" at HHS on March 31, 1993, which
included representatives from United Health Care, Humana, Kaiser, AT&T,
Hewlett Packard, and other potential government contractors under the Clinton
plan for managed care and uniform data systems. Declarations of Marjorie
Tanney, Documents Nos. 1287-1308, 30025, 30027, 30028, and 30070-30073.
Group 20 was the group responsible for developing the price controls in the
Clinton Plan, and Karen Davis, a Vice President of the Commonwealth Fund, and
at the 'time when she was on the Task Force was also a member of the
10
·,
�Congressionally-appointed Physician Payment Review Commission, which reports
to Congress on the Medicare Fee Schedule's impact on physician services (a form
of price controls) was a member of this Working Group. Declarations of
Marjorie Tanney, Documents Nos. 484, 30100; List of PPRC Members, PPRC
Annual Report 1993, as Exhibit 32).1 Philip Lee, now the Assistant Secretary
of HHS, who was on the Robert Wood Johnson Board of Directors in 1992, was
in this Working Group, as well as Alain Enthoven, and Uwe Reinhardt. James
Ucockis of the Treasury Department placed a note on a sign-in list that he was
involved in the Nixon/Carter price controls. Declarations of Marjorie Tarmey,
Documents Nos. 30052.
Cluster VIU - Health Policy Initiatives for the Underserved
Mark Smith, Vice President of the Henry J. Kaiser Family Foundation, was the
Group 22 Leader, and while he served on the Task Force, was promoted to
Executive Vice President of the Kaiser Family Foundation. News Release dated
March 30, 1993, attached as Exhibit 24. Non-federal employees on Cluster VIII,
also known as Working Group 22 included Joycelyn Elders, then an employee at·
the ArkanSJJS Department of Health, Diane Rowland, and Kristin Gebbie,
subsequently appointed the Clinton Administration's" AIDS czar." Group 22 and
its four subgroups had extensive contacts with outside participants. Bob Hattoy,
known for his speech on AIDS at the Democratic National Committee's
Convention in 1992,· now a White House Special Assistant, invited 21 members
of the private sector to meet at the White House with Mark Smith and Carol
Rasco of the Task Force (Declarations of Marjorie Tarmey, Documents Nos.
1234-1239), and others member of the Task Force. The other subgroups, notably
the Group· on Women and Children, were mainly composed of private sector
representatives.
Cluster XII - Quantitative Analysis
Cluster XII, Working Group 32, Quantitative Analysis was dominated by wellknown private sector think tanks, such A~ Research Corporation,
Mathematica Policy Research, Lewin-ICF or Lewin Associates, RAND, The
Urban Institute, and the Brookings Institution.
Cluster XIII - Legal Audit
This entire group was drawn from the private sector.
•other members of the PPRC who were also on the Task Force are
Linda Aiken, Karen Davis, Philip Lee, and Uwe Reinhardt.
Declaration of Genevieve M. Young, attached hereto as Exhibit 32.
11
�Cluster XIV - Numbers Audit
This entire group was drawn from the private sector.
Working Group 36 - Disability Cross-Cutting Group
This group is led by Simi Litvak, of the World Institute on Disability.
Working Group 39 - Minority Issues Review Group
This entire group was drawn from the private sector.
Working Group 40 - Academic Health Centers Group
Of the 14 members, only five are federal employees. On Aprill4, 27 individuals
with. academic positions at medical schools met with Ira Magaziner. Declarations
of Marjorie Tarmey, Documents Nos. 1242-1244.
Working Group 41 - Workers' Compensation
Group 41 was led by Gary Claxton from the private sector, and met mainly with
private sector representatives.
33.
That Declarant obtained on September 8, 1993, a copy of the published and public
document entitled, "WORKING GROUP DRAFT PRIVILEGED AND CONFIDENTIAL, •
dated 9/7/93, attached hereto as Exhibit 33, and it is the work product of the President's Task
Force on National Health Care Reform, its Interdepartmental Working Group, Cluster Groups,
Working Group and Subgroup thereof.
.
.
34.
That Declarant obtained from University of Minnesota medical student David Hartsuch
the agenda for "Health Care Summit '93: National Proposals, Minnesota Perspectives, • attached
hereto as Exhibit 34.
I declare under penalty of perjury that the foregoing is true and correct. Executed on March 22,
1994.
~~~
Genevieve M. Y~
12
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
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72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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American Physicians Lawsuit HCTF (Health Care Task Force); March 22, 1994
Creator
An entity primarily responsible for making the resource
First Lady's Office
Maggie Williams
Evan Ryan
Melanne Verveer
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Reproduction-Reference
Date Created
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1/8/2015
Source
A related resource from which the described resource is derived
42-t-2194630-20060223F-006-006-2015
2194630
-
https://clinton.presidentiallibraries.us/files/original/d3713c530cdf95c1887363d89d203ae2.pdf
6ca9f84d782b530c4ae203f15d33dd3f
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
First Lady's Office
Series/Staff Member:
Maggie Williams; Evan Ryan; Melanne Verveer
Subseries:
Misc. Subject Files
OA/ID Number:
12822
FolderiD:
Folder Title:
American Physicians Lawsuit-HCTF (Health Care Task Force); March 3, 1994
Stack:
Row:
Section:
Shelf:
Position:
s
59
4
7
2
�UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.,
AMERICAN COUNCIL FOR HEALTH
CARE REFORM AND NATIONAL
LEGAL & POLICY CENTER,
Plaintiffs,
v.
)
)
)
)
)
)
Civil Action
No. 93-399
)
)
(Judge Lamberth)
)
)
HILLARY RODHAM CLINTON,
DONNA E. SHALALA, Secretary of
Health and Human Services,
LLOYD E. BENTSEN, Secretary of
the Treasury, LES ASPIN,
Secretary of Defense, JESSE
BROWN, Secretary of Veterans
Affairs, RONALD H. BROWN,
Secretary of Commerce, ROBERT
B. REICH, Secretary of Labor,
LEON E. PANETTA, Director of
the Office of Management and
Budget, ALICE RIVLIN, Deputy
Director of the Office of
Management and Budget, CAROL
RASCO, IRA MAGAZINER and
JUDITH FEDER, White House
Advisors, THE PRESIDENT'S
TASK FORCE ON NATIONAL
HEALTH CARE REFORM, the
INTERDEPARTMENTAL WORKING
GROUP OF THE PRESIDENT'S TASK
FORCE ON NATIONAL HEALTH CARE
REFORM, and its CLUSTER GROUPS,
WORKING GROUPS and SUBGROUPS,
et al.,
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)·
)
)
)
)
)
)
)
)
)
)
Defendants.
)
)
)
liO'l'ION FOR SUIIJIARY JUDGIIBN'P AND
PBRIIAN~
INJUNC'.riON
ORAL IIEARING REQUESTED
Plaintiffs, by counsel, hereby move this Honorable Court,
pursuant to Rules 56 (a) and 65 of the Federal Rules of Civil
1
�Procedure, for an Order directing entry of summary judgment and a
permanent injunction in favor of the Plaintiffs and against the
Defendants on the cause of action and for the relief sought in
Plaintiffs' Verified Second Amended and Substituted Complaint for ·,
Declaratory Judgment and Restraining Order and Preliminary and
Permanent Injunctive Relief.
This Motion is made on the ground that no genuine issue of
material fact exists, and Plaintiffs are entitled to Judgment and
a Permanent Injunction as a matter of law that the Defendants,
INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM, ITS CLUSTER GROUPS, WORKING GROUPS and
its SUBGROUPS; namely, Cluster Group I, "New System Organization",
and Working Group 1,
Cooperatives";
Providers";
"Principles and Operation of Purchasing
Working Group 1A,
Working Group
2,
"Health Plans,· Patients
"Managed care/Toward
&
and
Beyond";
Working Group 3, "Governance"; Working Group 4, "A Global Budget",
and Working Group 5, "Insurance Reform"; Cluster Group II, "New
System Coverage", and Working Group 6, "Benefits Package"; Working
Group
7,
"Coverage
for
Working
Families"; · Working
Group
8,
"Coverage for Low Income and Non-Working Families"; Cluster Group
III, "New System Infrastructure", and Working Group 9, "Quality
Measurement"; Working Group 10,
"Information Systems"; Working
Group 111 "Malpractice and Tort Reform" 1 and Working Group 12,
"Facilitating
Professional
Development";
Cluster
Group
"Integration of Government Programs Into the New System",
IV,
and
Working Group 13, ."Medicare"; Working Group 14, "Department of
2
�Defense"; Working Group 15, "Veterans"; Working Group 16, "Federal
Employees'
Health Benefits
Government Programs";
Plan";
Working
Cluster Group V,
Group
16A,
"Other
"Bioethics or Ethical
Foundations of the New System", and Working Group 17,
"Bioethic~";
Cluster Group VI, "Transition to the New System, Short-Term Cost
Controls",
and
Working
Group
18,
"Accelerating
New
System
Development"; Working Group 19, "Administrative Simplification";
Working Group 20, "Interim Cost Controls"; Cluster Group VII,
"Financing", and Working Group 21, "Financing"; Cluster Group VIII,
"Health Policy Initiatives for the Underserved", and Working Group
22, "Health Policy Initiatives for the Underserved", and Subqroup
A,
"Underserved
·"Vulnerable/High
Rural
Risk
and
Inner
Populations";
City
Areas";
Subgroup
c,
Subgroup
B,
"Women
and
Children", and Subgroup D, "Population-Based Public Health and
Prevention"; Cluster Group IX, "Mental Health", and Working Group
23, "Mental Health Benefits Package"; Working Group 24, "Substance
Abuse"; Working Group 25, "Children's Services"; Working Group 26,
"Public System Impact/Special Populations"; Cluster Group X, "Long
Term Care", and Working Group 27, "Long Term Care-Background";
Working Group 28, "Long Term Care-Public Options"; Working Group
29, "Long Term Care-Private Options"; Working Group 30, "Cost and
Revenue"; Cluster Group XI, "Economic Impact", and Working Group
31, "Economic Impact"; Cluster Group XII, "Quantitative Analysis";
and Working Group 32, "Quantitative Analysis"; Cluster Group XIII,
"Legal Audit", and Working Group 33, "Legal Audit"; Cluster Group
XIV,
"Numbers Audit",
and Working Group 34,
3
"Numbers Audit";
�Cluster Group XV, "The Drafting Group", and Working Group 35, "The
Drafting Group", and Working Group 36, "Disability Cross-cutting
Work Group"; Working Group 37, "Rural Cross-cutting Group"; Working
Group 38, "Benefits Coordination"; Working Group 39,
!~;sues
"Minor~ty
Review Group"; Working Group 40, "Academic Health Centers",
and Working Group 41,
"Workers' Compensation Task Force, " are
Advisory committees within the meaning of the Federal Advisory
Committee Act, 5 u.s.c. App.
§§
1 through 14, and must be enjoined
to comply with· the provisions thereof, including the filing of
charters·and the opening of all meetings (with proper notice), and
the
opening
of
all
records,
reports,
transcripts,
minutes,
appendixes, working papers, drafts, studies, agenda, and all other
documents to the public for inspection and copying.
Plaintiffs have suffered and are suffering irreparable harm
for which there is no adequate remedy at law.
This Motion is based upon the Verified Second· Amended and
Substituted Complaint for Declaratory Judgment and Restraining
Order
and
Preliminary
and
Permanent
Injunctive
Relief,
the
documents provided by the Defendants in their Responses to the
Interrogatories and Second Request for Production of Doucuments
propounded by the Plaintiffs, and sworn to in the Declarations of
Marjorie
Tarmey,
and
the
Declarations
of
Ira Magaziner
and
Genevieve M. Young and the documents introduced thereby, and the
Memorandum of Law in support hereof filed herewith, and on the
files and pleadings in this proceeding.
4
·,
�Pursuant to Local Rule 108, Plaintiffs hereby request an oral
hearing on the within Motion •
Dated:
March
..,~.,.;_
1"1
,
1994.
KENT MASTERSON BROWN, ESQ.
CHRISTOPHER J. SHAUGHNESSY, ESQ.
1114 First National Building
167 West Main Street
Lexington, Kentucky 40507
(606) 233-7879
(606) 252-6791 - facsimile
r-D~J::.M~~
Y~~NORTHAM, ES~
Bar No. 206110
ALAN P. DYE, ESQ.
Bar No. 2125379
WEBSTER, CHAMBERLAIN & BEAN
1747 Pennsylvania Avenue, N.W.
Suite 1000
Washington, D.C. 20006
(202) 785-9500
COUNSEL FOR PLAINTIFFS, ASSOCIATION
OF AMERICAN PHYSICIANS AND SURGEONS 1
INC., AMERICAN COUNCIL FOR. HEALTH
CARE REFORM, and NATIONAL LEGAL &
POLICY CENTER
CERTIFICATE OF SERVICE
This is to certify that a true and correct copy of the
. foregoing Motion for Summary Judgment and Permanent Injunction has
been served upon Defendants by hand-delivering a copy of same to
Defendants' counsel of record as follows:
Hon. Jeffrey Gutman, Hon. Robert
5
s.
Hon. Elizabeth Pugh,
Whitman,
u.s.
Department of
�Justice, Civil Division, 901 E Street, N.W., Room 952, Washington,
D.C. 20004-2037, on this the
-~'}..;
~~
c:\wpwin\clinton\summjudg.mot
6
day of March, 1994.
�UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.,
AMERICAN COUNCIL FOR HEALTH
CARE REFORM AND NATIONAL
LEGAL & POLICY CENTER,
Plaintiffs,
)
)
)
)
)
)
)
)
v.
Civil Action
No. 93-399
(Judge Lamberth)
)
)
HILLARY RODHAM CLINTON,
DONNA E. SHALALA, Secretary of
Health and Human Services,
LLOYD E. BENTSEN, Secretary of
the Treasury, LES ASPIN,
Secretary of Defense, JESSE
BROWN, Secretary of Veterans
Affairs, RONALD H. BROWN,
Secretary of Commerce, ROBERT
B. REICH, Secretary of Labor,
LEON E. PANETTA, Director of
the Office of Management and
Budget, ALICE RIVLIN, Deputy .
Director of the Office of
Management and Budget, CAROL
RASCO, IRA MAGAZINER and
JUDITH FEDER, White House
Advisors and THE PRESIDENT'S
TASK FORCE ON NATIONAL
HEALTH CARE REFORM, and THE
INTERDEPARTMENTAL WORKING GROUP
OF THE PRESIDENT'S TASK FORCE
ON NATIONAL HEALTH CARE REFORM
and its CLUSTER GROUPS, WORKING
GROUPS, AND SUBGROUPS, et al.,
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
Defendants.
)
)
)
PLAINTIFFS' MOTION FOR LEAVE TO FILE A
MEMORANDUM OF POINTS AND AUTHORITIES IN SUPPORT OF
THEIR MOTION FOR SUMMARY JUDGMENT THAT EXCEEDS
THE PAGE LIMITS UNDER LOCAL RQLE 108Ce)
NOW COME the Plaintiffs, ASSOCIATION OF AMERICAN PHYSICIANS
AND SURGEONS, INC. , AMERICAN COUNCIL FOR HEALTH CARE REFORM and the
�NATIONAL LEGAL & POLICY CENTER,
~y
and through counsel, pursuant to
Local Rule 108(e), and hereby move the Court for leave to file
Plaintiffs' Memorandum of Points and Authorities in Support of
Motion for summary Judgment and Permanent Injunction in excess .of ·,
the 45-page limit established by the Local Rules.
Statement of Points and Authorities
In support of the foregoing motion, Plaintiffs state that the
Motion for summary Judgment and Permanent Injunction asks this
court to adjudge that the Interdepartmental Working Group of the
President's Task Force on National Health Care Reform and its
fifteen (15) Cluster Groups, forty-three (43) Working Groups and
four ( 4) subgroups are Advisory Committees for purposes of the
Federal Advisory committee Act, 5 U.s. c. App. ,
§§
1 through 14,
because all of the aforementioned groups contained one (1) or more
members who were not full-time officers or employees of the fede.ral
government· and because all such groups were "established" and
"utilized" by the President of the United States for purposes of
making recommendations which were ultimately used by him in the
formulation of the Health Security Act of 1993.
To present the facts relating to each of the aforementioned
sixty-three {63) groups - and all of the members of each group necessitates the filing of a memorandum in excess of 45-pages.
supplementing the Plaintiffs' Memorandum of Points and Authorities
in support of the Motion for Summary Judgment and Permanent
Injunction are nearly one thousand five hundred (1,500) pages of
carefully selected supporting exhibits representing the documents
2
�provided by the Defendants duz:ing discovery.
To distill those
authenticated documents and the supporting exhibits introduced by
the Declaration of Genevieve M. Young into a form understandable
and complete requires the filing of Plaintiffs' Memorandum . of
Points and Authorities in support of the Motion for
summary
Judgment and Permanent Injunction in excess of the 45-page limit.
WHEREFORE, Plaintiffs, by counsel pray that the Court enter an
Order permitting the filing of Plaintiffs' Memorandum of Points and
Authorities in Support
Permanent
Injunction
~f
in
the Motion for Summary Judgment and
excess
of
the
45-page
limit.
The
Plaintiffs' Memorandum of Points and Authorities in Support- of
Motion for Summary Judgment, Statement of Material Facts as to
which there Is No Genuine Issue, Exhibits in Support of Motion for
Summary Judgment,
and Declaration of Genevieve M.
Young are
appended hereto and submitted herewith.
~=f:zi;ted. ~-----KENT MASTERSON BROWN, ESQ.
CHRISTOPHER J. SHAUGHNESSY, ESQ.
1114 First National Building
167 West Main Street
Lexington, KY 40507
(606) 233-7879
(606) 252-6791 - facsimile
~1C2 A~ t£rA4vvz----~NORTHAM, SQ.
WEBSTER, CHAMBERLAIN & BEAN
17 4 7 Pennsylvania Avenue, · N. w.
Suite 1000
Washington, D.C. 20006
(202) 785-9500
3
�CERTIFICATE OF SERVICE
This is to certify that a true and correct copy of the
foregoing Motion for Leave to File a Memorandum of Points and
Authorities in Excess of the Page Limits with Statement of Points
and Authorities and Proposed Order have been served upon Defendants
by hand-delivering a copy of same to Defendants' counsel of record,
Hon. Elizabeth A. Pugh, Jeffrey Gutman, Esq., Roberts. Whitman,
Esq., and David Andersen, Esq., u.s. Department of Justice, Civil
Division, 901 E Street, N.W., Room 952, Washington, D.C. 20004-2037
on this
~rJ/. day
of March, 1994.
c£~MI2-M~
Frank M. Northam
4
�UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS,
INC. , et al • ,
Plaintiffs,
v.
)
)
)
)
)
)
)
Civil Action
No. 93-399
(Judge Lamberth)
)
)
HILLARY RODHAM CLINTON, et al., )
)
Defendants.
)
)
)
ORQER.
On Motion of the Plaintiffs for leave to file their Memorandum
of Points and Authorities in support of Motion for Summary Judgment
and Permanent In)unction in excess of the 45-page limit, pursuant
to Local Rule 108(e), and the court having considered said motion
and being otherwise sufficiently advised,
IT IS HEREBY ORDERED that said Motion be and the same is
hereby
GRANTED,
and
the
tendered
Memorandum
of
Points
and
Authorities in Support of Motion for Summary Judgment and Permanent
Injunction be and the same is hereby FILED.
Dated:
JUDGE, UNITED STATES DISTRICT COURT
�UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.,
AMERICAN COUNCIL FOR HEALTH
CARE REFORM AND NATIONAL
LEGAL & POLICY CENTER,
)
)
)
)
)
)
Plaintiffs,
)
)
v.
Civil Action
No. 93-399
(Judge Lamberth)
)
)
HILLARY RODHAM CLINTON,
DONNA E. SHALALA, Secretary of
Health and Human Services,
LLOYD E. BENTSEN, Secretary of
the Treasury, LES ASPIN,
Secretary of Defense, JESSE
BROWN, Secretary of Veterans
Affairs, RONALD H. BROWN,
Secretary of Commerce, ROBERT
B. REICH, Secretary of Labor,
LEON E. PANETTA, Director of
the Office of Management and
Budget, ALICE RIVLIN, Deputy
Director of the Office of
Management and Budget, CAROL
RASCO, IRA MAGAZINER and
JUDITH FEDER, White House
Advisors and THE PRESIDENT'S
TASK FORCE ON NATIONAL
HEALTH CARE REFORM,
)
)
)
)
)·
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
Defendants.
)
)
)
ORDBR
On Motion of the Plaintiffs, pursuant to Rules 15, 19, 20 and
'21 of the Federal Rules of Civil Procedure, to file their Verified
Second Amended and Substituted Complaint for Declaratory Judgment
and Restraining Order and Preliminary and Permanent Injunctive
Relief I
and the COURT having considered said Motion and beinq
otherwise sufficiently advised:
1
�IT IS HEREBY ORDERED that said Motion be and the same is
hereby GRANTED and the Verified Second Amended and Substituted
Complaint for Declaratory Judgment and Restraining Order and
Preliminary and Permanent Injunctive Relief be, and the same is ·,
hereby FILED.
The Defendants shall be granted
days within which to
Answer or otherwise plead thereto.
Dated:
JUDGE, UNITED STATES DISTRICT COURT
c:\wpwin\clinton\amendcom.ord
2
�UNITED STATE~ DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS,
INC. , et al • ,
Plaintiffs,
v.
)
)
)
)
)
)
)
)
)
Civil Action
No. 93-399
(Judge Lamberth)
HILLARY RODHAM CLINTON, et al., )
Defendants.
)
)
)
)
PLAINTIFFS' MEMORANDUM OF POINTS AND AUTHORITIES
IN SUPPORT OF THEIR MOTION FOR LEAVE '1'0
FILE A SECQND AMENDED COMPLAINT
In this court's order of November 9, 1993, the Court stated:
"After full discovery, the court will require an amended compliant
to be filed that conforms to the evidence and frames the issues for
deciding dispositive motions • • • "
Although the plaintiffs are not convinced that they have
received "full discovery" from the defendants,
plaintiffs are
satisfied that they have adduced sufficient evidence as to the
membership and activities of the Interdepartmental Working Group of
the President's Task Force on National Health Care Reform, its
Cluster Groups, Working Groups, and Subgroups, to support their
Second Amended compliant, which names all of those groups as
defendants.
Motion
fo~
Plaintiffs are filing simultaneously herewith their
summary Judgment based on the allegations of the Second
Amended Compliant,
the documents provided in response to the
plaintiffs' discovery requests, and other information developed by
�the plaintiffs.
The plaintiffs' motion for leave to file an amended complaint
has been filed with the Court as soon as the plaintiffs were able
to assimilate all of the information obtained in discovery and .to ·,
establish that the Interdepartmental Working Group, the Cluster
Groups, Working Groups and the Subgroups were appropriate parties
defendant.
In accordance with the Court's November 9, 1993 Order, the
plaintiffs seek leave to file their Second Amended Complaint.
Respectfully submitted,
KENT MASTERSON BROWN
1114 First National Building
167 West Main Street
Lexington, KY 40507 ·
(606) 233-7879
(606) 252-6791 - facsimile
FRANK M. NORTHAM
WEBSTER, CHAMBERLA N & BEAN
1747 Pennsylvania Avenue, N.W.
suite 1000
Washington, D.C. 20006
(202) 785-9500
2
�CERTIFICATE OF SERVICE
This is to certify that a true and correct copy of the
foregoing Memorandum of Points and Authorities in Support of Motion ·,
for Leave to File an Amended Complaint and Proposed Order have been
served upon Defendants by hand-delivering a copy of same to
Defendants' counsel of record, Hon. Elizabeth A. Pugh, Jeffrey
Gutman, Esq., Roberts. Whitman, Esq., and David Andersen, Esq.,
u.s. Department of Justice, civil Division, 901 E Street, N.W.,
Room 952, Washington, D.C. 20004-2037 on this
2~.(~day of _March,
1994.
~Mw~~
Frank M. Northam
3
�..
UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.,
AMERICAN COUNCIL FOR HEALTH
CARE REFORM AND NATIONAL
LEGAL & POLICY CENTER,
)
)
)
)
)
)
Plaintiffs,
)
)
v.
Civil Action
No. 93-399
(Judge Lamberth)
)
)
HILLARY RODHAM CLINTON,
DONNA E. SHALALA, Secretary of
Health and Human. Services,
LLOYD E. BENTSEN, Secretary of
the Treasury, LES ASPIN,
Secretary of Defense, JESSE
BROWN, Secretary of Veterans
Affairs, RONALD H. BROWN,
Secretary of Commerce, ROBERT
B. REICH, Secretary of Labor,
LEON E. PANETTA, Director of
the Office of Management and
Budget, ALICE RIVLIN, Deputy
Director of the Office of .
Management and Budget, CAROL
RASCO, IRA MAGAZINER and
JUDITH FEDER, White House
Advisors and THE PRESIDENT'S
TASK FORCE ON NATIONAL
HEALTH CARE REFORM,
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
Defendants.
)
)
)
IIO'l'ION FOR LEAVE ro FILE VERIFIED SECOND
AIIENDBD AND SUB~I'I'U'.l'ED COIIPLAINT FOR
DECLARATORY JUDGIIBNT AND RB~RAINING ORDER AND
PRBLIIIINARY AND PERIIANBN'P INJUNC'.PIVE RELIEF
Plaintiffs, by counsel, hereby move this Honorable Court,
pursuant to Rules 15, 19, 20 and 21 of the Federal Rules .of Civil
Procedure, .for leave to file their Verified Second Amended and
1
�Substituted Complaint for
Order
and
Preliminary
Decl~ratory
and
Permanent
Judgment and Restraining
Injunctive
Relief
filed
herewith, adding as parties the INTERDEPARTMENTAL WORKING GROUP OF
THE PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and its
CLUSTER GROUPS, WORKING GROUPS AND SUBGROUPS; namely, Cluster Group
I, "New system organization", and Working Group 1, "Principles and
Operati~n of PUrchasing Cooperatives"; Working Group 1A, "Health
Plans,
Patients
Care/Toward
&
and
Providers";
Working
2,
"Managed
Beyond"; Working Group 3, "Governance"; Working Group
4, "A Global Budget", and Working Group 5,
Cluster Group II,
"Benefits
Group
"Insurance Reform";
"New system Coverage", and Working Group 6,
Package";
Working
Families"; Working Group 8,
Group
7,
"Coverage
for
Working
"Coverage for Low Income and Non-
Working Families"; Cluster Group III, "New System Infrastructure",
and Working Group 9,
"Quality Measurement"; Working Group 10,
"Information Systems"; Working Group 11,
Reform",
and
Working
Group
12,
"Malpractice and Tort
"Facilitating
Professional
Development"; Cluster Group IV, "Integration of Government Programs
Into the New System", and Working Group 13, "Medicare"; Working
Group 14, "Department of Defense"; Working Group 15, "Veterans";
Working Group
16,
"Federal
Employees'
Health Benefits
Plan";
.working Group 16A, "Other Government Programs"; Cluster Group
v,
"Bioethics or Ethical Foundations of the New System", and Working
Group 17, "Bioethics"; Cluster Group VI, "Transition to the New
System,
Short-Term
"Accelerating
New
Cost
System
Controls",
and
Development";
2
Working
Group
18,
Working
Group
19,
�"Administrative Simplification"; Working Group 20, "Interim Cost
Controls"; Cluster Group VII, "Financing", and Working Group 21,
"Financing"; Cluster Group VIII, "Health Policy Initiatives for the
Underserved", and Working Group 22, "Health Policy Initiatives
~or
tbe Underserved", and Subgroup A, "Underserved Rural and Inner City
Areas"; subgroup B, "Vulnerable/High Risk Populations"; Subgroup
"Women and Children", and Subgroup D,
c,
"Population-Based Public
Health and Prevention"; Cluster Group IX,
"Mental Health", and
Working Group 23, "Mental Health Benefits Package"; Working Group
24, "Substance Abuse"; Working Group 25, "Children's Services";
Working Group 26,
"Public System Impact/Special Population.s";
Cluster Group X, "Long Term Care", and Working Group 27, "Long Term
Care-Background";
Working
Group
Options"; Working Group 29,
28,
"Long
Term
Care-Public
"Long Term care-Private Options";
Working Group 30, "Cost and Revenue"; Cluster Group XI, "Economic
Impact", and Working Group 31, "Economic Impact"; Cluster ·Group
XII, "Quantitative Analysis"; and Working Group 32, "Quantitative
Analysis"; Cluster Group XIII, "Legal Audit", and Working Group 33,
"Legal Audit"; Cluster Group XIV, "Numbers Audit",
and Working
Group 34, "Numbers Audit"; Cluster Group XV, "The Drafting Group",
and Working Group 35, "The Drafting Group", and Working Group 36,
"Disability Cross-cutting Work Group"; Working Group 37, "Rural
Cross-cutting Group"; Working Group 39, "benefits Coordination";
Working Group 39, "Minority Issues Review Group"; Working Group 40,
"Academic
Health
Centers";
and
Working
Compensation Task Force," and adding
3
Group
41,
"Workers'
allegations with respect to
·,
�the application of the Federal Advisory Committee Act, 5
App.
§
§§
1 through 14, the Government in the Sunshine Act, 5
552b, and the Freedom of Information Act, 5
u.s.c.
§
u.s.c.
u.s.c.
552a, to the
Interdepartmental Working Group of the President's Task Force on
National Health Care Reform, its Cluster Groups, Working Groups and
Subgroups, aforementioned.
Dated:
March
'-~ r;J-1994.
-
KENT MASTERSON BROWN, ESQ.
CHRISTOPHER J. SHAUGHNESSY, ESQ.
1114 First National Building
167 West Main Street
Lexington, Kentucky 40507
(606) 233-7879
(606) 252-6791 - facsimile
~<A\·,~~
FRANK
M. NORTHAM, ESQ:
Bar No. 206110
ALAN P. DYE, ESQ.
Bar No. 2125379
WEBSTER, CHAMBERLAIN & BEAN.
1747 Pennsylvania Avenue, N.W.
Suite 1000
Washington, D.C. 20006
(202) 785-9500
COUNSEL FOR PLAINTIFFS, ASSOCIATION
OF AMERICAN PHYSICIANS AND SURGEONS,
INC., AMERICAN COUNCIL FOR HEALTH
CARE REFORM, and NATIONAL LEGAL &
POLICY CENTER
CERTIFICATE OF SERVICE
This is to certify that a true and correct copy of the
foregoing 'Motion for leave to File Verified Second Amended and
4
�Substituted Complaint for Declaratory Judgment and Restraining
Order and Preliminary and Permanent Injunctive Relief has been
served upon Defendants by hand-delivering a
Defendants' counsel of record as follows:
Hon. Jeffrey Gutman, Hon. Robert
s.
copy of
same to
Hon. Elizabeth Pugh, .,
Whitman,
u.s.
Department of
Justice, Civil Division, 901 E Street, N.W., Room 952, Washington,
.
.
D.C. 20004-2037, on this the
')j,rl
~
day of March, 1994.
L
KENT MASTERSON BROWN
c:\wpwin\clinton\leav2nd.mot
5
�February 24, 1993
From:
Helen Levy (202 690-7802)
Subject:
Weekly report on activities of Quantitative Analytic Support Work Group
(32), week of 2/14-2/21.
To:
Lynn Margheri
The Quantitative Analytic Support Work Group (Chair: Ken Thorpe) met twice during
the week of 2114-2/21 to discuss:
The AHCPR microsimulation model and analytic work
peatures of the Agency for Health care Policy and Research (AHCPR) microsimulation model were presented by AHCPR staff, including the model's capacity to
simulate the effect on health insurance and health spending of proposed refonns.
Key behavioral assumptions underlying this model and other models (such as those
operated by HCFA and the Department of the Treasury) were discussed, including
price eiasticity of demand for medical care services and the wage reduction effect
caused by mandated employment-related health insurance benefits.
AHCPR also presented analysis and information completed to date for use by the
Work Group.
The Work Group was also engaged in the following activity:
Calibration exercise
HCFA, AHCPR and NIMH ran four standardized benefit plans through their
microsimulation models to see how results compare so that differences can be
resolved. Results will be discussed the week of 2/22.
Responses to requests from other Work Groups
The Work Group began conducting analyses and literature reviews in response to a
request from group 5 about the effects on premiums of community rating and a
request from group 3 on the distribution of employees and health expenditures by
firm size.
The workgroup plans to meet twice during the week of 2/22-2/29 to discuss:
Results of the benefit package
~st
calibration exercise
State health care spending estimates: HCFA will explain the data behind their State
health care spending estimates and the group will examine the assumptions underlying these estimates.
�/Xo.~Jorlt1
~e_ a.rl- ~ CJ jtJ c tJ /oi.LI\ {t
fJ.le_ pro vt'dd ~ ~"~ ~
1
we.r-e_
NJI-;dol //e_ft!e
Cbp!J ye..s/ldof.
~ ~o£
I
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
American Physicians Lawsuit HCTF (Health Care Task Force); March 3, 1994
Creator
An entity primarily responsible for making the resource
First Lady's Office
Maggie Williams
Evan Ryan
Melanne Verveer
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-2194630-20060223F-006-005-2015
2194630
-
https://clinton.presidentiallibraries.us/files/original/a06e62191cddf74b6c65da079cb3b1fa.pdf
039dfd06b29e34883e861770717df116
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
First Lady's Office
Series/Staff Member:
Maggie Williams; Evan Ryan; Melanne Verveer
Subseries:
Misc. Subject Files
OA/ID Number:
12822
FolderiD:
Folder Title:
American Physicians Lawsuit-HCTF (Health Care Task Force); 2-23-93 Info Flow
Stack:
Row:
Section:
Shelf:
Position:
s
59
4
7
2
��I .~, ....
. ·. .·..
~.:
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- ..
...............,....... ··- :·.·- · ............ ·.·,· ............. _......,.,...... '•"" .... .' .....................·:· ........ ,. ,. "· '?(~?./T-·3 ..... .
FOR OFFICIAL USE ONLY
:r~~
INFORMATION FLOW DIAGRAMS
FOR QUAL-ITY MEASUREMENT AND IMPROVEMENT
Version 1.0, February 23, 1993
Workgroup on Quality Measurement and Improvement (Group 9)
INTRODUCTION
By its very nature, the measurement and improvement of quality
.. .. .
involves information. Examples include the reports an Accountable
Health Practice (AHP) must provide to help Health Insurance
Purchasing Corporations (HIPCs) and consumers select AHPs,
resear~h information on the effectiveness of treatments, and
guidelines on the appropriate use of diagnostic tests. One of the
major .tasks.of the Q~ality workgroup is to defin~ th~ ~nformation
··.:on cost, · ·quali·ty cind· ace·e'ss
t.ha·t~
Will· bEr· re!quired ·to peiform·· the·
~-.
·.· ·· ...
essential functions of the health care system. Because of the
extreme complexity of the health care system, both as it is
currently configured and as it is envisioned for the future, and
because issues of quality relate to virtually every aspect of the
system, the Quality workgroup faced the problem that unless it
developed a systematic approach to its work it would run a great
risk of missing important functions and transactions that affect
quality. To help develop a comprehensive picture of all the
information that will be required to measure and improve quality,
the workgroup has developed a set of information flow diagrams
that systematically identify the main processes that must be
performed in-the. new system, and the information flows between
processes that will be required for their performance~- To keep
the diagrams relatively simple, only the most important
information flows relating to each process are described in the
diagrams. These diagrams should also be useful to the Informat-ion
workgroup that is responsible for designing the infrastructure · ·
that will collect, store and transmit the information, and to
other workgroups that need to visualize the relationship between
the functions they are analyzing and other functions to which they
relate.
INFORMATION FLOW DIAGRAMS
Information flow diagrams are convenient and powerful ways to
describe the processes a system uses to achieve its objectives and
the information required and produced by those processes. An
information flow diagram uses four main symbols. Processes are
represented by circles, information flowing between processes are
represented by arrows, data stores are represented by double lines
that break arrows (to symbolize that the information is not
transmitted instantaneously between two functions, but is stored
temporarily to be drawn on when needed), and processes outside the
system of primary interest are represented by squares. In
reality, data flows between processes occur in both directions.
For example, in a financial transaction a seller will submit a
bill and a buyer will write a check. To simplify the
PRELIMINARY STAFF WORKING PAPER FOR ILLUSTRATIVE PURPOSES ONLY.
Page 1
·. ·.
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FOR OFFICIAL USE ONLY
representation of such transactions, however, only the most
important d~rection of flow will usually be shown, using an
arr,owhead. In some cases the choice of a direct~on was arbitrary.
....
";·
It is important to understand that an information flow diagram
focuses on functions, not on the entities that are performing
those functions. This distinction is important because there is
rarely a one-to-one correspondence between functions and entities.
For example, one entity can perform several functions, the way an
HMO both arranges for financing, and provides care. Similarly,
most functions are performed by a wide variety of entities. For
example, financing is also provided by insurance companies, the
federal government, state governments, business (as an employee
benefit1, and individual patients (as out-of-pocket expenses).
After an information flow diagram has been developed to identify
.,.the: fl;lnc.tionS., ... cie$.C.rip,ti,qns. ·.o~ ~. ~·.e ·f?n,.~~ti~~ . ·.t~·a.~ J?~F~~·~· t.p~~~
functJ.ons can be added.
,·. ·:·... ·
Another point about information flow diagrams is that multiple
diagrams can be used to describe various levels of detail about
functions and information flows. For example, an insurance
company whose primary function is financing has many subfunctions
that include the design of benefit packages, marketing,
accounting, reporting, legal support, and so forth. Deeper levels
of detail are illustrated by creating •layers• of diagrams, where
each successive layer "blows up" the details of higher levels of
functions. Macintosh users can think of "double clicking• on a
fun~tj,.on .to ~xpose the subfu.nct~ons .. This use of layers. of
diagrams is not intended to imply any hierarchy of·control
(although such a hierarchy might exist). In an information flow
diagram, it is only intended to show different levels of detail.
·,.
Because each of the functions are performed by a wide variety ·.of·
entities, the workgroup has chosen very general labels to describe
the functions (eg, •contract for services,• •consume services•).
The use of these general labels might suggest that the information
flow diagrams are too abstract to be useful for actual planning.
That problem disappears when functions are divided into their
components. As higher levels of detail are described, tne labels
become more precise descriptions of specific functions.
Eventually, a level of detail is reached at which it is possible
to identify the specific entities that will perform each function
and that will produce and use each piece of information.
This report describes the current draft of the information flow
diagram being developed by the workgroup on Quality Measurement
and Improvement (Group 9). Because of the charge to the
workgroup, the report concentrates on those functions and
transactions that are related to quality. It should be considered
a living document that will be revised and expanded continuously
to reflect the workgroup's progress. The diagram can easily be
expanded to incorporate the functions and information flows of
other workgroups.
PRELIMINARY STAFF WORKING PAPER FOR ILLUSTRATIVE PURPOSES ONLY.
Page 2
..... ·.. ..
•:
�.•... : .. ·..· . •.
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.. : .. .
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..
.
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':
.. ....
.. . . ,. . . ...
··.•
·.
..... '
..
.
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.•~
.
FOR OFFICIAL USE ONLY
.· . ·,.,
FIGURE 1. THE HEALTH CARE DELIVERY SYSTEM
Because virtually every aspect of the health care delivery system
has implications for the quality of care, an information flow
diagram for quality measurement and improvement must begin with a
description of the entire health care delivery system. The
highest level function therefore is the delivery of health care.
This process receives information from •society• in the form of
the expectations people have for health care. In this context,
•society• includes not only the individuals who make up American
society but all the nonhealth functions that are performed in
various sectors of our society, including, for example, housing,
education, transportation, business, parks, welfare, the legal
system, and agriculture. As the health care delivery system
perform~ its functions, it delivers information back to society
about the performance of the health care system, and the extent to
... wo~cn it .has ..sati~f:ieq soc;~.e.ty'.s expe.c.t~t.io:n.s.
. ....
•••• •
•'
.··~··· . . . .
• ••
•
:
.: •
•••••••••••
•• • •
••
••
• ... :
••
••
·~
•••
.,~·- • • ·~.
·.~ . . .
·:
•
~.:
•
.....
•':
~-
·-··
•
• ••
,•'
·,#
·••••
·:
FIGURE 2. THE FIVE MAIN FUNCTIONS OF THE HEALTH CARE DELIVERY
SYSTEM
The health care delivery system consists of five main functions:
provision of services to maintain and improve people's health
(1.0), overall management of the system (2.0), consumption of
health care services by •consumers• (3.0), administration of
contracts to pay for the services (4.0), and supply of the wide
variety of intermediate products that are needed to provide
services (5.0).
Although there is not a one-to-one correspondence between these
functions. and the various entities.that.make up the. health car.e
system, for the purposes of understanding these functions it is
reasonable to think of examples of entities that perform each of
them. For example, in the current health care system hospitals
provide services (1.0), patients consume services (3.0), insurers
and other third-party payers administer contracts between
·
providers and consumers (4.0), and the Health Care Financing
Administration (HCFA) manages its system (2.0). Intermediate
products are supplied (5.0) by a wide variety of entities
including drug companies, device manufacturers, medical schools
(trained personnel), researchers (information on the effec~iveness
of interventions), guidelines developers, construction companies
(facilities), hospital suppliers, and so forth. Examples of new
types of entities that might be created in the new health care
system include AHPs that will perform the function of providing
services, HIPCs that will administer contracts for financing and
services, a National Health Board that will manage various aspects
of the system, such as defining a standard benefit package, and so
forth.
Each of these main functions consists of many subfunctions and is
performed by many different entities. Furthermore, a vast amount
of information of various types flows between each of the main
functions and their subfunctions. The following are some
highlights that are particularly pertinent to quality measurement
and improvement.
PRELIMINARY STAFF WORKING PAPER FOR ILLUSTRATIVE PURPOSES ONLY.
Page 3
··:·:
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.
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·,. ....
'·
Provide Health Care Services (1.0)
Providers include all the personnel who either provide health care
or who directly support the provision of health care, and the
organizations in ~hich they work. In the current system providers
include solo practitioners, group practices, hospitals, HMOs,
CHAMPUS, laboratories, pharmacies, and nursing homes. In the new
system, AHPs will provide health care services.
.....,
:
~
. .:
Those who provide services (1.0) will not only receive information
that has been reviewed and •approved• by the managers (2.0), they
will also receive information from those who supply intermediate
products (5.0). Examples of the latter are information from
researchers about the effectiveness of treatments, information
from pharmaceutical companies about their products, and so forth.
The quality of this information will vary widely, from peerreviewed research publications to highly distorted marketing
. .... ··.1 i ~e;ra.t:u~.e· •.... :I'Jli.~ . : col-l.e.~. tl~p~_·: p ~·.. in~ or·~~ .i~.n:. -~~-~ 1 ~ .b,e·.. s-~;}}~4 -: ...· . . . . . . .· ... . .
"nonapproved" to distingi.lish it from information that has been
formally reviewed and approved by the managers. This is not
intended to be a pejorative term, and some of the nonapproved
information will be of very high quality. The important point is
that those who receive nonapproved information will have to judge
its quality for themselves.
Providers will enter into contracts with those who contract for
services, such as insurers and HIPCs (4.0). The contract will
specify the services the provider will provide, the information on
the budget for providing the services, and the information that
providers must report to enable contractors to administer the
provision of services·. ·Providers might. alsO" report ii).formation to
managers (2.0) on the. quality, cost and utilization of their
services so that the managers can monitor the overall performance
of the system, and to consumers of services (3.0) so that .. they can
make choices between providers.
Manage the Health Care System (2.0)
This function is concerned with the top-level management of the
health care system as a whole. Examples of specific functions
that might be performed by top-level management are the definition
of the standard benefit package, the assessment of specific
services that might be excluded from the standard benefit package,
the monitoring of the overall performance of the system (cost,
quality, access, utilization, variations), and the •accreditation"
of HIPCs and AHPs. Some of these functions are currently being
performed by HCFA, state health commissioners, and state insurance
commissioners. It is important to distinguish between these
global management functions and the management that occurs at the
level of individual health care providers and other organizations
(eg, hospital administration, management of insurance companies).
To help keep the distinction clear, terms such as •macro"
management and "oversight" will be used to describe the former,
and "micro" management and "administration" will be used to
describe the latter.
PRELIMINARY STAFF WORKING PAPER FOR ILLUSTRATIVE PURPOSES ONLY.
Page 4
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The information flows pertinent to the management function
correspond to its major subfunctions. In the proposed health care
system, it is envisioned that one or more national boards (eg,
National Health Board, Outcomes Management Board; Health Standards
Board) will manage the overall operation of the health care system
by performing such functions as designing the standard benefit
package that will be used by those who write contracts with
providers and consumers (4.0); reviewing information about medical
practices and passing on to providers (1.0) •approved• information
in the form of •approved" research results, technology assessments
and guidelines; and providing to consumers (3.0) standardized
reports about the quality of providers so that the consumers can
choose between different providers. National boards and other
entities that perform the management functions might also provide
feedback both formally and informally to the suppliers of
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. ·companies. a"i-id. ..device· ·inam..ifacturer·s·· about:· cOverage ({ecisions .·····. ... .
concerning their products, feedback to medical educators about the
demand for various types of practitioners, requests to the
research establishment for information about the effectiveness of
particular services, and so forth.
Consume Health Care Services (3.0)
The term •consumer" is used to describe any entity that makes
choices between providers, that contracts with contractors (eg,
that joins a prepaid plan, buys insurance, or accepts Medicare),
or that actually consumes health care services. Consumers can be
organiz.ed at several levels of aggregation, ranging from..
individual people to large groups· of people ·created for the
purpose of collective. bargaining (eg, AARP, unions). ·The term
also includes the consumer function of HIPCs, which must evaluate
AHPs.
To help them make choices about providers, consumers receive
information on the quality, cost and access of various providers.
This information will come from two main sources: "standardized"
or "approved" information will be provided by system managers such
as a National Health Board, or the monitoring function of a HIPC
(2.0). In addition, consumers will undoubtedly receive ·
information directly from providers (1.0). This information will
not have been evaluated by managers, and therefore will be called
"nonapproved." Consumers will also receive "nonapproved"
information directly from suppliers such as drug companies (5.0).
As consumers make their choices, they will enter into contracts
with contractors (4.0), and will make decisions about specific
providers and health care services (eg, participate in decisions
about treatments).
Contract for Services (4.0)
ucontracting" is used in a general sense to describe the financial
arrangements made between providers and consumers of services. In
the current system this function is performed by insurers, other
third-party payers, and prepaid health plans .
PRELIMINARY STAFF WORKING PAPER FOR ILLUSTRATIVE PURPOSES ONLY.
Page 5
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Those who contract for services will enter into contracts with
both consumers (3.0) and providers (1.0) to arrange the coverage
for the standard benefit package. The contractors will also
provide consumers (3.0) with jnformation about the quality of
various providers. There will also be information flows between
consumers, providers and contractors associated with the reporting
and resolution of grievances.
--·.·· ·
Supply Intermediate Products (5.0)
As stated above, a wide variety of products is needed to provide
services. They include personnel, facilities, equipment,
supplies, drugs, devices, research information, guidelines,
information systems, management tools, and so forth. Providers
organize and convert these products into the forms necessary to
provide· actual health care services to consumers. For example, a
.hospital will assemble surgeons, nurses, an operating room,
.inst·rumEmts·,,· . sPe>riges,.· know-ledge.) .,technical· skfl.ls·•...and :·other< . . .. :, ··, .. ·:· ·:.,.
products to perform the health care service of operating on a
patient with a hernia.
Suppliers of intermediate products will receive ideas for new
products required to deliver health care services, and feedback
about existing products from health care providers (1.0), managers
(2.0), and contractors (4.0). This information can range from
informal suggestions from providers, to formal research results,
to coverage decisions. Suppliers of intermediate products will
provide information to providers (1.0), managers (2.0),
contractors (4.0) and consumers (3.0) about their products.
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Finally, those who supply intermediate products (5.0) .will
undoubtedly receive information from contractors in the form of
feedback about coverage decisions and the outcomes of their
products.
FIGURE 3. PROVIDE HEALTH CARE SERVICES (1.0)
Providers of services will perform three main functions. They
include actually providing care to consumers (1.3), administering
the organizations that provide care (1.1), and improving quality
(1.2). This function also includes a data store (DS 1.1). that
contains information about the provider system.
Administrators of provider systems (1.1) such as administrators of
HIPCs (1.1) will require information from several sources:
feedback on provider performance from the managers of the health
care system (2.0), contracts from the contractors (4.0), and
feedback from the quality improvement process on the performance
and efficiency of the system they are administering (1.2). In
turn, this function will pass administrative information to the
practitioners who actually provide care (1.3); information on
quality, cost and utilization, to the managers of the health care
system (2.0) in the form of standardized reports, contract
information to contractors (4.0), and reports on quality, cost and
access to consumers (3.0) to help them choose between various
providers.
PRELIMINARY STAFF WORKING PAPER FOR ILLUSTRATIVE PURPOSES ONLY.
Page 6
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The process of providing services (1.3) will receive information
from several sources. They include •approved" guidelines as well
as feedback on performance from managers (2.0), nonapproved
information from suppliers of intermediate products such as
researchers and drug companies (5.0), and feedback on the
effectiveness and efficiency of the service delivery system from
the quality improvement process (1.2). It will also draw on the
data store (DS 1.1) for the patient-specific data needed to serve
patients. In turn, providers of services will make decisions
about services with patients (consumers, 3.0) and will pass
patient care data to the data store.
The quality improvement process (1.2) will use performance
measures developed by the managers (2.0) and others (5.0), and
will examine patient care data CDS 1.0). It will feed back
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pat1ent satisfact1on to the providers of care (1.3) and to
·
administrators (1.1).
FIGURE 4. MANAGE THE HEALTH CARE SYSTEM (2.0)
The management process will perform five main functions. They
include management of the system as a whole (2.2), management of
individual services (eg, individual treatments) (2.1}, definition
of criteria for the system entities (eg, AHPs, HIPCs) and
transactions between entities (2.3), definition of the standard
benefit package (2.4), and specification of the budget limit or
cap for the standard benefit package (2.5). To perform these
f'l,lnctions, the management function will use at least two.data
st.ores. ·one~ shoWn in Figure 4 as DS 2~1, will store·.infoimation
on the effectiveness and appropriate use of specific services or
technologies (eg, mammography, coronary artery bypass surgery,
antismoking education programs). The other, shown as DS 2..2, will
store information about the quality, cost and access of providers.
The former will be called the service-specific data store.. The
latter will be called the provider-specific data store.
Management of the system is a very comprehensive and complex task.
As described above, the adjectives •macro" and •oversight" are
intended to distinguish between the management of the system as a
whole (what might be called •macro• management) and the management
of the particular organizations within the system that actually
provide care (•micro• management, or •administration•). In the
new system being envisioned, one of the most important entities
responsible for the management function is the National Health
Board.
Management of service improvement (2.2) involves evaluating and
making recommendations about specific services or technologies.
An example is the evaluation and •approval" of guidelines for use
by practitioners. The managers who will perform this function
will use information (from data store 2.1) about the effectiveness
of specific services and guidelines that have been developed to
define the appropriate uses of those services. Information of
PRELIMINARY STAFF WORKING PAPER FOR ILLUSTRATIVE PURPOSES ONLY.
Page 7
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that type will be received from suppliers of intermediate products
such as researchers and drug companies and stored in the data
store for individual services (DS 2.1). The putputs of this
function, such as the •approved• guidelines about the appropriate
use of specific services, will be passed to providers (1.0), as
well as to any others who must make decisions about appropriate
services. For example, some decisions of this type might be made
at the local level by HIPCs. These results will undoubtedly also
be of great interest to those who supply intermediate products
(5.0) (eg, drug companies).
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Those who are managing the performance of the system as a whole
(2.1) (as opposed to managing individual services) will receive
reports· about the quality, cost and access of the care being
provided by providers (1.0). They will use that information to
,.frack:fhe· over.ai.l-.qual'ity.· of.:. t:b.e:- h¢al.tll :car.$. sys.tem ·as .. w.~lJ. .. q.~ ~<;>;:....... .
identify specific providers that might need techn.i'cal assistance.
The information gathered through this process will be stored in
the second data store that contains information about the
performance of specific providers (DS 2.2).
The management process will also perform a variety of functions
relating to defining the criteria that will establish the various
entities that will comprise the new health care system, and the
transactions that will occur between those entities. Examples
from the current system are the criteria the federal government
uses to define an HMO, the criteria the JCAHO uses to accreditate
hospitals, anO. the .. crite.ria. the N9,tional Cancer Institute :uses to
define a comprehensive cancer center.· In· the new· system,· this···
function would define·the criteria for what constitutes an HIPC or
AHP. Examples of information required for transactions are the
information on quality, cost and access that providers must r~port
to enable consumers to evaluate and make choices between AHPs.
For this function, information will be needed about both the
performance and structures of specific providers (data store 2.2)
as well as about the effectiveness and utilization of specific
services (data store 2.1). Once developed, the criteria will be
passed to providers (1.0), suppliers (5.0) and contractors (4.0).
g
-
One of the most important and visible functions of the managers
will be to specify the standard benefit package to which all
patients will have access. Determining the standard benefit
package will require information about the effectiveness and
recommended uses of specific services (DS 2.1), as well as
information about the quality, cost and utilization of services
being offered by providers (from DS 2.2). Additional information
will be needed about the maximum budget or cap under which the
standard benefit package must fit. This budget or cap will be
determined by the budget-setting function (2.5) of the management
function (eg, the National Health Board). Once the standard
benefit package has been defined, it will be passed to those who
contract for services (4.0) so that they can enter into contracts
with both providers and consumers.
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Page 8
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FIGURE 5. CONSUME HEALTH CARE SERVICES (3.0)
Consumers of services will perform three main functions. They are
to make a variety of decisions or choices (3.3); to receive health
care services when they develop health problems or are exposed to
health programs (eg, prevention programs) (3.2); and to provide
evaluative information (3.1) about such things as what diseases
they get (epidemiology), what is done to them (utilization), and
what happened afterward (outcomes).
.,,
· ··
··=:
Consumers make choices of many different types. They range from
deciding whether to join a HIPC at all (eg, a business can decide
between developing its own contract or joining a HIPC), to
selecting an AHP, to selecting a specific provider (eg, a
particular back specialist), to deciding on a treatment (eg,
lumpectomy vs radical mastectomy for breast cancer). To make
these choices, consumers will draw on information about
cont.ra·ctors .( 4; 0"·) ·, .. :such ·;·as· the ·pros·.· ·and<cons .. c)._t j·o~inirig· a·· HtPC·i.' :. ·, • ·.·. · ·
and about providers of services (1.0), such as their quality, cost
and access. Once a choice about a HIPC or provider has been made,
contracts can be developed (4.0). Decisions about individual
services will draw on information from providers (1.0) and will
determine the particular services that patients receive (3.2).
Managers (2.0) might also want to track information on the choices
consumers make.
Because the process of rece1v1ng services (3.2) affects service
utilization, information of this type will be important to
providers (1.0) and contractors (4.0).
The third main function of consumers is to provide information
( 3 . 1) to providers ( 1·. 0) , contractors ( 4 . 0) , and managers ( 2 . 0)
about their care, to help them assess needs, utilization and
outcomes. The types of information required for managing ··and, .
improving the delivery system include information on who they are
(demographics), what health problems they have (epidemiology),
what is done to them (utilization), what happens (outcomes), how
they feel about it (patient satisfaction), and what it costs
{resources). The information consumers report will be determined
by providers (1.0) and contractors {4.0) through such instruments
as questionnaires, interviews, and measurements.
FIGURE 6. CONTRACT FOR SERVICES (4.0)
The contract function includes three main processes. The most
obvious is to write and administer contracts for benefit packages
(4.1), both the standard benefit package developed by the
management function (2.0), as well as additional packages
developed locally by individual HIPCs or insurers. The second is
to provide fiscal intermediary services (4.2) such as setting
rates {including any adjustment for risks), receiving money from
consumers, investing the money, paying out money to providers and
maintaining an acceptable reserve. The third function is to
manage the activities of providers {4.3) that fall within the
scope of the contracts.
PRELIMINARY STAFF WORKING PAPER FOR ILLUSTRATIVE PURPOSES ONLY.
Page 9
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The first function, contracting for benefit packages (4.1)
requires information about the standard benefit package from the
managers (2.0). To the extent that the contractors want tc·
develop other benefit packages they will also need information
about the cost, effectiveness and utilization of specific services
that might be contained in the new benefit package. This
information can be obtained from providers as well as from
suppliers of intermediate products (in the form of research on
services). This function will pass information on covered
services to the fiscal intermediary function (4.2), and the
provider management function (4.3). This function will also pass
information to managers (reports on quality, cost and access of
provid~rs), providers (contracts), and suppliers (feedback on
coverage and utilization of their products).
,.·. · .. '··· ··ThEF
third 'function,· ·mana.g·ing· providers ''<'4··. j:~ ~·· wiii···dra\.i···on-··; ··
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evaluation criteria provided b¥ managers (2.0) as well as
information on covered services provided b¥ the administration
function (4.1). In turn, the management function will involve
passing reports on quality, cost and access to consumers (3.0) and
managers (2.0) and making payments to providers (1.0).
FIGURE 7. SUPPLY INTERMEDIATE PRODUCTS (5.0)
The term uintermediate product• is intended to be extremely
general, to encompass a very wide variety of •products• that are
used b¥ providers to provide health care services to consumers.
There are three main types of intermediate products. One is
trained personnel ·(5.1). Examples of suppliers of.such products
are medical schools, dental schools, postdoctoral fellowship
programs, CME programs, and annual meetings of professional
societies. The second type of intermediate product consists of
tangible products such as drugs, devices, sponges, and cafeteria
trays (5.2). They are developed and manufactured b¥ drug
· ·
companies, device manufacturers, hospital supply companies, and so
forth. The third type of intermediate product consists of
information {5.3). This information can vary from raw data, to
published research results, to guidelines.
For all of these functions, data will be stored in and retrieved
from a variety of data stores, summarized in this diagram as data
store 5.1. Specific examples of data stores pertinent to this
function include medical libraries, journal articles sitting on
physicians' shelves, the archives of the Food and Drug
Administration, and the Medicare databases used by health services
researchers. Those who produce information (eg, researchers) will
also receive information directly from consumers (3.0), providers
{1.0), from the management function (2.0) (eg, about utilization
patterns, the quality of specific types of providers), and from
contractors such as insurance companies or HIPCs {4.0). A wide
variety of information will be obtained from these sources. They
include information on the effectiveness of specific treatments,
information on utilization of services, suggestions for research
priorities and agendas, information on service delivery systems,
and so forth.
PRELIMINARY STAFF WORKING PAPER FOR ILLUSTRATIVE PURPOSES ONLY.
Page 10
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Suppliers of intermediate products will also provide a great deal
of information to providers, consumers and the management
function. For examples: The training function (5.1) will provide
medical knowledge to providers (1.0); the tangib~e products
production function (5.2) will provide information of varying
degrees of validity about the effectiveness of their products; and
the research function (5.3) will provide information about the
effectiveness, harms and costs of specific services to clinical
providers, consumers and researchers. Researchers and experts
will also provide information to administrators and managers in
the form of guidelines, planning tools, statistical methods,
advice, and so forth.
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INFORMATION FLOW DIAGRAM
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SUPPLY
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CONSUME HEALTH
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Dublin Core
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Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
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72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
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American Physicians Lawsuit HCTF (Health Care Task Force); 2-23-93 Info Flow
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First Lady's Office
Maggie Williams
Evan Ryan
Melanne Verveer
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2006-0223-F
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Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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William J. Clinton Presidential Library & Museum
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1/8/2015
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42-t-2194630-20060223F-006-004-2015
2194630
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https://clinton.presidentiallibraries.us/files/original/9ccb18c060d7478f4b84d182f491c9d0.pdf
040e6bf1a4612aee8cfefab5ea6a406c
PDF Text
Text
with DHHS earnings and leave statements.
See Tab 64 attached to
this Memorandum.
Carolyn Handy
Chief Executive Officer, Blacks Educate Blacks About Sexual
Health Issues (Declaration of Marjorie Tarmey, Document No. 1077).
Ms.
Handy played a major role in the Interdepartmental Working
Group and its Cluster Groups,
Working Groups and Subgroups.
According to the DHHS earnings and leave statements, Ms. Handy was
reimbursed
for
at
least
640
hours
of
participation
on the
Interdepartmental working Group and its Cluster Groups, Working
Groups and Subgroups.
Ms.
Bandy entered the Old Executive Office
Building on at least 42 occasions.
Ms.
Handy was assiqned to
Cluster IIB, "New system Coverage, Coverage for Working Families"
(Declaration of Marjorie Tarmey, Document No. 145), and Cluster
IIC, "Coverage for Low-Income and Non-Working Families (Declaration
of Marjorie Tarmey, Document No. 155), and was a Special Consultant
to Cluster III, "Integrated Health Plans", Group 12, "Health Care
Workforce Development" (Declaration of Marjorie Tarmey, Document
No. 197).
Ms. Bandy's SF 450 form states her date of appointment
was February 10, 1993, but DHHS earnings and leave statements
indicate that she started on February 5, 1993.
see Tab 65 attached
to this Memorandum.
Rick Kronick, Ph.D.
Assistant Professor of
Political
Science,
University
of
California (Declaration of Marjorie Tarmey, Document No. 1090).
Kr. Kronick was reimbursed for at least 560 hours of participation
128
�on the Interdepartmental Working Group and its Cluster Groups,
Working
Groups
and
Subgroups.
Kronick
Mr.
Executive Office Building at least 28 times.
entered
the
Old
Mr. Kronick served as
Group Leader for Cluster I, "New System Organization••, Group 1,
"Principles and Operation of Purchasing Cooperatives •• , and Group 4,
"A Global Budget••.
He was also a member of Cluster II, "New System
coverage 11 , Group 7, ••coverage for Working Families (Declaration of
Marjorie Tarmey, Document No. 774).
See Tab 66 attached to this
Memorandum.
Roz D. Lasker, M.D.
Member,
(
Physician
Payment
Review
Commission
'PPRC 11 ) (Declarations of Marjorie Tarmey, Document Nos. 1070 and
1
1090). Declaration of Genevieve H. Young, Exh. 31.
Other members of
the PPRC who participated on the Task Force include Linda Aiken,
Karen David,
reimbursed
Philip Lee,
for
at
least
and Uwe Reinhardt.
544
hours
of
Dr.
Lasker was
participation
on
the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
Dr. Lasker entered the Old Executive Office
Building on at least 19 occasions.
Cluster II,
Dr. Lasker was assigned to
"New system Infrastructure and Support 11 ,
Special Consultant to Group 9,
11
Quality Management••.
and as a
See Tab 67
attached to this Memorandum.
Lawrence R. Levitt, IIPP
Special Assistant for Health Policy, California Department of
Insurance (Declarations of Marjorie Tarmey, Documents Nos. 1077 and
1091).
According to·his DHHS earnings and leave statements, Mr.
129
�Levitt was reimbursed for
640 hours of participation on the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
Mr. Levitt entered the Old Executive Office
Building on at least 26 occasions.
Cluster I,
Mr. Levitt was assigned to
"New System organization", Group 4 Leader,
"Global
Budget" (Declaration of Marjorie Tarmey, Document No. 14), and
Group 5,
"Insurance Reform"
Document No. 34).
over
thirty
(Declaration
of
Marjorie
Tarmey,
Mr. Levitt's SF 450 was signed March 11, 1993,
(30)
days
after
Interdepartmental Working Group.
he
was
appointed
See Tab
68
to
the
attached to this
Memorandum.
Simi H. Litvak
World Institute on Disability-California Research Director.
According to DHHS earnings and leave statements, Ms. Litvak was
reimbursed
for
at
least
408
hours
of
participation
on .the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
Ms. Litvak entered the Old Executive Office
Building at least 12 times.
Ms. Litvak was assigned to Cluster IX,
"Long Term Care", Group 36, "Disability cross-cutting Group", where
she is identified as being from the World Institute on Disability
(Declaration of Marjorie Tarmey, Document No.
671).
See Tab 69
attached to this Memorandum.
carol Miller, MPH
Public Health Consultant, Mountain Management company, New
Mexico (Declarations of Marjorie Tarmey, Documents Nos. 1077 and
1091). According to DHHS earnings and leave statements, Ms. Hiller
130
�was reimbursed for at least 560 hours of participation on the
Interdepartmental Working Group and its Clusters, Working Groups
and Subgroups.
Ms.
Miller entered the Old Executive Office
Building on at least 54 occasions.
Ms. Miller was assigned to
Working Group 6, "Benefits", of Cluster IIA, "New System Coverage"
(Declaration of Marjorie Tarmey, Document No. 134), and on Working
Group 1,· "Principles and Operations in Purchasing Cooperatives",
Cluster I,
"New System organization"
Tarmey, Document No. 3).
(Declaration of Marjorie
Ms. Miller's SF 278 reveals that she is
the sole proprietor of a management consulting firm called Mountain
Management company in Ojo Sarco, New Mexico, and the company
contracts for state and federal funds to consult as a government
contractor through the New Mexico General Services Administration.
See Tab·7o attached to this Memorandum.
Lois Quam, MA
Vice President, Public Sector services, United Health Care
Corporation (Declaration of Marjorie Tarmey, Document No. 734).
Lois Quam was perhaps one of the most important players on the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
Ms. Quam was reimbursed for at least 640
hours of participation on the Interdepartmental Working Group and
its Cluster Groups, Working Groups and Subgroups. Ms. Quam entered
the Old Executive Office Building on at least 26 occasions, and Ms.
Quam also was on the "passholder's list".
of
Cluster
care/Toward
1,
Ms. Quam was the Leader
"New System Organization",
& Beyond-Rural"
(Declaration
131
Group
2,
"Managed
of Marjorie Tarmey,
�Document No. 7), and was also on Working Group 19, Cluster VI,
"Short-Term
Cost
Controls"
(Declaration
of
Marjorie
Tarmey,
Document No. 482), and Group 18 of Cluster VI, "Accelerating New
System Development" (Declaration of Marjorie Tarmey, Document No.
478). Ms. Quam's SF 278 states that she earns $112,763 from United
Health Care Corporation in Minneapolis, Minnesota, and is also a
Board Member of the Center for Health Care Access and Reform, St.
Paul, Minnesota.
In Part II of her SF 278 form, which would
disclose compensation in excess of $5,000. 00,
it reads,
"See
attached Page (p7)", but this attached page was omitted from the
documents produced by Defendants.
As will be seen, infra, United
Health Care corporation is an important name to remember.
See Tab
71 attached to this Memorandum.
Sally
K.
Richardson
Director, Public Employees' Insurance Agency, West Virgi_nia
Health Care Planning Commission, Vice-Chair, West Virginia Health
Care
Planning
Commission
(Declarations
of
Marjorie
Tarmey,
Documents Nos. 1079 and 1091). Ms. Richardson played a significant
role in the Interdepartmental Working Group and its Cluster Groups,
Working Groups and Subgroups. According to DHHS earnings and leave
statements, Ms. Richardson was paid for at least 376 hours of
participation on the Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups.
lis.
Richardson
entered the Old Executive Office Building on at least 56 occasions.
Ms.
Richardson
was
assigned
to
Cluster
I,
"New
System
Organization", Group lA, "Health Plans, Providers, and Patients in
132
�the New System" (Declaration of Marjorie Tarmey, Document No. 5) 1
Group 2 1 "Managed Care/Toward & Beyond" (Declaration of Marjorie
Tarmey 1 Document No. 8)
Marjorie Tarmey,
Group 12,
1
Group 3 1 "Governance" (Declarations of
Documents Nos. 12 and 82 Cluster III 1 Working
"Health Care Workforce Development"
Marjorie Tarmey,
Documents
Nos~
(Declarations of
197 and 520).
The Robert Wood
Johnson Foundation gave the West Virginia Health Care Planning
Commission
$149,971
for
16
months
to
assist
the
system needed
State
for
in
strengthening
its health statistics
health
policymaking.
Declaration of Genevieve H. Young, Exh. 4, 1992 RWJF
Annual Report, ID No. 13607, at 55-56, a preliminary step towards
participating in the "State Initiatives in Health care Reform"
program.
See Tab 72 attached to this Memorandum.
Aaron Shirley, M.D.
Project Director and Pediatrician, Jackson-Hinds Comprehensive
Health Center,
Jackson,
Mississippi
Tarmey, Documents Nos. 1091 and 1079).
(Declarations
of
Marjorie
According to DHHS earnings
and leave statements, Dr. Shirley was paid for at least 408 hours
of participation on the Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups.
Dr. Shirley entered
the Old Executive Office Building on at least 22 occasions, but
also held a
pass.
Dr.
Shirley served on Working Group IV,
"Integration of Government Programs",
Subgroup 13,
"Medicare"
(Declaration of Marjorie Tarmey, Document No. 407), Cluster Group
III, "Integrated Health Plans", Group 12, "Health Care Workforce
Development" (Declarations of Marjorie Tarmey, Document Nos. 2 and
133
�526),
and
Cluster
VIII,
"Health
Policy
Initiatives
for
the
Underserved" , Group 2 2 , "Urban/Rural" , Subgroup, "Underserved Rural
and Inner City Areas" (Declaration of Marjorie Tarmey, Document No.
30034).
The State of Mississippi has been a recipient of large
amounts of RWJF funds.
See Tab 73 attached to this Memorandum.
Shoshanna Sofaer, DRPB
Associate Professor,
George Washington University Medical
Center, Health service Researcher (Declarations of Marjorie Tarmey,
Document Nos.
1079 and 1091) •
Shoshanna Sofaer was
heavily
involved in the Interdepartmental Working Group and its Cluster
Groups, Working Groups and Subgroups.
According to DHHS earnings
and leave statements, Shoshanna Sofaer received reimbursement for
at least 520 hours of participation on the
Interdepartmental
Working Group and its Cluster Groups, Working Groups and Subgroups.
There are some discrepancies
in the DHHS earnings and
statements relative to lis. SOfaer.
lis.
SOfaer entered the Old
Executive Office Building at least 22 times.
Cluster
I,
"New
System Organization",
leave
liS. Sofaer served on
Group
3,
"Governance"
(Declaration of Marjorie Tarmey, Document No. 94), and Cluster II,
"New System Coverage", Group 8, "Coverage for Low-Income and NonWorking Families", where she was a Subgroup Leader (Declaration of
Marjorie Tarmey, Document No. 157).
Group
40,
"Academic Health
Ms. SOfaer also served on Work
Centers".
The
George
washington
University Medical Center as noted supra, has received considerable
amounts of RWJF and Kaiser grant monies.
this Memorandum.
134
See Tab 74 attached to
�Paul Starr, Ph.D.
Sociologist, Princeton University (Declarations of Marjorie
Tarmey, Document Nos. 1079 and 1092).
According to DHHS earnings
and leave statements, Dr. Starr was reimbursed for at least 680
hours of participation on the Interdepartmental Working Group and
its Cluster Groups,
Working Groups and Subgroups.
Dr.
Starr
entered the Old Executive Office Building on at least 31 occasions,
and his name appeared on the list of passholders.
Dr. Starr was
assigned to be Chair, "Transition to the New System" Task Group,
Group 18 (Declarations of Marjorie Tarmey, Document Nos. 477 and
478), and also served on Cluster VI, "Cost Containment", Group 20,
"Cost Controls" (Declaration of Marjorie Tarmey, Document No. 482).
See Tab 75 attached to this Memorandum.
Robyn Stone, DRPB
Health Services Researcher, Senior Policy Analyst, Project
HOPE (Declarations of Marjorie Tarmey, Document Nos.
1092).
1079 and
MS. Stone played a central role on the Interdepartmental
Working Group and its Cluster Groups, Working Groups and Subgroups.
According to DHHS earnings and leave statements, MS. Stone was
reimbursed
for
at
least
656
hours
of
participation
on
the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
Ms. Stone entered the Old Executive Office
Building on at least 28 occasions,
passholder's list.
and she appeared on the
MS. Stone was the Chair of Cluster X, "Long
Term Care" (Declaration of Marjorie Tarmey, Document No. 584), and
was also a member of· the "Disability Cross-cutting" work Group,
135
�Group 36 (Declaration of Marjorie Tarmey, Document No. 671).
See
Tab 76 attached to this Memorandum.
Robert Valdez, Ph.D. ·
Associate Professor, UCLA School of Public Health and Health
Policy Analyst Specializing in Children's Issues at the RAND
Corporation (Declarations of Marjorie Tarmey, Document Nos. 1079
and 1092).
According to DHHS earnings and leave statements, Dr.
Valdez was reimbursed for at least 400 hours of participation on
the Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
Dr. Valdez·entered the Old Executive Office
Building on at least 15 occasions, and his name appears on the
passholder's list.
Dr. Valdez served on Cluster I, "New System
coverage", Group 5, "Insurance Reform", Working Group II, "New
System Coverage", Subgroup 6, "Benefits" (Declaration of Marjorie
Tarmey, Document No. 116), where he was a co-subgroup Leader with
Linda Bergthold (Declarations of Marjorie Tarmey, Document Nos. 122
and 123) • Dr. Valdez also served on Working Group 7, "Coverage for
Working Families" (Declaration of Marjorie Tarmey, Document No.
139) and Working Group 8, "Coverage for Low-Income and Non-Working
Families" (Declaration of Marjorie Tarmey, Document No. 157).
See
Tab 77 attached to this Memorandum.
Richard Veloz, JD, MPH
Staff Director, House Aging Committee, 8/89-2/93, full-time
SGE (Declarations of Marjorie Tarmey, Document Nos. 1679, 1080 and
1092).
According to DHHS earnings and leave statements, Mr. Veloz
was reimbursed for at least 600 hours of participation on the
136
�Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
After he had resigned as Staff Director for
the House Select Committee on Aging,
Mr.
Veloz entered the Old
Executive Office Building on at least 48 occasions.
Mr.
Veloz was
the staff Director for the House Select Committee on Aging, a
committee which lost its funding on March 31, 1993.
his SF 278,
Mr.
According to
Veloz apparently left this position as of February,
1993 to work on the Interdepartmental Working Group.
Mr.
Veloz was
assigned to Working Group III, "Integrated Health Plans", Group 12,
"Health Care Workforce
Tarmey,
Document
No.
Development"
526),
Cluster
(Declaration
VIII,
of Marjorie
Working
Group
22
(Declarations of Marjorie Tarmey, Document Nos. 167, 168 and 178),
and Cluster X,
"Long-Term Care",
Liaison between Cluster II,
Working Group 8 and Cluster VIII, Working Group, "Underserved Rural
and Inner-City Areas" (Declarations of Marjorie Tarmey, Document
Nos. 624, 584 and 715).
See Tab 78 attached to this Memorandum.
Josh Wiener, Ph.D.
senior Fellow, Brookings Institution (Declaration of Marjorie
Tarmey, Document No. 1093) •
Dr. Wiener played a large role in the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
According to DHHS earnings and leave
statements, Dr. Wiener was reimbursed for at least 566 hours of
participation on the
Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups.
Dr. Wiener entered
the Old Executive Office Building on at least 32 occasions, and he
is on the
passholder~s
list.
Dr. Wiener served on Cluster Group
137
�IV,
"Integration of Government Programs", Subgroups "Medicare"
(Declaration of Marjorie Tarmey, Document No. 407), Subgroup 14,
"Department of Defense" (Declarations of Marjorie Tarmey, Document
Nos. 416 and 417), Subgroup 14A, "Government Programs" (Declaration
of Marjorie Tarmey, Document No. 451), and Cluster X, "Long Term
Care",
Liaison
with
"Integration
of
Government
(Declaration of Marjorie Tarmey, Document No. 584).
Programs"
See
Tab
79
attached to this Memorandum.
Walter Zelman
Special Deputy for Health Insurance, California Department of
Insurance
and . author
of
the
so-called
"Garamendi
Plan 1115
(Declarations of Marjorie Tarmey, Document Nos. 1080 and 1093).
Mr. Zelman played a major role on the Interdepartmental Working
Group
and
its Cluster Groups,
Working Groups
and Subgroups.
According to DHHS earnings and leave statements, Mr. Zelman was
reimbursed
for
at
least
720
hours
of
participation
on
the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
Mr. Zelman entered the Old Executive Office
Building on at least 48 occasions.
Mr. Zelman served as Chair of
Cluster III, "New system organization" (Declaration of Marjorie
Tarmey,
Document No.
1218) ,
and attended Toll Gates 2 and 3
(Declarations of Marjorie Tarmey, Documents Nos. 976 and 977).
Tab 80
See
attached to this Memorandum.
15
For an explanation of the "Garamendi Plan," see Declaration
of Genevieve H. Young, Exh. 32.
138
�H.
ALLEGED UNCOMPENSATED WORK GROUP "EXPERTS" AND "CONSULTANTS"
Declaration of Marjorie Tarmey,
Document No.
1083,
lists
alleged uncompensated "experts and consultants" who participated on
the Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
The persons listed in these categories in
Document No. 1083 (Declarations of Marjorie Tarmey) and relevant
information regarding each of these persons as reflected in other
documentation produced by the Defendants, are attached as Tabs Bl
through 99 to this Memorandum.
Each person and their respective
roles on the Interdepartmental Working Group and its Cluster
Groups, Working Groups and Subgroups, as revealed by documents
produced by the Defendants, are discussed below, seriatim.
1.
Full-Time "Consultants"
Judith F. Eddy
Research Associate, Duke University.
In their First Discovery
Responses, the Defendants stated that Judith Eddy participated
full-time as a "member of the interdepartmental working group" • Ro
travel vouchers or DBBS earnings and leave statements have been
produced by the Defendants relative to Judith Eddy.
the precious
According to
little documentation which was supplied by the
Defendants, Ms. Eddy entered the Old Executive Office Building on
at least 19 occasions, and was on the passholder's list.
The only
really significant paperwork on Judith Eddy is an SF 450 conflict
of interest form which was signed on March 31, 1993, more than
thirty
(30)
days
after
she
began
her
assignments
on
the
Interdepartmental Working Group and its Cluster Groups, Working
139
�Groups and Subgroups. Judith Eddy was available full-time, but was
unpaid.
She
(Declaration
of
was
assigned
Marjorie
a
White
Tarmey,
House
telephone
Document No.
260),
number
and was
assigned to Cluster III, "New System Infrastructure and Support"
(Declaration of Marjorie Tarmey, Document No. 260), where she is
described as "Staff, Health Care Workforce" (Group 12) (Declaration
of Marjorie Tarmey,
Document No. 357), and "Cluster Assistant"
(Declarations of Marjorie Tarmey, Document Nos. 357 and 364).
See
Tab 81 attached to this Memorandum.
Arnold M. Epstein, M.D., M.A.
Professor, Harvard Medical School Brigham & Women's Hospital:
Robert Wood Johnson Foundation Health Policy Fellow (Declarations
of Marjorie Tarmey,
supra,
Document Nos. 1094 and 1078) •
As stated,
Dr. Epstein was a Robert Wood Johnson Foundation Health
Policy Fellow.
For some reason, of all the RWJF Fellows on the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups, Dr. Epstein was the only Fellow classified as
an "SGE, full-time" (Declaration of Marjorie Tarmey, Document No.
1094) • The Defendants openly mislead the Plaintiffs and this Court
by attempting to classify the other RWJF Fellows as full-time
government employees.
On March 15, 1993, Dr. Epstein filed an SF
450 conflict of interest form stating he was a "special government
employee, intermittent," with Health and Human Services, and that
he started on February 17, 1993.
Of course, documents produced by
Defendants show that Dr. Epstein was a full-time participant, not
an "intermittent" participant (Declaration of Marjorie Tarmey,
140
�Document No. 1094).
Dr. Epstein entered the Old Executive Office
Building on at least 37 occasions, and Dr. Epstein possessed a
White House pass.
Dr. Epstein played an important role in the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups, which is not surprising considering the
integral role of the Robert Wood Johnson Foundation in the push for
preconceived health care reform legislative measures on the state
and federal level.
Dr. Epstein was identified as both an "SGE" and
as a Congressional representative from the Senate Labor and Human
Resources Committee (Declaration of Marjorie Tarmey, Document No.
260).
Dr. Epstein served on Working Group 40,
Centers"
(Declaration of Marjorie Tarmey,
"Academic Health
Document No.
704),
Cluster III, Group 9, "Quality Measurement", as Task Group Leader
(Declarations of Marjorie Tarmey, Document Nos. 233 and 186), and
Cluster III, "New System Infrastructure and Support" (Declaration
of Marjorie Tarmey, Document No. 260).
See Tab 82 attached to this
Memorandum.
Alan Billman, II.D.
University of Pennsylvania Medical School, alleged consultant,
part-time,
Document
no
No.
documentation
compensation
1077).
relative
The
to
(Declaration
of
Defendants
have
Dr.
Hillman's
Marjorie
produced
service
Tarmey,
little
on
the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
Dr.
Hillman's SF 450 shows his date of
appointment was February 8, 1993, but his SF 450 was dated october
15, 1993, clearly more than thirty (30) days after his appointment.
141
�The records produced by the Defendants show no entries by Dr.
Hillman to the Old Executive Office Building.
Dr. Hillman was
assigned as a consultant to work with Cluster III, "New System
Infrastructure
and
Document No. 261).
Support"
(Declaration
of Marjorie Tarmey,
According to records produced by Defendants,
Dr. Hillman worked without compensation and kept no record of his
time on the Interdepartmental Working Group.
See Tab 83 attached
to this Memorandum.
Mark .D. Smith, M.D., MBA
Vice President,
Kaiser Family Foundation
Marjorie Tarmey, Document No. 1075).
(Declaration of
During Dr. Smith's tenure on
the Task Force, he was promoted to Executive Vice President of the
Kaiser Family Foundation (Declaration of Genevieve M. Young, Exh.
24).
The Defendants' records with regard to Mark Smith are
blatantly contradictory and misleading.
1678, Smith was an "SGE".
According to Document No. 1094, Smith
was a "consultant, full-time,
Document No.
1101,
According to Document No.
Smith was
no compensation".
"full-time,
According to
with compensation".
According to Declaration of Marjorie Tarmey, Document No. 1079,
Smith was "part-time (double check)".
What is clear, however, is
that Smith played a key role on the Interdepartmental Working Group
and its Cluster Groups, Working Groups and Subgroups, "leveraging
government dollars" for the Henry J. Kaiser Family Foundation.
Smith executed an SF 450 conflict of interest form on April 22,
1993, more than thirty (30) days after he began serving on the
Interdepartmental Wor-king Group and its Cluster Groups, working
142
�Groups and Subgroups.
The SF 450 is also part of the contradictory
documentation because on it he identifies himself as an "unpaid
special employee". Smith entered the Old Executive Office Building
on at least 19 occasions, and his name appears on the passholder's
list.
Smith participated on Cluster VIII, Group 22, "Underserved
Populations", and was interested in monitoring "Accountable Health
Plans on Underserved Populations" (Declaration of Marjorie Tarmey,
Document No. 1318).
Smith also served on Cluster III, Group 12,
"Health Care Workforce Development (Declaration of Marjorie Tarmey,
Document No. 526}.
See Tab 84 attached to this Memorandum.
Ciro Sumaya, M.D.
Associate Dean, University of Texas Health Sciences Center,
San Antonio, Texas (Declarations of Marjorie Tarmey, Document Nos.
197 and 1079).
Marjorie
According to Document No. 1092, Declaration of
Tarmey,
compensation".
Sumaya served
as
an
"SGE,
Full-Time,
with
Document No. 1079 indicates she was "Full-Time".
However, no DIDIS earninqs and leave statements were produced for
Sumaya, and on her administrative time and leave record it is
stated "Employee worked without compensation: kept no record of
time on the job."
states
her
Sumaya's SF 450 is dated March 20, 1993, and
starting
date
as
February
22,
1993,
which
is
contradicted by the 2/1/93 date on her administrative time and
leave statement.
Sumaya entered the Old Executive Office Building
at least 22 times, and, her name appears on the passholder's list.
Sumaya was assigned as a "special consultant" to Working Group III,
"New system Infrastructure", Group 12 I
143
"Health Care Workforce
�Development" (Declaration of Marjorie Tarmey, Document No. 197),
and Group 14, "Facilitating Professional Development" (Declaration
of Marjorie Tarmey, Document No. 206).
Sumaya is listed under
"Chairs and Consultants for Cluster 3" (Declaration of Marjorie
Tarmey, Document No. 304), and Group 40, "Academic Health Centers"
(Declaration of Marjorie Tarmey, Document No. 704).
See Tab 85
attached to this Memorandum.
Farah M. Walters, MBA, MA
President and CEO,
University Hospitals,
Cleveland,
(Declaration of Marjorie Tarmey, Document No. 1092).
Ohio
According to
Declarations of· Marjorie Tarmey, Documents Nos. 1080 and 1092,
Walters was a "Consultant, Full-Time, With Compensation".
Despite
this status, no DIDIS earnings and leave statements exist regarding
Ms.
Walters.
According to her administrative time and leave
record, Walters allegedly worked without compensation and kept no
record of her time.
Ms.
Walters entered the Old Executive Office
Building on at least 10 occasions.
According to the Defendants'
First Discovery Responses, Walters was assigned to the group
entitled
11
Accelerating New System Development 11 •
See Tab 86
attached to this Memorandum.
Megan Toohey
According
Defendants,
Ms.
to
the
little
Toohey was
documentation
a
"special
provided
assistant"
by
from
the
HHS.
According to the working group lists provided by Defendants (see
discussion, supra), Ms. Toohey was assigned to several clusters.
Mo DIDIS earnings and leave statements or conflict of interest forms
144
�have been provided with respect to Ms. Toohey.
See Tab 87 attached
to this Memorandum.
2.
Part-Time "Consultants"
Document No.
1084 lists
"Part-Time Consultants"
for
the
Interdepartmental Working Group and its Cluster Groups, Working
Groups
and Subgroups.
individuals
based
Defendants,
and
Personal
upon
the
along with
summaries
on each of
documentation
by
the
supporting documentation
the
produced
these
are
attached at Tab 104 attached to this Memorandum.
When one reviews
the'documentation with respect to these individuals, especially the
number of times these persons attended meetings within the Old
Executive
Office
individuals
Building,
participated as
it
is
clear
members
of
that
the
many
of
these
Interdepartmental
Working Group and its Cluster Groups, Working Groups and Subgroups,
regardless of the flagrantly misleading characterizations of the
Defendants.
Each of these
individuals are discussed below,
seriatim.
Linda Aiken, Ph.D. , RH
Linda Aiken is a Professor and Director of the Center for
Health
Services
and
Policy
Research
at
the
University
of
Pennsylvania School of Nursing (Declarations of Marjorie Tarmey,
Document Nos. 1078 and 1087).
that she was
a
consultant,
Documents No. 1078 and 1087 state
part-time with compensation,
Document No. 1678 states that she was an "SGE".
but
According to DHHS
earnings and leave statements, Aiken was paid $300.00 per day for
a total of $6, 600. 00 for her participation on the Interdepartmental
145
�Working Group and its Cluster Groups, Working Groups and Subgroups.
Aiken is a former Vice President for Research at the Robert Wood
Johnson Foundation, where she served for fifteen ( 15) years.
Aiken
entered the Old Executive Office Building on at least 20 occasions.
Aiken
served
on
Working
Group
12,
"Health
Care
Workforce
Development", Cluster III, "Integrated Health Plans", as a Senior
Consultant (Declaration of Marjorie Tarmey, Document No. 197). Not
surprisingly,
considerable
the
sums
Robert
Wood
to
University
the
Johnson
Foundation
of
has
Pennsylvania.
given
See,
Declaration of Genevieve M. Young, Exh. 4, 1992 RWJF Annual Report.
See Tab 88 attached to this Memorandum.
Alan B. Krueger, Ph.D.
Economist,
Princeton University (Declarations of Marjorie
Tarmey, Document Nos. 1077 and 1090).
According to Document No.
-1090, Krueger was a "consultant, full-time, with compensation".
According to DHHS earnings and leave statements, Krueger earned
$300.00 per day for a total of $3,600.00
Krueger entered the Old
Executive Office Building on at least 7 occasions.
Document No.
1077 shows his availability full-time as of- February 10, 1993.
Krueger's administrative time and leave records are inconsistent
with his earnings records.
Krueger served on Cluster II, "New
System Coverage,
(Declarations
Benefits"
of
Marjorie
Tarmey,
Document Nos. 116 and 188), and "Coverage for Working Families"
(Declaration of Marjorie Tarmey, Document No. 136).
Krueger also
served on Cluster XII, Working Group 32, "Quantitative Analysis"
(Declarations of Marjorie
Tarmey, Document Nos. 713 and 714).
146
In
�1992, Princeton University received $50,000 from the Robert Wood
Johnson Foundation for a conference on managed competition.
See,
Declaration of Genevieve M. Young, Exh. 4, 1992 RWJF Annual Report
ID No. 20587, at 54.
See Tab 89 attached to this Memorandum.
Kathleen N. Lohr, Ph.D.
Public Policy Analyst, Deputy Division Director, Division of
Health Care Services,
Institute of Medicine
(Declarations
Marjorie Tarmey, Document Nos. 1077 and 1087).
of
Ms. Lohr earned
$300.00 per day for total of $6,300.00 for her participation on the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
Ms. Lohr's SF 450 conflict of interest form
is dated April 5, 1993, more than thirty (30) days after she became
a participant on the Interdepartmental Working Group.
Ms. Lohr had
two documented entries into the Old Executive Off ice Building. Ms.
Lohr's
employer,
the
Institute
of
Medicine,
has
received
considerable sums from the Robert Wood Johnson Foundation.
See,
Declaration of Genevieve M. Young, Exh. 4, 1992 RWJF Annual Report,
ID Nos. 19634 and 18555, at 59 and 56.
See Tab 90 attached to this
Memorandum.
David Satcher, M.D.
President, Meharry Medical College, Nashville, Tennessee, coChair,
Health
Care
Reform
Technical
Work
Group
on
Health
Professionals for the Health Policy Transition Team (Declarations
of Marjorie Tarmey, Documents Nos. 1079 and 1087).
According to DHHS earnings and leave statements,
earned
$300.00
per· day
for
a
147
total
of
$4,500.00
Satcher
for
his
�participation on the
Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups.
Satcher entered the
Old Executive Office Building on at least 12 occasions.
Satcher
attended each of the seven "Toll Gates", and was assigned as a
"consultant"
to
Cluster
III,
"New System
Infrastructure
and
Support" (Declarations of Marjorie Tarmey, Document Nos. 186 and
194), and was a "Senior Consultant to the Steering Committee" of
Working Group III, "Integrated Health Plans", Group 12, "Healthcare
Workforce Development" (Declaration of Marjorie Tarmey, Document
No. 197).
In 1992, the Robert Wood Johnson Foundation gave Meharry
Medical College $50,000 for enhancement of clinical training sites
and strategic planning for one year.
See, Declaration of Genevieve
H. Young, Exh. 4, 1992 RWJF Annual Report ID No. 20436, at 56.
According to the November, 1993 issue of Philanthropic Digest,
Meharry Medical College received a grant of $430, 408 from the
United States Department of Health and Human Services.
See Tab 91
attached to this Memorandum.
Jane L. Schadle, RH, MBA
Iowa Department of Health, Health Program Analyst, Program
Planner, Office of Rural Health (Declaration of Marjorie Tarmey,
Document No. 1087).
The DHHS earnings and leave statements show
that Schadle was paid $300.00 per day for a total of $12,000.00.
SChadle entered the Old Executive Office Building on at least 11
occasions.
Coverage",
Sehadle was assigned to Cluster II,
Group
8,
"Low
Income
and
"New System
Non-Working
Families"
(Declaration of Marjorie Tarmey, Document No. 167), and Cluster
148
�III,
"New
System
Infrastructure",
Group
12,
"Facilitating
Professional Development" (Declaration of Marjorie Tarmey, Document
No. 371).
Schadle's SF 450 was signed more than thirty (30) days
after she began participation on the Interdepartmental Working
Group and its Cluster Groups, Working Groups and Subgroups.
The
Robert Wood Johnson Foundation gave $285,923 to the State of Iowa,
Department of Public Health, for two years as part of its State
Initiatives
in
Health
Care
Financing Reform
Program.
See,
Declaration of Genevieve M. Young, Exh. 4, 1992 RWJF Annual Report,
ID No. 18519, at 37.
See Tab 92 attached to this Memorandum.
Documents Nos. 1073 and 1085 (Declarations of Marjorie Tarmey)
produced by the Defendants lists the support staff, or Temporary
Schedule c Employees, serving the members of the Task Force and the
Interdepartmental Working Group and its Cluster Groups, Working
·Groups and Subgroups. These persons included Steven Adamske, Molly
Brostrom, Toby Graff, Jim Jorling, Debbie Levine, Denise Ricketson,
Mary
Schuneman, Karj Tarmey, and Barbara Wooley.
These individuals
were hired by the Department of Health and Human Services, but
worked at the White House virtually every day, .and were holders of
White
House
$48, ooo. oo,
passes.
Each
was
paid
depending on their rank.
between
$18,000.00
and
Personal summaries and
supporting documentation regarding each of these individuals is
attached at Tab 93 to this Memorandum.
Document No. 1086 (Declaration of Marjorie Tarmey), states
that the twenty-four ( 24) individuals who were "original" full-time
"SGE" members of the Interdepartmental Working Group and its
149
�Cluster Groups, Working Groups and Subgroups should be off the
payroll in intervals, starting April 16, 1993, with four (4) to six
(6) persons, on May 1, 1993, six (6) to nine (9) persons, and then
on May 17, 1993, "the rest".
the working group.
This directive was not adhered to by
Most workin9 group members were paid until May
29, 1993, and then given a lump sum leave payment.
Many working
group members continued to report to the Old Executive Office
Building until the end of May, or, in light of pre-appointment
entry records into the Old Executive Office Building, at least
until May 21, 1993, which is the cut-off date on that document.
Many other individuals with ties to the private sector served
on the Interdepartmental Working Group and its Cluster Groups,
Working Groups and Subgroups.
The Defendants produced documents
relative to many of these individuals, but many were not accounted
for by the Department of Health and Human Services.
Personal
summaries and supporting documentation relative to each of these
individuals is attached at Tabs 94-99 to this Memorandum.
Each of
these individuals and their roles on the Interdepartmental Working
Group, and its Cluster Groups, Working Groups and Subgroups are
discussed below, seriatim.
Dr. Richard G. Frank
Johns
Hopkins
Development center.
University,
Dr.
Health
Services
Frank served on the
Research
and
"Mental Health"
Cluster Group and reimbursed for travel on at least 32 separate
occasions between February 15, 1993 and May 4, 1993.
Ro DIIBS
earnings and leave statements exist with respect to Dr. Frank, and
150
- -
- - - - - - - - - - - - - - - - - - - - -
�no conflict of interest form was filed for Dr. Frank.
There are no
records of his entries into the Old Executive Office Building.
Many of his travel reimbursement forms are from "Tascon, Inc." and
refer to Health Care Reform Task Force Meetings.
Clearly, Dr.
Frank participated in at least 32 meetings of the Interdepartmental
Working Group and its Cluster Groups, Working Groups and Subgroups,
and must be considered a member who participated significantly.
See Tab 94 attached to this Memorandum.Howard B. Goldman
University of Maryland, School of Medicine. According to DHHS
earnings and leave statements, Goldman was paid $355.00 per day for
thirty-one
(31)
days
participation on the
for
a
total
of
$11,390.00
for
his
Interdepartmental Working Group and its
Cluster Groups, Working Groups and
~ubgroups.
Goldman appears to
have entered the Old Executive Office Building on at least 27
occasions.
Goldman was assigned to Cluster IX, "Mental Health"
(Declaration of Marjorie Tarmey,
Document No. 537), "Children's
Mental Health Services" (Declaration of Marjorie Tarmey, Document
No. 558), and the "Mental Health Benefits Package" Cluster Group
(Declaration of Marjorie Tarmey,
Document No. 559).
The 1992
Robert Wood Johnson Foundation Annual Report reveals that he was a
grantee.
Unlike other "SGEs", Goldman's pay documents refer to
contract numbers.
Despite having requested production of these
contracts, Defendants have never supplied these documents to the
Plaintiffs in direct defiance of this Court's Orders.
attached to this Memorandum.
151
See Tab 95
�Stanley Jones
Self-employed independent contractor,
invoices for services rendered.
by the
Defendants
as evidenced by his
Little documentation was provided
regarding Mr.
Jones'
participation on the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
for two
( 2)
Mr. Jones appears to have been reimbursed
days work on Working Group
IV,
"Integration of
Government Programs", Subgroup 16, "FEHBP" (Declaration of Marjorie
Tarmey, Document No. 446).
Ro DHBS earnings and leave statements
or conflict of interest forms were produced with respect to Mr.
Jones.
See Tab 96 attached to this Memorandum.
Deborah Lewis-Idema
Vice President, MDS Associates, Inc. , Laurel, Maryland (a
Health and Human
Services Consulting Firm,
company's letterhead).
according to the
In their First Discovery Responses, the
Defendants classified Lewis-Idema as an "SGE" full-time "member" of
the Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
a "consultant".
In Document No. 545, she is referred to as
Lewis-Idema was paid a total of $14,135.00 for her
participation on the
Interdepartmental Working Group and
Cluster Groups, Working Groups and Subgroups.
its
Lewis-Idema entered
the Old Executive Office Building on at least 12 occasions.
She
was assigned to Cluster VIII, "Health Policy Initiatives for the
Underserved", Working Group 22, Subgroup c, "Women and Children"
(Declarations of Marjorie Tarmey, Document Nos. 525 and 1245).
152
Ro
�SF 278 or SF 450 conflict of interest form was filed by her.
See
Tab 97 attached to this Memorandum.
Joanne Lukomnik, M.D., MPH
Self-employed,
classified
by
Defendants
as
(Declaration of Marjorie Tarmey, Document No. 1678).
an
"SGE"
By invoice
dated May 17, 1993, Lukomnik billed HHS for thirty (30) days of
participation on the Interdepartmental Working Group and
its
Cluster Groups, Working Groups and Subgroups, at $693.00 per day
for a total of $20, 790. oo.
Lukomnik entered the Old Executive
Office Building on at least 15 occasions, and she also possessed a
White House pass.
Lukomnik was a Subgroup Leader on Cluster VIII,
"Health Policy Initiatives for the Underserved", Group 22, Subgroup
B Leader, "Vulnerable/High Risk Populations".
She also served on
Group 38, "Benefits Coordination" (Declarations of Marjorie Tarmey,
Document Nos. 30119 and 30129).
provided by Ms. Lukomnik.
Affairs
for
Project
Reither an SF 278 nor SF 450 were
Ms. Lukomnik is a contributor to Health
HOPE. 1 "
see
Tab
98
attached
to
this
Memorandum.
1
"Several members of the Interdepartmental Working Group, and
its Cluster Groups, Working Groups and Subgroups were on the
editorial board of Health Affairs, a publication of Project HOPE
funded by the Henry J. Kaiser Family Foundation. Many members of
the Interdepartmental Working Group, and its Cluster Groups,
Working Groups and Subgroups also published articles in Health
Affairs, and Health Affairs recently published the "Clinton Plan
Issue". See, Declaration of Genevieve H. Young, Exhs. 21, 22 and
23.
153
�Thomas o. Pyle, MBA
Senior Advisor, The Boston Consulting Group and President of
the Jackson Hole Group: Former President and CEO, Harvard Community
Health Plan (Declarations of Marjorie Tarmey, Document Nos. 1077
and 1100).
The Defendants labeled Mr. Pyle a "consultant, full-
time, with compensation" (Declaration of Marjorie Tarmey, Document
No. 1100).
It cannot be contested that Mr. Pyle was a full-time
active member of the Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups.
According to DHHS
earnings and leave statements, Pyle was paid $300.00 per day for
his participation on the Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups, for thirty-two (32)
days for a total of $9, 000. 00.
Pyle entered the Old Executive
Office Building on at least 36 occasions.
Pyle was assigned to be
Chair of Cluster III, "New System Infrastructure" (Declarations of
Marjorie Tarmey, Document Nos. 305 and 1218) , and was also a member
of Working Group 40, "Academic Health Centers" (Declaration of
Marjorie Tarmey, Document No. 704).
Pyle attended Toll Gate 2 and
Toll Gate 3 (Declarations of Marjorie Tarmey, Document Nos. 976 and
977).
Pyle's administrative time and leave record state that he is
"part-time intermittent, effective 2/8, resignation effective 4/8",
which
completely conflicts
Defendants.
with
other
documents
produced
by
Pyle executed an SF 450 conflict of interest form on
May 14, 1993, more than thirty (30) days after he began his
participation.
In 1992, the Robert Wood Johnson Foundation gave
three ( 3) grants to the Harvard Community Health Plan.
154
•.
Declaration
�of Genevieve M. Young, Exh. 4, 1992 RWJF Annual Report, ID Nos.
19450, 20091 and 18610, at 53, 58 and 59.
See Tab 99 attached to
this Memorandum.
I.
GOVERNOR'S REPRESENTATIVES
What is at least as or more important than the previous
discussion of private "outsider" members of the Interdepartmental
Working Group and its Cluster Groups, Working Groups and Subgroups
are the other members who were not disclosed in Defendants' First
Discovery Responses.
Indeed, the lists which were leaked to the
press by the Defendants while this case was on appeal to the D.C.
Circuit were woefully lacking in both accuracy and completeness.
The names of these individuals are disclosed from an analysis of
the sign-in lists from working group meetings,
and from the
telephone and fax lists of working group members.
Many of these
·individuals are from state ·and local government entities and
organizations, clearly not full-time officers or employees of the
federal government.
The lists reveal that numerous "outsiders"
were active members of the Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups, yet no official,
exact documentation has been produced relating to their activities.
Many members of the National Governors Association served on the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
with
the
National
Personal summaries on each person affiliated
Governors
Association
who
served
on
the
Interdepartmental Working Group and its Cluster Groups, Working
155
�Groups and Subgroups are attached at Tab 100 to this Memorandum.
Each of these persons are discussed below, seriatim.
Alan Weil
Health Policy Advisor to the Governor of Colorado, National
Governors Association, Washington, D.C.
Mr. Weil participated as
a member of the Interdepartmental Working Group and its Cluster
Groups, Working Groups and Subgroups.
Mr. Weil entered the Old
Executive Office Building on at least 27 occasions.
assigned
to
"Principles
Cluster
and
I,
"New System
Operation
Cooperatives", and Group 2,
of
Mr. Weil was
Organization",
Health
Insurance
Group
1,
Purchasing
"Managed care: Toward and Beyond"
(Declarations of Marjorie Tarmey, Document Nos. 1786 and 1787). Ho
DIDIS earnings and leave statements were produced for Mr. Weil and
Mr. Weil did not file either an SF 278 or an SF 450 conflict of
interest form.
In 1992, the Office of the Governor of the State of
Colorado received $566,999 from the Robert Wood Johnson Foundation
for an initiative to help states plan and develop reforms that
improve the financing and delivery of health care.
Declaration of
Genevieve H. Young, Exh. 4, 1992 RWJF Annual Report, ID No. 18519,
at 37.
See Tab 100 attached to this Memorandum.
Lane Volpe
President, National Governors Association, Washington, D.C.
Mr. Volpe was a key member of the Interdepartmental Working Group
and its Cluster Groups, Working Groups and Subgroups.
Mr. Volpe
entered the Old Executive Office Building on at least 36 occasions.
Mr. Volpe was assigned to Cluster X, "Long Term Care", Group 30,
156
�"Cost and Revenue" (Declaration of Marjorie Tarmey, Document No.
613), and Cluster XI, Group 31, "Economic Impact" (Declarations of
Marjorie Tarmey, Document Nos. 1786 and 1787).
served
on
Cluster
I,
"New
System
Mr.
organization",
Volpe also
Group
3,
"Governance" (Declarations of Marjorie Tarmey, Document Nos. 13 and
837).
Mr.
Volpe did not file either an SF 278 or an SF 450
conflict of interest form.
According to the Foundation Center, Who
Gets Grants, Who Gives Grants (1st ed. Fall, 1992), in 1991 and
1992, the National Governors Association received a total of
$425,000 from the Henry J. Kaiser Family Foundation to establish
the State Public Health Leadership Recruitment Center and to
identify actions that states can take to improve their health care
systems.
Declaration of Genevieve M. Young,
Foundation Annual Report, 1992, Exh. 10.
Henry J. Kaiser
See Tab 100 attached to
this Memorandum.
Anya Rader
National Governors Association, Special Assistant for Health
care Policy for Governor Dean of Vermont.
MS. Rader played an
integral role on the Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups.
Rader entered the
Old Executive Office Building on at least 44 occasions.
Rader was
assigned to Cluster I, "New System Organization", Group 4, "A
Global Budget", and Cluster VI, "Cost Containment", Group 20, "Cost
Controls" (Declarations of Marjorie Tarmey, Document Nos. 1786 and
1787) • Ro DBBS earninqs and leave statements were produced for MS.
Rader, and MS. Rader- did not file either an SF 278 or an SF 450
I
157
�conflict of interest form.
In 1992, the Robert Wood Johnson
Foundation
gave
of
Authority,
$808, 341
the
State
for
two
Vermont,
( 2)
Vermont
Health
years as part of
Care
the state
Initiatives in Health Care Financing Reform program,
to help
Vermont plan and develop reforms that improve the financing and
delivery of health care.
4,
1992
Declaration of Genevieve M. Young, Exh.
RWJF Annual Report, ID No. 18519, at 37.
attached to this Memorandum.
See Tab 100
Sen. Jeffords (R-VT) is currently the
Declaration of
only Republican co-sponsor of the Clinton plan.
Genevieve M. Young, n.2.
Raymond Scheppach
Executive Director, Virginia, National Governors Association,
Washington, D.C.
Mr.
Scheppach played an integral role in the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
Mr.
Scheppach entered the Old Executive
Office Building on at least 33 occasions.
Mr.
Scheppach was
assigned to Cluster VII, Group 21, "Financing" (Declarations of
Marjorie Tarmey, Document Nos. 1786 and 1787).
National
Governors
Association/Raymond
c.
In 1990, the
Scheppach,
Ph.D.,
received $25,000 from the Henry J. Kaiser Family Foundation to
publish a Report on Health Reform from the States' Perspective.
Declaration of Genevieve M.
Young,
Foundation Annual Report 1992, at 68.
Exh.
10,
Henry J.
Kaiser
Ro DBBS earnings and leave
statements were produced for Mr. SCheppach, and Mr. Scheppach filed
neither an SF 278 nor SF 450 conflict of interest form.
100 attached to this Memorandum.
158
See Tab
�Nikki McNamee
National Governors Association,
South Carolina.
Ms.
Office of the Governor of
McNamee entered the Old Executive Office
Building on at least 17 occasions.
She was assigned to Cluster I,
"New System Organization", Group 3, "Governance" (Declaration of
Marjorie Tarmey, Document No. 1787).
No DHHS earnings and leave
statements were produced for Ms. McNamee, and Ms. McNamee did not
file either an SF 278 or an SF 450 conflict of interest form.
According to Volume 39 of Philanthropic Digest (December 1993), the
Robert Wood Johnson Foundation gave $1,000,000 to South Carolina to
participate in the Information for State Health Policy program to
help state policymakers make
programs.
informed decisions
about health
See Tab 100 attached to this Memorandum.
Mary Jo O'Brien
National Governors Association, Deputy Commissioner, Minnesota
Department of Health.
Ms.
O'Brien played a key role on the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
Ms. O'Brien entered the Old Executive Office
Building on at least 29 occasions.
She was assigned to Cluster II,
"New System Coverage", Group 6, "Benefits", and Cluster VI, "Cost
Containment",
Group 18,
"Accelerating New System Development"
(Declaration of Marjorie Tarmey, Document No. 1787).
Ms. O'Brien
also served on Cluster I, "New System Organization", Group 1A,
"Health
Plans,
Providers,
and
Patients
in
the
New
system"
(Declaration of Marjorie Tarmey, Document No. 5). No DIDIS earnings
and leave statements were provided for Ms. O'Brien and Ms. O'Brien
159
�did not complete either an SF 278 or an SF 450 conflict of interest
form.
The Robert wood Johnson Foundation has given considerable
sums to the State of Minnesota.
See, Declaration of Genevieve M.
Young, Exh. 4, 1992 RWJF Annual Report, at 37 and 51.
See Tab 100
attached to this Memorandum.
Mary Leigh Brown
National
Governors
Oklahoma Health care.
Association,
Governor's
Commission
on
Ms. Brown entered the Old Executive Office
Building on at least 8 occasions.
Ms. Brown served on Cluster I,
"New System organization", Group 2, "Managed Care, Toward and
Beyond" (Declaration of Marjorie Tarmey, Document No. 11), Cluster
II, "New System Coverage", Group 6, "Benefits" (Declaration of
.Marjorie Tarmey, Document No. 153), Group 7, "Coverage for Working
Families" (Declaration of Marjorie Tarmey, Document No. 153).
Ho
· DIDIS earnings and leave statements were provided for Ms. Brown .and
she did not complete either an SF 278 or an SF 450 conflict of
interest form.
In 1992, the Robert Wood Johnson Foundation gave
the state of Oklahoma, Office of the Governor, $854,595 for two (2)
years for the State Initiatives in Health Care Financing Reform
program.
Declaration of Genevieve M. Young, Exh. 4, 1992 RWJF
Annual Report, ID No. 18519, at 37.
See Tab 100 attached to this
Memorandum.
DeAnne Friedholm
Office of Governor Ann Richards, State of Texas (Declaration
of .Marjorie Tarmey, Document No. 166).
Ms. Friedholm played an
integral role on the Interdepartmental Working Group and its
160
�Cluster Groups 1
Working Groups and Subgroups.
Ms.
Friedholm
entered the Old Executive Office Building on at least 27 occasions.
Ms.
Friedholm served on Cluster II 1 "New System Coverage" 1 Group
81
"Coverage for Low Income and Non-Working Families" (Declaration of
Marjorie Tarmey, Document No. 166), and also served on Group 36,
"Disability Cross-Cutting Working Group" (Declaration of Marjorie
Tarmey, Document No. 30080) • No DIDIS earnings and leave statements
were produced by the Defendants for Ms.
Friedholm,
and Ms.
Friedholm did not file an SF 278 or an SF 450 conflict of interest
form.
In 1992, the Robert Wood Johnson Foundation gave the State
of Texas, Office of the Governor, $50,000 for a task force to
develop an agenda for health care reform in Texas.
Declaration of
Genevieve M. Young, Exh. 4, 1992 RWJF Annual Report ID No. 19707,
at 59.
Texas was also one of fifteen (15) states to receive a
grant from the Robert Wood Johnson Foundation for a program. to
improve the distribution of primary care providers in underserved
rural and inner-city areas.
(June 1993).
Barbara
See Tab 100 attached to this Memorandum.
Smith
Office of the Governor,
Association.
See Vol. 39, Philanthropic Digest
Ms.
South Dakota, National Governors
Sm.ith played a key role as a member of the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
MS. Smith entered the Old Executive Office
Building on at least 25 occasions.
She was assigned to Cluster
VIII, "Health Policy Initiatives for the Underserved", Group 22,
"Urban/Rural". No DBBS earnings and leave statements were provided
161
�for Ms. Smith, and she did not file either an SF 278 or an SF 450
conflict of interest form.
South Dakota was also one of the
fifteen (15) states to receive a grant from the Robert Wood Johnson
Foundation for a program to improve the distribution of primary
care providers in underserved rural and inner-city areas.
39, Philanthropic Digest (June 1993).
See Vol.
See Tab 100 attached to this
Memorandum.
Emily Myers
National Association of Attorneys General, Washington, D·. C.
Due to a lack of documentation provided by the Defendants, Ms.
Myers' role on the Interdepartmental Working Group and its Cluster
Groups, Working Groups and Subgroups is somewhat of a mystery.
Ms.
Myers entered the Old Executive Office Building on at least 6
occasions, and her name also appears on the passholder' s list
produced by the Defendants.
Ho DBBS earnings and leave statements
or conflict of interest forms were produced regarding Ms. Myers.
See Tab 100 attached to this memorandum.
J.
CQUNTY REPRESENTATIVES
Numerous persons from the National Association of Counties
also played important roles as members of the Interdepartmental
Working Group and its Cluster Groups, Working Groups and Subgroups.
Personal summaries of each of these individuals' roles as discerned
from documents produced by the Defendants is attached at Tab 101 to
this Memorandum.
seriatim.
Each of these individuals is discussed below,
See Tab 101 attached to this Memorandum.
162
�Andrea Bempong
National Association of Counties,
National Association of
County Health Officials, Washington, D.C.
Ms. Bempong was assigned
to Cluster I, "New System coverage", Group 3, "Governance", on
behalf of the National Association of Counties.
There are no
records of her entries into the Old Executive Office Building, and
no DIDIS earnings and leave statements or conflict of interest forms
were produced regarding Ms. Bempong.
See Tab 101 attached to this
Memorandum.
Thomas Joseph
National Association of counties,
National Association of
County Health Officials, Washington, D.C.
Mr. Joseph was assigned
to attend group meetings other NACO employees were supposed to
attend but could ·not attend
·Document No. 1787).
(Declaration
of
Marjorie
Tarmey,
Mr. Joseph entered the Old Executive Office
Building on at least 18 occasions.
Ro DBHS earnings and leave
statements or conflict of interest forms were provided with respect
to Mr. Joseph.
See Tab 101 attached to this Memorandum.
Joseph Garcia
National Association of County Health Officials,
County, Ohio Department of Human Services.
cuyahoga
Mr. Garcia entered the
Old Executive Office Building on at least 15 occasions.
He was
assigned to Cluster II, "New System Coverage", Group 6, "Benefits",
group 7, "Coverage for Working Families", and Group 8, "Coverage
for Low-Income and Non-Working Families" (Declarations of Marjorie
Tarmey, Document Nos •. 1786 and 1787).
163
Ro DBHS earnings and leave
�statements or conflict of interest forms were provided for Mr.
Garcia.
See Tab 101 attached to this Memorandum.
Marcia Egbert
National Association of Counties,
County
Health
Commissioners
recorded
Building.
Officials,
~
entry
cuyahoga
National Association of
County,
Intergovernmental Affairs.
of
Ms.
Egbert
into
the
Ohio
Board
of
There is only one
Old
Executive
Office
She was assigned to Cluster II, "New System Coverage",
Group 6, "Benefits", Group 7, "Coverage for Working Families", and
Group
8,
"Coverage
for
Low
Income
and
Non-Working
Families"
(Declarations of Marjorie Tarmey, Document Nos. 1786 and 1787).
Ro
DHHS earnings and leave statements or conflict of interest forms
were provided with respect to Ms. Egbert.
See Tab 101 attached to
this Memorandum.
Irene Riley
National Association of counties, National Association of
County Health Officials, Los Angeles County Department of Health
Services.
Ms. Riley entered the Old Executive Office Building on
at least 13 occasions.
She was assigned to Cluster VI,
Containment",
"Accelerating New System Development",
Group 18,
Group 19, "Administrative Simplification", and Group 20,
Controls".
Ms.
Riley also served on Cluster VII,
"Cost
"Cost
Group 21,
"Financing" (Declaration of Marjorie Tarmey, Document No. 505).
Ro
DHBS earnings and leave statements or conflict of interest forms
were provided with respect to Ms. Riley.
this Memorandum.
164
....
See Tab 101 attached to
�Ellen Benavides
National Association of county Health Officials, Director of
Health Policy, Hennepin county, Minnesota Bureau of Health.
Ms.
Benavides played an integral role on the Interdepartmental Working
Group and its Cluster Groups, Working Groups and Subgroups.
Ms.
Benavides entered the Old Executive Office Building on at least 41
occasions.
She was assigned to Cluster VIII,
Initiatives
for
the
Underserved",
(Declarations of Marjorie Tarmey,
523) •
Group
22,
"Health Policy
"Urban/Rural"
Document Nos. 1786, 1787 and
No DBHS earnings and leave statements or conflict of
interest forms were provided with respect to Ms. Benavides.
See
Tab 101 attached to this Memorandum.
Herbert Bolt
National Association of County Health Officials, Director,
Mental Health Services, Montgomery County, Maryland.
Mr.
Bolt
played a key role on the Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups.
Mr.
Bolt entered the
Old Executive Office Building on at least 21 occasions.
He served
on Cluster IX, "Mental Health", Group 24, "Benefits", Group 25,
"Substance
Abuse",
and
Group
(Declarations of Marjorie Tarmey,
543) •
26,
"Children's
Services"
Document Nos. 1086, 1087 and
No DIDIS earnings and leave statements or conflict of
interest forms were provided with respect to Hr. Holt.
attached to this Memorandum.
165
See Tab 101
�Mary Uyeda
Director, County Health Policy Project, National Association
of Counties.
Ms. Uyeda played a key role on the Interdepartmental
Working Group and its Cluster Groups, Working Groups and Subgroups.
Ms. Uyeda entered the Old Executive Office Building on at least 23
occasions.
She was assigned to Cluster VII, Group 21, "Financing"
(Declarations of Marjorie Tarmey,
505) •
Document Nos.
1786,
1787 and
Ho DHHS earnings and leave statements or conflict of
interest forms were provided vi th respect to Ms. Uyeda.
See Tab
101 attached to this Memorandum.
Dan McLaughlin
National Association of County Health Officials, Hennepin
County, Minnesota Bureau of Health (Declaration of Marjorie Tarmey,
Document No. 478).
the
The Defendants failed to list Mr. McLaughlin on
intergovernmental
empioyee
list,
but
Mr.
McLaughlin
nevertheless participated heavily on the Interdepartmental Working
Group and its Cluster Groups, Working Groups and Subgroups.
Mr.
McLaughlin entered the Old Executive Office Building on at least 23
occasions.
He was
Initiatives
for
assigned to Cluster VIII 1
the
Underserved" 1
Group
22 1
"Health Policy
"UrbanjRural
Populations" (Declaration of Marjorie Tarmey, Document No. 478}.
Ho DHHS earnings and leave statements or conflict of interest forms
were provided vith respect to Mr. McLaughlin.
to this Memorandum.
166
See Tab 101 attached
�Robert Benedict
Pennsylvania
State
Association
of
County
Commissioners.
Little documentation has been produced by the Defendants with
respect to
Mr.
Benedict's role on the Interdepartmental Working
Group and its Cluster Groups, Working Groups and Subgroups.
Mr.
Benedict entered the Old Executive Office Building on at least 7
occasions.
Group 9,
He served on Cluster III, "New System Infrastructure" I
"Quality Measurement".
No DHIIS earnings and leave
statements or conflict of interest for:ms were produced with respect
to
K.
Mr.
Benedict.
See Tab 101 attached to this Memorandum.
OTHER INTERGOVERNMENTAL EHPLOYEES
Numerous other
11
intergovernmental employees 01 played roles on
the Interdepartmental Working Group and its Cluster Groups, Working
Groups
and Subgroups.
Personal
summaries on
each of
these
individuals derived from documents produced by the Defendants are
attached at Tabs 102 and 106 to this Memorandum.
Each of these
persons are discussed below, seriatim.
David Coronado
D.C. Department of Human services.
The records produced by
Defendants show that David coronado entered the Old Executive
Office Building on at least two occasions and that he was assigned
to Cluster VII, Group 21, "Financing" (Declaration of Marjorie
Tarmey, Document No. 505) •
No DHBS earnings and leave statements
or conflict of interest for:ms were produced regarding
See Tabs 102 and 106 attached to this Memorandum.
167
"·
Mr.
coronado.
�Douglas Peterson
The records produced by the
National League of Cities.
Defendants show that
Mr.
Peterson entered the Old Executive Office
Building on at least 5 occasions.
VII, Group 21, "Financing".
Peterson was assigned to Cluster
No DHIIS earnings and leave statements
or conflict of interest forms were produced for
Mr.
Peterson.
See
Tabs 102 and 106 attached to this Memorandum.
Janet Quist
National League of Cities.
The records . produced by the
Defendants show that she entered the Old Executive Office Building
on at least 7 occasions.
Ms. Quist was assigned to Cluster II,
"New System Coverage", Group 6, "Benefits", Group 7, "Coverage for
Working Families", and Group 8, "Coverage for Low-Income and Non
Working Families".
Ro DBBS earnings and leave statements or
conflict of interest forms were produced for Ms. Quist.
See Tabs
102 and 106 attached to this Memorandum.
Byron J. Barris
United states Conference of Mayors.
Barris was assigned to
Cluster VIII, "Health Policy Initiatives for the Underserved 11 ,
Group 22, "UrbanjRural Areas" (Declarations of Marjorie Tarmey,
Document Nos. 524 and 1787).
Ro DBBS earnings and leave statements
or conflict of interest forms were produced with respect to Mr.
Barris.
See Tabs 102 and 106 attached to this Memorandum.
Christine Milliken
National Association of Attorneys General.
Ms.
Milliken
entered the Old Executive Office Building on at least 6 occasions.
168
�The Defendants have produced little documentation regarding Ms.
Milliken, and no DHHS earnings and leave statements or conflict of
interest forms were produced for Ms. Milliken.
See Tabs 102 and
106 attached to this Memorandum.
Janis O'Meara
Intergovernmental Affairs.
Ms.
O'Meara entered the Old
Executive Office Building on at least 41 occasions.
The Defendants
have produced little documentation regarding Ms. O'Meara, and thus,
her role on the Interdepartmental Working Group and its Cluster
Groups, Working Groups and Subgroups is unknown.
See Tabs 102 and
106 attached to this Memorandum.
Roxlinne Wada
Pacific Island Health Officers Association.
There is only one
record of her entry into the Old Executive Office Building.
She
was assigned to Cluster I, "New System Organization", Group 2,
"Managed Care, Toward and Beyond".
Ro DHBS earninqs and leave
statements or conflict of interest forms were provided for Ms.
Wada.
See Tabs 102 and 106 attached to this Memorandum.
Enrique Vasquez-Quinlan
Secretary of Health/Puerto Rico.
The Defendants produced
little documentation regarding Mr. Vasquez-Quinlan's role on the
Interdepartmental Working Group, and its Cluster Groups, Working
Groups and Subgroups.
Mr.
Vasquez-Quinlan was assigned to Cluster
I, "New System Organization", Group 2, "Managed care, Toward and
Beyond" •
Ro DHBS earninqs and leave statements or conflict of
169
�interest forms were produced for
Mr.
Vasquez-Quinlan.
See Tabs 102
and 106 attached to this Memorandum.
L.
OTHER PRIVATE PERSONS
Numerous other persons who were not "full-time officers or
employees
of
the
federal
government"
also
served
on
the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
These persons are as follows:
Stuart A1 tman, Ph.D.
stuart Altman. is a Dean and Professor at the Heller School,
Brandeis University.
Altman was on the Clinton Transition Team
(Declaration of Marjorie Tarmey, Document No. 1097), and served on
Cluster VI, "Short-Term Cost Controls", . Group 20, "Interim Cost
Controls" (Declaration of Marjorie Tarmey, Document No. 1075). See
Tab 28 attached to this Memorandum.
Thomas Chapman, MPH
llr.
Chapman
is
the
Chief
Executive
Officer
of
Greater
Southeast Health Care Corporation and was a Program Director for
the Robert Wood Johnson Foundation Program, "Opening Doors" • See,
Declaration of Genevieve M. Young, Exh. 12.
Chapman
served on
Cluster VII, Group 21, "Financing" (Declaration of Marjorie Tarmey,
Document No. 1088).
Karen
See Tab 29 attached to this Memorandum.
Davis
Ms. Davis is a health economist and Senior Vice President of
the Commonwealth Fund.
She is a member of the Physician Payment
Review Commission (Declaration of Marjorie Tar.mey, Document No.
1714). Ms. Davis served on Cluster VI, "Short-Term Cost Controls",
170
...
�Group 20,
Tarmey,
"Interim Cost Controls".
Document No.
741).
Ms.
(Declaration of Marjorie
Davis served
part-time,
with
compensation (Declarations of Marjorie Tarmey, Document Nos. 1073
and 1095).
See Tab 28 attached to this Memorandum.
Jocelyn Elders, M.D.
or. Elders was appointed, but not yet confirmed, as Surgeon
General while she served on the Interdepartmental Working Groups
its Cluster Groups, Working Groups and Subgroups.
Thus, Dr. Elders
was still employed by the Arkansas State Department of Health when
she was serving on the Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups.
Dr. Elders served
"part-time with compensation" on Cluster VIII, Group 22, "Health
Policy Initiatives for the Underserved" (Declarations of Marjorie
Tarmey, Document Nos. 1111 and 1073).
See Tabs 30, 31 attached to
this Memorandum.
Lynn Etheredge
Ms. Etheredge was a health economist and consultant, former
Director at the Office of Management and Budget (OMB), and an
expert on managed care.
Ms.
Etheredge served part-time with
compensation, on Cluster I, "New System Organization", Groups 1
through 5 (Declarations of Marjorie Tarmey, Document Nos. 1073 and
1095).
See Tabs 3, 4, 5, 6, 7, 8 attached to this Memorandum.
Fernando Torres-Gil, Ph. D.
Torres-Gil is a gerontologist and Professor at the UCLA School
of Public Welfare.
Torres-Gil is the former director of the House
Select Committee on Aging.
He served on Cluster IX, "Long Term
171
�Care", Groups 27 through 30, and served part-time with compensation
(Declarations of Marjorie Tarmey, Document Nos. 1076 and 1096).
See Tabs 41, 42, 43, 44 attached to this Memorandum.
William Jews
Mr. Jews is President of Dimensions Health Corporation and
served on the Interdepartmental Working Group and its Cluster
Groups, Working Groups and Subgroups on Cluster III, Group 10,
"Information Systems". (Declaration of Marjorie Tarmey, Documents
Nos. 281, 1107).
See Tab 15 attached to this Memorandum.
Philip Lee, M.D.
Dr. Lee is a Health Policy Researcher, Professor of Social
Medicine and Director of the Institute for Health Policy studies at
the University of California San Francisco.
Dr. Lee also chair the
Physician Payment Review Commission. Dr. Lee served full-time with
compensation on the Interdepartmental Working Group and its Cluster
Groups, Working Groups and Subgroups Cluster VI, Group 20, "ShortTerm Lost Controls". (Declaration of Marjorie Tarmey, Documents
Nos. 485, 489, 494, 1100).
See Tab 28 attached to this Memorandum.
Steve McConnell, Ph. D.
Dr. McConnell is the Senior Vice President of the Alzheimer's
Association and served on the Interdepartmental Working Group and
its Cluster Groups, Working Groups and Subgroups on Cluster X,
Group 27, "Long-Term Care-Background", Group 28, "Long Term carePublic Options," Group 29, "Long Term Care-Private Options," and
Group 30, Long Term Care-Cost and Revenue" (Declaration of Marjorie
172
�Tarmey, Document No. 1108).
See Tabs 41, 42, 43, 44 attached to
this Memorandum.
Uwe Reinhart, Ph.D.
Reinhart is a Professor at Princeton University, School of
Public
and
International
Affairs
who
served
on
the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups on Cluster VI, Group 20, "Short-term Cost
Controls". (Declaration of Marjorie Tarmey, Document No. 1108).
See Tab 28 attached to this Memorandum.
Bobby Siapson, MA
Bobby
Siapson
is
the
Director
of
the
Division
of
Rehabilitation services, Arkansas Department of Human Services, who
was also the Disability Constituency Coordinator for the ClintonGore campaign.
Siapson
served on the Interdepartmental Working
Group and its Cluster Groups, Working Groups and Subgroups on
Working Group 36, "Disability Cross-cutting Group", and Cluster
VIII, Group 22, "Underserved Populations," and Cluster X, Group 28,
"Long-Term care-Public options". (Declaration of Marjorie Tarmey,
Documents Nos. 717, 1109, 1553).
See Tabs 30, 42 and so attached
to this Memorandum.
Diane Rowland, SC.D.
Rowland is a Health Policy Researcher, Director of the Kaiser
Commission on the Future of Medicaid, and Professor at the Johns
Hopkins University School of Public Health and Hygiene.
She served
full-tiae, with no compensation on the Interdepartmental Working
Group and its Cluster Groups, Working Groups and Subgroups on
173
�Cluster
II,
Group
8,
"Coverage
for
Non-Working
Families".
(Declarations of Marjorie Tarmey, Documents Nos. 173 and 806).
See
Tab 12 attached to this Memorandum.
Alan Hillman, M.D.
Hillman is a physician and professor at the Wharton School of
Business, University of Pennsylvania, conducting quality assurance
research.
Hillman served on Cluster III,
Group 9,
"Quality
Measurement" (Declaration of Marjorie Tarmey, Documents Nos. 261,
1088).
see Tab 14 attached to this Memorandum.
Lawrence Baker
Mr.
Baker is from Princeton University and served on Cluster
XI, Group 31, "Economic Impacts" (Declaration of Marjorie Tarmey,
Documents Nos.
687,
695, 697).
See Tab
45
attached to this
Memorandum.
Charlie Dockerty
Mr.
Dockerty
served
on
Cluster
v,
Group
17,
"Ethical
Foundations of the New system" (Declaration of Marjorie Tarmey,
Document No. 741).
See Tab 24 attached to this Memorandum.
Sybil Goldman
Ms. Goldman is emp;Loyed by Georgetown University 1 Maternal
Network for Children with Special Needs 1
Child and Adolescent
Service system Program Technical Assistance Center (which is funded
by the Department of Health and Human Services, Substance Abuse and
Mental Health Services). Ms. Goldman served on Cluster IX, "Mental
Health Services", Group 25 1 "Children's Mental Health Services".
Tab 106 attached to this Memorandum.
174
�Mike Hix
Mr. Hix is employed by the RAND Corporation.
He served on
Cluster IV, Group 13, "Medicare" (Declaration of Marjorie Tarmey,
Document No. 746).
See Tab 19 attached to this Memorandum.
Susan Hosek
Ms.
Hosek is employed by the RAND Corporation.
Ms.
Hosek
served on Cluster IV, "Integration of Government Programs," Group
14, "Department of . Defense".
(Declaration of Marjorie Tarmey,
Documents Nos. 417, 419, 421, 423 and 425).
See Tab 20 attached to
this Memorandum.
David Jackson, M.D.
Dr. Jackson is the President and Chief Executive Officer of
Assurqual, a quality management consulting firm located in Ohio.
Dr. Jackson served on Cluster III, "New System Infrastructure",
Group 9, "Quality Measurement" and Group 10, "Information Systems,"
as
a
full-time
"SGE"
hired through the White House Office.
(Declaration of Marjorie Tarmey, Documents Nos. 233, 234, 279).
See Tabs 14 and 15 attached to this Memorandum.
Jim Mays
Mr. Mays is employed by Actuarial Research Corporation, and
served
on
Cluster
XII,
Group
32,
"Quantitative
Analysis."
(Declaration of Marjorie Tarmey, Documents Nos. 751, 1334).
See
Tab 46 attached to this Memorandum.
Vincente Navarro, M.D.
Dr. Navarro is a Professor at the Johns Hopkins University.
Navarro served on Cluster I, "New system Organization", Group 3,
175
�"Governance". Navarro entered the Old Executive Office Building on
at least 12 occasions for meetings.
of
the
International
Journal
Navarro is the Editor-in-Chief
of Health Service,
repeatedly advocated a national health program.
and he has
Navarro is the
author of "Has Socialism Failed? An Analysis of Health Indicators
Under Socialism", International Journal of Health Services, Vol.
22, No.
4, pps. 583-601 (1992) and "Capitalism Has Not Won",
International Journal of Health Services, Vol. 22, No. 4, p. 603
(1992).
(Declaration of Marjorie Tarmey, Documents Nos. 13, 837).
See Tab 6 attached to this Memorandum.
Sara Rosenbaum
Ms. Rosenbaum is employed by George Washington University,
Center for Health Policy Research. Ms. Rosenbaum served on Cluster
VIII, "Health Policy Initiatives for the Underserved" (Declaration
of Marjorie Tarmey, Document No. 755) •
See Tab 30 attached to this
Memorandum.
Sheila Pires
Ms.
Pires
Washington, D.C.
is
employed
by
Human
Service
Collaborative,
She served on Cluster IX, Group 25, "Children's
Mental Health Services" (Declaration of Marjorie Tarmey, Documents
Nos. 558, 563,
567,
576,
579) •
See Tab 38 attached to this
Memorand~.
Anne Stoline, M.D.
Dr. Stoline is a practicing psychiatrist from the state of
Maryland who served on Cluster IX, "Mental Health" (Declaration of
176
�Marjorie Tarmey, Documents Nos. 558, 563, 567, 576, 579).
See Tab
38 attached to this Memorandum.
Beth Stroul
Ms. Stroul is employed by Management Training and Innovations,
a company located in Virginia.
Management Training and Innovations
works under a subcontract with Georgetown University's Child and
Adolescent Service System Program Technical Assistance Center.
She
served on Cluster IX, Group 23, "Benefits Package," and Cluster IX,
(Declaration of Marjorie Tarmey,
Group 25, "Childrens' services."
Documents Nos. 558, 563).
See Tabs 34 and 36 attached to this
Memorandum.
Gordon Trapnell
Trapnell is employed by Actuarial Research Corporation.
Mr.
Mr.
Trapnell. served
on·· Cluster
XII,
Group
32,
"Quantitative
Analysis" (Declaration of Marjorie Tarmey, Documents Nos. 700, 701,
1334).
See Tab 46 attached to this Memorandum.
Pete Welch
Mr.
Welch is employed by the Urban Institute.
served on Cluster I,
Purchasing
Group 1,
Cooperatives,"
and
Mr.
Welch
"Principles .and Operations of
Cluster
IV,
"Integration
of
Government Programs into the New System" (Declaration of Marjorie
Tarmey, Documents Nos. 21, 406).
See Tabs 3 and 19 attached to
this Memorandum.
Steve Zuckerman
Mr.
Zuckerman
Zuckerman
served
is employed by the Urban
on. Cluster
VI,
177
"Short
Term
Institute.
Cost
Mr.
Controls"
�(Declaration of Marjorie Tarmey, Document No. 761).
See Tab 25
attached to this Memorandum.
Ann zuvekas
Ms.
zuvekas is employed by George Washington University,
Center for Health Policy Research.
Ms. zuvekas served on Cluster
VIII, Group 22, "Health Policy Initiatives for the Underserved"
(Declaration of Marjorie Tarmey, Document No. 545).
See Tab 31
attached to this Memorandum.
L.
THE MEMBERS OF CLUSTER V OF THE INTERDEPARTMENTAL WORKING
GROUP. "ETHICAL FOQNDATIONS OF THE NEW SYSTEM" (ALSO KNOWN AS
11 BIOETHICS 11 )
In their First Discovery Responses, the Defendants conceded
that virtually all of the persons who served on the "Ethical
Foundations of the New System" Subgroup of the Interdepartmental
Working Group were
11
SGE 11 members who participated full-time on the
Interdepartmental Working Group. The Defendants have asserted that
this category of "SGEs", who worked out of the White House Office,
were not paid by the government.
The Defendants also asserted that
travel expense records were produced for "The White House Office
SGEs
and
consultants
who
requested
reimbursement
from
the
government for travel related to their work on the working group."
Defendants' Third Supplemental Responses, at 16. More importantly,
the Defendants asserted as follows:
The travel authorizations for Elliott Dorff and Ruth
Purtillo [sic] indicate that only these two individuals
were authorized to travel on official government
business. Neither of these individuals has received any
reimbursement for the travel indicated, nor has any
request for reimbursement been approved. In the case of
Ms. Purtillo [sic], no vouchers have been submitted.
178
�Marjorie Tarmey, Assistant to Ira Magaziner, attested to the
truth of the statements relating to these documents. Id., at 21.
Id.
In addition to their First Responses listing the
members of the "Ethical Foundations of the New System"
Cluster Group, in Defendants' Second Responses, Documents
Nos. 462 through 473, and Document 867, there is further
information about other members of this group, not given
any designation by the White House as SGEs or any other
designation.
These documents are attached as Tabs 108 to
116 to this Memorandum.
These documents reveal that the
following persons were also members of Working Group 17.
ELLIS, GARY, Ph.D.
GEHAN I MARGERY
PICILLO, THERESA
NIH - Office for Protection from
Research Risks (466)
Policy Assistant
Policy Assistant
OTHER:
Professor of Law, Director of Center
for Medical Ethics (467)
Associate Professor,
School of
Divinity, Howard University (468)
MEISEL I ALAN I JD
SANDERS I CHERYL
SOURCES: Declaration of Marjorie Tarmey, Documents Nos.
465-469, 867. See Tab 108 attached to this Memorandum.
Documents Nos.
462 through 464
(Declarations
of Marjorie
Tarmey), attached in Tab 107 attached to this Memorandum, contain
more names and more information about the "Ethical Foundations of
the New System" Working Group.
the Defendants
employment
Defendants.
in
category
These names were not produced by
their earlier Discovery Responses,
or
status
was
assigned
to
them
and no
by
the
Document· No. 462 reveals that Raney Dubler and Marian
179
�Secundy were Co-Chairs
for Working Group
17.
According
to
Documents No. 462 and 463, there were only nine (9) working group
members, including the two co-chairs.
Documents No. 463 and 464
contains a list of "other services", some of whose names appear on
the "master list" of "SGEs" initially produced by the Defendants,
but many whose names do not appear on that document.
David Eddy,
a central Cluster and Working Group member who was listed as an
"SGE" from the Department of Health and Human Services, is named as
an additional member of Working Group 17.
The persons whose names
do not appear on the "master list" of SGEs initially produced by
the Defendants are as follows:
BEAUCHAMP, TOM
BOYLE, PHILIP
CHILDRESS, JAMES
FADEN, RUTH
FLETCHER, JOHN
GORLAND, MICHAEL
GUDORF, CHRISTINE
LEBAQZ, KAREN
LYNE, SR., SHEILA
LYNN, JOANNE
MARINER, WENDY
MUNDINGER, MARY
NATHAN, DAVID
PELLEGRINO, EDWARD
Georgetown
University,
Kennedy
Institute of Ethics
The Hastings Institute, NY
Professor,
Religious
Studies,
University of Virginia
Professor, Johns Hopkins University,
School of Public Health
Professor, University of Virginia
(Former NIH Ethicist Who Formulated
Policy on Fetal Tissue, In Vitro
Fertilization)
Oregon Health Sciences University
(Ethicist Involved in oregon Plan)
Professor, xavier University, Ohio
Professor,
University
of
California/Berkeley
(Ethicist
Focusing on Women's Issues)
City Commissioner of Health, Chicago
(Recommended by Rep. Rostenkowski,
Concerned About Amounts of Money
Spent on Last and First 6 Months of
Life, Interested in Encouraging
Family Practice and Primary care)
Georgetown University
Boston University
Dean of Nursing, Columbia University
School of Medicine
Chief
at
Children's
Hospital,
Boston, MA (Recommended by Tom Pyle)
Georgetown University
180
�WALTERS, LEROY
WOLF, SUSAN
WOLF, MARSHALL
VEATCH, ROBERT
Georgetown University
Harvard University, Ethics in the
Professions Program
The Brigham, Boston, MA (Interested
in Societal Guidelines, Recommended
by Tom Pyle)
Director,
Kennedy
Institute of
Ethics
Tabs 108 to 117, attached to this Memorandum, contain certain
persona~_
summaries based upon documentation provided by Defendants,
along with travel records, regarding the following individuals who
served on the "Ethical Foundations of the New System" Cluster
Group: Adrienne Asch, Norman Daniels, Annette Dula, Abigail Evans,
Joan Gibson, Larry Gostin, carol Levine, Pilar Ossorio, Elliot
Dorff and Ruth Purtilo.
The records produced by the Defendants relative to these
individuals reveal the gross inaccuracy of Marjorie Tarmey's sworn
testimony claiming that only Dorff and Purtilo were authorized to
travel on government business, because all of the above-listed
employees except Dorff and Purtilo filed travel vouchers which were
approved by a government official.
Numerous discrepancies also
exist as to these travel vouchers.
It must be recalled that the
decision of the United Statse Court of Appeals remanding this case
for further proceedings, including expedited discovery regarding
the Interdepartmental Working Group, was handed down on June 22,
1993.
Many of the travel vouchers produced by the Defendants
reveal that they were faxed to these individuals after that date as
shown by the facsimile masthead appearing at the top of many of
these documents.
well.
Some of these documents appear to be backdated as
A classic example of this is the travel vouchers for Joan
181
�Gibson.
On July 6, 1993, starting at 16:06, according to the
facsimile masthead, the White House faxed five travel vouchers to
Joan Gibson at the University of New Mexico.
She appears to have
signed the forms and dated them on July 7, 1993.
The Approving
Official, whose name is illegible, signed them
11
6/10/93", but also
appears to have signed the documents twice.
Another example of
this mad scramble to generate documents can be seen in the travel
vouchers for Pilar ossorio.
On June 22, 1993, starting at 14:26,
the White House faxed five travel voucher forms to Ossorio.
Ossorio apparently filled them out, dated them 6/22/93, and faxed
them back to the White House that same day, according to the
facsimile mastheads on the documents.
The Approving Official dated
three of them 6/10/93, one of them 6/22/93, and one of them
8/25/93.
Of course, none of the above-listed persons, or other
members of the "Ethical Foundations of the Hew System" Working
Group appeared to have filed SF 278 or SF 450 conflict of interest
forms.
Finally, the travel vouchers produced with respect to the
listed individuals on the "Ethical Foundations of the New System"
Working Group vindicate the position taken by the Plaintiffs before
the
United
states
court
of
Appeals,
namely,
that
the
Interdepartmental Working Group was the main body providing policy
advice and recommendations, and that the "Task Force" named by the
President was simply a political facade.
each
of
these
individuals
requests
The travel vouchers of
reimbursement
for
"HCTF
meetings". Obviously, these persons considered themselves the real
members of the "Task Force" which would produce recommendations for
182
�Ira Magaziner and the President,
disingenuously
litigation.
asserted
Indeed,
by
that
and not mere "staff", as so
the
is
Defendants
exactly
throughout
what
occurred,
this
as
is
illustrated by a simple comparison of the document entitled,
"Working Group Draft" to the proposed Health Security Act of 1993.
See, Declaration of Genevieve M. Young, Exhibit 33, "Working Group
Draft".
N.
THE DEFENDANT. IRA HAGAZINER MISLED THE PLAINTIFFS AMP TUIS
COURT IN HIS KARCH 3. 1993 PECLABATION ABOUT THE HAKE-UP OF
THE INTERDEPARTMENTAL WORKING GROUP
Under penalty of perjury, the Defendant, IRA MAGAZINER, Senior
Advisor to the President for Policy Development, and the one who
led [and is leading] the Defendant, INTERDEPARTMENTAL WORKING GROUP
OF THE PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM and
its CLUSTER GROUPS, WORKING GROUPS AND SUBGROUPS, testified as
follows:
"only federal government employees serve as members
of the interdepartmental working qroup.
employees fall into two categories.
These federal
The first category
includes full-time, permanent employees, who work for the
Executive Office of
for
members
committees.
of
~e
President, for federal agencies,
Congress
or
for
Senate
or
House
I have arranged for these federal employees
to be informed that they are subject to the conflict of
interest provisions set forth in 18 u.s.c.
§§
202-209:
the standards of Ethical Conduct for Employees of the
Executive
Branch:
and
all
183
related
ethics
laws
and
�regulations.
As of March 1, approximately 300 such
permanent employees were serving as members of the
working group.
These employees have been provided by the
White House, members of Congress, and several agencies,
including the Department of Health and Human Services,
the Office of Management and Budget, the Department of
Defense,
the
Department
of
Veterans
Affairs,
the
Department of Labor, the Department of Commerce, the
Department of the Treasury, and the Council of Economic
Advisors.
The second category of federal employees serving as
members of the working group includes. "special government
employees" who have been employed by an agency or the
Executive Office of the President for less than 130 days
in a 365-day period, either with or without compensation.
I have arranged for these special government employees to
be informed that throughout the period of their special
employment, they are subject to a limited version of the
conflict of interest provisions set forth in 18
u.s.c.
§§
202-209; the Standards of Ethical Conduct for Employees
of the Executive Branch; and all related ethics laws and
regulations.
government
I have also arranged for these special
employees
to
be
informed that they
are
required to abide by limitations on public speaking and
by applicable post-employment restrictions.
As of March
1, approximately 40 such special government employees
184
�were serving as members of the interdepartmental working
group.
These special government employees have been
retained, and provided to the interdepartmental working
group, by the White House and several agencies, including
the
Department
of
Health
and
Human
Services,
the
Department of Defense, and the Office of Management and
Budget."
Declaration of Ira Magaziner, March 3, 1993, ! 11 and ! 12.
On the aforementioned, sworn testimony of Mr. Magaziner, both this
Court and the United States Court of Appeals relied.
Yet, what Mr. Magaziner said was far from the truth.
The
Plaintiffs, on February 28, 1994, asked counsel for the Defendants
to take Mr. Magaziner's deposition.
dates.
A letter was sent suggesting
See, Declaration of Kent Masterson Brown, Exhibit A.
reply was ever received by telephone or letter or otherwise.
No
Id.
Mr. Magaziner, the one person who would have known the truth
of his testimony, utterly misled this Court and the United States
Court of Appeals.
When one examines the documents provided by the
Defendants, paltry as they are, they reveal that the membership of
the Defendants, INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S
TASK FORCE ON NATIONAL HEALTH CARE REFORM and its CLUSTER GROUPS,
WORKING GROUPS AND SUBGROUPS, were not only not composed of "only
federal government employees", but were filled with individuals who
had no official status at all, and who came, in significant part,
from managed care,
insurance and non-profit organizations and
academic centers which would benefit from the health reform plan
185
�ultimately recommended to the President.
In fact, the presence of
wholly private persons was so evident that three (3) entire working
groups--Cluster Group v, "Ethical Foundations of the New System",
Working Group 17, "Bioethics", Cluster Group XIV, "Numbers Audit",
Working Group 34, "Numbers Audit", and Working Group 39, "Minority
Issues Review Group"--were composed entirely of individuals who had
no official status with the federal government at all, but were
drawn from private business, non-profits and academic centers.
In
other cluster groups, working groups and subgroups, very large
numbers of private individuals made up the membership.
All of
these facts, of course, Mr. Magaziner had to have known at the time
he signed his Declaration.
The following represents the listing by Cluster Group, Working
Group
and
Subgroup,
of
all
members
of
the
Defendant,
INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM and its CLUSTER GROUPS, WORKING GROUPS
AND SUBGROUPS, who were not, in any way, employees of the federal
government [SGEs or FTEs], and were assigned no official status at
all.
None of these individuals were full-time employees or
"special government employees" of the federal government.
CLUSTER I HEW SYSTEM ORGAHIZATIOH
GROUP 1 -
PRINCIPLES AHD OPBRATIOH OF PORCIIASIHG
COOPERATIVES
EHTBOVEH, ALAIH
O'BRIEH, MARY JO.
The Jackson Hole Group, Inc. (2): No
Official Status Given
National
Governors
Association,
State of Minnesota (835): Listed as
186
�KUSH, GAIL
PAYTON, SALYANNE
RICHARDSON, SALLY
WElL,
ALAN
Representative of Intergovernmental
Organization (1786-87); No Official
Status Given
Listed as Participant (835); No
Affiliation; No Status Given
University of Michigan School of Law
(2); No Employment Status Assigned
West Virginia Health Care Planning
Commission; No Official Status
National Governors Association, Gov.
Romer of Colorado (3); No Official
Status
Assigned;
Listed
as
Representative of Intergovernmental
Organization (1786-87); No Official
Status
SOURCES: Declarations o:f Marjorie Tarmey, Documents Nos.
1-4, 17-25, 37-42, 54-56, 732, 767-768, 798-799, 834-835,
864-868, 1516-1517, 1560-1561, 1678-1679, 1795-1796. See
Tab 3 attached to this Memorandum.
GROUP :IA -
HEALTH PLANS, PROV:IDERS AND
THE NEW SYSTEM
KUSH, GA:IL
0, BRI:EN I MARY JO
R:ICHARDSON I SALLY
PAT:IEHTS :IN
No Affiliation; No Employment Status
Given (5, 1513, 1514)
National
Governors
Association,
State of Minnesota (835); Listed as
Representative of Intergovernmental
Organization; No Official Status
West Virginia Health Care Planning
Commission; No Official Status
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
5, 6, 26, 57, 1513-1515.
See Tab 4 attached to this
Memorandum.
GROUP 2 -
MANAGED CARE/TOWARDS 1i BEYOND -
SPBC:IAL
:ISSUES :IN PORCBAS:IRG COOPERAT:IVBS
BOWLES, ROBERT L.
BROWN I MARY
lONG, GARY
LB:IGB
D. c. Chartered Health Plan, Inc.
(1364, 1371); No Official status
National
Governors
Association;
Representative of Intergovernmental
Organization; No Official Status
(1496)
Assistant
Professor,
Community
Medicine, University of Connecticut
Health Center (1374); No Official
Status
187
�LACEY, LORETTA
McCABE, EUGENE
NORMAN, PATRICIA
RICHARDSON, SALLY
ROSS, SHEILA
TERRY, DONALD
WElL, ALAN
Associate
Professor,
Community
Health
Sciences,
University
of
Illinois at Chicago School of Public
Health (1365, 1374); No Official
Status
President,
CEO,
North
General
Hospital, New York (30209); No
Official Status
VP Finance, CFO, North General
Hospital, NY (30209); No Official
Status
West Virginia Health Care Planning
Commission; No Official Status
Rep.
Deluge
(Not
Listed
in
Director) ; Not Listed as FTE; No
Official Status
No
Affiliation;
No
Official
Employment Status
National Governors Association, Gov.
Romer of Colorado (3); No Official
Status; Listed as Representative of
Intergovernmental
Organization
(1786-87)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
7-11, 27-30, 52, 53, 58, 59, 66-91, 96, 97, 102-105, 769,
800, 83~, 1496-1508, 1524, 1562-1564, 1801-1807, 3000030005, 30179-30223.
See Tab 5 attached to this
Memorandum.
GROUP 3 -
GOVERNANCE
BEIIPONG, ANDREA
McNAMEE, NIKKI
VOLPE, LANE CARL
( 1786)
National
Association
of
Counties;
Representative
of
Intergovernmental
Organization;
Assigned to Group 3; No Official
Status
National
Governors
Association,
Office of the Governor of South
Carolina (13)(837); Representative
of Intergovernmental Organization
(1786-87);
State
Government
Representative ( 983); No Official
Status
National
Governors
Association
(13)(837);
Representative
of
Intergovernmental
Organization
(1786-87);
State
Government
Representative (983); No Official
Status
188
-------------------------------~~-~--
----~-~
--~----
---~~----
�SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
12, 13, 46, 47, 61, 92-95, 770, 801, 837, 1095, 1510,
1520, 30148.
See Tab 6 attached to this Memorandum.
GROUP 4 -
GLOBAL BUDGET
National
Governors
Association,
Office of Governor Dean, Vermont
(838)~
Representative
of
Intergovernmental
Organization
( 1786-87) ~
State
Government
Representative (984)~ No Official
Status
RADER, ANYA
SOUCES: Declaratioll$ of Marjorie Tarmey, Documents Nos.
14-16' 31-33' 43-45' 62' 63' 98-101' 771' 802' 1511'
1512, 1518, 1519, 1565, 1566, 30006, 30007, 30177.
see
Tab 7 attached to this Memorandum.
GROUP 5 -
IHSURANCE REFORM
AUBIH, LESLIE
BASS, RR.ISTIH
BATEMAH, KEITH
BUR~H,
JOHN
CATOR, TOM
FARMER, DAVID
HOFFERT, STAN
KIST, FRED
LAWSOH, ROGER
LLEWELLYN, B.
KA-rl'ERA, PAUL
MAYS, HUBERT, JR.
MILLSTEIJI, ARNIE
PATRICELLI, ROBERT
(1326)
National
Federation
of
Independent Businesses~ No Official
Status
(1326)
Chamber of Commerce~ No
Official Status
( 30075)
Alliance
of
American
Insurers~ No Official Status
(1265)
Rutgers
University,
No
Official Status
(1326) National Small Businesses
Limited: No Official Status
( 30075)
Alliance
of
American
Insurers: No Official Status
(30075) Wausau Insurance Company: No
Official Status
( 1265)
Coopers
&
Lybrand:
No
Official Status
Alliance · of American Insurers: No
Official Status
(1265)
National
council
on
compensation Insurance: No Official
Status
( 30025) Liberty Mutual Insurance: No
Official Status
( 30075)
Attorney,
Alliance
for
American
Insurers:
No
Official
Status
William M. Mercer, Inc.: No Official
Status
(1326)
Chamber of Commerce: No
Official Status
189
�RAY I
( 1265)
Coopers
&
Lybrand;
No
Official Status
(1326) National Retail Federation;
No Official Status
( 1326)
National
Association
of
Independent Businesses; No Official
Status
TIMOTHY
SCULLY, TOM
STUART I MARK
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
34-36, 48-51, 64, 65, 106-115, 772, 803, 839, 1521, 1567.
See Tab 8 attached to this Memorandum.
CLUSTER GROUP II -
HEW SYSTEM COVERAGE
GROUP 6 -
BENEFITS PACKAGE
CLARK, WILLIAM
Robert Wood Johson Fellow, Sponsored
by University of Florida, in Senator
Dale Bumpers' (D-AR) Office (773)
N
a
t
i
o
n
a
1
Association of counties ( 134) ( 1786):
Representative of Intergovernmental
Organization (1786); No Official
status
National Association of counties
(134,
1786),
Representative
of
Intergovernmental Organization; No
Official Status
Robert
Wood
Johnson
Fellow,
Sponsored by University of Rochester
Medical Center, in Office of senator
Kennedy
(199) (135) ;No
Official
Status
Robert
Wood
Johnson
Fellow,
Sponsored by Columbia University
School of Nursing, In Office of
Senator Bradley (D-NJ) (735-773)
EGBERT I MARCIA
GARCIA, JOSEPH
POWELL, KEITH
SOCBELSKI I JULIE
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
116-135, 773, 804, 1590.
See Tab 10 attached to this
Memorandum.
GROUP 7 -
COVERAGE FOR WORKIHG FAMILIES
BROWN, MARY LEIGH
National
Governors
Association,
Minnesota (153); Representative of
Intergovernmental
Organization
(1786); No Official status
190
-
--- ---
- - - -
�CLARK, WILLIAM
GOLDSTEIN I ELAINA
QUIST I JANET
Robert
Wood
Johnson
Fellow,
Sponsored by University of Florida,
Off ice
of
Senator
Bumpers
( DAR)(153); No Official Status
House Select Committee on Aging; Not
in Directory.
As of 3/31/93 When
House Select Committee on Aging's
Appropriations Expired and Were Not
Renewed, Goldstein Began Working on
Task Force (153); No Official Status
National League of Cities (154);
Representative of Intergovernmental
Organization (1786); No Official
status
SOURCES: Declarations o:t Marjorie Tarmey, Documents Nos.
136-154, 184, 185, 774, 805, 1591. See Tab 11 attached
to this Memorandum.
GROUP 8
COVERAGE FOR IDW INCOME AND NON-WORKI:NG
FAMILIES
DENTON, DENISE
Colorado Office of Rural Health; No
Official Status (1678) (SGE in First
Responses)
The Johns Hopkins University/Kaiser
Commission on the Future of Medicaid
(173,
806)
SGE
(1678);
No
Affiliation;
No Official Status
(First Responses)
Formerly House Select Committee on
Aging, Lost Appropriation 3/31/93;
No Official Status (1678-1679)-SGE
(First Responses)
ROWLAND, DIANE
VELOZ, RICHARD
SOURCES: Declarations o:t Marjorie Tarmey, Documents Nos.
155-179, 775, 806, 1592.
See Tab 12 attached to this
Memorandum.
CLUSTER GROUP J:J:J:
GROUP 9 -
QUALITY ASSESSMENT
EPSTEJ:N, ARNOLD
JACKSON, DAVJ:D
NEW SYSTBII J:NFRASTRUC'l'OlRE
Robert
Wood
Johnson
Fellow,
Sponsored by Harvard University
Medical School and Brigham & Women's
Hospital, Office of Senator Kennedy
(D-MA) (233); No Official status
CEO, Assurqual (233, 260, 262, 276)SGE (First Responses); No Official
Status (1678-1679)
191
�SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
189, 190, 193, 194, 200, 201, 213, 214, 215, 216, 232265, 273-278, 776, 807, 1593, 1594, 30019-30022, 3016830172. See Tab 14 attached to this Memorandum.
GROUP 10
INFORMATION SYSTEMS
JACKSON, DAVID
CEO, Assurqual (233, 281, 289); No
Official Status
Phone (301) 925-7000 - Dimensions,
Inc. ( 281) ; Declaration of Genevieve
M. Young, Exhibit 30); No Official
Status
JEWS, WILLIAM
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
191, 192, 195, 196, 202, 203, 266-269, 279-322, 777, 808,
1143-1150, 30023, 30024, 30073. See Tab 15 attached to
thiss Memorandum.
GROUP 11 -
MALPRACTICE Aim TORT REFORM
ABRAHAM, KENNETH
BOVBJERG, RANDALL
CREASEY, DAVID
DAHZON, PATRICIA
GOSFIELD, ALICE
BAvnmtJRST, CLARK
MORLOCK, LAURA
O'COHRELL, JEFFREY
WADLINGTON, WALTER
WEILER, PAUL
University of Virginia - Professor
of Law (1331); No Official Status
The Urban Institute; No Official
Status (1331)
Risk Management Foundation, Harvard
Medical Institution; No Official
Status (1331)
The Wharton School - Health Care
Policy and Insurance - University of
Pennsylvania; No Official status
(1331)
Law Office
of Alice Gosfield,
Philadelphia,
Pennsylvania;
No
Official Status (1331)
Duke University School of Law: No
Official Status (1331)
The Johns Hopkins University School
of Public Health; No Official Status
(1331)
University of Virginia School of
Law; No Official Status (1331)
University of Virginia School of
Law; No Official Status (1331)
Professor, Harvard Law School: No
Official status (1331)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
204, 205, 209, 210-212, 217, 218, 291-294, 323-332, 778,
809, 1610, 1330-1331, 30026. see Tab 16 attached to this
Memorandum.
192
�GROUP 12 -
FACILITATING PROFESSIONAL DEVELOPMENT
Robert
Wood
Johnson
Fellow,
Sponsored by the Center for Health
Professions,
University
of
California, San Francisco, Office of
Senator Rockefeller (D-WV)
(197,
206)
Legislative Fellow, Office of Sen,
Bingaman
(Not
Listed
in
Congressional
Directory)(198)(FTE
841): No Official Status
Colorado Rural Health Office (300)SGE (First Responses): No Official
status (1678-1679)
White House Fellow/HHS (198); No
Affiliation: No Official status
ALTMAN, DAVID
DAVIES, MONICA
DENTON, DENISE
GOLUB, LAWRENCE
SOURCES: Declarations of Marjorie Tarmey 1 Documents Nos.
197-199 I 206-2081 219-2211 270-2721 295-2971 298-4051
779 1 810 1 1601-1609.
See Tab 17 attached to this
Memorandum.
CLUSTER GROUP IV
GROUP 13 -
INTEGRATION OF GOVERNMENT
PROGRAMS INTO NEW SYSTEM
HEALTH
MEDICARE
:NONE
SOURCES: Declarations of Marjorie Tarmey 1 Documents Nos.
406-410 1 700 1 811 1 1534 1 1614. See Tab 19 attached to
this Memorandum.
GROUP 14 HOSEK, SUSAlf
DEPARTMENT OF DEFENSE
RAND Corporation ( 310 1 393 1 0411 1
419); Not Listed: No Official Status
SOURCES: Declarations of Marjorie Tarmey 1 Documents Nos.
411-425, 787 1 1537 1 1615. See Tab 20 attached to this
Memorandum.
GROUP 15 -
VETERANS
:NONE
SOURCES: Declarations of Marjorie Tarmey 1 Documents Nos.
426-437 1 788 1 1536.
See Tab 21 attached to this
Memorandum.
GROUP 16 -
FEDERAL EMPLOYEES' HEALTH BENEFITS PLAK
193
- - - - - - - - - - - - - - - - - - - - - - - - - - - _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ j
�(446) No Official Status; Contractor
JONES, STANLEY
SOURCES:
Declarations of Marjorie Tarmey, Documentss
Nos. 438-446, 789 1 1535 1 30029. See Tab 22 attached to
this Memorandum.
OTHER GOVERNMENT PROGRAMS
GROUP 16A
NONE
SOURCES: Declarations of Marjorie Tarmey 1 Documents Nos.
449-452 1 30030, 30031.
See Tab 23 attached to this
Memorandum.
CLUSTER GROUP
V -
ETHICAL FOUNDATIONS OF
THE NEW
SYSTEM
GROUP 17 - BIOETBICS
GROUP 17 - co-LEADER
NANCY
DOBLER,
Medical Center.
status
Montefiore
No Official
MARIAN
SECUNDY,
Howard
University. No Official Status
ASCH I ADRIENNE
BAYER, RONALD
BROCK,
DANIEL
CAPLAN I
ARTHUR
DANIELS I NORMAN
DORFF I
ELLIOTT
DULA, ANNETTE
ELLIS I
GARY
EIIANtJEL I
EZEK:IAL
EVAN, ABIGAIL R.
FAHEY I
MGSR CHARLES
FLECK, LEN
FOST I NORMAN
B.U. School of Social Work; No
Official status
Coluiibia University School of Public
Health; No Official Status
Director of Center for Biomedical
Ethics; No Official Status
University of Minnesota, center for
Biomedical
Ethics;
No Official
Status
Tufts University; No Official Status
Provost, Professor, . University of
Judaism; No Official Status
Rockefeller Fellow, University of
Colorado; No Official Status
Office for Protection from Research
Risks; No Official Status
Harvard Medical School/Dana Farber
Cancer Institute; No Official Status
Princeton Theological Seminary; No
Official status
Third Age Center; No Official Status
Michigan State; No Official Status
University of Wisconsin; No Official
Status
194
�GIBSON, JOAN
University of New Mexico, Director,
Center for Health Law and Ethics; No
Official Status
GOSTIN, LAWRENCE
American Society of Law, Medicine &
Ethics; No Official Status
KING, PAT
Georgetown University Law Center; No
Official status
LAHTOS, JOHH
Chief,
Medical
Staff,
Larabida
Hospital; No Official Status
LEVINE, CAROL
The Orphan Project Fund; No Official
Status
LO, BERNARD
USCF, Director, Program in Medical
Ethics; No Official Status
MAY, BILL
SMU Professor of Ethics; No Official
Status
MEISEL, ALAR
University of Pittsburgh Center for
Medical Ethics; No Official Status
MEZEY, KATHY
NYU
Independence
Professor
of
Nursing; No Official Status
MILES, STEVEN
University of Minnesota, Center for
Biomedical
Ethics;
No
Official
Status
O'CONNELL, LAWRENCE Howard
University
School
of
Medicine; No Official Status
OSSORIO, PILAR
Post-Doc Associate, Yale University
. School of Medicine; No Official
Status
PURTILO, ·RUTH
Creighton University Center for
Health
Policy
and
Ethics;
No
Official Status
SANDERS, CHERYL
Howard University Divinity School:
No Official Status
SECUHDY, MARIAH
Howard University, Medical Ethics;
No Official Status
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
453-469, 867, 1538.
See Tab 24 a-ttached to this
Memorandum.
CLUSTER GROUP VI
GROUP 18 -
SYSTEM
ACCELERATING HEW SYSTEM DEVELOPMENT
EPSTEIN, ARMOLD
GARCIA, JOSEPH
T.RAHSITION TO THE HEW
SHORT-TERM COST CONTROLS
Robert
Wood
Johnson
Fellow,
Sponsored by Harvard Medical School
and Brigham & Women's Hospital,
Service in the Office of Senator J.
Rockefeller
(479);
No
Official
Status
cuyahoga county, Ohio Department of
Human
Services;
Listed
as
Intergovernmental
Representative
195
�McLAUGHLIN, DAN
O'BRIEN, MARY JO
QUIST, JANET
from
National
Association
of
Counties (1786); No Official Status
No Affiliation Listed; No Official
Status (478)
National
Governors
Association,
Minnesota: Listed as Representative
From Intergovernmental Org.anization
(1786); No Official Status
Listed
as
Representative
of
Intergovernmental Organization from
National League of Cities (1786); No
Official Status
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
4 78-487, 724-729, 790, 1313-15, 30101.
See Tab 26
attached to this Memorandum.
GROUP 19 -
ADMINISTRATIVE SIMPLIFICATION
ABRAMCHECK, F.
ABRAMSON, LEONARD
ALBERTINE, JIM
ALEXANDRE, LESLIE
BARRETT, LEE
BATALDEN, PAUL, MD
CAULEY I BANK
CHERTOFF, STEVE
CONHELL, RICHARD
CURTIS I BENJAMIN
DOWLING I ALAN
GAUCHER, EJ.I,P
GIEL, MICHAEL
GILLIGAN, T. J.
KOVRER, CHRISTINE
MACABER, JIM
METZ, ARTHUR
MOSSER, GORDON
HUDELMAN, PETER
O'DOHHELL, KEN
EDS Health Care: No Official Status
(30027)
u. s. Health Care: No Official
Status
Albertine Enterprises (SMS) (30028);
No Official Status
EDS (30028); No Official Status
Aetna (30028); No Official Status
Hospital Corporation of America; No
Official Status
Telesis: No Official Status
PCS Health Systems; No Official
status
NEIC
(now
Aetna)
(30073);
No
Official Status
NEIC
(now
Aetna)
(30028);
No
Official status
No Official Status
University of Michigan Hospital; No
Official Status
Cooperative Healthcare Networks; No
Official Status
EIS; No Official Status
New York University; No Official
Status
SMS Corporation, No Official status
First Health; No Official Status
(30027, 30028)
Internist/Minnesota:
No
Official
Status
Group Health Cooperative of Puget
Sound; No Official Status
NEIC (now Aetna); No Official Status
196
�O'ROARK, FRANK
RICKSON, NORENE
SCHROEDER, KATHY
SOUDER, BARBARA
SOVDIERS, R.
STEPHEN,
JACK
WESTON, DAVID
WOLFORD, G. RODNEY
Blue
Cross/Blue
Shield
Association/WED!: No Official Status
(30028)
Telesis; No Official Status
William
Beaumont
Hospital;
No
Official status
WEDI/The Travelers; No Official
Status (30027)
CIS Technologies; No Official Status
(30027)
Lakeland Regional Medical Center: No
Official Status
The Travelers/WED!; No Official
Status (30028)
Alliant Health Systems; No Official
Status
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
477, 791, 30025, 30027, 30028, 30073, 30100. See Tab 27
attached to this Memorandum.
GROUP 21 ALTMAN,
INTERIM COST CONTROLS
STUART
LEE, PHILIP
O'BRIEN, MARY JO
REINHART, UWE
RILEY, IRENE
The
Heller
School,
Brandeis
University, No Official Status
Director,
Robert
Wood
Johnson
Foundation, No Official status (405,
489, 494, 497, 500)
National
Governors
Association,
Minnesota
(490);
Listed
as
Representative of Intergovernmental
Organization; No Official status
Princeton University, No Official
Status
National Association of counties;
Listed
as
Representative
of
Intergovernmental organization; No
Official Status
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
480-498, 790, 1539-1543, 1617-1625, 30052. See Tab 28
attached to this Memorandum.
CLUSTER VII
FIHAHCING
GROUP 21 -
FINANCING
197
�CORONADO, DAVID
ENTHOVEN, ALAIN
LEE, PHILIP
O'BRIEN,
MARY
JO
PETERSON, DOUGLAS
REINHART, UWE
RILEY, IRENE
SHEPPACH, RAYMOND
UYEDA,
MARY
DC Commissioner of Health Care
Finance
(505);
Listed
as
Intergovernmental Employee in First
Responses; No Official Status
The Jackson Hole Group, Inc. ; No
Official Status
(in Handwriting
"Consultant")(480, 488, 493, 496)
Director,
Robert
Wood
Johnson
Foundation (485, 489, 494, 497, 500)
National
Governors
Association,
Minnesota
(490);
Listed
as
Representative of Intergovernmental
Organization,
NGA
(1786);
No
Official Status
National League of Cities (505,
512); Listed as Representative of
Intergovernmental Organization; No
Official Status
(In Handwriting "Consultant") (482,
486, 490, 494, 497, 500); Princeton
University, No Official status
National Association of Counties
(1787); Listed as Representative of
Intergovernmental Organization: No
Official Status
National Governors Association ( 521,
504, 509, 511, 514, 516, 518, 519);
Listed
as
Representative
from
Intergovernmental Organization; No
Official Status (1787)
National Association of Counties
(505, 512); Listed as Representative
of Intergovernmental Organization
(1787); No Official Status
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
501-522, 793, 1544, 1545, 30109, 30110, 30032. See Tab
29 attached to this Memorandum.
CLUSTER GROUP VIII
GROUP 22 I
HEALTH POLICY INITIATIVES FOR THE
ONDERSERVED
SUBGROUP A -
ONDERSERVED
RURAL
AND
INNER
CITY AREAS
CLARK, WILLIAM
Robert
Wood
Johnson
Fellow,
Sponsored by University of Florida,
in Senator Bumpers (D-AR) Office
SUBGROUP 22A - SUBGROUP - HIV
198
�MAXWELL I CELIA
Volunteer
PETERSON I BOBBIE
No Official Status (1238)
MET WITH SUBGROUP 22A:
San Francisco AIDS Foundation; No
Official Status
American Psychological Association;
BILL BAILEY
No Official Status
National Association of People With
CORNELIUS BAKER
AIDS; No Official Status
AIDS Research Policy Analyst With
TERRY BESWICK
HRCF; No Official Status
CEO, AIDS Project Los Angeles; No
LEONARD BLOOM
Official Status
Greater Baltimore HIV & Health
ANNE BROOMFIELD
Services
Planning
Council;
No
Official Status
Health Care Finance Expert (San
PAUL DEDONATO
Francisco); No Official Status
SONDRA ESTEPA
Latino Commission on AIDS:
No
Official Status.
RUTH FINKELSTEIN
Director, Public Policy, GMHC, New
York; No Official Status
JIM GRAHAM
Executive Director, Whitman-Walker
· Clinic; No Official Status
DAVID HARVEY
National Pediatric HIV Resource
Center; No Official Status
DEBRA FRZER-HOWZE
CEO, Black Leadership Commission on
AIDS; No Official Status
DR. BILLY JONES
Executive
Director,
Health
&
Hospitals Corporation; No Official
Status
PAUL KAWATA
National Minority AIDS Council; No
Official Status
JEFF LEVI
AIDS Action Council; No Official
Status
CHRISTINE LUBINSKI AIDS Action Council; No Official
Status
JANE SILVER
American
Foundation
for
AIDS
Research; No Official Status
PETER STALEY
Treatment Action Group; No Official
Status
TODD SUMMERS
AIDS
Housing
Corporation;
No
Official Status
SANDY TlltJRMAN
AID Atlanta; No Official Status
ROY WIDDES
NCA; No Official Status
LAUREN FOGT
No Official Status
DEREK HODEL
TAG; No Official Status
B. J. SYLES
NLCA; No Official Status
DAVID BARR
TAG, GMHC; No Official Status
REGINA
ARAGAN
199
�JULIE SCOFIELD
REGGIE WILLIAMS
EIJ.EH RIKER
NASDAD; No Official Status
NTFAP; No Official Status
National Hemophilia Foundation; No
Official Status
PHIL WILSON
National Minority Gay and Lesbian
Association; No Official Status
APHA; No Official Status
KRISTIN GEBBIE
JEFF JACOBS
APHA; No Official Status
AARON SHIRLEY
Jackson-Hinds Comprehensive Health
Center; No Official Status
FREDA MITCHEM
NACHC; No Official Status
BYRON J. HARRIS
U.S.
Conference of Mayors;
No
Official Status
C. ATCHISON
ASTHO; No Official Status
VALERIA MORELLI
ASTHO; No Official Status
SUSAN FORBES-MARTIN Commission on Immigration Reform; No
Official Status
ARTHURY J. LAWRENCE PHS; No Official Status
MICHAEL KAISER, MD Pediatric AIDS Program; No Official
Status
ALICIA BEATTY TEE
The Circle of Care; No Official
status
BRIAN FEIT
Dimock Community Health Center; No
Official Status
DAVID HARVEY
Department of
Policy
Analysis,
National Pediatric HIV Resource
Center; No Official Status
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
715, 716, 1234-1239, 1252-1253, 1327, 1328, 30033, 30034,
30035, 30058, 30059, 30091, 30120, 30123, 30176. See Tab
31 attached to this Memorandum.
GROUP 22, SUBGROUP B ELDERS, JOCELYN
LURIE, ALEXANDER
SMITH, BARBARA
VULNERABLE
POPULATIONS/HIGH
RISK POPULATIONS
Arkansas
Department
of
Health
(1310); No Official Status
No Official Status
National
Governors
Association,
south
Dakota;
Listed
as
Representative of Intergovernmental
Organization
(1786-1787);
No
Official Status
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
1310-1312, 30056.
See Tab 32 attached to this
Memorandum.
GROUP 22, SUBGROUP C -
WOMEN AND CHILDREN
200
�KATHY BASSET
JEANNIE ROSO
RACHEL GOLD
RAE CERAD
MARY CARPENTER
AARON SHIRLEY
PETERS, D. WILLIAM
LARRY McAHDEREWS
JACKIE NOYES
EJ.T.EN
BATISTILLI
BILL HAMILTON
CAROL REGAN
ADOLPH P. FALCON
EJ.T.£N
YUHG-FATAH
FREDERICK
c. FOARD
LEROY ROBINSON
BILL CHAMBRES
American College of Obstetricians
and
Gynecologists;
No
Official
Status
Alan
Guttmacher
Institute;
No
Official Status
Alan
Guttmacher
Institute;
No
Official Status
National
Commission
to
Prevent
Infant Mortality; No Official Status
National
Commission
to
Prevent
Infant Mortality; No Official Status
Signs in as "HHS", Gives JacksonHinds Comprehensive Health Center,
Jackson, MS, Phone Number; NB: on
2/18/93 signed in as "Jackson-Hinds
HC" (30059); No Official Status
National Association of Children's
Hospitals and Related Institutions;
No Official Status
National Association of Children's
Hospitals and Related Institutions;
No Official Status
American Academy of Pediatrics; No
Official Status
Planned Parenthood Federation; No
Official Statuss
Planned Parenthood Federation; No
Official Status
Children's Defense Fund; No Official
Status
National
Coalition
of
Hispanic
Health
&
Human
Services
Organizations; No Official status
Chief,
Outpatient
Services,
DC
Department
of
Consumer
and
Regulatory Affairs; No Official
Status
Chair, National Operations Board,
National
Minority
Health
Association; No Official Status
Executive
Director,
National
Minority Health Association; No
Official Status
NMHA Meeting & Conference Planner,
Newsletter
Editor;
No
Official
Status
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
30092, 30093. See Tab 33 attached to this Memorandum.
GROUP
22 I
SUBGROUP
D -
POPULATION-BASED PUBLIC HEALTH
AND PREVENTION .
201
�ROSENBAUM, SARAH
George Washington University Center
for Health Policy Research (545): No
Official Status
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
1547, 30036.
See Tab 34 attached to this
Memorandum.
1546,
CLUSTER GROUP IX
GROUP 23 -
MENTAL HEALTH
BENEFITS PACKAGE
FRANK I RICHARD
GORE I TIPPER
SCHUTER, JAMES
STOLINB I ANNE I MD
( 566) Mental Health Economist, Johns
Hopkins University; No Official
Status
Wife of the Vice President
Rep. Strickland (Not in Directory);
Law Student From George Washington
University: Now Back at School. He
was an Intern: No Official Status
Psychiatrist at Springfield State
Hospital, Maryland (867); Full-time
Volunteer from .State of Maryland
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
537-580, 796, 1140, 1240, 1241, 1338, 1549, 1550, 16261630, 30034-30037, 30111, 30145-30167, 30178. See Tab 36
attached to this Memorandum.
GROUP 24 -
SUBSTANCE ABUSE
GUST, STEVE
BOLT, HOBERT
STOLIHE I ANNE I MD
No Official status
Montgomery County Department of
Addiction Services (537, 543)
Psychiatrist at Springfield State
Hospital, Maryland (867); Full-time
Volunteer from State of Maryland
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
552, 556, 569, 578, 795, 1316, 1317. See Tab 37 attached
to this Memorandum.
GROUP 25 GOLDMAH I
SYBIL
GORE, TIPPER
PIRES I SHEILA
CHILDREN'S SERVICES
Georgetown
University
Child
Development Center (538)
Wife of the Vice President
Human services Collaborative (538)
202
�STOLIHE, ANNE, MD
STROUL, BETH
Psychiatrist at Springfield State
Hospital, Maryland (867); Full-time
Volunteer from State of Maryland
Management Training & Innovations,
Inc. (538)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
558, 563, 567, 576, 797.
See Tab 38 attached to this
Memorandum.
IMPACT/SPECIAL
WORKING GROUP 26 -
PUBLIC
SYSTEM
POPULATIONS
MELMAN, SORI
HHS-SGE (1678); Part-time Volunteer
STOLIHE I ANNE I MD
Psychiatrist at Springfield State
Hospital, Maryland (867); Full-time
Volunteer from State of Maryland
(1626)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
557, 562, 568, 577, 812, 813.
See Tab 39 attached to
this Memorandum.
CLUSTER GROUP X
GROUP 27 -
LOHG-TERM CARE - BACKGROUND
ECKERT I KEVIN
SOCBALSKI I JULIE
VELOZ I RICHARD
LONG TERM CARE
Robert
Wood
Johnson
Fellow,
Sponsored by University of Maryland,
In the Office of Senator Wofford (DPA)
Robert
Wood
Johnson
Fellow,
Sponsored by Columbia University, in
Senator Bradley's Office (846)
Not Listed as FTE; Formerly Staff
Director, House Select Committee on
Aging, Lost Funding 3/31/93; No
Official Status
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
581-686, 781, 1309, 1552.
See Tab 41 attached to this
Memorandum.
GROUP 28 -
LOHG-TERM CARE - PUBLIC OPTIONS
HONE
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
782, 1553. See Tab 42 attached to this Memorandum.
203
�GROUP 29 -
LONG-TERM CARE - PRIVATE OPTIONS
NONE
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
783, 1554, 30045.
See Tab 43 attached to this
Memorandum.
GROUP 30 -
LONG-TERM CARE - COST AND REVENUE
BROWN, MARY L.
National
Governors
Association
(30138): No Official Status
National
Governors
Association,
South Carolina, Representative of
Intergovernmental Organization: No
Official Status (1787)
National
Governors
Association,
South Dakota:
Representative of
Intergovernmental Organization: No
Official Status (1787)
National
Governors
Association,
Representative of Intergovernmental
organization: No Official Status
(1787)
McNAMEE, NIKKI
SMITH, BARBARA
VOLPE, CARL
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
784, 1551, 30046, 30138.
See Tab 44 attached to this
Memorandum.
CLUSTER GROUP XI
GROUP 31 -
ECONOMIC IMPACTS
ECONOMIC IMPACTS
REINHART, OWE
Princeton University
(687,
694): No Official Status
691,
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
687-689, 785, 1555.
See Tab 45 attached to this
Memorandum.
CLUSTER GROUP XII
GROUP 32
ALECTIN, LISA
HOLAHAN, JOHN
ILLSTON, LAURA
KENNELL, DAVID
LONG, STEPHEN
QUANTITATIVE ANALYSIS
QUANTITATIVE ANALYSIS
Lewin (1335): No Official Status
Urban Institute (1333): No Official
Status
Lewin (1335): No Official status
Lewin (1335); No Official Status
RAND Corporation ( 1333); No Official
status
204
�MAXFIELD I MYLES
McKUSICK, DAVID
TRAPNELL I
GORDON
ZEDLEWSKI I SHEILA
Mathematical Policy Research ( 1333);
No Official Status
Actuarial
Research
Corporation
(699); No Official Status
Actuarial
Research
Corporation
(699); No Official Status
Urban Institute; No Official Status
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
699-7031 713 1 7141 1861 1333-13371 15561 15571 16331
30047. See Tab 46 attached to this Memorandum.
CLUSTER
GROUP
GROUP
XIII
LEGAL AUDIT
33 -
AHTIIONY I
BARNES I
BARBARA
MARK
BIDDLE I BARBARA
BRIFFAULT, RICBRAD
GOLDMAN, ED
GRAETZ I
LEGAL AUDIT
MICHAEL
BOLDER, ANGELA
McGAREY, BARBARA
MEYER, KATHRYN
HILLOCK, PETER
RYAN, BETSY
SCHULTZ, MARJORIE
SLOWES, RICK
ZELMER, BARBARA
Office of the Massachusetts Attorney
General; No Official Status
NYC
Department
of
Health;
No
Official Status
DOJ-Civil (30149)-FTE
Columbia Law School; No Official
Status
University of Michigan Hospitals; No
Official Status
Yale Law School; No Official Status
Yale University School of Medicine;
No Official Status
National Institutes of Health-FTE
Beth Israel Medical Center; No
Official Status
New York State Department of Health;
No Official Status
New Jersey Department of Health; No
Official Status
Boal t
Hall School of Law;
No
Official Status
Office of the Attorney General of
Minnesota; No Official Status
National Association of Attorneys
General (30149); No Official Status
SOURCES: Declarations of Marjorie Tarmey 1 Documents Nos.
15581 30149 1 unnumbered page 1 "Legal Issues". See Tab 47
attached to this Memorandum.
CLUSTER
GROUP
GROUP
34 -
XIV
HUMBERS
HUMBERS
ATKINSON, HOWARD
BERTKO 1 JOHN
AUDIT
AUDIT
Atkinson & co., Inc.
Coopers & Lybrand
205
----~--~---~-~--~~
~~--~---~----------~---~~-~~
------
------~------
--~-~------~~~
�DORAN I PHYLLIS
GREENWOOD I BRENT
HELMS, DICK
OSTUW, RICH
PORTER, KEN
RODGERS I JACK
Millman & Robertson
Tillinghast/Towers Perrin
The Principal Financial Group
Towers Perrin
The DuPont Co.
Price Waterhouse
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
1559, unnumbered page, "Cost Issues".
See Tab 48
attached to this Memorandum.
CLUSTER XV
THE DRAFTING GROUP
GROUP 35 -
THE DRAFTING GROUP
NOHE
SOURCES:
738-761.
Declarations of Marjorie Tarmey, Documents Nos.
See Tab 49 attached to this Memorandum.
WORKING GROUP 36 -
DISABILITY CROSS-CUTTING WORK GROUP
FREIEDHOLM, DEAHH
Representative of Intergovernmental
organization (1786); No Official
Status
(30080)
State
of
California
Department
of
Health
Services,
Chief, Children's Medical Services;
No Official Status
United Cerebral Palsey (30080); No
Official Status
George Washington University Center
for Health Policy Research; No
Official Status
(30080) The Association of Retarded
Citizens; No Official Status
American Psychological Association,
Assistant
Director
for
Public
Interest Policy; No Official Status
( 30080)
Epilepsy
Foundation
of
America; No Official status
Project HOPE (671)
ADD/Protection & Advocacy ( 30080) ;
No Official Status
Amputee
coalition
of
America
(30080); No Official Status
National
Chronic
care
consortium/Beth
Israel
Hospital
(3008); No Official Status
American
Speech-Language
Hearing
Association (30080); No Official
Status
GREGORY, M.
GRISS I ROBERT
JEHSEH I
ALAR
McGRALY, KATHLEEN
O'KEEFE, JANET
SCHMIDT I BILL
STORE I ROBYN
STRAHAH I MARIE
THOMAS, PETER
THOMPSON, IDRI
WHITE, STEVER
206
�CEO, Blacks Educate
Sexual Health Issues
HANDY I CAROLYN
Blacks
About
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
671, 717-718, 1068, 30128, 30141, 30048, 30051, 30174,
30175. See Tab 50 attached to this Memorandum.
GROUP 37 -
RURAL CROSS-CU'rl'IHG GROUP
SMITH, BARBARA
National
Governors
Association
(1787); No Official Status
National Association of Counties
(1787); No Official Status
UYEDA, MARY
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
709-712, 1634, 1635.
See Tab 51 attached to this
Memorandum.
GROUP 38 -
BENEFITS COORD.IHATIOH
BROWN, lUCK
MAHOWITZ I MICHEJ.T.E
UCLA School of Public Health
The Johns Hopkins University (732)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
Sign-in Sheet, 30129.
See Tab 52 attached to this
Memorandum.
GROUP 39 -
MINORITY ISSUES REVIEW GROUP
JAMES ACEVEDO
JESSE BARBER
PHILLIP BROOKS
RICHARD BUTCHER
MICHAEL BYRD
PAMELA CASHEW
LINDA CLAYTOR
Assistant
Director,
American
HealthCare Management, Huntington
Park, CA; No Official Status
National Medical Association, Chair
of Council Medical Legislation,
Washington, DC; No Official Status
National Black Hospital Association,
President,
Norfolk
Community
Hospital, Norfolk, VA; No Official
Status
President,
National
Medical
Association,
El
Cajon,
CA;
No
Official Status
Research
Fellow,
Department
of
Health Policy & Management, Harvard
School of Public Health, Boston, MA;
No Official Status
Assistant Administrator, Riverside
General Hospital, Houston, TX; No
Official Status
Research
Fellow,
Department
of
Health Policy & Management, Harvard
207
�ROSEMARY DAVIS
SUSAN DRAKE
ADOLPH FALCON
MARIA ELENA FLOOD
HECTOR FLORES
JOYCE ESSIEH
LUIS ESTEVEZ
THURIIAH EVANS
ERNEST GIBSON III
TESSIE GUILLERMO
HAZEL HARPER
JOSEPH HENRY
HILL
SADAKO HOLMES
ANNE
CHARLES KAMASAKI
ELIZABETH KING
DAPHNE
JOHN
School of Public Health, Boston, MA;
No Official Status
National
Medical
Association,
Washington, DC; No Official Status
Senior
Attorney,
National
Immigration Law Center, Los Angeles,
CA; No Official Status
National
Coalition
of
Hispanic
Health
&
Human
Services
Organizations, Washington, DC; No
Official Status
Program Director, Health Sciences
Center, Texas Tech, El Paso, TX; No
Official Status
Co-Director,
Family
Practice
Residency Program, White Memorial
Medical Center, Los Angeles, CA; No
Official Status
Director, Office of Public Health
Practice, School of Public Health,
Emory University, Atlanta, GA; No
Official Status
Medical
Director,
Segundo
Ruiz
Belvis, Neighborhood Family care
Center,
Bronx, NY; No Official
status
President
&
CEO,
WholeLife
Associates, Elkins Park, PA; No
Official Status
Administrator/CEO, Riverside General
Hospital, Houston, TX; No Official
Status
Executive Director, Asian American
Health Forum, San Francisco, CA; No
Official status
National
Dental
Association,
Washington, DC; No Official status
Associate Dean, Harvard School of
Dental Medicine, Boston, MA; No
Official Status
National Urban League, New York, NY
Executive Director, National Black
Nurses'
Association,
Inc.,
Washington, DC; No Official Status
National
Council
of
La
Raza,
Washington, DC; No Official status
Medical Director, Queens Village
Community for Mental Health, St.
Albany, NY; No Official Status
Riverside General Hospital, Houston,
TX; No Official Status
208
�B. WAINE KONG
OSVALDO LOPEZ
RANDALL MAXEY
RAMONA McCARTHY
LAURIN MAYENO
TERRI SMITH MOORE
VERHELLIA RANDALL
ELENA
RENE
RIOS
RODRIGUEZ
DIANE SANCHEZ
SESSOMS
WES SHOLES
FRANK
SAMUEL
SIMMONS
PAUL SIMMS
SARA TORRES
DAVID VALDEZ
HERBERT WELDON
Executive Director, The Association
of Black Cardiologists, Miami, FL;
No Official Status
Chairman, Department of Opthomology,
Chicago, IL; No Official Status
President,
CEO,
HealthQuest,
Hawthorne, CA; No Official Status
President, National Pharmaceutical
Association, Silver Spring, MD; No
Official Status
Association
of
Asian
Pacific
community
Health
Organizations,
Oakland, CA; No Official Status
National Pharmaceutical Association,
Washington, DC; No Official Status
Assistant Professor of Law, School
of Law,
University of Dayton,
Dayton, OH; No Official Status
President,
The
ChicanojLatino
Medical Association of California,
Huntington Park, CA; No Official
Status
President, Interamerican College of
Physicians and Surgeons, Washington,
DC; No Official Status
Women's Medical Arts, Milpitas, CA
Pittsburgh, PA; No Official Status
National Association of Black County
Officials, Rancho Palos Verdes, CA;
No Official Status
caucus and Center on Black Aged,
Washington, DC; No Official Status
Department of Health Services, San
Diego, CA; No Official Status
National Association of Hispanic
Nurses, College of Nursing - USF,
Tampa, FL; No Official status
Family Practice Center, Memorial
Medical Center, Corpus Christi, TX;
No Official Status
Administrator
&
CEO,
Southwest
Hospital & Medical Center, Atlanta,
GA; No Official status
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
"Minority Issues Review Group", unnumbered. See Tab 53
attached to this Memorandum.
GROUP 40 -
ACADEMIC HEALTH CENTERS
209
�ALTMAN, DAVID
CLARK, WILLIAM
DAUMIT, GAIL
DAVIES, MONICA
EPSTEIN, ARNOLD
BANDY, CAROLYN
PAUL, KAREN
REDLENER, IRWIN
STOLINE, ANNE
Robert
Wood
Johnson
Fellow,
Sponsored by UCSF Center for Health
Professionals (704)
Robert
Wood
Johnson
Fellow,
Sponsored by University of Florida,
In Senator Bumpers' Office (708)
White House (704), Emory University
School of Medicine, Medical Student
(734); Internal Medicine MGH Intern
6/93 (30049)
Massachusetts
General
Hospital
Legislative
Fellow,
In
Sen.
Bingaman's Office (708)
Robert
Wood
Johnson
Fellow,
Sponsored by Harvard Medical School
& Brigham & Women's Hospital, In
Senator Kennedy's Office (704)
CEO, Blacks Educate Blacks About
Sexual Health Issues (704)
White House ( 704) Cornell Medical
School (30049)
Pediatrician, Montefiore Hospital;
No Official Status
Psychiatrist, Volunteer
SOURCES:
Declarations of Marjorie Tarmey, Documentss
Nos. 704, 705, 707, 708, 1242, 1243, 1244, 706, 1587,
30048, 30050. See Tab 54 attached to this Memorandum.
GROUP 41 -
WORKER'S COMPENSATION TASK FORCE
BAKER, LAWRENCE
BATEMAN, KEITH
BURTON, JOHN
CLAYTON, ANN
ELLENBURGER, J.
GRANNEMANH, T.
GREENWOOD, JUDITH
BAUGH I KEVIN
NOTH, DAVID
THORNQUIST, LISA
Princeton University; No Official
Status (30133)
Alliance
of
American
Insurers
(1344); No Official Status
Editor,
John
Burton's
Worker's
Compensation Monitor ( 1285) , Rutgers
University; No Official Status
Florida Insurance Commission ( 1285) ;
No Official Status
AFL-CIO; No Official Status
Workers'
Compensation
Research
Institute
( 30133);
No
Official
Status
Workers' Compensation Fund, West
Virginia; No Official Status (1344)
Institute
for
Health
Policy
Solutions; No Official Status
Johnson
&
Higgins
( 1344) ;
No
Official status
Minnesota
Workers'
Compensation
Research (1270); No Official Status
210
�Workers 1
Compensation
Research
Institute (1344); No Official Status
Oregon Insurance Commission (1270);
No Official Status
VICTOR, RICHARD
WEEKS, GARY
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
1270-1276, 1285, 1344, 1345, 30069, 30085, 30090, 30115,
30132, 30133. see Tab 55 attached to this Memorandum.
In addition, other important individuals were listed as part
of the Interdepartmental Working Group of the President 1 s Task
Force on National Health Care Reform,
Working Groups and Subgroups.
and its Cluster Groups,
Documents Nos. 1680 through 1692,
authenticated by the Declaration of Marjorie Tarmey, indicated that
the
following
deliberations
President 1 s
persons,
of
the
among
others,
Interdepartmental
were
involved
Working
Group
in
the
of
the
Task Force on National Health Care Reform and its
Cluster Groups; Working Groups and Subgroups:
SEINHART, J.
WHELAH, K.
MARCUS, K.
WATSON I JR.
I
J.
EIDENBERG, E.
GARAMENDI I
JOHH
Democratic Governor's Association;
No Official status (1682, 1686)
Democratic Governor's Association:
No Official Status (1682)
Democratic National Committee: No
Official Status (1682)
Democratic National Committee; No
Official Status (1682)
Long, Aldridge & Norman, Atlanta,
Georgia,
Attorneys
for
MCI
corporation.
1994
MartindaleHubbell Law Directory, Vol. 6, GA
219B; No Official Status (1682,
1686)
MCI Communications;
No Official
Status (1682, 1685)
State of California; No Official
status (1685)
See Tab 118 attached to this Memorandum.
Clearly, Mr. Magaziner misled the Plaintiffs and this Court.
211
�0.
THE SCANT MEETING MINUTES AND MEETING AGENDAS PRODUCED BY THE
DEFENDANTS.
NOTE:
Because this portion of the Memorandum discusses
documents subject to the Protective Order entered by this Court,
this portion of the Memorandum is attached hereto in a sealed
envelope subject to the terms of the Protective Order entered by
this Court.
P.
SEROUS ETHICAL CONCERNS SQRROUND THE TASK FORCE AND THE
INTERDEPARTMENTAL WOBKING GROUP OF THE PRESIDENT'S TASK FORCE
ON NATIONAL HEALTH CARE REFORM AND ITS CLUSTER GROUPS. WOBKING
GROUPS AND SUBGROUPS
All
executive
personnel,
including
"special
government
employees", are required to file conflict of interest forms, either
SF 278s or SF 450s.
5 u.s.c.
§
201.
If an individual has a
conflict of interest by serving as an SGE, he or she is required to
obtain a waiver. 18 u.s.c.
may violate 18 u.s.c.
§
208.
§
208.
Otherwise, the decisions made
From the records produced by the
Defendants, only thirty-five (35) SGEs and consultants appointed to
the Interdepartmental Working Group of the President's Task Force
on National Health care Reform, filed a conflict of interest form
(either SF 278 or SF 450).
all.
Many SGEs and consultants filed none at
None of the members of Cluster Group V, "Bioethics or Ethical
Foundations of the New System", Working Group 17, "Bioethics",
complied with the Ethics in Government Act at all.
Adrienne Asch,
Horman Daniels, Annette Durla, Abigail Evans, Joan Gibson, Larry
Gostin,
carol Levine,
Pilar Ossorio,
Elliott Dorff and Ruth
Portillo, all named SGE's in Working Group 17, filed no conflict of
212
�interest forms.
In addition, Megan Toohey, an SGE, failed to file
a conflict of interest form at all.
Among those who did file some form, many of them filed late.
Robert A. Berenson, David Eddy, Kathleen N. Lohr, Jane L. Schadle,
Thomas
o. Pyle, filed the forms late, some many months after the
due date.
Others, Shelly crow, Richard E. curtis, Denise A.
Denton, Aaron Shirley and David Satcher, filed forms that appear to
be backdated.
In almost every case, the conflict of interest forms of the
SGEs and consultants were filled out in the handwriting of someone
other than the person filing the form.
Sometimes, the forms
revealed two different handwritings of those filling out the forms,
both different from the person filing the form.
For some forms, it
is noted that information was obtained over the telephone.
appear to have been faxed to the filer.
Others
Several conflict of
interest forms, although otherwise completely handwritten, reveal
a typed date alongside the signature line.
to have been inserted over a "white-out".
The typed dates appear
The conflict of interest
forms of Richard E. curtis, Denise A. Denton, Aaron Shirley and
David Satcher fall within that category.
Not one SGE or consultant obtained a waiver for any conflict
of interest, yet there were those on the Interdepartmental Working
Group of the President's Task Force on National Health Care Reform
and its Cluster Groups, Working Groups and Subgroups, such as
Robert Berenson, Lois Quam, and David Eddy, among others, who had
blatant
conflicts
of
interest
since
213
they
were
officials
or
�consultants to large managed care entities that were the ultimate
beneficiaries of their work.
Even assuming the legitimacy of the conflict of interest forms
which were produced by the Defendants·, at least three persons had
serious conflicts regarding making policy recommendations on health
care matters which led to the bureaucratic managed care scheme now
proposed by the Clinton Administration.
As stated previously,
Robert Berenson is the President of National Capital Preferred
Provider Organization, Lois Quam is the Vice President of Public
Operations for United Health Care Corporation, and David Eddy is an
advisor to Kaiser Permanente. All three entities are large managed
Other
care corporations operating within the United ·States.
members of the Working Groups also appear to have had ties to
managed care interests or consulting firms intimately tied to the
United States health care market.
Title 18
u.s.c.
§
208(a)
provides as follows:
§208.
Acts affecting a personal financial interest
(a) Except as permitted by subsection (b) hereof ,
whoever, being an officer or employee of the executive
branch of the United States Government, or of any
independent agency of the United States, a Federal
Reserve bank director, officer, or employee, or an
officer or employee of the District of Columbia,
including a Special Government employee; participates
personally and substantially as a Government officer or
employee, through decision, approval, disapproval,
recommendation, the rendering of advice, investigation,
or otherwise, in a judicial or other proceeding,
application, request for a ruling or other determination,
contract, claim, controversy, charge, accusation, arrest,
or other particular matter in which, to his knowledge,
he,
his spouse,
minor child,
general
partner,
organization in which he is serving as officer, director,
trustee, general partner or employee, or any person or
organization with whom he is negotiating or has any
214
�arrangement concerning prospective employment,
financial interest--
has a
Shall be subject to the penalties set forth in section
216 of this title.
Title 18 u.s.c.
§
208(b) sets forth three exceptions to this
rule (none of which have been complied with in this case) 16 as
follows:
(b) Subsection (a) shall not apply-(1) if the officer or employee first advises the
Government official responsible for appointment of his or
her position of the nature and circumstances of the
judicial or other proceeding, application, request for a
ruling or other determination,
contract,
claim,
controversy, charge, accusation, arrest, or other
particular matter and makes full disclosure of the
financial interest and receives in advance a written
determination made by such official that the interest is
not so substantial as to be deemed likely to affect the
integrity of the services which the Government may expect
from such officer or employee;
( 2) if, by regulation issued by the Director of the
Office of Government Ethics, applicable to all or a
portion of all officers and employees covered by this
section, and published in the Federal Register, the
financial
interest has been exempted from the
requirements of subsection (a) as being too remote or too
inconsequential to affect the integrity of the services
of the Government officers or employees to which such
regulation applies;
( 3) in the case of a special Government employee serving
on an advisory committee within the meaning of the
Federal Advisory Committee Act [ 5 USCS Appx § § 1 et
seq. ] (including an individual being considered for an
appointment to such a position), the official responsible
for the employee's appointment, after review of the
financial disclosure report filed by the individual
As in the case with certain travel vouchers manufactured and
madly faxed about after the June 22, 1993 Opinion of the D.c.
Circuit was rendered, one can anticipate that the papers which may
alleviate the conflict of interest problems will magically appear
some time after this Memorandum is filed.
16
215
�pursuant to the Ethics in Government Act of 1978 [5 USCS
Appx §§ 101 et seq.], certifies in writing that the need
for the individual's services outweighs the potential for
a conflict of interest created by the financial interest
involved. • • •
(Emphasis added.)
Title 18
u.s.c.
§
208(a) was clearly violated in this case.
This should come as no surprise given the history and tactics
employed by the government in this
litigation.
Indeed,
the
President and First Lady themselves possessed a financial interest
in managed care· throughout the time that the Interdepartmental
Working Group and its Cluster Groups, Working Groups and Subgroups
were in full advisory mode.
According to the President's SF 278,
the President and First Lady held a share in Valuepartners I, an
investment partnership located in Little Rock, Arkansas.
Declaration of Genevieve M. Young, Exh. 26.
See,
A large number of
·shares in health care stocks, including managed care stocks, were
held
by Valuepartners
I.
One
of
these
stocks
was
United
Healthcare, the corporation with whom Lois Quam held the position
of Vice President for Public operations while she was serving on
the Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
Certainly, the pronounced absence of cutting
square corners in the ethics realm militates in favor of opening
the records of the Interdepartmental Working Group and its Cluster
Groups, Working Groups and Subgroups to at least post hoc public
scrutiny.
216
�ARGUHEN'l'
I.
THE DECISION OF THE UNITED STATES COURT OF APPEALS FOR THE
DISTRICT OF COLQMBIA CIRCUIT IN THIS CASE COMPELS THE
CONCLUSION THAT THE INTERDEPARTMENTAL WORKING GROUP AND ITS
CLUSTER GROUPS. WORKING GROUPS AND SUBGROUPS ARE "FEDERAL
ADVISORY COMMITTEES" WITHIN THE MEANING OF THE FEDERAL
ADVISORY COMMITTEE ACT 5 U.S.C. APP •. § 3.
On June 22, 1993, the United States Court of appeals for the
District of Columbia Circuit rendered its opinion in Association of
American Physicians and Surgeons, Inc., et al. v. Hillary Rodham
Clinton, et al., now published at 997 F2d. 898.
In its Opinion,
the D.C. Circuit extensively discussed the Plaintiffs' contentions
with respect to the Interdepartmental Working Group, led by Ira
Magaziner, and the Cluster Groups and Subgroups thereof, and the
Defendants' arguments in response thereto.
The D.C. Circuit first
addressed the government's argument that the Working Group is not
in contact with the President and is not, therefore, "utilized" by
the
Presi~ent
Act (FACA).
within the meaning of the Federal Advisory Committee
The D.C. Circuit expressly rejected this argument,
stating as follows:
The statute cannot be properly interpreted as applying
only to those advisory committees, established in the
Executive Office of the President, that present the most
delicate constitutional problems.
[Footnote omitted.]
Otherwise, the government's argument effectively would
render almost all presidential advisory committees free
from FACA.
Committees in direct . contact with the
President implicate the President's executive power and
hence cannot be covered by FACA, while committees not
directly in contact are not "utilized". In any event,
the statutory language does not remotely support the
government.
Not only does FACA define an advisory
committee as "a task force or any subcommittee or
subgroup thereof", 5 u.s.c. App., 2 § 3(2), but it also
specifies that an advisory committee is a group that is
either established or utilized by the President. See,
Id.
217
�997 F.2d at 912 (Emphasis in the original.)
The D.C. Circuit then went on to consider the government's and
this Honorable Court's reliance on National Anti-Hunger Coalition
v. Executive Committee, 711 F.2d 1071 (D.C. Cir. 1983).
The D.C.
Circuit distinguished Anti-Hunger on its facts and concluded that
this Court's conclusion that the working group could be disregarded
as staff depended on the determination that the Task Force was
covered by FACA.
997 F2d. at 913.
The D.C. Circuit then concluded
as follows:
But when the Task Force itself is considered part of the
government--due to the government officials exemption--we
must consider more closely FACA's relevance to the
working group. For it is the working group now that is
the point of contact between the public and the
government.
The district court's conclusion that the
working group can be disregarded as staff depended on its
determination that the Task Force was covered by FACA.
Our disagreement with the district court on the latter
issue therefore compels a different analysis of the
working group's status.
Id.
After implicitly rejecting the argument that the working group
could not be considered "staff" under Anti-Hunger, the D.C. Circuit
addressed the government's argument that the working group is not,
as a matter of law, a FACA advisory committee because it is not
expected
to
offer
consensus
advice.
In
response
to
this
contention, the D.C. Circuit concluded that "since one of the
purposes of FACA is to achieve some balance, and thereby diverse
views on advisory committees, it would be passing strange if FACA
only applied to those committees
recommendations."
Id.
218
that would offer consensus
�Finally, the D.C. Circuit embarked on an extensive analysis of
the characteristics of an "advisory committee" within the meaning
of the FACA.
The D.C. Circuit observed:
The point, it seems to us, is that a group is a FACA
advisory committee when it is asked to render advice or
recommendations, as a group and not a collection of
individuals. The group's activities are expected to, and
appear to, benefit from the interaction among the members
both internally and externally. Advisory committees not
only provide ideas to the government, they also often
bestow political legitimacy on that advice. As the House
Committee that investigated advisory committees before
FACA's passage stated: "The work product of a committee
composed of distinguished and knowledgeable individuals
appointed by the President to advise him is presumed to
have value and should be considered." H.H.Rep. No. 1731,
91st Cong., 2d sess. 12 (1970).
Advisory committees are not just mechanisms for
transmitting policy advice on a particular subject matter
to the government. These committees also possess a kind
of political legitimacy as representative bodies.
Membership on a committee is often highly prized and
sought after because it carries recognition and even
prestige. When the executive branch endorses its advice
and seeks to promote the.policy course suggested by the
committee,
the executive branch draws upon the
committee's political legitimacy. Congress' effort to
ensure that these committees are balanced in terms of
viewpoint recognizes their usefulness for political (and
patronage) purposes. But committees bestow these various
benefits only insofar as their members act as a group.
The whole, in other words, must be greater than the sum
of the parts.
Id., at 913-914.
Relying upon Judge Gesselis opinion in Nader v. Baroody, 396
F.Supp.
1231
important
(D.D.c. 1975), the D.C. Circuit stated that "an
factor
in determining the presence of
an advisory
committee becomes the formality and structure of the group" •
at 914.
The D.C. Circuit then went on to observe as follows:
In order to implicate FACA, the President, or his
subordinates, must create an advisory group that has, in
219
Id. ,
�large measure,
an organized structure,
a
fixed
membership, and a specific purpose.
The government
suggests that working groups, composed as they are of a
crowd of 340 virtually anonymous persons, do not bear the
characteristics of the paradigm FACA advisory committee.
That may well be so. The working groups, as a whole,
seem more like a horde than a committee. on the other
hand, the groups have been created ("established") with
a good deal of formality and perhaps are better
understood as a number of advisory committees. We simply
cannot determine how to classify the working groups based
on the record before us.
Id.
The final argument advanced by the government before the D.C.
Circuit was that all of the members of the working groups were
full-time officers or employees of the federal government and that,
therefore, the working groups are not FACA advisory committees.
The government claimed that the working groups also included 40
"special government employees" who were "full-time".
The D.C.
Circuit expressly observed, however, that n[t]he record does not
reflect where these persons come from, nor does it show how many
hours they work.n
Id.
(Emphasis added.)
While the government
relied heavily upon the definition of "special government employee"
found in 18
u.s.c.
§
202(a), the D.C. Circuit did not believe that
"section 202 (a) helps the government".
Id., at 915.
The D.C.
Circuit explained the reason for this aspect of its opinion.
We must construe FACA in light of its purpose to regulate
the growth and operation of advisory committees. FACA
would be rather easy to avoid if an agency could simply
appoint 10 private citizens as special government
employees for two days, and then have the committee
receive the section 3(2) exemption as a body composed of
full-time employees.
Id.
220
�Finally, the D.C. Circuit considered the government's argument
regarding
a
third
class
of
persons
participating
in
the
Interdepartmental Working Group described by the government as
"consultants".
The D.C. Circuit's discussion of the issues raised
by "consultants" participating in the Interdepartmental Working
Group was as follows:
The key issue, it seems to us, is not whether these
consultants are "full-time" government employees under
section 3(2), but whether they can be considered members
of the working group at all. When an advisory committee
of wholly government officials brings in a "consultant"
for a one-time meeting, FACA is not triggered because the
consultant is not really a member of the advisory
committee. In that situation, the relationship between
the temporary consultant and committee is very similar to
the one between the White House officials and various
private sector representatives exempted from FACA in
Nader. • • •
But a consultant may still be properly described as a
member of an advisory committee if his involvement and
role are functionally indistinguishable form those of the
other members. Whether they exercise any supervisory or
decision-making authority is irrelevant.
If a
"consultant" regularly attends and fully participates in
working group meetings as if he were a "member", he
should be regarded as a member. Then his status as a
private citizen would disqualify the working group from
the section 3 ( 2) exemption for meetings of full-time
government officials.
Id.
Finally, the D.C. Circuit summarized the scope of the factual
inquiry under FACA as follows:
When we examine a particular group or committee to
determine whether FACA applies, we must bear in mind that
a range of variations exist in terms of the purpose,
structure and personnel of the group. Perhaps it is best
characterized as a continuum.
At one end one can
visualize a formal group of a limited number of private
citizens who are brought together to give publicized
advice as a group. That model would seem covered by the
statute regardless of other fortuities such as whether
221
�the members are called "consultants". At the other end
of the continuum is an unstructured arrangement in which
the government seeks advice from what is only a
collection of individuals who do not significantly
interact with each other. That model, we think, does not
trigger FACA.
Id.
When one construes the FACA in light of its purpose, as is
required by the law of the case, it is clear that the FACA was
intentionally circumvented by
the
Defendants
throughout
this
litigation through sworn non-truths, half-truths, distortions, and
indeed, documents belatedly manufactured after the D.C. Circuit
rendered its Opinion in this case,
among other things.
For
example, the documents reluctantly produced by the Defendants after
this Court entered its Order requiring their production reveals
vastly
more
than
40
"SGEs"
from
outside
private
interests
participating on the Interdepartmental Working Group as represented
in the Declaration of Ira Magaziner and before the D.C. circuit.
Furthermore, the documentation itself which the Defendants later
produced
is
a
laughable
exercise
in
semantics,
with
some
individuals being referred to as "full-time", "part-time", "with
compensation", "without compensation", "SGEs", or "consultants",
often within the very same document!
As to compliance with federal
conflict of interest statutes, Judge Buckley, in his concurring
opinion, relied on the assurances contained in the Declaration of
Ira Magaziner by concluding that "Mr. Magaziner nevertheless took
pains to stress the fact that every member or consultant to the
Group--whether a regular or special government employee, whether
working full-time or part, for pay or without--was required to file
222
---------
---------------
�a
financial
disclosure
statement
requirements of these laws."
concurring).
and
to
comply
997 F. 2d at 921
with
other
(Buckley, J.,
Of course, discovery revealed that nothing can be
further from the truth.
The Interdepartmental Working Group and
its Cluster Groups, Working Groups and Subgroups were dominated by
private persons from managed care interests and many of their
academic minions and "non-profit" sounding boards such as the
Robert Wood Johnson Foundation and the Henry J. Kaiser Family
Foundation.
Additionally, a host of "intergovernmental employees"
were members of the Working Groups, who clearly do not constitute
"full-time officers or employees of the federal government" within
the meaning of Section 3 of the FACA.
See, Center for Auto Safety
v. Cox, 580 F.2d 689, 692 (D.C. Dir. 1978).
This patent violation
of the FACA has led to precisely what the FACA was designed to
prevent.
In Public Citizen v.
109 S.Ct. 2558, 2562,
u.s.
Dept. of Justice, ____
L.Ed.2d
u.s. ____ ,
(1989), the United States
Supreme Court, citing Section 2(b) of the statute, recognized that
the purpose of the Federal Advisory Committee Act was "to ensure
that new advisory committees be established only when essential and
that their number be minimized; that they be terminated when they
have outlived their usefulness; that their creation, operation, and
duration be subject to uniform standards and procedures; that
congress and the public remain apprised of their existence,
activities, and cost; and that their work be exclusively advisory
in nature."
(Emphasis added.)
Furthermore, in one of the first
223
�reported decisions construing the Federal Advisory Committee Act
and the exceptions to its open meetings requirement, the United
states District court for the District of Columbia recognized one
of
the overarching salutary purposes
and rationales
for
the
legislation by observing:
The importance of the Federal Advisory Committee Act is
epitomized by Senator Metcalf who handled the legislation
in the senate:
What we are dealing with here goes to the
making.
bedrock
of
government
decision
. Information is an important commodity in this
capital.
Those who get information to policymakers, or information for them, can benefit
their causes whatever it [sic] may be.
OUtsiders can be adversely and unknowingly
affected.
And decisionmakers who get
information from special interest groups who
are not subject to rebuttal because opposing
interests do not know about the meetings--and
could not get in the door if they did--may not
make tempered judgments.
118 Cong. Rec.
§15285-86 (daily ed. September 19, 1972)
This court will not allow the door to close on
these meetings when Congress has expressly
ordered the door to be open except on the
rarest occasion.
Nader v.
added.)
Dunlop,
370 F.Supp 177, 179
(D. D.C.
1973)
(Emphasis
The purpose of the FACA is further evidenced by the Report of
the House Government Operations Committee,
1017, reprinted in 1972
2d Sess. at 3491-3501.
u.s.
Ho~se
Report No. 92-
Code Cong. & Admin. News, 92nd Cong.
There, the House Government Operations
Committee observed as follows:
One of the great dangers in the unregulated use of
advisory committees is that special interest groups may
use their membership on such bodies to promote their
224
�private concerns. Testimony received a hearings before
the Legal and Monetary Affairs Subcommittee pointed out
the danger of allowing special interest groups to
exercise undue influence upon the Government through the
dominance of advisory committees which deal with matters
in which they have vested interests.
Id., at 3496.
Further,
the
Report
of
the
House
Government
Operations
Committee went on to virtually predict what has occurred in this
case by way of slipshod record keeping and outright deception:
Section 10(b) also provides that each advisory
committee shall keep minutes of its meetings, including
a record of persons present, a complete and accurate
description of matters discussed and conclusions reached,
and copies of all reports received, issued, or approved
by the advisory committee. The chairman of the advisory
committee is required to certify to the accuracy of the
minutes.
This provision will help to remedy the
situation disclosed in the 1970 committee report which
revealed that "it is impossible to find accurate and
complete records on all Presidential committees."
Section 10(b) also provides that:
The provisions of section 551 of title 5,
United States Code, shall apply to all records
and files including agenda, transcripts,
studies, analyses, reports, meeting notices,
and any other data, compilations, and working
papers which were made available to or
prepared for or by each advisory committee.
This provision has the effect of assuring openness
in the operations of advisory committees. This provision
coupled with the requirement that complete and accurate
minutes of committee meetings be kept serves to prevent
the surreptitious use of advisory committees to further
the interests of any special interest group. Along with
the provisions for balanced representation contained in
§4 of the bill, this requirement of openness is a strong
safeguard of the public interest.
225
�****
Section 10(c) of the bill requires that each
advisory committee give timely public notice of the time
and place of committee meetings. This requirement, like
those contained in Section 10(b), is designed to assure
public access to deliberations of advisory committees.
An exception to the requirement that notice be given is
made in the case where notice would endanger the national
defense and foreign policy.
Under Section 10 (d) of the bill, each advisory
committee is required to keep records of its activities
which will fully disclose the disposition of the
committee's funds. These records must be accessible to
the Comptroller General of the United States for the
purpose of audit.
Id., at 3500.
The Conference Report went on to state as follows:
10.
ADVISORY COMMITTEE PROCEDURES
With regard to the availability of the records and
other papers of the advisory committees and public access
to their meetings, the Senate amendment differed from the
House bill. · The conference substitute provides for
publication in the Federal Register of timely notice of
advisory committee meetings, except where the President
dete~ines otherwise for reasons of national security.
The conference substitute further provides for public
access to advisory committee meetings subject to
restrictions which may be imposed by the President or the
head of any agency to which an advisory committee
reports. such restrictions may be imposed after it is
determined that an advisory committee meeting is
concerned with matters listed in section 552(b) of title
5, United states Code. The conference substitute also
provides that subject to section 552 of title 5, United
Stats Code, the records and other papers of advisory
committees shall be available for public inspection and
copying.
The conference substitute requires that each
advisory coliiiRittee keep detailed minutes of its meetings.
The conference substitute requires that a designated
officer or employee of the Government attend each
226
�advisory committee meeting.
No such meeting may be
conducted in his absence or without his approval. Except
in the case of Presidential advisory committees the
agenda of such meeting must be approved by him.
****
13.
FISCAL AND ADMINISTRATIVE PROCEDURES
The Senate amendment and the House bill differ
slightly regarding the requirement that records be kept
concerning the disposition of funds and the nature and
extent of activities of advisory committees.
The
conference substitute provides that each agency shall
keep financial and other records regarding the advisory
committees under its jurisdiction and that either the
General services Administration or such agency as the
President may designate shall maintain financial records
of Presidential advisory committees.
Id., at 3511-3512 (Emphasis added.)
The documents produced by Defendants, when coupled with other
documents
of
public
record,
clearly
reveal
that
the
Interdepartmental Working Group and its Cluster Groups, Working
·Groups and Subgroups were "federal advisory committees" within the
meaning of Section 3 of the FACA.
It is time for the government's
self-serving, year-long charade to come to an appropriate end, and
the records of the Interdepartmental Working Group and its Cluster
Groups, Working Groups and Subgroups to be made public.
It is the
bare minimum remedy which is required given the overtly misleading
conduct which has permeated this litigation from the outset.
227
�CONCIDSION
For all the foregoing reasons, the Plaintiffs' Motion for
Summary Judgment and
Permanen~
Injunction should be granted.
;~t~~itte~~----KENT MASTERSON BROWN, ESQ.
CHRISTOPHER J. SHAUGHNESSY, ESQ.
1114 First National Building
167 West Main Street
Lexington, KY 40507
(606) 233-7879
(606) 252-6791 - facsimile
cf?&r;~ M E:
~--FRANK M. NORTHAM I
Bar No. 206110
ALAN P. DYE, ESQ.
Bar No. 2125379
WEBSTER, CHAMBERLAIN & BEAN
1747 Pennsylvania Avenue, N.W.
Suite 1000
Washington, D.C. 20006
(202) 785-9500
COUNSEL FOR PLAINTIFFS, ASSOCIATION
OF AMERICAN PHYSICIANS AND SURGEONS,
INC. 1 AMERICAN COUNCIL FOR HEALTH
CARE REFORM, and NATIONAL LEGAL &
POLICY CENTER
228
�CERTIFICATE OF SERVICE
This is to certify that a true and correct copy of the
foregoing has been served upon Defendants by hand-delivering a copy
of same to Defendants' counsel of record, Hon. Elizabeth A. Pugh,
Jeffrey Gutman, Esq., Roberts. Whitman, Esq., and David Andersen,
Esq. , U.s. Department of Justice, Civil Rights Division, 901 E
Street, N.W., Room 952, Washington, D.C. 20004-2037 on this
day of March, 1994.
KENT MASTERSON BROWN
I.
229
~r~
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
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72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
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Paper
Dublin Core
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Title
A name given to the resource
American Physicians Lawsuit HCTF (Health Care Task Force); March 23, 1994 [2] [2]
Creator
An entity primarily responsible for making the resource
First Lady's Office
Maggie Williams
Evan Ryan
Melanne Verveer
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
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Reproduction-Reference
Date Created
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1/8/2015
Source
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42-t-2194630-20060223F-006-003-2015
2194630
-
https://clinton.presidentiallibraries.us/files/original/7ae4725d443cb62fd5f66b16f232f289.pdf
1fa9e6aa3beafa84cb51837a497a2444
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
First Lady's Office
Series/Staff Member:
Maggie Williams; Evan Ryan; Melanne Verveer
Subseries:
Misc. Subject Files
OA/ID Number:
12822
FolderiD:
Folder Title:
American Physicians Lawsuit-HCTF (Health Care Task Force); March 23. 1994 [2]
Stack:
Row:
Section:
Shelf:
Position:
s
59
4
7
2
�UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS,
INC. , et al. ,
Plaintiffs,
}
}
}
}
}
}
v.
Civil Action No. 93-399
(Judge Lamberth}
}
}
HILLARY RODHAM CLINTON, et al., }
}
Defendants.
}
}
}
PLAINTIFFS' MEMORANDUM OF POINTS AND AUTHORITIES
IN SUPPORT OF MOTION FOR SUMMARY JUDGMENT
AND PERMANENT INJUNCTION
Kent Masterson Brown
BROWN & BROWN
1114 First National Building
167 West Main Strget
Lexington, Kentucky 40507
(606} 233-7879
Frank M. Northam
D.C. Bar No. 206110
WEBSTER, CHAMBERLAIN & BEAN
1747 Pennsylvania Avenue, N.W.
Suite 1000
Washington, D.C. 20006
(202} 785-9500
Attorneys for Plaintiffs
�UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.,
AMERICAN COUNCIL FOR HEALTH
CARE REFORM AND NATIONAL
LEGAL & POLICY CENTER,
Plaintiffs,
v.
HILLARY RODHAM CLINTON,
DONNA E. SHALALA, Secretary of
Health and Human Services,
LLOYD E. BENTSEN, Secretary of
the Treasury, LES ASPIN,
Secretary of Defense, JESSE
BROWN, Secretary of Veterans
Affairs, RONALD H. BROWN,
Secretary of Commerce, ROBERT
B. REICH, Secretary of Labor,
LEON E. PANETTA, Director of
the Office of Management and
Budget, ALICE RIVLIN, Deputy
Director of the Office of
Management and Budget, CAROL
RASCO, IRA MAGAZINER and
JUDITH FEDER, White House
Advisors and THE PRESIDENT'S
TASK FORCE ON NATIONAL
HEALTH CARE REFORM, and THE
INTERDEPARTMENTAL WORKING GROUP
OF THE PRESIDENT'S TASK FORCE
ON NATIONAL HEALTH CARE REFORM
and its CLUSTER GROUPS, WORKING
GROUPS, AND SUBGROUPS, et al,
Defendants.
)
)
)
)
)
)
)
)
)
)
Civil Action
No. 93-399
(Judge Lamberth)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
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)
)
PLAill'riFFS' IIEIIORABIXJII OF POIN'PS AND AlJ'PBORI'riES
IB SUPPORP OF lfO'riOB FOR SUiflfARY JUDGIIElf'r
AND PBRIIABElrP IBJUBC'.riOB
The
Plaintiffs,
ASSOCIATION
OF
AMERICAN
PHYSICIANS
AND
SURGEONS, INC. ("AAPS 11 ) , AMERICAN COUNCIL FOR HEALTH CARE REFORM
1
�("ACHCR"), and NATIONAL LEGAL
&
POLICY CENTER ("NLPC"), submit the
within Memorandum of Points and Authorities in Support of their
Motion for summary Judgment and Permanent Injunction.
S'.PMEIIENT OF FACTS
IBTRODUCTION
Two multi-billion dollar not-for-profit, private foundations,
among others, have provided the financial and personal resources
and backing for health care reform at the state government level in
the preceding years, and the formation of the PRESIDENT'S TASK
FORCE ON NATIONAL HEALTH CARE REFORM and its INTERDEPARTMENTAL
WORKING GROUP and its CLUSTER GROUPS, WORKING GROUPS AND SUBGROUPS
represents those efforts paying off on a grand scale on the
national
level.
The two
primary not-for-pro(it
foundations
involved in these efforts to "promote change" in governmental
policy on health care delivery are
the Robert Wood Johnson
Foundation1 and the Henry J. Kaiser Family Foundation.
When one
views the structure of the Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups, and the persons who
composed those groups, it becomes clear that large, well-heeled
non-profit foundations invented this bureaucratic yet secretive
means of achieving "change" in the delivery of health care in the
United States by directly influencing the government decision-
In his first Declaration filed at the outset of this
litigation, Defendant Ira Magaziner stated "[t]he First Lady also
plans to attend four regional health care forums sponsored by the
Robert Wood Johnson Foundation." Declaration or Ira Hagaziner,
! ll.
1
2
�making processes from the inside to achieve their goal of promoting
their own well-planned agendas, a goal which they unsuccessfully
attempted to achieve from the outside.
This Memorandum examines
the Interdepartmental Working Group and its Cluster Groups, Working
Groups and subgroups in depth from start to finish, and illustrates
that the Robert Wood Johnson Foundation and the Henry J. Kaiser
Family Foundation each had a large presence and influence on the
Interdepartmental Working Group and its Cluster Groups, Working
Groups
and Subgroups.
This Memorandum also
illustrates the
pronounced presence and influence of other outside interests on the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups, particularly the managed care sector of the
health insurance industry and their allies, a sector which, along
with non-profit groups with whom the government may contract to
administer health care programs, has the world to gain from the
enactment of the now proposed Health Security Act of 1993.
When
one reviews the entire history of this case, in light of what will
follow herein,
from the filing of the Complaint through the
Defendants' overtly misleading representations and stonewalling
when legitimate discovery requests were made,
and legitimate
questions about the existence or non-existence of documents were
raised,
the
Defendants'
actions
and motives
understandable, but certainly not laudable.
are
politically
When one examines the
structure, purpose and composition of the Interdepartmental Working
Group and its Cluster Groups, Working Groups and Subgroups, as
shown by the discovery documents which Defendants have chosen to
3
�produce, in light of the purpose of the Federal Advisory Committee
Act ( FACA) , the Defendants' violations of the Federal Advisory
Committee Act are manifest.
enacted FACA,
were
real.
The concerns of Congress, when it
"One
of
the
great dangers
in the
unregulated use of advisory committees is that special interest
groups may use their membership on such bodies to promote their
private concerns."
H.R. Rep. No. 92-1017, 92nd cong. 2d Sess.,
reprinted in U.S. CODE CONG. & ADMIN. NEWS, 3491, 3496 (1972).
Those concerns are clearly visible in this case.
This Honorable
Court should enter Judgment declaring that the Interdepartmental
Working Group of the President's Task Force on National Health Care
Reform and its Cluster Groups, Working Groups and Subgroups are
advisory committees for purposes of the FACA and further issue a
Mandatory Injunction opening up to the public the working papers of
the Interdepartmental Working Group of the President's Task Force
on National Health Care .Reform and its Cluster Groups, Working
Groups and Subgroups so that the salutary purpose of the Federal
Advisory Committee Act may be served, albeit after the illegal
secretive meetings occurred.
A.
THE NON-PROFIT
1.
11
PLAYEBS" IN HEAtTH CARE REFORM
Tbe Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation ( "RWJF") has "invested"
over $90 Million in state health care reform initiatives in the
past several years.
See, Declaration of Genevieve H. Young, Exh.
8, Preamble to Brochure, "Call for Proposals, State Initiatives in
Health Care Reform", Robert Wood Johnson Foundation.
4
In 1991, the
�RWJF announced the program,
and in 19 9 2 ,
received "development grants" from the RWJF:
twelve
( 12 )
states
Arkansas, Colorado,
Florida, Iowa, Minnesota, New Mexico, New York, North Dakota,
Oklahoma, oregon, Vermont and Washington.
See, Declaration
of
Genevieve M. Young, Exh. 9, Advances, Newsletter of the Robert Wood
Johnson Foundation, Vol. VI, No. 3, Summer, 1993: Exh. 8, Brochure,
"Call for Proposals, state Initiatives in Health Care Reform", the
Robert Wood Johnson Foundation, p. 3.
In every state except North
Dakota, significant progress in creating health care reform has
occurred,
and
Washington,
some
have
states,
already
Declaration of Genevieve M.
such
passed
as
Florida,
comprehensive
Minnesota,
bills.
and
See,
Young, Exh. 9, Advances, Newsletter of
the Robert Wood Johnson Foundation, Vol. VI,
No. 3, Summer, 1993
(Noting enactment of health care reform legislation in Florida,
Health Care Reform Act of 1992: Minnesota, Minnesota Care Act, and
Washington) •
It should also be noted that Oregon,
a
state
mentioned in the RWJF Newsletter, has drastically changed its
Medicaid coverage through "the Oregon Plan".
As one can see from
the RWJF Newsletter, Advances, many of these states given money by
RWJF· formed "task forces" to address health care policy issues.
The ideas for "task forces" or "interagency working groups" to
advance health reform policy were taken directly from the playbook
of RWJF.
In the document entitled, "Call for Proposals, State
Initiatives in Health Care Reform", the RWJF sets forth the rules
for governments receiving its grant money.
5
�First, the application guidelines for the program stipulate
that the applicant must be the Office of the Governor of one of the
fifty States, Puerto Rico, the five United States Territories, or
the Mayor of the District of Columbia o Declaration of Genevieve Mo
Young, Exho 8, Brochure, "Call for Proposals, State Initiatives in
Health Care Reform", the Robert Wood Johnson Foundation, at 14 o
The brochure then goes on to state:
Applications must be accompanied by a letter from the
governor designating a lead agency to be responsible for
overseeing and coordinating the planning and development
of the state's proposed initiative o
The lead
organization should either represent or be charged with
convening
an
interagency
working
group
having
participation from all relevant. health-related state
agencies--including the public health department. human
services. aging. the Medicaid agency. the insurance
department. and the budget office--as well as legislators
from relevant health committees in both houses of the
state legislature preferably drawn from more than one
political party if appropriate.
It also maY include
representatives from private sector organizations.
including business. the health care provider community.
consumer groups. and researchers. The working group may
be. • .formed expressly to carry out the work proposed.
Id., at 14.
Another, equally interesting provision of the RWJF funding of
state government
n initiatives"
is that states are expected to
provide cash or in-kind JDatching support in each phase of the
program.
The brochure expressly provides that
11 [
s] tates are
strongly encouraged to use grant monies to leverage other private
funding to fulfill their matching requirement."
Id., at 14-15.
Thus, RWJF "grants" to the states for "initiatives" are contingent
upon state appropriations.
6
�The second aspect of the RWJF grant program to encourage
"initiatives" in health care reform policy by state policymakers is
through providing certain organizations funds to provide "technical
assistance"
to the
state.
The
brochure
expressly states
follows:
In addition to providing direct grant support, the
Foundation has funded the following organizations to
provide technical assistance to program grantees:
Alpha Center (Washington, DC) serves as the
national program office coordinating all
technical assistance provided under the
program. Alpha provides technical assistance
to individual states· on key design and
operational
issues
and
conducts
policy
. retreats for officials in states considering
broad reform options to help them reach
consensus on which options to pursue. Alpha
also will hold regional workshops and smaller
group consultations for states that face
similar issues.
In addition to conducting
national meetings for state and federal
officials, Alpha will convene smaller working
groups with leading national policymakers to
resolve
specific
technical
issues
in
implementing reforms and will brief executive
branch officials, congressional staff, and key
national interest groups about the states'
experiences in developing and implementing
health care reform.
Alpha prepares and
disseminates
monographs
and
technical
memoranda on major health policy reform and
implementation
issues
and
publishes
a
newsletter tracking states' progress under the
program.
National Governors Association (Washington,
DC) is the liaison with the federal government
for states undertaking health care reform.
NGA will report to states regularly on key
developments on national reform efforts. NGA
also will publish the lessons learned from
state-based reform initiatives to inform other
states and national policymakers.
NGA will
monitor the waiver process and is available .
for
consultation with
individual
states
preparing specific waiver requests. NGA also
7
\
as
�will help states address the political issues
involved in developing and implementing their
reform initiatives.
BAND [Corporation] (Washington, DC) helps
states analyze the potential impact of
specific policy options, using state-specific
data.
RAND coordinates surveys of families
and employers in selected states currently
funded under the program.
RAND also will
assist states and the federal government in
developing state health accounts to track
health care expenditures and will prepare
technical monographs on key policy issues.
Urban Institute (Washington, DC) assists
states in tracking trends in eligibility and
coverage under state health care programs, as
well as simulating the effects of policy
changes on the uninsured and Medicaid
populations. Urban Institute will update its
State-Level Data Book on Health care Access
and Financing and will prepare additional
technical monographs on key policy issues.
Many of these.technical assistance resources also
will be available to states that do not receive grant
funding under the program. All states will receive the
products developed by Alpha, the NGA, RAND, and the Urban
Institute. In addition, all states will be invited to
send representatives to the program's national meetings
and regional workshops. To the degree resources permit,
individual states also may receive briefings and limited
on-site consultations on key design and operational
issues encountered as they develop their reforms.
Id., at 7-8.
The brochure of the RWJF sets forth precisely what occurred
with respect to the President's Task Force on National Health Care
Reform, its Interdepartmental Working Group and its Cluster Groups,
Working Groups and Subgroups on the national level.
seen,
infra,
the
RWJF
model
is
directly
As will be
applicable
to
the
Defendants, even down to the "technical assistance" players, the
Alpha Center, the National Governors' Association, RAND, and the
8
�Urban Institute, as well as the fact that the Interdepartmental
Working Group and its Cluster Groups, Working Groups and Subgroups,
included
representatives
Department
of
Health
and
from
Congress,
Human
the
Services,
the
United
States
United
States
Department of Labor, the United States Department of the Treasury,
the
United
States
Department
of
Justice,
the
Veterans'
Administration, and the Department of Commerce, and a host of
private sector individuals representing private organizations as
well.
The role of the Robert Wood Johnson Foundation in the
Clinton Administration's health care reform scheme became apparent
to certain members of Congress.
on March 15, 1993, Senator Robert
Dole and Representative Robert Michel sent a letter to Steven
Schroeder, the President of RWJF, inquiring about its role "to help
build public support for the Clinton approach to health care
reform", citing "overt" assistance for the Democrats on health
reform issues.
Declaration of Genevieve H. Young, Exh. 18, March
15, 1993 letters from Senator Robert Dole to Steven Schroeder.
In
particular,
of
Senator
Dole
was
concerned
approximately $450,000 to George Washington
about
the
Universit~
grant
to arrange
~he ties of George Washington University to both the Kaiser
Family Foundation and the Robert Wood Johnson Foundation are well
known. According to the Special Supplement, Philanthropic Digest,
Million Dollar Gifts and Grants of 1992 (January, 1993), the Robert
Wood Johnson Foundation gave $2,181,979 to George Washington
University for continued support for the National Health Policy
Forum. According to the June, 1993 edition of Philanthropic Digest
(Vol. 39), the RWJF gave $1,046,404 to George Washington University
to the Medical Center for Programs on Critically Ill Adults,
$849,944 to George washington University to the Intergovernmental
Health Policy Project to support research, and $490,500 -to George
Washington University· to support the National Health Policy Forum
for the development, design and implementation of forums to educate
9
�the
series
Dearborn,
"Conversations
and Washington,
in
Health"
D.c.
Id.
in
Des
Moines,
Tampa,
The Senator asked five
questions:
1.
What led you to decide to join with the White House
in sponsoring and financing these hearings?
2.
Was it the White House's decision that
hearings should be closed except to
specifically invited?
3.
Did the White House determine the invitation list?
4.
Did the White House determine that only Mrs.
Clinton and Mrs. Gore should be on-stage with you
during these hearings?
5.
Is the Democratic National Committee playing any
role in these hearings, such as being permitted to
film the proceedings, orchestrating the hearings,
or helping finance the costs?
these
those
Id.
In a letter dated March 16, 1993, Steven Schroeder replied to
Senator Dole's letter.
See, Declaration of Genevieve H. Young,
Exh. 19, March 16, 1993 letter from steven A. Schroeder, M.D. to
Senator Robert Dole.
This interaction between Senator Dole and
representatives of the RWJF was reported in the Chronicle of
Americans about health care reform. According to the July, 1993
edition of Philanthropic Digest (Vol. 39), the Henry J. Kaiser
Family Foundation gave $310,000 to George Washington University for
the Center for Health Policy and Research to define the role of
safety net providers in managed care and managed competition health
delivery. According to the November, 1993 edition of Philanthropic
Digest (Vol. 39), the Henry J. Kaiser Family Foundation gave
$300, ooo to the George Washington University Intergovernmental
Health Policy Project to co-sponsor with the National conference of
State Legislatures and State Legislative Leaders Foundation, a
series of regional health care reform meetings, and also gave
$10,000 to host a conference to develop a research .agenda to
improve women's primary care.
10
�and the article offered the explanation that Dr.
Philanthropy,
Schroeder
had
indeed
made
the
overtures
to
the
Clinton
Administration to help "get out the word" on health care reform.
"Republican Congressional Leaders Attack Johnson Fund as Partisan",
Chronicle of Philanthropy, April 20, 1993,
Thomas P. Gore II, then
the Vice-President of Communications for the RWJF, stated that the
Foundation,
with help from its grant recipients,
was solely
responsible for selecting the panelists and the audience.
Id.
These four "public hearings", personnel and funding courtesy of the
RWJF, were nothing more than a sounding board for tales of woe
justifying health care reform, and nothing of any substance took
place at the "public hearings".
23,
1993~
Chronicle of Philanthropy, March
Declaration of Genevieve H. Young, Exh. 20, Advances, the
newsletter of the Robert Wood Johnson Foundation, Spring, 1993.
The influence of RWJF will be addressed in further depth,
infra,
where
individuals
playing
major
roles
in
the
Interdepartmental Working Group, and its Cluster Groups, Working
Groups and Subgroups, and their direct ties to RWJF are discussed.
2.
The Henry J. Kaiser Family Foundation and Other NonProfits
The Henry J. Kaiser Family Foundation ("Kaiser") is a large,
extremely well-funded non-profit foundation which has a substantial
interest in government health care policy.
Kaiser, along with the
Pew Charitable Trusts and RWJF, help finance Health Affairs, a
l.l
�health
policy
magazine
published
Exh.
Declaration of Genevieve M. Young,
by
~1,
Project
HOPE. 3
Health Affairs,
See,
Summer,
Since 1988, non-profits such as Kaiser have
1993, at 185-192.
shared with one another a new strategy which has contributed to an
atmosphere ripe for change in how non-profits operate in the United
States.
Many of the new young presidents of the non-profits all
appear to know one another.
1991,
Rebecca Rimel,
Town and Country,
December, 1991.
In
President of the Pew Charitable Trusts
remarked that Peter Goldmark (at the Rockefeller Foundation) and
she started on the same day, while Adele Simmons of the MacArthur
Foundation started a year later.
Id.
Steven Schroeder, President
of RWJF in 1990 and 1991, roomed at Harvard Medical School with
Thomas Vernon, who was formerly with the health and human services
group at Pew Charitable Trusts.
Id.•
Steven Schroeder, a former
professor of medicine, went to Stanford University and Harvard
Medical
School,
and taught at Harvard and George Washington
University before moving to the University of California at San
Francisco, where he is chief of the medical center's division of
internal medicine.
Chronicle of Philanthropy; February 6, 1990.
As will be seen, infra, the Defendants' responses to
discovery requests show that many individuals from Project HOPE
were active members of the Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups thereof.
3
•In his first Declaration filed at the outset of this
litigation, Defendant Ira Magaziner stated that 11 [o]n February 11,
1993, the First Lady attended and participated in a health care
conference in Harrisburg, Pennsylvania, sponsored by Senator Harris
Wofford and the Pew Chari table Trusts, 11
Declaration of Ira
Magaziner, '
26.
12
�Dr. Schroeder founded health maintenance organizations at George
Washington University and the University of California at San
Francisco.
Town and country, December, 1991.
He had administered
grants from, and served as a consultant to, the Commonwealth Fund,
the
Hartford
Foundation,
Kaiser,
and
Chronicle
RWJF.
of
Philanthropy, February 6, 1990.
The young presidents of these various non-profit foundations
squarely believe that government has
the solution to social
problems.
steven Schroeder, when President of RWJF, stated that
"[c]hange
is not going to happen
without government".
Chronicle of Philanthropy, April 23, 1991.
Kaiser, has flatly stated:
The
Drew Altman, hea.d of
"Making grants is like picking stocks.
When you see a chance of action, you buy."
Id.
These heads of
foundations have insisted that foundations can work .effectively to
reform government, having made statements that what the government
does is of "all-consuming importance" and that "[g]overnment is the
ball game ••• we will make no meaningful progress in health care if
we don't make government work better."
Id.
Drew Altman's leadership and philosophy at Kaiser may be
summarized by the following excerpt from an article by Anne Lowry
Bailey contained in the July 30, 1991 issue of
~he
Chronicle of
Philanthropy:
The Henry J. Kaiser Family Foundation has traded
foundations' traditional treatment of government for a
big bear hug • • • Mr. Altman is one of a handful of new
foundation leaders who believe that government is the
most important player in resolving tgday's pressing
health problems, and that making government programs work
better is one of the important roles for philanthropy.
Steven c. Schroeder. the new president of the Robert Wood
13
�Johnson Foundation, and Thomas M. Vernon. the new program
director for health and human services as the Pew
Charitable Trusts. have also persuaded their foundations
to put more money into efforts to help the government do
a better job in the health field.
"What I have in mind, and I think Drew has in mind, is
not just being a partner with government, " says Mr.
Vernon, who previously was executive director of the
Colorado Department of Health. "It's grant making that
strengthens the ability of governments itself to perform
competently and be responsive." • • •
Under Mr. Altman, Kaiser has eschewed traditional grantmaking strategies in support of medical research and
training and elite private universities • • • • while it's
not new for foundations to work with government, the
level of involvement envisioned by Mr. Altman is unusual.
• • .Kaiser's new leaders say they will find ways to give
government officials an active role in the planning and
administration of Kaiser grant programs. To that end.
Mr. Altman has recruited four politically pragmatic
aides. drawn from the top levels of federal and state
government. to form his senior grant-making team. Says
David E. Rogers, a professor of medicine at cornell
University Medical Center:
"If Drew can put
demonstrations in place inside government, where pegple
can kick the fenders and slam the doors. he should be
able to leverage government dollars enormously." Dr.
Rogers was formerly the president of RWJF, where he
employed Altman as a young grant maker. • • "If it were
some blue-eyed academic proposing this, I'd smile," says
uwe E. Reinhardt, 5 professor of economics and public
affairs at Princeton University.
"If it were a
businessman, you could hear me laugh clear across the
country. But if its Drew Altman, there must be something
to that. This guy really knows what he's talking about."
He adds, "If anybody can pull this off, it would be
Drew."
The Chronicle of Philanthropy, July 30, 1991.
Dennis F. Beatrice, the Vice President of the Henry J. Kaiser
Family Foundation,
made it clear that Kaiser was playing an
5
As will be seen, infra, Uwe E. Reinhardt played a significant
role within the Interdepartmental Working Group and its Cluster
Groups, Working Groups and Subgroups.
14
�integral part in the Clinton Administration's health care reform
agenda.
Mr. Beatrice set out the "ground rules" for Kaiser's
participation in the
Interdepartmental Working Group and
its
Cluster Groups, Working Groups and Subgroups, "ground rules" that
Kaiser itself has since ignored.
In a speech entitled, "The Role
of Philanthropy in Health care Reform" for the Grantmakers in
Health on February 19,
1993 in Tarpon Springs,
Florida,
Mr.
Beatrice stated as follows:
Several [Kaiser] grantees are providing analytic support
to the elaborate task force structure that is designing
President Clinton's reform plan, notably in the areas of
how best to incorporate low-income people and persons
with developmental disabilities and mental illness into
a reformed health care system.
Tbe ground rules are
simple: This work is made available to anyone who wants
it; Kaiser sypports only analytic help. not outreach or
coalition building to "sell" whatever approach emerges,
and the foundation will offer similar support to other
credible groups (such as a congressional committee) that
request it.
Declaration of Genevieve M. Young, Exh. 21, Health Affairs, Summer,
1993, 185, 191 (emphasis added.)
Of course, the statement that Kaiser will not attempt to "sell
whatever plan emerges" is belied by recent events.
On January 31,
1994, the Henry J. Kaiser Family Foundation and the League of Women
Voters Education Fund announced their National Public Education
Initiative on Health Reform, with research provided by the Harvard
University School of Public Health and the Johns Hopkins University
School of Hygiene and Public Health, two entities with significant
representation on the Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups.
entitled "Straight Facts on Health Reform",
15
The program is
and it has been
�discussed extensively in the press.
See, Declaration of Genevieve
M. Young, Exh. 16, Washington Times, 2/14/94 editorial "Lies and
statistics About Health Care": Washington Times, 2/28/94 "Murky
statistics on Health Insurance, Round Two": Letter from Becky Cain,
League of Women Voters Education Fund, Washington Times, 2/28/94.
In addition to funding the above "educational" project, the
Henry J. Kaiser Family Foundation funded "The Patient's Advocate"
column in The washington Post, entitled "The Clinton Health Plan
and You", written by Marilyn Moon, a senior research associate at
the Urban Institute, another nonprofit with representation on the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
Most recently, the name of the column has
been changed to "Health Care Change and You" and "Health Reform and
You", and the reference to the Henry J. Kaiser Family Foundation
deleted, although the column is still written by Marilyn Moon.
See, Declaration of Genevieve H. Young, Exh. 17, Washington Post,
columns dated 2/15/94, 2/8/94, 2/1/94, 12/21-28/93, 12/14/93, and
12/7/93.
The influence of Kaiser will be addressed in further depth,
infra,
where
individuals
playing
major
roles
in
the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups and their direct ties to Kaiser are discussed.
3.
The Robert Wood Johnson Foundation Congressional Fellows
Program
As will be set forth in more detail, infra, there were several
participants on the Interdepartmental Working Group and its Cluster
Groups, Working Groups and Subgroups, who were Robert Wood Johnson
16
�Foundation "Health Policy Fellows" serving in various offices of
Democratic Congressional representatives.
The Robert Wood Johnson
Foundation Health Policy Fellowships Program was established in
1973, and is funded by the Robert Wood Johnson Foundation and
conducted by the Institute of Medicine of the National Academy of
Sciences.
Declaration of Genevieve M. Young, Exh. 3, Directory,
Robert Wood Johnson Health Policy Fellowships 1974-1993 (published
8/93) at 1.
According to the Directory, six ( 6) RWJF Fellows
"participate each year in a one-year program of orientation and
full-time work" in Washington, D.C. Id.
Under the heading "Purpose
of the Program", the Directory states that "[F]ellows are selected
from: ( 1) academic faculties in medicine, dentistry, the biomedical
sciences, nursing, public health, health services administration,
the
allied
health
professions,
economics,
and
other
social
·sciences: and (2) other not-for-profit providers and institutions
in the health care system., such as BIIOs, coJIIDlUility health centers,
and health departments." Id. (Emphasis added.)
The Directory also
explicitly states that the purpose of the program is to influence
public policy relating to health care:
The Robert Wood Johnson Health Policy Fellowship Program
is designed to develop the capacity of outstanding midcareer health professionals in academic and communitybased settings to assume leadership roles in health
policy and management. This career development program
provides opportunities for mid-career professionals to
gain an understanding of the health policy process and to
contribute to the formulation of new policies and
programs.
(Emphasis added.)
Id.
17
�The RWJF Health Policy Fellowships Program is run by Marion
Ein Levine,
Institute of Medicine of the National Academy of
Sciences, 2101 Constitution Avenue, NW, Washington, DC 20418.
The
program has also been described by RWJF as being a "one-year
fellowship with the federal government in washington, D.C., for
faculty
from academic health science centers
(for 1 year)."
Declaration of Genevieve M. Young, Exh. 4, ID #4888 RWJF Annual
Report 1992, at 57.
Under the RWJF Health Policy Fellowships
Program, six (6) fellows per year participate in the September to
August program.
Declaration of Genevieve M. Young,
Exh.
13,
Brochure, "Call for Nominations, The Robert Wood Johnson Health
Policy Fellowships Program 1993-1994", at 1. The assignments begin
in December (following orientation and introduction to federal
executive
agency
officials,
including OMB
Congressional aides) and end in August.
Id.
officials
and top
According to the
1993-1994 RWJF Health Policy Fellowships brochure, RWJF Fellows:
develop legislative proposals, arrange hearings, brief
legislators for committee sessions and floor debates, and
participate with staff in House and Senate conferences.
They take part in all areas of the policy process, not as
onlookers, but as full-time working participants. • •
• Each fellow is required to submit an evaluation report
on the program at the end of the Fellowship years.
Id.
The brochure then goes on to state as follows:
The work assignments begin in December and end in August.
• • Fellows help develop legislative proposals, arrange
hearings, brief legislators for committee sessions and
floor debates, and participate with staff in House and
Senate conferences. They take part in all areas of the
policy process, not as onlookers, but as full-time,
working participants.
18
�***
Nominations for Health Policy Fellowships are made by the
chief executive officers of eligible institutions.
***
Fellows are paid annual stipends equal to their salaries
prior to entering the program, up to $50,000 per year.
In addition, the Fellows' existing fringe benefits are
maintained at levels corresponding to the stipends.
Sponsoring institutions may supplement both sums.
Fellows are reimbursed for relocation expenses to and
from washington, DC within certain specified limits.
Id.
Most importantly, the Call for Nominations Brochure states,
"[F]ellows meet with key White House advisors, including officials
of the Office of Management and Budget; top administrators of
agencies responsible for health activities; Congressional committee
staff members; and
repr~sentatives
of health interest groups--the
_people who influence and help formulate national health policy."
Id.•
~he Robert Wood Johnson Foundation, Henry J. Kaiser Family
Foundation, and the Urban Institute, among others, are exempt from
federal taxation pursuant to 26 u.s.c. § 50l(c)(3) and 26 u.s.c. §
509. To maintain the exemptions afforded such foundations, they
are required to comply with the dictates of 26 u.s.c. § 501(h),
"Expenditures by public charities to influence legislation. 11 Under
26 u.s.c. § 50l(h), the exemption from taxation will be denied when
a "substantial part of the activities of such organization consists
of carrying on propaganda, or otherwise attempting, to influence
legislation." This issue, although not a part of this case, should
be examined for those organizations at some time by the appropriate
authorities. As will be seen intra, though, these private, nonprofit foundations have completely insinuated themselves into both
the Executive and Legislative branches of the federal government,
using hundreds of millions of tax-free dollars in order to plan,
draft, promote and influence health care reform legislation, towit, The Health Security Act of 1993.
19
�As is discussed, infra,
these RWJF Health Policy Fellows
during 1993 played an active role in the Interdepartmental Working
Group and
its
Cluster Groups,
Working Groups
and Subgroups.
However, the Defendants (and Ira Magaziner in his Declaration to
this Court) attempted to pass off these RWJF Health Policy Fellows
(with private sector interests) as being full-time, federally-paid
staffers from various Congressional Representatives and Senators,
a
categorization
which
was
plainly
misleading
to
both
the
Plaintiffs and this Court.
B.
THE NON-PROFIT FOYNPATIONS AND THE CLINTON APMINISTBATION
Daniel T. Oliver, a research associate at the Capital Research
Center,
and
editor
of
the
publication,
Alternatives
in
Philanthropy, a monthly newsletter, wrote in the April, 1993 issue
an adept summary of the Clinton Administration's. view of nonprofits:
With the election of President Bill Clinton, many
advocacy groups in the "progressive" wing of the
nonprofit sector believe the time is ripe to promote
greater government involvement in philanthropy. • •
• [ g] roups with interests ranging from more subsidized
housing to increased federal spending for children's
programs "flooded" the transition office.with proposals
offering "cooperation and advice".
Alternatives in Philanthropy (April, 1993), at 1.
Mr.
Oliver opined that one overriding objective of the
nonprofits
is
apparent:
to
use
more
of
the
United
States'
charitable infrastructure as a vehicle to expand government wealth
redistribution programs.
Id.
Mr. Oliver points out that in the
nonprofit sector, there are competing views regarding the role of
nonprofits:
20
�1)
one view is that nonprofits should mainly address
social problems with funds mainly provided by the
government. such "collaboration," with both government
and nonprofits designing and administering social
programs, is more likely to result in effective
approaches to social problems.
If such efforts have
failed in the past, the remedy is increased funding.
2)
The other view is that government officials, as
self-interested agents, have a stronger incentive to
expand programs (even ineffective ones) rather than to
help the poor, and that when nonprofi ts join with
government, this incentive structure tends to dominate
the nonprofit sector as well.
Id., at
s.
Mr. Oliver then goes on to state:
While wholly private programs are not immune to problems
of self-interest, they are more subject to scrutiny by
donors--many of whom are volunteers--than are government
programs in which monitoring for ineffectiveness and
waste by taxpayers is more difficult.
Mr. Oliver observes that the point of view which will dominate will
depend in part on the policies of the Clinton Administration, but
warns
nonprofits
to
look
at
the
government/nonprofit collaboration.
role
of
self-interest
in
Id., at S-6.
The Clinton Administration is no stranger to the world of
nonprofits.
Hillary Rodham Clinton is listed as a
"Funding
decisionmaker" in FUnding Decision Makers Comprehensive Guide to
Donor Connections
~993
(2d ed.) for the New World Foundation, a
nonprofit that supports "avoidance of war" projects, among others.
Peter B. Edelman, a professor at Georgetown University Law Center,
was a member of the New World Foundation, and is the spouse of
Marian Wright Edelman, who heads the Children's Defense Fund,
another nonprofit on whose board Hillary Rodham Clinton has served.
Id.
21
�In addition to the Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups being dominated by
nonprofit
actors
(see
discussion,
infra),
the
Clinton
Administration's views of the role of nonprofits in governmental
affairs are epitomized by recent actions within the Administration.
In the December 14, 1993 issue of The Chronicle of Philanthropy, it
was announced that President Clinton, through Doris Matsui, Deputy
Assistant to the President and Deputy Director of the White House
Office of Public Liaison, is naming an official in each of the 14
Cabinet departments and several other federal agencies to serve as
liaisons to nonprofit groups.
December 14, 1993.
The Chronicle of Philanthropy,
According to Ms. Matsui, this is a reflection
of "the Administration's desire to work more closely with nonprofits on various domestic issues. 11 Id.
Ms. Matsui will serve as
·the White House's representative on non-profit concerns.
c.
Id.
THE
ADMITTEDLY
PBIVATE
FYLL-TIHE
MEMBERS
OF
THE
INTERDEPARTMENTAL WQRKING GROUP AND ITS CLUSTER GROQPS.
WORKING GRQYPS AND SUBGROUPS THEREOF
In
requests,
their
the
First
Responses
Defendants
to
produced
the
Plaintiffs'
"dribbl.es
and
discovery
drabs"
of
information, but even those "dribbles and drabs" themselves leave
it undeniable that numerous individuals from the private sector
(especially non-profit foundations, "academic health centers", and
"managed care corporations 11 )
were active participants
in the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups, and were indeed some of the prime architects
of the proposed Health Security Act of 1993, with its unsurprising
22
�emphasis on government-mandated managed care and a special niche
Of course, the composition and
for "academic health centers".
funding for the Interdepartmental Working Group and its Cluster
Groups,
Working
Groups
and
Subgroups,
legislative mandates a foregone conclusion.
correlates
and
cross-references
the
made
such
proposed
In any event, when one
documents
at
Tab
3
of
Defendants' First Responses (in which Defendants', at that time,
stated contained lists of individuals who participated in the
Interdepartmental Working Group, except Groups lA and 22A-D, for
which no list was compiled) with documents at Tab 12 (in which
Defendants', at that time, stated contained lists of individuals
allegedly "special government employees" who participated full-time
on
the
Interdepartmental
Working
Group
as
"members"),
the
Defendants at the outset of discovery admitted that, at a minimum,
the following were "members of the Interdepartmental Working Group
and its Cluster Groups, Working Groups and Subgroups 11 , and had
private affiliations:
PRINCIPLES AHD OPEBATION OF PURCHASING COOPERATIVES
ORGANIZATION
BERENSON I ROBERT
KRONICK, RICHARD
MILLER I CAROL
NAVARRO, VINCENTE
PAYTON, SALLANNE
RICHARDSON, SALLY
SOFAER, SHOSHANNA
WELCH 1 WILLIAM
HHS-Practicing Internist
HHS-University of California, San Diego:
Assistant Professor
HHS-Mountain Management co., New Mexico
WHO [White House Office): The Johns Hopkins
University
WHO - University of Michigan - Professor
HHS - West Virginia Health Care Planning
Commission
HHS-George Washington University Medical
Center - Associate Professor
OMB - Urban Institute
SPECIAL ISSUES IN PURCHASING COOPEBATIYES
23
�ORGANIZATION
KING, GARY
QUAM, LOIS
RICHARDSON, SALLY
WHO - University of Connecticut Health Center
HHS - United Health Care Corporation, Vice
President7
HHS - West Virginia Health Care Planning
Commission
GOVERNANCE ISSUES
ORGANIZATION
CURTIS, RICHARD
NAVARRO, VINCENTE
SOFAER, SHOSHANA
WELCH I WILLIAM
HHS - Institute for Health Policy Solutions,
President
WHO - The Johns Hopkins University
HHS - George washington University Medical
Center - Associate Professor
OMB - Urban Institute
A GLOBAL BUDGET
ORGANIZATION
KRONICK, RICHARD
NAVARRO, VINCENTE
WELCH I WILLIAM
HHS - University of California, San Diego Assistant Professor
WHO ~ The Johns Hopkins University
OMB - Urban Institute
INSQRANCE REFORM
ORGANIZATION
CLAYTON, GARY
LEVITT I LARRY
HHS
National Association of Insurance
Commissioners
HHS - Special Assistant for Health Policy California Department of Insurance
BENEFITS PACKAGE
ORGANIZATION
BERENSON 1 ROBERT
BERGTHOLD 1 LINDA
BROWN I E. RICHARD
HHS - Practicing Internist
HHS - William M. Mercer, Inc.
HHS - UCLA School of Public Health
Uni ted Health care corporation is a large managed care
business and an obvious beneficiary of the proposed Health Security
Act of 1993.
7
24
�EDDY, DAVID
MILLER, CAROL
VALDEZ, ROBERT
HHS - Duke University - Professor & Kaiser
Permanente - Senior Advisor Health Policy8
HHS - Mountain Management Company - New Mexico
HHS - UCLA School of Public Health - Associate
Professor
COVERAGE FOR WORKING FAMILIES
ORGANIZATION
BERGTHOLD, LINDA
BROWN, E. RICHARD
HANDY, CAROLYN
KRONICK, RICHARD
SOFAER, SHOSHANA
VALDEZ, ROBERT
HHS - William M. Mercer, Inc.
HHS - UCLA School of Public Health
HHS
Blacks Educate Blacks About Sexual
Health Issues
HHS - University of California, San Diego Assistant Professor
HHS - George Washington University Medical
Center - Associate Professor
HHS - UCLA School of Public Health - Associate
Professor
COVEBAGE FOR LQW-INCOHE AHD NON-WORKING fAMILIES
ORGANIZATION
DENTON, DENISE
HANDY, CAROLYN
VALDEZ, ROBERT
HHS - Colorado Rural Health Resource Center
HHS
Blacks Educate Blacks. About Sexual
Health IS$Ues
HHS - UCLA School of Public Health - Associate
Professor
QUALITY MEASUREMENT
ORGANIZATION
EDDY, DAVID
EDDY, JUDITH
EPSTEIN, ARNOLD
JACKSON, DAVID
SAGE, WILLIAM
HHS - Duke University - Professor: Kaiser
Permanente - Senior Advisor Health Policy
HHS - Research Associate - Duke University
HHS - Harvard Medical School - Associate
Professor - Brigham & Women's [Hospital]
WHO - Assurqual - CEO and President
WHO - Policy Analyst - Cluster Leader
INFQRMATIQN SYSTEHS
ORGANIZATION
Kaiser Permanente is one of the nation's largest managed care
corporations, and an obvious potential beneficiary of the
provisions of the proposed Health Security Act of 1993.
8
25
�HHS - Research Associate - Duke University
HHS - Duke University - Professor; Kaiser
Permanente - Senior Advisor Health Policy
EDDY, JUDITH
EDDY, DAVID
MALPRACTICE AND TORT REFORM
ORGANIZATION
BERENSON, ROBERT
EDDY, JUDITH
HHS - Practicing Internist
HHS - Research Associate - Duke University
HEALTH CARE WOBKFORCE DEVELOPMENT
ORGANIZATION
DENTON, DENISE
EDDY, JUDITH
HANDY I CAROLYN
SAGE I WILLIAM
HHS - Colorado Rural Health Research Center
HHS - Research Associate - Duke University
HHS - Blacks Educate Blacks About Sexual
Health Issues
WHO - Policy Analyst - Cluster Leader
HEDICABE
ORGANIZATION
SHIRLEY I AARON
WIENER, JOSHUA
HHS
Jackson-Hinds Comprehensive
Center
HHS - Brookings Institution
Health
DOD rpEPARTHENT OF DEFENSE]
ORGANIZATION
HIX I WILLIAM
DOD - RAND Corporation
VETERANS
ORGANIZATION
[NONE LISTED IN DEFENDANTS' FIRST DISCOVERY RESPONSES]
FEHB [FEDERAL EMPLOYEE HEALTH BENEFITS]
ORGANIZATION
CROW, SHELLEY
HHS - Chief, Muscogee creek Nation
16A - INPIAN HEALTH SEBVICE
ORGANIZATION
CROW, SHELLEY
HHS - Chief, Muscogee creek Nation
26
�MILLER, CAROL
HHS - Mountain Management Company, New Mexico
ETHICAL FOUNDATIONS OF NEW SYSTEM
ORGANIZATION
WHO - Boston University - School of Social
Work
WHO - Columbia University School of Public
BAYER, RONALD
Health
WHO - Brown University - Director - Center for
BROCK, DANIEL
Biomedical Ethics
WHO - University of Minnesota
CAPLAN, ARTHUR
WHO - Tufts University
DANIELS I NORMAN
WHO - University of Judaism
DORFF, ELLIOT
WHO - Einstein University
DOBLER I NANCY
WHO - University of Colorado
DULA I ANNETTE
WHO - The Dana Farber Cancer Institute
EMANUEL, EZEKIEL
WHO - Princeton Theological Seminary
EVANS 1 ABIGAIL
WHO - Fordham University
FAHEY I CHARLES
WHO - Michigan State University Center for
FLECK, LEONARD
Ethics
WHO - University of Wisconsin
FOST, NORMAN
GIBSON, JOAN
WHO - University of New Mexico
GOSTIN, LAWRENCE
WHO - American Society of Law, Medicine &
Ethics
KING, PATRICIA
WHO - Georgetown University Law Center
KLEIN I JENNIFER
.WHO - Policy Analyst
LANTOS I JOHN
WHO - University of Chicago
LEVINE I CAROL
WHO - Orphan Project - New York City
LO, BERNARD
WHO
University of
California
San
Francisco
MAY I WILLIAM .
WHO - southern Methodist University
MEZEY I MATHY
WHO - New York University
MILES, STEVEN
WHO
Hennepin County Medical Center
University of Minnesota
MURRAY I JR. I ROBERT WHO - Howard University College of Medicine
0 I CONNELL I LAURENCE WHO - The Park Ridge Center - Chicago
OSSORIO, PILAR
WHO - Yale University
PURTILO I RUTH
WHO - Creighton University
SECUNDY I MARIAN
WHO - Howard University
NAME
ASCH, ADRIENNE
ACCELERATING NEW SYSTEM DEYELOPHENT
ORGANIZATION
QUAM, LOIS
STARR, PAUL
HHS - United Health Care Corporation, Vice
President
HHS - Princeton University
SHORT-TERM STEPS TOWARP APMINISTBATIVE SIMPLIFICATION
ORGANIZATION
27
-
-
_ _ _ _ _ _ _ _ _ _____J
�STARR, PAUL
HHS-Princeton University
INTERIM COST CONTAINMENT
ORGANIZATION
STARR, PAUL
HHS-Princeton University
FIMANCING
ORGANIZATION
[NONE LiSTED AS SGEs I.E. "MEMBERS" OF WORKING GROUPS; HOWEVER, 3
PERSONS WERE LISTED IN THE NOW FAMILIAR OBFUSCATING MANNER AS BEING
"SGEs OR CONSULTANTS FROM STATE AND LOCAL GOVERNMENTS".]
HEAtTH POLICY INITIATIVES FOR YNPEBSERYED POPULATIONS
ORGANIZATION
CROW, SHELLEY
HHS - Chief - Muscogee Creek Nation
LEWIS-IDEMA, DEBORAH
MDS Associates - Vice President
LUKOMNIK, JOANNE
Columbia University School of Public Health Associate Professor
QUAM, LOIS
HHS - United Health Care Corporation - Vice
President
RICHARDSON, SALLY
HHS -. West Virginia Health Care Planning
Commission
SHIRLEY, AARON
HHS
Jackson-Hinds Comprehensive Health
Center
Vice
SMITH, MARK
HHS
Kaiser Family Foundation
President
George Washington University
ZUVEKAS I ANN
MENTAL HEAtTH; BENEFIT BPACKAGE
ORGANIZATION
FRANK I RICHARD
GOLDMAN, HOWARD
Johns Hopkins University - Health Services
Research & Development Center
HHS - University of Maryland - School of
Medicine
SUBSTAHCE ABYSE
ORGANIZATION
[NONE LISTED IN DEFENDANTS' FIRST DISCOVERY RESPONSES]
MENTAL HEALTH: CHILDREN Is SERVICES
28
�ORGANIZATION
GOLDMAN, SYBIL
PIRES, SHEILA
STROUL, BETH
HHS
casp. Technical Assistance Center,
Georgetown University Child Development
HHS - Human Service Collaborative
HHS - Management & Training Innovations
MENTAL HEALTH: PUBLIC SYSTEM IMPACT
ORGANIZATION
[NONE LISTED IN DEFENDANTS' FIRST DISCOVERY RESPONSES]
LONG TERM CABE: 8ACKGROYND
ORGANIZATION
LITVAK, SIMI
STONE, ROBYN
WIENER, JOSHUA
HHS
World Institute on
California Research Director
HHS - Project HOPE
HHS - Brookings Institution
Disabilities
LONG TERM CARE: PUBLIC
ORGANIZATION
STONE, ROBYN
HHS - Project HOPE
LONG TERM CABE: PRIVATE
ORGANIZATION
STONE, ROBYN
HHS - Project HOPE
LONG TERM CARE; COST ABD REYENUE
ORGANIZATION
STONE, ROBYN
HHS - Project HOPE
ECONOMIC IMPACT
ORGANIZATION
[NONE LISTED IN DEFENDANTS' FIRST DISCOVERY RESPONSES]
OUAHTITATIYE ANALYSIS
ORGANIZATION
[NONE LISTED IN-DEFENDANTS' FIRST DISCOVERY RESPONSES]
29
�When one correlates the documents at Tab 3 of the Defendants'
First
Responses
contained
lists
(in
of
which
Defendants,
individuals
who
at
that
time,
participated
stated
in
the
Interdepartmental Working Group, except Groups 1A and 22A-D, for
which no list was compiled) with the documents at Tab 13 (lists of
"consultants") and at Tab 14 ("SGEs" or "consultants" from state
and local governments), the following non-federal personnel, at a
minimum, also participated in the Interdepartmental Working Group
and its Cluster Groups, Working Groups and Subgroups:
PRINCIPLES AND OPEBATION OF PQRCUASING COOPERATIVES
ORGANIZATION
0 I BRIEN I MARY JO
(State or Local)
WEIL, ALAN
(State or Local)
WHO [White House Office] - NGA [National
Governors Association] - Deputy Commissioner Minnesota Department of Health
WHO - Governor's Office - Colorado - Health
Policy Advisor
SPECIAL ISSUES IN PQRCUASING COOPEBATIYES
QRGANIZATION
HEATH I ALFRED
(State or Local)
SMITH I BARBARA
(State or Local)
WADA, ROYLINNE
(State or Local)
WEIL, ALAN
(State or Local)
WHO - Commissioner of Health Islands
u.S. Virgin
WHO - NGA - Secretary jHealth - south Dakota
Department of Health
WHO
Pacific
Island
Health
Officers
Association (RIHOA) - Executive Director
WHO - Governor's Office - Colorado - Health
Policy Advisor
GOVERNANCE ISSQES
OBGANIZATION
McNAMEE, NIKKI
30
�{State or Local)
RADER, ANYA
{State or Local)
WHO - NGA - Office of the Governor of South
Carolina
WHO - Deputy cos & Special Assistant/Health
Care Policy for Governor Dean
****
BENEFITS PACKAGE
ORGANIZATION
GARCIA, JOSEPH
{State or Local)
0 I BRIEN I MARY JO
(State or Local)
WHO - cuyahoga County, Ohio - Department of
Human Services
WHO - NGA - Deputy Commissioner - Minnesota
Department of Health
COYERAGE FOB WOBKING FAKILIES
ORGAUIZATION
BROWN MARY LEIGH
(State or Local)
I
GARCIA, JOSEPH
_(State or Local)
KRUEGER, ALAN
("Consultant")
PETERSON I DOUGLAS
(State or Local)
WHO - NGA - Governor's Commission on Oklahoma
Health Care
WHO - Cuyahoga county, Ohio - Department of
Human Services
HHS - Princeton University
WHO - National League of Cities
COVERAGE FOR LOW-INCOME AND NON-WQRKING fAMILIES
QRGANIZATION
EGBERT 1 MARCIA
(State or Local)
FRIEDHOLM I DEANN
(State or Local)
GARCIA, JOSEPH
(State or Local)
WHO
cuyahoga County, Ohio
Board
Commissioners - Intergovernmental Affairs
of
WHO - NGA - Texas Medicaid Director
WHO - cuyahoga County, Ohio - Department of
Human Services
QUALITY MEASUREMENT
ORGANIZATION
BENEDICT, ROBERT
31
�WHO - Pennsylvania State Association of County
Commissioners
(State or Local)
****
HEALTH CARE WORKFORCE DEVELOPMENT
ORGANIZATION
AIKEN, LINDA
("Consultant")
HHS - University of Pennsylvania - Professor,
Nursing Director - Center for Health Services
****
ACCELEBATING NEW SYSTEM DEVELOPMENT
ORGANIZATION
O'BRIEN, MARY JO
(State or Local)
RILEY, IRENE
(State or Local)
WALTERS, FARAH
("Consultant")
WHO - NGA - Deputy Commissioner - Minnesota
Department of Health
WHO - Los Angeles County Health Services
Department of
HHS - University Hospitals of Cleveland, Ohio
- President & CEO
****
INTERIM COST CONTAINMENT
ORGANIZATION
RADER, ANYA
(State or Local)
WHO - Deputy COS & Special Assistant/Health
Care Policy for Governor Dean
****
FIMANCING
ORGANIZATION
CORONADO, DAVID
(State or Local)
SCHEPPACH, RAY
(State or Local)
UYEDA, MARY
HHS - D.C. Department of Human Services
WHO
National Governors Association
Executive Director - Virginia
32
�(State or Local)
WHO - Director, City Health Policy Project National Association of Counties
HEALTH POLICY INITIATIVES FOR PNDERSERVED POPULATIONS
ORGANIZATION
BENAVIDES, ELLEN
(State or Local)
WHO - Hennepin County, Minnesota Bureau of
Health; Director, Health Policy
MENTAL HEAtTH: BENEFITS PACKAGE
ORGANIZATION
HOLT I HERBERT
(State or Local>·
JOSEPH I THOMAS
(State or Local)
WHO - Director, Department of Mental Health
Services, Montgomery County, Maryland
WHO - National Association of Counties
****
LONG TEBM CARE; PYBLIC
ORGANIZATION
.VOLPE, LANE
(State or Local)
WHO - National Governors Association
****
LONG TERM CARE; COST AND REVENUE
ORGANIZATION
KRUEGER, ALAN
("Consultant")
HHS - Princeton University
OUABTITATIVE ANALYSIS
ORGANIZATION
KRUEGER, ALAN
("Consultant")
The
HHS - Princeton University
Defendants
also
listed
the
following
"consultants" at Tab 13 of their First Responses:
ORGANIZATION
33
persons
as
�CONSULTANT
AIKEN, LINDA
CALLAHAN I CATHI
HILLMAN I ALAN
JONES, STANLEY
KRUEGER I ALAN
LOHR I KATHERINE
MAYS, JAMES
PYLE, THOMAS
STACHER, DAVID
SCHADLE, JANE
TRAPNELL I GORDON
WALTERS I FARAH
D.
HHS-UNIV. OF PENN. -PROF. NURSING-DIRECTOR-CTR.
HEALTH SVCS
ACTUARIAL RESEARCH CORP. (ASPE)
HHS-UNIV. OF PENNSYLVANIA-ASSISTANT PROFESSOR
OFFICE OF PERSONNEL MANAGEMENT-INDEPENDENT
CONSULTANT
HHS-PRINCETON UNIVERSITY
HHS-HEALTH CARE SVCS-INST. OF MEDICINE/NAS
ACTUARIAL RESEARCH CORPORATION
HHS-HARVARD COMMUNITY HEALTH PLAN/BOSTON
CONSULTING GROUP
HHS-PRESIDENT-MEHARRY
MEDICAL
COLLEGETENNESSEE
HHS-IOWA DEPT. PUBLIC HEALTH-HEALTH PROGRAM
ANALYST
ACTUARIAL RESEARCH CORPORATION
HHS-UNIVERSITY HOSPITALS OF CLEVELAND 1 ORPRESIDENT & CEO
THE COKPLEX STBUCTQRE AND TAINTED COMPOSITION OF THE
INTERDEPARTMENTAL WORKING GRQUP. AUD ITS Cluster GRQUPS.
WORKING GBOYPS AUD SUBGROUPS
As
an adjunct to the President's Task Force on National Health
Care Reform, an "Interdepartmental Working Group" was organized tor
purposes of gathering information, developing a recommendation for
a new health care delivery system and reaching a consensus on its
provisions.
The "Interdepartmental Working Group" was made up of
fifteen ( 15) so-called Cluster Groups, and forty-three ( 43) Working
Groups and four ( 4) Subgroups, most of which were assigned to
individual clusters.
system.
It was a highly regimented and orchestrated
Each working group had a definite membership and each
cluster had a definite number of working groups.
According to Ira
Magaziner, "The interdepartmental working group has been organized
into fifteen 'cluster' groups, each of which addresses a subject
area relevant to heal'th care reform.
34
To date, fifteen such cluster
�groups have been created or planned, and include groups addressing
new
system
organization;
new
system
infrastructure/integrated health plans;
coverage;
integration
of
health
programs into new systems; ethical foundations of a new system;
transition
to
the
new
system/short-term
cost
containment;
financing; health policy initiatives for underserved populations;
mental
health:
analysis;
long-term care:
economic
legal audit; numbers audit;
impact:
quantitative
and a drafting group."
Declaration of Ira Magaziner, March 3, 1993, ' 15.
Mr. Magaziner
continued, explaining how the fifteen (15) cluster groups were
further divided into subgroups.
"The new system organization
cluster includes subgroups addressing principles and operation of
purchasing cooperatives, health plans, providers and patients in
the
new
system;
special
issues
in
purchasing . cooperatives;
governance issues; a global budget; and insurance reform."
new system cluster", Magaziner testified,
"The
"includes subgroups
addressing benefits packages; coverage for low-income and nonworking families.
cluster
includes
The infrastructure/integrated health plans
subgroups
addressing
quality
measurement;
information systems; malpractice and tort reform: and health care
workforce development. The integration of health programs clusters
includes subgroups addressing Medicare: the Department of Defense:
veterans; federal employees' health benefits programs: and other
government health programs.
The cluster addressing the transition
to the new system development includes short-term steps toward
administrative simpli·fication, and interim cost containment.
35
The
�cluster addressing
underserved
populations
includes
subgroups
addressing high risk populations; urbanjrural populations; and
women and children.
The mental health cluster includes subgroups
addressing benefits packages; substance abuse; children's services;
and public system impact.
subgroups addressing
cost and revenue."
And the long-term care cluster includes
backgroun~;
public care; private care; and
Id., !! 16, 17 and 18.
Indeed, the Interdepartmental Working Group and its Cluster
Groups, Working Groups and Subgroups were highly structured; their
membership was well-established.
According to Magaziner, all the
aforesaid groups were "established" by him (under direction from
the President) on or about January 25, 1993, and, the groups "met
regularly as part of an intensive effort to document the impact of
existing health care policies and to gather information on possible
alternatives. 11
the
Id. , ! 18.
Interdepartmental
In ·fact, according to Magaziner, he led
Working
Group
which
was
"gathering
information concerning the impact of existing health care policies
and delivery services, and possible alteratives to those policies.
The information that was gathered and analyzed by the working group
[was]
used,
in turn,
by the Task Force
recommendation to the President."
in
formulating
its
Id., ! 5.
From the documents authenticated by Marjorie Tarmey in the
Defendants' Answers to Interrogatories and Responses to the Second
Request
for
Production
of
Documents
(hereinafter
cited
as
Declarations of Marjorie Tarmey), the formality and structuring--as
well as membership in--the Interdepartmental Working Group, fifteen
36
�(15)
Cluster Groups and forty-three (43) Working Groups and four
( 4) Subgroups is clearly and unequivocally seen.
As well 1 the fact
that every group contained numerous members who were not full-time
officers or employees of the federal government is totally and
clearly obvious.
The fifteen ( 15) Cluster Groups 1 forty-three ( 43) Working
Groups and four (4) Subgroups which made up the Interdepartmental
Working Group of the President's Task Force on National Health Care
Reform were established and utilized by the President.
A chart of
the Interdepartmental Working Groups its Cluster Groups, Working
Groups and Subgroups is attached hereto at Tab 1 attached to this
Memorandum.
Cluster Group I, "New System organization•, was composed of
Working
Group
"Principles
1,
and
Cooperatives•; Working Group· 1A,
Providers•; Working Group 2,
Operation
"Health Plans,
of
Purchasing
Patients and
"Managed carejToward
&
Beyond•;
Working Group 3, "Governance•; Working Group 4, "A Global Budget•,
and Working Group 5, "Insurance Reform.•
See Tab 2 attached to
this Memorandum.
Cluster I, "New system organization•, and its cluster leader
was listed as follows:
CLUSTER I -
NEW
CLUSTER LEADER -
SYSTEM ORGARIZATION
WALTER ZELMAII', Chairman of the
Health care Advisory Commission and
Special Deputy for Hea1th Insurance
37
�in the California Department
Insurance (864) - SGE (1679) 9
of
Working Group 1 of Cluster Group I, was composed of the
following members:
GROUP 1 - PRINCIPLES AND
COOPERATIVES
RICK KRONICK
WK.
(PETE) WELCH
ALBERGHINI, THERESA
ALLEN, LUCY
ALTMAN,
DAVI:D
ANTOS, JOSEPH
OPERATION
OF
PURCHASING
Group 1 Leader ( 1) UCLA School of
Public HealthfRand Corporation(864)
- SGE (1678)
Group 1 co-Chair ( 1) Urban Institute
(866) - SGE (1679)
Sen. Leahy (Congressional Directory
[Hereinafter, "CD"], Vol. I, P.327)FTE
Council on Economic Advisors (CEA)FTE
Robert
Wood
Johnson
Fellow,
. Sponsored by Center for the Health
Professions, UCSF [Tab 56 Attached
to this Memorandum], Office of Sen.
Rockefeller (835)-FTE (840)
HHS-FTE
All non-full-time officers and/or employees of the federal
government are listed in bold-black with their private affiliations
also listed in bold black. "FTE" and "SGE" desicp1ations were given
to the persons by the Defendants except where noted. "CD" refers
to the 1993 Brownson, A., ed. Congressional Staff Directory, Vol.
1 which was cross-referenced for purposes of exact identification
of all Congressional personnel. All numbers in parentheses refer
to documents authenticated by the Declarations of Marjorie Tarmey.
For reference, participants from the Veterans Administration are
included in Tab 119, participants from the Department of Labor in
Tab 120, participants from the Department of Health and Human
Services in Tab 121, participants from the Office of Management and
Budget in Tab 122, participants from the Department of the Treasury
in Tab 123, participants from the Department of Defense in Tab 124,
participants from the Department of Justice in Tab 125,
participants from the Department of Commerce in Tab 126,
participants from the Department of Education in Tab 127 and
participants from Congressional staffs in Tab 128. All private
persons will be discussed at length, infra.
9
38
�Rep. L. Stokes/Health Issues for
Ways and Means Committee (CD Vol. I,
P.653)-FTE
National Capital Preferred Provider
BERENSON 1 ROBERT
Organization {868, 30016, 30136) SGE (1678)
Rep. Harry Johnston (CD Vol. I, P.
BERRY, ROGER
562)-FTE
BRIGGS, BETTY
Labor-PTE
Sen. Breaux (CD, Vol. I, P. 930)-FTE
BURNETT I LAIRD
Sen. Daschle (CD, Vol. I, P. 942)COHEN, RIMA
FTE
House Select Committee on Aging
COSTER, JOHN
(Lost Funding 3/31/93)-FTE (841)
President, :Institute ,for Health
CDR.T:IS I RICHARD
Policy Solutions, Washington, DC SGE (1678)
Sen. Budget Committee-PTE
DEIGNAN, KATHLEEN
Sen. Finance Committee (CD, Vol. I,
DRUMMOND, FAYE
P. 963)-FTE
Commerce-PTE
EDGELL, JONATHAN
Federal Trade Commission-PTE
EGAN, JAMES
The Jackson Bole Group, :Inc. ( 2) ; No
ENTIIOVEN I ALA:IN
Official Status Assigned
Rep. Earl Pomeroy (CD, Vol. I, P.
FRANTZ I MOLLY
705)-FTE
FUY, GEORGE
HHS-FTE
HADLEY I JAMES
HHS-FTE
HATTON, MELINDA
Sena~e
Judiciary/
Antitrust
Subcommittee (CD, Vol. I, P. 392)FTE
HASH, MIKE
Rep. Waxman (CD, Vol. I, P. 712)-FTE
HICKMAN I PETER
HHS-FTE
HOGUE, BONNIE
Sen. Special committee on Aging (CD,
Vol. I, P.401)-FTE
HUMAN I JEFFREY
Senate Special committee on Aging
(CD, Vol. I, P.
)-FTE (843)
JODREY I DARREL
Not in Directory - FTE (843)
JONES I SANDRA
Veterans Affairs-PTE
JONES, MARCIA
Sen. Breaux (CD, Vol. I, P. 276)-FTE
KAZDIN, ROBERT
Treasury-PTE
KENYON I KATHLEEN
Federal Trade Commission-PTE
KICHAK, NANCY
OPM-FTE
KING I KATHLEEN
Senate Finance (CD, Vol. :I, P.
1025)-FTE
KRONICK, RICHARD
UCLA/S@ool of PUblic Health/Rand
Corporation; SGE ( 1678)
KOSB, GA:IL
Listed as Participant ( 835) - lfo
Affiliation, lfo Status Given
LANGENBRUNNER, JACK OMB-FTE
LASKER, ROZ
Physician Payment Review Commission
(864-868)-SGE (1678)
ATKINSON, LESLIE
39
�LAWSON I KURT
LEVITT, LAWRENCE
Treasury-FTE
Staff of California Department of
Insurance,
Commissioner's Health
Care Advisory Commission ( 864) - SGE
(1678)
Veterans Affairs-FTE
MANTEL, LEWIS
Mountain Manaqement Company, NM - No
MILLER, CAROL
Employment Status Given on 16781679)-SGE (First Responses)
Rep. S. Levin (CD,, Vol. I, P.
MILLER, MICHAEL
1056)-FTE
Treasury-FTE
MUNNELL, ALICIA
Federal Trade Commission-FTE
NARROW, DAVID
House Ways and Means (CD, Vol. I, P.
NEUMAN I TRICIA
1065)-FTE
National
Governors
Association,
0' BlUER, MARY JO
State of Minnesota (835)
No
Official Status Assiqned: Listed as
Representative of Interqovernmental
Orqanization (1786-87)
Veterans Affairs-FTE
O'NEILL, PATRICIA
OBEY, CRAIG
Sen. Conrad (CD, Vol. I, P. 1068)FTE
OFFNER, PAUL
Senate Finance (CD, Vol. I, P.
1069)-FTE
PATEL, PARASHAR
OMB-FTE
PAYTON, SALLYARNE
University of Michiqan School of Law
( 2) : No Employment Status Assiqned
POTETZ, LISA
HHS-FTE
REINECKE 1 PETER
Sen. Harkin (CD, Vol. I, P. 396)-FTE
lUCBARDSON I SALLY
Vice-Chair, West Virqinia Health
care
Planninq
CoBmission:
No
Official status Assiqned
ROSS, HARJOIUE
White Bouse Policy Analyst (835):
Johns Hopkins University (732)-SGE
(1678)
ROVIN, LISA
HHS - HCFA - FTE
SHRIBER I DONALD
House Enerqy & Commerce (CD, Vol. I,
P. 1109)-FTE
SMITH I CURTIS
OPM-FTE
SOFAER, SHOSIIAHlfA
Georqe Washinqton University Medical
center - SGE ( 1678)
VARNHAGEN, MICHELLE Sen. Metzenbaum (CD, Vol. I , P.
396)-FTE
WALTERS, FARAH
President
&
CEO,
University
Hospitals of Cleveland, Ohio (2) Consultant (First Responses)
WEIL, ALAN
National Governors Association, Gov.
Romer of Colorado (3): No Official
Status
Assiqned:
Listed
as
Representative of Interqovernmental
Orqanization (1786-87)
40
�WELCH I WILLIAM
WERNER I MICHAEL
The Urban Institute - SGE (1679)
Sen. Democratic Policy Committee
(CD, Vol. I, P. 403)-FTE
WILLIAMS, CHRISTINE Sen. Mitchell (CD, Vol. I, P. 338)FTE
ZARABOZO, CARLOS
HHS-HCFA-FTE (835)
Chairman of the Health care Advisory
ZELMAN I WALTER
Commission, and Special Deputy for
Health Insurance in the california
Department of Insurance ( 864) - SGE
(1679)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
1-4, 17-25, 37-42, 54-56, 732, 767-768, 798-799, 834-835,
864-868, 1516-1517, 1560-1561, 1678-1679, 1795-1796. See
Tab 3 attached to this Memorandum.
Working Group 1A of Cluster Group I, was composed of the
following members:
GROUP 1A-
HEALTH PLARS, PROVJ:DERS, AND
THE HEW SYSTEM
PATIENTS IH ·
GROUP 1A LEADER
ROBERT BERENSON, M.D., (1568)
Rational capital Preferred Provider
Organization ( 30016, 30136) - SGE
(1678)
GROUP 1A co-LEADER
ROZ LASKER, Physician Payment Review
COmmission (1568)
ALTMAR I DAVID
Robert Wood Johnson Health Policy
Fellow, Sponsored by Center for the
BERENSON I ROBERT
BLOCH I ROBERT
CADE, DAVID
EGAN, JAMES
GOODMAN I NANCY
HATTON I MELINDA
KENYON I KATHY
KUSH, GAIL
Health Professions, University of
california, San Francisco, in the
office of Senator Rockefeller [Tab
56 Attached to This llemorandlDil] ( 6)
- r.rE (840)
Rational capital Preferred Provider
Organization ( 30016, 30136) - SGE
(1678)
Department of Justice - FTE
HHS/General Counsel - FTE
FTC - FTE
Department of Justice - FTE
Senate
Judiciary/Antitrust
Subcommittee (CD, Vol. I, P. 392) FTE
FTC - FTE
Ro Affiliation: No Elllployment Status
Given (5, 1513, 1514)
41
�MANTEL, LEWIS
MILES I STEVEN
Veterans Affairs - FTE
Former President of the American
College of Physicians, Hennepin
County Medical Center, University of
Minnesota (1513, 1514); Ro Official
status Assigned
NARROW, DAVID
FTCC-FTE
Rational
Governors
Association,
O'BRIEN I MARY JO
state
of
Minnesota
( 835) ;
Ro
Official Status Assigned; Listed as
Representative of Intergovernmental
Organization (1786-87)
Veterans Affairs-FTE
O'NEILL, PATRICIA
West Virginia Health Care Planning
RICHARDSON, SALLY
COJIIDli.ssion;
Ro
Official
Status
Assigned
ROVIN, LISA
HHS - HCFA - FTE
VARNHAGER 1 MICHELLE Sen. Metzenbaum (CD, Vol. I 1 P.
396)-FTE
WINSLOW I WALTER
FTC-FTE
SULLIVAN, T.J.
Internal Revenue Service
FTE
(1513, 1514)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
5, 6, 26, 57, 1513-1515.
See Tab 4 attached to this
Memorandum.
Working Group 2 of Cluster Group I
was
composed of the
following members:
GROUP 2 - MAHAGED CARE/TOWARD & BEYO:tm -
SPECIAL ISSUES
IR PURCHASING COOPERATIVES
GROUP 2 LEADER -
IDIS QUAM ( 7) Former Chairman of the
Minnesota
Health
care
Access
Commission
and
CUrrent
Vice
President,
United.
Health
care
Corporation,
Minneapolis,
MN-SGE
(1678)
GROUP 2 CO-CHAIR
CLAUDIA BAQUET, M.D. - HHS - FTE ( 7)
ALBERGHINI, THERESA Sen. Leahy (CD, Vol. I, P. 327)-FTE
ALLEN, LUCY
Council on Economic Advisers ( 1364)FTE
ALMENDAREZ, ISABEL Rep. Washington (CD, Vol. I, P. 904)FTE
ATKINSON, LESLIE
Rep. L. StokesjHealth Issues, Ways
and Means committee (CD, Vol. I, P.
653)-FTE
BAQUET 1 CLAUDIA
HHS-FTE
42
-
- - - · - - - - - - - -
�BERENSON, ROBERT
BOWEN, STEVEN
BOWLES I ROBERT L.
NCPPO (30005)-SGE (1678)
HHS - HRSA - FTE
DC Chartered Health Plan, Inc.
(1364, 1371); No Official Status
Assigned
Rep. Towns (1371) - FTE
BRANSON, CHERRI
Rep. Foglietta (CD, Vol. I, P. 424)BRODNITZ, PETER
FTE
BROWN, MARY LEIGH
National
Governors
Association;
Representative of Intergovernmental
organization; No Official Status
(1496)
CARLSON, RON
HHS - HRSA - FTE
Veterans Affairs - FTE
CLAY, JIMMIE L.
Rep. Conyers (Chair, Gov. Ops.)(CD,
CLEMENTE I FRANK
Vol. I, P. 717) - FTE
Sen. Daschle (CD, Vol. I, P. 942)COHEN, RIMA
FTE
Rep. Roybal-Allard (CD, Vol. I, P.
CONTRERAS 1 HENRY
633)-FTE
Sen. Moseley-Braun (CD, Vol. I, P.
COOK, FRANCESCA
339)-FTE
President, Institute for Health
CURTIS I RICHARD
Policy Solutions ( 30005) -SGE ( 1678)
DAVIS, LOUIS, JR.
Rep. Serrano (CD, Vol. I, P. 955)FTE
DENON, MARGARET
Rep. Meek (CD, Vol. I, P. 1371)-FTE
Colorado Rural Health Resource
DENTON I DENISE
Center-SGE (First Responses) , Not
Listed 1678-1679
DRUMMOND, FAYE
Senate Finance (CD, Vol. I, P. 963)FTE
FALETTI I THOMAS
Rep. Durbin (CD, Vol. I, P. 969)-FTE
FORTIER I JULIA
Rep. WaxmanjEnergy & Commerce (CD,
Vol II, P. 711)-FTE
FRANTZ I MOLLY
Rep. Pomeroy (CD, Vol. I, P. 705)FTE
FUENTES, JENNICE
Rep. Gutierrez (CD, .Vol. I, P. 979)FTE
GASTON 1 MARYLYN
HHS-HRSA-FTE
GOODELL, JEFFREY
Rep. Lipiniski (CD, Vol. I, P. 987)FTE
GORMAN I JOHN
Rep. Rep Conyers (CD, Vol. I, P.
987)-FTE
GROSS I LAUREN
Sen. Pell (CD, Vol. I, P. 991)-FTE
HAND, LUCY
Rep. Serrano (CD, Vol. I, P. 995)FTE
HASH I MICHAEL
Rep. Waxman/Energy & Commerce (CD,
Vol. I, P. 712)-FTE
HENRY 1 CHRISTOPHER Rep. Flake (CD, Vol. I, P. 1002)-FTE
HUNTER, MARK
Rep. Ortiz (1373)-FTE
JACKSON, MORGAN, M.D.
43
�JONES, LEROY
JONES, SANDRA
KEPNER, COLLEEN
KIM, DAVID
KING, GARY
KINGHT, R.
KOVNER I RONNIE
LACEY I LORETTA
LUTTBERG I CARRIE
MARCONI I KATHY
MARQUEZ, MIGUEL
McCABE, EUGENE
McDONOUGH, DONEG
MANTEL I LEWIS
MILLER, CAROL
MILLS, JOHN
MITCHELL, MARLOW
MURGUIA I JANET
NORIIAH I PATRICIA
QUAM, LOI:S
RI:CBARDSON I
SALLY
HHS-ACHPR {1373)-FTE
Rep. Watts {1374)-FTE
Veterans' Affairs-FTE
Rep. Stenholm {CD, Vol. I, P. 768)FTE
Rep. Becerra (CD, Vol. I, P. 1024)FTE
Assistant
Professor,
Community
Medicine, University of Connecticut
Health Center (1374): No Official
Status Assigned
Rep. Franks (CD, Vol. I, P. 528)-FTE
Rep. Reed (CD, Vol. I, P. 766)-FTE
Associate
Professor,
Community
Health
Sciences,
University
of
I:llinois at Chicago School of Public
Health (1365, 1374): Ho Official
Status Assigned
Rep. Coleman (CD, Vol. I, P. 496)FTE
HHS-HRSE (1375)-FTE
Rep. Richardson (CD, Vol. I , P.
626)-FTE
President,
CEO,
North
General
Hospital, HY (30209): Ho Official
status Assigned
Rep. Stark (CD, Vol. II, P. 1065)FTE
Veterans Affairs-FTE
University of Hew Mexico School of
Public Health (30000)-SGE (First
Responses), Hot Listed on 1678-1679
Rep. Engel (CD, Vol. I, P. 1056)-FTE
Rep. Dixon (CD, Vol. I, P. 511)-FTE
Rep. Slattery (CD, Vol. I, P. 741)FTE
VP
Finance, CFO, North General
Hospital, HY (30209): Ho Official
status Assigned
Veterans' Affairs-FTE
OMB-FTE
Rep.
Tejeda
(Hot
Listed
in
Directory) - Hot Listed in First
Responses, Hot Listed as FTE.
Former Chairman of the Minnesota
Health care Access Commission and
CUrrent
Vice
President,
United
Health
care
corporation,
Minneapolis, IIN-SGE (1678)
West Virginia Health care Planning
commission ( 30005) - Bo Official
Status Assigned
44
--
~
---------------------------
�Rep. Pastor (CD, Vol. I, P. 613)-FTE
Rep. McKinney (CD, Vol. I, P. 1093)FTE
Rep.
Delugo
(Not
Listed
in
ROSS I SHEILA
Directory) - Not Listed as FTE; Ho
Official Status Assiqned
Rep. Bishop (1376); HHS- Office of
SEGARRA, MARIA
Minority Health (First Responses) Not Listed as FTE
House Select Committee on Education
SELTMAN I PAUL
and Civil Rights (CD, Vol I, P.
1106)-FTE
Rep. Vento (CD, Vol. I, P. 668)-FTE
SHEEHAN 1 KATHLEEN
Rep. Rangel (CD, Vol. I, P. 1107)SHEINER I JOHN
FTE
HHS - National cancer Institute SIMPSON I NANCY
FTE
Rational
Governors
Association,
SMITH, BARBARA
South Dakota (1366 & 1786): Rep.
McDermott (1377) - Not Listed as
FTE: Listed as Representative of
Intergovernmental
organization
(1786-87):
Ho
Official
Status
Assiqned (Rote: on 1508, Handwriting
says,
nsarbara
A.
Smith,
SD
Department
of
Health,
605/773. 3361) (1508)
SPIELBERG, DEBORAH Rep. Lewis (CD, Vol. I, P. 578)-FTE
TERRY I DOHALD
Ro
Affiliation:
Ro
Official
Employment status Assiqned
TESTORI, MAUREEN
Sen. Baucus (CD, Vol. I, P. 268)-FTE
TINTARY I RUTH
Rep. Torres (CD, Vol I, P. 663)-FTE
TOMLINSON, LISA
Rep. Collins (CD, Vol. I, P. 496)FTE
TRUBITT I MITCBEI.T.
Chicago
Health
Maintenance
organization ( 30209) : Ho Official
Employment Status Assiqned
VARMA, VIVEK
Rep. Synar (CD, Vol •. I, P. 1132)-FTE
WEIL, ALAR
Rational
Governors
Association
( 1786) Office Governor ROJBer, State
of
Colorado:
Listed
as
Representative of Intergovernmental
organizations ( 1786-87) : Ro Official
Employment Status Assiqned
WESTFALL I LISA
Rep. Richardson (CD, Vol. I, P.
711)-FTE
WILLIAMS 1 CHRISTINE Sen. Mitchell (CD, Vol I, P. 338)FTE
ZELMAH I WALTER
BBS/Chairman,
Health
Advisory
Commission, and Special Deputy for
Health Insurance in the california
Department of Insurance ( 1679) -SGE
RODRIGUEZ, GLADYS
RODRIGUEZ, SUSANA
45
�SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
7-11, 27~30, 52, 53, 58, 59, 66-91, 96, 97, 102-105, 769,
800, 836, 1496-1508, 1524, 1562-1564, 1801-1807, 3000030005, 30179-30223.
See Tab 5 attached to this
Memorandum.
Working Group 3, nGovernancen, of Cluster Group I, consisted
of the following members:
GROUP 3 - GOVERHAHCE
GROUP 3 LEADER -
RICK CURTIS, President, Institute
for Health Policy Solutions ( 12) -SGE
(1678)
GROUP 3 CO-CHAIR -
NANCY DELEW, HHS (12)-FTE
Sen. Leahy (CD, Vol. I, P. 327)-FTE
( 1786)
Rational
Association
of
Counties
Representative
of
Intergovernmental
Organization,
Assigned to Group 3; Ro Official
status
BRIGGS, BETTE
Labor-FTE
DELEW, NANCY
HHS-FTE
GREENBERG, G.
HHS-FTE
KENDALL, DAVID.
Rep. Andrews - Not in Directory;
Listed as FTE (844)
LANGENBRUNNER I JACK OMB-FTE
LINK I KENNETH
Veterans Affairs-FTE
Rational
Governors
Association,
MelfAIIEE I NIKKI
Office of the Governor of south
Carolina (13) (837) - Representative
of Intergovernmental organization
(1786-87);
State
Government
Representative (983): Ro Official
Status Assigned
MEANS I KATHLEEN
HHS-FTE
The
Johns
Hopkins
University
NAVARRO I VINCENTE
(13)(837) - SGE, White Rouse Office
(First Responses): Rot Listed, 167879
OFFNER, PAUL
Senate Finance (CD, Vol. I, P.
1069)-FTE
PATEL, PARASHAR
OMB-FTE
RICHARDSON, SALLY
West
Virginia
Public
Employee
Insurance Agency and Real th care
Planning CoDIIIlission ( 1520) - SGE
(First Responses) : Rot Listed on
1678-79
ALBERGHINI, T.
BEMPONG I ARDREA
46
�ROSS I MARJORIE
SOFAER, S.
STEELE I PAMELA
SULFRIDGE, H.
SYKES, KATHLEEN
VOLPE I LANE CARL
WELCH I
WILLIAM
WERNER I MICHAEL
ZELMAN I
WALTER
White House Policy Assistant - SGE;
The Johns Hopkins University (732)
George Washington University Medical
Center (1520, 30148)-SGE
Veterans Affairs-FTE
HHS-FTE
Rep. Obey (CD, Vol. I, P. 1122)-FTE
National
Governors
Association
(13)(837)
Representative
of
Intergovernmental
Organization
(1786-87);
State
Government
Representative ( 983) ; Mo Official
status
The Urban Institute - SGE (1678)
Sen. Democratic Policy Committee
(CD, Vol. I, P. 403)-FTE
HHS/Cbairman,
Health
Advisory
Commission, and Special Deputy for
Health Insurance in the California
Depclrtment of Insurance ( 864) -SGE
(1679)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
12, 13, 46, 47, 61, 92-95, 770, 801, 837, 1509, 1510,
1520, 30148. see Tab 6 attached to this Memorandum.
Working
Group
4,
"Global
Budget",
of
Cluster
Group
consisted of the following members:
GROUP 4 - GLOBAL BUDGET
GROUP 4 LEADER -
LARRY LEVITT I
Staff I
california
Department
of
Insurance,
COmmissioner's Health care Advisory
COmmission (14, 864)-SGE
GROUP 4 LEADER -
SHERRY GLIED, OMB (14)-FTE
BERRY, ROGER
Rep. Johnston (CD, Vol. I, P. 562)FTE
Sen •. Bingaman (CD, Vol. I, P. 271)FTE
HHS-FTE
Rep. Cooper (CD, Vol. I, P. 936)-FTE
Treasury-FTE
Rep. Pomeroy (CD. Vol. I, P. 705)FTE
CEA (White House Employee)(838)-FTE
HHS-FTE
HHS-HCFA-FTE
Rep. Sabo (CD, Vol. I, P. 704)-FTE
BILLY I CARRY
BUTO I KATHLEEN
CHAMBER, C.
COHEN I ALLAN
FRANTZ I MOLLY
GLIED, SHERRY
GOOD, BRIGID
GREENWALD, LESLIE
GRUNDMANN, MARTHA
47
I,
�IRWIN, JEAN
JONES, SANDRA
KING, ANDREA
KRONICK I RICHARD
LEVITT I
LARRY
LUTTER I RANDY
MILLER, MICHAEL
MUNNELL, ALICIA
NEXON, DAVID
O'NEILL, PATRICIA
OFFNER, PAUL
RADER, AHYA
ROSS I MARJORIE
SAMUELSON, ELLEN
SCHIEBER, G.
SCHULKE, DAVID
SCHRIBER I D.
TESTORI, M.
VARMA, VIVEK
VARNHAGEN, M.
WELCH, W.
Rep. Cantwell (CD, Vol. I, P. 490)FTE
Veterans' Affairs-FTE
Rep. Gephardt (CD, Vol. I, P. 532)FTE
UCLAfRAND
Corporation
(864)-SGE
(1678)
Staff,
California Department of
Insurance,
Commissioner's Health
Care Advisory Commission (864}-SGE
(1678)
OMB-FTE
Rep. Levin (CD, Vol. I, P. 1056)-FTE
Treasury-PTE
Sen. Kennedy (CD, Vol. I, P. 395)FTE
Veterans Affairs-FTE
Senate Finance (CD, Vol. I, P.
1069)-FTE
National
Governors
Association,
Office of Governor Dean, VerJDont
(838),
Representative
of
Intergovernmental
organization
(1786-87),
State
Government
Representative ( 984)
White Bouse Policy Assistant; The
Johns Hopkins University (732)-SGE
Rep. Sabo (CD, Vol. I, P. 695)-FTE
HHS-HCFA-FTE
Rep. Wyden (CD, Vol. I, P. 1104)-FTE
Energy & Commerce (CD, Vol. I, P.
1109)-FTE
Sen. Baucus (CD, Vol. I, P. 268)-FTE
Sen. Synar (CD, Vol. I, P. 1132)-FTE
Sen. Metzenbaum (CD, Vol. I , P.
396)-FTE
The Urban Institute (866)-SGE (1679)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
14-161 31-331 43-451 62, 631 98-1011 7711 8021 15111
1512, 1518, 1519, 1565, 1566, 30006, 30007, 30177. See
Tab 7 attached to this Memorandum.
Working Group 5,
•Insurance ReforJD•,
of Cluster Group I,
consisted of the following members:
GROUP 5 -
INSURANCE REFORM
GROUP 5 LEADER -
CLAXTON, National Association
of Insurance Commissioners (106,
969)-SGE (1678)
GARY
48
�AUBIN I LESLIE
BASS I KRISTIN
BATEMAN I KEITH
BERGTHOLD I LINDA
BLAUWET 1 ROGER
BORZI, PHYLLIS
BRODBECK, LAURA
BUONORA, DAVID
BURTON I JOHN
CATOR, TOM
CLAXTON I
GARY
COPELAND, ROBERT
DUGGAN I JAMES
FALETTI I THOMAS
FARMER, DAVID
HICKMAN I PETER
HOFFERT I STAR
JONES I SANDRA
KEENE, BRAD
KIST, FRED
LAWSON I ROGER
LEVINE I GREGORY
LEVITT I
LAWRENCE
LI..EWELLYH I B.
LOFTI, SHERIF
LUCAS, DEBORAH
LUBITZ I JAMES
MAGURIE, DANIEL
(1326)
National
Federation
of
Independent Businesses; No Official
status
(1326)
Chamber of Commerce; No
Official Status
(30075)
Alliance
of
American
Insurers
(1286) w. B. Mercer, Inc.-SGE (1678)
(Also on Cluster II, Group 6,
Benefits)
Rep. Hoagland (CD, Vol. I, P. 549)FTE (840)
(30075)
Subcommittee
on
Labor/Management Relations-FTE (840)
Rep. McCurdy (CD, Vol. I, P. 589)FTE
Rep. Kennelly (CD, Vol. I, P. 565)FTE
(1265) - Rutgers University; No
Official Status
( 1326) - National Small Business
United; No Official status
National Association of Insurance
Commissioners (106, 969)-SGE (1678)
Labor-FTE
Treasury-FTE (841)
Rep. Durbin (CD, Vol. I, P. 969)-FTE
(30075)
Alliance
of
American
:Insurers
HHS-HCFA
(30075) Wausau :Insurance COapany; Ro
Official Status
Veterans Affairs-FTE
Rep. Collins/Energy & Commerce (Not
Listed in Directory)-FTE (844)
( 1265)
Coopers
&
Lybrand;
No
Official Status
Alliance of American :Insurers; No
Official status
Rep. Delauro (CD, Vol. I, P. 506)FTE
Staff of California Department of
:Insurance Commissioner's Health care
Advisory Commission (866)-SGE
(1265)
National
council
on
Compensation :Insurance; Ro Official
Status
Council on Economic Advisors-FTE
Council on Economic Advisors-FTE
HHS-HCFA-FTE
Labor-FTE
49
�MATTERA,
PAUL
{30075) Liberty Mutual Insurance: No
Official Status
( 30075)
Attorney,
Alliance
for
American
Insurers:
No
Official
Status
MEANS 1 KATHLEEN
HHS-FTE
w. H. Mercer, Inc.: No Official
MILLSTEIN I ARNIE
Status
commerce-FTE
MOLLOY, JANE
Veterans Affairs-FTE
O'NEILL, PATRICIA
PATRICELLI, ROBERT {1326) Chamber of Commerce: Ho
Official Status
Sen. Rockefeller (CD, Vol. I, P.
PAYNE, MARY ELLA
352)
Senate Finance
(Not Listed
in
POTETZ, LISA
Directory)-FTE (845)
(1265) Coopers & Lybrand
RAY, TIMOTHY
Policy Assistant, White Bouse: The
ROSS, MARJORIE
Johns Hopkins University {732) - SGE
{1326) Rational Retail Federation:
SCULLY, TOM
Ho Official status
SISKIND, FRED
Labor-FTE
STUART, MARK
( 1326)
Rational
Association
of
Manufacturers: Ro Official Status
STEVERSON, DAVID
(1326)
Rational
Federation
of
Independent Businesses: Ho Official
·status
VALDEZ, ROBERT
UCLA/RAHD COrporation - SGE (1679)
(Also on Cluster II, Group 6,
Benefits)
WERNER, MICHAEL
Senate Democratic Policy Committee
(CD. Vol. I, P. 403)
WOODS, STEVEN
(1326)
Rational
Federation
of
Independent Businesses: Ho Official
status
ZELIIAH, WALTER
Chairman of the Health care Advisory
COmmission and Special Deputy for
Health
Insurance,
California
Department of Insurance ( 864)
MAYS I
HUBERT I JR.
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
34-36, 48-51, 64, 65, 106-115, 772, 803, 839, 1521, 1567.
See Tab 8 attached to this Memorandum.
Cluster Group II,
"Hew System coveraqe",
was composed of
Workinq Group 6, "Benefits Packaqe", Workinq Group 7, "COveraqe for
Workinq Families", and Workinq Group 8 1
and Ron-Working Families".
11
Coveraqe for Low Income
See Tab 9 attached to this Memorandum.
50
�Cluster Group II, "New system Coverage", and its leader was
listed as follows:
CLUSTER II -
NEW SYSTEM COVERAGE
CLUSTER II LEADER - ATUL GAWANDE, HHS-FTE
Working Group 6, "Benefits Package" of Cluster Group II, was
composed of the following members:
GROUP 6 - BENEFITS PACKAGE
GROUP 6 LEADER -
LIIIDA BERGTHOLD, Employee Benefits
consultant
to
w. B. Mercer
COrporation (864)-SGE (1678)
co-LEADER-
BOB VALDEZ ( 118) , UCLA SChool of
Public Health, Senior Health Policy
Analyst, Rand COrporation (865)-SGE
(1679)
BERENSON I ROBERT
National Capital Preferred Provider
Organization (868, 30016, 30136) SGE (1678)
William M. Mercer, Inc. (864) - SGE
(1678)
UCLA School of Public Health ( 864) SGE (1678)
Robert
Wood
Johnson
Fellow,
Sponsored by University of Florida,
in sen. Dale Bumpers Office (DAR)(773) [Tab 56 Attached to this
MeJDOrandum]-FTE (841)
HHS-HCFA-FTE
senior Advisor for Health Policy &
Management to Kaiser-Permanente;
Professor
of
Health
Policy
&
Management, Duke University ( 118,
866)-SGE (1678)
Commerce-FTE
National Association of COunties
(134)(1786)
Representative of
Intergovernmental
Organization
(1786); No Official status Assigned
Rep. Glickman (CD, Vol. I, P. 535)FTE
sen. Kennedy (P. 395)-FTE
National Association of Counties
(134)(1786)
Representative of
BERGTHOLD I LIIIDA
BROWN I RICHARD
CLARK, WILLZAK
CLAUSER I STEVEN
EDDY I DAVID
EDGELL, JOHN
EGBERT I MARCIA
FRASCHE, MARY
FISKE, MARY BETH
GARCIA, JOSEPH
51
�GILLINGHAM, ROBERT
GOLD I MARTHA
JOHNSON, SCHELEEN
KRUEGER, ALAH
LIPNER, ROBYN
MAHOWITZ I MICHELLE
MILLER, CAROL
MURPHY I SHEILA
NELSON, KAREN
NEXON, DAVID
NIX, SHEILA
POWELL, KEITH
PRICE I ANDREA
REINECKE I PETER
RICE, CHERI
ROSWELL 1 ROBERT
SHORT I PAMELA
SMITH I ELMER
SOCHAI..SK1 I JULIE
VALDEZ, ROBERT
WOOD, SUSAN
WREN I ROBERT
ZELMAN I
WALTER
Intergovernmental
organization
(1786); No Official Status Assigned
Treasury-FTE
HHS-PHS-FTE
Rep. Bryant (CD, Vol. I, P. 1015)FTE
Princeton University (116)(773)-SGE
(1678)
Consultant
(First
Responses)
Sen. Mikulski (CD, Vol. I, P. 395) FTE
White House Policy Assistant (119);
The Johns Hopkins University (732) SGE, White House Office (1678)
Mountain Management Co. , OJO Sarco,
Nil; No Official Status Given (1678);
SGE (First Responses)(134)
Sen. Kerrey (CD, Vol. 1, P. 332)-FTE
Rep. Waxman (CD, Vol. I, P. 711)-FTE
Sen. Kennedy (CD, Vol. I, P. 395)FTE
Sen. Kerrey (CD, Vol. I, P. 322)-FTE
Robert
Wood
Johnson
Fellow,
Sponsored by University of Rochester
Medical Center, in Office of Sen.
Kennedy (119) (135) [Tab 56 Attached
to this Memorandum]; No Official
Status Assigned
Rep. Payne (CD, Vol. I, P. 615)-FTE
Sen. Harkin (CD, Vo~. I, P. 396)-FTE
OMB-FTE
Veterans Affairs-FTE
HHS-ACHPR-FTE
HHS-HCFA-FTE
Robert
Wood
Johnson
Fellow,
Sponsored by Columbia University
School of Nursing, in .Office of Sen.
Bradley
(D-NJ)(135)(773)[Tab
56
Attached to this Memorandum] - FTE
(847)
UCLA School of Public Health: Senior
Health
Policy
Analyst,
Rand
Corporation (865) - SGE (1679)
Congressional Caucus for Women's
Issues-FTE
HHS-FTE
Chairman of the Health care Advisory
Colllllission and Special Deputy for
Health
Insurance,
California
Department of Insurance ( 864) ~ SGE
(1679)
52
�SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
116-135, 773, 804, 1590.
See Tab 10 attached to this
Memorandum.
Working Group 7, "Coverage for Working Families", of Cluster
Group II, was composed of the following members:
GROUP 7 - COVERAGE FOR WORKING FAMILIES
GROUP 7 LEADER GROUP 7 LEADER GROUP 7 LEADER -
STEVEN FINAN, Labor-FTE
LAWRENCE CAMPBELL, Commerce-FTE
RANDY HARDOCK, Treasury-FTE
ANDERSON I ROBERT
BERGTHOLD 1 LINDA
OMB-FTE
William M. Mercer, Inc. (864) - SGE
(1678)
sen. Bingaman (CD, Vol. I, P. 271)FTE
Education & Labor Commission (Not
Listed in Directory)-FTE (840)
National Governors Association - MN
(153),
Representative
of
Intergovernmental
Organization
(1786); No Official Status Assigned
Rep.
Gray /Deputy
GC
to
House
Committee on Post Office & Civil
Service (CD, Vol. I, P. 928)-FTE
Sen. Breaux (CD, Vol. I, P. 930)-FTE
Sen, Riegle (CD, Vol. I, P. 350)-FTE
Robert
Wood
Johnson
Fellow
Sponsored by University of Florida,
Office
of
Sen.
Bumpers
(DAR) (153) [Tab 56 Attached to This
Memorandum) - PTE. {841)
HHS-HCFA-FTE
Commerce-FTE
Sen. Pryor (CD, Vol •. I, P. 348)-FTE
Rouse Select committee on Aging · Not in Directory.
As of 3/31/93
When Rouse select commi. ttee on
Aqing's Appropriations Expired and
Were Rot Renewed, Goldstein Beqan
Working on Task Force (153)(See Bio
Sheet); No Official Status Assigned
- She Row Works in sen. Jefford's
Office
CEO, Blacks Educate Blacks About
Sexual Health Issues (153) - SGE
(1678)
Treasury-FTE
Treasury-FTE
BILLY, CARRIE
BORZI, PHYLLIS
BROWN 1 MARY LEIGH
BRUNS I KEVIN
BURNETT, LAIRD
CHANG, DEBBIE
CLARK, WILLIAM
CLAUSER, STEVEN
EDGELL, JOHN
GLAZE, STEVEN
GOLDSTEIN I ELAINA
BANDY I
CAROLYN
HUNTER, GILLIAN
IWRY, MARK
53
�JARBOE, KENAN
KING, KATHLEEN
KRONICK, RICK
KRUEGER I ALAN
LINDREW, GERALD
LYON, ANDREW
MAGUIRE I DANIEL
MINK, DOUG
MONHEIT, ALAN
NELSON, KAREN
QUIST, JAHET
ROZEN, ROBERT
SHORT I PAMELA
SOLOMON I LOEL
TRUJILLO I THOMAS
VALDEZ, ROBERT
ZAWISTOWICH, LU
Sen. Riegle (CD, Vol. I, P. 377)-FTE
Senate Finance (CD, Vol. I, P.
1025)-FTE
UCLA (184-864)-SGE {1678)
Princeton University (153) - SGE
{1678), Consultant (First Responses)
Labor-FTE
CEA-FTE
LABOR-FTE
Rep. Johnson (CD, Vol. I, P. 560)FTE
HHS-ACHPR-FTE
Rep. Waxman (CD, Vol. I, P. 711)-FTE
National League of Cities ( 154) Representative of Intergovernmental
organization (1786); Ho Official
Status Assigned
Sen. Mitchell (CD, Vol. I, P. 1096)FTE
HHS-ACHPR-FTE
Sen. Labor (Hot in Directory) - FTE
(848)
Veterans Administration-PTE
UCLAfRand
Corporation
{865)-SGE
(1679)
HHS-HCFA-FTE
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
136-154, 184, 185, 774, 805, 1591. See Tab 11 attached
to this Memorandum.
Working Group 8, •coverage for Low Income and Non-Working
Families•, of Cluster Group II, was composed of the following
members:
GROUP 8 - COVERAGE
FOR
IDW-DCOME
Aim
HOH-WORKIHG
FAMILIES
GROUP 8 LEADER -
SHOSBARHA SOFAER
( 969) 1
George
Washington University Medical Center
- SGE (1678)
BEREHSOH, R
Rational capital Preferred Provider
organization
( 181,
868,
30016,
30136) - SGE (1678)
William M. Mercer, Inc. (864) - SGE
(1678)
Labor-FTE
UCLA/SChool of Public Health ( 182,
864) - SGE (1678)
BERTHOLD I LIHDA
BEVERLY, J.
BROWH, RICK
54
�CHANG, DEBORAH
CLAUSER, STEVEN
COOPER, DAVID
DENTON I DENISE
FEDER, JUDY
FISKE, MARY B.
GAWANDE I ATUL
GILLINGHAM 1 ROBERT
GLAZE I STEVEN
GOLD I MARTHA
HARDY I CAROLYN
HEADLEY, EDWOOD
HIGHT, JOSEPH
HOLTZBLATT I JANET
HORVATH I JANE
JOHNSON I DONALD
KRUEGER, ALAN
MANOWITZ I
MILLIIAR I
MICJIET.T.E
MICHAEL
MINK I DOUGLAS
NIX, SHEILA
PARADISE, JULIA
RICE, CHERI
ROWLAND I DIANE
ROZEN, ROBERT
SHORT, PAMELA
SIMON, MARSHA
SMITH, MARY BETH
SMITH, ELMER
VALDEZ I ROBERT
VELOZ I RICHARD
Sen. Riegle (CD, Vol. I, P. 350)-FTE
HHS-HCFA-FTE
HHS-ASPE-FTE
Colorado Office of Rural Health; No
Official Status Assigned ( 1678 ) ;
SGE (First Responses)
HHS-FTE
sen. Kennedy (CD, Vol. I, P. 395)FTE
HHS-FTE
Treasury-FTE
Sen. Pryor (CD, Vol. I, P. 348)-FTE
HHS-PHS-FTE
CEO - Blacks Educate Blacks About
Sexual Health Issues - SGE (1678)
Veterans Affairs-FTE
Labor-FTE
Treasury-FTE
Senate Finance; Not in Directory FTE (843)
HHS-HCFA-FTE
Princeton University (182) - SGE
( 1678) ; Consultant (First Responses)
White House Policy Assistant - SGE;
The Johns Hopkins University (732)
National
Academy
of
Sciences/Institute of Hedicine-FTEBBS (843)
Rep. Johnson (CD, Vol. I, P. 560)FTE
Sen. Kerrey (CD, Vol. I, P. 322)-FTE
HHS-FTE
OMB-FTE
Tbe Johns Hopkins UniversityjKaiser
CoJIImi.ssion on the Future of Medicaid
[Tab 56 Attached to this Memorandum]
(173, 806)
SGE (1678)
Ro
Affiliation; Ro Official Status
Given (First Responses)
Sen. Mitchell (CD, Vol. I, P. 1096)FTE
HHS-AHCPR-FTE
Sen. Kennedy (CD, Vol·. I, P. 395)FTE
Veterans Affairs-FTE
HHS-HCFA-FTE
UCLAfRand Corporation(865)
SGE
(1679)
Formerly House select Committee on
Aging, Lost Appropriation 3/31/93 Ro Official Status Given (16781679); SGE (First Responses)
55
�CEA-FTE
WILLS, DARRYL
SOURCES: Declarations o:f Marjorie Tarmey, Documents Nos.
155-179, 775, 806, 1592. See Tab 12 attached to this
Memorandum.
Cluster Group III, "New System Infrastructure", consisted of
Working
Group
9,
"Quality
Measurement":
Working
Group
10,
"Information Systems", Working Group 11, "Malpractice and Tort
Reform"~
and
Development".
Working
Group
12,
"Facilitating
Professional
See Tab 13 attached to this Memorandum.
Cluster Group III,
"New System Infrastructure",
and its
Cluster Leaders, were as follows:
CLUSTER III -
NEW SYSTEM INFRASTRUCTURE
CLUSTER LEADERS -
TOM PYLE, Boston Consulting Group
and Harvard Colllllunity Health Plan
(969, 1218)- SGE (1678), consultant
(First Responses) and Subsequently,
BILL SAGE - WHO - Policy Analyst
(NB:. on Bates Number 300, Sage is
Described in Sameone's Handwriting,
"Bill Sage Liaison - Magaziner, MD
JD Stanford") (300)
Working Group 9, "Quality Measurement", of Cluster Group III,
was composed of the following members:
GROUP 9 - QUALITY MEASURBMEMT
GROUP 9 LEADER -
ARNOLD EPSTEIN, Robert Wood Johnson
Fellow,
Sponsored
by
Harvard
University
Medical
SChool
and
Brigham and Women's Bospital, Office
of Sen. Kennedy (D-MA)(233) [Tab 56
ATtached to this Me.orandlDl]
Status Given as SGE ( CF. , other RWJ
Fellows'
Status
is
"FTE"
or
Ignored). Note: Handwritten Note
Next to Epstein's Name on 948
Indicates That Be is the "Recorder".
Several References, in Different
Handwriting, Indicate that Be Will
56
�Be "External n to
946, 948, 950.
the
Group:
944,
"CONSULTANTS TO WORKGROUP": (261)
ALAN HII..LM.AN, M.D. , University of
Pennsylvania; 215/898-9400 (261)
KATfii.EEN, LOIIR, Ph.D., IOM; 202/3342165 (261)
SANDY SCHWARTZ, M.D., University of
Pennsylvania; 215/898-5611 (261)
WORK GROUP 9 MEMBERS:
AXKEN, LINDA
BARBOUR, GALEN
CBAPHAN, THOMAS
DEMLO, LINDA
EDDY, DAVID
EDDY, JUDITH
EPSTEIN, ARNOLD
GAGEL, BARBARA
GAUDETTE, SYLVIA
GROSS I LAUREN
JACKSON, DAVID
JENCKS, STEVEN
JORLING, JIM
KRAKAUER, HENRY ·
University of Pennsylvania, School
of Nursing
Consultant
(First
Responses); SGE {1678)
Veterans Affairs-FTE
Greater Southeast Real th Care System
( 30008) ,
Director,
Robert
Wood
Johnson Foundation PrograD, "Opening
Doors" (523)[Tab 56 Attached to this
MemorandUJD]; (Rote: on 724 says,
"BBS". Chapman Rot Listed in First
Responses; Listed as.SGE on 1678)
HHS-AHCPR-FTE
senior Advisor for Health Policy &
Management
to
Kaiser-Penaanente;
Professor
of
Health
Policy
&
Management, Duke University ( 119,
866) - SGE {1678)
Research Associate, Duke University
- SGE {1678)
Robert
Wood
Johnson
Fellow,
Sponsored by Harvard University
Medical School & Brigham & Women's
Hospital, Office of sen. Kennedy (DIIA) (233)[Tab 56 Attached to this
MemorandUJD] - Listed as SGE (1678)
HHS-HCFA-FTE
Rep. Oliver (CD, Vol. I, P. 609)-FTE
Sen. Pell (CD, Vol. I, P. 991)-FTE
CEO, Assurqual {233, 260, 262, 276)
- SGE (First Responses) ; No Official
Status AssiC)Ded ( 1678-1679)
HHS-HCFA-FTE
White Rouse - Special Assistant SGE {1678); Unemployed (732)
HHS-PHS-Uniform Services, University
of Health Sciences, Bethesda, MD-FTE
57
�Physicians'
Payment
Commission (186)
No
Status
LASKER, ROZ
Review
Official
LAVIZZO-MOUREY, RISA
HHS-AHCPR-FTE
National
Academy
of
LOHR, KATHERINE
Sciences/Institute of Medicine
Consultant (First Responses)
DOD-FTE
McKEE, TOMOTHY
Boston consulting Group, Harvard
PYLE, THOMAS
Community Health Plan - Consultant
(First Responses)- SGE {1678)
President, Meharry Medical college
SATCHER, DAVID
( 186,
869)
consultant (First
Responses)
SCHULKE, DAVID
Rep. Wyden (CD, Vol. I, P. 1104)-FTE
TIBBITS, PAUL
Defense-FTE
WILLIAMSON, JONATHAN
Veterans Affairs-FTE
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
189, 190, 193, 194, 200, 201, 213, 214, 215, 216, 232265, 273-278, 776, 807, 1593, 1594, 30019-30022, 3016830172. See Tab 14 attached to this Memorandum.
Working Group 10, •Information Systems•, of Cluster Group III,
was composed of the following members:
GROUP 10 -
INFORMATION SYSTEMS
GROUP 10 LEADER -
DAVID EDDY, Senior Advisor for
Health Policy and Management to
Kaiser-Permanente:
Professor
of
Health Policy and Management, Duke
University (119, 866)
AUKERMAN I GLEN
BLED, PETER
HHS-HRSA-FTE
( 282) lfo Affiliation, lfo Official
Status Given
HHS-HCFA-FTE
{281) lfo Affiliation, llo Official
Status Given
Senior Advisor for Health Policy &
Management to Kaiser-Permanente:
Professor
of
Health
Policy
&
Management, Duke University (119,
866) - SGE (1678)
Research Associate, Duke University
- SGE (1678)
HHS-AHCPR-FTE
HHS-HCFA-FTE
BUFFINGTON, MAX
DOWLIHG, ALAR
EDDY, DAVID
EDDY, JUDITH
FITZMAURICE, J.M.
HILL I TIMOTHY
58
�HORVATH, JANE
JACKSON, DAVID
JEWS I WILLIAM
JORLING I JAMES
KOLODNER, ROBERT
KOSS, SHANHAH
KRAUKAUER, HENRY
KUZMACK I RICHARD
MALONEY, DANIEL
McCONNELL, BRUCE
PYLE, THOMAS
SAGE, WILLIAM
SILVER, JONATHAN
STEINAUER, DENNIS
Senate Finance-FTE ( 846) - Not in
Directory
CEO, Assurqual (233, 281, 289); No
Official Status Assigned
Phone (301) 925-7000 - Dimensions,
Inc.
(281); No Official Status
Assigned
White House Special Assistant - SGE;
Unemployed (732)
Veterans Affairs-FTE
OMB-FTE
HHS-PHS- Uniform Services University
of
Health
Sciences,
Bethesda,
Maryland-FTE
OMB-FTE
Veterans Affairs-FTE
OMB-FTE
Boston Consulting Group & Harvard
Community Health Plan (969, 1218) SGE
(1678),
Consultant
(First
Responses)
MD, JD, Stanford - SGE (1678)
Commerce-PTE
Commerce. - National Institute of
Standards and Technology (282)-FTE
SOURCES:· Declarations of Marjorie Tarmey, Documents Nos.
191, 192, 195, 196, 202, 203, 266-269, 279-322, 777, 808,
1143-1150, 30023, 30024, 30073. See Tab 15 attached to
this Memorandum.
Working Group 11, •Malpractice and TOrt Reform• of Cluster
Group III, was composed of the following members:
GROUP
11 -
GROUP
11 LEADER -
ROBERT BERENSON, National capital
Preferred
Provider
organization
(30016, 30136) - SGE (1678)
GROUP 11 LEADER -
K. HASTINGS, JD, RN, HH-PHS-ACHPRFTE. (843)
MALPRACTICE AND TORT REFORM
Professor of Law (1331) - No
Official Status
University of Pennsylvania School of
Nursing
(188)
SGE
(1678);
COnsu1tant (First Responses)
HHS-HRSA-FTE
HHS-HCFA-FTE
UVA -
AIKEN, LINDA
GLEN
BAUM, NANCY
AUKERMAN I
59
�BERENSON 1 ROBERT
BOVBJERG I
RANDALL
BRENNAN I TROYER
CREASEY I DANIEL
DANZON, PATRICIA
DONESKI, ELLEN
EDDY, DAVID
EDDY I JUDITH
GOSFIELD I ALICE
HADLEY, ELIZABETH
HASTINGS 1 KATHLEEN
BAVIGBORST I CLARK
HUCKABY I MICHELLE
JORLING, JAMES
MEADOW I CYNTHIA
KILLER, FRANCES
MORLOCK, LAURA
O'CONHELL, JEFFREY
PYLE, THOMAS
REEVES, LINDA
SATCHER, DAVID
SCHULTZ, WILLIAM
TAPLIN, CAROLINE
National Capital Preferred Provider
Organization (868) - SGE (1678)
The Urban Institute - No Official
Status ( 1331)
Harvard School of Public Health; No
Official Status (1331)
Risk Management Foundation, Harvard
Medical Institution; No Official
status (1331)
The Wharton School - Health Care
Policy and Insurance - University of
Pennsylvania;· Ho Official Status
(1331)
Sen. Rockefeller (CD, Vol. I, P.
352)-FTE
Senior Advisor for Health Policy &
Management to Kaiser-Permanente;
Professor
of
Health
Policy
&
Management, Duke University (119,
866)(188) - SGE (1678)
Research Associate, Duke University
(188)
Law Offices of Alice Gosfield,
Philadelphia,
Pennsylvania;
No
Official Status (1331)
HHS-ASPE-FTE
.
HHS-PHS-ACHPR-FTE
Duke University School of Law; Ho
Official Status (1331)
Rep. Clement (CD, Vol. I, P. 494)FTE
w.bite House Special Assistant; SGE
(1678); Unemployed (732)
Rep. Brooks (CD, Vol. I, P. 723)-FTE
B.U. School of Law - Ho Official
Status ( 1331)
The Johns Hopkins University School
of Public Health; Ho Official Status
(1331)
UVA SChool of Law; Ho Official
status ( 1331)
Boston Consulting Group & Harvard
COJmunity Health Plan (969, 1218) SGE
(1678),
COnsultant
(First
Responses)
HHS-PHS-AHCPR-FTE (847); Veterans
Affairs-FTE (First Responses)
President, Meharry Medical College
(188) -consultant (First Responses)
Rep. Waxman (CD, Vol. I, P. 1104)FTE
HHS-PHS-FTE
60
�VARNHAGEN, M.
WADLINGTON, WALTER
WEICH, RONALD
WEILER, PAUL
Sen. Metzenbaum (CD, Vol . I, P.
396)-FTE
UVA School of Law; Ho Official
Status (1331)
Sen. Labor & Human Resources (CD,
Vol. I, P. 737)-FTE
Professor, Harvard Law; Ho Official
Status (1331)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
204, 205, 209, 210-212, 217, 218, 291-294, 323-332, 778,
809, 1610, 1330-1331, 30026. Note: See Sign-in List at
30026, Attached at Tab 16, Describing a Seminar on March
5, DHHS, Room 800, 200 Independence Avenue, sw, for Task
Force Members and Private Lawyers and Other Individuals.
See Tab 16 attached to this Memorandum.
Working Group 12, •Facilitating Professional Development•, of
Cluster Group III, was composed of the following members:
GROUP 12 -
FACILITATING
(206)
PROFESSIONAL
DEVELOPMENT
STEERI:HG COMMITTEE: FITZHUGH
MULLAN,
. HHS/HRSA/BHPR
Chair,
LINDA AIKEN, Senior Consultant,
University of Pennsylvania SChool of
Nursing (197)
DAVID SATCHER, Senior Consultant,
President, Mebarry Medical COllege
(197)
CIRO
SUJIAYA,
Associate
Dean,
Universsity of Texas Health SCiences
center, San Antonio, Texas (197)
SPECIAL COHSOLTART: CAROLYN HARDY 1 CEO, Blacks Educate
Blacks About Sexual Health Issues
COHSOLTART:
SCBADLE (371) Iowa Department
of Health, Des Moines, Iowa
JANE
PART-TIME CONSULTANTS:
MARCIA BRAND HHS-HRSA (372)
NEIL SAMPSON HHS-HRSA (372)
Handwritten Rote:
"Suzy El Attar, David, Me.dical
Students From Pitt" (300).
Handwritten Rote:
"Dave,
Include Us, suzyn (303). According to Bates Number 351,
61
�David Evans and Suzanne El Attar are "Workgroup
Assistants" in the Division of Medicine, Bureau of the
Health Professions, HHA-HRSA (351).
ALTMAN, DAVID
BEASON, CHARLOTTE
BIERWIRTH, M.
DAVIES, MONICA
DERTOH, DERISE
DUNN, VAN
DUZOR, DIERDRE
EDDY, JUDY
FORBES, RIPLEY
GOLOB, LAWRENCE
GROSS, MARCY
BAlmY 1 CAROLYN
HUNAN,
JEFFREY
JOHNSON, SCHELEEN
JORLIHG, JAMES
McLENNEY, LUCRETIA
FITZHUGH
HICBOLS, LIHDA
MULLAN,
PYLE, THOMAS
RIVO, MARC
SALMON, MARLA
Robert
Wood
Johnson
Fellow,
Sponsored by the Center for Health
Professions,
University
of
California, San Francisco, Office of
Sen.
Rockefeller
(D-WV) [Tab
56
attached to this Memorandum] (197,
206) - FTE (840)
Veterans Affairs-FTE
Rep. Gejdensen (CD, Vol. I, P. 531)FTE
Legislative Fellow, Office of Sen.
Bingaman
(Hot
Listed
in
congressional Directory) ( 198 )-FTE
(841)
COlorado Rural Health Office (300)SGE (First Responses) : Ho Official
Status Given (1678-1679)
Sen. Kennedy (CD, Vol. I, P. 395)FTE
HHS-HCFA-FTE
Research Associate, Duke UniversitySGE (1678)
Rep. Waxman (CD, Vol. I, P. 976)-FTE
White House Fellow/HilS (198) - Ho
Affiliation:
Ho Official Status
Given
HHS/OSHA-FTE
CEO, Blacks Educate Blacks About
Sexual Health Issues-SGE (1678)
Senate Special Committee on Aqinq
(Not in Directory)-FTE (843)
Rep. Bryant (CD, Vol. I, P. 1015)FTE
White House Special Assistant-SGE:
Unemployed (732)
DOD-FTE
HHS-PHS-FTE
Director of Interdisciplinary Team
Training, RaDada Renaissance Hotel,
999 Hinth Street, HW, Washinqton, DC
20001: 202/535-7527 (0); 202/5357522 (F) (369) - VA-FTE (846)
Boston Consulting Group; Harvard
CODIIIlunity Health Plan-SGE (1678);
Hot Listed (First Responses)
HHS-HRSA-FTE
HHS-HRSA-FTE
62
�SCHADLE I
Iowa
Department
of
Health;
Consultant (371, First Responses);
Associate Dean, University of Texas
Health Sciences Center, San Antonio
(197)-SGE (1679)
House Special Co:mmittee on Aqinq,
Lost Appropriation 3/31/93, Worked
for HHS ( 779) -SGE (First Responses) ;
Rot Listed as SGE on 1678-1679)
DOL-FTE
JANE
SOMAYA, CIRO
VELOZ I
RICHARD
WILSON, FRANK
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
197;_199 I 206-2081 219-221, 270-272, 295-2971 298-4051
779, 810, 1602-1609.
See Tab 17 attached to this
Memorandum.
Cluster Group IV,
11
Inteqration of GOvernment Health Proqrams
Into Hew system",
consisted of· Workinq Group 13,
"Medicare",
Workinq Group 14,
"Department of Defense", Workinq Group 15,
"Veterans", Workinq Group 16, "Federal Employees Health Benefitss
Plan•, and Workinq Group 16A, "other Government Proqrams 11 •
See
Tabe 18 attached to this Memorandum.
Cluster Group IV,
11
l:nteqration of Government Real th Proqrams
l:nto Hew System•, and its leaders were listed as follows:
CLUSTER I V -
l::trl'EGRATl:OR OF GOVERifKERT HEALTH PROGRAMS
l:RTO HEW SYSTEM (969)
CHAIR -
STEVE BANDEIAR, OMB-FTE
Workinq Group 13,
"Medicare",
of Cluster Group
IV,
composed of the followinq members:
GROUP 13 -
KEDXCARE
GROUP 13 LEADER -
BARBARA COOPER, HHS ( 406) -FTE
ADDISON-BURTON, L.
BUENO I IRERE
BARDEIAR I STEVE .
BURNEY, IRA
Rep. Sabo (CD, Vol. I, P. 930)
Policy
Assistant,
White
Bouse
(1634)-SGE (First Responses) - Rot
Listed 1678-1679 - Unemployed (732)
OMB-FTE
HHS-HCFA-FTE
63
was
�COOPER, BARBARA
GOLDWATER, DAVID
HARTZ, THOMAS
HICKMAN, PETER
HUCKABY, MICHELLE
KAZDIN, ROBERT
LIU, ERIC
MILLER, MELANIE
PAYNE, MARY ELLA
PRATT, DONALD
SHIRLEY, AARON
SOLOMON, AOEHEA
WELCH, PETE
WIENER,
JOSH
ZARABOZO, CARLOS
HHS-FTE
Rep. Bilbray (CD, Vol. I, P. 986)FTE
HHS-FTE
HHS-HCFA-FTE
Rep. Clement (CD, Vol. I, P. 484)FTE
Treasury-FTE
Sen. Boren (CD, Vol. I, P. 1038)-FTE
Rep. Andrews - Hot in Directory-FTE
(846)
Sen. Rockefeller (CD, Vol. I, P.
352)-FTE
Veterans Affairs
Director,
Jackson-Hinds
Comprehensive Healtb Center ( 407,
780, 811, 1534)-SGE (1678)
Census-FTE
Tbe Urban Institute (406)-SGE (OMB)
- 1679
Tbe Brookings Institution (780)SGE/BBS ( 1679)
HHS-HCFA-FTE
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
406-410, 780, 811, 1534, 1614. See Tab 19 attached to
this Memorandum..
·
Working Group 14, •Department of Defense•, of Cluster Group
rv, was composed of the following members:
GROUP
14 -
DEPARTIIEH'l' OF DEFERSE
GROUP
14 LEADER -
BANDEIAN, STEVE
BATES, JIM
CLAYPOOL, ROBERT
COOPER, BARBARA
FISH, JIM
HAMMERSCHLAG, ART
HEATH, KAREN
HIGGINS, MICHAEL
BIX, MICHAEL
HOSEK, SUSAN
LILLIE, STEVE
JOEL SLACKMAN, DOD-FTE
OMB-FTE
Navy surgeon General (425) - Not
Listed as FTE in 840-849; Listed in
First Responses-FTE
u.s. Army Surgeon General-FTE
HHS-FTE
OMB-FTE
Veterans Affairs-FTE
House Armed Services Committee (CD,
Vol. I, P. 1001)-FTE
Rep. Dellums (CD, Vol. I, P. 697)FTE
Rand Corporation-SGE/DOD (1678)
Rand Corporation, 310, 393, . 0411
{419); Hot Listed; Ho Status Given
DOD-FTE
64
�MORGAN, JACQUELINE
PANG, FREDERICK
SLACKMAN JOEL
SPAULDING, VERNON
WIENER, JOSH
I
DOD-FTE
Senate Armed Services Committee (CD,
Vol. I, P. 395)-FTE
DOD-FTE
DOD-FTE
Brookings
Institution
(424)-SGE
(1678)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
411-425, 787, 1537, 1615. See Tab 20 attached to this
Memorandum.
Working Group 15, •veterans•, of Cluster Group IV was composed
of the following members:
GROUP
15 -
VETERAHS
GROUP 15 LEADER -
KAREN WALTERS, Veterans Affairs-FTE
ALPERT, CYNTHIA
BANDEIAN, STEVE
BREW, WILLIAM
BUENO, :IRENE
Veterans Affairs-FTE
OMB-FTE
House VA Comm--Check CD.
Policy Assistant (426) SGE, White
Bouse (First Responses) : Not Listed
1678-1679 - Unemployed (732)
DOD-FTE
HHS-HCFA-FTE
Sen. ·campbell (CD, Vol. I, P. 282)FTE
OMB-FTE
Associate Dean,
VA,
SUNY/Stony
Brook,
79
Middleville
Road,
Northport, NY 11768: 914/939-2745
(427, 428, 429)-FTE (843)
Veterans Affairs-FTE
HHS-IHS-FTE
Veterans Affairs-FTE
Designee of Commerce Secretary Ron
Brown to the Task Force: Acting
Assistant Secretary for Policy &
Planning (432)-FTE (847) - Veterans
Affairs
Brookings (426)-SGE/HBS (1679)
COX, KENNETH
ERMANN, DAN
EVANS, JENNIFER
GRAMS, TODD
HORVATH, TEOMAS
IBSEN, RALPH
LINCOLN, MICHAEL
NORMAN, ALLINE
RAYMOND, VIC
WEIHER, JOSH
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
426-437, 788, 1536.
See Tab 21 attached to this
Memorandum.
Working Group 16, "Federal Employees' Health Benefits Plan• of
Cluster Group IV was composed of the following members:
65
�FEDERAL EMPLOYEES HEALTH BENEFITS PLAN
GROUP 16 -
GROUP 16 LEADER -
CURT SMITH (443), OPM-FTE
BANDEIAN I STEVE
BOERUM, DENISE
BLOCK, ABIGAIL
BRUNS, KEVIN
COPELAND, ROBERT
CROW I SHELLY
OMB-FTE
Senate Committee (CD, Vol. I, P. )
OPM-FTE
Rep. Gray (CD, Vol. I, P. 928)-FTE
Labor-FTE
Second Chief 1 Muscogee Creek Nation5GB (1678)
White Bouse Policy Assistant-SGE
(First Responses): Not Listed 16781679
Senate
Governmental
Affairs
Committee (CD, Vol I, P. 30)-FTE
( 446) No Official status Given contractor [see Tab ]
Senate ·Select Committee on Indian
Affairs, P. 1018)-FTE
HHS-IHS-FTE
Education & Labor (CD, Vol. I, P. )
OMB-FTE
CEA-FTE
HHS-FTE
OPM-FTE
Labor-FTE
Rep. Gray (CD, Vol I, P.
)
OMB-FTE
GEBAN I
MARGERY
GLEIMAN, EDWARD
JONES I STANLEY
JOSEPH-FOX, YVETTE
LINCOLN 1 MICHAEL
LOPATIN, ALAN
NAKAHATA I PETER
POSEY, KENDALL
SCHMID I STUART
SMITH I CURTIS
SVENONIUS, DIANE
WEISS, GAIL
WYLER I ROBERT
SOURCES:
Declarations of Marjorie Tarmey, Document Nos.
4~8-4461
See Tab 22 attached to this
789, 1535, 30029.
Memorandum.
Working Group 16A 1 •other Government Programs• of Cluster
Group
rv, was composed of the following members:
GROUP
16A-
O'J:BER GOVERlOIERT PROGRAMS
GROUP 16A LEADER -
MICHAEL LINCOLN, HHS-IHS-FTE
BANDEIAN I STEVE
SHELLY
OMB-FTE
Second Chief, lluscogee Creek Nation8GB (1678)
OMB-FTE
Senate Committee on Indian Affairs
(CD, Vol I, P. 1018)-FTE
WHO - Policy Assistant-SGE ( 1678)
IHS-FTE
IHS-FTE
CROW I
DOROTINSKY, BILL
JOSEPH-FOX, YVETTE
KLINE I JEMlfiFER
LINCOLN 1 MICHAEL
McCLOUD, MARMADUKE
66
�MILLER, CAROL
NAKAHATA, PETER
REYES, LUANA
SCHOENING, ATHENA
WEINER, JOSH
WIGGINS, CLIFF
Mountain Management Co.,
MN-SGE
(First Responses) - Not Listed 16781679)
OMB-FTE
HHS-IHS-FTE
HHS-IHS-FTE
Brookings Insti tution-SGE/HHS ( 1679)
HHS-IHS-FTE
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
449-452, 30030, 30031.
See Tab 23 attached to this
Memorandum.
Cluster V,
"Bioethics or Ethical
Foundations of the Hew
System•, consisted of one Working Group, that being Working Group
17, "Bioethics•.
Working Group 17, "Bioethics•, of Cluster Group
V, consisted of the following members:
CLUSTER V -
ETHICAL FOUHDATIOHS OF THE HEW SYSTEM
WORKDIG GROUP 17 -
BIOETHICS
GROUP 17 - co-LEADER
HAHCY
DUBLER,
Montefiore
Medical Center
MARIAH
SECUHDY,
University
ASCH, ADRIEHRE
BAYER, ROHALD
BROCK, DAHIEAL
CAPLAH, ARTHUR
DAHIELS, HORMAH
DOCKERTY, CHARLES
DORFF, ELLIOTT
DULA, AHHETTE
ELLIS, GARY
Howard
B. u. School of Social Work
Columbia University School of Public
Health
Director of Center for Biomedical
Ethics
University of Minnesota, Center for
Biomedical Ethics
Tufts University
Ho affiliation listed
Provost, Professor, University of
Judaism
Rockefeller Fellow, University of
Colorado
Office for Protection from Research
Risks
Harvard Medical SchoolfDana Farber
cancer Institute
EVAH, ABIGAIL R.
Princeton Theological Seminary
FAHEY, MGSR CHARLES Third Age Center
FLECK, LEN
Michigan State
POST, HORMAH
University of Wisconsin
EMAHUEL, EZEKIAL
67
�University of New Mexico, Director,
Center for Health law and Ethics
American Society of Law, Medicine &
GOSTIN I LAWRENCE
Ethics
Georgetown University Law Center
KING, PAT
Chief,
Medical
Staff,
Larabida
LANTOS I JOHN
Hospital
The Orphan Project Fund
LEVINE I CAROL
USCF, Director, Program in Medical
LO, BERNARD
Ethics
SHU Professor of Ethics
MAY, BILL
University of Pittsburgh Center for
MEISEL, ALAN
Medical Ethics
NYU
Independence
Professor
of
MEZEY I KATHY
Nursing
University of Minnesota, center for
MILES I STEVEN
Biomedical Ethics
O' CORNELL, LAWRENCE Boward University School of Medicine
Post-Doc Associate, Yale University
OSSORIO I PILAR
School of Medicine
creighton University Center for
PORTILO I RUTH
Bea1th Po1icy and Ethics
Boward University Divinity School
SANDERS I CHERYL
Boward University, Medical Ethics
SBCOHDY I MARIAN
OMB-Not Listed as an FTB on 840-849
TURMAN I RICHARD
GIBSON, JOAN
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
453-469, 867, 1538.
See Tab 24 attached to this
Memorandum.
Cluster Group VI, •Transition to the Hew System Short-Term
Cost Controls•, consisted of Working Group 18,
System
Deve1opment•,
Working
Group
8
19,
Acce1erating Hew
•administrative
Simplification• and Working Group 20, •Interim .Cost contro1s•.
see
Tab 25 attached to this Memorandum.
C1uster Group VI, •Transition to the Hew System Short-Term
Cost Constro1s•,
CLUSTER VI -
and its leader was listed as follows:
TRANSITIOH TO THE
1fBif
SYSTEM
SHORT-TERM COST CORTROLS
CLUSTER LEADER -
PAUL
STARR,
Princeton
(1763)-SGB/BBS (1678)
68
University
�Working Group 18, "Accelerating New System Development", of
Cluster Group VI, was composed of the following members:
GROUP 18 -
ACCELERATING NEW SYSTEM DEVELOPMENT
GROUP 18 LEADER -
LOIS QUAM (1760), SGE-HHS (1678)
ON TAP:
ALAIN ENTHOVEN, FROM OTHER CLUSTERS: WALTER
ZELMAN, RICK KRONICK, RICK CURTIS, ATUL GAWANDE (474)
Hennepin County, Minnesota Bureau of
Health, Director of Health Policy
(Stayed at the Holiday Inn Crowne
Plaza,
Metro Center)
(478);
No
Official Status Listed; Listed as
"Intergovernmental
Representative
from
National
Association
of
counties on 1786, But List Does Not
Show Participation in Group 18;
Listed as Participant in the Task
Force in First Responses
Rep. Cardin (CD, Vol. I, P. 936)-FTE
CAVANAUGH I SEAN
HHS-FTE
DELEW I NANCY
EPSTEIN I ARHOLD
Robert
Wood
Johnson
Fellow,
Sponsored by Harvard Medical School
&
Brighalll
&
Women's
Hospital;
Serving in the Office of Sen. J.
Rockefeller IV ( 4 79) ; Listed as SGE
( 1678) [See Tab 56 Attached to this
Memorandum]
GARCIA, JOSEPH
CUyahoqa County, Ohio Department of
Human
services
(Stayed at
the
Americana Hotel)(478) -Listed as a
Participant;
No Official Status
Given; Not Listed as SGE on 16781679: Listed as "Interqovernmental
Representative"
from
National
Association of counties on 1786, But
List Does Not Indicate Participation
in Group 18.
GREENBERG, GEORGE
HHS-FTE
KELLEY, LAUREN
White House Policy Assistant - SGE
(1678); Columbia University (732)
LANGENBRUNNER, JACK OMB-FTE
LEMASURIER, JEAN
HHS-HCFA-FTE
LUKOMNIK, JOANNE
contractor from NYC ( 4 78) ; SGE/HHS
(1678)
McLAUGBLDf, DAN
No Affiliation Listed; Stayed at the
Holiday Inn Crowne Plaza, Metro
Center ( 4 78) , Like Benavides; No
Official Status
BENAVIDES I EJ.T,g
69
�MILLER, CAROL
O'BRIEN I MARY JO
QUAM, LOIS
QUIST I JANET
SCHUMANN, BETH
STARR, PAUL
WELCH, PETE
WIIAHG I
JUDY
ZAWISTOWICH, LU
ZARABOZO, C.
Mountain Management co. , NM - SGE
(First Responses) - Hot Listed as
SGE on 1678-1679
Rational
Governors
Association,
Minnesota: Listed as Representative
from Intergovernmental Organization
on 1786: No Official Status Listed
VP, United Health Care Corporation,
SGE (1678)
Listed
as
Representative
of
Intergovernmental Organization from
Rational League of Cities (1786): No
Official Status Given
HHS-FTE
Princeton University - SGE (1678)
The Urban Institute- SGE/OMB (1679)
BHS: Hot Listed as an FTE on 840849: called "Policy Analystn in
First Responses
HHS-FTE
HHS-FTE
SOURCES: Declarations of Marjorie 2'armey, Documents Nos.
478-487 1 724-729 1 790 1 1313-1315 1 30101.
See Tab 26
attached to this Memorandum.
Working Group 19, "Administrative Simplification", of Cluster
Group VI, was composed of.the.following members:
GROUP 19 -
ADMINISTRATIVE SIMPLIFICATION
GROUP 19 LEADER -
TIM HILL I HHS-FTE
ON TAP - BERT TOBIN, RICHARD SHARPE, THE HARTFORD
FOUHDATIOH (477): FROM OTHER CLUSTERS: TOll PYLE, DAVID
EDDY (477)
ABRAMCBECK, F.
EDS Health Care; No Official status
(30027)
ABRAMSON I
LEONARD
ALBERTIRE I JIM
ALEXARDRE I
LESLIE
BARRETT I LEE
BATALDEN, PAUL, MD
BUFFINGTON I MAX
CAULEY, IIAifK
CBERTOPP I
STEVE
US Health Care; No Official Status
Albertine Enterprises ( SJIIS) ( 30028) :
No Official status
EDS ( 30028) ; lfo Official Status
Aetna ( 30028) ; No Official status
Hospital COrporation of America; No
Official Status
HHS-FTE
Telesis: No Official status
PCS Health systems; Ho Official
Status
70
�CONNELL, RICHARD
CURTIS, BENJAMIN
DOWLING, ALAN
GIEL, MICHAEL
GILLIGAN, T.J.
HILL, TIM
HERRELL, ILEANA
HUMPHRIES, BETSY
KRAKAUER, HENRY
KOSS I SHANN'AH
KOVHER, CHIUSTIHE
KUZMACK, RICH
LEDBE"I•I'ER, LEE
MACALEER, JDI
MALONEY, DAN
METZ I ARTHUR
MOSSER, GORDON
:NUDELMAN I
PETER
O'DONNELL, KEN
O'ROARK, FRARK
PICKERIHG I JDI
RICKSOH I NORENE
SCHROEDER, KATHY
SCOTT I JEAHHE
SILVA, JOHN
SOUDER, BARBARA
SOVDIERS, R.
STEPHENS, JACK
WESTOH I DAVID
WILSON, MARK
NEIC
(How
Aetna)
(30073);
No
Official Status
NEIC (How Aetna) : No Official Status
(30028)
Task Force (Hot Listed as FTE Phone 216/338-5866 - Which is the
Dowling's Home Humber)
AHCPR-HHS-FTE
University of Michigan Hospital; Ho
Official Status
Cooperative Healthcare :Networks; No
Official Status
CIS;Ho Official Status
HHS-FTE
us Public Health Service-FTE
:National Library of Medicine-FTE
Uniformed Services University of
Health Sciences-FTE
OMB-FTE
Hew York University; Ho Official
Status
OMB-FTE
SMS; :No Official Status (30027,
30028)
SMS Corporation- :No Official Status
Veterans' Affairs-FTE (844)
First Health; No Official Status
(30027, 30028)
Xnternist/Minnesota;
No
Official
status
Group Health Cooperative of Puget
SOund; Ro Official Status
HEXC (Row Aetna); Ro Official Status
(30027)
Blue cross/Blue Shied Ass'nfWEDX; Ro
Official status (30028)
JIEXC (Row Aetna); Ro Official Status
Telesis; Ro Official Status
William
Beumont
Hospital;
Ro
Official status
czs Technologies; Ro Official Status
OMB-FTE
WEDXjTravelers; No Official Status
(30027)
czs Technologies; Ro Official Status
(30027)
Lakeland Regional Medical Center; Ro
Official Status
T.be
Travelers/WED!;
Ro Official
Status ( 30028)
OMB-FTE
71
�WOLFORD, G. RODNEY
Alliant Health System; No Official
Status
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
477, 791, 30025, 30027, 30028, 30073, 30100, and List
Included in First Responses Entitled, "Administrative
Simplification", See Tab 27 attached to this Memorandum.
Working Group 20, •Interim Cost Controls•, of Cluster Group
VI, was composed of the following members:
GROUP 20 -
INTERIM COST CONTROLS
GROUP 20 LEADER -
DAVID CUTLER, CEA-FTE
ADDISON-BURTON, L.
Rep. Sabo (CD, Vol. I, P.930)
"Recorder" (30052)-FTE
The
Beller
School,
Brandeis
University.
In Handwriting, •BBSConsultant•
(480):
No Official
Status
Given;
Not
Listed
as ··
Participant in First Responses; No
other Docum.entation. Note: Alan B.
Cohen, Former RWJF Trustee is now at
the Beller School and is on the
Editorial Board of Beal.t;b Mfairs
[See Tab 56 Attached to this
Memorandum]
HHS-ACHPR-FTE
LABOR-PWBA-FTE
HHS-FTE
HHS-HCFA-FTE
HHS-HCFA-FTE
Rep. Cardin (CD, Vol. I, P. 936)-FTE
Rep. Cooper (CD, Vol. I, P. 936}-FTE
Select CODIIIli.ttee on Aqing (Lost
Appropriation 3/31/93)-Listed as
P'l'E-841
CEA-FTE
Vice President, the CoJIIDlOnwealth
Fund, Member of Physicians Payment
Review CoDIIIli.ssion (PPRC) (See Also
484, 488, 492, 496, 499); No
Official Status Given; Hot Listed as
a Participant in First Responses
HHS-HCFA-FTE
Sen. Budget (CD, Vol. I, P.
)-FTE
Sen. Rockefeller (CD, Vol. I, P.
352-FTE
In Handwriting, •consultant• (480,
488, 493, 496); The Jackson Hole
AL'l'MAN I
STUART
BALL, JUDY
BRIGGS, BETTY
BUFFINGTON, MAX
BURNEY I IRA
BUTO, KATHLEEN
CAVANAUGH, SEAN
CHAMBERS, CAROLINE
COSTER, JOHN
CUTLER, DAVID
DAVIS I KAREN
DEWANE, MARY
DEIGNAN, KATHY
DONESKI, ELLEN
ENTBOVEN I ALAIN
°
72
�FINIGAN, TOM
FITZMAURICE, M.
FRIEDMAN I BERNARD
GREENBERG, GEORGE
HASH I MICHAEL
HILL, TIM
KELLEY, LAUREN
KING I ANDREA
KOLUDNER 1 ROBERT
KOSS I SHANNAH
KRAKAUER I HENRY
KUZMACK I RICH
LANGENBRUNNER, J.
LEATHERS I HOWARD
LEE, PHILIP
LUTTER,. RANDY
NEXON, DAVID
NICHOLS, LEN
O'NEILL, KIM
0' BRIEN, MARY
JO
POTETZ, LISA
QUAM, LOIS
REIRBARDT, UWE
RILEY, IREHE
Group, Inc.; No Official Status
Given; Not Listed as a Participant
in First Responses.
Sen. Baucus (CD, Vol. I, P. 268)-FTE
(Identifies Self as "Congressional
Fellow" on Sign-In List)
HHS-FTE
HHS-FTE
HHS-FTE
Rep. Waxman (CD, Vol. I, P. 712)-FTE
HHS-HCFA-FTE
White
House
Policy
Assistant
(30052); Columbia University (732)SGE (1678)
Rep. Gephardt (CD, Vol. I, P. 532)FTE
Veterans Affairs-FTE
OMB-FTE
Uniformed Services University of
Health Sciences-FTE
OMB-FTE
OMB-FTE
CEA-FTE
(In
Handwriting,
•BBS-Special
Government Employee•).
Director,
Robert Wood Johnson Foundation (See
A1so 485, 489, 494, 497, 500) (See
Tab 56 Attached to this Memorandum):
No Official Status Given, Not Listed
as a Participant in First Responses.
OMB-FTE
Labor Comm. (CD, Vol. I, P.395)-FTE
OMB-FTE
CEA-FTE
Rational
Governors
Association,
Minnesota ( 490) : No Official Status
Given - Listed as Representative of
Interqovernmental Orqanization, RGA
on 1786)
Sen. Finance (CD, Vol. I, P.
)(In Handwriting, •BBS Spec Gov Emp•)
(482, 490, 494, 497, 500) VP, United
Health Care Corp-SGE (1678)
(In Bandwriting, •eonsultant•) ( 482,
486, 490, 494, 497, 500) Princeton
University;
No Official
Status
Given; Hot Listed as a Participant
in First Responses
Rational Association of Counties
{1787); Listed as Representative of
Interqovernmental Orqanization; No
Official Status
73
�RODRIGUEZ, LOUISE
ROSEN, BOB
SHEINGOLD, STEVE
SILVA, JOHN
SOLOMON, LOEL
STARR, PAUL
THORPE, KEN
UKOCKIS I JAMES
WERNER I MICHAEL
WILSON, MARK
Veterans Affairs-FTE
Sen. Mitchell (CD, Vol. I, P. 1096)FTE
HHS-HCFA-FTE
Uniformed Services University of
Health Sciences-FTE
Sen. Kennedy (CD, Vol. I, P.
)(In Handwriting, •HHs-spec Govt
Emp•) {482), Princeton UniversitySGE (1678)
HHS-HCFA
Treasury-FTE
senate Democratic Policy committee
(CD, Vol. I, P. 403)-FTE
Labor-FTE
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
480-498, 790, 1539-1543, 1617-1625, 30052. See Tab 28
attached to this Memorandum.
Cluster Group VII,
•Financing•, consisted of one Working
Group, that being Working Group 21, •Financing." Working Group 21,
•Financing", of Cluster Group VII was composed of the following
members:
CLUSTER VII -
FINANCING
CLUSTER LEADER GROUP
21 -
ANTOS, JOSEPH
BERNER I KEVIN
CHARLES I GERALD
CORONADO, DAVID
FLYNN, ED
GALE, JOSEPH
GLAZE I STEVEN
HARDOCK I RANDY
HELLINGER, FRED
JACKSON, PAUL
KERY, PAT
KING, ROLAND
LYON, RANDY
MARINA WEISS, Treasury-FTE
FINANCING
HHS-FTE
Veterans' Affairs-FTE
Treasury-FTE
DC Commissioner of Health care
Finance ( 505) : No Official Status
Given: Listed as Intergovernmental
Employee in First Responses
OPM (503)-FTE
Sen. Moynihan (CD, Vol. I, P. 980)FTE
Sen. Pryor (CD, Vol. I, P. 348)-FTE
Treasury-FTE
HHS-FTE
HHS-FTE
Rep. Kenelly (CD, Vol. I, P. 1023)FTE
HHS-FTE
OMB (502)-FTE
74
�MUNNELL I ALICIA
PATEL, PARASHAR
PETERSON, DOUGLAS
RAYMOND 1 VICTOR
RILEY, IRENE
SCIIEPPACH, RAYMOND
SCHNEIDER I ANDREW
SWIRE I ANDREW
TITUS I FRANK
UYEDA, MARY
WEISS, MARINA
I
MICHAEL
. woo
Treasury-FTE
OMB-FTE
National League of Cities (505,
512): No Official Status Given:
Listed
as
Representative
of
Intergovernmental
Organization
(1787)
Veterans Affairs-FTE
L.A. County Health Department -NACO
(505, 512) - No Official Status
Given, Listed as Representative of
Intergovernmental organization on
1787)
National Governors Association ( 521,
504, 509, 511, 514, 516, 518, 519):
No Official Status Given, Listed as
Representative
From
Intergovernmental
Organization
(1787)
Rep. Waxman (CD, Vol. I, P. 711)-FTE
OMB-FTE
OPM (502)-FTE
Rational Association of Counties
(505, 512): No Official Status
Given: Listed as Representative of
Intergovernmental
Organization
(1787)
Treasury-FTE
Energy & Comm (CD, Vol. I, P. 710)FTE
SOURCES: Declarations o:t Marjorie Tarmey, Documents Nos.
501-522, 793, 1544, 1545, 30109, 30110, 30032. See Tab
29 attached to this Memorandum.
Cluster
Underserved•,
Group
VIII,
"Health
consists· of
Policy
Working
Group
Initiatives
22,
"Health
for
the
Policy
Initiatives for the Underserved•, Subgroup A, •underserved Rural
and Inner City Areas•, Subgroup B, •vulnerable Populations/High
c, •women
Risk Populations 01 , Subgroup
and Children", and Subgroup
D, "Population-Based Public Health and Prevention•.
See Tab 30
attached to this Memorandum.
Cluster
Underserved•,
Group
VIII,
"Health
Policy
Initiatives. for
and its leader was listed as follows:
75
the
�CLUSTER VIII - HEALTH
POLICY
UHDERSERVED
Group
FOR
THE
MARK SMITH, Vice President, Kaiser
Family Foundation
CLUSTER LEADER Working
INITIATIVES
22,
"Health
Policy
Initiatives
for
the
Underserved", Subgroup A, "Underserved Rural and Inner City Areas",
of Cluster Group VIII, listed the following members:
GROUP 22 -
HEALTH POLICY
UHDERSERVED
INITIATIVES
SUBGROUP A -
UHDERSERVED RURAL
AHD
GROUP 22 LEADER GROUP 22 co-LEADER
GROUP 22A LEADER
ALLEN, LUCY
CARLSON, RON
CLARK, WILLIAM
CROW,
SHELLY
DEMTOH, DEH:ISE
DUNN, VAN
F:IH:IGAH, TOM
GROSS I LAUREN
HAYES I SHERRY
KEPNER, COLLEEN
LINK I KENNETH
PATEL, PARASHAR
SBDU.EY, AARON
SOBEL, LARRY
FOR
IHHER CITY
THE
AREAS
BONNIE LEFKOWITZ, HHS-FTE
SMI:TB, Vice President Kaiser
Family Foundation (1546)-SGE (1678);
Consultant ( 526)
ARB
ztJVEKAS,
Center for Health
Policy Research (962); Ro Official
Status-SGE (First Responses) , Hot
Listed on 1678-1679
MARK
CEA-FTE
HHS-FTE
Robert Wood Johnson Fellow Sponsored
by University of Florida; in Sen.
Bumpers (D-AR) Office-FTE (841) [See
Tab 56 Attached to this Memorandum]
Second Chief, Huscogee creek Nation
(30034)-SGE (1678)
Colorado Rural Health Resource
Center-SGE (First Responses) ; Hot
Listed in 1678-1679
Sen. Kennedy (CD, Vol. I, P. 395)FTE (30034)
Congressional Fellow Sponsored by ??
in Sen. Baucus' Office-FTE (842)
Sen. Pell (CD, Vol. I, P. 991)-FTE
(30034
Sen. Kohl (CD, Vol. I, P. 1001)-FTE
Rep. Stenholm (CD, Vol. I, P. 768)FTE
Veterans Affairs-FTE
OMB-FTE
Director,
Jackson-Binds
Comprehensive
Health
Center-SGE
(1678) (30034)
DOD-FTE
76
�SPRINGER, M.
STEELE, PAMELA
SYKES, KATHEY
VELOZ I RICHARD
ZUVEKAS I
ANN
Treasury-FTE
Veterans Affairs-FTE
Rep. Obey (CD, Vol. I, P. 1122)-FTE
Formerly, House Aging Committee
Which Lost FUnding
3/31/93-SGE
(First Responses) : Not Listed as SGE
on 1678-1679
center for Health Policy Research:
No
Official
Status-SGE
(First
Responses only
GROUP 22A SUBGROUP - HIV
HIV SUBGROUP
CHAIR
BERGTHOLD 1 LINDA
BROSTROM, MOLLY
HEENAN, CHRISTINE
ISKOWITZ, MICHAEL
LASKER, ROZ
MATHER, SUSAN
MAXWELL, CELIA
STONE ROBYN
PETERSON I BOBBIE
WESTMORELAND, TOM
I
MET WITH
w. H. Mercer, Inc.-SGE (1678) (1239)
WBO-SGE-Policy Assistant
Domestic Policy staff, White House
(1239) - Listed as FTE-HHS (843)
Sen. Kennedy (843)-FTE
PPRC-SGE ( 1678)
Veterans Affairs-FTE (846)
Volunteer from Boward University
Project BOPE-SGE (1679)
No Official status (1238)
Rep. Waxman (CD, Vol. I, P. 711)-FTE
GROUP 22A
REGINA ARAGAN
BILL BAILEY
CORNELIUS BAKER
TERRY
Vice President, Kaiser
Family Foundation
MARK SMJ:TH,
BESWICK
san Franciso AIDS Foundation
American Psychological Association
National Association of People With
AIDS
AIDS Research Policy Analyst With
BRCF
LEONARD
BLOOM
ANNE BROOMFIELD
PAUL DEDONATO
SONDRA ESTEPA
RUTH FINKELSTEIN
JDI GRAHAM
DAVID HARVEY
DEBRA FRZER-HOWZE
DR. BILLY JONES·
CEO, AIDS Project Los Angeles
Greater Baltimore B:IV· & Health
Services Planning Council
Health Care Finance Expert (san
Francisco)
Latino Commission on AIDS
Director, Public Policy, GMHC, New
York
Executive Director, Whitman-Walker
Clinic
Rational Pediatric B:IV Resource
Center
CEO, Black Leadership Co.mission on
AIDS
Executive
Director,
Health
&
Hospitals Corporation
77
�PAUL KAWATA
JEFF LEVI
CHRISTINE LUBINSKI
JANE SILVER
PETER STALEY
TODD SUMMERS
SANDY THURMAN
ROY WIDDES
National Minority AIDS Council
AIDS Action Council
AIDS Action Council
for
AIDS
American
Foundation
Research
Treatment Action Group
AIDS Housing Corporation
AID Atlanta
NCA
LAUREN FOGT
DEREK HODEL
TAG
B. J. SYLES
DAVID BARR
RLCA
JULIE SCOFIELD
REGGIE WILLIAMS
RASDAD
:NTFAP
TAG, GHHC
Rational Hemophilia Foundation
Rational Hinority Gay and Lesbian
Association
ETJ.EN RIKER
PHIL WILSON
KRIST:tN GEBBIE
JEFF JACOBS
AARON SHIRLEY
APHA
&l'EPHEN BOWER
FREDA MITCHEM
BHS
RACIIC
APHA
Jackson-Hinds Co:mprehensive Health
Center
BYRON J. HARRIS
u.s. Conference of Mayors
C. ATCII:tSOH
_ASTBO
VALEIUA MORBLL:t
ASTBO
SUSAN FORBES-MART:tH Commission on :t:mmigration Reform
ARTHORY J. LAWRENCE PHS
PENELOPE P:tHO
HCFA
MICHAEL KAJ:SER, MD Pediatric IUDS Program
AL:tC:IA BEATTY TEE
The Circle of care
BRIAR FEIT
Dimock Community Health Center
DAVID HARVEY
Department of Policy Analysis,
Rational Pediatric HIV Resource
Center
SOURCES: Declarations of Har jorie Tarmey, Documents Nos.
715, 716, 1234-1239, 1252-1253, 1327, 1328, 30033, 30034,
30035, 30058, 30059, 30091, 30120, 30173, 30176. See Tab
31 attached to this Memorandum.
Working Group 22, Subgroup B, •vulnerable Populations/High
Risk
Populations•,
of
Cluster Group VIII,
consisted
of
following :members:
GROUP 22 -
HEALTH
POLICY
ORDERSERVED
GROUP 22 LEADER -
IRIT:IATIVES
BONNIE LEFKOWITZ, HHS-FTE
78
FOR
THE
the
�GROUP 22 CO-LEADER
SUBGROUP B
MARK SMITH, Vice President, Kaiser
Family Foundation ( 1546) -SGE ( 1678) ;
Consultant (526)
POPULATIONS/HIGH
VULNERABLE
POPULATIONS
SUBGROUP B LEADER - JOANNE LUKOMNIK,
(545)-SGE (1678)
DUNN, VAN
ELDERS, JOYCELYN
FIEDELHOLTZ, J.
FINIGAN I TOM
FISKE, MARY BETH
HANDY I CAROLYN
HAYES, SHERRY
HEADLEY, ELWOOD
BOHAN, J.
ISKOWITZ, M.
KATTAN I AZAR
KEPNER, COLLEEN
KOPLAN, JEFF
LEFKOWITZ, BONNIE
LEWIS-IDEMA, D.
LEVINE I DEBBIE
LURIE I ALBXAMDER
LINK I KENNETH
LUKOMNIK, JOANNE
MATHER SUSAN
McKENNEY, NAMPEO
OBEY, CRAIG
OLIVER, JUDY
PATEL, PARASHAR
QUAM, LO:IS
REINECKE I PETER
RICHARDSON I
SALLY
RODGERS I JUDITH
M.D. ,
RISK
Consultant
Sen. Kennedy (CD, Vol. I, P. 395)FTE
Arkansas
Department
of
Health
(1310); No Official status Assigned
HHS-PHS-FTE
Congressional Fellow; Sen. Baucus;
Not Listed in Directory-PTE (842)
Sen. Labor (Kennedy) (CD Vol. I, P.
395)-FTE
CEO, Blacks Educate Blacks About
Sexual Health Issues-SGE (1678)
Sen. Kohl (CD, Vol. I, P. 1001)-FTE
VA-FTE
Commission
on
Aging;
Not
in
Directory-PTE (843)
Sen. Kennedy (CD, Vol. I, P.
)
Rep. Matsui (CD, Vol. I, P. 586)-FTE
Rep. Stenholm (CD, Vol. I, P. 768)FTE
Centers for Disease control-FTE
HHS-FTE
MDS
Associates
(COnsultant)-FTE
(844)
White Bouse Policy Assistant-SGE
(1678)
No Official Status Assigned
Veterans Affairs-FTE ·
Consultant-SGE ( 1678)
Veterans Affairs-FTE
Census-FTE
Sen. conrad (CD, Vol. I, P. 1068)FTE
HHS-FTE
OMB-FTE
V.P.,
United
Health
Care
Corporation-SGE (1678)
Sen. Harkin (CD, Vol. I, P. 396)-FTE
West Virginia Health Care Planning
COmmission; (•consultant•) (1312)SGE (First Responses)-Not Listed
1678-1679
BHS-Not Listed as PTE, 840-846
79
�ROWLAND I DIANE
SHINN, RITH
SHIRLEY, AARON
SMITH I BARBARA
SMITH, ELMER
SMITH, MARK
SOBEL, LARRY
SPRINGER, M.
STEELE I PAMELA
SYKES, KATHY
TOWNSEND, JESSICA
Kaiser Commission on the Future of
Medicaid: Johns Hopkins UniversitySGE (1678): No OFficial Status, Not
Listed in First Responses
Department of Labor-FTE
Jackson-Hinds Comprehensive Health
Center-SGE (1678)
National Governors Association ( SD)No Official Status:
Listed as
Representative of Interqovernmental
organization (1786-1787)
HHS-HCFA-FTE
Vice
President,
Kaiser
Family
Foundation ("Consultant") (1312)-SGE
(1678)
DOD-FTE
Treasury-FTE
Veterans Affairs-FTE
Rep. Obey (CD, Vol. I, P. 1122)-FTE
HHS-PHS-FTE
SOURCES: Declarations or Marjorie Tarmey, Documents Nos.
1310-1312, 30056.
See Tab 32 attached to this
Memorandum.
Working Group 22, Subgroup c, "Women and Children", of Cluster
Group VIII, consisted of the following members:
GROUP 22 -
HEALTH
POLICY
INITIATIVES
FOR
THE
UNDERSERVED
GROUP 22 LEADER
BONNIE LEFKOWITZ, HHS-FTE
GROUP 22 co-LEADER
MARK
SUBGROUP C KATHY BASSET
JEAHNIE ROSO
RACHEL GOLD
RAE CERAD
MARY CARPENTER
AARON SHIRLEY
SMITH, Vice President, Kaiser
Family Foundation ( 1546) -SGE ( 1678) :
Consultant (526)
WOMEN AND CHILDREN
American College of Obstetricians
and Gynecologists
Alan Guttmacher Institute
Alan Guttmacher Institute
National
Commission to Prevent
Infant Mortality
National
Commission to Prevent
Infant Mortality
SiCJDS in as "BBS", Gives JacksonBinds Comprehensive Health Center,
Jackson, MS, Phone Number: RB: on
80
�2/18/93 signed in as "Jackson-Hinds
HC" (30059)
PETERS 1 D. WILLIAM National Association of Children's
Hospitals and Related Institutions
National Association of Children's
LARRY McAHDEREWS
Hospitals and Related Institutions
Office on Women's Health; U.S.
AGNES H. DONAHUE
Public Health Service/HHS
PHS, Office of Population Affairs
JERRY BENNET
MCHB/HRSA/PHS
CAROL GALATZ
Department of Aqriculture/Food &
RONALD J. VOGEL
NutritionjWIC
American Academy of Pediatrics
JACKIE NOYES
ASPE/HHS
ANNE SEGAL
Planned Parenthood Federation
EI.r.p BATISTILLI
Planned Parenthood Federation
BILL HAMILTON
Children's Defense Fund
CAROL REGAN
National Coalition of Hispanic
ADOLPH P. FALCON
Health
&
Human
Services
Orqanizations
Chief,
OUtpatient Services,
DC
'RJJ.Q YUHG-FATAB
Department
of
ConslDler
and
Regulatory Affairs
FREDERICK C. FOARD Chair, National Operations Board,
National llinority Health Association
Executive
Director,
National
LEROY ROBINSON
Minority Health Association
NMBA Meeting & Conference Planner,
BILL CHAMBRES
Newsletter Editor
LUCY ALLEN
Council on Economic Advisors
RUTH SHINN
Women's Bureau, Department of Labor
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
30092, 30093. See Tab 33 attached to this Memorandum.
Workinq Group 22, Subpart D, "Population-Based Public Health
and Prevention", of Cluster Group VIII, consisted of the followinq
members:
GROUP 22 -
HEALTH
POLICY
UHDERSERVED
INITIATIVES
FOR
THE
GROUP 22 LEADER
BONNIE LEFKOWITZ, HHS-FTE
GROUP 22 co-LEADER
MARK SMITH, Vice President, Kaiser
Family Foundation (1546)-SGE {1678):
Consultant {526)
SUPGROUP D -
POPULATION-BASED
PREVENTION
81
PUBLIC
HEALTH
�JOANNE LUKOMNIK, MD NYC Phone Number Given--Private
Physician (lUIS) (525)-SGE (1678)Consultant (545)
SUSAN MATHER, MD
OMB-FTE
LUCY ALLEN
CEA-FTE
Veterans Affairs-FTE
KEN LINK
Census-FTE
NAMPEO McKENNEY
George Washington University Center
ROSENBAUM, SARAH
for Health Policy Research; Listed
as "Others to Whom Information
Should be Sent" (545); Listed as
"White House" on 1546, but Phone
Number Listed is for the GWU CHP.R;
Signs in as "White House", but Gives
Phone Number for GWD CHP.R ( 30150,
30151) ; Same Phone Number as Ann
zuvekas Below
Johns Hopkins University, Kaiser
ROWI..AHD I DIAHE
Commission
on
the
Future
of
Medicaid; Listed Among "Others to
Whom Information Should be Sent" on
545; Listed as SGE-White House
(1678)
RYAN, ELAINE
Rep. Slaughter (CD, Vol. I, P.
),
Women's Task Subgroup-FTE (847)
SHINN, RUTH
Labor (526)-FTE
SHIRLEY I AARON
Jackson-Binds Comprehensive Health
Center (526)-SGE (1678)
SMITH, MARK
Vice
President,
Kaiser
Family
Foundation ( 526) ; consultant ( 526,
1312); SGE-BBS (1678)
SOBEL, LARRY
Defense-FTE
STEELE I PAMELA
Veterans Affairs-FTE
VELOZ I RICHARD
Formerly House Select Committee on
Aging,
Appropriations
Expired
3/31/93; Hot Listed as FTE 840-840,
Listed as consultant (526)
YAMAMOTO, ALAN
Rep. Abercrombie (CD, Vol. I , P.
436)-FTE
ZETTLER I SUSAN
Rep. Strickland (CD, Vol. I, P.
654)-FTE
ZUVEKAS I ANN
George Washington University Center
for Health Policy 296-6922 ( 527) ;
Listed as Consultant (545); Ho
Official Status in Any of the
Responses
JEFF KOPLAN
CDC Phone Number Given-FTE
MARTHA KATZ
CDC Phone Number Given-FTE
BOB KEEGAN
CDC Phone Number Given-FTE
CHERYL AUSTEIN
HHS Phone Number-FTE
CARRIE, BILLY
Sen. Bingaman (CD, Vol. I, P. 271)FTE
82
�SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
1546, 1547, 30036.
See Tab 34 attached to this
Memorandum.
Cluster Group IX, "Mental Health", consisted of Working Group
23,
"Benefits Package",
Working Group 24,
"Substance Abuse",
Working Group 25, Children's Services", and Working Group 26,
"Public System Impact/Special Populations".
See Tab 35 attached to
this Memorandum.
Cluster Group IX, "Mental Health", and its leader are listed
as follows:
CLUSTER IX-
MENTAL HEALTH
CLUSTER IX LEADER - BERNARD ARONS, HHS-NIMH-FTE
Working Group 23, "Benefits Package", of Cluster Group IX,
consisted of the following:
GROUP 23 -
BENEFIT PACKAGE
GROUP 23 LEADER -
NONE LISTED (1761)
ARONS I BERNARD
BARSTOW SCOTT
HHS-NIMH-FTE
Rep. Kopetski (CD, Vol. I, P. 570)FTE
White House communications-FTE
Defense-FTE
( 566) Mental Health Economist, Johns
Hopkins University
BHS CMBS-SGE {1678)
Office of the Vice President
lUIS-NIB, Rep. Strickland-PTE ( 842) ;
Part-time
COngressional
Liaison
{1626)
Office of the Vice President
Office of the Vice President
Veterans Affairs-FTE
BHS-SGE ( 1678) ; Part-time Volunteer
(1626)
HHS-FTE (846)
HHS-FTE (846)
BOORSTIN, ROBERT
BROCK I PETER
PRANK, RICHARD
GOLDMAN I BOWARD
GORE, TIPPER
GUST, STEVEN
BARIUS, · SiaLA
BAYES, CHARLOTTE
HORVATH 1 THOMAS
IIELMAH,LORI
MELNICK I DANIEL
NORQUIST, GRAYSON
83
�PIRES I SHEILA
ROSENMAN, PAT
SCHUSTER, JAMES
STEPHENS, SHARMAN
STOLINE I ANNE I MD
STROUL, BETH
TIMS, FRANK
WEICH, RONALD
ZETTLER, SUSAN
Part-time Consultant, HHS (1627):
202/333/1892,
Human
Services
Collaborative (1692) - See Sign-in
List (30038): Not in Directory:
Responses Say She Works for Riegle:
Riegle's Office Never Heard of Her
HHS-FTE (847)
Rep. Strickland (Not in Directory) Law Student from George Washington
University: Now Back at School
According to Strickland's Office at
10:45 a.m. on 1/27/94 - He was an
J:ntern
HHS-FTE
Psychiatrist at Springfield State
Hospital, Maryland (867); Classified
as nWhi te Hausen on 796 and as a
Full-time Volunteer from the State
of Maryland (572, 1627)
Part-time Consultant to HHS (1627);
SGE-HHS-CMHS
(1679); Dimensions,.
J:nc., According to Phone Number on
30041
HHS-FTE
Sen. Labor and HR Committee (CD,
Vol. I, P. 1137)-FTE
Rep. Strickland (CD, Vol. I , P.
~S4)-:-FTE
ON 566 THE POLLOWJ:NG NAMES ARE ADDED TO THE GROUP:
SPECJ:AL AREAS:
EFFECTJ:VENESS ( 566)
FULLER, DICK
HAVERKOS I HARRY
KEITH, SAM
TIMS, FRANK
DATA
AND
QUANTJ:TATJ:VE AHALYSJ:S
FRANK, RICHARD
MELNICK, DAN
MANDRSCHIED, RON
REFIER, DARRELL
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
537-580, 796, 1140, 1240, 1241, 1338, 1549, 1550, 16261630, 30034-30037, 30111, 30145-30167, 30178. See Tab 36
attached to this Memorandum.
84
�Working Group 24, "Substance Abuse", of Cluster Group IX,
consisted of the following Members:
GROUP 24 -
SUBSTANCE ABUSE
GROUP 24 LEADER -
NONE LISTED (1761)
HHS-NIMH-FTE
HHS-FTE
DOD-FTE
HHS-FTE
!DIS-NIH (First Responses) -FTE-Rep.
Strickland (841); Rep. Strickland's
Office Rever Heard of Him; nor sen.
Wellstone's Office
OVP-FTE
HARRIS, SKILA
Montgomery county Department of
HOLT I HERBERT
Addiction Services (537, 539, 543)
MELMAN, LORI
!DIS-Rot Listed as FTE on 846; Listed
as SGE (1678); Listed as Part-time
Volunteer (1626)
MELNICK I DANIEL
HHS-FTE
NOBLE, JONATHAN
NIAAA/HHS-FTE (846)
ROUSE I BEATRICE
HHS-FTE
SCHECKEL, LISA
.HHS-FTE
STEPHENS, SHARMA
HHS-FTE
STOLINE I AHHB
Psychiatrist at Springfield state
Hospital, Maryland (867); courtesy
Staff Psychiatrist, Sheppard-Pratt
Hospital,
Baltimore
(764)-SGE
(1695); Full-time Volunteer, State
of Maryland (1627)
TRACHTENBERT I ALAN HHS-FTE
WOODWARD I ALAN
HHS-FTE
ARONS, BERNARD
BLOSS, GREGORY
BROCK, PETER
GOPLERUD, ERIC
GUST, STEVE
SOURCES: Declarations o:f Marjorie Tarmey, Documents Nos.
552, 556, 569, 578, 795, 1316, 1317. See Tab 37 attached
to this Memorandum.
Working Group 25, "Children's Services", of Cluster Group IX,
consisted of the following members:
GROUP 25 -
CHILDREN'S SERVICES
GROUP 25 LEADER -
NONE LISTED (1761)
ARONS I BERNARD
HHS-NIMH-FTE
Georgetown
University
Child
Deveopment center ( 538)
Office of the Vice President
GOLDMAM I SYBIL
GORE I TIPPER
85
�HARRIS, SKILA
KATZ-LEAVY, JUDITH
MELMAN I LORI
MELNICK, DANIEL
PIRES I SHEILA
RICKEL I AHHETTE
STEPHENS, SHARMAN
STOLINE I ANHE
STROOL, BETH
Office of the Vice President
HHS
.
HilS-Not Listed as FTE: Listed as SGE
(1678):
Listed
as
Part-time
Volunteer (1627)
HHS-FTE
Human Service Collaborative (538)
Sen. Riegle - Office Never Heard of
Her
HHS-FTE
Psychiatrist,
Springfield
State
Hospital, Maryland (867)
Management Training & Innovations,
Inc. (703/790-0990) (538)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
558, 563, 567, 576, 797. See Tab 38 attached to this
Memorandum.
Working Group 26, •Public System Impact/Special Populations•,
of Cluster Group IX, consisted of the following members:
GROUP 26 -
PUBLIC SYSTEM DIPACT/SPEC:IAL POPULATIONS
GROUP 26 LEADER -
NONE LISTED (1761)
ARONS I BERNARD
GUST, STEVEN
HHS-NIMH-FTE
HilS-NIH, Rep. Strickland-FTE {842):
Part-time
Congressional
Liaison
(1626)
HHS: Part-time (1627): Listed as FTE
(843)
Office of the Vice President
Office of the Vice President
Veterans Affairs-FTE
HBS-SGE ( 1678) : Part-time Volunteer
(1626)
HHS-FTE (846)
HHS-FTE
Psychiatrist at Springfield State
Hospital, Maryland (867): Classified
as •White Bouse• on 796, and as
Full-time Volunteer from the State
of Maryland (572, 1627)
HARPER I MARY
HARRIS I SKILA
HAYES, CHARLOTTE
HORVATH, THOMAS
IIELKAN,LORI
MELNICK I DANIEL
STEPHENS, SHARMAN
STOLINE I ANNE I MD
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
557, 562, 568, 577, 812, 813. See Tab 39 attached to
this Memorandum.
86
�Cluster Group X, nLong Term Caren, consists of Working Group
27, "Long Term Care-Backgroundn, Working Group 28, nLong Term CarePublic Options", Working Group 29, "Long Term Private Optionsn, and
Working Group 30, "Cost and Revenue".
See Tab 40 attached to this
Memorandum.
Cluster Group X , "Long Term care", and its leader was as
follows:
CLUSTER LEADER -
ROBYN STORE, Project HOPE (584)
STAFF -
ATUL GAWANDE, 11 ASPE Staff Assistant.
Can Provide the Latest Master
Calendar." (585)
Working Group 27, nLong Term Care - Background", of Cluster
Group X, consisted of the following members:
GROUP
27 -
CHAIR -
LONG
TERM CARE -
BACKGROUND
MARY HARAHAN, (591) HHS-FTE
ALTMIRE I JASON
Rep. Peterson (CD, Vol. I, P. 921)-
ADLER I MICHELE
ASH, SHERRY
BLOOM, FELICIA
HHS-ASPE-FTE (840)
HHS-FTE (840)
Rep. Slaughter (CD, Vol. I, P. 647)FTE
Senate Committee on Aging-FTE
HHS-ASPE-FTE (841)
HHS-HCFA (781)-FTE (841)
HHS-ACF-ADD-FTE (841)
(781) Sen. Rockefeller (CD, Vol. I,
P. 352)-FTE
HHS-FTE
HHS-ASPE (No Official Status Given)
Robert
Wood
Johnson
Fellow,
Sponsored by University of Maryland
in the Office of Sen. Wofford (D-PA)
[See Tab 56 attached to this
MeJDorandum]: FTE-841
Veterans Affairs-FTE
HHS-ASPE-FTE
HHS-ASPE-FTE
FTE
BODE, HOLLY
CLARK, ROBERT
CLAUSER I STEVEN
DANIELS I SUSAN
DONESKI, ELLEN
DOTY I PAMELA
DRABEK I JOHN L.
ECKERT, KEVIN
GOODWIN, MARSHA
HARAHAN, MARY
KATZ, RUTH
87
�KELLEY I LAUREN
LIPNER, ROBYN
MILLER, NANCY
OTRIN I SUSAN
SIMON I MARSHA
SMITH, BETH
SOCHALSKI I JULIE
STONE I ROBYN
VELOZ I RICHARD
(585) Policy Assistant - WHO - SGE
(First
Responses):
Columbia
University (732)
Sen. Mikulski (CD, Vol. I, P. 395)FTE
HHS-HCFA-FTE
(585) WHO - Policy Assistant - SGE
(First
Responses):
Columbia
University (732)
Sen. Kennedy (CD, Vol. I, P. 395)FTE
Veterans Affairs-FTE
Robert
Wood
Johnson
Fellow,
Sponsored by Columbia University in
Sen. Bradley's Office (See Tab 56
attached to this Memorandum] : FTE
(846)
Project BOPE-SGE (1679)
Not Listed as FTE: Formerly Staff
Director, Bouse Select Committee on
Aging, Lost Funding 3/31/93. (Gives
BODle Address and Phone HUlllber as
Task Force Contact (584))
SOURCES: Declarations o~ Marjorie Tarmey, Documents Nos.
581-686, 781, 1309, 1552. See Tab 41 attached to this
Memorandum.
Working Group 28,
"Long Term care -
Public Options", of
Cluster Group X, consisted of the following members:
GROUP
28 -
LONG TERM CARE - PUBLIC OPTIONS
CHAIR -
PETER KEMPER, AHCPR ( 659) -FTE
BODE, HOLLY
Sen. Pryor (Senate Aqinq Committee)
(840)-FTE
HHS-FTE (841)
Sen. Rockefeller (CD, Vol. I, P.
352)-FTE
HHS-ASPE-FTE (842)
HHS-FTE (843)
Senate Aqinq Committee (CD, Vol. I,
P. 401)-FTE
HHS-ASPE-FTE (844)
Rep. Collins (CD, Vol. I, P. 1019)FTE
Council on Economic Advisors
OMB-FTE (844)
State of Arkansas
Veterans Affairs-FTE
DANIELS 1 SUSAN
DONESKI, ELLEN
HARAHAN, M.
HARVELL, J.
HOGUE, BONNIE
RUTH
KEENE, BRAD
KATZ,
LUCAS, DEBBIE
McCONNELL, S.
SIMPSON I BOBBIE .
SMITH, MARY B.
88
�Project HOPE-HHS SGE (1678)
OMB-FTE
Brookings Institution (Gives Phone
Humber - 797-6266) (1553) - SGE
(1679)
STONE I ROBYN
WASSERMAN, M.
WIENER, JOSH
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
782, 1553. See Tab 42 attached to this Memorandum.
Working Group 29, •Long Term Care Cluster
~roup
Private Options•, of
X, consisted of the following members:
GROUP 29 -
LONG
GROUP CHAIR DANIELS, SUSAN
DONESKI, ELLEN
GOODWIN, MARSHA
HARVELL, J.
KEENE, BRAD
LUCAS, DEBBIE
McCONNELL, S.
SMITH I MARY B·.
STONE I ROBYN
WASSERMAN M.
WIENER, JOSH
I
TERM CARE -
PRIVATE OPTIONS
PETER KEMPER ( 659)
HHS-FTE (841)
sen. Rockefeller (CD, Vol. I, P.
352)-FTE
Veterans Affairs-FTE
HHS-FTE (843)
Rep. Collins (CD, Vol. I, P. 1019)FTE
council on Economic Advisors
. OMB-FTE ( 844)
Veterans Affairs-FTE
Project HOPE-HHS-SGE (1678)
OMB-FTE
Brookings Znstitution (Gives Phone
Number 797-6266) (1553)-SGE (1679)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
783, 1554, 30045.
See Tab 43 attached to this
Memorandum.
Working Group 30, "Long Term Care - Cost and Revenue", of
Cluster Group X, consisted of the following members:
GROUP 30 -
LONG
BLOOM, FELICIA
Rep. Slaughter (CD, Vol. I, P. 647)FTE
National
Governors
Association
(30138): No Official Status
HHS-HCFA-FTE (840)
HHS-FTE
HHS-FTE (841)
Johns Hopkins University-SGE (1678)
Rational Governors Association (TX) :
Representative of Zntergovernmental
BROWN, MARY L.
BUCK, JEFF
DANIELS 1 SUSAN
ENGLISH, MIKE
FRANK, Rl:CBARD
FIUEDHOLM, DEAIDI
TERM CARE -
89
COST
AND REVENUE
�organization, Assigned to Group 8
(1787): No Official Status
National Governors Association ( sc) ;
No Official Status - Representative
of Intergovernmental Organization Assigned to Group 3 (1787)
Sen. Kennedy (CD, Vol. I, P. 395)FTE
National Governors Association ( SD) ;
No Official Status - Representative
of Intergovernmental organization,
Assigned to Group 22 (1787)
Project BOPE-SGE ( 1679)
Rational Governors Association; No
Official Status; Representative of
Intergovernmental
Organization,
Assigned to Groups 28 and 30 (1787)
McNAMEE, NIKKI
SIMON I MARSHA
SMITH, BARBARA
STONE I
ROBYN
VOLPE, CARL
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
784, 1551, 30046, 30138. See Tab 44 attached to this
Memorandum.
Cluster Group XI, •Economic Impacts•, consisted of one (1)
Working Group, that being Working Group 31, •Economic Impacts.•
Working
Group
31,
•Economic
Impacts•,
of
CllllSter
Group
consisted of the following members:
CLUSTER XI
ECONOMIC IMPACTS
GROUP 31 -
ECONOMIC IMPACTS
GROUP LEADER -
DAVID CUTLER, OMB ( 971) -FTE
ANDERSON 1 ROBERT
BAKER, LAURENCE
OMB (695)-FTE
Princeton University ( 687, 695, 697)
(Office RUDiber and FAX Number at
Princeton) (697) - Listed as 8 SGE•
(1678)
Census Bureau (695)-FTE
Treasury (695)-FTE
CEA-FTE
BEA/Commerce (695)-FTE
Princeton University (687, 691,
694)-SGE-BBS (1678)
OMB {695)-FTE
Policy Assistant (695) White Bouse
SGE (1678)
Princeton University (687, 691,
694);
llo
Official
Status;
CAMPBELL, PAUL
DIHKELACKER, BILL
GLIED, SHERRY
KASS, DAVID
KRUEGER, ALAR
NICHOLS, LEN
PI CILLO I THERESA
REIRIIARDT I UWE
90
XI,
�Participation Not Acknowledged in
First Responses
Joint Tax Committee (CD, Vol. I, P.
) (695)-FTE
Sen. Wofford (CD, Vol. I, P. 1115)
(695)-FTE
HHS (696)-FTE
HHS (696)-FTE
HHS-HCFA (696)-FTE
Sen. Dingell (CD, Vol. I, P. 710)
(696)-FTE
SHEINER, LOUISE
SOLOMON, DAN
TAYLOR, AMY
THORPE, KEN
WALDO, DAN
WOO, MICHAEL
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
687-698, 785, 1555.
See Tab 45 attached to this
Memorandum.
Cluster Group XII, •Quantitative Analysis•, consisted of one
(1) Working Group,
Analysis•.
that being Working Group 32, •Quantitative
Working Group 32, •Quantitative Analysis•, of Cluster
Group XII, consisted of the following members:
CLUSTER XII -
QUAIITITATIVE ANALYSIS
GROUP 32 -
QUAIITITATIVE ANALYSIS
CLUSTER/GROUP LEADER
ALECXIH, LISA
ANDERSON ROBERT
ARNETT I ROSS
BANTHIN, JESSICA
BURNER I SALLY
I
CALAHAN, CATBI
COHEN, JOEL
CUTLER I DAVID
FRANK, RICHARD
FREELAND I MARK
HOLAHAN, JOHN
HOLTZBLATT I JANET
HUNTER I GILLIAN
ILLSTON, LAURA
KASS, DAVID
KEN THORPE, HHS-FTE (971)
Lewin (1335): No Official Status
Given
OMB (699)-FTE
HHS-HCFA (699)-FTE
HHS-ACHPR (699)-FTE
HHS-HCFA (699)-FTE
Actuarial Research Corporation ( 699)
- Consultant (First Responses)
HHS-AHCPR (699)-FTE
council on Economic Advisors (699)FTE
Johns Hopkins University ( 1334) CSIII
(699) - SGE BBS NIMH (1678)
HHS-HCFA (699)-FTE
Urban Institute (1333): No Official
status Given
Treasury (699)-FTE
Treasury (699)-FTE
Lewin (1335): Ro Official status
Given
SEA/Commerce (699)-FTE
91
�KEHHELL I DAVID
KING, ROLAND
LONG I STEPHEH
KRUEGER,
ALAR
MAXFIELD I MYLES
McKUSICK, DAVID
NELSON, CHUCK
NICHOLS, LEN
SHELDON, GEORGE
SHEINER, LOUISE
Lewin ( 1335) : No Official Status
Given
HHS-HCFA (699)-FTE
Rand Corporation ( 1333) : No Official
Status Given
Princeton
University
(702)-SGE
(1678): Consultant (First Responses)
Matbmatical Policy Research (1333);
No Official status Given
Actuarial
Research
Corporation
(699); No Official Status;
No
Participation Acknowledged (First
Responses)
Census {699)-FTE
OMB {699)-FTE
Veterans Affairs-FTE
Joint Taxation Committee (CD, Vol.
I, P.
)
HHS-AHCPR (699)-FTE
Census {699)-FTE
HHS-FTE
Actuarial Research Corporation ( 699)
TRAPHELL, GORDON
- Consultant (First Responses)
VISTRIES, JESSICA
HHS-AHCPR {699)-FTE
WALDO, DAN
HHS-HCFA {699)-FTE
WASSERMAN I MARK
.. OMB
WIENER, JOSH
Brookings (1335) - SGE (1679
ZEDLEWSia:, SHEILA
Urban Institute; No Official Status
Given (1333)
SHORT, PAMELA F.
TAUBER, CYHTHIA
THORPE, KEN
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
699-7031 7131 7141 7861 1333-13371 15561 15571 16331
30047. See Tab 46 attached to this Memorandum.
Cluster Group XIII,
•Legal Audit•,
Working Group, that being Working Group
Group
33,
33,
consisted of one
•Legal Audit•.
( 1)
Working
•Legal Audit•, of Cluster Group XIII, consisted of the
following members:
CLUSTER XIII -
LEGAL
AUDIT
GROUP 33 -
LEGAL
AUDIT
ANTHONY,
BARBARA
BARNES, MARK
BIDDLE I BARBARA .
Office of the Massachusetts Attorney
General; No Official Status
NYC Department of
Health;
No
Official Status
DOJ-Civil (30149)-FTE
92
�BRIFFAULT, RICHRAD
GOLDMAN, ED
GRAETZ I MICHAEL
HOLDER, ANGELA
McGAREY, BARBARA
MEYER, KATHRYN
HILLOCK, PETER
RYAH, BETSY
SCHULTZ I MARJORIE
SLOWES I RICK
ZELHER, BARBARA
Columbia Law School; No Official
status
University of Michigan Hospitals; No
Official Status
Yale Law School; No Official Status
Yale University School of Medicine;
No Official Status
National Institutes of Health-PTE
Beth Israel Medical Center; No
Official Status
Hew York State Department of Health;
No Official Status
Hew Jersey Department of Health; No
Official Status
Boalt Hall School of Law;
No
Official Status
Office of the Attorney General of
Minnesota; No Official Status
National .Association of Attorneys
General (30149); No Official Status
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
1558, 30149, unnumbered page, "Legal Issues". See Tab 47
attached to this Memorandum.
Cluster Group XIV,
Working Group,
•Numbers Audit•,
consisted of one
that being Working Group 34,
( 1)
•Numbers Audit•.
Working Group 34, •Numbers Audit•, of Cluster Group XIV, consisted
of the following members:
CLUSTER XIV -
HUMBERS AUDIT
GROUP 34 -
HUMBERS AUDIT
ATKINSON, HOWARD
BERT.KO, JOHN
DORAN, PHYLLIS
GREENWOOD, BRENT
HELMS, DICK
OSTUW, RICH
PORTER, KEN
RODGERS, JACK
Atkinson & Co., Inc.
Coopers & Lybrand
Millman & Robertson
Tillinghast/TCWers Perrin
The Principal Financial Group
Towers Perrin
The DuPont co.
Price Waterhouse
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
1559, unnumbered page, "Cost Issues".
See Tab 48
attached to this Memorandum.
93
�Cluster Group XV, "The Drafting Group•, consisted of one (1)
Working Group, that being Working Group 35, "The Drafting Group•.
Working Group
35,
"The Drafting Group•
of
Cluster Group XV,
consisted of the following members:
CLUSTER XV -
THE DRAFTING GROUP
GROUP 35 -
THE DRAFTING GROUP
OMB (738)
DOL (739)
?? (756)
Treasury (761)
STEVE BANDEAIAN
BETTE BRIGGS
SHIRLEY SAGAWA
MARINA WEISS
SOURCES: Declarations of Marjorie Tarmey, Documents Hos.
738-761. See Tab 49 attached to this Memorandum.
Working Group 36, "Disability Cross-cutting Work Group•, was
not part of any Cluster Group, but, rather, was free-standing.
Working
Group
36,
"Disability Cross-cutting Work
Group, n
composed of the following members:
GROUP 36 LEADER -
SIMI LITVAK,
Disability
BROWN I RICK
UCLA/Rand Corporation - SGB (1678)
Rational Rehabilitation Bospital
Research Center: Ho Official Status
Assigned
(671)-HHS-ASPE-FTE (1672)
Representative of Intergovernmental
Organization ( 1786) : Signed in as
•Texas Medicaid/Task Force• (30080):
Assigned to Group 8, Underserved
( 1786) : No Official Status Assigned
HHS-Office of Disability Policy-FTE
(842)
( 30080)
State
of
california
Department
of
Health
Services,
Chief, Children's Medical Services:
No Official status
United Cerebral Palsy (30080): No
Official status
George Washington University, Center
for Health Policy Research;
Ro
Official Status Assigned
DeJONG I GERBER
DOTY, PAMELA
FRIEDBOLM, DEAIIH
GOLD I MARTHA
GREGORY, K.
GRISS I ROBERT
JEHSEH, ALAR
94
World
Institute
on
was
�JOHNSON, DON
LITVAK, SIMI
McGRALY, KATHLEEN
O'KEEFE, JAHET
OTRIH, SUSAN'
SCHMIDT, BILL
SELTMAN, PAUL
SILVERSTEIN, BOB
STORE, ROBYN
STRABAH, MARIE
SYLVESTER, GREG
THOMAS, PETER
THOMPSON, GERI
1111ITE, STEVEN
WODATCH t JOHN
HHS-HCFA-FTE (843)
World Institute on Disability - SGE
(First Responses); Hot Listed as SGE
on 1678-1679
(30080) The Association of Retarded
Citizens; Ho Official Status
American Psychological Association,
Assistant
Director
for
Public
Interest Policy; Ho Official Status
Assigned
no-Policy Assistant
Columbia
University (732) (30174)
( 30080)
Epilepsy
Foundation
of
America; Ho Official Status
House Education & Labor committee
(CD, Vol. I, P. 1106)
u.s.
senate
Subcommittee
on
Disability
Project HOPE (671)
ADD/Protection & Advocacy (30080);
Ho Official Status
u.s.
senate,
Subcommittee
on
Disability
Amputee
COalition
of
America
(30080); Ro Official status
Rational
Chronic
Care
consortium/Beth
Israel
Hospital
(3008); Ro Official Status
American
Speech-Language-Bearing
Association (30080); Ro Official
Status
Department of Justice, Civil Rights
Division
FTEs:
ASH, SHERR!
BROWN, RICK
CLAUSER, STEVE
DAHIELS, SUSAN
DOTY, PAMELA
HARAHAN, MARY
KATZ, RUTH
MANDERSCHEID, RON
PARADISE, JULIA
REINECKE, PETER
HHS-ACF
UCLA
HHS-HCFA
HHS-ACF
HHS-ASPE
HHS-ASPE
HHS-ASPE
HHS-PHS
HHS-ASPE
Sen. Harkin (CD, Vol. I, P. 396)
SIGH-IR LIST (URDATBD) :
BILLY WEBSTER
Chief
of
Education
95
Staff,
Department
of
�ELAINE HOLLAND
ANITA BICKSTELL
WILLIAM MODZOLESKI
AARON SHIRLEY
DEBORAH LEVINE
CONNIE GARAU
GAIL HOULE
JUDITH KATZ-LEAVY
CAROLYN BAHDY
SHEILA PIRES
PAT ROSENMAN
SHIRLEY JACKSON
CHARLOTTE BEASON
SUSAN OTIUH
JULIA TILLMAN
CHERYL AUSTEIN
SUSAN DANIELS
SHERRI ASH
MARGERY GEHAH
RUTH SHINN
LARRY SOBEL
CARRIE BILLY
BLANCA RODRIGUEZ
FRANK CORRIGAN
JON WADE
KIMMON RICHARDS
VAL KISKO
Department
of
Education,
Intergovernmental Office
Department of Education
Department of Education
Jackson-Hinds Comprehensive Health
Center
WHO-Policy Assistant - Unemployed
(732) - SGE (1678)
Department of Education, Office of
Special Education and Rehabilitation
Department of Education, Office of
special Education and Rehabilitation
co-Chair,. Child
Mental
Health
workgroup - HHS, Center for Mental
Health Services
CEO, Blacks Educate Blacks About
sexual Health Issues (Cluster III,
Hew system Infrastructure, Group 12,
Health care Workforce)
Human Service Collaborative; coChair, Mental Health and Substance
Abuse Work Groups
HHS (Substance Abuse Work Group)
Department of Education
HHS-Cluster
III,
New
System
Infrastructure, Group 12, Health
Care Workforce)
Health Care Policy Analyst - SGE
(First
Responses);
Columbia
University (732); Hot Listed 16781679; Assistant to Cluster X, Long
Term Care
HHS/PHS
HHS/PHS
HHS - LTC Work Group
HHS - LTC Work Group
WHO - Health care Policy Assistant
to Clusters rv (Integration of
Government Health Programs Into Hew
System) , V (Ethical Foundations of
the Hew System) , and VII (Financing)
Department of Labor, Women's Bureau
Department of Defense
Sen. Bingaman (CD, Vol. I, P. 271)FTE
White House on Education Excellence
for Hispanic Americans
Department of Education
Department of Education
Department of Education
Department of Education
96
�SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
671, 717-718, 1068, 30128, 30141, 30048, 30051, 30174,
30175. See Tab 50 attached to this Memorandum.
Working Group 37, "Rural Cross-cutting Group", was not part of
any Cluster Group, but, rather was free-standing.
Working Group
37, "Rural Cross-cutting Group", was composed of the following
members:
GROUP 37 -
RURAL CROSS-CUTTING GROUP
ADLER, MICHELE
ALBERGHINI, THERESA
ALLEN I LUCY
ARCADOZ, RICHARD
BOEHM, JENNIFER
COHEN, RIMA
CLAY, JIMMY
DEHTOH, DENISE
EVANS I JENNIFER
FALETTI I TOM
FRANTZ, MOLLY
KEPNER 1 COLLEEN
MANDERSCHEID, RON
MANTEL I LEWIS
KILLER, CAROL
MINTZER I CAROL
MURGUIA I JANET
O'BIUEN I MARY JO
PUSKIN I DENA
QUAil, LOIS
REINECKE I PETER
HHS/ASPE-FTE (840)
Sen. Leahy (CD, Vol. I, P. 327)
CEA-FTE ( 840)
1D1S (709): Ho Official Status Given
Rep. Long (CO, Vol. I, P. 581)
Sen. Oaschle (CO, Vol. I, P. 942)
Veterans Affairs-FTE (841)
Colorado
Rural
Health
Resource
Center-SGE (First Responses) : Hot
Listed 1678-1679
Sen. Campbell (CD, Vol. I, P. 282)FTE
Sen. Durbin (CO, Vol. I, P. 969)-FTE
Rep. Pomeroy (CD, Vol. I, P. 705)FTE
Rep. Stenholm (CD, Vol. I, P. 768)FTE
HHS-CMHS-FTE (844)
Veterans Affairs-FTE (844)
Mountain
Management
co. ,
:tDI
(Handwritten Rote, •o•, BBS Phone
Humber
Given)
( 709) -SGE
(First
Responses, Hot Listed 1678-1679)
Public Health Service (Not Listed as
a Public Employee)
Rep. Slattery (CD, Vol. I, P. 741)FTE
Rational
Governors
Association
( 709) : SGE (First Responses, Hot
Listed on 1678-1679)
PHS-FTE (847)
Handwritten Rote •u. IIH• (709), VP,
United
Health
Care
Corp.,
Minneapolis:
SGE
(1678,
First
Responses)
Sen. Harkin (CO, Vol. I, P. 396)-FTE
97
�RICHARDSON, SALLY
West Virginia Health Care Planning
Commission: SGE (First Responses,
Not Listed 1678-1679)
Iowa Department of Public Health SCHADLE I JANE
Consultant (First Responses)
Jackson-Hinds Comprehensive Health
SHIRLEY I AARON
Center: SGE (1678)
National
Governors
Association
SMITH I BARBARA
(1787): No Official Status ·
Veterans Affairs-FTE
STEELE, PAMELA
Rep. Obey (CD, Vol. I, P. 1122)-FTE
SYKES I KATHLEEN
Sen. Baucus (CD, Vol. I, P. 268)-FTE
TESTORI, MAUREEN
National Association of Counties
UYEDA, MARY
(1787): No Official Status Given
WILLIAMS 1 CHRISTINE Sen. Mitchell (CD, Vol. I, P. 338)FTE
HHS-FTE (848)
WOODWARD 1 ALBERT
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
709-712, 1634, 1635.
See Tab 51 attached to this
Memorandum.
Working Group 38, •Benefits Coordination•, was no.t part of any
Cluster Group, but, rather, was free-standing.
Working Group 38,
•Benefits Coordination•, was composed of the following members:
GROUP 38 -
BENEFITS COORDINATION
BROWN, RICK
LUKOMNIK 1 JOANHB
LEFKOWITZ, BONNIE
GATZ I CAROLYN
PUSKIN, DEENA
SOFAER 1 SHOSHANA
RICHARDSON I SALLY
IIAROWITZ I JIICJmJ.T.E
BERGTHOLD I LIRDA
UCLA SChool of Public Health
(Group 22) Practicing Physician from
Hew York City: SGB (1678)
(Group 22) HHS, Bureau of Primary
Health Care
Louisville - Commerce - Louisville
Mayor's Office
(First Responses
Dnly): Ro Official Status Assigned.
Bote That She Was Hired by Commerce 1
Ellployed in White Bouse
(Group 2) HRSA (Earlier, PROPAC)
(Group
8)
George
Washington
University
Medical
Center:
SGE
(1678)
(Groups 2 & 22) West Virginia
Department
of
Health
Public
Ellployees Insurance commission: SGE
(First Responses) : Rot Listed in
1678-1679
The Johns Hopkins University (732)
(Group 6) Wm. Mercer (SF)-SGE (1678)
98
�VALDEZ, BOB
SMITH, MARK
JOHNSON, DON
FISKE, MARY BETH
RICE, CHERI
(Group 6) UCLA School of Public
Health; SGE (1679)
(Group 22) Vice President, Kaiser
Family Foundation; SGE (1678)
(Group 8) HCFA - Medicaid DivisionFTE
{Groups 6 & 8) Labor Committee
(Previous: HCFA)-FTE
(Group 8) OMB-FTE
SOURCES: Declarations of Marjorie Tarmey, Document No.
30129, "Sign-in Sheet".
See Tab 52 attached to this
Memorandum.
Working Group 39, "Minority Issues Review Group", was not part
of any Cluster Group, but, rather, was free-standing.
Group 39,
Working
"Minority Issues Review Group" was composed of the
following members:
MINORITY ISSUES REVIEW GROUP
JAMES
ACEVEDO
JESSE BARBER
PIULLIP BROOKS
RICHARD BUTCHER
MICHAEL BYRD
PAMELA CASHEW
LDmA CLAYTOR
ROSEMARY DAVIS
SUSAR DRAKE
Assistant
Director,
American
HealthCare Management, Huntington
Park, CA
Rational Medical Association, Chair
of Council Medical Legislation,
Washington, DC
Rational Black Hospital Association,
President,
Norfolk
Community
Hospital, Norfolk, VA
President,
Rational
Medical
Association, El cajon, CA
Research
Fellow,
Department
of
Health Policy & Management, Harvard
School of PUblic Health, Boston, MA
Assistant Adlllinistrator, Riverside
General Hospital, Houston, TX
Research
Fellow,
Department
of
Health Policy & Management, Harvard
School of PUblic Health, Boston, MA
Rational
Medical
Association,
Washington, DC
Senior
Attorney,
Rational
IDIIIigration Law center, Los Angeles,
CA
ADOLPH FALCON
Rational
Coalition
of
Hispanic
Health
&
Human
Services
organizations, Washington, DC
99
.... _ _ _ _ _ _ _ ___.
�MARIA ELENA FLOOD
HECTOR FLORES
JOYCE ESSIEH
LUIS ESTEVEZ
TlltJRMAN EVANS
ERNEST GIBSON III
TESSIE GUILLERMO
HAZEL HARPER
JOSEPH HENRY
ARNE Hl:LL
SADAKO HOLMES
CHARLES KAMAS.Aia
ELIZABETH KING
DAPIIHE JOHN
Program Director, Health Sciences
Center, Texas Tech, El Paso, TX
Co-Director,
Family
Practice
Residency Program, White Memorial
Medical Center, Los Angeles, CA
Director, Office of Public Health
Practice, School of Public Health,
Emory University, Atlanta, GA
Medical
Director,
Segundo
Ruiz
Belvis, Neighborhood Family care
Center, Bronx, NY
President
&
CEO,
WholeLife
Associates, Elkins Park, PA
Administrator/CEO,RiversideGeneral
Hospital, Houston, TX
Bxecutive Director, Asian American
Health Forum, san Francisco, CA
National
Dental
Association,
Washington, DC
Associate Dean, Harvard School of
Dental Medicine, Boston, MA
National Urban League, New York, NY
Bxecutive Director, National Black
Nurses'
Association,
Inc.,
Washington, DC
National
Council
of
La
Raza,
washington, DC
Medical Director, Queens Village
CoJIIJilUDity for Mental Health, · st.
Albany, NY
Riverside General Hospital, Houston,
TX
B. WAINE KONG
OSVALDO LOPEZ
RANDALL MAXEY
RAMONA McCARTHY
LAURIN MAYENO
TERRI SMITH MOORE
VERNELLIA RANDALL
ELENA RIOS
Bxecutive Director, The Association
of Black cardiologists I Miami I FL
Chairman, Department of Opthomology,
Chicago, IL
President,
CEO,
HealthQuest,
Hawthorne, CA
President, National Pharmaceutical
Association, Silver Spring, MD
Association
of
Asian
Pacific
Community
Health
Organizations,
oakland, CA
National Pharmaceutical Association,
Washington, DC
Assistant Professor of Law, School
of Law,
University of Dayton,
Dayton, OR
President,
The
Chicana/Latino
Medical Association of california,
Huntington Park, CA
100
�RENE RODRIGUEZ
President, Interamerican College of
Physicians and Surgeons, Washington,
DIANE SANCHEZ
FRANK SESSOMS
WES SHOLES
Women's Medical Arts, Milpitas, CA
Pittsburgh, PA
National Association of Black County
Officials, Rancho Palos Verdes, CA
caucus and Center on Black Aged,
Washington, DC
Department of Health Services, San
Diego, CA
National Association of Hispanic
Nurses, College of Nursing - USF,
Tampa, FL
Family Practice Center, Memorial
Medical Center, Corpus Christi, TX
Administrator
&
CEO,
Southwest
Bospital & Medical Center, Atlanta,
DC
SAMUEL SIMMONS
PAUL
SIMMS
SARA TORRES
DAVID VALDEZ
HERBERT WELDON
GA
.
SOURCES:
Declarations of Marjorie Tarmey, "Minority
Issues Review Group", unnumbered. See Tab 53 attached to
this Memorandum.
Working Group 40, •Academic Health centers•, was not part of
any Cluster Group, but, rather, was free-standing.
40,
•Academic Health Centers•,
Working Group
was composed of the
following
members:
GROUP 40
ACADEMIC HEALTH CENTERS
GROUP 40 LEADER -
ELIZABETH SHORT, Veterans AffairsFTE (846)
ALTMAN, DAVID
BERENSON, BOB
CLARK, Wl:LLIAM
DAtJMIT, GAIL
Wood
Johnson
Fellow,
Sponsored by UCSF center for Health
Professionals
(704):
in
Sen.
Rockefeller's Office [See Tab 56
Attached to this MemorandlDl] (Also
on Group 12)
National capital Preferred Provider
organization (704) (Also on Groups 11
and 1A)
Robert
Wood
Johnson
Fellow,
Sponsored by University of Florida:
in sen. Bumpers Office (708) [See Tab
56 Attached to this MemorandlDl]
llhite Bouse ( 704) : Also on Groups 15:
Blllory
University School of
Robert
101
�DAVIES, MONICA
EDDY, DAVID
EMANUEL I EZEKIAL
EPSTEIN I ARNOLD
CAROLYN
BANDY I
HORVATH TOM
LASKER, ROZ
MEYERS I
GREGG
MIN, NANCY
MULLAN, FITZHUGH
NEXON, DAVID
PAUL,
KAREN
PYLE I
'l'HOKAS
REDLEHER, IRWIN
SAGE I WILLIAM
STEELE I PAMELA
STOLID I ANRE
Medicine, Medical Student (734);
Internal Medicine MGH Intern 6/93
(30049)
Massachusetts
General
Hospital
Legislative
Fellow
in
Sen.
Bingaman's Office (708); Not in
Directory-FTE (841)
Senior
Policy
Advisor,
Kaiser
Permanente; Duke University Medical
School Professor (708)-SGE (1678)
Harvard
Medical
School
(704)
( 30049) ; Also on Cluster V, Group
17; Dana Farber cancer Institute
(1587)-SGE (First Responses)
Robert
Wood
Johnson
Fellow,
Sponsored by Harvard Medical School
&
Brigham & Women's Bospital;
Serving Sen. Kennedy on Senate Labor
Committee ( 704) [See 'l'ab 56 attached
to this Memorandum]
CEO, Blacks Educate Blacks on Sexual
Health Issues (704) (Also on Groups
8 ' 12)
Veterans Affairs (704)-FTE
Physician Payment Review Commission
(704); SGE (1678)
Massachusetts
General
Hospital
Fellow,
Senate Labor
& Human
Resources Committee (Sen. Kennedy)
and
SGE,
According
to
First
Responses: Rot Listed 1678-1679
OMB
BHS (704) (Also on Group 12)-FTE
Sen. Labor (CD, Vol. I, P. 395)
(Also on Groups 1-5)
White Bouse (704) (Also on Groups 15) Cornell Medical School ( 30049)
Harvard
COIIIIU!lity Health Plan;
Boston consulting Group
( 704) :
consultant (First Responses) : SGE
(1678)
"BPRG"
( 704) :
Pediatrician,
Montefiore Hospital (See Health
Professions! Review Group, 'l'ab ) ;
Signs in as •Liaison to Health
Professions! Review Group•) ( 30049) ;
Ro Official status
White Bouse (704); Stanford, Hopkins
(30049); SGE (1678)
OMB (Also on Group 22)-FTE
Volunteer; Psychiatrist (704) (Also
on Groups 23 and 26) (Graduate of
102
�Johns Hopkins Medical School, 1992)
(30049)
Dean, University of Texas Medical
School (704); SGE (1679)
University Hospitals of Cleveland
(704)
(Also on Groups 1, 20);
Consultant, First Responses.
SUMAYA, CIRO
WALTERS I FARAH
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
704, 705, 707, 708, 1242, 1243, 1244, 706, 1587, 30048,
30050. See Tab 54 attached to this Memorandum.
Working Group 41, •workers' Compensation Task Force•, was not
part of any Cluster Group, but, rather, was free-standing.
Working
Group 41, •workers' Compensation Task Force•, was composed of the
following members:
GROUP 41 -
WORKERS 1 COMPENSATION TASK FORCE ( 30090)
GROUP 41 LEADER -
GARY CLAXTON, National Association
of Insurance Commissioners ( 1345) ;
SGE (1678)
BAKER,
LAWRENCE
BATEKAH I KEITH
BORZI, PHYLLIS
BRODBECK, L.
BURTON I JOHN
CLAX'l'ON I GARY
CLAY'l'ON I
ANN
DUGGAN I JAMES
ELLENBERGER, J.
GRANNEMANN, T.
Princeton University; Ro Official
Status (30133)
Alliance
of
American
Insurers
(1344); No Official Status
House
Subcommittee
on
Labor/Management Relations-PTE ( 841)
Rep. McCurdy (CD, Vol. I, P. 589)FTE
Editor,
John Burton's Workers 1
Compensation Monitor ( 1285) , Rutgers
University;
No Official Status
(1270 1 1271, 1344) (NOTE: on 1285 1
in
Typewritten
COJIIIIlent
Below
Burton's Name, it says 1 "Kreuger
Indicated
That
Burton
can
Participate.•
Does This Convey
Leadership Status on Kreuqer??)
National Association of Insurance
Commissioners (1345); SGE (1678)
Florida Insurance Commission ( 1285) ;
No Official status
Treasury-PTE (842)
AFL-ciO; No Official Status
Workers'
Compensation
Researcch
Institute
(30133);
No Official
Status
103
�GREENWOOD, JUDITH
HAUGH, KEVIN
KREUGER, ALAN
LEVITT LARRY
LLEWELLYN, BARRY
MEANS I KATHLEEN
MOLLOY I JANE
NELSON I WILLIAM
NOTB, DAVID
PAYNE I MARY ELLA
SISKIND, FRED
'l'BORHQUIST, LISA
VICTOR, RICHARD
WEEKS, GARY
WERNER, MICHAEL
Workers' Compensation Fund, West
Virginia; No Official Status (1344)
Institute
for
Health
Policy
Solutions; No Official Status
Princeton University - Consultant
(First Responses); SGE (1678)
(1272)
Staff
of
California
Department
of
Insurance,
Commissioner's Health Care Advisory
Commission; SGE (1678)
National Council on Compensation
Insurance (1344); No Official Status
HHS-HCFA-FTE
Treasury-FTE
SSA-Office of Research & Statistics
(1270); Not Listed as FTE, 840-849
Johnson
&
Higgins
( 1344) ;
No
Official Status
Sen. Rockefeller (CD, Vol. I, P.
352)-FTE
Department of Labor-FTE
Minnesota
Workers'
Compensation
Research (1270): Ho Official Status
Workers'
Compensation
Research
Institute (1344); No Official Status
_
oreqon J:nsurance Commission ( 1270) ;
Ho Official Status
Sen. Democratic Policy Committee
(CD, Vol. I, P. 403)-FTE
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
1270-1276, 1285, 1344, 1345, 30069, 30085, 30090, 30115,
30132, 30133. See Tab 55 attached to this Memorandum.
E.
PERSONNEL WITHIN THE UHITED STATES DEPARTMENT OF HEALTH AND
HUMAN SERVICES WITH DIBECT TIES TO THE HEMBY J. KAISWER FAMILY
FOUNDATION AND THE ROBERT WOOD JOUNSON FQUNPATION
According to the 1992 Annual Report of the Henry J. Kaiser
Family Foundation, Philip R. Lee, M.D., and Bruce c. Vladeck,
Ph.D., were Trustees of the Henry J. Kaiser Family Foundation.
See, Declaration of Genevieve H. Young, Exh. 10, 1992 Annual Report
of the Henry J. Kaiser Family Foundation.
Philip R. Lee, M.D., had
a role in the Interdepartmental Working Group and its Cluster
Groups, Working Groups, and Subgroups, while he was still serving
104
�as
a
Trustee of Kaiser
in
San Francisco,
California.
(See,
Declaration of Marjorie Tarmey, Document No. 1100, which indicates
he is to serve "Full-time, with compensation, Different Budget" on
the Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.)
Philip R. Lee, M.D., was subsequently
appointed to Assistant Secretary of the United States Department of
Health and Human Services below Secretary Donna Shalala.
Bruce
c.
Vladeck, Ph.D., was appointed as the Administrator of the Health
Care Financing Administration (a division of the United States
Department of Health and Human Services), one of the regulatory
agencies that will implement health reform and which is currently
charged with the administration of Medicare and Medicaid.
Id.
In 1992, the Defendant, Judith Feder, Ph.D., now the Clinton
Administration's Assistant Secretary for Planning and Evaluation at
the
Department of
Health
and
Human
Services,
was
a
Senior
Investigator for the Robert Wood Johnson Foundation's Health Care
Financing Organization ("HCFO") Project at Georgetown University,
a $623,482 project to study "Efficiency/Quality/OUtcome Trade-Offs
in Medicare's Prospective Payment system".
See, Declaration of
Genevieve H. Young, Exh. 11, "Call for Proposals, Changes in Health
Care Financing and organization 1993", RWJF.
Ph.D.,
an Urban
Stephen Zuckerman,
Institute economist who also served on the
Interdepartmental Working Group and its Cluster Groups, Working
Groups
and
Subgroups,
(see,
Declaration of Marjorie
Tarmey,
Document No. 875), was also a Senior Investigator for the HCFO
Project. Ken Thorpe, ·ph.D., who was the Principal Investigator for
105
....
�the University of North Carolina,
Managed Care Work?
Chapel Hill Project,
"Does
An Empirical Study of Corporate Health Care
Cost Containment Initiatives, 11 and "Evaluation of State Risk Pools:
The Current and Potential Experience", which were financed to the
tune of $428,442 and $405,633, respectively, by the HCFO Program,
became the Deputy Assistant Secretary for Planning and Evaluation
under the Defendant,
Judith Feder.
Id.
Other HCFO Program
Investigators who were members of the Interdepartmental Working
Group and its Cluster Groups, Working Groups and Subgroups include:
*
E. Richard Brown. Ph.D. , from the University of
California Los Angeles School of Public Health, a
key player in Cluster II,
New System Coverage
(Designing Benefits Packages) • See, Declarations o:f
Marjorie Tarmey, Documents Nos. 773, 775, 864).
*
Stephen Lona, RAND Corporation (see Document No.
875 produced by Defendants) served on Cluster VI,
Cost Containment (Declarations o:f Marjorie Tarmey,
Document No. 875) and Cluster XII, Working Group
32, Quantitative Analysis (Declarations o:f Marjorie
Tarmey, Document No. 1333).
*
John Holahan. Ph.D., and Sheila Zedlewski. Pb.D.,
of the Urban Institute,
Working
Group
Declarations
32,
o:f
served on Cluster XII,
Quantitative
Marjorie
1333).
106
Tarmey,
Analysis
Document
(see,
No.
�*
Arnold Epstein. M.D.,
of the Harvard University
School of Medicine, served as the Leader of Cluster
III, New system Infrastructure, Group 9, Quality
Measurement (see, Declarations of Marjorie Tarmey,
Document
No.
Academic
Health
233),
and
Centers
on
Working
(see,
Group
Declarations
40,
of
Marjorie Tarmey, Document No. 704), in his capacity
as a Robert Wood Johnson Fellow for the Office of
· Senator Kennedy. 10
The
Defendant,
Judith
Feder,
chaired
the
Clinton
Administration's Health Policy Transition Team (see, Declarations
of Marjorie Tarmey,
Document No. 1099).
Other members of the
Clinton Administration Health Policy Transition Team were the
following persons:
*
Atul Gawande. Ph.D., now Senior Policy Advisor to
Judith Feder at the Department of Health and Human
Services
(see, Declarations of Marjorie Tarmey,
Document No. 1099).
*
Dayid Satcher . M.D. ,
President, Meharry Medical
College, Nashville, Tennessee, now Chief, Center
~he
Robert Wood Johnson Fellows who served on the
Interdepartmental Working Group are discussed in depth, infra. It
must be noted, however, that the Defendants overtly mislead the
Plaintiffs in their initial responses to discovery requests by
classifying numerous persons as being members of Congressional
staffs (implying they were full-time federal government employees)
when they were, in fact, RWJF Fellows being paid with RWJF money.
The only hint the'Defendants gave of this fact was their listing of
Keith Powell on the "Benefits Package" subgroup as being assigned
from "Senate Labor & ·Human Resources Committee (Fellow)".
1
107
�for Disease Control (see, Declarations of Marjorie
Tarmey, Document No. 1096).
*
Ken Thorpe. Ph.D.
(see, Declarations of Marjorie
Tarmey, Document No. 1102).
*
Judy Whang,
Public
MPH,
Health
Tarmey,
Columbia
(see,
Document
University
Declarations
No.
School
of
Marjorie
now
1103),
of
at
the
Administration on Aging, HHS.
*
Robert Berenson. M.D. , co-founder, National Capital
Preferred Provider·organization (see, Declarations
of Marjorie Tarmey, Document No. 1098).
*
tynn Etheredge, self-employed consultant, formerly
at Office of
Managed
Management
Competition
and Budget,
(Declarations
expert
of
on
Marjorie
Tarmey, Document No. 1095).
*
Thomas Chapman.
Care
System
MPH·
CEO, Greater Southeast Health
(Declaration
of
Marjorie
Tarmey,
Document #1088 produced by Defendants). 11
Tho:mas Chapman was also the Program Director of a program
entitled "Opening Doors: A Program to Reduce Sociocultural Barriers
to Health Care", a joint program of the Robert Wood Johnson
Foundation and the Henry J. Kaiser Family Foundation. Declaration
of Genevieve M. Young, Exh. 12, "Call for Proposals: Opening
Doors", at 5. Mark Smith, another member of the Interdepartmental
Working Group, was one of the coordinating staff for the program at
the Henry J. Kaiser Family Foundation. Id. The program brochure
describes the purpose of the program as follows:
11
Opening Doors: A Program to Reduce Sociocultural Barriers
to Health care, is a new national program of the Robert
Wood Johnson Foundation and the Henry J. Kaiser Family
Foundation that will provide grants for demonstration and
research projects to improve access to maternal, child,
108
...
�F.
ROBERT WOOD JOHNSON FOQNDATION HEALTH POLICY FELLOWS WHO
SERVED ON THE INTERDEPARTMENTAL WORKING GROUP AND ITS CLUSTER
GROUPS. WORKING GROUPS AND SUBGROUPS THEREOF
There
several
were
Interdepartmental
Group
Working
participants who were Robert Wood Johnson Foundation Health Policy
Fellows serving in various offices of Democratic Congressional
representatives.
Declaration of Genevieve M. Young, Exh. 3.
In
what has now become typical misleading fashion of the Defendants,
they were all, with the exception of Arnold Epstein, classified as
"full-time government employees" by the Defendants.
Arnold Epstein,
of
all
Curiously,
the RWJF Fellows who served on the
Interdepartmental Working Group, was classified as an "SGE", while
the others were classified as "full-time employees".
Personal
summaries on the Working Group activities of the Robert Wood
Johnson Foundation Fellows who served on the Interdepartmental
Working Group are attached in Tab 56 to this Memorandum.u
Opening .Doors: A Program to Reduce Sociocultural Barriers
to Health Care, is a new national program of the Robert
Wood Johnson Foundation and the Henry J. Kaiser Family
Foundation that will provide grants for demonstration and
research projects to improve access to maternal, child,
and reproductive health services.
We expect this
initiative to proyide useful information to policymakers,
providers, and community groups about overcoming
sociocultural barriers. (Emphasis added.)
Declaration of Genevieve H. Young, Exh. 12, "Call for Proposals:
Opening Doors", at 2.
12
All of the personal summaries on participants in the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups thereof are based upon the documents produced
by the Defendants to date as their Answers to Interrogatories and
Responses to the Second Request for Production of Documents. In
each of these summaries, the references are as follows:
109
�refers to earnings and leave
statements from the United states Department of Health and Human
Services.
DHHS Earnings and Leave Statement
refers to Public Financial Disclosure Forms, if any, that
were or were not filled out by members of the Interdepartmental
Working Group and its Cluster Groups, Working Groups and Subgroups
thereof.
SF 278
refers to Confidential Financial Disclosure Forms, if any,
that were or were not filled out by members of the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups thereof.
SF 450
refers to travel vouchers showing reimbursement
given to members of the Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups thereof. According to
the previous statements of the Defendants, "SGEs" were allowed
reimbursement for one round-trip between Washington, D.c. and their
hometown, and "consultants" were typically reimbursed for their
travel on a per diem basis.
Travel Vouchers
# WAVl92BS refers to the records of entry into the Old
Executive Office Building for the period February 14, 1993 through
May 21, 1993 showing the names of individuals placed on the health
care "access list".
Persons. were permitted entry into the Old
Executive Office Building on the dates and times indicated without
pre-appointment, but would obtain an appointment pass from the
Secret Service when they checked in at the Old Executive Office
Building. These records basically show only the minimum nlDiber of
entries into the Old Executive Office Building because of the time
period to which it is restricted, which is shorter than the time
period during which the Working Group, according to Defendants,
allegedly came into existence and expired, January 21, 1993 through
May 31, 1993.
Another reason for this document not being
exhaustive is because of the Defendants' own assertion that the
list was "frequently revised" either because these persons were no
longer participating on the Working Group or because they had
obtained a "picture pass" that enabled them to enter without
obtaining an appointment pass from the Secret Service. Defendants'
Fourth Supplemental Responses, at 2.
Report
# WAVl99BS refers to the records of entry into the Old
Executive Office Building for the period January 25, 1993 through
May 31, 1993. Persons were permitted entry into the Old Executive
Office Building on an appointment basis, or who possessed a picture
pass, but did not have it with them upon entry. According to the
Defendants, this list is incomplete because if a participant's name
was misspelled when entered into the computer, the persons's name
may not have been recorded on this record.
Defendants' Fourth
Record
110
�The
December,
August,
1992
1993
Robert
Wood
Johnson
Foundation Health Policy Fellows (obtained from Brochure, "RWJF
Health Policy Fellowships, 1974-1993 11 , Declaration of Genevieve M.
Young, Exh. 3) who served on the Interdepartmental Working Groups,
and
its Cluster Groups,
Working Groups,
and Subgroups,
with
relevant information on each person, are as follows:
David F. Altman, M.D.
Center for the Health Professions
University of California, San Francisco
School of Medicine
Office of senator John D. Rockefeller, IV, D-WVA
Dr.
Altman was sponsored by the University of California
School of Medicine, which received $55,780 from the Robert Wood
Johnson Foundation.
0
Declaration of Genevieve H. Young, Exh. 4,
1992 RWJF Annual Report"
(ID No. 4888).
Dr. Altman served on
Cluster II, "New System Coverage", Group 8," Coverage for LowIncome and Non-Working Families" (Declarations of Marjorie Tarmey,
Document
No.
197) 1
served
on
Cluster
III,
"New
System
Infrastructure", Group 12, "Facilitating Professional Development"
(Declarations of Marjorie Tarmey, Document No. 206), and also
Supplemental Responses, at 3.
Record # WAV 194BS refers to the record of Working Group
participants who were provided picture passes. Redactions to this
list included the names of individuals whose picture passes expired
prior to January 25, 1993, and those who had the same name as a
working group participant, whatever that means. Defendants' Fourth
Supplemental Responses, at 6.
Administrative Time and Leave Records refers to the administrative
time and leave records, if any, for a smattering of "SGEs"
recruited by the Department of Health and Human Services, all of
which appear to be completed by the same person.
111
�served on Group 40, "Academic Health Centers" (Declarations of
Marjorie Tarmey,
Document No. 704).
Dr. Altman entered the Old
Executive Office Building at least 17 times between February 19,
1993 and April 22, 1993.
No
earninqs and leave statements,
DHHS
travel vouchers, or conflict of interest forms were produced by
Defendants reqardinq Dr. Altman.
It should be noted that the
Robert Wood Johnson Foundation gave the following sums to the
University of California,
San Francisco,
School of Medicine,
according to the 1992 Annual Report of the Robert Wood Johnson
Foundation:
*
$152,500 to the University of
California,
San
Francisco, School of Medicine for a proqram to
provide two-year biomedical postdoctoral research
fellowships
(Declaration
of Genevieve M.
Young,
Exh. 4, 1992 RWJF ·Annual Report, ID No. 7854, at
33).
*
$3,899,833 to the University of California, san
Francisco,
School
of
Medicine
for
a
44-month
proqram to stimulate academic health centers to
become more responsive to the health needs or
populations
Genevieve
and
M.
communities
Young,
Exh.
4,
(Declaration
1992
RWJF
of
Annual
Report, ID No. 20933, at 39).
*
$654,266 to the University of California, School of
Medicine, for postdoctoral fellowships for young
physicians- to
develop
112
research
skills
on
new
�biological disciplines relevant to medical care
(Declaration of Genevieve M. Young, Exh. 4, 1992
RWJF Annual Report, ID No. 55109, at 56).
William B. Clark, DDS, DMS
Professor of Oral Biology and Director,
Periodontal Disease Research Center
University of Florida College of Dentistry
Office of Senator Dale Bumpers, D-AR
Dr. Clark was sponsored by the University of Florida, College
of Dentistry, which received $58,011 for the year.
(Declaration of
Genevieve M. Young, Exh. 4, 1992 RWJF Annual Report, ID No. 4888,
at 57) •
Dr. Clark served on Cluster II, "New System Coverage",
Group 6, "Benefits" (Declarations of Marjorie Tarmey, Document No.
118), and also served on Cluster VIII,· "Health Policy Initiatives
for the Underserved", Group 22 (Declarations of Marjorie Tarmey,
Document No. 715).
Dr. Clark entered the Old Executive Office
Building at least 33 times between February 19, 1993 and May 25,
1993.
llo DBBS earnings and leave stattments, travel vouchers, or
conflict of interest forms were produced by Defendants regarding
Dr. Clark.
see
Tab 56
attached to this Memorandum.
J. Kevin Eckart, Ph. D.
Professor, Sociology, Anthropology, and Policy Studies
Associate Dean, Arts and Sciences
University of Maryland-Baltimore County
Office of Senator Harris Wofford, D-PA
Dr. Eckart was sponsored by the University of Maryland, which
received $54,900 for the year.
(Declaration of Genevieve H. Young,
Exh. 4, 1992 RWJF Annual Report, ID No. 4888, at 57).
Dr. Eckart
served on Cluster X, "Long Term care" (Declaration of Marjorie
Tarmey, Document No. ·581), Group 29, "Program Design" (Declaration
113
�of Marjorie Tarmey, Document No.
591), and Group 28,
"Public
Design" (Declaration of Marjorie Tarmey, Document No. 591).
Dr.
Eckart entered the Old Executive Office Building at least 22 times
between February 25, 1993 and April 29, 1993.
lfo DIDIS earnings and
leave statements, travel vouchers, or conflict of interest forms
were provided by the Defendants regarding Dr. Eckart.
The Robert
Wood Johnson Foundation gave $199,747 to the University of Maryland
College of Behavioral and Social Sciences to study the priority of
public health issues for county government leaders.
(Declaration
of Genevieve H. Young, Exh. 4, 1992 RWJF Annual Report, ID No.
20074, at 58).
See Tab 56 attached to this Memorandum.
Arnold M. Epstein, M.D., M.A.
Associate Professor of Medicine & Health care Policy
Harvard Medical School
Office of Senator Edward Kennedy, D-MA
Committee on Labor and Human Resources
Co-Chair, ·Quality of Care Committee, White House
Interagency Task Force on Health Care Reform
Dr. Epstein was sponsored by the Harvard Medical School, which
received $51,536 for the program.
(Declaration of Genevieve H.
Young, Exh. 4, 1992 RWJF Annual Report, ID No. 4888, at 57).
Dr.
Epstein played an integral role on the Interdepartmental Working
Group, serving on Cluster III, "New System Infrastructure and
Support", Group 9, "Quality Measurement" (Declaration of Marjorie
Tarmey, Document No. 260), and Working Group 40, "Academic Health
Centers" (Declaration of Marjorie Tar.mey, Document No. 704).
~stein
Dr.
entered the Old Executive Office Building at least 37 times
between February 15, 1993 and April 1, 1993.
Dr. Epstein also had
a White House pass, so he may have entered the Old Executive Office
114
....
�Building on numerous other occasions •. No DHHS earnings and leave
statements or travel vouchers were provided by the Defendants
regarding Dr. Epstein.
interest
produced.
Dr. Epstein filed an SF 450 conflict of
form on March
15,
1993,
which the Defendants have
Dr. Epstein was a Task Group Leader for Group
9,
Quality
Measurement (Declaration of Marjorie Tarmey, Document No. 186).
Harvard Medical School received the following sums from the Robert
Wood Johnson Foundation in 1992:
*
$170,658, an Ad Hoc Education and Training Grant,
to provide technical assistance for the Minority
Faculty
Development
Program
Declaration of Genevieve M.
(for
Young,
one
year) ,
Exh. 4, 1992
RWJF Annual Report, ID No. 19685, at 32.
*
$152,320 for 2 years to Brigham & Women's Hospital,
Inc.,
to
provide
a
two-year
postdoctoral research fellowship.
biomedical,
Id.,
ID No.
7854, at 33.
*
$181,372 for 1.5 years to analyze the Medicaid
prescription drug reimbursement policies.
Id., ID
NO. 19782, at 36.
*
$296,960 to Harvard University, School of Public
Health, for a new forecasting and simulation model
of the United States Health Care Sector (for one
year).
*
Id., ID No. 2066, at 53.
$482,425 to Harvard Medical School for 3 years to
support projects to examine and test how changes in
115
�the financing and organization of health services
affect health care costs,
quality,
and access.
Id., ID No. 12590, at 54.
*
$398,733
to
Harvard
University,
School
of
Government, for 2 years to examine and test how
changes in the financing and organization of health
services affect health care costs,
access.
*
quality and
ID No. 12590, at 54.
Id.,
$32,441 to Harvard Medical School for a synthesis
and summary of the outcomes research field (for 5
months).
*
Id.,
No. 20337, at 58.
$82,000 to Harvard University to develop a project
to
analyze
months).
domestic
Id.,
policy
gridlock
(for
11
ID No. 20355, at 58.
Brigham and Women's Hospital received:
*
$75,000 for a study of the effects of health system
reform on medical practice.
Id., ID No. 18858, at
58.
See Tab 56 attached to this Memorandum.
Keith P. Powell, M.D.
Professor and Associate Chair of Clinical Affairs
Department of Pediatrics
Chief, Division of Infectious Diseases
University of Rochester Medical Center
Office of Senator Edward Kennedy, D-MA
committee on Labor and Human Resources
Dr.
Powell was sponsored by the University of Rochester, which
received $56,925 for the year.
Declaration of Genevieve M. Young,
Exh. 4, 1992 RWJF Annual Report, ID No. 4888, at 57.
116
Dr. Powell
�served on Cluster II, "New system Coverage", Group 6, "Benefits".
(Declaration of Marjorie Tarmey, Document No. 119). The University
of Rochester School of Medicine and Dentistry received $2,499,501
from the Robert Wood Johnson Foundation for 52 months for a program
entitled,
"Preparing Physicians for the Future: A Program in
Id., ID No. 15397, at 57.
Medical Education."
Dr. Powell entered
the Old· Executive Office Building at least 14 times between
February 23, 1993, and April 28, 1993.
Ho DBHS earnings and leave
statements, travel vouchers, or conflict of interest forms were
produced by the Defendants regarding Dr. Powell.
See Tab 56
attached to this Memorandum.
Julie SOchalski, Ph.D.
Assistant Professor
School of Nursing
College of Physicians and Surgeons
Columbia University
Office of Senator Bill Bradley, D-NJ
Dr. Sochalski was sponsored by Columbia University, College of
Physicians and Surgeons, which received .$60,075 for the program.
Declaration of Genevieve M. Young, Exh. 4, 1992 RWJF Annual Report,
ID No. 4888, at 57.
System Coverage",
Dr. SOChalski served on Cluster II,
Group
6,
"Benefits"
Marjorie Tarmey, Document No. 119) •
(see,
"New
Declarations
of
Dr. SOchalski entered the Old
Executive Office Building at least 21 times between February 15,
1993, and May 5, 1993.
Ho DBHS earnings and leave statements,
travel vouchers, or conflict of interest forms were produced by the
Defendants regarding Dr. Sochalski.
Columbia University, College
of Physicians and Surgeons, received $2,501,497 from the Robert
Wood
Johnson
Foundation
for
a
117
program
entitled,
"Preparing
�Physicians
for
the
Future:
A Program in Medical
Education" •
Declaration of Genevieve M. Young, Exh. 4, 1992 RWJF Annual Report,
ID No. 15397, at 57.
See Tab 56 attached to this Memorandum.
Other individuals who served on the Interdepartmental Working
Group, and its Cluster Groups, Working Groups and Subgroups also
identified themselves
as
Fellows,
although
the
name
of
the
sponsoring organization and the source of their funding is unclear.
Those persons were as follows:
*
Monica Davies,
Bingaman
congressional
Fellow to
Senator
(see Declarations of Marjorie Tarmey,
Documents Nos. 198 and 705).
*
Thomas Finigan, congressional . Fellow, no sponsor
named
(see
Declarations
of
Marjorie
Tarmey,
Document No. 715).
*
Lawrence Golub, White House Fellow.
*
Greqq Meyer,
Massachusetts General
Fellow
(see
Declarations of Marjorie Tarmey, Document No. 705).
G.
PRIVATE SECTOR MEMBERS OF THE INTERDEPARTMENTAL WQRKING GROUPS
ITS CLUSTER GROUPS WORKING GRQUPS AND SUBGROUPS
AND
I
The documents produced by the Defendants to date leave no
doubt that the Interdepartmental Working Group, and its Cluster
Groups Working Groups and Subgroups were heavily populated by
members of the private sector.
A number
of
health
care
providers
participated
on
the
Interdepartmental Working Group and its Cluster Groups, Working
Groups, and Subgroups, including many practicing physicians from
the private sector.
Declarations of Marjorie Tarmey, Documents
118
�Nos.
762,
763,
764,
765,
766,
attached to this Memorandum.
980,
981
and 982; See Tab
~06
Document No. 764 clearly shows a
large number of practicing physicians from the private sector.
Additionally,
numerous
persons
who
were
members
of
the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups were from either state or local government
organizations or private consulting groups.
Declarations
of
Marjorie Tarmey, Documents Nos. 864, 865, 866, 867, 868, 869; See
Tabs
~oo,
~o~
and
~02
attached to this Memorandum.
Document No.
864 explicitly refers to the list as "Members of the Health Care
Reform Task Force Working Group".
Representatives from state
governments, representatives of intergovernmental organizations,
self-employed
consultants,
individuals
who
are
officers
or
employees of private, non-profit foundations, grant recipients of
non-profit foundation funds, ·and other members of the private
sector participated on the Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups as shown by documents
produced by the Defendants.
Declarations of Marjorie Tarmey,
Documents Nos. 983, 1786, 1787, 734, 477; See
attached
to
this
Memorandum.
Some
of
~abs
these
56 through
other
~~8
private
individuals included persons employed by the Democratic National
Committee, the Democratic Governors Association, Long, Aldridge and
Norman, Attorneys at Law, Atlanta, Georgia, MCI Communications
Corporation, the National Academy of State Health, the National
Association of Insurance Companies, the National Conference of
State Legislatures, :the Pennsylvania Governor's Office and the
119
�Colorado Governor's Office.
Documents Nos. 1680-1692.
1.
Declarations
See Tab
~~B
of Marjorie
Tarmey,
attached to this Memorandum.
Full-Time SGEs
Documents Nos. 1082, 1083 and 1086 (Declarations of Marjorie
Tarmey)
are facsimiles from the Department of Health and Human
Services, Office of the General Counsel, Office of the Special
counsel for Ethics dated April 5, 1993.
Documents Nos. 1082 and
1083 contain a list of "EXPERTS: FULL TIME WORK GROUP MEMBERS"
dated March 26, 1993, listing totally private members and their
salaries, some up to $97,000, and also showing when these persons
came "on board".
Most of the persons listed are shown as coming
"on board" in February, 1993, although two (2) persons are listed
as coming "on board" in early March, 1993.
See
Tab ~03
attached to
this Memorandum.
Document No. 1082, produced by the Defendants, appears to have
been dated March 26, 1993, after this Court's initial decision in
this case, and it states there were twenty-four (24) paid fulltime, special government employee working group members.
The date
of the receipt of the SF 171 (the application form which all
federal employees must file in order to be paid by the federal
government), the date of hire, and the salary level for all those
persons are all set forth in this document.
After thoroughly
reviewing all of the documents provided by the Defendants to date,
which are not subject to the Protective Order, summaries on the
role
of
each
of
these
twenty-four
(24)
individuals
on
the
Interdepartmental Working Group and its Cluster Groups, working
120
�Groups and Subgroups, and documents produced by the Defendants
relative to each person13 , are attached at Tabs 57
Memorandum.
~o 80
to this
These summaries of the twenty-four (24) individuals
who were members of the Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups reveals the following:
Robert Berenson, M.D.
Practicing Internist and co-Founder of the National Capital
Preferred Provider Organization: Chair, Health Reform Task Group on
Quality,
Malpractice
and
Technology
for
the
Health
Policy
Transition Team (Declaration of Marjorie Tarmey, Document No.
1089).
There can be no doubt that Dr. Berenson played a major role
in the Interdepartmental Working Group, and its Cluster Groups,
Working Groups and Subgroups.
According to his DHHS earnings and
leave statements, Dr. Berenson was paid for at least 512 hours of
participation on the Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups.
According to the
The summary reports contained at Tabs 57 ~o 80 to this
Memorandum are based upon the documents produced by the Defendants
to date. These summary reports are similar to the summary reports
regarding Robert Wood Johnson Fellows (see footnote 8, supra), with
the addition of dates and hours working. The heading "PPE" refers
to "pay period ending" based upon the DHHS earnings and leave
statements provided by Defendants.
It must be noted that the
recorded entries into the Old Executive Office Building are not
exhaustive of the participation of the various me~rs of the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups. In addition to many members holding passes
to the OEOB, the Defendants have stated that many meetings took
place at locations other than the OEOB, such as the Vista Hotel,
Shoreham Hotel, various rooms at the Department of Health and Human
Services Building and conference rooms at the Veterans Affairs
Building.
Food, it appears, was often obtained for meeting
participants from a Chinese Restaurant, "The City Lights of China."
Declarations of Marjorie Tarmey, Documents Nos. 1682 and 1685.
13
121
�records of entry to the Old Executive Office Building, Dr. Berenson
entered that building on at least 39 occasions,
because Dr.
Berenson's name also appears on the passholder's list supplied by
the Defendants.
interests,
Dr. Berenson has close ties to managed care
as well as. having been a consultant to the Urban
Institute (a prominent player on the Working Group) and the Alpha
Center /Robert Wood Johnson Foundation.
Dr. Berenson is on the
Editorial Board of Health Affairs, a publication published by
Project HOPE and funded by the Henry J. Kaiser Family Foundation.
Dr. Berenson, for some reason, filed two (2) SF 278 conflict of
interest forms.
The two (2) forms differ slightly, but it is
unknown why two (2) SF 278s were submitted.
Neither form was
submitted within thirty (30) days of beginning his duties on the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
See Tab 57 attached to this Memorandum.
Linda Bergthold, Ph. D.
Employed as Benefits Consultant by William M. Mercer, Inc.:
Principal,
Medical Audit Services and Expert in Managed care
(Declaration o:f Marjorie Tarmey, Document No •. 1089).
question
that
Dr.
Bergthold
played
a
major
There is no
role
in
the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
According to her DHHS earnings and leave
statements, Dr. Bergthold was paid for at least 560 hours of
participation on the
Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups.
records
of entry to
According to the
the Old Executive Office Building,
122
Dr.
�Bergthold entered that building on at least 29 occasions, because
Dr. Bergthold's name also appears on the passholder's list supplied
by the Defendants.
Dr. Bergthold served on Cluster I, "New System
Organization", Group 5, "Insurance Reform" (Declaration of Marjorie
Document
Tarmey,
Families",
No.
1286),
Cluster II,
Group
7,
"Coverage
"New System Coverage"
for
Working
(Declaration
of
Marjorie Tarmey, Document No. 136), and Group 8, "Coverage for Low-
Income and Non-Working Families" (Declaration of Marjorie Tarmey,
Document No. 775).
See Tab 58 attached to this Memorandum.
Eugene R. (Rick) Brown, Ph.D.
Professor of Behavioral Sciences,
UCLA School
of Public
Health, Health Policy Analyst (Declaration of Marjorie Tarmey,
Document No. 1089).
There is no question that Rick Brown played a
major role in the Interdepartmental Working Group and its Cluster
Groups, Working Groups and Subgroups.
According to his DHHS
earnings and leave statements, Rick Brown was paid for at least 400
hours of participation on the Interdepartmental Working Group and
its Cluster Groups, Working Groups and subgroups.
According to the
records of entry into the Old Executive Office Building, Rick Brown
entered that building at least 23 times.
Rick Brown was the
Principal Investigator for a Robert Wood Johnson Project under the
Health
Care
(discussed,
Financing Organization
supra),
entitled
(HCFO)
"Californians'
Funding
Health
Initiative
Insurance
coverage: Research for Public Policy Making and Planning" at the
UCLA School of Public Health, which was funded by the RWJF for
$128,137.
Rick Brown Served on Cluster II, "New system coverage"
123
�(Declaration of Marjorie Tarmey, Document No. 116), Cluster IIA,
Work Group 6, "Benefits" (Declaration of Marjorie Tarmey, Document
No. 118), Work Group 7, "Coverage for Working Families (Declaration
of Marjorie Tarmey, Document No. 136), Work Group 8, "Coverage for
Low-Income and Non-Working Families"
(Declaration of Marjorie
Tarmey, Document No. 155), where he was a Co-Subgroup Leader with
Shoshana ·sofaer, and Cluster IX, "Long Term Care", Work Group 30,
"Disability cross-cutting Group" (Declaration of Marjorie Tarmey,
Document No. 671).
Gary J.
See Tab 59 attached to this Memorandum.
Claxton
senior Policy Analyst,
National Association of Insurance
Commissioners (Declaration of Marjorie Tarmey, Document No. 1089).
There is no question that Hr. Claxton played a prominent role in
the Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
statements,
Hr.
According to his DHHS earnings and leave
Claxton was paid for at least 640 hours of
participation on the Interdepartmental Working Groups, its Cluster
Groups, Working Groups and Subgroups.
According to the records of
entry into the Old executive Office Building, Hr. Claxton entered
that building on at least 32 occasions.
Cluster I,
"New System Organization",
Hr. Claxton served on
as Leader of Group 5,
"Insurance Reform" (Declaration of Marjorie Tarmey, Document No.
1357),
and also
served on Group 41,
"Workers'
Compensation"
(Declaration of Marjorie Tarmey, Document No. 30090).
attached to this Memorandum.
124
See Tab 60
�Shelly L. Crow, RN, MS
Second Chief, Muscogee (Creek Nation), Office of the Chief
(Declaration of Marjorie Tarmey, Document No. 1089).
Shelly crow
was also a key participant in the Interdepartmental Working Group
and its Cluster Groups, Working Groups and Subgroups.
According to
DHHS earnings and leave statements, Shelly crow was paid for at
least 44.0 hours of participation on the Interdepartmental Working
Group,
and its Cluster Groups,
Working Groups and subgroups.
Shelly crow entered the Old Executive Office Building at least 13
times.
Shelly crow served
Government
Programs",
on
Cluster
Subgroup 16A,
IV,
11
Integration
"Indian Health
of
Services"
(Declaration of Marjorie Tarmey, Document No. 447), and Cluster
VIII, Work Group 22, Subgroup A, "Underserved Rural and Inner city
Areas" (Declaration of Marjorie Tarmey, Document No. 523).
See Tab
61 attached to this Memorandum.
Richard E. curtis, 11PP
President, Institute for Health Policy Solutions, Inc., and
former Director of Policy, Health Insurance Association of America
(Declarations of Marjorie Tarmey, Document Nos. 1089 and 864). Mr.
CUrtis was a key player in the Interdepartmental Working Group and
its Cluster Groups, Working Groups and Subgroups.
According to his
DHHS earnings and leave statements, Mr. curtis was paid for at
least 640 hours of participation on the Interdepartmental Working
Groups and its Cluster Groups, Working Groups and Subgroups.
Mr.
curtis also entered the Old Executive Office Building on at least
34 occasions.
Mr. · curtis
served on Cluster I,
125
"New System
�Organization", Group 3, "Governance", as Group Leader (Declaration
of Marjorie Tarmey, Document No. 12).
The SF 278 of Mr. curtis,
otherwise totally handwritten, for some reason, has a typed date on
it.
See Tab 62 attached to this Memorandum.
Denise A. Denton, MS
Executive Director, Colorado Rural Health Resource Center,
President-Elect
of
the
National
Rural
Health
Association
·,
(Declaration of Marjorie Tarmey, Document No. 1090).
Ms.
Denton
played a major role in the Interdepartmental Working Group and its
Cluster Groups, Working Groups and Subgroups.
According to her
DHHS earnings and leave statements, Ms. Denton was compensated for
at least 400 hours of participation on the Interdepartmental
Working Group and its Cluster Groups, Working Groups and Subgroups.
Ms.
Denton entered the Old Executive Office Building on at least 47
occasions.
Ms.
Organization",
Denton was assigned to Cluster I
Group
2,
"Managed care/Toward
(Declaration of Marjorie Tarmey, Document No. 7).
participated on Cluster II,
I
"New system
& Beyond-Rural"
Ms.
"New System coverage",
Denton also
Group 13,
"Coverage for Low-Income and Non-Working Families" (Declaration of
Marjorie Tarmey, Document No. 166).
under
"Chairs
and
Consultants,
lis.
Cluster
Marjorie Tarmey, Document No. 304).
Denton was also listed
III"
(Declaration
of
The SF 278 of Ms. Denton,
otherwise totally handwritten, for some reason, has a typed date on
it.
The Robert Wood Johnson Foundation gave $566,999 to the Office
of the Governor, State of Colorado, for an initiative to help
states plan and develop reforms that improve the financing and
126
�delivery of health care.
See, Declaration of Genevieve M. Young,
Exh. 4, 1992 RWJF Annual Report, ID No. 18519, at 37.
See Tab 63
attached to this Memorandum.
David Eddy, M.D., Ph.D.
Professor, Duke University Medical School, Senior Advisor for
Health
Policy,
Kaiser
Permanente1 • ,
Research
Specialist
(Declaration of Marjorie Tarmey, Document No. 1090). Dr. Eddy, and
his wife, Judith Eddy, played major roles in the Interdepartmental
Working Group and its Cluster Groups, Working Groups and Subgroups.
According to the DHHS earnings and leave statements, David Eddy was
reimbursed
for
at
least
184
hours
of
participation
on
the
Interdepartmental Working Group and its Cluster Groups, Working
Groups and Subgroups.
This does not count the other hours after
Dr. Eddy allegedly became "part-time".
Dr. Eddy entered the Old
Executive Office Building at least 25 times.
Dr. Eddy was the Task
Group Leader for Cluster III, Group 10, "Information Systems"
(Declaration of Marjorie Tarmey, Document No. 187), and was also a
special consultant for Cluster III, Group 9, "Quality Measurement".
Dr.
Eddy was also a participant on Group 40, "Academic Health
Centers"
(Declaration of Marjorie Tarmey,
Document No.
704).
Judith Eddy was listed as "Cluster Assistant" and "Staff-Health
Care Workforce" for Cluster III (Declarations of Marjorie Tarmey,
Documents Nos. 357 and 364).
Both David Eddy's and Judith Eddy's
conflict of interest forms have date discrepancies when compared
1
•Kaiser Permanents is a large managed care corporation.
127
�
Dublin Core
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Title
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Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
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White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
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1993
Identifier
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2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
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72 files in 6 boxes
Provenance
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Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
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William J. Clinton Presidential Library & Museum
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<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
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American Physicians Lawsuit HCTF (Health Care Task Force); March 23, 1994 [2] [1]
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First Lady's Office
Maggie Williams
Evan Ryan
Melanne Verveer
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2006-0223-F
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Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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1/8/2015
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42-t-2194630-20060223F-006-002-2015
2194630
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https://clinton.presidentiallibraries.us/files/original/03e6a6a77d4997e3435b26df67552ee2.pdf
152f1c966131dbe89c968c86361a49f9
PDF Text
Text
UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.,
AMERICAN COUNCIL FOR HEALTH
CARE REFORM AND NATIONAL
LEGAL & POLICY CENTER,
Plaintiffs,
v.
HILLARY RODHAM CLINTON,
DONNA E. SHALALA, Secretary of
Health and Human services,
LLOYD E. BENTSEN, Secretary of
the Treasury, LES ASPIN,
Secretary of Defense, JESSE
BROWN, Secretary of Veterans
Affairs, RONALD H. BROWN,
Secretary of Commerce, ROBERT
B. REICH, Secretary of Labor,
LEON E. PANETTA, Director of
the Office of Management and
Budget, ALICE RIVLIN, Deputy
Director of the Office of
Management and Budget, CAROL
RASCO, IRA MAGAZINER and
JUDITH FEDER, White House
Advisors, THE PRESIDENT'S
TASK FORCE ON NATIONAL
HEALTH CARE REFORM, . and the
INTERDEPARTMENTAL WORKING
GROUP OF THE PRESIDENT'S TASK
FORCE ON NATIONAL HEALTH CARE
REFORM, AND ITS CLUSTER GROUPS,
WORKING GROUPS AND SUBGROUPS
(the Specific Names and Group
Numbers of Which are Set Forth
Hereinbelow at Paragraph 18),
Defendants.
)
)
)
)
)
)
)
)
)
)
Civil Action
No. 93-399
(Judge Lamberth)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
VBRIFIBD
SECOND AHBNDBD AND SUBS!'I'l'Cr.l'BD COIIPLAIN'l' FOR DECLARATORY
JUDGIIBNT, RBS!'RAINING ORDER, AND PRBLilfiNARY
AND PBRIIANBN'l' INJUNCTIVE RELIEF
1
�a.
NOW COME the Plaintiffs, ASSOCIATION OF AMERICAN PHYSICIANS &
SURGEONS,
INC.,
an Indiana not-for-profit corporation,
through Jane M. Orient, M.D.,
Executive Director,
COUNCIL FOR HEALTH CARE REFORM,
by and
the AMERICAN
a Virginia corporation,
by and
through William Shaker, President, and the NATIONAL LEGAL & POLICY
CENTER, a District of Columbia not-for-profit corporation, by and
through Kenneth F. Boehm, Chairman and C.E.O., pursuant to Rule 15
of the Federal Rules of Civil Procedure, after being duly sworn,
and for their verified second banded and Substituted complaint for
Declaratory
Judgment,
Restraining
Order
and
Preliminary
Permanent Xnjunctive Relief against the Defendants, HILLARY
and
ROD~
CLINTON, DONNA E. SHALALA, Secretary of Health & Human Services;
LLOYD E. BENTSEN, Secretary of the Treasury; LES ASP IN, Secretary
of Defense; JESSE BROWN, Secretary of Veterans Affairs; RONALD H.
BROWN, Secretary of Commerce; ROBERT B. REICH, Secretary of Labor,
LEON E. PANETTA, Director of the Office of Management and Budget;
ALICE RIVLIN,
Deputy Director of the Office of Management and
Budget, CAROL RASCO, IRA MAGAZINER and JUDITH FEDER, White House
Advisors, individually, and in their official capacities as members
of the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, the
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM,
and the
INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM, and its CLUSTER GROUPS, WORKING GROUPS
and SUBGROUPS (the specific names and group numbers of which are
set
forth
hereinbelow at paragraph 18) ,
follows:
2
allege
and
state
as
�..
_.
JURISDICTION
That this is a civil action arising under the laws of the
1.
United states, specifically the Federal Advisory Committee Act
("FACA"), Titles u.s.c. App.,
in the sunshine Act,
§§
Title 5 u.s.c.
Information Act, Title 5 u.s.c.
pursuant to Title 28 u.s.c.
§§
552b and 702.
1 through 14, and the Government
§§
§
§
552b,
the Freedom of
552a ("FOIA"), and is brought
1331, 1361, 1651 and Title 5 u.s.c.
· This Court may grant the declaratory and
injunctive relief sought herein pursuant to Title 28, u.s.c.
§
1631
and 2201 and Rules 57 and 65 of the Federal Rules of Civil
Procedure.
2.
That this action involves the legality and course of
conduct of federal advisory committees and the interpretation and
meaning of the Federal Advisory Committee Act (FACA), Title 5
u.s.c. App.,
§§
Title 5 u.s.c.
u.s.c.
§
1 through 14, the Government in the Sunshine Act,
552b, and the Freedom of Information Act, Title 5
§
552a, enacted by the Congress of the United States of
American, and, therefore, the Attorney General of the United States
shall be served with a copy of the Verified ·second Amended and
Substituted complaint for Declaratory Judgment, Restraining Order,
and Preliminary and Permanent Injunct!ve Relief, and shall be
entitled to be heard as required by Rule 4 of the Federal Rules of
Civil Procedure.
VDIUB
3.
That venue is laid in this judicial district
Title 28 u.s.c.
§
p~suant
to
1391·(e) in that the individual Defendant members
3
�·of the Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE
REFORM, with the exception of HILLARY RODHAM CLINTON, are officers
and agents of, and employed by, the Government of the United
States, and all of the individual Defendants are acting_ in an
official capacity for the Government of the United States as
members of the Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH
CARE REFORM,
and all of the individual Defendants have their
offices--in the case of the Defendant, HILLARY RODHAM CLINTON, her
residence--within this judicial district;
and,
the Defendant,
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and the
Defendants, the INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S
TASK FORCE ON NATIONAL HEALTH CARE REFORM, and its CLUSTER GROUPS,
WORKING GROUPS AND SUBGROUPS (the specific names and group numbers
of which are set forth hereinbelow at paragraph 18), have their
offices located within this judicial district; the cause of action
arose within this judicial district, and, no real property is
involved herein.
PLAIIITII78
4.
That the Plaintiff, ASSOCIATION OF AMERICAN PHYSICIANS
SURGEONS, INC.
&
("AAPS"), is a national physician and osteopath
membership corporation, organized and existing under and by virtue
of the not-for-profit corporation laws of the state of Indiana,
with its principal offices located at 1601 North Tucson Boulevard,
Suite 9, Tucson, Arizona 85716. AAPS consists of member physicians
and osteopaths from every state and territory in the Union and the
District of Columbia.-
The purpose of the association is to
4
�•
preserve
and
osteopathy.
protect
the
practice
of
private
medicine
and
The members of AAPS have a deep concern over the
formation of national health care policy and any health care reform
measures which may be devised, and, accordingly, desire to attend
and participate in the meetings and deliberations and examine the
records, reports, transcripts, minutes, appendixes, working papers,
drafts, studies, agenda, and all other documents of the individual
Defendants, as members of the PRESIDENT'S TASK FORCE ON NATIONAL
HEALTH CARE REFORM, and the Defendant, PRESIDENT'S TASK FORCE ON
NATIONAL
HEALTH
CARE
REFORM,
and
the
Defendants,
the
INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM, and its CLUSTER GROUPS, WORKING GROUPS
AND SUBGROUPS (the specific names and group numbers of which are
set forth hereinbelow at paragraph 18), in order to advance and
protect the interests of physicians and osteopaths. The Plaintiff,
AAPS, and its members are "interested persons" within the meaning
of the FACA.
4.
REFORM
That the Plaintiff, AMERICAN COUNCIL FOR HEALTH CARE
("ACHCR")
is
a
national
public
interest,
membership
corporation, organized and existing under and by virtue of the notfor-profit corporation laws of the Commonwealth of Virginia, with
its principal offices located at 5155 North 37th street, Arlington,
Virginia 22207.
The purpose of the ACHCR is to represent consumers
of health care services in an effort to ensure that the health care
market
remains
free
of
unnecessary
and
costly
9overnment
regulations and for ·the implementation of reforms within the
5
�insurance
industry
to
protect
the
consumers
of
health
care
services. Like the members of AAPS, the members of ACHCR desire to
attend and participate in the meetings and examine the records,
reports, transcripts, minutes, appendixes, working papers, drafts,
studies,
agenda
and
all
other
documents
of
the
individual
Defendants, as members of the PRESIDENT'S TASK FORCE ON NATIONAL
HEALTH CARE REFORM, and the Defendant, PRESIDENT'S TASK FORCE ON
NATIONAL
HEALTH
CARE
REFORM,
and
the
Defendants,
the
INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM, and its CLUSTER GROUPS, WORKING GROUPS
AND SUBGROUPS (the specific names and group numbers of which are
set forth hereinbelow at paragraph 18), in order to advance and
protect the interests of consumers of health care services.
The
Plaintiff, ACHCR, and its members are"interested persons" within
the meaning of the FACA.
6.
That the Plaintiff 1
NATIONAL LEGAL
&
POLICY CENTER
("NLPC") is a private foundation, organized and existing under and
by virtue of the not-for-profit corporation laws of the District of
Columbia, with its offices located at 1156 15th.Street, suite 500,
Washington, D.c. 20005
The Plaintiff, NLPC, was established to
promote ethics in qovernment by publicizinq and distributinq a
"Code of Ethics for Government" which it believes is essential to
the health of the nation's democratic institutions.
The NLPC has
a deep concern over the fact that the Defendants, the PRESIDENT'S
TASK FORCE ON NATIONAL HEALTH CARE REFORM and the Defendants, the
INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK FORCE ON
6
�...
NATIONAL HEALTH CARE REFORM, and its CLUSTER GROUPS, WORKING GROUPS
AND SUBGROUPS (the specific names and group numbers of which are
set forth hereinbelow at paragraph 18),
are not operating under
advisory committee charters and are not conducting their meetings
in public with advance notice thereof in the Federal Register, or
opening their records, reports, transcripts, minutes, appendixes,
working papers, drafts, studies, agenda, and other documents to the
public for inspection and copying, and it regards such conduct as
violative of federal law.
Like the members AAPS and ACHCR, the
members of NLPC desire to attend ·and participate in the meetings
and examine the records, reports, transcripts, minutes, appendixes,
working papers, drafts, studies, agenda, and all other documents of
the individual Defendants, as members of the PRESIDENT'S TASK FORCE
ON NATIONAL HEALTH CARE REFORM, and the Defendant, PRESIDENT'S TASK
FORCE ON NATIONAL HEALTH CARE REFORM,
and the Defendant,
the
INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM, and its CLUSTER GROUPS AND SUBGROUPS,
not only due to Plaintiffs' and its officers' interest in health
care reform,
but their interest in the
government and the task force itself.
prope~
operation of
The Plaintiff, NLPC, and its
members are "interested persons" within the meaning of the FACA.
DD'DDUTS
7.
That the Defendant, HILLARY RODHAM CLINTON, is the wife
of the President of the United states, William Jefferson Clinton,
and resides at 1600 Pennsylvania Avenue, Washington,
D.~.
20500.
The Defendant, HILLARY· RODHAM CLINTON, is not now an employee or
7
�.4111
••
..
official of the Government of the United states and receives no
remuneration from the Government of the United States.
The
Defendant, HILLARY RODHAM CLINTON, was named Chairperson of the
Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM,
on January 25, 1993 by President Clinton.
8.
That the Defendant, DONNA E. SHALALA, is now, and at all
times mentioned herein has been, the Secretary of the United States
Department of Health & Human Services, an official of the federal
government, with her offices located at 615 F Hubert H. Humphrey
Building_, 200 Independence Avenue, s.w., Washinqton, D.C. 20410.
on January 25, 1993, the Defendant, DONNA E. SHALALA, was named a
member of the Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH
CARE REFORM, by President Clinton.
9.
That the Defendant, LLOYD E. BENTSEN, is now, and at all
times mentioned herein has been, the Secretary of the United States
Department of the Treasury, an official of the federal government,
with his offices located at 3330 Main Treasury Building, 1500
Pennsylvania Avenue, N.W.
I
Washinqton, D.C. 20220.
on January 25,
1993, the Defendant, LLOYD E. BENTSEN, was named a member of the
Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM,
by President Clinton.
10.
That the Defendant, LES ASPIN, at all times relevant
hereto, was the Secretary of the United States Department of
Defense, an official of the federal government, with his offices
located at 3880 the Pentagon, Washinqton, D.C. 20301.
on January
25, 1993, the Defendant, LES ASPIN, was named a member of the
8
�•
••
.'
Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM,
by President Clinton.
11.
That the Defendant, JESSE BROWN, is now, and at all times
mentioned herein has been, the Secretary of the United States
Department
of
Veterans Affairs,
an
official
of
the
federal
government, with his offices located at 114 Tech World Plaza, 801
Eye Street, N.W. (the mailing address is 810 Vermont Avenue, N.W.,
Washington, D.C. 20420), Washington, D.C. 20001.
1993,
the Defendant, JESSE BROWN,
On January 25,
was named a member of the
Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM,
by President Clinton.
12.
That the Defendant, RONALD H. BROWN, is now, and at all
times mentioned herein has been, the Secretary of the United States
Department of Commerce, an official of the federal government, with
his offices located at 5858 Herbert Clark Hoover Building 14th
Street and Constitution Avenue, N.W., Washington, D.C. 20230.
On
January 25, 1993, the Defendant, RONALD H. BROWN, was named a
member of the Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH
CARE REFORM, by President Clinton.
13.
The Defendant, ROBERT B. REICH, is now, and at all times
mentioned herein has been, the Secretary of the United States
Department of Labor, an official of the federal government, with
his
offices
located at
52018
Frances
Perkins
Constitution Avenue, N.W., Washington, D.C. 20210.
Building,
200
on January 25,
1993, the Defendant, ROBERT B. REICH, was named a member of the
9
�•
Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM,
by President Clinton.
14.
The Defendant, LEON E. PANETTA, is now and at all times
mentioned herein has been, the Director of the Office of Manaqement
and Budqet of the United states,
an official of the federal
qovernment, with his offices located at 52018 Frances Perkins
Buildinq, 200 Constitution Avenue, N.W., Washinqton, D.C. 20210 •
•
on January 25, 1993, the Defendant, LEON E. PANETTA, was named a
member of the Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH
CARE REFORM, by President Clinton.
15.
The Defendant, ALICE RIVLIN, is now, and at all times
mentioned herein has been, the Deputy Director of the Office of
Manaqement and Budqet of the United States, an official of the
federal qovernment, with her offices located at Executive Office of
the President, Washinqton, D.C. 20503.
On January 25, 1993, the
Defendant, ALICE RIVLIN, was named a member of the Defendant,
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, by President
Clinton.
16.
The Defendants, CAROL RASCO, IRA MAGAZINER, and JUDITH
FEDER, are now, and at all times mentioned herein have been,
domestic advisors to President Clinton, and are officials of the
federal qovernment, with their offices located in the Executive
Office of the President, Washinqton, D.C. 20500.
On January 25,
1993, the Defendants, CAROL RASCO, IRA MAGAZINER and JUDITH FEDER,
were named as members of the Defendant, PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM, by President Clinton.
10
�.:
.......
17.
.
The Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH
CARE REFORM, is an "Advisory committee" composed of the Defendants,
HILLARY RODHAM CLINTON,
wife of President Clinton;
DONNA E.
SHALALA, Secretary of the Department of Health & Human Services;
LLOYD E. BENTSEN, Secretary of the Treasury; LES ASPIN, Secretary
of Defense; JESSE BROWN, Secretary of Veterans Affairs; RONALD H.
BROWN, secretary of commerce; ROBERT B. REICH, Secretary of Labor;
LEON E. PANETTA, Director of the Office of Management and Budget;
ALICE RIVLIN, Deputy Director of the Office of Management and
Budqet; CAROL RASCO, IRA MAGAZINER and JUDITH FEDER, White House
advisors, formed by the President of the United States on January
25, 1993, for the purpose of listening to all parties and preparing
health
care
Conqress.
reform
legislation which
could
be
submitted
to
The offices of the Defendant, PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH
CARE
REFORM, are located at the Executive Office of
the President, washington, D.C. 20500.
The Defendant, PRESIDENT'S
TASK FORCE ON NATIONAL HEALTH CARE REFORM, is named as a party
herein for all purposes of Rule 17(b) of the Federal Rules of Civil
Procedure.
Service of Process shall be made upon the Chairperson
of the Defendant, HILLARY RODHAM CLINTON, at her address, the White
House, 1600 Pennsylvania Avenue, Washington, D.C.
Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH
20500.
CARE
The
REFORM is
referred to hereinbelow at times as the "TASK FORCE".
18.
The Defendants, INTERDEPARTMENTAL WORKING GROUP OF THE
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH
CLUSTER GROUPS, WORKING GROUPS
AND
11
CARE
REFORM_, and its
SUBGROUPS; namely, Cluster Group
�I, "New system Organization", and Working Group 1, "Principles and
operation of Purchasing Cooperatives"; Working Group 1A, "Health
Plans,
Patients
care/Toward
Group 4,
&
and
Providers";
Working
Group
2,
"Managed
Beyond"; Working Group 3, "Governance"; "Working
"A Global Budget",
and Working Group 5,
"Insurance
Reform"; Cluster Group II, "New System Coverage", and Working Group
6,
"Benefits Package"; Working Group 7,
Families"; Working Group 8,
"Coverage for Working
"Coverage for Low Income and Non-
Workinq Families"; Cluster Group III, "New System Infrastructure",
and Workinq Group 9, "Quality Measurement"; Working Group 10,
"Information Systems"; Working Group 11, "Malpractice and T9rt
Reform",
and
Development";
Workinq
Cluster
Group
Group
12,
IV,,
"Facilitating
"Integration
Professional
of
Government
Programs into the New system", and Workinq Group 13, "Medicare";
Workinq Group 14,
"Department of Defense"; Workinq Group 15,
"Veterans"; Workinq Group 16, "Federal Employers Health Benefits
Plan"; Working Group 16A, "Other Government Programs"; Cluster
Group V, "Bioethics or Ethical Foundations of the New System", and
Workinq Group 17, "Bioethics";
Cluster Group VI, "Transition to
the New System, Short-Term Cost Controls", and Working Group 18,
"Accelerating
New
System
Development 11 ;
Working
Group
19,
"Administrative Simplification"; Working Group 20, "Interim cost
Controls"; Cluster Group VII, "Financing", and Workinq Group 21,
"Financinq"; Cluster Group VIII, "Health Policy Initiatives for the
Underserved", and Working Group 22, "Health Policy
Initia~ives
for
the Underserved", and Subqroup A, "Underserved Rural and Inner City
12
�•
Areas"; Subqroup B, "Vulnerable/Hiqh Risk Populations"; Subqroup C,
"Women and Children",
and Subqroup D,
"Population-Based Public
Health and Prevention"; Cluster Group IX,
"Mental Health", and
Workinq Group 23; "Mental Health Benefits Packaqe"; Workinq Group
24, "Substance Abuse"; Workinq Group 25, "Children's Services";
Workinq Group 26,
"PUblic System Impact/Special Populations";
Cluster Group X, "Lonq Term Care", and Workinq Group 27, "Lonq Term
care-Backqround";
Options";
Workinq
Group
Workinq Group 29,
28,
"Lonq
Term
Care-Public
"Lonq Term Care-Private Options";
Workinq Group 30, "Cost and Revenue"; Cluster Group XI, "Economic
Impact", and Working Group 31, "Economic Impact"; Cluster
G~oup
XII, "Quantitative Analysis"; and Workinq Group 32, "Quantitative
Analysis; Cluster Group XIII, "Leqal Audit", and Workinq Group 33,
"Leqal Audit"; · Cluster Group XIV, "Numbers Audit ••, and Workinq
Group 34, "Numbers Audit"; Cluster Group XV, "The Drafting Group",
and Workinq Group 35, "The Draftinq Group", and Working Group 36,
"Disability Cross-cutting Work Group"; Workinq Group 37, "Rural
Cross-cutting Group"; Workinq Group 38, "Benefits Coordination";
Workinq Group 39, "Minority Issues Review Group"; Working Group 40,
"Academic
Health
Centers",
and
Workinq
Group
41,
"Workers'
compensation Task Force", are "advisory committees" formed by or
under the direction of the President of the United States on
January 25, 1993 and utilized by the President for the purpose of
"documenting the impact of existing health care policies and
gathering information concerninq present health care systems and
alternatives for health care reform legislation to be recommended
13
�......
to the TASK FORCE and to the President of the United States.
The
offices of the Defendants, INTERDEPARTMENTAL WORKING GROUP OF THE
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and its
CLUSTER GROUPS, WORKING GROUPS AND SUBGROUPS, aforementioned, are
located at the Executive Office of the President, Washington, D.C.
20500.
The Defendants, INTERDEPARTMENTAL WORKING GROUP OF THE
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and its
CLUSTER GROUPS, WORKING GROUPS AND SUBGROUPS, aforementioned, are
named as parties herein for all purposes of Rule 17 (b) of the
Federal Rules of Civil Procedure.
Service of process shall be made
upon the Chairperson of the Defendant, PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM,
HILLARY RODHAM CLINTON,
at her
address, the White House, 1600 Pennsylvania Avenue, Washington,
D.• c.
20500.
STATEMENT OF THE CASE
A.
THE FORMATION OF THE PBESIDENT 1 S TASK FORCE ON NATIONAL HEALTH
CARE REFORM AS AN AQVISORY COMMITTEE
19.
Jefferson
That on or about January 25, 1993 President William
Clinton announced
the
formation
of
the
Defendant,
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, at the White
House, the announced purpose of which was, according to the press
release from the White House,
campaign and the transition.
n
[to} build on the work of the
Listen to all parties and prepare
health care reform legislation to be submitted to Congress within
one-hundred (100) days of our taking office [on January 20, 1993]."
A true and correct copy of the President's Remarks on Health Care
Reform of January 25, 1993, is attached hereto and made a part
14
�hereof as though set out at length herein and marked, for purposes
of identification, as Exhibit "A".
20.
That the Defendant, PRESIDENT'S TASK FORCE ON NATIONAL
HEALTH CARE REFORM, was formed by the President for the purpose of
furnishing him with "expert advice, ideas and diverse opinions,"
and is a "task force" and "advisory committee" established and
utilized by the President in the interest of obtaining advice and
recommendations on national health reform, and consists of at least
one member who is not a full-time officer or employee of the
federal government.
B.
THE FORMATION OF THE IHTERPEPABTMENTAL WOBKING GROUP OF THE
PRESIDENT Is TASK FORCE ON NATIONAL HEALTH CARE BEFORK AND ITS
CLUSTER GROYPS WOBKING GROYPS AND SQBGROUPS
I
I
21.
That on or about January 25, 1993, the President of the
United States, through the Defendant, IRA MAGAZINER, established
the Defendants, INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT 1 S
TASK FORCE ON NATIONAL HEALTH CARE FORM and its CLUSTER GROUPS,
WORKING GROUPS and SUBGROUPS, which met [and possibly still meets]
"regularly as part of an intensive effort to document the impact of
existing health care policies and to gather information concerning
the present health care system and alternatives for [health care]
reform
[legislation]"
to
be
recommended
to
the
individual
Defendants and the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE
REFORM, and to the President of the United states.
22.
That the Defendants 1 INTERDEPARTMENTAL WORKING GROUP OF
THE PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFOR)I, and its
CLUSTER GROUPS 1 WORKING GROUPS AND SUBGROUPS 1
include, Cluster
15
-
--~-~--~------------------------------------__j
�.,
Group
I,
"New
System
Organization",
and
Working
Group
1,
"Principles and Operation of Purchasing Cooperatives"; Working
Group 1A, "Health Plans, Patients and Providers"; Working Group 2,
"Managed care/Toward
"Working Group
4,
&
Beyond"; Working Group 3, "Governance";
"A Global
Budget",
and Working
Group
5,
"Insurance Reform"; Cluster Group II, "New System Coverage", and
Working Group 6, "Benefits Package"; Working Group 7, "Coverage for
Working Families"; Working Group 8, "Coverage for Low Income and
Non-Working
Families";
Infrastructure••,
Working
Group
Cluster
Group
and Working Group
10,
"Information
9,
III,
"New
System
"Quality Measurement";
Systems";
Working
Group
11,
"Malpractice and Tort Reform", and Working Group 12, "Facilitating
Professional
Development";
Cluster Group
IV,
"Integration of
Government Programs into the New System", and Working Group 13,
"Medicare"; Working Group 14, "Department of Defense"; Working
Group 15, "Veterans"; Working Group 16, "Federal Employers Health
Benefits Plan"; Working Group 16A, "Other Government Programs";
Cluster Group V, "Bioethics or Ethical Foundations of the New
System", and Working Group 17, "Bioethics";
Cluster Group VI,
"Transition to the New System, Short-Term Cost controls", and
Working Group 18, "Accelerating New System Development"; Working
Group
19,
"Administrative Simplification";
"Interim Cost Controls";
Cluster Group VII,
Working
Group
20,
"Financing",
and
Working Group 21, "Financing"; Cluster Group VIII, "Health Policy
Initiatives for the Underserved", and Working Group 22, "Health
Policy
Initiatives
for
the
Underserved",
16
and
Subgroup
A,
�.
"Underserved
..
Rural
"Vulnerable/High
Risk
and
Inner
City
Populations";
Children", and Subgroup D,
Areas";
Subgroup
Subgroup
B,
"Women
and
c,
"Population-Based Public Health and
Prevention" ; Cluster Group IX, "Mental Health", and Working Group
23, "Mental Health Benefits Package"; Working Group 24, "Substance
Abuse"; Working Group 25, "Children's Services"; Working Group 26,
"Public System Impact/Special Populations"; Cluster Group X, "Long
Term care", and Working Group 27, "Long Term care-Background";
Working Group 28, "Long Term Care-Public Options"; Working Group
29, "Long Term Care-Private Options"; Working Group 30, "Cost and
Revenue"; Cluster Group XI, "Economic Impact", and Working Group
31, "Economic Impact"; Cluster Group XII, "Quantitative Analysis";
and Working Group 32, "Quantitative Analysis; Cluster Group XIII,
"Legal Audit", and Working Group 33, "Legal Audit"; Cluster Group
XIV,
"Numbers Audit",
and Working Group 34,
"Numbers Audit";
Cluster Group XV, "The Drafting Group", and Working Group 35, "The
Drafting Group", and Working Group 36, "Disability Cross-cutting
Work Group"; Working Group 37, "Rural Cross-cutting Group"; Working
Group 38,
"Benefits Coordination"; Working Group 39, "Minority
Issues Review Group"; Working Group 40, "Academic Health Centers",
and Working Group 41, "Workers' Compensation Task Force. n That the
INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM, and its CLUSTER GROUPS, WORKING GROUPS
AND SUBGROUPS, aforementioned, consist of members who are not fulltime officers or employees of the federal government.
17
�C.
THE PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM IS
AN ADVISORY COMMITTEE WITHIN THE MEANING OF THE FEDERAL
ADVISORY COMMITTEE ACT.
23.
committee"
That, pursuant to Title 5 u.s.c. App.,
is
any
"committee,
board,
§
3, an "advisory
commission,
council,
conference, panel, task force, or other similar group" which is
"established or utilized by the President. • • in the interest of
obtaining advice or recommendations for the President or one or
more agencies of the federal government, except that such term
excludes. • • any committee which is composed wholly of full-time
officers or employees of the Federal Government."
24.
That the Defendant, PRESIDENT'S TASK FORCE ON NATIONAL
HEALTH CARE REFORM,
was "esta!)lishe411 and
11
utilize4"
by the
President of the United States in the interest of obtaining advice
and recommendations on national health care reform and legislation,
and the Defendant, HILLARY RODHAM CLINTON, Chairperson of the
Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM,
and wife of the President of the United States, is not now,.nor at
any time relevant hereto has been, a full-time officer or employee
of the Government of the United States.
25.
That
the
Defendant,
HILLARY
RODHAM
CLINTON,
the
Chairperson of the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE
REFORM, and wife of the President of the United states, is barred
from being a full-time officer or employee of the Government of the
United States under the Kennedy Act, Title 5 u.s.c.
26.
§
3110.
That the Defendant, PRESIDENT'S TASK FORCE ON NATIONAL
HEALTH CARE REFORM, is an "advisory committee" within the meaning
18
�••
of the Federal Advisory Committee Act, 5 u.s.c. App.,
§§
1 through
14.
D.
THE PRESIDENT 1 S TASK FORCE ON NATIONAL HEALTH CARE REFORM
FILED AN ADVISORY COMMITTEE CHARTER UNDER COURT ORDER.
27.
That, according to Title 5 u.s. c. App., S 9 (a), "no
advisory committee shall meet or take any action until an advisory
committee charter has been filed with the Director [of the Office
of Management and Budget][Administrator of the General Services
Administration]."
such charter shall contain, according to Title
5 u.s. c. App.,
9 (c),
§
the following information:
"(A)
the
committee's official designation; (B) the committee's objectives
and the scope of its activity; (c) the period of time necessary for
the committee to carr¥ out its purposes; (D) the agency or official
to whom the· committee reports;
providing
the
necessary
(E) the agency responsible for
support
for
the
committee;
(F)
a
description of the duties for which the committee is responsible,
and, if such duties are not solely advisory, a specification of the
authority for such functions; (G) the estimated annual operating
costs
in dollars
and man-years for
such committee;
estimated number and frequency of committee meetings;
(H)
the
(I) the
committee's termination date, if less than two years from the date
of the committee's establishment; and, (J) the date the charter is
filed." The advisory committee charter shall be filed as well with
the Library of Congress.
28.
Amended
That as of the date of the filing of this Verified Second
and
Substituted
Complaint
for
Declaratory ·Judgment,
Restraining Order, and Temporary and Permanent Injunctive Relief,
19
�an
advisory
committee
charter
establishing
the
Defendant,
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, was filed
pursuant to FACA, Title 5
Preliminary
Injunction,
u.s.c. App., § 9(c), and this Court's
dated
March
10,
1993,
although
the
Preliminary Injunction aforementioned was dissolved by the United
States Court of Appeals for the District of Columbia on June 22,
1993.
E.
THE MEETINGS OF. THE PRESIDENT'S TASK FORCE ON NATIONAL HEALTH
CARE REFORM MUST BE OPEN TO THE PUBLIC WITH ADVANCE NOTICE
PUBLISHED IN THE FEDERAL REGISTER.
29.
That, pursuant to Title 5,
u.s.c. App., § 10(a) (1), "Each
advisory committee meetinq shall be open to the public."
Further,
under said§ 10(a)(2) of said Title, "Except when the President
determines otherwise for reasons of national security,
timely
notice of each such meeting shall be published in the Federal
Register,
and the Director
[of the Office of Management and
Budget] [Administrator of the General Services Administration] shall
prescribe regulations to provide for other types of public notice
to ensure that all interested persons are notified of such meetinq
prior thereto. 11
According to subsection (3) 'of § 10 (a) of said
Title, "Interested persons shall 'be permitted to attend, appear
before, or file statements with any advisory committee, subject to
reasonable rules or regulations as the Director [Administrator] may
prescribe."
u.s.c., App., §
10(d), and the Government in the Sunshine Act, Title 5 u.s.c. §
30.
That accordinq to the FACA, Title 5
552b(b), "every portion of every meeting of an agency shall be open
20
�to public participation" except where the agency finds that its
meeting or meetings shall be closed because not closing the meeting
or meetings would involve the disclosure of matters outlined in
Title 5
u.s.c.
forth in Title 5
An
§
552b(c), and it takes the requisite steps set
u.s.c.
App.,
§
10(d), and Title 5
u.s.c. §
Title 5 u.s.c.
"agency" according to Title 5
those entities set forth in
u.s.c.
§
552(d).
552b, shall include all
§
552(d), including any
"establishment in the executive branch of the Government".
F.
THE PRESIDENT 1 S TASK FORCE ON NATIONAL HEALTH CARE REFORM MOST
OPEN FOR PUBLIC INSPECTION ITS RECORDS REPORTS TRANSCRIPTS
MINQTES. APPENDIXES. WORKING PAPERS. DRAFTS. STUDIES. AGENDA
AND OTHER DOCUMENTS.
I
31.
That, pursuant to Title 5
u.s.c.
I
App.
§
I
10(b), "subject
to Section 552 of Title 5, United States Code (FOIA), the records,
reports, transcripts, minutes, appendixes, working papers, drafts,
studies, agenda or other documents which were made available to or
prepared for or by each advisory committee shall be available for
public inspection and copying at a single location in the offices
of the advisory committee or the agency to which the advisory
committee reports until the advisory committee_ ceases to exist."
32.
The Defendants and the Defendant Task Force must maintain
certain records consisting generally of: (1) the Advisory Committee
Charter of the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE
REFORM; (2) all records, reports, transcripts, minutes (including
minutes containing a record of the persons present and a complete
and accurate description of the matters discussed and conclusions
reached) , appendixes, working papers, drafts, studies, · or other
documents which have been or will be ma4e available to or have been
21
�••
prepared ))y the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE
REFORM; (3) all schedules of meetings and agenda of the PRESIDENT'S
TASK FORCE ON NATIONAL HEALTH CARE REFORM; and (4) the names and
background histories of all persons who are members of or consult
or advise (whether on a full-time or part-time basis and whether
they are paid or not, and the amount paid where applicable) the
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, which relate
to the conduct of the meetings of the PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM, and Plaintiffs have an interest in
said documents and records by reason of the fact that they are and
will be directly affected by the work and deliberations of the
Defendants and the Defendant TASK FORCE.
G.
TBE INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK
FORCE ON NATIONAL HEALTH CARE REFORM. ANP ITS CLUSTER GROUPS.
WORKING GROUPS AND SYBGROUPS ARE APVISORY COMMITTEES WITBIN
THE MEANING OF TBE FEDERAL APVISORX COMMITTEE ACT.
33.
committee"
That, pursuant to Title 5,
is
any
"committee,
u.s. c. App.,
board,
§
3, an "advisory
commission,
council,
conference, panel, task force, or other similar group" which is
"established or utilized by the President. • • in the interest of
obtaining advice or recommendation for the President or one or more
aqencies of the federal government, except that such term excludes.
• • any committee which is composed wholly of full-time officers or
employees of the Federal Government."
34.
That the Defendant, INTERDEPARTMENTAL WORKING GROUP OF
THE PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and its
CLUSTER GROUPS, WORKING GROUPS AND SUBGROUPS; namely, Cluster Group
I, "New System Orqanization", and Working Group 1, "Principles and
22
�Operation of Purchasing Cooperatives"; Working Group 1A, "Health
Plans,
Patients
care/Toward
Group 4,
&
and
Providers";
Working
Beyond"; Working Group 3,
"A Global Budget",
Group
2,
"Managed
"Governance";
and Working Group 5,
"Working
"Insurance
Reform"; Cluster Group II, "New system Coverage", and Working Group
6,
"Benefits Package"; Working Group 7,
Families"; Working Group 8,
"Coverage for Working
"Coverage for Low Income and Non-
Working Families"; Cluster Group III, "New System Infrastructure",
and Working Group 9,
"Quality Measurement"; Working Group 10,
"Information systems"; Working Group 11, "Malpractice and Tort
Reform",
and
Working
Group
12,
"Facilitating
Professional
Development"; Cluster Group IV, "Integration of Government Programs
into the New System", and Working Group 13, "Medicare"; Working
Group 14, "Department of Defense"; Working Group 15, "Veterans";
Working Group 16, "Federal Employers Health Benefits Plan"; Working
Group 16A, "Other Government Programs"; Cluster Group V, "Bioethics
or Ethical Foundations of the New System", and Working Group 17,
"Bioethics";
Cluster Group VI, "Transition to the New system,
Short-Term Cost Controls", and Working Group 18, "Accelerating New
System
Development";
Working
Group
19,
"Administrative
Simplification"; Working Group 20, "Interim Cost Controls"; Cluster
Group VII, "Financing", and Working Group 21, "Financing"; Cluster
Group VIII, "Health Policy Initiatives for the Underserved", and
Working Group 22, "Health Policy Initiatives for the Underserved",
and Subgroup A, "Underserved Rural and Inner City Areas"; Subgroup
B,
"Vulnerable/High Risk Populations";
23
Subgroup
c,
"Women and
�•••
Children", and Subgroup D, "Population-Based Public Health and
Prevention"; Cluster Group IX, "Mental Health", and Working Group
23, "Mental Health Benefits Package"; Working Group 24, "Substance
Abuse"; Working Group 25, "Children's Services"; Working Group. 26,
"Public System Impact/Special Populations"; Cluster Group X, "Long
Term Care", and Working Group 27, "Long Term Care-Background";
Working Group 28, "Long Term care-Public Options"; Working Group
29, "Long Term care-Private Options"; Working Group 30, "Cost and
Revenue"; Cluster Group XI, "Economic Impact", and Working Group
31, "Economic Impact"; Cluster Group XII, "Quantitative Analysis";
and Working Group 32, "Quantitative Analysis; Cluster Group XIII,
"Legal Audit", and Working Group 33, "Legal Audit"; Cluster Group
XIV,
"Numbers Audit" , and Working Group 34 ,
"Numbers Audit" ;
Cluster Group XV, "The Drafting Group", and Working Group 35, "The
Drafting Group", and Working Group 36, "Disability cross-cutting
Work Group"; Working Group 37, "Rural cross-cutting Group"; Working
Group 38, "Benefits Coordination"; Working Group 39, "Minority
Issues Review Group"; Working Group 40, "Academic Health Centers",
and working Group 41, "Workers' Compensation· Task Force", were
established and utilized by the President of the United States in
the interest of obtaining advice and recommendations on national
health care reform and legislation, and, the INTERDEPARTMENTAL
WORKING GROUP OF THE PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE
REFORM, and its CLUSTER GROUPS, WORKING GROUPS AND SUBGROUPS,
aforementioned, were not composed wholly of full-time officers or
employees of the Federal Government.
24
�...
•
..
That the Defendants, INTERDEPARTMENTAL WORKING GROUP OF
35.
THE PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and its
CLUSTER GROUPS, WORKING GROUPS AND SUBGROUPS; namely, Cluster Group
I, "New System organization", and Working Group 1, "Principles and
Operation of Purchasing Cooperatives"; Working Group lA, "Health
Plans,
Patients
and
Providers";
Working
care/Toward & Beyond"; Working Group 3,
Group 4,
"A Global Budget",
Group
2,
"Managed
"Governance";
and Working .Group 5,
"Working
"Insurance
Reform"; Cluster· Group II, "New System Coverage", and Working Group
6,
"Benefits Package"; Working Group 7,
Families"; Working Group 8,
"Coverage for Working
"Coverage for Low Income and Non-
Working Families"; Cluster Group III, "New System Infrastructure",
and Working Group 9,
"Quality Measurement"; Working Group 10,
"Information systems"; Working Group 11,
Reform",
and
Development";
Working
Cluster
Group
Group
12,
IV,,
"Malpractice and Tort
"Facilitating
"Integration
Professional
of
Government
Programs into· the New System", and Working Group 13, "Medicare";
Working Group 14,
"Department of Defense";
Working Group 15,
"Veterans"; Working Group 16, "Federal Employers Health Benefits
Plan"; Working Group 16A,
"Other Government Programs"; Cluster
Group V, "Bioethics or Ethical Foundations of the New System", and
Working Group 17, "Bioethics";
Cluster Group VI, "Transition to
the New System, Short-Term Cost Controls", and Working Group 18,
"Accelerating
New
system
Development n;
Working
Group
19 I
"Administrative Simplification"; Working Group 20, "Interim Cost
Controls"; Cluster Group VII, "Financing", and Working Group 21,
25
�~
••
...
"Financing"; Cluster Group VIII, "Health Policy Initiatives for the
Underserved", and Working Group 22, "Health Policy Initiatives for
the Under served" , and Subgroup A, "Underserved Rural and Inner City
Areas"; Subgroup B, "Vulnerable/High Risk Populations"; Subgroup
"Women and Children", and Subgroup D,
Health and Prevention 11 ;
c,
"Population-Based Public
Cluster Group IX,
"Mental Health" , and
Working Group 23, "Mental Health Benefits Package"; Working Group
24,
"Substance Abuse"; Working Group 25, "Children's Services";
Working Group
26,
"Public system Impact/Special
Populations";
Cluster Group X, "Long Term Care", and Working Group 27, "Long Term
Care-Background";
Options";
Working
Group
Working Group 29,
28,
"Long
Term
Care-Public
"Long Term Care-Private Options";
Working Group 30, "Cost and Revenue"; Cluster Group XI, "Economic
Impact", and Working Group 31, "Economic Impact";· Cluster Group
XII, "Quantitative Analysis"; and Working Group 32, "Quantitative
Analysis; Cluster Group XIII, "Legal Audit", and Working Group 33,
"Legal Audit 11 ;
Cluster Group XIV,
"Numbers Audit", and Working
Group 34, "Numbers Audit"; Cluster Group XV, "The Drafting Group",
and
Wor~ing
Group 35, "The Drafting Group", and Working Group 36,
"Disability Cross-cutting Work Group"; Working Group 37, "Rural
Cross-cutting Group"; Working Group 38, "Benefits Coordination";
Working Group 39, "Minority Issues Review Group"; working Group 40,
"Academic
Health
Centers",
and
Working
Group
41,
"Workers'
Compensation Task Force", are "advisory committees" within the
meaning of the Federal Advisory Committee Act,
through 14.
26
5 u.s.c.
§§
1
�H.
THE INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK
FORCE ON NATIONAL HEALTH CARE REFORM AND ITS CLUSTER GROUPS
WORKING GROUPS AND SUBGROUPS HAVE FAILED TO FILE ADVISORY
COMMITTEE CHARTERS.
I
36.
That, according to Title 5
I
u.s.c. App.,
9 (a),
§
"no
advisory committee shall meet or take any action until an advisory
committee charter has been filed with the Director [of the Office
of Management and Budget] [Administrator of the General Services
Administration]."
5
u.s.c. App.,
Such charter shall
§
9(c),
the
con~ain,
following
according to Title
information:
"(A)
the
committee's official designation; (B) the committee's objectives
and the scope of its activity; (C) the period of time necessary for
the committee to carry out its purposes; (D) the agency or official
to whom the committee reports;
providing
the
necessary
(E) the agency responsible for
support
for
the
committee;
(F)
a
description of the duties for which the committee is responsible,
and, if such duties are not solely advisory, a specification of the
authority for such functions; (G) the estimated annual operating
costs
in dollars and man-years for
such committee;
estimated number and frequency of committee meetings;
(H)
the
(I)
the
committee's termination date, if less than two years from the date
of the committee's establishment; and, (J) the date the charter is
filed."
The advisory committee charter shall be filed as well with
the Library of Congress.
37.
Amended
That as of the date of the filing of this Verified Second
and
Substituted
Complaint
for
Declaratory
Judgment,
Restraining Order, and Temporary and Permanent Injunctive Relief,
no
advisory
committee
charters
27
establishing
the
Defendants,
�••
INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM, and its CLUSTER GROUPS, WORKING GROUPS
AND SUBGROUPS, namely, Cluster Group I, "New System Organization",
and Working Group 1,
Cooperatives";
Providers";
"Principles and Operation of Purchasing
Working Group
Working Group
1A,
2,
"Health Plans,
Patients
"Managed care/Toward
and
Beyond";
&
Working Group 3, "Governance"; "Working Group 4, "A Global Budget",
and Working Group 5, "Insurance Reform"; Cluster Group II, "New
System Coverage", and Working Group 6, "Benefits Package"; Working
Group
7,
"Coverage
for
Working
Families";
Working
Group
8,
"Coverage for Low Income and Non-Working Families"; Cluster Group
III, "New System Infrastructure", and Working Group 9, "Quality
Measurement"; Working Group 10,
"Information systems"; Working
Group 11, "Malpractice and Tort Reform", and Working Group 12,
"Facilitating
Professional
Development";
Cluster
Group
"Integration of Government Programs into the New system",
Working Group 13,
IV,
and
"Medicare"; Working Group 14, "Department of
Defense"; Working Group 15, "Veterans"; Working Group 16, "Federal
Employers
Government
Health
Benefits
Programs";
Plan";
Working
Cluster Group V,
Group
"Bioethics
16A,
"Other
or Ethical
Foundations of the New system", and Working Group 17, "Bioethics";
Cluster Group VI, "Transition to the New System, Short-Term Cost
Controls",
and
Working
Group
18,
"Accelerating
New
System
Development"; Working Group 19, "Administrative Simplification";
Working Group 20,
"Interim Cost Controls"; Cluster Group VII,
"Financing", and Working Group 21, "Financing"; Cluster Group VIII,
28
�....
.tiL
"Health Policy Initiatives for the Underserved", and Working Group
22, "Health Policy Initiatives for the Underserved", and Subgroup
A,
"Underserved
"Vulnerable/High
Rural
Risk
and
Inner
Populations";
City
Areas";
Subgroup
C,
Subgroup
B,
"Women
and
Children", and Subgroup D, "Population-Based Public Health and
Prevention"; Cluster Group IX, "Mental Health", and Working Group
23, "Mental Health Benefits Package"; Working Group 24, "Substance
Abuse"; Working Group 25, "Children's Services"; Working Group 26,
"Public System Impact/Special Populations"; Cluster Group X, "Long
Term care", and working Group 27, "Long Term care-Background";
Working Group 28, "Long Term care-Public Options"; Working Group
29, "Long Term Care-Private Options"; Working Group 30, "Cost and
Revenue"; Cluster Group XI, "Economic Impact", and Working Group
31, "Economic Impact"; Cluster Group XII, "Quantitative Analysis";
and Working Group 32,
11
QuantitativeAnalysis; Cluster Group XIII,
"Legal Audit", and Working Group 33, "Legal Audit"; Cluster Group
XIV,
"Numbers Audit", and Working Group 34,
"Numbers Audit";
Cluster Group XV, "The Drafting Group", and Working Group 35, "The
Drafting Group", and Working Group 36, "Disability cross-cutting
Work Group"; Working Group 37, "Rural cross-cutting Group"; Working
Group 38, "Benefits Coordination"; Working Group 39,
"Minority
Issues Review Group"; Working Group 40, "Academic Health Centers",
and Working Group 41, "Workers' Compensation Task Force", have been
filed pursuant to FACA, Title 5 u.s.c. App.,
I.
§
9(c).
THE MEETINGS OF THE INTERDEPARTMENTAL WQRKING GROpp OF THE
PRESIDENT Is TASK FORCE ON NATIONAL HEALTH CARE REFORM AND ITS
CLUSTER GROQPS WORKING GROQPS AND SQBGROYPS MUST BE OPEN TO
I
1
29
�._
...
THE PUBLIC WITH ADVANCE NOTICE PUBLISHED IN THE FEDERAL
REGISTER.
38.
That, pursuant to Title 5,
u.s.c. App.,
lO(a)91), "Each
§
advisory committee meeting shall be open to the public. "
under said
§
Further,
10 (a) (2) of said Title, "Except when the President
determines otherwise for reasons of national security,
timely
notice of each such meeting shall be published in the Federal
Register, and the Director (of the Office of Management and Budget]
[Administrator
of
the General
Services Administration]
shall
prescribe regulations to provide for other types of public notice
to ensure that all interested persons are notified of such meeting
prior thereto."
According to subsection (3) of
§
lO(a) of said
Title, "Interested persons shall be permitted to attend, appear
before, or file statements with any advisory committee, subject to
reasonable rules or regulations as the Director [Administrator] may
prescribe."
u.s.c, App., § lO(d),
and the Government in the Sunshine Act, Title 5 u.s.c. § 552(b),
39.
That according to the FACA, Title 5
"every portion of every meeting of an agency shall be open to
public participation except where the agency finds that its meeting
or meetings shall be closed because not closinq the meetinq or
meetings would involve the disclosure of matters outlined in Title
5
u.s.c.
Title 5
§
552b(c), and it takes the requisite steps set forth in
u.s.c.
App., S lO(d), and Title 5
u.s.c.
§
552(d).
u.s.c. § 552b, shall include
Title 5 u.s.c. § 552(d), including
An
"agency" accordinq to Title 5
all
those entities set forth in
any
"establishment in the executive branch of the Government."
30
�. ..
40.
·--
The Defendants, INTERDEPARTMENTAL WORKING GROUP OF THE
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and its
CLUSTER GROUPS,
WORKING GROUPS and SUBGROUPS,
aforementioned,
functioned, and continue to function in total secrecy, and have
refused, and now refuse, to permit Plaintiffs or the public-atlarge to attend and participate in said meetings.
J.
THE INTERDEPARTMENTAL WOBKING GROPP OF THE PRESIDENT'S TASK
FORCE ON NATIONAL HEALTH CARE REFORM AND ITS CLUSTER GROUPS
WORKING GROUPS ·AND SYBGROUPS MUST OPEN FOR PUBLIC INSPECTION
THEIR RECORPS REPORTS TRANSCRIPTS MINYTES APPENDIXES
WOBKING PAPERS DRAFTS STUDIES AGENDA AND OTHER DOCUMENTS.
I
I
I
I
41.
I
I
I
I
I
I
That, pursuant to Title 5
u.s. c. App.,
§
10 (b), "subject
to Section 552 of Title 5, United States Code (FOIA), the records,
reports, transcripts, minutes, appendixes, working papers, drafts,
studies, agenda or other documents which were made available to or
prepared for or by each advisory committee shall be-available for
public inspection and copying at a single location in the offices
of the advisory committee or the agency to which the advisory
committee reports until the advisory committee ceases to exist.
42.
The Defendants, INTERDEPARTMENTAL WORKING GROUP OF THE
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and its
CLUSTER GROUPS, WORKING GROUPS AND SUBGROUPS, aforementioned, are
required to maintain certain records consisting generally of: (1)
the Advisory Committee Charters of the INTERDEPARTMENTAL WORKING
GROUP OF THE PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM,
and
its
CLUSTER
aforementioned;
GROUPS 1
WORKING
GROUPS
AND
SUBGROUPS
(2) all records, reports, transcripts, minutes,
(including minutes containing a record of the persons present and
31
~--~~
---~-------
---
�a complete and accurate description of the matters discussed and
conclusions reached), appendixes, working papers, drafts, studies,
or other documents which have been or will be made available to or
have been prepared by the INTERDEPARTMENTAL WORKING GROUP OF THE
PRESIDENT 1 S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and its
CLUSTER GROUPS, WORKING GROUPS AND SUBGROUPS aforementioned; (3)
all schedules of meetings and agenda of the INTERDEPARTMENTAL
WORKING GROUP OF THE PRESIDENT 1 S TASK FORCE ON NATIONAL HEALTH CARE
REFORM,
and its CLUSTER GROUPS,
WORKING GROUPS AND SUBGROUPS
aforementioned; and (4) the names and background histories of all
persons who are members of or consult or advise (whether on a fulltime or part-time basis and whether they·are paid or not, and the
amount paid where applicable) of the INTERDEPARTMENTAL WORKING
GROUP OF THE PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM,
and
its
CLUSTER
GROUPS,
WORKING
GROUPS
AND
SUBGROUPS,
aforementioned, which relate to the conduct of the meetings of the
INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM, and its CLUSTER GROUPS, WORKING GROUPS
AND SUBGROUPS, aforementioned; and Plaintiffs·have an interest in
said documents and records by reason of the fact that they are and
will be directly affected by the work and deliberations of the
Defendants, INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK
FORCE ON NATIONAL HEALTH CARE REFORM, and. its CLUSTER GROUPS,
WORKING GROUPS AND SUBGROUPS, aforementioned.
43.
The Defendants, INTERDEPARTMENTAL WORKING GROUP OF THE
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and its
32
�CLUSTER GROUPS,
WORKING GROUPS and SUBGROUPS,
aforementioned,
functioned, and continue to function in total secrecy, and have
refused, and now refuse, to permit Plaintiffs or the public-atlarge to inspect and copy the records aforementioned.
K.
PLAINTIFFS HAVE REQUESTED TO PARTICIPATE IN ALL OF THE
MEETINGS OF THE PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE
REFORM.
44.
That on February 10, 1993, the Plaintiff, AAPS, by and
through its Executive Director, Jane M. Orient, M.D., forwarded a
letter, overnight mail, to the Defendant, HILLARY RODHAM CLINTON,
Chairperson of the Defendant, PRESIDENT'S TASK FORCE ON NATIONAL
HEALTH CARE REFORM, with a copy to Bon. Bernard w.
Nussba~,
counsel to the President of the Untied States, demanding that she
and members of the Plaintiff, AAPS, be permitted to attend the
meetings
of
the
individual
Defendants,
as
members
of
the
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and the
Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM,
and that she and it receive advance notice of all subsequent
meetings, pursuant to Title 5
u.s.c. App.,
§
10.
A true and
correct copy of the aforementioned letter is attached hereto and
made a part hereof as though set out at length herein and marked,
for purposes of identification, as Exhibit "B".
45.
That on February 10, 1993, the Plaintiff ACHCR, by and
through its executive director, William Shaker, forwarded a letter,
overnight
mail,
to
the
Defendant,
HILLARY
RODHAM
CLINTON,
Chairperson of the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE
REFORM, with a copy to Bon. Bernard
33
w.
Nussbaum, counsel to the
�....
••
..
President of the United States, demanding that he and members of
the Plaintiff, ACHCR,
be permitted to attend meetings of the
individual Defendants, as members of the PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM, and the Defendant, PRESIDENT'S TASK
FORCE ON NATIONAL HEALTH CARE REFORM, and that he and it receive
advance notice of all subsequent meetings pursuant to Title 5
u.s.c. App.,
§
10.
A true and correct copy of the aforementioned
letter is attached hereto and made a part hereof as though set out
at length herein and marked, for purposes of identification, as
Exhibit
46.
11
C11 •
That on February 11, 1993, the Plaintiff, NLPC, by and
through its President, Peter T. Flaherty, forwarded a letter to the
Defendant, HILLARY RODHAM CLINTON, Chairperson of the PRESIDENT'S
TASK FORCE ON NATIONAL HEALTH CARE REFORM, with a copy to Hon.
Bernard w. Nussbaum, counsel to the President of the United States,
demanding that he and members of the Plaintiff, NLPC, be permitted
to attend the meetings of the individual Defendants, as members of
the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and the
Defendant, PRESIDENT'S TASK FORCE ON NATIONAL'HEALTH CARE REFORM,
and that he and it receive .advance notice of all subsequent
meetings pursuant to Title 5
u.s.c. App.,
§
10.
A true and correct
copy of the aforementioned letter is attached hereto and made a
part hereof as though set out at length herein and marked, for
purposes of identification, as Exhibit "D".
L.
THE DEFENDANTS ASSERT THAT THE FEDERAL AQYISORY COMMITTEE ACT
DOES NOT APPLY TO THEM AND THYS HAVE REFUSED · TO ALLOW
PLAINTIFFS TO AT'l'ENP AI.I. OF THE MEETINGS OF THE PRESIDENT'S
TASK FORCE ON NATIONAL HEALTH CARE BEFORK.
34
�••
......
47.
That the Defendants, by and through Bernard
w.
Nussbaum,
counsel to the President, notified the Plaintiffs, AAPS, ACHCR and
NLPC, by letters dated February 12 and 16 1993, that no meetings of
the individual Defendants, as members of the PRESIDENT'S TASK FORCE
ON NATIONAL HEALTH CARE REFORM, and the Defendant, PRESIDENT'S TASK
FORCE ON NATIONAL HEALTH CARE REFORM, had been held and, further,
responded to the demands of the Plaintiffs, AAPS, ACHCR and NLPC,
regarding their attendance and participation in the meetings and
providing advance notice thereof in the Federal Register,
and
otherwise following the Federal Advisory Committee Act, 5 u.s.c.
App.,
§§
1 through 14, and the Government in the sunshine Act,
Title 5 u.s.c.
552b, by stating the following:
§
It is our opinion that the Federal Advisory Committee Act
does not, and was not intended by Congress to, apply to
the health task force--composed solely of Cabinet
secretaries, senior White House officials and the First
Lady. The participation of the First Lady on the task
force does not trigger application of the Act.
True and correct copies of the aforesaid letters from Bernard
w.
Nussbaum, counsel to the President, to the Plaintiffs, AAPS,
ACHCR and NLPC, dated February 12 and 16, 1993, are attached hereto
and made a part hereof as though set out at lenqth herein and
marked, for purposes of identification, as Exhibits "E", "F" and
"G".
M.
THE PLAINTIFFS HAVE REQUESTED COPIES OF AI,I. RECORDS REPORTS
TRANSCRIPTS MINYTES APPENDIXES WORKING PAPERS DRAFTS
STUPIES AND AT,T, OTHER DOCUMENTS OF THE DEFENDANTS PBESIPENT' s
TASK FORCE ON NATIONAL HEALTH CARE REFORM AND THE
INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK FORCE
ON NATIONAL HEALTH CARE REFORM AND ITS CLUSTER GROUPS
WORKING GROUPS AND SUBGROUPS.
I
I
I
I
I
I
I
I
I
35
I
�.:.
48.
On or about March 17, 1993, Plaintiffs, ASSOCIATION OF
AMERICAN PHYSICIANS AND SURGEONS, INC. and AMERICAN COUNCIL FOR
HEALTH CARE REFORM, duly requested, in writing, that the Defendants
and Defendant TASK FORCE, through the Defendants, HILLARY RODHAM
CLINTON and IRA MAGAZINER, and Bernard Nussbaum, council to the
President, pursuant to the Federal Advisory Committee Act, 5
§
10(b) CFACA), and the Freedom of Information Act, 5
u.s.c.
u.s.c.
§
552a
(FOIA), disclose records of the Defendant, PRESIDENT'S TASK FORCE
ON
NATIONAL
HEALTH
CARE
REFORM
and
the
Defendants,
THE
INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM, and its CLUSTER GROUPS, WORKING GROUPS
and SUBGROUPS aforementioned, to the Plaintiffs, ASSOCIATION OF
AMERICAN PHYSICIANS AND SURGEONS, INC., and the
AMERICAN COUNCIL
FOR HEALTH CARE REFORM, and that they and it permit· inspection and
copying thereof by the Plaintiffs.
The Plaintiff, NATIONAL LEGAL
& POLICY CENTER, forwarded its request (which was identical to the
aforesaid requests of the Plaintiffs, ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC. and AMERICAN COUNCIL FOR HEALTH CARE
REFORM) on April 8, 1993.
49.
On or about April 1,
1993,
the Defendants and the
Defendant TASK FORCE, by letters to the Plaintiffs, ASSOCIATION OF
AMERICAN PHYSICIANS AND SURGEONS, INC and AMERICAN COUNCIL FOR
HEALTH CARE REFORM, refused to produce to the Plaintiffs: (1) all
records,
reports,
transcripts,
minutes
(including
minutes
containing a record of the persons present and a complete and
accurate description · of the matters discussed and conclusions
36
�··~
reached),
appendixes, working papers,
drafts,
studies,
or other
documents which have been or will be made available to or have been
prepared :by the PRESIDENT 1 S TASK FORCE ON NATIONAL HEALTH CARE
REFORM; (2) all schedules of meetings and agenda of the PRESIDENT'S
TASK
FORCE
reports,
record
ON
NATIONAL HEALTH
transcripts,
of
the
minutes
persons
CARE
REFORM;
(3)
(including minutes
present
and
a
complete
all
records,
containing
and
a
accurate
description of the matters discussed and the conclusions reached),
appendixes,
working papers,
drafts,
studies,
or other documents
which have been or will be made available to or have been prepared
:by the INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT 1 S TASK
FORCE ON NATIONAL HEALTH CARE REFORM,
and its CLUSTER GROUPS,
WORKING GROUPS AND SUBGROUPS, aforementioned; ( 4) the schedules of
all meetings and agenda of the INTERDEPARTMENTAL WORKING GROUP OF
THE PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and its
CLUSTER GROUPS 1 WORKING GROUPS AND SUBGROUPS, aforementioned; and
( 5)
the names and background histories of all persons who are
members of or consult or advise (whether on a full-time or parttime basis and whether they are paid or not, and the amount paid
where applicable), the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH
CARE REFORM, THE INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S
TASK FORCE ON NATIONAL HEALTH CARE REFORM, and its CLUSTER GROUPS,
WORKING GROUPS AND SUBGROUPS, aforementioned.
The Defendants have
not responded to the FOIA and FACA requests of the Plaintiff,
NATIONAL LEGAL & POLICY CENTER.
I t is presumed the response of the
Defendants to the Plaintiff, NATIONAL LEGAL & POLICY CENTER, would
37
�.....
be
identical to the responses to the requests
filed by the
Plaintiffs, ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS, INC.
and AMERICAN COUNCIL FOR HEALTH CARE REFORM, as said request of the
Plaintiff, NATIONAL LEGAL & POLICY CENTER, is identical to those of
the Plaintiffs, ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS,
INC. and AMERICAN COUNCIL FOR HEALTH CARE REFORM.
so.
Attached hereto as Exhibits "H", "I" and "J" are true and
correct copies of the FACA and FOIA requests made by the Plaintiffs
and attached hereto as Exhibits "K" and "L", are true and correct
copies of the letters from the Defendants, refusinq the requests.
51.
Plaintiffs have employed attorneys to represent them in
this action and have incurred and will continue to incur expenses
for attorneys' fees and costs herein.
52.
The
identifiable
records
records
hereinabove
within
the
referred
meaninq
to
of
were
the
and
Freedom
are
of
u.s.c. S 552a (FOIA), and the Federal Advisory
u.s.c. App., S 10(b) (FACA), and the Defendants'
Information Act, 5
Committee Act, 5
and the Defendants refusal to disclose the same to the Plaintiffs
is wronqful and without lawful reason to excuse, and Plaintiffs are
entitled to the relief provided by the aforesaid acts.
N.
THE DEFENDANTS ARE IN VIOLATION OF THE FEDERAL ADVISORY
COMMITTEE ACT AND THE GOVERNMENT IN THE SYNSHINE ACT AND THE
FREEDOM OF INFQRMATION ACT.
53.
The Defendants, HILLARY RODHAM CLINTON, DONNA E. SHALALA,
LLOYD E. BENTSEN, LES ASPIN, JESSE BROWN, ROBERT B. REICH, LEON
PANETTA, ALICE RIVLIN, CAROL RASCO, IRA MAGAZINER, JUDITH FEDER, as
members of the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE
38
�REFORM, and the Defendant, PRESIDENT'S TASK FOR ON NATIONAL HEALTH
CARE REFORM,
PRESIDENT'S
by not opening their meetings of the Defendant,
TASK
FORCE
ON
NATIONAL
HEALTH
CARE
REFORM,
to
attendance and participation by the Plaintiffs and the public-atlarge, and by not providing advance notice of said meetings in the
Federal Register, and by not making available for inspection and
copying by the Plaintiffs and the public-at-large at a single
location in the OFFICES OF THE PRESIDENT'S TASK FORCE ON NATIONAL
HEALTH CARE REFORM, the records, reports, transcripts, minutes,
appendixes, working papers, drafts,
studies,
agenda,
or other
documents which were made available to or prepared for or by the
PRESIDENT 1 S TASK FORCE ON NATIONAL HEALTH CARE REFORM, are in
violation of the FACA,
5 u.s. c.
App.,
§§ 1 through 4,
and
specifically §§ 10 thereof, the Government in the Sunshine Act, 5
u.s.c. § 552b, and the Freedom of Information Act, 5 u.s.c. §552a.
The Defendants, INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT 1 S
TASK FORCE ON NATIONAL HEALTH CARE REFORM and its CLUSTER GROUPS,
WORKING GROUPS and SUBGROUPS 1 namely, Cluster Group I, "New System
Organization", and Working Group 1, "Principles and Operation of
Purchasing Cooperatives"; Working Group lA, "Health Plans, Patients
and Providers"; Working Group 2, "Managed care/Toward & Beyond";
Working Group 3, "Governance"; "Working Group 4, "A Global Budget",
and Working Group 5, "Insurance Reform"; Cluster Group II, "New
System Coverage", and Working Group 6, "Benefits Package"; Working
Group
7,
"Coverage
for
Working Families";
Working Group
8,
"Coverage for Low Income and Non-Working Families"; Cluster Group
39
�.
•••
..
III, "New System Infrastructure", and Working Group 9, "Quality
Measurement"; Working Group 10,
"Information Systems"; Working
Group 11, "Malpractice and Tort Reform", and Working Group 12,
"Facilitating
Professional
Development";
Cluster
Group
"Integration of Government Programs into the New System",
IV,
and
Working Group 13, "Medicare"; Working Group 14, "Department of
Defense"; Working Group 15, "Veterans"; Working Group 16, "Federal
Employers
Health
Benefits
Government Programs";
Plan";
Working
Cluster Group V,
Group
"Bioethics
16A,
"Other
or Ethical
Foundations of the New System", and Working Group 17, "Bioethics";
Cluster Group VI, "Transition to the New System, Short-Term Cost
Controls",
and
Working
Group
18,
"Accelerating
New
System
Development"; Working Group 19, "Administrative Simplification";
Working Group 20,
"Interim Cost Controls"; Cluster Group VII,
"Financing", and Working Group 21, "Financing"; Cluster Group VIII,
"Health Policy Initiatives for the Underserved", and Working Group
22, "Health Policy Initiatives for the Underserved", and Subgroup
A,
"Underserved
"Vulnerable/High
Rural
Risk
and
Inner
City
Populations";
Children", and Subgroup D,
Areas";
Subgroup
c,
Subgroup
B,
"Women
and
"Population-Based Public Health and
Prevention"; Cluster Group IX, "Mental Health", and Working Group
23, "Mental Health Benefits Package"; Working Group 24, "Substance
Abuse"; Working Group 25, "Children's Services"; Working Group 26,
"Public System Impact/Special Populations"; Cluster Group X, "Long
Term care", and Working Group 27,
"Long Term care-Background";
Working Group 28, "Long Term Care-Public Options"; Working Group
40
�......
29, "Long Term Care-Private Options"; Working Group 30, "Cost and
Revenue"; Cluster Group XI, "Economic Impact", and Working Group
31, "Economic Impact"; Cluster Group XII, "Quantitative Analysis";
and Working Group 32, "Quantitative Analysis; Cluster Group XIII,
"Legal Audit", and Working Group 33, "Legal Audit"; Cluster Group
XIV,
"Numbers Audit",
and Working Group 34,
"Numbers Audit";
Cluster Group XV, "The Drafting Group", and Working Group 35, "The
Drafting Group", and Working Group 36, "Disability Cross-cutting
Work Group"; Working Group 37, "Rural Cross-cutting Group"; Working
Group 38, "Benefits coordination"; Working Group 39, "Minority
Issues Review Group"; Working Group 40, "Academic Health Centers",
and Working Group 41, "Workers' Compensation Task Force", by not
filing advisory committee charters and by not opening their
meetings to attendance and participation by the Plaintiffs and the
public-at-large,
and by not providing advance notice of said
meetings in the Federal Register, and, by not making available for
inspection and copying by the Plaintiffs and the public-at large at
a single location in the offices of said Defendants the records,
reports, transcripts, minutes, appendixes, working papers, drafts,
studies, agenda, or other documents which were made available to or
prepared for or by said Defendants are in violation of the FACA, 5
u.s.c.
App., §§ 1 through 4, and specifically§§ 10 thereof, the
Government in the Sunshine Act, 5
Information Act, 5
O.
u.s.c.
u.s.c. S 552b,
and the Freedom of
§552a.
THE PLAINTIFFS ARE BEING DENIED TBEIR RIGHTS TO PARTICIPATE IN
TBE MEETINGS OF TBE DEFENDANTS
TO BE INFORMED OF THE
DEFENDANTS 1 LIMITS OF AUTHORITY UNDER AQVISORY COMMITTEE
CHARTERS AND TO EXAMINE THE BECORPS OF THE DEFENDANTS.
I
41
�·:·.
54.
That as a direct and proximate result of the acts of the
Defendants, the Plaintiffs, AAPS, ACHCR and NLPC, are being, and
will be, denied their right, under the Federal Advisory Committee
Act, 5 u.s.c.
5 u.s.c.
§
§
1 through 14, the Government in the sunshine Act,
522b, and the Freedom of Information Act, 5 u.s.c.
552a to attend and participate in all
of
the meetings
§
and
deliberations of the individual Defendants, and are being denied
their right to be informed of the limits of authority of the
Defendants, particularly the Defendants, INTERDEPARTMENTAL WORKING
GROUP OF THE PRESIDENT'S TASK FORCE ON NATIONAL HEALTH
and
its
CLUSTER
GROUPS,
WORKING
GROUPS
and
CARE
REFORM
SUBGROUPS,
aforementioned, by said Defendants failing and refusing to file
advisory committee charters, and are being denied their right to
inspect and copy at a single location in the off ices of the
Defendants the records, reports, transcripts, minutes, appendixes,
working papers, drafts, studies, agenda, or other documents which
were made available to or prepared for or by said Defendants, all
to Plaintiffs' damage and detriment.
55.
That by reason of the Defendants' conduct aforesaid , the·
Plaintiffs, AAPS, ACHCR and NLPC have suffered, and will continue
to suffer,
immediate, actual and irreparable harm in that the
Defendants, INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK
FORCE ON NATIONAL HEALTH CARE REFORM, and its CLUSTER GROUPS,
WORKING GROUPS and SUBGROUPS, aforementioned, will continue to
conduct their meetings without advisory committee charters being
filed, and the Plaintiffs are being and will be denied their right
42
--
---------
________
_____)
�•••
to participate in the meetings and deliberations of the Defendants,
including the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM
and the INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK
FORCE ON NATIONAL HEALTH CARE REFORM, and its CLUSTER GROUPS,
WORKING GROUPS and SUBGROUPS, aforementioned, unless this Honorable
Court grants the relief sought herein.
56.
That by reason of the Defendants' conduct aforesaid, the
Plaintiffs, AAPS, ACHCR, and NLPC, have suffered, and will continue
to suffer,
immediate, actual and irreparable harm in that the
Plaintiffs have been, and will continue to be, denied their right
to inspect and copy at a single location in the offices of the
Defendants the records, reports, transcripts, minutes, appendixes,
working papers, drafts, studies, agenda, or other documents which
were made available to or prepared for or by said Defendants, the
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM and the
INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM, and its CLUSTER GROUPS, WORKING GROUPS
and SUBGROUPS, aforementioned, unless this Honorable Court grants
the relief sought herein.
57.
Plaintiffs have no adequate remedy at
law and are
suffering and will suffer immediate and irreparable harm unless the
Grout grants the relief sought herein.
PBAYER
WHEREFORE, Plaintiffs, ASSOCIATION OF AMERICAN PHYSICIANS AND
SURGEONS, INC., AMERICAN COUNCJ.l, FOR HEALTH CARE REFORM, and THE
NATIONAL LEGAL
&
POLICY CENTER, pray that this Honorable Court
43
�enter judgment against the Defendants,
HILLARY RODHAM CLINTON,
DONNA E. SHALALA, LLOYD E. BENTSEN, LES ASPIN, JESSE BROWN, RONALD
BROWN, ROBERT B. REICH, LEON PANETTA, ALICE RIVLIN, CAROL RASCO,
IRA MAGAZINER, JUDITH FEDER, individually, and as members of the
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM,
and the
Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM,
and
the
Defendants,
INTERDEPARTMENTAL
WORKING
GROUP
OF
THE
PRESIDENT 1 S TASK FORCE ON NATIONAL HEALTH CARE REFORM and its
CLUSTER GROUPS, WORKING GROUPS and SUBGROUPS aforementioned,
as
follows:
(A)
Declare that the said Defendants, HILLARY RODHAM CLINTON,
DONNA E. SHALALA, LLOYD E. BENTSEN, LES ASPIN, JESSE BROWN, RONALD
BROWN, ROBERT REICH, LEON PANETTA, ALICE RIVLIN, CAROL RASCO, IRA
MAGAZINER,
JUDITH
FEDER,
individually,
and
as
members
of
THE
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM and .the
INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM and its CLUSTER GROUPS 1 WORKING GROUPS
and SUBGROUPS, namely, Cluster Group I, "New System Organization",
and Working
Group 1,
Cooperatives";
Providers";
"Principles
Working
Working
Group
Group
2,
1A,
and Operation of
"Health
"Managed
Plans,
Purchasing
Patients
care/Toward
&
and
Beyond";
Working Group 3, "Governance"; "Working Group 4, "A Global Budget",
and Working Group. 5, "Insurance Reform"; Cluster Group II,
"New
System Coverage", and Working Group 6, "Benefits Package"; Working
Group
7,
"Coverage
for
Working
Families";
Working
Group
8,
"Coverage for Low Income and Non-Working Families"; Cluster Group
44
�·-·
III, "New System Infrastructure", and Working Group 9, "Quality
Measurement"; Working Group 10,
"Information Systems"; Working
Group 11, "Malpractice and Tort Reform", and Working Group 12,
"Facilitating
Professional
Development";
Cluster
Group
"Integration of Government Programs into the New System",
IV,
and
Working Group 13, "Medicare"; Working Group 14, "Department of
Defense"; working Group 15, "Veterans"; Working Group 16, "Federal
Employers
Health
Benefits
Government Programs";
Plan";
Working
Cluster Group V,
Group
"Bioethics
16A,
"Other
or Ethical
Foundations of the New Systq", and Working Group 17, "Bioethics";
Cluster Group VI, "Transition to the New System, Short-Term Cost
Controls",
and
Working
Group
18,
"Accelerating
New
System
Development"; Working Group 19, "Administrative Simplification";
Working Group 20,
"Interim Cost Controls";
Cluster Group VII,
"Financing", and Working Group 21, "Financing"; Cluster Group VIII,
"Health Policy Initiatives for the Underserved", and Working Group
22, "Health Policy Initiatives for the Underserved", and Subgroup
A,
"Underserved
"Vulnerable/High
Rural
Risk
and
Inner
City
Populations";
Children", and Subgroup D,
Areas";
Subgroup
c,
Subgroup
B,
"Women
and
"Population-Based Public Health and
Prevention"; Cluster Group IX, "Mental Health", and Working Group
23, "Mental Health Benefits Package"; Working Group 24, "Substance
Abuse"; Working Group 25, "Children's Services"; Working Group 26,
"Public System Impact/Special Populations"; Cluster Group X, "Long
Term Care", and Working Group 27,
"Long Term Care-Background";
Working Group 28, "Long Term Care-Public Options"; Working Group
45
�••
29, "Long Term Care-Private Options"; working Group 30, "Cost and
Revenue"; Cluster Group XI, "Economic Impact", and Working Group
31, "Economic Impact"; Cluster Group XII, "Quantitative Analysis";
and Working Group 32, "Quantitative Analysis; Cluster Group XIII,
"Legal Audit", and Working Group 33, "Legal Audit"; Cluster Group
XIV,
"Numbers Audit",
and Working Group 34,
"Numbers Audit";
Cluster Group XV, "The Drafting Group", and Working Group 35, "The
Drafting Group", and Working Group 36, "Disability Cross-cutting
Work Group"; Working Group 37, "Rural cross-cutting Group"; Working
Group 38, "Benefits Coordination''; Working Group 39, "Minority
Issues Review Group"; Working Group 40, "Academic Health Centers",
and Working Group 41,
"Workers' Compensation Task Force", are
"advisory committees" under the Federal Advisory Committee Act, 5
u.s.c.
App.,
§§
1 through 14, and that they are in violation of the
Federal Advisory Committee Act, Title 5
u.s.c.
14, the Government in the Sunshine Act, Title 5
the Freedom of Information Act, 5
u.s.c.
App.,
u.s.c.
§§
1 through
§
552b, and
S 552a, in that they have
failed to file advisory committee charters, and have refused and
are refusing to open all of their meetings to ·the Plaintiffs, and
have refused and are refusing to permit Plaintiffs' participation
therein, and have refused and are refusing to notify the Plaintiffs
of their meetings by formally announcing said meetings in the
Federal Register, and have refused and are refusing to permit the
Plaintiffs to inspect and copy at a single location in the officers
of the Defendants, the records, reports, transcripts, minutes,
appendixes, working papers, drafts, studies, agendas, and other
46
�.til:.
documents which were made available to or prepared for or by the
Defendants.
(B)
Enter a
Temporary Restraining Order and a
Permanent
Injunction, pursuant to Rule 65 of the Federal Rules of Civil
Procedure, enjoining the Defendants, HILLARY RODHAM CLINTON, DONNA
SHALALA, LLOYD E. BENTSEN, LES ASPIN, JESSE BROWN, RONALD BROWN,
ROBERT B. REICH,
MAGAZINER,
JUDITH
PRESIDENT'S
TASK
LEON PANETTA, ALICE RIVLIN,
FEDER,
FORCE
individually
ON
NATIONAL
and
CAROL RASCO,
as
HEALTH
members
IRA
the
REFORM,
CARE
of
the
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and the
INTERDEPARTMENTAL WORKING GROUP OF THE PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM and its CLUSTER GROUPS, WORKING GROUPS
AND SUBGROUPS, namely, Cluster Group I, "New System Organization",
and Working Group 1,
Cooperatives";
Providers";
"Principles and Operation .of Purchasing
Working Group
Working Group
lA,
2,
"Health
Plans,
Patients
"Managed care/Toward
&
and
Beyond";
Working Group 3, "Governance"; "Working Group 4, "A Global Budget",
and Working Group 5, "Insurance Reform"; Cluster Group II, "New
System Coverage", and Working Group 6, "Benefits Package"; Working
Group
7,
"Coverage
for
Working
Families";
Working
Group
8,
"Coverage for Low Income and Non-working Families"; Cluster Group
III,
"New system Infrastructure", and Working Group 9, "Quality
Measurement"; Working Group 10,
"Information Systems"; Working
Group 11, "Malpractice and Tort Reform", and Working Group 12,
"Facilitating
Professional
Development";
Cluster
Group
"Integration of Government Programs into the New System",
47
IV,
and
�working Group 13, "Medicare"; Working Group 14, "Department of
Defense"; Working Group 15, "Veterans"; Working Group 16, "Federal
Employers
Health
Benefits
Government Programs";
Plan";
Working
Cluster Group V,
Group
16A,
"Other
"Bioethics or Ethical
Foundations of the New System", and Working Group 17, "Bioethics";
Cluster Group VI, "Transition to the New System, Short-Term Cost
controls",
and
Working
Group
18,
"Accelerating
New
System
Development"; Working Group 19, "Administrative Simplification";
Working Group 20,
"Interim Cost Controls"; Cluster Group VII,
"Financing", and Working Group 21, "Financing"; Cluster Group VIII,
"Health Policy Initiatives for the Underserved", and Working Group
22, "Health Policy Initiatives for the Underserved", and Subgroup
A,
"Underserved
"Vulnerable/High
Rural
Risk
and
Inner
Populations"·;
City
Areas";
Subgroup
c,
Subgroup
B,
"Women
and
Children", and Subgroup D, "Population-Based PUblic Health and
Prevention"; Cluster Group IX, "Mental Health", and Working Group
23, "Mental Health Benefits Package"; Working Group 24, "Substance
Abuse"; Working Group 25, "Children's Services"; Working Group 26,
"Public System Impact/Special Populations"; Cluster Group X, "Long
Term Care", and Working Group 27, "Long Term Care-Background";
Working·Group 28, "Long Term care-Public Options"; Working Group
29, "Long Term Care-Private Options"; Working Group 30, "Cost and
Revenue"; Cluster Group XI, "Economic Impact", and Working Group
31, "Economic Impact"; Cluster Group XII, "Quantitative Analysis";
and Working Group 32, "Quantitative Analysis; Cluster Group XIII,
"Legal Audit", and Working Group 33, "Legal Audit"; Cluster Group
48
�••
XIV,
"Numbers Audit" ,
and Working Group 34 ,
"Numbers Audit" ;
Cluster Group XV, "The Drafting Group", and Working Group 35, "The
Drafting Group", and Working Group 36, "Disability Cross-cutting
Work Group"; Working Group 37, "Rural Cross-cutting Group"; Working
Group 38, "Benefits Coordination"; Working Group 39, "Minority
Issues Review Group"; Working Group 40, "Academic Health Centers",
and Working Group 41, "Workers' Compensation Task Force", and all
those in active concert or participation therewith, from holding or
conducting any meetings, or destroying or otherwise defacing any
records, until a final hearing and determination of this action,
perpetually enjoining the said Defendants, and all those in active
concert therewith, from holding or conducting any meetings until
advisory committee charters are filed in accordance with the
Federal Advisory Committee Act, 5
u.s.c.
App.,
§
9, and mandatorily
enjoining said Defendants, and all those in active concert and
participation therewith, to open all of their meetings to the
Plaintiffs (and the public's) attendance and participation, and to
announce said meetings in advance in the Federal Register in
accordance with the Federal Advisory Committee·Act, 5
§
10, and the Government in the Sunshine Act, 5
u.s.c.
u.s.c.
§
App.,
552b, and
permit the Plaintiffs (and the public) to inspect and copy at a
single location in the offices of the Defendants, the records,
reports, transcripts, minutes, appendixes, working papers, drafts,
studies, agendas, and all other documents which were made available
to or prepared for or by the said Defendants in accordance with the
49
�"' ~
.
Federal Advisory Committee Act,
5 u.s.c. App.,
Freedom of Information Act, 5 u.s.c.
(C)
§
§
10, and the
552a.
Award Plaintiffs such other and further relief, including
attorneys' fees and costs, to which this Honorable Court may deem
Plaintiffs entitled.
I, Jane M. Orient, M.D., declare under penalty of perjury that
the foregoing is true and correct.
Executed on this
ci<;~ of
March, 1994.
DISTRICT OF COLUMBIA )
WASHINGTON, D.C.
)
sworn an_d _l!uqscribed to before me by Jane M. Orient, M.D., all
on this the~ay of March, 1994.
My commission Expires: _y"'----..:....f...~...~_-_9:....;;;;.~ _ _ •
&it· . oe: ~-r
Y PUBLIC
perjury that the
DISTRICT OF COLUMBIA)
WASHINGTON, D.C.
)
50
�·:-._
Sworn and~~ubscribed to before me by William Shaker, all on
this the gl¢~Y of March, 1994.
My commission Expires:
~
-rcr-r '-
I, Kenneth F. Boehm, declare under penalty of perjury that the
foreqoinq is true and correct.
Executed on this the d-
,._~ of March,
1994.
KENNETH F. BOEHM
DISTRICT OF COLUMBIA)
WASHINGTON, D.C.
)
Sworn an~subscribed to before me by Kenneth F. Boehm, all on
this the &; (J. v~ay of March, 1994.
-
'f_-_r_eo-=---·
My Commission Expires: --~-----...;.l
......
KENT MASTERSON BROWN, ESQ.
CHRISTOPHER J. SHAUGHNESSY, ESQ.
1114 First National Buildinq
167 West Main street
Lexinqton, Kentucky 40507
(606) 233-7879
(606) 252-6791 - facsimile
cP~. k1 f?Pa;-~
NORTHAM, ESQ~~
Bar No. 206110
ALAN P. DYE, ESQ.
FRANK M.
51
�·-·
Bar No. 2125379
WEBSTER, CHAMBERLAIN & BEAN
1747 Pennsylvania Avenue, N.W.
Suite 1000
Washington, D.C. 20006
(202) 785-9500
COUNSEL FOR PLAINTIFFS, ASSOCIATION
OF AMERICAN PHYSICIANS AND SURGEONS 1
INC. 1 AMERICAN COUNCIL FOR HEALTH
CARE REFORM, and NATIONAL LEGAL &
POLICY CENTER
CERTIFICATE OF SEBVICE
This is to certify that a true and correct copy of the
foreqoinq
Verified
Judqment,
Restraininq
Injunctive Relief
Second
has
Amended
Order,
been
and
Complaint
for
Preliminary
served upon
Declaratory
and
Permanent
Defendants
by hand-
deliverinq a copy of same to Defendants' counsel of record as
follows:
Whitman,
Hon. Elizabeth Puqh, Hon. Jeffrey Gutman, -Hon. Robert
u.s.
s.
Department of Justice, Civil Division, 901 E Street,
N.W., Room 952, Washington,
o.c.
20004-2037, all on this the
day of March, 1994.
KENT MASTERSON BROWN
c\wpwin\clinton\amendcom.2nd
52
;t~r~
�.....
Weekly Compilation of
Presidential
Documents .
• Mcmday, Februa:jl, 1993
Volume 29-Number 4
Pages 93-114
.
...
..
.......................
EXHIBIT A
-A24
�·~·
Jan. 2S I .~dmini.s~rc::ion cf William]. Cli~::-n,l993
once agnin they s:tid. i!.' you want to c:~ something to help rebuild :he auto inc:!lt.-y, do
something to ecnt:ol hellt."t C:lre c:::sts. And
William J. Clinlon
as Mr. Pane~..a just said again, in a rather
Tne \\nite House,
plaintive way before you c:ame in. t.~ere is
January2S,l993.
no way we .....Ul eve:- get c:ontrol of the F eder.U
budget ciefic:it unless we do something about
[Filed ~-r.b. the Offic: nf t.~e F edenl Regi.tter, health care.
2!07 p.m., Ja."\uaty 25, 1993]
The message is pret"ty simple. It's time to
make sense of America's heald'l care svstem.
Nan: 'n'.i.t C::.Xecutive nrc!er .,..,..t pubUshed in the It's time to bring c:-osts under oon::::-::1 ~d to
Fedenl Register on Janu.,.· 27.
make our families and b•uinesses s~~:-e. It's
t:i:ne to make good on :.'te America.-:. ?!'Omise
th:: too many people have talked about for
too long. while we ha..·e c:-ontinued :o spend
Remarks on Health Care Reform and more than 30 pe:-:ent more of O\!:' income
an Exchange 'Vith Reporters
on health c::t:-e than anv other ~t:ien in the
]cr.uary 25,1993
wo:-!d. get less !'or it. a:1~ see lOO.OOJ .A.merica."ls :l mont.'l losir.g ·their h~th i::r.:ranee.. ·
I wan: :o say good .U:ernoon to me:nbe:s
.o\s a first ste? in respondi."lg to :!le deof t.'te press. We have jus: finished a very
m:.."lcis of lite:a.i!y miilicns of A..-::ericans,
lively cllic:-.:ssion :1bout the al&Ssive task before w in hwth c:ue. vice P:-esidect Core today I am annou.."lc:ing the formaee: of the
and 1 ~e a st::-ong commitment to the P:-esident's Tasic Fore: on National Health
.Americ:az: ;>eaple during the last elec::ion that Re!or:n. Although the issue is com?ic:. the
task force's mission is riint)le: Bl:ild on the
we woulc present to the United States Congress. wi:bi."l 100 d:ys. a ~~ that would take worlc of the =..-::paign and the tn:ui:ion,lisstrong ac:ion to control cealth care costs in ten to all par:es, and pn=are h~:: care
Ameri=. and to begin :c prcvide for the reform legislation to be submit:ee :o Cong:-ess within 100 days of our talc:::g office.
health care needs of all.~ericans.
Tnis task fore: .....Ul be chaired b-.· :!:e FU'St
~ I t:-aveled ac:css ce c=unt:y last year,
no stories moved me more than the healt.~ I...ady,. Hillazy Roci.~am Clinton. ;..;e, ·.a.ill iDc:re stories. ~ I think :11 oi you know, many ch:de the Sec:e::r.:ies of He:Uth anC: ~uman
of t.~e peocle in our Faces of Hooe luncheon Se:v;c:=s, Treasury. Oefeose, Vete:a.ns A!last week curing dte Inaugur.al ~repeople fai:s, Comme:c:, Labor. :lS well as t.~e Direcwho were st.-uggling to overcome incfed.ible tor of the Offic:= of M:.."l:lge:nent a."ld 3udget
. adversity occasioned by their health care and senior White House staff memhe:s.
I am grate£~1 that Hillary has ago:-eed to
problems. We've me~ elderly people choosing every week betweeo :nedic:ne and food: chaiz' this task for= and not onlv becwse
we've met people for-c:ed to leave their jobs it means she'll be sba.r'.ng some o'r :e beat
I e=ee: to geneDte. lu many or )''e\! lcnaw,
tc get on ?ublic assistance to deal wit."t children wit!l :e::i!'ic prcble::u; we·..·e met count-. whife I wa.s Covernor of my State. Hillary
less ~pie who c:an': C::an~e d'leir jobs be- chaired the A:iwuas Eduacon Sta.::dards
cause the-.· or someone i:l tnei: family have Commi:tee. wh.ic.~ c:-nted public cool acc:ediction s=nCa.-ds t.~t have siDe:: became
bad hwt.~ =re preblems.
You will all remember. :lt t.i.e economic a model for nat:ion:ll reform. She se~ u
conference th:lt we sponsored i:l tittle Rock. my designee on the Southem Regioc.al Task
perhllps t!:e overwhe!.oni::g conc:=m of the For-ee on Infant Morulity. was also 6.air or
business people there. of all sizes, was doing ou: St:ue's r'Unl be:llt.l.i commit:ee i.."l l9i9
something about the c=rt and the availability and 1980, a time in whic.~ we initiated a uumof health c::are. When the Vic= President and ber or health cue n:ror:ns that be:ent: the
I met wit!l the big three auto makers and people of my State to t.~e present eay. And
the presic=t of the Ynited Auto Workers, on tne board of the .o\rbns:lS Child.""'e::'s Hosthe Counc:il as the Cou:1c::l may request, to
the e=:en: pe:-mitted by law.
A25
·.
�••
97
;p~t.al. she· he! pee to establish our St:lte's fint
-.n.eocatal unit.
I think that in the ccming months ~
.Ar.lericm pCQple .,..'ill learn, as the people of
·ou: State did. th.at we have a First L.ady Qf
"ma.-ty talents, t.lu.t who most of all c:.:Ln bririg
"people together around complex· and difficult
ru::sl area.s, co,·erage for li::le c:hi.ld:en, dealing with the AIDS c::-'.sis adeq1.:ateiy, still
unrnet nee~ in the are:~. of women's health
care, the proble:n of the , .. ete~"'.l in this
country who don't h:ve aceess to care, eve:
a.s their own network goes broke. All these
issues will be dealt with in :his wk force.
issues to lwnmer out consensus and get This is going to be an unprecedented effort.
And let me just say, in general. we're going
things done.
· Here in the White House, Hillary will to set up a work:rcom. lend 'Of like· the war
·work with my dcmestic policy ad..iser. Carol :rcom we had in the campaign, over in the
:Rasco: my se:Uor policy adviser, Ira E:ecutive ocr~ Building..~"ld all of the deMagaziner; and the head of our health care partments you see here , re:m:s~nted and
transition team, Judy Feder. I've a.slced all leaders )IOU see representee a.-ounc this table
of them to be as inc!wive as possibie. And will be reorese:ued in th:~.: :rcorn. And we
a.s a part of that. we are inviting the American are going to 'III'Ork consb."ldy. ~y and lligbt.
public to write w here at the White House until we have a health =re :la."l reaev to subwit.~ their SU!3cr..ions. All of them should be mit to the Congress t.~t .;,e believ~ we em
sent to the Task Force on Nationai Health pass.
Fi..-wly, le: me SAy I a.-n cornmi::ed to
Care Re£'onn at the \Vhite House in Washin;:ton, DC 20500.
doing :his in a oat:\ership ...."i:h :he Congress.
\ve will no C::,ubt be c:itici%eci by some I ... aslc t..'le le:!.Cership of :.~e Congress to
for under-.:Ucing somethi."\g very. ve:y ambi- waric wit.~ me en a bio:1:":isa.-: b~is md to
tious. But as I sa.ic! in my IAaugural ACdress, CO whatever we C.."l to malce SU:"C :.hat as we
we're going to have to malce some tough present the pian. we have wo rna-':ni:=d its
choices in order :o control health care costs, Chances oi eariypassage in t.~e Congress.
to bring them c!own within inflation. md to
I thank all these people !'or the!: willmg,provide he~th =re far all. In order to pre- ness to serve and to woric together. I hope
serve the vitality of the American pri..-ate sec- the American people will sec. jus: how pastor. in order to keep the Americm people's sionately I personally :m cornmi:::d :o damg
budget here at th.:s national level f:rcm gomg something about health ca:: refor=. We've
totally bAnkrupt, we are going to have to tallced abOut it long enou;:h. The time bas
malce some tough c.~oic:s. Powerfui lobbies come to a.c::. and I hAve Chose: :he course
and sp~ inte:-esu m:y seek to de:-:W our th:~ot I t."Unk is most likely :o lead to adon
efforts, and we m:~.y m~e some people angry. that will improve the li,·es oi tnillions of
But we are ciete::nined to come uc with the Americans.
best possible solution. And in my lifetime,
Q. Mr. President. c::m you provide univer·
at le~. there has never been so muc.~ con- s:U coverage without driving up the deficit?
sensus that something
to be done.
The P~. I think vou ~"l do it i£
We have a plan from t.'-le American Nunes you cont:ol the cost of heal~ care. You have
A.uoc=tion, rrom the Ameri=n Acc!emy of to ~et me just-1 c!on't want to get
Pb.ysicians, f:rcm the American Academy of into one or these things t.~at prc"Cice & let
F:mily Prac:ic:. from the h=th insurance of CU"tcons about my polic::1 wonlc weabess.
industry itsel.f. We h:ve a plan uniting busi- hut we're at 14 percent oi ou:- \:'.come em
ness and labor. Tne:-e is :n overwhelming h=ch care now. The nex: mos: ~
knowledge th:t we have to move and move· be:lth c:are svstem in the wcrici i.s cWda's.
now. We are going tc do our best to reform It's at about '9.2 percent ct" inco~e. 'lAat Ls
.O&Jr system. We are going to do our best to a huge difference, massive. .o\nd yet. tM:ty
meet the human need.s oF the people of this orher major count:y with which we compete
countty.
p~des some basic he:lth -care to evetyThere are :11 \cinds or p:rcblems th:t have body. somet."&i.-,g we don't do. So the answer
to be d=t wit."& thole we haven't even dis· to your Ciuesticn is. in my judgment, if' we
c:-.:ssed yet Ac:c=ss to care in inner cities and do this right eve:- the nez: 8 ynrs. yau':e
-.u
w
A26
�4111111
98
'
Jan. 2.5 I Adrr.i:'\i.stn:tion of Will£cm J. Clin:an,lS93
going to see h1.:ge s=.vings in tax doll~ and
even bigger sa..ings, more :han t-Aice the savings. in rrivate dollars th:lt will free up hundreds o billions of dollan Uter:Uly between
now and the end of the decade to reinvest
in ~nomic growth and opportunity.
·
In the she~ nm, our tough call will be
how do you tAke the savings and phase ln
universal coverage. Or shoulCi there be some
ot.~er way to pay for that? We've got some
sho~-term calls to make. But there's no question that in the median term, S to 8 yean.
you're looking at massive savings with uni.vers:U cove::1ge in both t:x doU:u"S and private
s~or dollars if we do it right.
Q. Mr. President. do you intend to p:iy
· t.'le First Lady for her effor-..s?
Tis. PnaiJ.ent. No. No. I never h:ve p:Ud
he:- for he:- public servic: efforts. I don't w:mt
we will never, neve:- get :lft)-...·here if we stand
paralyzed, because there's no such thing as
a perfect alternative.
Q. W'hat factors did you =nsider in giving
this high-protue position to Mrs. Clintca?
The Prc•idcm.. Of all the people rve eYer
worked with in my Ufe, she's better at organizing and leading people from a complc:z
beginning to a c:rtain end than anybody I've
ever worlced with in my life. And that's what
I want done here.
NOTE; The President Jpc'llre u 2:02 p.m. In the
RoosCYelt Room at the White House at a meeting
oC rhe Health Care Worlcing Cmup.
tost~now.
Q. Is 100 d:ys h:lrd :."'1d fast, or are you Statement by the Director of
willi..,§ to be flexible on tZ..:t if it's not quite Communications on the Presicient•s
re:a.dv.
Meeting With the Joint Chiefs of
The Preailknt.. If it were 101 days I Staff
wouldn't have: hc:\rt :ltt:lc:lc. but 1 don't w:mt JanUDry 2S. 1993
to-1 want it done now. I think we know
whAt the major alternatives are. 'What we
The President anci the Joint Chie!s of StaE
have to do now is somet.'Ung nobod.y's done. had a co~ honest. and respectful meeting.
and :=t is to meld them into the best pos- T'ney coYCred a range of issues but !ocuseCl
sible legislation, t:alcing account or some of primarily on gays in the military.
the proale:ns t.~t ezist with C'YCf)' course.
The President reiterated his c:om:nitment
And let me mAke one ac:lcnowleegment on to ending disc::imination against hotnOsc:zcals
the front end about this. Legitimate objec- in the military solely on the basis of status
tions can be ::Used to any course of action md to maintaining morale and cohesion iD
in this area. Tn:t is, the:-e is no such thing the military.
as a peri'ec:: solution. So wh:tever course we
The Joint Chiefs of Staf'I' ezpresseci their
choose to take, somebody can say. -weD. it's concerns aud dimc:ulties with the President's
not ?e:fec: for these re:sons.-To tbt,l have
commit:nent but also er.:ressed their re=ect
t'NO =swers, and I'm going to say this until
for his decisionmalang pC,wer as Co~der
I'm "blue in t.'te face for this enti.~ yea.r until
we get action. N umbe:- one, the want thing in Chief.
we an do is lceep on doing wh~t we're doing·
now, be=use more and more people are falling out oi the system :ind the cost is becoming more and more burdensome to those who
are still "be:uing it. So wh:tever course we Appointment of John D. Hart as
talce, we will preserve wh:lt is best about Deputy Assistant to the President
Ameri=n hdth care, some consumer choice and Deputy Director of the O£Bce o£
mci the qUAlity or care. So whatCYer pral>- Intergoveramental.Ufairs
lcms we b&ve. they won't be as bad as the Jcnw:ry 2S.l99J
•
ones we've got now. Number t'NO. this is not
The President tr::Mhy appointed Jolm D.
going to 1:te the end of the line. Whatever
problems are there can be fU:ed later. But Hart to the position of Deputy Assistant CD
A27
�·~·
1601 N. Tucson Blvd. Suite 9
Tucson, N. 85716
(800) 635-1196
( 602) 327-4885 in A1.
Association of American Physicians ond Surgeons, Inc.
February 9, l99J
O~i-!C!RS
Notte: •..t
C:~N. MD.
;:,~
Nc--.a.
o•
c:n::..s w. ~.Jt. t.l~;
:"'SS((CN.i:hl:t
1\-='~.r.t-:. Goa
t."co,g~C ~..
~'01''
N:i~hl...r.t
:..tc.
II
~. ~ Oole!l ~M.D.
"''C:UVI
t;:nic:crct. TA
.ocr.-.r. H
boa. ·"_ '.t D.
~-l"z"~
c,;;;,lleM~~t. Ott
DIRECTORS
Oc-~"
ac,cr.1. M.D.
l..iQI.t#Q. Gf,
0,.1osW ec..,.~. M.D.
~s::l\.t.S
I.Cio. J. ~ \'lD.
H:li~
.JC.-~ I.
I'IJ
C..-v. :.t~
Dc-.~k
r.t~n J ew~. r.tO
o~•
VL
~r,.~).
Hillary Redham Clinton
Chairperson
'
President's Task Force on National Health care Reform
The White House
Washington, DC 20500
Dear Ms. Clinton:
on behalf of the Association of American Physicians
and Surqeons, Inc., a national association of private,
practicinq physicians, please be advised that ! and its
members desire ~o attend the next and all subsecuent
meetin;s of the President's Task Force on National Health
Care Refon1.
This request is made pursuant to Section ~o of the
Federal Advisory Committee A.ct, vhich mandate~ that all
such advisory committees be open to the public. Advance
notice of the next meeting and any and all sUbsequent
mee~in9s would be appreciated so tha~ I and other members
may make plans ~o travel to·washin;ton to be in
attendance.
~.:r.
r-n..• t.. Goos..c..... s. . :..ta'").
$on I"YifC:O'I'O. JX
I will appreciate a reply at the
earlies~
possible
dat:e.
w.~~.r.·~
.1\IICI'Itft.. G:A
1¥0- L at.c::'IC1t. '"'r..
O=lttt:ln'.J
:.m
Sincerely,
.
~tu~
llC:" w """"·\tO
luc:tr... ~
JI'IWICI'I Sc."'oiil.:w. M.~
~<~IV..'QIIL 1,1
M.\:1\Qf!! r.c:N~!t.
~~~Oft. Y.!.l\
ex:CUtM: C:AfCIOA
.,~ur...,
Jane M. Orient, MD
Executive Director
"·"' c
r.\. ~-MI.)
("'..;:1\!E:!~A: C:OUfGI.
~· .......
.nl--.ltvMr"
KMB/jmo
cc:
Bernard w. Nussbaum
Counsel to the President
The White House
..
·-----··----••,
EXHIBIT B
A28
�..
A.rnerica11
•
.
Council for Health Care Reform
$155 North 37tb Street
Arlington, Virginia 22207
Febnury 9, l99J
·.
Hillary ~ ,,dham Clinton
Ch:1irpcrson
President's T:I.Sk Force on National Healtbcare Reform
The White House
Washinbton, D.C. 20006
Dear M~. <1inton:
I am writing on behalf of the American Cauncill~lr Heal~ Care Rd'orm. We were
establi:ih\:d in 1983 as a non-profit organization to protect consumer rights and help lower the
cost of hCllth care delivery.
t•t=se nceept my request to attend the next and all subsequent mc:tings o(the President'~
Task fnrc:e on National Healthcarc Reform. The American Council for Rcal~'t Care Reform is.
making this request pursu.ant to S~on 10 of the Federal Advisory Committee Ac:c. As you
must know, this Act mandates that all suc.'t advisory ccmmiuee m=inss be open tO the public.
We are asked cbily if. we suppcn the President's health care rcf'orm initiatives. Our t1nly
answer c:m be that we have: no idea of what is being proposed because all delibentions arc: hc:inlt
conduc."'tc:d in secret. We would be supportive of a numbt-:r of changes in health care policy.
Howevc:r these changes mu..st be thoroughly examinc:d; SC"\.&et deliberations can produce nothing
but hBti ('ublic policy.
Plc:a:;c: reply to our request a.t yr:mr earliest possible convenience.
;_:::_, L -----__.wm;D a~
H.
Exet utive Director
c;c:
~mard
W. Nussbaum
\uunsc:l to the President
The: White House ·
PI Case.provide us with advanced notice of' the nc>~t and any and all subsequent meetingJ;
so that we= may plan accordingly.
.....................
EXHIBI'I· C
A29
..
�,
NATIONAL LEGAL & POLICY CENTER
1156 15th Street, Suite 550, vV;1shington, DC 20005 202-331-0541
Februa~
11, 1993
Mrs. Hillari'
Rcdha.rr~
Clint.on
·.
Chairm=:n
President's Task Force
on National E:alth Care Reform
The w~ite House
.
Wasr~geon, DC
20006
Oaar Mrs.
Cli~ton:
Please be advised that members of the staff of the National
Legal and Policy Cer.ter wish to attend ehe next and all s~se~~~~t
maetings of t:.e President's Task Force o~ Eealth ca=e Ref==~This re~~est is made pu:su~~t to Section 10 c! ~he AcviSO=Y
Committee Act, whic~ re~uires that. all such ad.visory CO:!'.::tittee
meetings be open to the public~ Advance notice of the ne~: ~d all
s~bsequent
meetin~s
would be appreciated so t:.a~ cur
representatives may at.t.end.
The Natio::.al. Legal ar..d Policy. Center pro::oc.es e:.hics in
government. we do r..ot. believe that the secrecy of Task Force
delibera:io::.s, inclcding the closed r~ture of its ~eet.i~gs. serves
this end.
I t.ave enclosed a coi)~' of tl:.e •code of Ethics for co·..-e::-:.er..t
Se~;ice.• Yocr atter.:ion is direc:ed to item #2 wtich states, ·~~Y
~erson in Gove~~e~c service shculd uphold the Cor~citution~ la~s.
regu~ations of the United States ar.d all ;overnme~cs therein ane
n~ver
CCF~
be a parcy to their evasion.• I encourage yo~ to circtilace a
of the Code to all m~~e~s and staff of the Task Force.
I look
fc~ward
to your reply.
~et.er T. Flaherty
President
cc: Bernard
w.
Nussbau~.
Counsel to the President
........................
EXHIBIT D
A30
�'
THE: WHITE HOUSE:
WASI-'41NGTON
February 12, 1993
Jane M. Orient, M.D.
··
Executive Director
Association of American Physicians
and surgeons, Inc.
~601 N. Tucson Blvd., Suite 9
Tucson, Arizona 85716
Dear Or. Orient:.
The First Lady has asked me to respond to your letter,
dated February 9, 1993, concerning the President's health care
task force.
The President has selected the First Lady, Hillary
to chair the health care task force. In addition
-:o the First Lady, the task force currently includes t."le
Secretaries of·the Treasury, Defense, Commerce, Labor, Health and
Human Services, and Veterans Affairs; the Director of t.~e Office
of Management and Budget; the Assistant to the President for
Domestic Policy; the Assistant to the President tor Economic
Pcli·cy; the C."lair of the Council of Econold.c Advisors; and the
Senior Adviser to the President fer Policy Development.
Ro~am Clin~on,
The task force has not yet held a meetin;, although
of t."le task force were present on January 25 when t.~e
¥resident announced the formation of the task force and defined
its mission. The task force is planning to hold some public
~eetings in the future.
Those meetings have not yet been
scheduled.
~embers
.
As the President aMouncec! en January 25, the Senior·
Adviser to the President for Policy Development will lead an
interdepartmental working group that will gather inforcation tor,
and provide information to, the task force. The working group
will consist of government employees, and will ec~sul~ with a
vide ranqe of citizens in the public ana private sectors. The
task force, in turn, will review information provided by the
working group and make recommendations to the President.
'It is our opinion that the Federal Ad.yisory Committee
Act does not, and was net intended ~y Congress to, apply to the
health care task force -- compcsed solely of Cabinet secretaries,
senior White House otficials and the First Lady. The participation of the First Lady on the task force does not triqqer
application of the Act.
Fi=!OM COY
·-----··-----EXHIBIT E
A3l
�A ._
••
Jane M. orient, M.D.
February 12, 1993
Paqe 2
As noted above, the task force will be holdin9 some
public meetings at which citizens, orqanizations and institutions
will have an opportunity to present their views. ~ose meetings
have not yet been scheduled, but will be announced in advance.
Xf you and other representatives·of the Association of American
Physicians and Surgeons, Inc., are interested in attentinq such
public meetings, please contact Mike Lux at 202-456-2930.
Please feel free to contact me, my deputy Vincent
Foster cr Associate Counsel Stephen Neuwirth should you require
further information in response to your request.
Bernard W. N'Ussbat.m
Counsel to the ·President
.. A32
�THE: WHITE: HOUSE:
WASHINGTON
·.February 12, 1993
William H. Shaker, P.E.
Executive Director
American Council tor Health Care Reform
SlSS North 37th Street
Arlington, Virqinia 22207
... -. ·.
The First Lady has asked :e to respond to your letter,
da~ed February 9, 1993, concerninq the President's health c~re
't.ask force.
The rresident has selectee the First Lady, Hill~~
Rcdham Clinton, to chair ~~e health care task force. In addition
to the First Lady, the task force currently includes the
Sec:-etaries of the Treasury, Defense, Co::zmerce, Labor, Health and
Hu::1an Services, and Veterans Affairs; the Director of the Office
of Manaqement and Budqet; the Assistant to the President for
Domestic Policy; the Assistant to the President for Economic
Policy; the Chair of the council of Economic Advisors; and the
Senior Advisor to the President for Policy Development.
The task force has not yet held a meet~r.q, althcu~~
of the task force were present on January 25 when the
President an.~ounce4 the formation of the task force and de!ined
its mission. 'l'he task force is planning to hold. some public
meetinqs in the future. These meetings have not yet been
scheduled.
me~ers
·As t:le Presi~ent announced on Jan~a:;,y·:··~S·,_,.. th~.~s~nio..;:
Advisor to the President for Policy Oevelopment will leaa an
1nter4epartmental wcrkinq qroup that will gather infor=ation ~or,
and provicie information to, the taslc terce. 'rhe working qroup
will consist of government employees, and will consult with a
wide range of citizens in ~e public and private sectors. The
task force, in turn, will review information provided by the ·
working qroup and make recommendations to the President.
It is our opinion that the Federal Advisory Committee
Act does not, and was not intended ~Y congress to, apply to the •
health care task force -- composed solely ot Cabinet secretaries,·
senior White House officials and the First Lady~ The participation of the First Lady on the task force 4oes not trlq;er
~pplication of the Act •
...................
~
EXHIBIT F
A33
�William H. Shaker, P.E.
February 12, 1993
Page~
As noted above, the task rorce will be holdinq some
public meetings at which citi~ens, organizations and institution
will have an opportu~ity to present their views. Those meetings
have not yet been scheduled, ~ut will be announced in advance.
If you and other representatives of the American CoUncil for
Health Care Re~orm are lnter~sted in at~endinq such public
meetinqs, please contact Mike Lux at 202-456-2930.
.
Please feel free to contact me, my deput;! Vincent
Foster or Associate Cour~el Stephen Neuwirth should you require
fu~ther information in response to your request.
~34
�.......
':..
•
.....
_
___ _
I
THE: WHITE: HOUSE
WASH.INGTON
.Fe~ruary
16, 1993
Peter T. Flaherty
President
National Leqal and Policy Cente~
~~56 15th Street, Suite 550
Washington, o.c. 20005
Dear Mr.
Fla.he...~y:
The First Lady has asked m~ to respond to your letter,
dated Febr~ary ~l, ~993, concerninq the Presidentrs healt.~ care
task force.
The President has selec~ed the First.Lady, Hillary
Clinton, to chair the health care task force •. ~r. addition
to the First Lady, the task force currently includes the
Secretaries of the Treasury, Defense, Commerce, La!)or, Heal.th and
Human Services, and Veterans A! fairs; the Direc:.or of tlle Office
of Manaqement and Budget; the Assistant to the President ~or
Domestic Policy; the Assistant to the President fer Economic
Pol.icy; the Chair of the council of Econcmic Aaviscrs; and the
Senicr Adviser to the President for Policy Development.
~odham
The task fcrce has not yet held a meetir.q, al~:ouqh
:e:za.bers cf the task force were present on Ja.nua...-y 2 s when the
President annc~~ced the formation of the task force and defined
its mission. The task force is plar.ni.'"lq to hold so:ne puJ:2lic
meetings in t.~e future. Those meetings have not yet ~een
scheduled.
·
.
.
.
As the President announced on January 25, the Senior
Advisor to the P=esident for Policy Development will lead an
i~terdepartmental working qrcup that will gather in!o~ation for,
ana provide intormation to, the task force. ~he wcrkinq qroup
will consist of government employees, and will consult with a
wide ranqe of citizens in the public and private sectors. The
task force, in turn, will review information proviaed bv the
wcrkinq group and make recommendations· to the President:
.
It is our opinion th~t UJc Fe~er~l Adviccry Cc=mit~~A
Ace does not, and was not intended by Congress to, apply to the
health care task force -- composed solely of Ca~inet secretaries,
senior White House .officials and the First Lady. The partici•
pation of the. First Lady on the task force does not trigger
application of the Act.
Jane M. orient, M.D .
......................
EXHIBIT G
A35
�February 16, 1993
Page 2
As noted above, the task force will be holdinq some
public meetings at which citizens, orqanizations and institutionf
will have an opportunity to present their views. ~hose meetings
have not yet been scheduled, . but will be announced in advance.
If you and other representatives·of the Association of A:merican
Physicians and .surgeons, Inc., are interested in attendinq such
public meetings, please contact Mike Lux at 202-456-2930.
Please feel free to co~tact me, my ·deputy Vincent
Foster or Associate Counsel Stephen Neuwirth should you require
further infor:ation in response to your re~est.
Very truly yours,
A36
�Association of American Physicians and Surgeons, Inc.
1601 N. Tucson Blvd. Suite 9
Tucson. AZ 85716
(800) 635-1196
(602) 327~885 in AZ.
March 17, 1993
c~rc~RS
N;nc r.~ (;urr.o:rc:kue. tAn.
~':~tsi'.:ent
~k.OII
C!"'C".nes W. McOYWeti, .:r.. M.&").
"'cso:~anl-l:lcf
Altli1UI~ttlo.
L;;Jn~
c::;.a..
OA!inton. MD.
SP.c'.ll!!lOIV
~~CI1nfJCtO.
il
r~. ;.OWQ!I Currpbell, M.O.
lntCSIIff.!f
C01stcono.lX
J~ "'· Suvtes. ·"·· M.n.
lr':"'mtfe:.;,t~ Past Pfe-.,iCJCnl
CeniP.rlil:e. Cu
BEQUEST FOR·QQCUMENTS ANP INFORMATION fROM THE
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE BEFOBM,
lTS INTERDEPARTMENTAL WORKING GROUP AND ALL CLUSTER
GROUPS, PURSUANT TO THE fREEDOM OF INFOBMATION ACT. 5
U.S.C. SECTION 552 AND THE FEDERAL ADVISORY COMMITTEE
ACT. 5 U.S.C. APP. lOCbl
TO:
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE
REFORM C/O HILLARY ROOHAM CLINTON, Chair, ana
IRA MAGAZINER, senior Advisor to the President for
. Policy Development
BERNARD NUSSBAUM, Counsel
Executive Office of the President
The White House
Washington, D.C. 20500
DIRCCTO~
C!c:u~ .A,. ~. Jr..
M.D.
i..UWSIQ. C.:.
C1 Jr.l$ W C~n<il. Sr .• M.D.
Jo:J'::k$0;>. MS
to:s.l. CQPelond.
1-!·QSdOiC r.:J
JC'lmo:. ~.
M.O.
Cr:t. M.O.
Pursuant to the Freedom of Information Act,
5
u.s.c.
Section 552, and the Federal Advisory committee Act, S
u.s.c. App., Section
~O(b),
the Association of American
wLand. F.
r>..w. MO.
ChtCCI'JC. IL
v.;,. C...-!lr;. ~tO
BOIS!!. II'.'
!'c:u; i Gr..csvCh. 51.. M.O.
Son M:a11io. TX
.!t:"l~ .;
W
~uniltl.lcltrinn,
M. (;
Allnntc.GII
/..n.;Jrr:.v :. M-;rr-"· M.D.
0<.1klcr\d, 1\M')
lkn W. f'Pimz. M.O.
7uCICcr. ~
Jc;opn Sc:n-. M.D.
Sc;cllsdOIA, ,1;'
~. . ~;~~~~
f'.et\iUt. M.O
Physicians and Surgeons, Inc., by and through Jane
M. Orient, M.D., Executive Director, hereby requests from
the President's Task Force on National Health care Reform
and its interdepartmental working groups and all cluster
groups thereof the following
doc~ments
to be made
available for public inspection and copying at the
r~o~:cr•. WI\
offices of the President's Task Force on National Health
!:Y.!'=C\Jl'fvc DIU!:CTOR
ltr.(t h/1 (.)liunl.
M.O.
G~N!:IfAL COJNSEL
IC~' ~.'IOs:vr:a::r;
Care Reform:
1.
Brown
2.
~
The Advisory committee Charter of the
President's Task Force on National Health care
Reform.
All records, reports, transcripts, minutes
(including minutes containing a record of the
persons present and a complete and accurate
description of the matters discussed and
conclusions reached), appendixes, working
.....................
EXHIBIT H
�••
3.
4.
5.
6.
papers, drafts, studies, or other documents which have
been or will be made available to or have been prepared
by the President's Task Force on National Health care
Reform;
All schedules of meetings and agenda of the President's
Task Force on National Health care Reform;
All records, reports, transcripts, minutes (including
minutes containing. a record of persons present and a
complete and accurate description of the matters
discussed and the conclusions reached), appendixes,
working papers, drafts, studies, or other documents
which have been or will be made available to or have
been prepared by the interdepartmental woi·kinq qroup
and any and all of its cluster groups for the
President's Task Force on National Health Care Reform;
The schedules of all meetings and agenda of the
interdepartmental working group and each of its cluster
groups; and
The names and background histories of all persons who
are members of or consult or advise (whether on a fulltime or part-time basis and whether they are paid or
not, and the amount paid where applicable), the
President's Task Force on National Health care Reform,
the interdepartmental working group and all of the
cluster groups thereof.
As this request will contribute significantly to public
understanding of the operations and activities of the President's
Task Force on National Health care Reform and its
interdepartmental working group and cluster groups and the
activities of the government itself, the aforesaid documents and
information should be furnished without any charge or at a charge
reduced below
t~e
fees established in
s u.s.c.
Section
552 (a) (4) (A) (ii).
Pursuant to 5
u.s.c.
Section 552(a)(6)(A), a determination
of compliance is expected within ten (10) days.
Dated March 17, 1993.
Respectfully submitted,
cl'-- m tJ • :
~
Jane M. Orient, M.D.
Executive Director
�••
AMERICAN COUNCIL FOR HEALTH CARE REFORM
5155 North 37th Street • Arlington. Virginia 22207
(703) 534-6028
REQUEST FOR DOCUMENTS AND INFORMATION FROM
THE PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE
REFORM. ITS TNTEBDEPARTMENTAL WORKING GROllPAND ALL
CLUSTER GROUPS. PURSUANT TO THE FREEDOM Of. INFORMATION
ACT. 5 U.S.C SECTTON 522 AND THE FEDERAL ADVTSOR'Y
.
COMMITTEE ACT. Sl,j_.S.CAPP. JO(bl
M:arch 11. 1993
Tt•:
PRESIDENT'S TASK FORCE ON NAT10NAI. HEALTH CARE REFORM
Ctn HILLARY RODHAM CLINTON, Chair. and
IRA MAOAZINER, Senior Advisur to the President for Policy Development
I~ERNARD NUSSBAUM, Counsel
E"ccutive Office of the President
l'h~ White House
Washington, D.C. 20050
l,ursuant to the Freedom of Information Act. 5 II.S.c·~ Section S52, and the Federal
Advisory <"nmmittee Act, S lJ.S.C. App., Section 10(1~). the American Council for Health ('nrc
Rd(Jrm, hy and through William Shaker, Executive Oin:ctor, hereby requests from its interdepartmental working groups and all cluster aroups thereof the following documents to be m:1eic
availahlc thr public inspection and copying at the ofti,:es of the President's Task Force on
Natiunal Health Care Reform:
The Advisory Committee Charter of the.! Prc5ident's Task Force on National
Health Care Reform•
2.
AU records, transcripts, minutes (inclucfing minutes containing a record ofth"·
persons present and a complete: and ac.:"·uratc d~cription of the matters discus.~'tl
and conclusions reached). appendixes. working papers, drafts, studies, or uthcl'
documents which have been or will be made available to or have been p~an:d
by the President's Task Force on National Health Care Refonn:
...................
~
EXHIBI'I· I
�PRFSIDI~N·rs TASK FORCF. ON NATIONAL HF.Al.TH CARE
C/0 HILLARY RODHAM CLINTON, Chair. c:t al.
REFORM
Mun:h 17. ll)93
Page 1.
'
All schedules of meetings and asenda of the President's Task Force on National
Health Care Reform;
:
4.
All records, reports, transcripts, minute:~; (including minutes containing a rec(mt
nf the p<..~ons present and a complete and accurate description of the matters
discussed and conclusions reached).
~-
The schedules of all meetings and agen,fa of the interdepartmental working
groups and each of its cluster groups; aud
h
·me names and background histories of all persons who are members of or
consult or advise (whether on a full tim': ur part time basis and whether they an: .
paid or not, and the amount paid wher~ applicable), the President's Task Pure'~ on
National Health Care Reform, the intentepartmental working group and all uf the.~
cluster groups, thereof.
As this rc:qucst will contribute siynificantly lo public understanding of the opemtiun.~ und
activities of the President's Task Force on National He•llth Care Refonn and its interdepa.rtmt:nt~l wnrking groupt :and lll ofth1 c1U£tar group& and ootivitioc of the sovcmmont it~lf. the
afnrc8aid documents and information shou1d be furnished without any charge or at a charge
n:duccd ~Jt,w the fees estab1ished in 5 U.S. C. Sectinu 5S2(a)(4)(A)(ii).
Pursuant to S U.S. C. Section 522(a)(6)A9A), u detennination of compliance is expected
within ten ( 10) days.
Rc:~peetfuiJy
submitted
4.v;l(:- .1(
~c:c:utive Director
�••
APR- 8-93 THU 15:02
FAX NO. 2028285625
MMWR WDH NEB
P. 02
HAPiD DELIVERED
r'
REQ'C.lEST FO.R DOCUMENTS AND TNF'QRMA.TlON FROM THE
PRESIDENT'S TASK FORCE ON NAUONAL HE.4LTH CARE REFQRM. ITS
INTERDEPARTMENTAL WORKJ,\lG GROUP AND ALL CLUSTER GROUPS.
PURSUANT TO TTTF: F'REEDOM OF LVFORMA.TlON ACT. 5 U.S.C, SECTION
,;,-;2 AND THE FEDERAL ADVISORY COMMITTEE ACT. 5 U.S.C. AP,e 1n£QJ.
'
TO:
PRESIDE~"T'S TASK FORCE ON NATIONAL HEALTit CARE REFORlvl
c/o Hll..LARY RODHA..\1 CLJ:!I.a'TON, Chair, and
lRA MAGAZINER, Senior Advisor to the President .for Policy Development
BERNARD NUSSBAUM, counsel
Executive Office of the President
The White House ·
Washington, DC 20500
Pursuant to the Freedom ofinfonnation Act, S U.S.C. Section 552, and the Federal
Advisory Committee Act, S U.S.C. App .• Section ·lO(b). the ~ar.ional Legal & Policy Center, by
and through Peter T. Flaherty, President, hereby requests from the President's Task Force on
National Health Care Refonn and its interdepartmental worldng groups and all cluster groups
thereof the following documc:ms to be made available for public inspection and copying at the
offices of the President's Task Force on N<llional Health Care Refonn:
1.
The Advisory Committee Charter of the President's Task
Force on National Health Care Reform;
2.
All records, reportS, transcripts, minutestincluding minutes containing a record of
the persons present a complete and accurate description of the matterS discussed
and conclusions reached), appendixes, working paoers, drafts,
studies, or
other documents which have been or will be made available to or have been
prepared by the President's Task Force en National Health Care Reform;
~.
All schedules of meetings and agenda of the President's Task Force on National
Health Care Reform;
4.
All records, reports, transcripts, minutes (including minutes containing a record of
the persons present a complete and accurate description of the matters discussed and
conclusions reached), appendi."<es, working papers, drafts, studies, or other
documents which have been or will be made available to or have been prepared by
the interdepartmental working group_ and any and all of its cluster groups fer the
President's Task Force on National Health Care Reform;
..
S.
The schedules of all meetings and agenda of the interdepartmental working group
·and each of its cluster groups; and
·
1
........................
EXHIBIT
J
�MMWR WDH NEB
APR- 8-93 THU 15:02
....
6.
FAX NO. 2028285625
P.03
The names and background histories of all persons who are members of or consult
or advise (whether on a full-time or part-time basis and whether they are paid or
not, and t!1e amount paid where applicable), the President's Task Force on National
Health Care Reform, the interdepartmental working group and any of the cluster
groups thereof.
''
As thi~ request will contribute significantly to public understanding of the operations and
activities of the President's Task F~rce on N"ational Health Care Reform and its interdepartmental
working group and cluster groups and rhe activities of the government itself, the aforesaid
docume11ts and infonnation should be furnished without any charge or at a charge reduced below
the fees established in 5 U.S.C. Section 522(a)(4)(A)(li).
Pursuant to S U.S.C. Section S22 (a)(6)(A), a determination of compliance is expected
within ten (10) days.
Dated:
'f/8(93
Respectfully submined,
p~2~
President
.
2
�·-·
--------------------------
CFi:OUI=o
THE WHITE •tOUS£
WASI-41NG ... ON
April 1, tCJ93
•.
· .Dr. Jane M. Orient
P.xecutive Director
~oc:iation of American Physician~
and Surseo!2S, Inc.
·160t·N. Tucson Boulevard
Suite 9
Tucson. Arizona 85716
Re~
Request for Documents and Information
Dear ·or. Orient:
On behalf of the President's Task Force on National Health Care Reform (the
"Task Force"), lam responding to your March 17. 1993 request .for documents and
information pursuAnt to the Federal Advisory Committee Act \fACA•), 5 U.S.C. App. 2
f lO(b) and the Freedom of Information Act f'FOIA"), 5 U.S.C. I SS2. 1'be Task Force
reeeived your request on March 18.
With reaard to )'Ol:lr request under FACA. the Court in kj~;pc;iatign gf Am;rican
PJtysicians and Suqenns (AAPS.). et al. v. Clinton et aL No. 93·0399 (D.D.C. Mar. 10,
1993) held that the Task Force is an advisory committee under fACA. Although the
defendants believe that rulins to be an error as a statutory and constitutional matter, and
huve uppeated it io the United States Court of Appeals for the Distrl~ of Columbia
Citc:W&, the T~ ;'ore~ lntencts tu make uo.o-cxc~lLpt documents which have been and
'WW M •made available to or prepared for or bY' rhe Task Porce, 'FACA, l10(b),
available for publie inspection and copyins (Request 2). As explained in peater detail
below. the Court's Opinion permits the Task Fore~ to withhold documents covered by
privileges protecting deh1~eratlve processes and Presidential co~nicatlons.
The· Task Force has established a public readin& room located in Room 1010 of
the Humphrey Builc!ins. U.S. Department of Health and Human Services, 200
lftdependence Avenue, S.W. The reactins room L\ open to the public between the hours
of 9:00 a.m. and S:OO p.m. Monday through Friday. Please contact Steven Pigeon at
_
..........,...........
(202) 69Q.7000 mor~er to ar.ranse for access to Uie reading room.
EXHIBIT K.
...
�..
....
..
.. •· • -·
._ ~ """""' ..,.
••1 ... ......
1-11"'~ ld~ '0.::"3 11: '37 WEE'5TER CHA~1BERLAIN & BEAt~
I
'-a PIC U
U
-------------.
P.3/4
~-C,-::11
~
- 2 -
The T~k For~e's intake ~e.nter has received over SO,OOO pieces of corr~ponc1ence
from the public and 1s now recewt;,g several thct~Jsanclletters daily. These and other
documents that have been received and reviewed are being moved into this reading
room for public inspection. The Task Foree will send newly receivec:l.or created non· .
exempt Task Force documents to the readin& roe')m pcriodicaU)' after they arc reviewed. .
.
.. .
· In addition. the Task Foree's charter (Request 1). non-exempt meeting agendas ·
(Request 3), and non-exempt Task Foree documents (Requests 2 and 4) will be available
in the reading room.
. ·..
The Court also held that the interdepartmental working group is not an advisory
committee under FACA.. The Task Force resards Request 4 to seek a Sl.lbset nf the
documentS sous~t in Request 2. However. lO the: extent ~.~.f~.J!.qU!,~t.oY.~~~n~ cut
subsumed unaot Request 2 that were made available to or prepare«! fOl"Of..bY'tlie
working group or its cluster groups, they are not subject to c!iscloaurc UDder llO(b). ID
particular, tho documents requested in Requests 5 and 6, if they exist -at all, would be
workin& sroup records, not documents mad~ available to the Task Force mat are subject
to disclosure. As you a.-e probably aware, however, the names of persons on the working
aroup and its consultantS have been made public.
In accordance with FACA, § lO{b), S U.S.C. § SS2(b). and the Court's Opinion
and Order, tho Task Force· hu and will withhold documents determined tO be QOVered
by privileges protectma deliberative processes and President!al communications and
other applicable privileses.
In panic:ular, the Task Force is withholdinlt the categories of documents listed
below. Tbe Task Force may withhold additional ~tesori~ of material detenrJned to be
privile&ed that have not yet been created or reviewed.
1.
Personal Jetters,submitted by members of me public to the Task Force that
contain. for example, descriptions of health probl:ms and financial information are
wichhcld pursuant to S lJ.S.C. § SS2(b)(6);
2.
.Pe~onalletters, many attaching resumes. submitted by ~embers of.me
publie offerin& to help the Task Force are withheld pursuant to S U.S.C. f SS2{b)(6)~
3.
Coding and routing slips for correspnndence received by the intake center
are withheld pursuant to S U.S.C. f SS2(b)(2);
4. Backsround and options papers prepared by workina poup members an<! seen
by Task roree members or the President related t~ national health care reform are
withheld putsUant to privlleaes protectin& deliberative processes ancl Presidential
communicadons. ~ S U.S.C. I SS2(b)(S) and A:.~ sUp op. at 18-26.
Insofar as your request
may be based on FOIA, that statute applies only to
records maintained by "agencies" within the Executive Branch.
kA S U.S.C. I S52(a)(3).
..
�•.. II.
APR 08 '93 11:58 WEBSTER CHAMBERLAIN & BEAN
APR-
-.
~-9Z.
MO~
i-·e~
' •
W~SH
·
M~KT
P.4/4 p .
GROUP
- 3 ..
Neither the Task Force nor che interdepartmental working sroup or its •ctuster" groups
are agencies for purposes of FOIA because thtir functions are. respectively, to advise
and to assist the President. 5= KiFsinpr v. Beporte!'$ CQZDm. for Ereedom of the Press.
445 U.S. 136 (1980): Mcye: v. ~ ~81 F.2d 1288 (D.C. Cfr. 1993). The Task Force,
working group and •cluster" groups are, therefore, not subject to FOIA.
.
·sincut·ly.
~1 :?-··y
.. . ... ..~\ll..,..-c..·
K'.L,_,If}....._ _
B :~nr,~ W. Nus.~baum
Cwnsc:l to tbe President
..
. '! ... ,.. .•-:"1'-~·l'f~~if<'$..~ -tr-'
1
cc: Kent Masterson Brown
Framk M. Northam
..
~.
'
.
~.
e~-
�••
8350243
TO
.
'
. .. ..
..... .
·~
.
.
. ..
'
:-
:
r
•
.
.
.
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.·.•
THE WHIT£ HOUS£
WASHINGTON
April 1, l 993
Mr. William H.· Sh:1kcr ·
Executive Director
American Council for Health
Care Reform
51SS North 37th Street
ArlinJton, Virginia 22207 ·
Re: Request for Documents and Information
·Dear Mr. Shaker:
On behalf of the President's Task Force on National Health Care Reform (the
'Task Porccj, I am responding to your March 17, 1993 request for documtnts and·
information pursuant to the Federal Advisory Committee Act ("FACA"), S U.S.C. App. 2
I lO(b) and the Freedom of Information Act ("FOIA"), S U.S.C. § 552. The Task Force
received your request on March 18.
With regard to your request under FACA. the Court in Association of American
Pbysiqaps and Sur1eons CAAPS). et at. v. Cintop. et al.. No. 93-0399 (D.D.C. Mar. 10,
-·1993) held that the Task Force u an advasory committee under PACA: AlibouJh the defendants believe that ruling to be an eaor as .a statutocy an4 constitutional matter, and
have appealed-it tu·tbe ·United States Court ~fAy~ for the DistriCt of Columbia
Circuit, the Task Foree intends to make non-exempt documents which have been and
will be "made available to or preparec! for,.or by" the Task Force, FACA, llO(b),
available for public Inspection and copying (Request 2). As explained &reater detail
below, the Coun's Opinion permits the Task Force to withhold docwnents covered by
privileges protecting dehc~tive processes and Presiden~ial communications.
m
The Task Force has e$tablished a public reading room located in Room 1010 of
me Humphrey Buildina, U.S. Department of Health and Human Services. 200
-~·-· -··-- lndepeudem:~AVenue, S.W. The readiftgTOOmin>p:en to the public· between the lm\lrS
.':
of 9:00a.m. and 5:00p.m. Monday through Friday. Please contact Steven Pigeon at
(202) 690-7000 in order. to arrange for access to the reading room.
.....................
-
EXHIBI'r· L
:.
�...
HPR-OS-l993
08:37AM
·-
'
FPOM St ~nc:l.!r d Prep. I r.c.
TO
83SC.2~'3
P.03
- 2-
The Task Force's intake center h~ts rccdved over 50,000 pieces of correspondence
from the public and is n<>w receiving several thousand )etters daily. These ancl other
documentS that have been received and reviewed are being moved into this reading
room for public inspection. The Task Force will srnd newly recehred or created nonexempt Task Force documents to the reading room pc.riodically after they are reviewed.
In addition, the Task Force's charter (Request 1), non-exempt meeting agendas
(Request 3), and records, reports, transcripts and minutes of Task Force meetings
involving fact·fin(]ing and fact-reporting (Request 4) will be available in the reading
room.
I
"1"he Court also held tho.~t the interdepartmental working group is not an advisory
committee under FACA. The document.~ requested in Requests Sand 6, if they exist at
all. would be working group records, not documents made available to the Task Force
that are subject to disclosure..
In accordance with FACA, f lO(b), S 'U.S.C. § S52(b), and the Court's Opinion
and Order, the Task Force has and will withhold documents determined to be covered
. by privileges protecting deliberative processes and PresicleJ1tial tOmmunications and
other applicable privileges.
In panicular, the Task Force is withholding the cateao~es of documents listed
below. The Task Force may withhold additional categories of material determined to be
privileged that have not yet been created or reviewed.
1.
Personal letters submitted by members of the public to the Task Force that
·contain, for example. descriptions of health problems and finanCial information are
withheld pursuant to 5 U.S.C. § 552(b}(6);
2.
Personal letters, many attaching resumes, submitted by members of the
public offering to help the Task Fo~c:c are wjthheld pursuant to~ U.S.C. § S52(b).(J.;:6;a);~---
---·-·-···-··. ·-- ·--·---·.
3.
Coding and routJn& slips for correspondence received by the intake center
are withheld pursuant to S U.S.C. § 552(b)(2);
4. Backaround and option5 papers prepared by working group members and seen
by Task Force members or the President related to national health care reform are
withhel~ pursuant to prlvDeges protecting deliberative processes and Presidential
wmmunications. ~ s U.S.C § S52(b)(S) and AAPS.. slip op. at 18-26.
Insofar as your request may be based on FOIA. that statute applies only to
records maintained by "agencies" within the Executive Branch. ~ 5 U.S.C. § S52(a)(3).
Neither. the Task Force nor the interdepartmental·workiDJ group or its ..clustet" groups ·
are agencies for purposes of FOIA because their functions are, respectively, to advise
and to assist the President ~Kissinger v. Beponea Comm. for Freedom of the Press.
�....
APF:-IaS-1993
08:37AM
FROM
Su.r,cJar~
P,.op. Inc.
TO
835024'3
- 3-
445 U.S. 136 (1980); Mevcr v. Bum. 981 F.2d 1288 (D.C. Cir. 1993). The Task Force,
working group and "cluster" groups are, therefore, not subject to FOIA.
Sincerely,
Bernard W. Nussbaum
Counsel to the President
cc Kent· Masterson Brown
Frank M. Northam·'
----··
,0:
------------- --- ·-··--·
··-····---···· ·- .. ·-
·-···.
P.G-4
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
American Physicians Lawsuit HCTF (Health Care Task Force); March 23, 1994 [1] [2]
Creator
An entity primarily responsible for making the resource
First Lady's Office
Maggie Williams
Evan Ryan
Melanne Verveer
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-2194630-20060223F-006-001-2015
2194630
-
https://clinton.presidentiallibraries.us/files/original/8132f8c5c8122fac721c05b8181175cf.pdf
e06e4704ae9d2387824511ae638444e5
PDF Text
Text
FOIA Number: 2006~0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
First Lady's Office
Series/Staff Member:
Maggie Williams; Evan Ryan; Melanne Verveer
Subseries:
Misc. Subject Files
OAIID Number:
12822
FolderiD:
Folder Title:
American Physicians Lawsuit-HCTF (Health Care Task Force); March 23, 1994 [1]
Stack:
Row:
Section:
Shelf:
Position:
s
59
4
7
2
�UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS,
INC., et al.,
Plaintiffs,
v.
)
)
)
)
)
)
)
civil Action No. 93-399
(Judge Lamberth)
)
HILLARY RODHAM CLINTON, et al., )
Defendants.
)
)
)
)
PLAINTIFFS' STATEMENT OF MATERIAL
FACTS AS TO WHICH THERE IS NO
GENUINE ISSUE
Kent Masterson Brown
BROWN & BROWN
1114 First National Building
167 West Main Street
Lexington, Kentucky 40507
(606) 233-7879
}\o.sc"-. Z-'S, l Cf. qV
]
Frank M. Northam
D.C. Bar No. 206110
WEBSTER, CHAMBERLAIN & BEAN
1747 Pennsylvania Avenue, N.W.
Suite 1000
Washington, D.c. 20006
(202) 785-9500
Attorneys for Plaintiffs
�UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS,
INC. , et al • ,
)
)
)
)
)
)
)
Plaintiffs,
Civil Action
No. 93-399
(Judge Lamberth)
)
v.
)
HILLARY RODHAM CLINTON, et al., )
)
Defendants.
)
)
)
PLAINTIFFS' STATEMENT OF MATERIAL FACTS
AS TO JIIIICB THERE IS NO GENQIHE ISSUE
Pursuant to Local Rule 108(h), and in support of their Motion
for Summary Judgment, plaintiffs submit the following statement of
material facts as those which they believe there is no genuine
issue to be tried.
1.
On
January
25,
1993,
the
President
announced
the
formation of the TASK FORCE ON NATIONAL HEALTH CARE REFORM ("the
TASK FORCE"), to make recommendations and advise him on proposals
for comprehensive national health care reform.
(Second Amended
Complaint, Ex. A; Declaration of Ira Magaziner, paragraph 1.)
2.
The
TASK
FORCE
was
charged
with
developing
recommendations for possible legislation on comprehensive health
care reform to the President.
(Second Amended Complaint, Ex. A;
Declaration of Ira Magaziner, paragraph 5.)
3.
The President appointed First Lady HILLARY RODHAM CLINTON
as a member of and to chair the TASK FORCE.
(Second Amended
�Complaint Ex. A; Declaration of Ira Magaziner, paragraph 3.)
4.
The TASK FORCE included the following other members:
secretary of the Treasury, LLOYD BENTSEN; Secretary of Defense, LES
ASP IN; secretary of commerce, RON BROWN; Secretary of Labor, ROBERT
REICH; secretary of Health and Human Services, DONNA SHALALA;
secretary of Veterans Affairs, JESSE BROWN; Office of Management
and Budget Director, LEON PANETTA; Assistant to the President for
Domestic Policy, ROBERT RUBINi Council of Economic Advisors Chair,
LAMA TYSON, and Senior to the President for Policy Development, IRA
MAGAZINER.
5.
(Declaration of Ira Magaziner, paragraph 3.)
IRA MAGAZINER, a member of the TASK FORCE,
assembled.~nd
led an "Interdepartmental Working Group" of the TASK FORCE.
The
Interdepartmental Working Group consisted of 15 "Cluster Groups,"
43 "Working Groups," and 4 "Subgroups," namely, Cluster Group I,
"New System Organization:, and Working Group 1, "Principles and
Operation of Purchasing cooperatives"; Working Group 1A, "Health
Plans, Patients and Providers"; Working Group 2, "Managed care
Toward & Beyond"; Working Group 3, "Governance"; Working Group 4,
"A Global Budget 11 , and Working Group 5, "Insurance Reform"; Cluster
Group II, "New System Coverage", and Working Group 6, "Benefits
Package"; Working Group 7, "Coverage for Working Families"; Working
Group 8,
"Coverage for Low Income and Non-Working Families";
Cluster Group III, "New System Infrastructure", and Working Group
9, "Quality Measurement"; Working Group 10, "Information Systems";
Working Group 11, "Malpractice and Tort Reform", and Working Group
12, "Facilitating Professional Development"; Cluster Group IV,
"Integration of Government Programs Into the New System", and
2
�Working Group 13 1 "Medicare"; working Group 141 "Department of
Defense"; Working Group 15 1 "Veterans"; Working Group 161 "Federal
Employees;
Health
Benefits
Government Programs";
Plan";
Working
Cluster Group V1
Group
16AI
"Other
"Bioethics or Ethical
Foundations of the New System", and Working Group 17, "Bioethics";
Cluster Group VI, "Transition to the New System, Short-Term Cost
controls",
and
Working
Group
18,
"Accelerating
New
System
Development"; Working Group 19, "Administrative Simplification";
Working Group 20,
"Interim Cost Controls"; Cluster Group VII,
"Financing", and Working Group 21, "Financing"; Cluster Group VIII,
"Health Policy Initiatives for the Underserved", and Working Group
22 1 "Health Policy Initiatives fore the Underserved", and Subgroup
A,
"Underserved
"Vulnerable/High
Rural
Risk
and
Inner
Populations";
City
Areas";
Subgroup
Subgroup
c,
B,
"Women
and
Children", and Subgroup D, "Population-Based Public Health and
Prevention"; Cluster Group IX, "Mental Health", and Working Group
23, "Mental Health Benefits Package"; Working Group 24, "Substance
Abuse"; Working Group 25, "Children's Services"; Working Group 26,
"Public System Impact/Special Populations";
Clust~r
Group X, "Long
Term Care", and Working Group 27, "Long Term Care-Background";
Working Group 28, "Long Term care-Public Options"; Working Group
29, "Long Term Care-Private Options"; Working Group 30, "Cost and
Revenue"; Cluster Group XI, "Economic Impact", and Working Group
31, "Economic Impact"; Cluster Group XII, "Quantitative Analysis";
and Working Group 32, "Quantitative Analysis"; Cluster Group XIII,
"Legal Audit", and Working Group 33, "Legal Audit"; Cluster Group
XIV,
"Numbers Audit",
and Working Group 34,
3
"Numbers Audit":
�Cluster Group XV, "The Drafting Group", and Working Group 35, "The
Drafting Group", and Working Group 36, "Disability Cross-Cutting
Work Group"; Working Group 37, "Rural Cross-Cutting Group"; Working
Group 38, "Benefits Coordination"; Working Group #39, "Minority
Issues Review Group"; Working Group 40, "Academic Health Centers",
and Working Group 41, "Workers' Compensation Task Force."
8.
IRA MAGAZINER,
a
TASK FORCE member,
assembled
and
regularly met and meets with the "Interdepartmental Working Group"
and all of the Cluster Groups, Working Groups and Subgroups.
(Declaration of Ira Magaziner, paragraph 20.)
9.
CAROL ROSCO, a TASK FORCE member, has met and meets with
the "Interdepartmental Working Group" and its Cluster Groups,
Working Groups and the Subgroups.
(Declaration of Ira Magaziner,
paragraph 20.)
10.
IRA MAGAZINER, a TASK FORCE member, regularly reports the
work of the "Interdepartmental Working Group" and its Cluster
Groups, working Groups and Subgroups to the First Lady, HILLARY
RODHAM
CLINTON
and
to
the
President.
(Declaration
of
Ira
Magaziner, paragraph 9.)
11.
Members of the "Interdepartmental Working Group" and its
Cluster· Groups, Working Groups and Subgroups have met with and
reported to the First Lady, HILLARY RODHAM CLINTON.
(Declaration
of Ira Magaziner, paragraph 9.)
12.
The Composition of the Interdepartmental Working Group
and its Cluster Groups, Working Groups and Subgroups (with non
full-time officers or·employees of the federal government noted in
bold black) are as follows:
4
�Cluster Group I, "New system Organization", was composed of
working
Group
cooperatives";
Providers";
1,
"Principles
and
Working Group lA,
Working Group 2,
Operation
"Health Plans,
of
Purchasing
Patients and
"Managed CarejToward
&
Beyondn;
Working Group 3, nGovernance"; Working Group 4, "A Global Budgetn,
and Working Group 5, "Insurance Reform.n See Tab 2 attached to the
Memorandum of Points and Authorities ("the Memorandum").
Cluster I, nNew System organization", and its cluster leader
was listed as follows:
CLUSTER I CLUSTER LEADER
NEW SYSTEM ORGAHIZATIOR
WALTER ZELMAR, Chairman of the
Health Care Advisory commission and
Special Deputy for Health Insurance
in the California Department of
Insurance (864) - SGE (1679) 1
Working Group 1 of Cluster Group I, was composed of the
following members:
1
All non-full-time officers and/or employees of the federal
government are listed in bold-black with their private affiliations
also listed in bold black. "CD" refers to the 1993 Brownson, A.,
ed. congressional Staxf Directory, Vol. 1 which was crossreferenced for purposes of exact identification of all
Congressional personnel.
All numbers in parentheses refer to
documents authenticated by the Declarations of Marjorie Tarmey.
For reference, participants from the Veterans Administration are
included in Tab 199, participants from the Department of Labor in
Tab 120, participants from the Department of Health and Human
Services in Tab 121, participants from the Office of Management and
Budget in Tab 122, participants from the Department of the Treasury
in Tab 123, participants from the Department of Defense in Tab 124,
participants from the Department of Justice in Tab 125,
participants from the Department of Commerce in , Tab 126,
participants from the Department of Education in Tab 127 and
participants from Congressional staffs in Tab 128. All private
persons will be discussed at length, infra.
5
�GROUP 1 - PRINCIPLES
AND
COOPERATIVES
RICK KRONICK
WM.
(PETE)
WELCH
ALBERGHINI 1 THERESA
ALLEN, LUCY
ALTMAN, DAVID
ANTOS, JOSEPH
ATKINSON, LESLIE
BERENSON, ROBERT
BERRY I ROGER
BRIGGS, BETTY
BURNETT I LAIRD
COHEN, RIMA
COSTER,
JOHN
CURTIS, RICHARD
DEIGNAN 1 KATHLEEN
DRUMMOND, FAYE
EDGELL I JONATHAN
EGAN, JAMES
ENTBOVEN, AI..Al:N
FRANTZ, MOLLY
FUY, GEORGE
HADLEY, JAMES
HATTON, MELINDA
HASH, MIKE
HICKMAN I PETER
OPERATION
OF
PURCHASING
Group 1 Leader (1) UCLA School of
Public HealthfRand Corporation(864)
- SGE (1678)
Group 1 co-Chair ( 1) Urban Institute
(866) - SGE (1679)
sen. Leahy (Congressional Directory
[Hereinafter, "CD"], Vol. I, P.327)FTE
Council on Economic Advisors (CEA)FTE
Robert
Wood
Johnson
Fellow,
Sponsored b¥ Center for the Health
Professions, UCSF [Tab 56 Attached
to this Memorandum] , Office of Sen.
Rockefeller (835)-PTE (840)
HHS-FTE
Rep. L. Stokes/Health Issues for
Ways and Means Committee (CD Vol. I,
P.653)-FTE
Rational Capital Preferred Provider
organization (868, 30016, 30136) SGE (1678)
Rep. Harry Johnston (CD Vol. I, P.
562)-FTE
Labor-FTE
Sen. Breaux (CD, Vol. I, P. 930)-FTE
Sen. Daschle (CD, Vol. I, P. 942)FTE
House Select Committee on Aqing
(Lost Funding 3/31/93)-FTE (841)
President, Institute for Health
Policy Solutions, Washington, DC SGE (1678)
.
sen. Budget Committee-FTE
sen. Finance committee (CD, Vol. I,
P. 963)-FTE
Commerce-FTE
Federal Trade Commission-FTE
The Jackson Hole Group, Inc. ( 2) : No
Official Status Assigned
Rep. Earl Pomeroy (CD, Vol. I, P.
705)-FTE
HHS-FTE
HHS-FTE
Senate
Judiciary/
Antitrust
Subcommittee (CD, Vol. I, P. 392)FTE
Rep. Waxman (CD, Vol. I, P. 712)-FTE
HHS-FTE
6
�Sen. Special Committee on Aging (CD,
Vol. I, P.401)-FTE
Senate Special Committee on Aging
HUMAN, JEFFREY
(CD, Vol. I, P.
)-FTE (843)
Not in Directory - FTE (843)
JODREY, DARREL
veterans Affairs-FTE
JONES, SANDRA
Sen. Breaux {CD, Vol. I, P. 276)-FTE
JONES, MARCIA
Treasury-FTE
KAZDIN, ROBERT
Federal Trade Commission-FTE
KENYON, KATHLEEN
OPM-FTE
KICHAK, NANCY
Senate Finance (CD, Vol. I, P.
KING, KATHLEEN
1025)-FTE
UCLA/School of Public Heal thjRand
KRONICK, RICHARD
Corporationi SGE (1678)
Listed as Participant ( 835) - No
KUSH, GAIL
Affiliation, No Status Given
JACK OMB-FTE
LANGENBRUNNER,
Physician Payment Review Commission
LASKER, ROZ
(864-868)-SGE (1678)
Treasury-FTE
LAWSON, KURT
Staff of California Department of
LEVITT, LAWRENCE
Insurance,
Commissioner's Heal tb
Care Advisory Commission (864) - SGE
(1678)
MANTEL, LEWIS
Veterans Affairs-FTE
MILLER, CAROL
Mountain Manaqement Company, 101 - No
Employment Status Given · on 16781679)-SGE (First Responses)
MILLER, MICHAEL
Rep. S. Levin (CD,, Vol. I, P.
1056)-FTE
MUNNELL, ALICIA
Treasury-FTE
NARROW, DAVID
Federal Trade Commission-FTE
NEUMAN, TRICIA
House Ways and Means (CD, Vol. I, P.
1065)-FTE
O'BRIEN MARY JO
National
Governors
Association,
State of Minnesota ( 835)
No
Official Status Assiqned i Listed as
Representative of Interqovernmental
Organization (1786-87)
O'NEILL, PATRICIA
Veterans Affairs-FTE
OBEY, CRAIG
Sen. Conrad (CD, Vol. I, P. 1068)FTE
OFFNER, PAUL
Senate Finance (CD, Vol. I, P.
1069)-FTE
PATEL, PARASHAR
OMB-FTE
PAYTON I SALLYAHNE
University of Michigan School of Law
( 2) i No Employment Status Assiqned
POTETZ, LISA
HHS-FTE
REINECKE, PETER
Sen. Harkin (CD, Vol. I, P. 396)-FTE
RICHARDSON I SALLY
West Virqinia Health care Planning
Commissioni
Ho Official
status
Assiqned
ROSS I MARJORIE
White Bouse Policy Analyst (835) i
Johns Hopkins University (732)-SGE
HOGUE, BONNIE
I
7
�(1678)
HHS - HCFA - FTE
ROVIN, LISA
House Energy & Commerce (CD, Vol. I,
SHRIBER, DONALD
P. 1109)-FTE
OPM-FTE
SMITH, CURTIS
George Washington University Medical
SOFAER, SHOSHANHA
Center - SGE (1678)
VARNHAGEN, MICHELLE Sen. Metzenbaum (CD, Vol. I, P.
396)-FTE
President
&
CEO,
University
WALTERS, FARAH
Hospitals of Cleveland, Ohio (2) Consultant (First Responses)
Rational Governors Association, Gov.
WElL, ALAR
Romer of Colorado (3); Ro Official
Status
Assigned;
Listed
as
Representative of Intergovernmental
organization (1786-87)
The Urban Institute - SGE (1679)
WELCH, WILLIAM
sen. Democratic Policy committee
WERNER, MICHAEL
(CD, Vol. I, P. 403)-FTE
WILLIAMS, CHRISTINE Sen. Mitchell (CD, Vol. I, P. 338)FTE
HHS-HCFA-FTE (835)
ZARABOZO, CARLOS
Chairman of the Health Care Advisory
ZELIIAH, WALTER
Commission, and Special Deputy for
· Health Insurance in the california
Department of Insurance ( 864) - SGE
(1679)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
1-4, 17-25, 37-42, 54-56, 732, 767-768, 798-799, 834-835,
864-868, 1516-1517, 1560-1561, 1678-1679, 1795-1796. See
Tab 3 attached to the Memorandum.
Working Group 1A of Cluster Group I, was composed of the
following members:
GROUP 1A-
HEALTH PLANS, PROVIDERS, AND
THE HEW SYSTEM
PATIENTS
:IR
GROUP 1A LEADER
ROBERT BERERSOR, M.D., (1568)
Rational Capital Preferred Provider
Organization ( 30016, 30136) - SGE
(1678)
GROUP 1A co-LEADER
ROZ LASKER, Physician Payment Review
Commission (1568)
ALTIIAH, DAVID
Robert Wood Johnson Health Policy
Fellow, Sponsored by Center for the
Health Professions, University of
california, san Francisco, in the
office of Senator Rockefeller [Tab
8
�56 Attached to This Memorandum] (6)
- FTE (840)
National capital Preferred Provider
BERENSON, ROBERT
Organization ( 30016, 30136) - SGE
(1678)
Department of Justice - FTE
BLOCH, ROBERT
HHS/General Counsel - FTE
CADE, DAVID
FTC - FTE
EGAN, JAMES
Department of Justice - FTE
GOODMAN, NANCY
senate
Judiciary/Antitrust
HATTON, MELINDA
Subcommittee (CD, Vol. I, P. 392) FTE
FTC - FTE
KENYON, KATHY
No Affiliation; No Employment Status
KUSH, GAJ:L
Given (5, 1513, 1514)
Veterans Affairs - FTE
MANTEL, LEWIS
ForDler President of the American
MILES, STEVEN
College of Physicians, Hennepin
County Medical Center, University of
Minnesota (1513 1 1514); No Official
Status Assigned
NARROW, DAVID
FTCC-FTE
National
Governors
Association,
O'BRIEN, MARY JO
State of Minnesota
(835);
No
Official Status Assigned; Listed as
Representative of Intergovernmental
organization (1786-87)
O'NEILL, PATRICIA
Veterans Affairs-FTE
RICHARDSON, SALLY
West Virqinia Health Care Planning
Comlllission;
No Official Status
Assigned
ROVIN, LISA
HHS - HCFA - FTE
VARNHAGEN, MICHELLE Sen. Metzenbaum (CD 1 Vol. I , P.
396)-FTE
WINSLOW, WALTER
FTC-FTE
SULLIVAN I T. J.
Internal Revenue service
FTE
(1513, 1514)
SOURCES: Declarations of Marjorie 2'armey, Documents Nos.
51
6 1 26 1 57 1 1513-1515.
see Tab 4 attached to the
Memorandum.
Working Group 2 of Cluster Group I
was composed of the
following members:
GROUP
2 -
MANAGED
CARE/TOWARD & BEYOND
IN PURCHASING COOPERATIVES
GROUP 2 LEADER -
- SPECIAL ISSUES
LOIS QUAM ( 7) ForDler Chairman of the
Minnesota
Health
care
Access
commission
and
current
Vice
President,
United
Health
Care
corporation, Minneapolis, MM-SGE
9
�(1678)
GROUP 2 CO-CHAIR
CLAUDIA BAQUET, M.D. - HHS- FTE (7)
ALBERGHINI, THERESA Sen. Leahy (CD, Vol. I, P. 327)-FTE
council on Economic Advisers (1364)ALLEN, LUCY
FTE
ALMENDAREZ, ISABEL Rep. Washington (CD, Vol. I, P.904)FTE
Rep. L. stokes/Health Issues, Ways
ATKINSON, LESLIE
and Means committee (CD, Vol. I, P.
653)-FTE
HHS-FTE
BAQUET, CLAUDIA
HCPPO (30005)-SGE (1678)
BERENSON, ROBERT
HHS - HRSA - FTE
BOWEN, STEVEN
DC Chartered Health Plan, Inc.
BOWLES, ROBERT L.
(1364 1 1371): No Official Status
AsSiCJDed
Rep. Towns (1371) - FTE
BRANSON, CHERRI
Rep. Foglietta (CD, Vol. I, P. 424)BRODNITZ, PETER
FTE
National
Governors
Association:
BROWN, MARY LEIGH
Representative of Intergovernmental
organization: No Official Status
(1496)
CARLSON, RON
HHS - HRSA - FTE
CLAY, JIMMIE L.
Veterans Affairs - FTE
Rep. Conyers (Chair, Gov. Ops.)(CD,
CLEMENTE I FRANK
Vol. I, P. 717) - FTE
COHEN, RIMA
Sen. Daschle (CD, Vol. I, P. 942)FTE
CONTRERAS I HENRY
Rep. Roybal-Allard (CD, Vol. I, P.
633)-FTE
COOK, FRANCESCA
Sen. Moseley-Braun (CD, Vol. I, P.
339)-FTE
CURTIS, RICHARD
President 1 I:nstitute for Health
Policy SOlutions (30005)-SGE (1678)
DAVIS, LOUIS, JR.
Rep. Serrano (CD, Vol. I, P. 955)FTE
DENON, MARGARET
Rep. Meek (CD, Vol. I, P. 1371)-FTE
DEH'l'OH, DEHJ:SE
COlorado Rural Health Resource
Center-SGE (First Responses) 1 Hot
Listed 1678-1679
DRUMMOND, FAYE
Senate Finance (CD, Vol. I, P. 963)FTE
FALETTI, THOMAS
Rep. Durbin (CD, Vol. I, P. 969)-FTE
FORTIER, JULIA
Rep. WaxmanjEnergy & Commerce (CD,
Vol I:I, P. 711)-FTE
FRANTZ, MOLLY
Rep. Pomeroy (CD, Vol. I, P. 705)FTE
FUENTES, JENNICE
Rep. Gutierrez (CD, Vol. I, P. 979)FTE
GASTON, MARYLYN
HHS-HRSA-FTE
GOODELL, JEFFREY
Rep. Lipiniski (CD, Vol. I, P. 987)-
10
�FTE
Rep. Rep conyers (CD, Vol. I, P.
987)-FTE
Sen. Pell (CD, Vol. I, P. 991)-FTE
GROSS, LAUREN
Rep. Serrano (CD, Vol. I, P. 995)HAND, LUCY
FTE
Rep. Waxman/Energy & Commerce (CD,
HASH, ·MICHAEL
Vol. I, P. 712)-FTE
HENRY, CHRISTOPHER Rep. Flake (CD, Vol. I, P. 1002)-FTE
Rep. Ortiz (1373)-FTE
HUNTER I MARK
JACKSON, MORGAN, M.D.
HHS-ACHPR {1373)-FTE
Rep. Watts {1374)-FTE
JONES, LEROY
Veterans' Affairs-FTE
JONES I SANDRA
Rep. Stenholm {CD, Vol. I, P. 768)KEPNER I COLLEEN
FTE
Rep. Becerra {CD, Vol. I, P. 1024)KIM, DAVID
FTE
Assistant
Professor,
Community
KING, GARY
Medicine, University of Connecticut
Health Center (1374) 1 Ho Official
Status Assigned
KINGHT, R.
Rep. Franks {CD~ Vol. I, P. 528)-FTE
KOVNER I RONNIE
Rep. Reed {CD, Vol. I, P. 766)-FTE
LACEY, LORETTA
Associate
Professor,
Community
Health Sciences,
University of
Illinois at Chicago School of Public
Health ( 1365, 1374) 1 Ho Official
status Assigned
LUTTBERG I CARRIE
Rep. Coleman {CD, Vol. I, P. 496)FTE
MARCONI I KATHY
HHS-HRSE {1375)-FTE
MARQUEZ, MIGUEL
Rep. Richardson {CD, Vol. I , P.
626)-FTE
McCABE, EUGENE
President,
CEO,
North
General
Rospi tal, NY ( 30209) 1 Ho Official
Status Assigned
·
McDONOUGH, DONEG
Rep. Stark (CD, Vol. II, P. 1065)FTE
MANTEL, LEWIS
Veterans Affairs-FTE
MILLER, CAROL
University of Hew Mexico SChool of
Public Realth ( 30000) -SGE (First
Responses) , Hot Listed on 1678-1679
MILLS I 'JOHN
Rep. Engel {CD, Vol. I, P. 1056)-FTE
MITCHELL, MARLOW
Rep. Dixon {CD, Vol. I, P. 511)-FTE
MURGUIA I JANET
Rep. Slattery (CD, Vol. I, P. 741)FTE
HORMAH, PATRICIA
VP Finance,
CFO,
North General
Hospital, NY (30209) 1 Ho Official
Status Assigned
O'NEILL, PATRICIA
Veterans' Affairs-FTE
PATEL, PARASHAR
OMB-FTE
POLANCO, IIArtBEW
Rep.
Tejeda
(Hot
Listed
in
Directory) - Hot Listed in First
GORMAN, JOHN
11
�QUAM, LOIS
RICHARDSON I SALLY
RODRIGUEZ, GLADYS
RODRIGUEZ, SUSANA
ROSS, SHEILA
SEGARRA, MARIA
SELTMAN I PAUL
SHEEHAN I KATHLEEN
SHEINER I JOHN
SIMPSON 1 NANCY
SMITH I BARBARA
SPIELBERG, DEBORAH
TERRY I
DOHALD
TESTORI, MAUREEN
TINTARY I RUTH
TOMLINSON, LISA
TRUBITT I MITCifEJ.J.
VARMA, VIVEK
WEI:L I
ALAif
Responses, Not Listed as FTE.
Former Chairman of the Minnesota
Health Care Access Commission and
current
Vice
President,
United
Health
Care
Corporation,
Minneapolis, HN-SGE (1678)
West Virginia Health care Planning
Commission ( 30005) - No Official
Status Assiqned
Rep. Pastor (CD, Vol. I, P. 613)-FTE
Rep. McKinney (CD, Vol. I, P. 1093)FTE
Rep.
Delugo
(Hot
Listed
in
Directory) - Hot Listed as FTE; No
Official Status Assiqned
Rep. Bishop (1376); HHS- Office of
Minority Health (First Responses) Hot Listed as FTE
House Select Committee on Education
and Civil Rights (CD, Vol I, P.
1106)-FTE
Rep. Vento (CD, Vol. I, P. 668)-FTE
Rep. Rangel (CD, Vol. I, P. 1107)FTE
HHS - National Cancer Institute FTE
National
Governors
Association,
South Dakota (1366 & 1786); Rep.
KcDermott (1377) - Hot Listed as
FTE; Listed as Representative of
Intergovernmental
Organization
(1786-87);
No
Official
Status
Assiqned (Note: on 1508 I Handwriting
8 Barbara
Says,
A.
Smith,
SD
Department
of
Health,
605/7733361)(1508)
Rep. Lewis (CD, Vol. ·I, P. 578)-FTE
No
Affiliation;
No
Official
Elllployment Status Assiqned
Sen. Baucus (CD, Vol. I, P. 268)-FTE
Rep. Torres (CD, Vol I, P. 663)-FTE
Rep. Collins (CD, Vol. I, P. 496)FTE
Chicago
Health
Maintenance
orqanization ( 30209) : No Official
Elllployment Status Assiqned
Rep. Synar (CD, Vol. I, P. 1132)-FTE
National
Governors
Association
(1786) Office Governor Romer, state
of
Colorado:
Listed · as
Representative of :tnterqovernmental
orqanizations ( 1786-87) : Ito Official
Employment Status Assiqned
12
�Rep. Richardson (CD, Vol. I, P.
711)-FTE
WILLIAMS, CHRISTINE Sen. Mitchell (CD, Vol I, P. 338)FTE
HHS/Cbairman,
Health
Advisory
ZELMAN I WALTER
Commission, and special Deputy for
Health Insurance in the California
Department of Insurance ( 864)
WESTFALL, LISA
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
7-11, 27-30, 52, 53, 58, 59, 66-91, 96, 97, 102-105, 769,
800, 836, 1496-1508, 1524, 1562-1564, 1801-1807, 3000030005, 30179-30223.
See Tab 5 attached to the
Memorandum.
Working Group 3, •Governance•, of Cluster Group I, consisted
of the following members:
GROUP 3 - GOVERNANCE
GROUP 3 LEADER -
RICK
CURTIS, President, Institute
for Health Policy Solutions ( 12) -SGE
(1678)
GROUP 3 CO-CHAIR -
NANCY DELEW, HHS (12)-FTE
ALBERGHINI , T.
BEMPOHG I ANDREA
Sen. Leahy (CD, Vol. I, P. 327)-FTE
( 1786)
Rational
Association
of
Counties
Representative
of
Intergovernmental
Organization,
Assigned to Group 3; No Official
status
BRIGGS, BETTE
Labor-FTE
DELEW, NANCY
HHS-FTE
GREENBERG, G.
HHS-FTE
KENDALL, DAVID
Rep. Andrews
Not in Directory:
Listed as FTE (844)
LANGENBRUNNER, JACK OMB-FTE
LINK, KENNETH
Veterans Affairs-FTE
McNAMEE I NIKKI
Rational
Governors
Association,
Office of the Governor of South
carolina (13)(837) - Representative
of Intergovernmental Organization
(1786-87);
state
Government
Representative (983); No Official
Status Assigned
MEANS, KATHLEEN
HHS-FTE
NAVARRO, VINCENTE
The
Johns
Hopkins
University
(13) (837) - SGE, White Bouse Office
(First Responses); Hot Listed, 167879
OFFNER, PAUL
Senate Finance (CD, Vol. I, P.
1069)-FTE
13
�PATEL, PARASHAR
RICHARDSON, SALLY
ROSS, MARJORIE
SOFAER, S.
STEELE, PAMELA
SULFRIDGE, H.
SYKES I KATHLEEN
VOLPE, LANE CARL
WELCH, WI:LLIAK
WERNER 1 MICHAEL
ZELMAN, WALTER
OMB-FTE
West
Virqinia
Public
Employee
Insurance Aqency and Health care
Planninq Commission ( 1520) - SGE
(First Responses); Hot Listed on
1678-79
White House Policy Assistant - SGE;
The Johns Hopkins University (732)
Georqe Washinqton University Medical
Center (1520, 30148)-SGE
Veterans Affairs-FTE
HHS-FTE
Rep. Obey (CD, Vol. I, P. 1122)-FTE
National
Governors
Association
(13)(837)
Representative
of
Intergovernmental
Organization
(1786-87);
state
Government
Representative ( 983) ; Ro Official
status
The Urban Institute - SGE (1678)
Sen. Democratic Policy Committee
(CD, Vol. I, P. 403)-FTE
HBS/Cb.airman,
Health
Advisory
Commission, and Special Deputy for
Health Insurance in the California
Department of Insurance ( 864) -SGE
(1679)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
12, 13, 46, 47, 61, 92-95, 770, 801, 837, 1509, 1510,
1520, 30148. See Tab 6 attached to the Memorandum.
Workinq
Group
4,
•Global
Budget•,
of
Cluster
Group
consisted of the followinq members:
GROUP 4 - GLOBAL BUDGET
GROUP 4 LEADER -
LARRY LEVITT I
Staff,
california
Department
of
Insurance,
Commissioner's Health care Advisory
Commission (14, 864)-SGE
GROUP 4 LEADER -
SHERRY GLIED, OMB (14)-FTE
BERRY I ROGER
Rep. Johnston (CD, Vol.
FTE
Sen. Binqaman (CD, Vol.
FTE
HHS-FTE
Rep. Cooper (CD, Vol. I,
Treasury-FTE
Rep. Pomeroy (CD. Vol.
FTE
BILLY, CARRY
BUTO, KATHLEEN
CHAMBER, C.
COHEN, ALLAN
FRANTZ, MOLLY
14
I, P. 562)I, P. 271)P. 936)-FTE
I, P. 705)-
I,
�GLIED, SHERRY
GOOD, BRIGID
GREENWALD, LESLIE
GRUNDMANN, MARTHA
IRWIN, JEAN
JONES, SANDRA
KING, ANDREA
KRONICK, RICHARD
LEVITT I
LARRY
LUTTER, RANDY
MILLER, MICHAEL
MUNNELL, ALICIA
NEXON, DAVID
O'NEILL, PATRICIA
OFFNER, PAUL
RADER, AHYA
ROSS I MARJORIE
SAMUELSON, ELLEN
SCHIEBER, G.
SCHULKE, DAVID
SCHRIBER, D.
TESTORI, M.
VARMA, VIVEK
VARNHAGEN, M.
WELCH, W.
CEA (White House Employee)(838)-FTE
HHS-FTE
HHS-HCFA-FTE
Rep. Sabo (CD, Vol. I, P. 704)-FTE
Rep. Cantwell (CD, Vol. I, P. 490)FTE
Veterans' Affairs-FTE
Rep. Gephardt (CD, Vol. I, P. 532)FTE
UCLA/RAND
Corporation
(864)-SGE
(1678)
Staff, California Department of
Insurance,
Commissioner's Health
care Advisory commission ( 864 )-SGE
(1678)
OMB-FTE
Rep. Levin (CD, Vol. I, P. 1056)-FTE
Treasury-FTE
Sen. Kennedy (CD, Vol. I, P. 395)FTE
Veterans Affairs-FTE
Senate Finance (CD, Vol. I, P.
1069)-FTE
National
Governors
Association,
Office of Governor Dean, Vermont
(838),
Representative
of
Intergovernmental
Organization
(1786-87),
State
Government
Representative ( 984)
White Bouse Policy Assistant: The
Johns Hopkins University (732)-SGE
Rep. Sabo (CD, Vol. I, P. 695)-FTE
HHS-HCFA-FTE
Rep. Wyden (CD, Vol. I, P. 1104)-FTE
Energy & Commerce (CD, Vol. I, P.
1109)-FTE
Sen. Baucus (CD, Vol~ I, P. 268)-FTE
Sen. Synar (CD, Vol. I, P. 1132)-FTE
Sen. Metzenbaum (CD, Vol. I , P.
396)-FTE
The Urban Institute (866}-SGE (1679)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
14-161 . 31-331 43-451 621 631 98-1011 7711 8021 15111
1512, 1518, 1519, 1565, 1566, 30006, 30007, 30177. See
Tab 7 attached to the Memorandum.
Working Group 5,
•Insurance Reform•, of Cluster Group I,
consisted of the following members:
15
�GROUP 5 - INSURANCE REFORM
GROUP 5 LEADER -
GARY CLAXTON, National Association
of Insurance commissioners (106,
969)-SGE (1678)
AUBIN I LESLIE
(1326)
National
Federation
of
Independent Businesses: No Official
status
(1326) Chamber of Commerce: No
Official status
( 30075)
Alliance
of
American
Insurers
(1286) w. H. Mercer, Inc.-SGE (1678)
(Also on Cluster II, Group 6,
Benefits)
Rep. Hoagland (CD, Vol. I, P. 549)PTE (840)
(30075).
Subcommittee
on
Labor/Management Relations-PTE (840)
Rep. McCUrdy (CD, Vol. I, P. 589)PTE
Rep. Kennelly (CD, Vol. I, P. 565)PTE
(1265) - Rutgers University: No
Official status
(1326) - National s:ma11· Business
United: Ro Official Status
Rational Association of Insurance
COmmissioners (106, 969)-SGE (1678)
Labor-FTE
Treasury-PTE (841)
Rep. Durbin (CD, Vol. I, P. 969)-FTE
(30075)
Alliance
of
American
Insurers
HHS-HCFA
( 30075) wausau Insurance Company: No
Official Status
Veterans Affairs-FTE
Rep. Collins/Energy & Commerce (Not
Listed in Directory)-FTE (844)
(1265)
Coopers
& Lybrand:
No
Official Status
Alliance of American :Insurers: No
Official Status
Rep. Delauro (CD, Vol. I, P. 506)PTE
Staff of California Department of
Insurance Commissioner's Realth care
Advisory Commission ( 866) -SGE ·
(1265)
Rational
Council
on
CoJDpensation :Insurance: No Official
status
Council on Economic Advisors-FTE
BASS, KRISTIN
BATEKAR I KEITH
BERGTHOLD I LINDA
BLAUWET I ROGER
BORZI, PHYLLIS
BRODBECK, LAURA
BUONORA, DAVID .
BURTON I JOHR
CATOR, TOM
CLAXTON I GARY
COPELAND, ROBERT
DUGGAN I JAMES
FALETTI 1 THOMAS
FARMER, DAV:ID
HICKMAN I PETER
HOFFERT I STAN
JONES SANDRA
KEENE, BRAD
I
K:IST, FRED
LAWSON,· ROGER
LEVINE I GREGORY
LEVITT I LAWRENCE
LLEWELLYN I B.
LOFTI, SHERIF
16
�LUCAS, DEBORAH
LUBITZ, JAMES
MAGURIE I DANIEL
MATTERA, PAUL
MAYS,
HUBERT, JR.
MEANS I KATHLEEN
MILLSTEIN, ARNIE
MOLLOY I JANE
O'NEILL, PATRICIA
PATRICELLI: I ROBERT
PAYNE, MARY ELLA
POTETZ, LISA
RAY, TDIOTHY
ROSS, IIARJOR:IE
SCOLLY, TOM
SISKIND, FRED
STUART, MARK
STEVERSON, DAV:ID
VALDEZ,
ROBERT
WERNER I
MICHAEL
WOODS, STEVEN
ZELKAR, WALTER
Council on Economic Advisors-FTE
HHS-HCFA-FTE
Labor-FTE
(30075) Liberty Mutual Insurance; Ro
Official Status
( 30075)
Attorney,
Alliance for
American Insurers:
Ro Official
Status
HHS-FTE
w. H. Mercer, Inc. : Ro Official
status
Commerce-FTE
Veterans Affairs-FTE
(1326) Cb.alllber of Commerce; Ro
Official status
sen. Rockefeller (CD, Vol. I, P.
352)
.
Senate . Finance (Not Listed in
Directory)-FTE (845)
( 1265) Coopers & Lybrand
Policy Assistant, llhite Bouse: The
Johns Hopkins University (732) - SGE
(1326) Rational Retail Federation;
Ro Official status
Labor-FTE
( 1326)
Rational Association of
Manufacturers; Ro Official status
(1326)
Rational
Federation
of
Independent Businesses; Ro Official
Status
UCLA/RAIID COrporation - SGE ( 1679)
(Also on Cluster :II:, Group 6,
Benefits)
Senate Democratic Policy Committee
(CD. Vol. I, P. 403}
(1326)
Rational
Federation
of
:Independent Businesses; Ro Official
Status
Cb.airDIBil of the Bealth care Advisory
COmmission and Special Deputy for
Health
:Insurance,
California
Departmm:tt of :Insurance ( 864)
SOURCES: Declarations or Marjorie Tarmey, Documents Nos.
34-36, 48-51, 64, 65, 106-115, 772, 803, 839, 1521, 1567.
See Tab 8 attached to the Memorandum.
Cluster Group :II:,
•xew
system coverage•, was composed of
Working Group 6, •Benefits Package•, Working Group 7, •coverage for
Working Families•, and Working Group 8 1 •coverage for Low :Income
and Ron-Working Families•.
See Tab 9 attached to the Memorandum.
17
�Cluster Group II, nNew System Coveragen, and its leader was
listed as follows:
CLUSTER II -
NEW SYSTEM COVERAGE
CLUSTER II LEADER - ATUL GAWANDE 1 HHS-FTE
Working Group 6, nsenefits Packagen of Cluster Group II, was
composed of the following members:
GROUP 6 - BENEFITS PACKAGE
GROUP 6 LEADER -
LINDA BERGTHOLD, Employee Benefits
Consultant
to
W.
H.
Mercer
Corporation (864)-SGE (1678)
co-LEADER-
BOB VALDEZ ( 118) , UCLA School of
PUblic Health, Senior Health Policy
Analyst, Rand Corporation ( 865) -SGE
(1679)
BERENSON I ROBERT
National capital Preferred Provider
Organization (868, 30016, 30136) SGE (1678)
William 11. Mercer, Inc. (864) - SGE
(1678)
UCLA School of PUblic Health ( 864) SGB (1678)
Robert
Wood
Johnson
Fellow,
Sponsored by university of Florida,
in sen. Dale Bumpers Office (DAR) ( 773) [Tab 56 Attached to this
lleaorandUJB]-P'l'B ( 841)
HHS-HCFA-FTE
Senior Advisor for Health Policy &
Management to Kaiser-Permanente;
Professor of Health
Policy
&
Management, Duke University ( 118,
866)-SGE (1678)
Commerce-FTE
Rational Association of counties
(134)(1786)
Representative of
Intergovernmental
Organization
( 1786) ; Ro Official status Assigned
Rep. Glickman (CD, Vol. I, P. 535)FTE
Sen. Kennedy (P. 395)-FTE
Rational Association of COUnties
(134)(1786)
Representative of
Intergovernmental
Organization
( 1786) ; Ro Official Status Assigned
Treasury-FTE
BERGTHOLD 1 LINDA
BROWH I RICHARD
CLARK, WJ:LLJ:AII
CLAUSER I STEVEN
EDDY, DAVID
EDGELL I JOHN
EGBERT, MARCJ:A
FRASCHE I MARY
FISKE MARY BETH
GARCJ:A, JOSEPH
I
GILLINGHAM I ROBERT
18
�GOLD, MARTHA
JOHNSON, SCHELEEN
KRUEGER,
ALAN
LIPNER, ROBYN
MANOWITZ I MICHELLE
KILLER, CAROL
MURPHY, SHEILA
NELSON, KAREN
NEXON, DAVID
NIX, SHEILA
POWELL, KEITH
PRICE, ANDREA
REINECKE, PETER
RICE, CHERI
ROSWELL, ROBERT
SHORT, PAMELA
SMITH, ELMER
SOCBALSKI I JOLIB
VALDEZ I ROBERT
WOOD, SUSAN
WREN I ROBERT
ZBLIWf ~ WALTER
HHS-PHS-FTE
Rep. Bryant (CD, Vol. I, P. 1015)FTE
Princeton University (116)(773)-SGE
(1678)
Consultant
(First
Responses)
Sen. Mikulski (CD, Vol. I, P. 395) FTE
White Bouse Policy Assistant (119);
The Johns Hopkins University (732) SGE, White Bouse Office (1678)
Mountain Management Co. , OJO Sarco,
101; No Official Status Given ( 1678) ;
SGB (First Responses)(134)
Sen. Kerrey (CD, Vol. 1, P. 332)-FTE
Rep. Waxman (CD, Vol. I, P. 711)-FTE
Sen. Kennedy (CD, Vol. I, P. 395)FTE
Sen. Kerrey (CD, Vol. I, P. 322)-FTE
Robert
Wood
Johnson
Fellow,
Sponsored by University of Rochester
Medical Center, in Office of Sen.
Kennedy (119) (135)[Tab 56 Attached
to this Memorandum]; No Official
Status Assigned
Rep. Payne (CD, Vol. I, P. 615)-FTE
Sen. Harkin (CD, Vol. I, P. 396)-FTE
OMB-FTE
Veterans Affairs-FTE
HHS-ACHPR-FTE
HHS-HCFA-FTE
Robert
Wood·
Johnson
Fellow,
Sponsored by Columbia University
School of Nursing, in Office of Sen.
Bradley
(D-NJ)(135)(773)[Tab
56
Attached to this Memorandum] - FTB
(847)
.
UCLA School of Public Health; Senior
Health
Policy
Analyst,
Rand
Corporation (865) - SGB (1679)
Congressional Caucus for Women's
Issues-FTE
HHS-FTE
Chairman of the Health Care Advisory
COJIIIDi.ssion and Special Deputy for
Health
Insurance,
California
Department of Insurance ( 864) - SGB
(1679)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
116-135, 773, 804, 1590.
See Tab 10 attached to the
Memorandum.
Working Group 7, •coverage for Working Families•, of Cluster
19
�Group II, was composed of the following members:
GROUP 7 - COVERAGE FOR WORKING FAMILIES
GROUP 7 LEADER GROUP 7 LEADER GROUP 7 LEADER -
STEVEN FINAN, Labor-FTE
LAWRENCE CAMPBELL, Commerce-FTE
RANDY HARDOCK, Treasury-FTE
ANDERSON, ROBERT
BERGTHOLD I LINDA
OMB-FTE
William M. Mercer, Inc. (864) - SGE
(1678)
sen. Bingaman (CD, Vol. I, P. 271)FTE
Education & Labor Commission (Not
Listed in Directory)-FTE (840)
National Governors Association - MN
(153),
Representative
of
Intergovernmental
Organization
(1786): No Official Status Assigned
Rep.
Gray /Deputy
GC
to
House
committee on Post Office & Civil
Service (CD, Vol. I, P. 928)-FTE
Sen. Breaux (CD, Vol. I, P. 930)-FTE
Sen, Riegle (CD, Vol. I, P. 350)-FTE
Robert Wood Johnson
Fellow
Sponsored by University of Florida,
Office
of
Sen.
Bumpers
(DAR) ( 153 )[Tab 56 Attached to This
lleJDorandum) - PTE (841)
HHS-HCFA-FTE
Commerce-FTE
Sen. Pryor (CD, Vol. I, P. 348)-FTE
Bouse select COJIIIIli.ttee on Aging Hot in Directory.
As of 3/31/93
When Bouse select COJIIIIli.ttee on
Aging's Appropriations Expired and
Were Not Renewed, Coldstein Began
Working on Task Force (153)(See Bio
Sheet) : No Official Status Assigned
- She Now Works in sen. Jefford's
Office
CEO, Blacks Educate Blacks About
Sexual Health Issues (153) - SGE
(1678)
Treasury-FTE
Treasury-FTE
Sen. Riegle (CD, Vol. I, P. 377)-FTE
Senate Finance {CD, Vol. I, P.
1025)-FTE
UCLA (184-864)-SGE (1678)
Princeton University ( 153)
SGE
(1678), COnsultant (First Responses)
Labor-FTE
CEA-FTE
BILLY, CARRIE
BORZI, PHYLLIS
BROWN, MARY LEIGH
BRUNS, KEVIN
BURNETT, LAIRD
CHANG, DEBBIE
CLARK, WI:LLIAM
CLAUSER, STEVEN
EDGELL, JOHN
GLAZE, STEVEN
GOLDSTEIN I ELAINA
HARDY I
CAROLYN
HUNTER, GILLIAN
IWRY, MARK
JARBOE, KENAN
KING, KATHLEEN
ICRONICK, RI:CK
KRUEGER, ALAN
LINDREW, GERALD
LYON, ANDREW
20
�MAGUIRE I DANIEL
MINK, DOUG
MONHEIT, ALAN
NELSON, KAREN
QUIST I JAHET
ROZEN, ROBERT
SHORT, PAMELA
SOLOMON, LOEL
TRUJILLO, THOMAS
VALDEZ, ROBERT
ZAWISTOWICH 1 LU
LABOR-FTE
Rep. Johnson (CD, Vol. I, P. 560)FTE
HHS-ACHPR-FTE
Rep. Waxman (CD, Vol. I, P. 711)-FTE
Rational League of Cities · ( 154) Representative of Intergovernmental
Organization (1786); No Official
status Assigned
Sen. Mitchell (CD, Vol. I, P. 1096)FTE
HHS-ACHPR-FTE
Sen. Labor (Not in Directory) - FTE
(848)
Veterans Administration-FTE
UCLA/Rand
Corporation
(865)-SGE
(1679)
HHS-HCFA-FTE
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
136-154, 184, 185, 774, 805, 1591. See Tab 11 attached
to the Memorandum.
Working Group 8, •coverage for Low Income and Ron-Working
Families•, of Cluster Group II, was composed of the following
members:
GROUP 8 - COVERAGE
FOR
IDW-IHCOME
AND
HON-WORKIHG
FAMILIES
GROUP
a
LEADER -
BERENSON 1 _ R
BERTHOLD I LINDA
BEVERLY, J.
BROWN, RICK
CHANG, DEBORAH
CLAUSER, STEVEN
COOPER, DAVID
DEN'l'OH, DENISE
FEDER, JUDY
FISKE, MARY B.
GAWANDE, ATUL
SHOSBARHA SOFAER
( 969) ,
George
Washington University Medical Center
- SGE (1678)
Rational capital Preferred Provider
orqanization
( 181, . 868,
30016,
30136) - SGE (1678)
William M. Mercer, Inc. (864) - SGE
(1678)
Labor-FTE
UCLA/School of Public Health (182,
864) - SGE (1678)
Sen. Riegle (CD, Vol. I, P. 350)-FTE
HHS-HCFA-FTE
HHS-ASPE-FTE
Colorado Office of Rural Health; Ho
Official Status Assigned ( 1678 ) ;
SGE (First Responses)
HHS-FTE
Sen. Kennedy (CD, Vol. I, P. 395)FTE
HHS-FTE
21
�GILLINGHAM, ROBERT
GLAZE, STEVEN
GOLD I MARTHA
HARDY I CAROLYN
HEADLEY, EDWOOD
HIGHT, JOSEPH
HOLTZBLATT I JANET
HORVATH, JANE
JOHNSON I DONALD
KRUEGER, ALAN
MAROWI:TZ I KI:CJIET.T.E
KI:I..I.MAR I KI:CHAEL
MINK I DOUGLAS
NIX, SHEILA
PARADISE, JULIA
RICE, CHERI
ROWLARD I
DI:ARB
ROZEN, ROBERT
SHORT I PAMELA
SIMON I MARSHA
SMITH I MARY BETH
SMITH, ELMER
VALDEZ I ROBERT
VELOZ I
RI:CBARD
WILLS I DARRYL
Treasury-FTE
Sen. Pryor (CD, Vol. I, P. 348)-FTE
HHS-PHS-FTE
CEO - Blacks Educate Blacks About
sexual Health Issues - SGE (1678)
Veterans Affairs-FTE
Labor-FTE
Treasury-FTE
Senate Finance; Not in Directory FTE (843)
HHS-HCFA-FTE
Princeton University (182) - SGE
(1678); Consultant (First Responses)
White House Policy Assistant - SGE:
The Johns Hopkins University (732)
Rational
Academy
of
SCiences/Institute of Medicine-FTEIDIS (843)
Rep. Johnson (CD, Vol. I, P. 560)FTE
Sen. Kerrey (CD, Vol. I, P. 322)-FTE
HHS-FTE
OMB-FTE
The Johns Hopkins University/Kaiser
COlllllli.ssion on the Future of Medicaid
[Tab 56 Attached to this Memorandum]
(173, 806)
SGE (1678)
Ro
Affiliation: Ro Official Status
Given (First Responses)
Sen. Mitchell (CD, Vol. I, P. 1096)FTE
HHS-AHCPR-FTE
Sen. Kennedy (CD, Vol. I, P. 395)FTE
Veterans Affairs-FTE
HHS-HCFA-FTE
UCLA/Rand Corporation(865)
SGE
(1679)
Formerly Bouse select COlllllli.ttee on
Aqing, Lost Appropriation 3/31/93 Ro Official Status Given (16781679): SGE (First Responses)
CEA-FTE
SOURCES: Declarations o:f Marjorie Tarmey, Documents Nos.
155-179, 775, 806, 1592.
See Tab 12 attached to the
Memorandum.
Cluster Group I:I:I:, "Hew system I:nfrastructure",
Workinq
Group
9,
"Quality
Measurement•:
Working
co~sisted
Group
of
10,
"I:nformation Systems•, Working Group 11, "Malpractice and Tort
22
�Reform",
and
Development".
Working
Group
12,
"Facilitating
Professional
See Tab 13 attached to the Memorandum.
Cluster Group
III,
"Hew system
Infrastructure",
and
its
Cluster Leaders, were as follows:
CLUSTER III -
:MEW SYSTEM I:NFRASTRUCTURE
CLUSTER LEADERS -
TOM PYLE, Boston Consulting Group
and Harvard Community Health Plan
(969, 1218) - SGB (1678), consultant
(First Responses) and Subsequently,
BILL SAGE - WHO - Policy Analyst
(HB: on Bates :Number 300, sage is
Described in Someone's Handwriting,
•Bill Sage Liaison - Magaziner, MD
JD Stanford") (300)
Working Group 9, "Quality Measurement•, of Cluster Group J;:I:I,
was composed of the following members:
GROUP 9 - QUAL:ITY IIEASUREMEMT
GROUP 9 LEADER -
8
ARNOLD EPSTE:IR, Robert Wood Johnson
Fellow,
Sponsored
by
HarVard
University
Medical
School
and
Brigham and Women's Hospital, Office
of Sen. Kennedy (D-IIA) (233) [Tab 56
ATtached to · this Memorandum]
Status Given as SGE ( CF. , Other RWJ
Fellows'
Status
is
"PTE" or
:Ignored) •
Rote:
Handwritten Rote
:Next to Epstein's Kame on 948
Indicates That Be is the •Recorder•.
several References, in Different
Handwriting, Indicate that Be Will
Be "External• to the Group: 944,
946, 948, 950.
COKSULTANTS TO WORKGROUP•: (261)
ALAll BII..IJIAJf,
Pennsylvania~
11. D. , University of
215/898-9400 (261)
KATHT.EEN, LOIIR, Ph.D.,
2165 (261)
lOll~
202/334-
SARDY SCHWARTZ, II.D., University of
Pennsylvania~ 215/898-5611 (261)
23
�WORK GROUP 9 MEMBERS:
University of Pennsylvania, School
of Nursinq
Consultant
(First
Responses); SGE (1678)
Veterans Affairs-FTE
BARBOUR I GALEN
Greater southeast Health Care System
CHAPMAN I THOMAS
(30008),
Director,
Robert
Wood
Johnson Foundation Proqram, "Openinq
Doors• ( 523) [Tab 56 Attached to this
Memorandum]; (Rote: On 724 says,
"HBS". Chapman Rot Listed in First
Responses; Listed as SGE on 1678)
HHS-AHCPR-FTE
DEMLO, LINDA
Senior Advisor for Health Policy &
EDDY, DAVID
llanaqement
to
Kaiser-Permanente;
Professor
of
Health
Policy
&
Manaqement, Duke University (119,
866) - SGE (1678)
Research Associate, Duke University
EDDY I JUDITH
- SGE (1678)
Robert
Wood
Johnson
Fellow,
EPSTEIN, ARMOlD
Sponsored b7 Harvard University
Medical SChool & Briqham & Women's
Hospital, Office of Sen. Kennedy (DIIA)(233)[Tab 56 Attached to this
Memorandum] - Listed as SGE (1678)
GAGEL, BARBARA
HHS-HCFA-FTE
GAUDETTE, SYLVIA
Rep. Oliver (CD, Vol. I, P. 609)-FTE
Sen. Pell (CD, Vol. I, P. 991)-FTE
GROSS I LAUREN
CEO, Assurqual (233, 260, 262, 276)
JACKSON I DAVID
- SGE (First Responses): No Official
Status Assiqned (1678-1679)
JENCKS I STEVEN
HHS-HCFA-FTE
JORLIRG, JIM
White House - Special Assistant SGE (1678); Unemployed (732)
KRAKAUER I HENRY
HHS-PHS-Uniform Services, University
of Health Sciences, Bethesda, MD-FTE
LASKER, ROZ
Physicians'
Payment
Review
Commission
(186)
No Official
Status
LAVIZZO-MOUREY, RISA
HHS-AHCPR-FTE
LOHR, KATHERINE
Rational
Academy
of
SCiences/Institute of Medicine
Consultant (First Responses)
McKEE, TOMOTHY
DOD-FTE
PYLE I THOMAS
Boston Consulting Group, Harvard
COmmunity Health Plan - Consultant
(First Responses)- SGB (1678) ··
SA'l'CBER, DAVID
President, lleharry Medical College
(186,
869)
Consultant
(First
Responses)
SCHULKE, DAVID
Rep. Wyden (CD, Vol. I, P. 1104)-FTE
AIKEN I LINDA
24
�TIBBITS, PAUL
Defense-FTE
WILLIAMSON, JONATHAN
Veterans Affairs-FTE
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
189, 190, 193, 194, 200, 201, 213, 214, 215, 216, 232265, 273-278, 776, 807, 1593, 1594, 30019-30022, 3016830172. See Tab 14 attached to the Memorandum.
Working Group 10, •Information Systems", of Cluster Group III,
was composed of the following members:
INFORMATION SYSTEMS
GROUP
10 -
GROUP
10 LEADER -
AUKERMAN I
GLEN
BLED, PETER
BUFFINGTON, MAX
DOWLING, ALAN
EDDY, DAVID
EDDY, JuDITH
FITZMAURICE, J.M.
HILL I TIMOTHY
HORVATH I JANE
JACKSON, DAVID
JEWS, WILLIAM
JORLING,
JAMES
KOLODNER ROBERT
KOSS, SHANHAH
KRAUKAUER I HENRY
I
KUZMACK, RICHARD
MALONEY I DANIEL .
McCONNELL, BRUCE
PYLE, THOMAS
DAVID EDDY, Senior Advisor for
Health Policy and Manaqement to
Kaiser-Permanente:
Professor
of
Health Policy and Management, Duke
University (119, 866)
HHS-HRSA-FTE
(282) No Affiliation, No Official
Status Given
HHS-HCFA-FTE
(281) No Affiliation, No Official
Status Given
Senior Advisor for Health Policy &
Management to Kaiser-Permanente:
Professor
of
Health
Policy
&
Management, Duke University (119,
866) - SGE (1678)
Research Associate, Duke University
- SGB (1678)
HHS-AHCPR-FTE
HHS-HCFA-FTE
Senate Finance-FTE ( 846) - Not in
Directory
CEO, Assurqual (233, 281, 289): No
Official Status Assigned
Phone (301) 925-7000 - Dimensions,
Inc.
(281): No Official Status
Assigned
White House Special Assistant - SGB:
Unemployed (732)
Veterans Affairs-FTE
OMB-FTE
HHS-PHS- Uniform Services University
of
Health
Sciences,
Bethesda,
Maryland-FTE
OMB-FTE
Veterans Affairs-FTE
OMB-FTE
Boston Consultinq Group & Harvard
Community Health Plan (969, 1218) -
25
�SAGE, WILLIAM
SILVER, JONATHAN
STEINAUER, DENNIS
SGE
(1678),
Consultant
(First
Responses)
MD, JD, Stanford - SGE {1678)
Commerce-FTE
commerce - National Institute of
Sta~dards and Technology (282)-FTE
SOURCES: Declarations o:t Marjorie Tarmey, Documents Nos.
191, 192, 195, 196, 202, 203, 266-269, 279-322, 777, 808,
1143-1150, 30023, 30024, 30073. See Tab 15 attached to
the Memorandum.
Working Group 11, nxalpractice and Tort Reformn of Cluster
Group III, was composed of the following members:
MALPRACTICE ARD TORT REFORM
GROUP
11 -
GROUP
11 LEADER -
ROBERT BERERSOR I Rational capital
Preferred
Provider
Organization
(30016, 30136) - SGE (1678)
GROUP 11 LEADER -
K. HASTINGS, JD, RN, HH-PHS-ACHPRFTE (843)
ABRAHAM, KENHETII
Professor of Law {1331) - Ro
Official status
University of Pennsylvania SChool of
Rursing
(188)
SGE
(1678):
COnsultant (First Responses)
HHS-HRSA-FTE
HHS-HCFA-FTE
Rational capital Preferred Provider
organization (868) - SGE (1678)
The Urban Institute· - Ro Official
Status {1331)
.
Harvard School of Public Health: Ro
Official Status (1331)
Risk Management Foundation, Harvard
Medical Institution: Ho Official
Status (1331)
The Wharton SChool - Health Care
Policy and Insurance - University of
Pennsylvania: Ro Official Status
(1331)
Sen. Rockefeller (CD, Vol. I, P.
352)-FTE
Senior Advisor for Health Policy &
Management to Kaiser-Permanente i
Professor of
Health Policy
&
Management, Duke University (119,
866)(188) - SGE (1678)
AIKEN I LIHDA
AUKERMAN, GLEN
BAUM, NANCY
BERENSON I ROBERT
BOVBJERG I
RARDALL
BRERRAif I
TROYER
CREASEY I
DANIEL
DANZOR, PATRICIA
DONESKI, ELLEN
EDDY, DAVID
UVA -
26
- - - - - - - - - - - - - - - - - - - - '
�EDDY I JUDITH
GOSFIELD I ALICE
HADLEY, ELIZABETH
HASTINGS, KATHLEEN
HAVIGHURST I CLARK
HUCKABY, MICHELLE
JORLING I JAMES
MEADOW, CYNTHIA
MILLER, FRARCES
MORLOCK,
LAURA
O'CONNELL, JEFFREY
PYLE I
THOMAS
REEVES I LINDA
SATCHER,
DAVID
SCHULTZ, WILLIAM
TAPLIN, CAROLINE
VARNHAGEN I M.
WADLIRGTON I WALTER
WEICH, RONALD
WEILER, PAUL
Research Associate, Duke University
(188)
Law Offices of Alice Gosfield,
Philadelphia,
Pennsylvania:
No
Official status (1331)
HHS-ASPE-FTE
HHS-PHS-ACHPR-FTE
Duke University School of Law: No
Official Status (1331)
Rep. Clement (CD, Vol. I, P. 494)FTE
White Bouse Special Assistant: SGE
(1678): Unemployed (732)
Rep. Brooks (CD, Vol. I, P. 723)-FTE
B. u. School of Law - Ro Official
Status (1331)
The Johns Hopkins University School
of Public Health: No Official Status
(1331)
UVA School of Law: Ro Official
status ( 1331)
Boston consulting Group & Harvard
Community Health Plan (969, 1218) SGE
(1678),
Consultant
(First
Responses)
HHS-PHS-AHCPR-FTE (847): Veterans
Affairs-FTE (First Responses)
President, Meharry Medical College
(188) -Consultant (First Responses)
Rep. Waxman (CD, Vol. I, P. 1104)FTE
HHS-PHS-FTE
Sen. Metzenbaum (CD, Vol. I , P.
396)-FTE
UVA School of Law: Ro Official
Status (1331)
Sen. Labor & Human , Resources (CD,
Vol. I, P. 737)-FTE
Professor, Harvard Law: Ro Official
status ( 1331)
SOURCES:
Decelarations of Marjorie Tarmey, Documents
Nos. 204, 205, 209, 210-212, 217, 218, 291-294, 323-332,
778, 809, 1610, 1330-1331, 30026. Note:
See Sign-in
List at 30026, Attached at Tab 16, Describing a Seminar
on March 5, DHHS, Room 800, 200 Independence Avenue, sw,
for Task Force Members and Private Lawyers and other
Individuals. See Tab 16 attached to the Memorandum.
Working Group 12, "Facilitating Professional Development•, of
Cluster Group III, was composed of the following members:
27
�GROUP 12 -
FACILITATING
(206)
PROFESSIONAL
DEVELOPMENT
STEERING COMMITTEE: FITZHUGH
MULLAN,
HHS/HRSA/BHPR
Chair,
Senior Consultant,
LINDA AIKEN,
University of Pennsylvania School of
Nursing (197)
DAVID SATCHER, Senior Consultant,
President, Meharry Medical College
(197)
cmo
SUIIAYA,
Associate
Dean,
Universsity of Texas Health sciences
center, San Antonio, Texas (197)
SPECIAL CONSULTANT: CAROLYN BANDY 1 CEO 1 Blacks Educate
Blacks About Sexual Health Issues
CONSULTANT:
JANE SCBADLE ( 371) J:owa Department
of Health, Des Moines, Iowa
PART-TIME CONSULTANTS:
MARCIA BRAND HHS-HRSA (372)
NEIL SAMPSON HHS-HRSA (372)
Handwritten Note:
"Suzy El Attar, David, Medical
Students From Pitt" (300).
Handwritten Note:
"Dave,
Include Us, suzy" (303). According to Bates Humber 351,
David Evans and suzanne El Attar are "Workgroup
Assistants" in the Division of Medicine, Bureau of the
Health Professions, HHA-HRSA (351). ·
ALTMAN, DAVJ:D .
Robert
Wood
Johnson
Fellow,
Sponsored by the center for Health
Professions,
University
of
california, San Francisco, Office of
Sen.
Rockefeller
(D-WV) [Tab
56
attached to this MemorandUDl] (197,
BEASON, CHARLOTTE
BIERWIRTH, M.
Veterans Affairs-FTE
Rep. Gejdensen (CD, Vol. I, P. 531)FTE
Legislative Fellow, Office of sen.
Bingaman
(Not
Listed
in
Congressional Directory) (198)-FTE
206) - PTE (840)
DAVJ:ES, MONICA
(841)
DENTON, DENJ:SE
DUNN, VAN
Colorado Rural Health Office (300)SGE (First Responses): No Official
Status Given (1678-1679)
Sen. Kennedy (CD, Vol. I, P. 395)FTE
28
�DUZOR, DIERDRE
EDDY, JUDY
FORBES, RIPLEY
GOLUB, LAWREIICE
GROSS, MARCY
HANDY, CAROLYif
HUNAN I JEFFREY
JOHNSON, SCHELEEN
JORLIIIG, JAMES
McLENNEY, LUCRETIA
MULLAN, FITZHUGH
lfiCBOLS, LDmA
PYLE, THOMAS
RIVO, MARC
SALMON, MARLA
SCBADLE, JAIIE
SOJIAYA, CIRO
VELOZ, RICHARD
WILSON I FRANK
HHS-HCFA-FTE
Research Associate, Duke UniversitySGE (1678)
.
Rep. Waxman (CD, Vol. I, P. 976)-FTE
White House Fellow/lfHS (198) - No
Affiliation;
No Official
Status
Given
HHS/OSHA-FTE
CEO, Blacks Educate Blacks About
sexual Health Issues-SGE (1678)
Senate Special committee on Aging
(Not in Directory)-FTE (843)
Rep. Bryant (CD, Vol. I, P. 1015)FTE
White House Special Assistant-SGE;
Unellployed (732)
DOD-FTE
HHS-PHS-FTE
Director of Interdisciplinary Team
Traininq, Ramada Renaissance Hotel,
999 Ninth street, HW, Washington, DC
20001; 202/535-7527 (0); 202/5357522 (F) (369) - VA-FTB (846)
Boston consulting Group; Harvard
CODIIIUility Healtb Plan-SGE ( 1678) ;
lfot Listed (First Responses)
HHS-HRSA-FTE
HHS-HRSA-FTE
Iowa
Department
of
Health;
Consultant (371, First Responses);
Associate Dean, University of TeXas
Health sciences center, San Antonio
(197)-SGE (1679)
Bouse Special Comdttee on Aqinq,
Lost Appropriation 3/31/93, Worked
for BBS ( 779 )-SGE (First Responses) ;
Not Listed as SGE on 1678-1679)
DOL-FTE
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
197-199, 206-208, 219-221, 270-272, 295-297, 298-405,
779, 810, 1602-1609.
See Tab 17 attached to the
Memorandum.
Cluster Group IV, "Integration of Government Health PrograJDS
Into lfew System•,
consisted of Workinq Group
Workinq Group
"Department of
14,
•veterans•, Workinq Group 16,
Plan", and Workinq Group 16A,
11
Defense•,
13,
11edicare11 ,
11
Workinq . Group
15,
Federal Employees Health Benefitss
11
otber Government Programs•.
29
See
�Tabe 18 attached to the Memorandum.
Cluster Group IV, •Integration of Government Health Programs
Into New System•, and its leaders were listed as follows:
CLUSTER IV-
INTEGRATION OF GOVERNMENT HEALTH PROGRAMS
INTO HEW SYSTEM (969)
CHAIR -
STEVE BANDEIAN, OMB-FTE
Working Group 13,
•Medicare•,
of Cluster Group
IV,
composed of the following members:
GROQP 13 -
MEDICARE
GROUP 13 LEADER -
BARBARA COOPER, HHS (406)-FTE .
ADDISON-BURTON, LAVARNE
Rep. Sabo (CD, Vol. I, P. 930)
Policy
Assistant,
White
House
BUENO I IRERE
(1634)-SGE (First Responses) - Not
Listed 1678-1679 - Unemployed (732)
BANDEIAN, STEVE
OMB-FTE
BURNEY, IRA .
HHS-HCFA-FTE
COOPER, BARBARA
HHS-FTE
GOLDWATER, DAVID
Rep. Bilbray (CD, Vol. I, P. 986)FTE
HARTZ, THOMAS
HHS-FTE
HICKMAN I PETER
HHS-HCFA-FTE
HUCKABY 1 MICHELLE
Rep. Clement (CD, Vol. I, P. 484)FTE
KAZDIN I ROBERT
Treasury-FTE
LIU, ERIC
Sen. Boren (CD, Vol. I, P. 1038)-FTE
KILLER, IIELAHI:B
Rep. Andrews - Not in Directory-PTB
(846)
PAYNE, MARY ELLA
Sen. Rockefeller (CD, Vol. I, P.
352)-FTE
PRATT I DONALD
Veterans Affairs
SHIRLEY I AARON
Director,
Jackson-Hinds
COmprehensive Health Center ( 407,
780, 811, 1534)-SGE (1678)
SOLOMON 1 AOEHEA
census-FTE
WELCH, PETE
The Urban Institute ( 406) -SGE ( OIIB)
- 1679
WIBNBR, JOSH
The Brookings Institution (780)SGE/BBS ( 1679)
ZARABOZO, CARLOS
HHS-HCFA-FTE
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
406-410, 780, 811, 1534, 1614. See Tab 19 attached to
the Memorandum.
30
was
�Working Group 14, nDepartment of Defensen, of Cluster Group
IV, was composed of the following members:
GROUP 14 GROUP 14
DEPARTMENT OF DEFENSE
LEADER -
BANDEIAN, STEVE
BATES, JIM
CLAYPOOL I ROBERT
COOPER, BARBARA
FISH, JIM
HAMMERSCHLAG I ART
HEATH KAREN
I
HIGGINS, MICHAEL
HIX I
MICHAEL
HOSEK,
SUSAN
LILLIE, STEVE
MORGAN, JACQUELINE
PANG I FREDERICK
SLACKMAN I JOEL
SPAULDING I VERNON
WIENER, JOSH
JOEL SLACKMAN, DOD-FTE
OMB-FTE
Navy Surgeon General ( 425) - Not
Listed as FTE in 840-849; Listed in
First Responses-FTE
u.s. Army Surgeon General-FTE
HHS-FTE
OMB-FTE
Veterans Affairs-FTE
House Armed Services Committee (CD,
Vol. I, P. 1001)-FTE
Rep. Dellums {CD, Vol. I, P. 697)FTE
Rand Corporation-SGE/DOD (1678)
Rand Corporation, 310, 393, 0411
(419): Hot Listed: Ho Status Given
DOD-FTE
DOD-FTE
Senate Armed Services Committee (CD,
Vol. I, P. 395)-FTE
DOD-FTE
DOD-FTE
Brookings
Institution
(424)-SGE
(1678)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
411-425, 787, 1537, 1615. See Tab 20 attached to the
Memorandum.
Working Group 15, •veterans•, of Cluster Group IV was composed
of the following members:
GROUP 15 -
VETERANS
GROUP 15 LEADER -
KAREN WALTERS, Veterans Affairs-FTE
ALPERT I CYNTHIA
BANDEIAN I STEVE
BREW, WILLIAM
BUENO I ZREifE
Veterans Affairs-FTE
OMB-FTE
House VA Comm--Check CD.
Policy Assistant ( 426) SGE, White
Bouse (First Responses) : Hot Listed
1678-1679 - unemployed (732)
DOD-FTE
HHS-HCFA-FTE
Sen. Campbell {CD, Vol. I, P. 282)FTE
cox KENNETH
ERMANN, DAN
EVANS, JENNIFER
I
31
�GRAMS, TODD
HORVATH I THOMAS
IBSEN, RALPH
LINCOLN, MICHAEL
NORMAN, ALLINE
RAYMOND, VIC
WEIHER, JOSH
OMB-FTE
Associate Dean,
VA,
SUNY/Stony
Brook,
79
Middleville
Road,
. :Northport, HY 11768; 914/939-2745
(427, 428, 429)-FTE (843)
Veterans Affairs-FTE
HHS-IHS-FTE
Veterans Affairs-FTE
Designee of commerce secretary Ron
Brown to the Task Force: Acting
Assistant Secretary for Policy &
Planning (432)-FTE (847) - Veterans
Affairs
Brookings (426)-SGE/BHS (1679)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
426-437, 788, 1536.
See Tab 21 attached to the
Memorandum.
Working Group 16, "Federal Employees' Health Benefits Plan" of
Cluster Group IV was composed of the following members:
GROUP
16 -
FEDERAL EMPLOYEES HEALTH
BENEFITS PLAN
GROUP 16 LEADER -
CURT SMITH (443), OPM-FTE
BANDEIAN, STEVE
BOERUM, DENISE
BLOCK, ABIGAIL
BRUNS I KEVIN
COPELAND, ROBERT
CROW, SHELLY
OMB-FTE
Senate Committee (CD, Vol. I, P. )
OPM-FTE
Rep. Gray (CD, Vol. I, P. 928)-FTE
Labor-FTE
second Chief, Kuscoqee Creek HationSGE (1678)
White Bouse Policy Assistant-SGE
(First Responses); Rot Listed 16781679
.
Senate
Governmental
Affairs
Committee (CD, Vol I, P. 30)-FTE
( 446) Ho Official Status Given Contractor [See Tab ]
Senate Select Committee on Indian
Affairs, P. 1018)-FTE
HHS-IHS-FTE
Education & Labor (CD, Vol. I, P. )
OMB-FTE
CEA-FTE
HHS-FTE
OPM-FTE
Labor-FTE
Rep. Gray (CD, Vol I, P.
)
OMB-FTE
GEBAR, MARGERY
GLEIMAN, EDWARD
JOBES, STANLEY
JOSEPH-FOX, YVETTE
LINCOLN I MICHAEL
LOPATIN, ALAN
NAKAHATA I PETER
POSEY I KENDALL
SCHMID, STUART
SMITH I CURTIS
SVENONIUS, DIANE
WEISS, GAIL
WYLER I ROBERT
32
�SOURCES: Declarations of Marjorie Tarmey, Document Nos.
438-446, 789, 1535, 30029. See Tab 22 attached to the
Memorandum.
Working Group 16A, •other Government Programs• of Cluster
Group IV, was composed of the following members:
GROUP 16A -
PROGRAMS
OTHER GOVERNMENT
GROUP 16A LEADER -
MICHAEL LINCOLN, HHS-IHS-FTE
BANDEIAN I STEVE
SHELLY
OMB-FTE
Second Chief I lluscogee creek NationSGE (1678)
OMB-FTE
senate Committee on Indian Affairs
(CD, Vol I, P. 1018)-FTE
WHO - Policy Assistant-SGE ( 1678)
IHS-FTE
IHS-FTE
Mountain Management Co. 1 MN-SGE
(First Responses) - Not Listed 16781679)
OMB-FTE
HHS-IHS-FTE
HHS-IHS-FTE
Brookings Institution-SGE/IDfS ( 1679)
HHS-IHS-FTE
CROW I
DOROTINSKY, BILL
JOSEPH-FOX, YVETTE
KLINE I JENHIFER
LINCOLN, MICHAEL
McCLOUD, MARMADUKE
MILLER, CAROL
NAKAHATA PETER
REYES, LUANA
SCHOENING, ATHENA
WEIHER, JOSH
WIGGINS, CLIFF
I
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
449-452, 30030, 30031.
See Tab 23 attached to the
Memorandum.
Cluster V,
"Bioethics or Ethical Foundations of the Hew
System", consisted of one Working Group, that.being Working Group
17, "Bioethics•.
Working Group 17,
11
Bioethics•, of Cluster Group
v, consisted of the following members:
CLUSTER V -
ETHICAL FOtJHDATIOHS OF THE 11EW SYSTEM
WORKDIG GROUP 17 -
BIOETBICS
GROUP 17 - co-LEADER
HAifCY
DUBLER,
Medical Center
MARIAH
SECUHDY,
University
ASCII, ADRIENNE
BAYER, RONALD
llontefiore
Boward
B.U. SChool of Social Work
Columbia University SChool of Public
33
- - - - - - - - - - - - - -
�BROCK, DAHIEAL
CAPLAN, ARTHUR
DANIELS, NORMAN
DORFF I ELLIOTT
DULA, ANNETTE
ELLIS, GARY
Health
Director of Center for Biomedical
Ethics
University of Minnesota, Center for
Biomedical Ethics
Tufts University
Provost, Professor, University of
Judaism
Rockefeller Fellow, University of
Colorado
Office for Protection from Research
Risks
Harvard Medical SChool/Dana Farber
Cancer Institute
EVAH, ABIGAIL R.
Princeton Theological Seminary
FAHEY, MGSR CHARLES Third Age Center
FLECK, LEN
Michigan State
FOST, HORMAN
University of Wisconsin
GIBSON, JOAN
University of Hew Mexico, Director,
Center for Health law and Ethics
American Society of Law, Medicine &
GOSTIN, LAWRENCE
Ethics
KING, PAT
Georgetown University Law Center
Chief,
Medical
Staff,
Larabida
LAHTOS, JOIDI
Hospital
-·
LEVINE, CAROL
The orphan Project FUnd
USCF, Director, Progr8lll in Medical
LO, BERNARD
Ethics
KAY, BILL
SMD Professor of Ethics
MEISEL, ALAR
University of Pittsburgh Center for
Medical Ethics
MEZEY, KATHY
NYU
Independence
Professor
of
Nursing
MILES, STEVER
University of Minnesota, Center for
Biomedical Ethics
O'CORHELL, LAWRENCE Boward University SChool of Medicine
OSSORl:O, PI:LAR
Post-Doc Associate, Yale University
SChool of Medicine
PORTILO, RUTH
Creighton University center for
Health Policy and Ethics
SANDERS, CHERYL
Boward University Divinity School
SECUNDY, IIA1UAH
Boward University, Medical Ethics
TURMAN I RICHARD
OMB-Not Listed as an FTE on 840-849
EIIAHOEL, EZEKIAL
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
453-469, 867 1 1538.
See Tab 24 attached to the
Memorandum.
Cluster Group
v:r, •Transition to the Hew System _ Short-Tera
Cost Controls•, consisted of Working Group 18, •Accelerating Hew
System
Development•,
Working
34
Group
19,
•ac:bdnistrative
�Simplification• and Working Group 20, "Interim Cost Controls".
See
Tab 25 attached to the Memorandum.
Cluster Group VI, "Transition to the New System Short-Term
Cost Constrols",
and its leader was listed as follows:
CLUSTER VI -
TRANSITION TO THE NEW SYSTEM
SHORT-TERM COST CONTROLS .
CLUSTER LEADER -
PAUL STARR, Princeton
(1763)-SGE/BBS (1678)
University
Working Group 18, "Accelerating New System Development•, of
Cluster Group VI, was composed of the following members:
ACCELERATING HEW SYSTEM DEVEIDPIIEMT
GROUP 18 -
GROUP 18 LEADER -
LOIS QUAil (1760), SGE-HHS (1678)
ON TAP:
ALADf ERTIIOVEM, FROM OTHER CLUSTERS: WALTER
ZELMAN, RICK KROHICK, RICK CURTIS, ATUL GAWANDE (474)
BENAVIDES 1
ET.T.Q
CAVANAUGH I SEAN
DELEW I NANCY
BPS'l'EDf, ARNOLD
GARCIA, JOSEPH
Hennepin County, Minnesota Bureau of
Health, Director of Health Policy
(Stayed at the Holiday Inn Crowne
Plaza, Metro Center)
(478); No
Official Status Listed; Listed as
•Intergovernmental
Representative
from
Rational
Association
of
COunties on 1786, But List Does Not
Show Participation in Group 18;
Listed as Participant in the Task
Force in First Responses
Rep. Cardin (CD, Vol~ I, P. 936)-FTE
HHS-FTE
Robert
Wood
Johnson
Pellow,
Sponsored by Harvard Medical School
&
Brigham & Women's Bospital;
Serving in the Office of sen. J.
Rockefeller IV ( 4 79) ; Listed as SGE
( 1678) [See Tab 56 Attached to the
Memorandum)
CUyahoga County, Ohio Department of
Human Services
(stayed at the
Americana Botel)(478) - Listed as a
Participant; Ho Official status
Given; Hot Listed as SGE on 16781679: Listed as •Intergovernmental
Representative•
from
Rational
Association of COunties on 1786, But
List Does Not Indicate Participation
35
�in Group 18.
HHS-FTE
White House Policy Assistant - SGE
(1678); Columbia university (732)
LANGENBRUNNER, JACK OMB-FTE
LEMASURIER, JEAN
HHS-HCFA-FTE
LUKOMNIK, JOANNE
Contractor from HYC (478); SGE/HHS
(1678)
Ho Affiliation Listed; Stayed at the
McLAUGHLIN, DAR
Holiday Inn crowne Plaza, Metro
Center ( 4 78) , Like Benavides; Ho
Official Status
Mountain Management Co. , Hll - SGE .
MILLER, CAROL
(First Responses) - Hot Listed as
SGE on 1678-1679
Rational
Governors
Association,
O'BRIEN I MARY JO
Minnesota; Listed as Representative
fro• Intergovernmental organization
on 1786; Ho Official Status Listed
VP, United Health care Corporation,
QUAM, LOIS
SGE (1678)
Listed
as
Representative
of
QUIST, JAHET
Intergovernmental Organization from
Rational Leaque of Cities ( 1786) ; Ho
Official Status Given
SCHUMANN, BETH
HHS-FTE
STARR, PAUL
Princeton University - SGE (1678)
WELCH, PETE
The Urban Institute - SGE/OIIB ( 1679)
BBS; Hot Listed as an PTE on 840WIIANG I JUDY
849; called •Policy Analyst• in
First Responses
ZAWISTOWICH, LU
HHS-FTE
ZARABOZO, C.
HHS-FTE
GREENBERG, GEORGE
KELLEY I LAUREH
SOURCES: Declarations of Marjorie Tarmey, Documents Hos.
478-487, 724-729, 790, 1313-1315, 30101.
see Tab 26
attached to the Memorandum.
·
Working Group 19, •Administrative Silllplification•, of Cluster
Group VI, was composed of the following members:
GROUP 19 -
ADIIIHISTRATIVE SIIIPLIFICATIOH
GROUP 19 LEADER -
TIM HILL, HHS-FTE
ON TAP - BERT TOBIN I RICHARD SHARPE I THE IIAR'l'FORD
FOONDATIOH (477); FROM OTHER CLUSTERS: TOM PYLE, DAVID
EDDY (477)
ABRAMCHECK, F.
ABRAMSOH I LEOHARD
ALBERTIHB, JDI
EDS Real th care; Ho Official Status
(30027)
US Health care; Ho Official Status
Albertine Enterprises (SIIS} (30028};
36
�ALEXANDRE, LESLIE
BARRETT, LEE
BATALDEH, PAUL, MD
BUFFINGTON, MAX
CAULEY, BANK
CHERTOFF, STEVE
CONNELL, RICHARD
CDRTIS, BENJAMIN
DOWLING,
ALAR
FITZMAUIUCE, J.
GAUCHER, EJ.I.£H
GIEL,
MICHAEL
GILLIGAN, T.J.
HILL, TIM
HERRELL, ILEANA
HUMPHRIES, BETSY
KRAKAUER, HENRY
KOSS I SHANNAH
CHRJ:STIHE
KOVHER,
KUZMACK, RICH
LEDBE'rl'Ek, LEE
MOSSER, GORDON
HUDELMAH I
PETER
O'DOHHELL, KEH
O'ROARK, FRAHK
PJ:CKEIUifG I JDI
lfOREHE
SCHROEDER, KATHY
RICKSON,
SCOTT I
JEAHifE
SILVA, JOHN
SOUDER, BARBARA
No Official Status
EDS (30028); No Official Status
Aetna (30028); No Official Status
Hospital Corporation of America; No
Official status
HHS-FTE
Telesis; No Official Status
PCS Health Systems; No Official
Status
HEIC
(How Aetna)
(30073);
No
Official Status
lfEIC (How Aetna); No Official Status
(30028)
Task Force (Hot Listed as FTE Phone 216/338-5866 - Which is the
Dowling's Home Number)
AHCPR-BHS-FTE
University of Michigan Hospital; No
Official status
Cooperative Healthcare Networks; No
Official Status
CIS;Ifo Official Status
HHS-FTE
us Public Health Service-FTE
National Library of Medicine-FTE
Uniformed services University of
Health Sciences-FTE
OMB-FTE
Hew York University; lfo Official
Status
OMB-FTE
SMS; lfo Official status (30027,
30028)
SMS Corporation - No Official Status
Veterans' Affairs-FTE (844)
First Health; lfo Official status
(30027, 30028)
J:nternist/Minnesota; lfo Official
Status
Group Health Cooperative of PUget
sound; lfo Official Status
HEJ:C (lfow Aetna): No Official Status
{30027)
Blue Cross/Blue Shied Ass'n/WEI)J:; lfo
Official Status (30028)
HEJ:C (How Aetna); No Official status
Telesis; lfo Official Status
William
Beumont
Hospital;
No
Official Status
CJ:S Technologies; lfo Official Status
OMB-FTE
WEDI:/Travelers; lfo Official Status
(30027)
37
�SOVDIERS I R.
STEPHENS I JACK
WESTON I DAVID
WILSON, MARK
WOLFORD, G. RODNEY
CIS Technologies; Ho Official Status
(30027)
Lakeland Regional Medical Center; Ho
Official Status
The Travelers/WED!; Ho Official
Status (30028)
OMB-FTE
Alliant Health System; Ho Official
status
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
477, 791, 30025, 30027, 30028, 30073, 30100, and List
Included in First Responses Entitled, "Administrative
Simplification", See Tab 27 attached to the Memorandum.
Working Group 20, •Interim Cost Controls•, of Cluster Group
VI, was composed of the following members:
GROUP
20 -
INTERIM COST CONTROLS
GROUP 20 LEADER -
DAVID CUTLER, CEA-FTE
ADDISON-BURTON, LAVARNE
ALTMAR I
STUART
BALL, JUDY
BRIGGS, BETTY
BUFFINGTON, MAX
BURNEY, IRA
BUTO I KATHLEEN
CAVANAUGH I SEAN
CHAMBERS I CAROLINE
COSTER, JOBH
CUTLER, DAVID
DAVIS, KAREN
DEWANE I MARY
Rep. Sabo (CD, Vol. I, P. 930) "Recorder" (30052)-FTE
The
Beller
School,
Brandeis
University.
In Handwriting, •BBSConsultant•
(480);
Ho Official
Status
Given;
Hot
Listed
as
Participant in First Responses; Ho
other Docum.entation. l'fote: Alan B.
COhen, Former RWJF Trustee is now at
the Beller SChool and is on the
Editorial Board of Beal:tb M:fairs
[See Tab 56 Attached to the
llemorandWil]
HHS-ACBPR-FTE
LABOR-PWBA-FTE
HHS-FTE
HHS-HCFA-FTE
HHS-HCFA-FTE
Rep. Cardin (CD, Vol. I, P. 936)-FTE
Rep. Cooper (CD, Vol. I, P. 936)-FTE
Select COmmittee on Aging (Lost
Appropriation 3/31/93 )-Listed as
PTE-841
CEA-FTE
Vice President, the commonwealth
Fund, Kember of Physicians Payment
Review Commission (PP.RC) (See Also
484, 488, 492, 496, 499); Ho
Official Status Given; Hot Listed as
a Participant in First Responses
HHS-HCFA-FTE
38
�Sen. Budget (CD, Vol. I, P.
)-FTE
Sen. Rockefeller (CD, Vol. I, P.
352-FTE
In Handwriting, •consultant• {480,
ENTHOVEH, ALAIN
488, 493, 496) ; The Jackson Hole
Group, Inc.; No Official Status
Given; Hot Listed as a Participant
in First Responses.
Sen. Baucus {CD, Vol. I, P. 268)-FTE
FINIGAN, TOM
(Identifies Self as "Congressional
Fellow• on Sign-In List)
FITZMAURICE, MICHAEL
HHS-FTE
HHS-FTE
FRIEDMAN I BERNARD
HHS-FTE
GREENBERG, GEORGE
Rep. Waxman (CD, Vol. I, P. 712)-FTE
HASH I MICHAEL
HHS-HCFA-FTE
HILL, TIM
White
House
Policy
Assistant
KELLEY, LAUREN
{30052); Columbia University {732)SGE (1678)
Rep. Gephardt (CD, Vol. I, P. 532)KING I ANDREA
FTE
KOLUDNER, ROBERT
Veterans Affairs-FTE
KOSS I SHANNAH
OMB-FTE
Uniformed Services University of
KRAKAUER I HENRY
Health Sciences-FTE
KUZMACK, RICH ·
OMB-FTE
LANGENBRUNNER, JACK OMB-FTE
LEATHERS I HOWARD
CEA-FTE
LEE, PHILIP
(In
Handwriting,
•BBS-Special
Government Employee•) •
Director,
Robert Wood Johnson Foundation {See
A1so 485, 489, 494, 497, 500) (See
Tab 56 Attached to the Memorandum) ;
No Official Status Given, Rot Listed
as a Participant in First Responses.
OMB-FTE
.
LUTTER I RANDY
NEXON, DAVID
Labor Comm. (CD, Vol. I, P.395)-FTE
NICHOLS, LEN
OMB-FTE
O'NEILL, KIM
CEA-FTE
O'BRIEN, MARY JO
Rational
Governors
Association,
Minnesota (490); Ro Official status
Given - Listed as Representative of
Intergovernmental Organization, HGA
on 1786)
POTETZ, LISA
Sen. Finance (CD, Vol. I, P.
)QUAM, LOIS
(In Bandwriting, •BBS Spec Gov Elllp•)
(482, 490, 494, 497, 500) VP, United
Health care Corp-SGE ( 1678)
REINHARDT, UWE
(In Handwriting, •consul tant•) ( 482,
486, 490, 494, 497, 500) Princeton
University;
Ro Official status
Given; Hot Listed as a Participant
in First Responses
DEIGNAN I KATHY
DONESKI, ELLEN
39
�RILEY I IRENE
RODRIGUEZ, LOUISE
ROSEN, BOB
SHEINGOLD, STEVE
SILVA, JOHN
SOLOMON, LOEL
STARR, PAUL
THORPE, KEN
UKOCKIS, JAMES
WERNER I MICHAEL
WILSON, MARK
National Association of Counties
(1787); Listed as Representative of
Interqovernmental organization; No
Official Status
Veterans Affairs-FTE
Sen. Mitchell (CD, Vol. I, P. 1096)FTE
HHS-HCFA-FTE
Uniformed Services University of
Health sciences-FTE
Sen. Kennedy (CD, Vol. I, P.
)(In Bandwriting, "HBS-Spec Govt
Emp") (482), Princeton UniversitySGE (1678)
HHS-HCFA
Treasury-FTE
senate Democratic Policy Committee
(CD, Vol. I, P. 403)-FTE
Labor-FTE
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
480-498, 790, 1539-1543, 1617-1625, 30052. See Tab 28
attached to the Memorandum.
Cluster Group VXI,
"Financing", consisted of one Working
Group I that being Working Group 21 I "Financing. n Working Group 21 I
"Financing•, of Cluster Group VXI was composed of the following
members:
CLUSTER VXI -
FINANCING
CLUSTER LEADER GROUP
21 -
MARINA WEISS, Treasury-FTE
FIHANCING
ANTOS, JOSEPH
BERNER, KEVIN
CHARLES, GERALD
CORONADO I DAVXD
FLYNN, ED
GALE, JOSEPH
GLAZE, STEVEN
HARDOCK, RANDY
HELLINGER, FRED ·
JACKSON, PAUL
KERY, PAT
HHS-FTE
Veterans' Affairs-FTE
Treasury-FTE
DC
Commissioner of Health care
Finance (505); No Official Status
Given; Listed as Intergovernmental
Employee in First Responses
OPM (503)-FTE
Sen. Moynihan (CD, Vol. I, P. 980)FTE
Sen. Pryor (CD, Vol. I, P. 348)-FTE
Treasury-FTE
HHS-FTE
HHS-FTE
Rep. Kenelly (CD, Vol. I, P. 1023)FTE
40
�KING, ROLAND
LYON, RANDY
MUNNELL, ALICIA
PATEL, PARASHAR
PETERSON I DOUGLAS
RAYMOND, VICTOR
RILEY I IRENE
SCIIEPPACB I RAYMOND
SCHNEIDER, ANDREW
SWIRE, ANDREW
TITUS, FRANK
UYEDA, MARY
WEISS, MARINA
WOO, MICHAEL
HHS-FTE
OMB (502)-FTE
Treasury-FTE
OMB-FTE
National League of Cities (505,
512); No Official Status Given;
Listed
as
Representative
of
Intergovernmental
Organization
(1787)
Veterans Affairs-FTE
L.A. County Health Department -NACO
(505, 512) - No Official Status
Given, Listed as Representative of
Intergovernmental organization on
1787)
National Governors Association ( 521,
504, 509, 511, 514, 516, 518, 519);
No Official Status Given, Listed as
Represen·tative
From
Intergovernmental
Organization
(1787)
Rep. Waxman (CD, Vol. I, P. 711)-FTE
OMB-FTE
OPM (502)-FTE
National Association of counties
(505,
512); No Official Status
Given; Listed as Representative of
Intergovernmental
Organization
(1787)
Treasury-FTE
Energy & Comm (CD, Vol. I, P. 710)FTE
SOURCES: Declarations of Marjorie 2'armey, Documents Nos.
501-522, 793, 1544, 1545, 30109, 30110, 30032. see Tab
29 attached to the Memorandum.
Cluster
Underserved",
Group
Vl:II,
consists
of
"Health
Working
Policy
Group
Initiatives
22,
"Health
for
the
Policy
Initiatives for the Underserved", Subgroup A, "Underserved Rural
and Inner City Areas", Subgroup B, "Vulnerable Populations/High
Risk Populations•, Subgroup
c,
"Women and Children", and Subgroup
D, "Population-Based Public Health and Prevention".
See Tab 30
attached to the Memorandum.
Cluster
Underserved•,
Group
VIII,
"Health
Plicy
Initiatives
and its leader was listed as follows:
41
for
the
�CLUSTER VIII - HEALTH
POLICY
UNDERSERVED
INITIATIVES
FOR
THE
MARK SMITH, Vice President, Kaiser
CLUSTER LEADER -
Family Foundation
Working
Group
22,
"Health
Policy
Initiatives
for
the
Underserved", Subgroup A, "Underserved Rural and Inner City Areas",
of Cluster Group VIII, listed the following members:
GROUP 22 -
HEALTH
POLICY
UNDERSERVED
SUBGROUP A -
UNDERSERVED RURAL AND IKNER CITY AREAS
GROUP 22 LEADER GROUP 22 co-LEADER
GROUP 22A LEADER
ALLEN, LUCY
CARLSON, RON
CLARK, WILLIAM
CROW, SHELLY
DENTON, DENISE
DUNN, VAN
FINIGAN, TOM
GROSS I LAUREN
HAYES, SHERRY
KEPNER, COLLEEN
LINK, KENNETH
PATEL, PARASHAR
SHIRLEY, AARON
SOBEL I LARRY
SPRINGER, M.
STEELE, PAMELA
INITIATIVES
FOR
THE
BONNIE LEFKOWITZ, HHS-FTE
SMITH, Vice President Kaiser
Family Foundation (1546)-SGE (1678);
Consultant (526)
AJOf
ZUVEKAS,
center for Health
Policy Research (962); No Official
Status-SGE (First Responses) , Rot
Listed on 1678-1679
MARK
CEA-FTE
··HHS•FTE
Robert Wood Johnson Fellow Sponsored
by University of Florida; in Sen.
Bulllpers (D-AR) Office-PTE (841) [See
Tab 56 Attached to this xe.orandWD]
Second Chief, Muscogee creek Ration
(30034)-SGE (1678)
Colorado
Rural
Health
Resource
Center-SGB (First Responses) ; Rot
Listed in 1678-1679 ··
Sen. Kennedy (CD, Vol. I, P. 395)FTE (30034)
Congressional Fellow Sponsored by ??
in sen. Baucus' Office-PTE (842)
Sen. Pell (CD, Vol. I, P. 991)-FTE
(30034
Sen. Kohl (CD, Vol. I, P. 1001)-FTE
Rep. Stenholm (CD, Vol. I, P. 768)FTE
Veterans Affairs-FTE
OMB-FTE
Director,
Jackson-Hinds
Comprehensive
Health
Center-SGB
(1678) (30034)
DOD-FTE
Treasury-FTE
Veterans Affairs-FTE
42
�SYKES, KATHEY
RICHARD
VELOZ,
ZUVEKAS, AHH
Rep. Obey (CD, Vol. I, P. 1122)-FTE
Formerly, House Aging Committee
Which Lost Funding 3/31/93-SGE
(First Responses) : Hot Listed as SGE
on 1678-1679
Center for Health Policy Research:
Ho
Official
Status-SGE
(First
Responses Only
GROUP 22A SUBGROUP - HIV
SMITH, Vice President, Kaiser
Family Foundation
HIV SUBGROUP CHAIR
MARK
BERGTHOLD I LDmA
BROSTROM, MOLLY
BEEHAH, CHRISTINE
w.
ISKOWITZ, MICHAEL
ROZ
MATHER, SUSAN
LASKER,
MAXWELL, CELIA
STORE I ROBYN
PETERSON I BOBBIE
WESTMORELAND I TOM
MET
WI~
H. Mercer, Inc.-SGE (1678) (1239)
WHQ-SGE-Policy Assistant
Domestic Policy Staff, White House
(1239) - Listed as FTE-HHS (843)
Sen. Kennedy (843)-FTE
PPRC-SGE ( 1678)
Veterans Affairs-FTE (846)
Volunteer
Project HOPE-SGE (1679)
Ho Official Status (1238)
Rep. Waxman (CD, Vol. I, P. 711)-FTE
GROUP 22A
REGINA ARAGAH
BILL BAILEY
CORNELIUS BAKER
TERRY BESWICK
san Franciso AIDS Foundation
American Psychological Association
Rational Association of People With
AIDS
.
AIDS Research Policy Analyst With
HRCF
LEOHARD BLOOM
AHHE BROOMFIELD
PAUL DEDOHATO
SONDRA ESTEPA
ROTH FIHKELSTEIH
JIM GRAHAM
DAVID HARVEY
DEBRA PRZER-HOWZE
DR. BILLY JONES
PAUL KAWATA
JEFF LEVI
CHRISTINE LUBINSKI
JANE SILVER
CEO, AIDS Project Los Angeles
Greater Baltimore HIV & Health
services Planning CoUncil
Health care Finance Expert (San
Francisco)
Latino commission on AIDS
Director, Public Policy, GMHC, Hew
York
Executive Director, Whitman-Walker
Clinic
Rational Pediatric BIV Resource
Center
CEO, Black Leadership Commission on
AIDS
Executive
Director,
Health
&
Hospitals Corporation
Rational Minority AIDS Council
AIDS Action Council
AIDS Action council
American
Foundation
for
AIDS
43
�Research
Treatment Action Group
AIDS Housing Corporation
AID Atlanta
RCA
PETER STALEY
TODD SUMMERS
SANDY THtlRMAH
ROY WIDDES
LAUREN FOGT
DEREK HODEL
TAG
B. J. SYLES
HLCA
DAVID BARR
JULIE SCOFIELD
REGGIE WILLIAMS
EJ.I.Q RIKER
TAG, GMHC
HASDAD
RTFAP
National Hemophilia Foundation
National Minority Gay and ·Lesbian
Association
PHIL WILSON .
KRISTIN GEBBIE
APHA
APHA
JEFF. JACOBS
AARON SHIRLEY
Jackson-Binds Comprehensive Health
Center
STEPHEN BOWEN
HBS
FREDA KITCHEN
HACHC
BYRON J. BARRJ:S
u.s. Conference of Mayors
C. ATCHISON
ASTHO
VALERIA MOREJ.I.I
ASTHO
SUSAN FORBES-MARTIN Commission on Immigration Reform
ARTIIORY J. LAWRENCE PHS
PENELOPE PIHO
MICHAEL KAISER, MD
ALICIA BEATTY TEE
BlUAH FElT
DAVID HARVEY
HCFA
Pediatric AIDS PrograJD
The Circle of care
Dimock Community Health Center
Department of Policy Analysis,
National Pediatric BIV Resource
Center
SOURCES: Declarations or Marjorie Tarmey 1 Documents Nos.
715, 716, 1234-1239, 1252-1253, 1327, 1328, 30033, 30034,
30035, 30058, 30059, 30091, 30120, 30173, 30176. See Tab
31 attached to the Memorandum.
·
Working Group 22, Subgroup B, -vulnerable Populations/High
Risk
Populations•,
of
Cluster
Group VIII,
consisted
of
following members:
GROUP
22 -
HEALTH
POLICY
INITIATIVES
POR
THE
UIIDERSERVED
GROUP 22 LEADER I.
GROUP
22 co-LEADER
BONNIE LEFKOWITZ, HHS-FTE
MARK SMITH, Vice President, Kaiser
Family Foundation ( 1546) -SGE ( 1678) ;
Consultant ( 526)
44
the
�SUBGROUP B
POPULATIONS/HIGH
VULNERABLE
POPULATIONS
SUBGROUP B LEADER - JOANNE LUKOMNIK,
{545)-SGE {1678)
DUNN, VAN
ELDERS I
JOYCELYN
FIEDELHOLTZ, J.
FINIGAN I TOM
FISKE, MARY BETH
IIAlfDY I CAROLYN
HAYES, SHERRY
HEADLEY, ELWOOD
HUMAN, J.
ISKOWITZ, M.
KATTAN I AZAR
KEPNER, COLLEEN
KOPLAN, JEFF
LEFKOWITZ, BONNIE
LEWIS-IDENA, D.
LEVINE I
DEBBIE
LURIE I ALEXANDER
LINK I KENNETH
LUKOMNIK, JOARHE
MATHER SUSAN
McKENNEY, NAMPEO
OBEY, CRAIG
OLIVER, JUDY
PATEL, PARASHAR
QUAM, LOIS
REINECKE 1 PETER
RICHARDSON I SALLY
RODGERS I JUDITH
ROWLAHD, DIANE
SHINN, RITH
SHIRLEY I AARON
M.D. ,
RISK
Consultant
Sen. Kennedy (CD, Vol. I, P. 395)FTE
Arkansas
Department
of
Health
( 1310) ; No Official Status Assigned
HHS-PHS-FTE
Congressional Fellow; Sen. Baucus;
Not Listed in Directory-PTE {842)
Sen. Labor (Kennedy) (CD Vol. I, P.
395)-FTE
CEO, Blacks Educate Blacks About
sexual Health Issues-SGE {1678)
Sen. Kohl (CD, Vol. I, P. 1001)-FTE
VA-FTE
Commission
on
Aging;
Not
in
Directory-FTE ( 843)
Sen. Kennedy (CD, Vol. I, P.
)
Rep. Matsui (CD, Vol. I, P. 586)-FTE
Rep. Stenholm (CD, Vol. I, P. 768)FTE
Centers for Disease Control-FTE
HHS-FTE
MDS · Associates
(consultant) -FTE
{844)
White House Policy Assistant-SGE
(1678)
No Official Status Assigned
Veterans Affairs-FTE
Consultant-SGE {1678)
Veterans Affairs-FTE
Census-FTE
Sen. Conrad (CD, Voi. I, P. 1068)FTE
HHS-FTE
OMB-FTE
V.P.,
United
Health
Care
Corporation-SGE {1678)
Sen. Harkin (CD, Vol. I, P. 396)-FTE
West Virqinia Health care Planning
commission; (•consultant•) {1312)SGE (First Responses)-Not Listed
1678-1679
BBS-Not Listed as PTE, 840-846
Kaiser Commission on the Future of
Medicaid; Johns Hopkins UniversitySGE {1678); No OFficial Status, Not
Listed in First Responses
Department of Labor-FTE
Jackson-Hinds comprehensive Health
45
�SMITH, BARBARA
SMITH, ELMER
SMITH, MARK
SOBEL, LARRY
SPRINGER, M.
STEELE, PAMELA
SYKES, KATHY
TOWNSEND, JESSICA
Center-SGE (1678)
National Governors Association ( SD)No Official Status: Listed as
Representative of Intergovernmental
Organization (1786-1787)
HHS-HCFA-FTE
Vice
President,
Kaiser
Family
Foundation ("Consultant") (1312)-SGE
(1678)
DOD-FTE
Treasury-FTE
Veterans Affairs-FTE
Rep. Obey (CD, Vol. I, P. 1122)-FTE
HHS-PHS-FTE
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
1310-1312, 30056. see Tab 32 attached to the Memorandum.
Working Group 22, Subgroup C, "Women and Children", of Cluster
Group V7II, consisted of the following members:
GROUP 22 -
HEALTH
POLICY . INITIATIVES
FOR
THE
UHDERSERVED
GROUP 22 LEADER
BONNIE LEFKOWITZ, HHS-FTE
GROUP 22 co-LEADER MARK SJaTH, Vice President, Kaiser
Fudly Foundation ( 1546) -SGE ( 1678) :
Consultant (526)
·
SUBGROUP C -
WOMEN ARD CHILDREN
American College of Obstetricians
and Gynecologists
JEAIOIIB ROSO
Alan Guttmacher Institute
RACHEL GOLD
Alan Gutblacher Institute
RAE CERAD
National Co.mission to Prevent
Infant Mortality
MARY CARPENTER
National COlllmi.ssion to Prevent
Infant Mortality
AARON SHDU.EY
Signs in as "BBS", Gives JacksonBinds Comprehensive Health center,
Jackson, liS, Phone HUDiber: RB: on
2/18/93 signed in as "Jackson-Binds
HC" (30059)
PETERS I D. WILLIAM National Association of Children's
Hospitals and Related Institutions
LARRY McANDEREWS
National Association of Children's
Hospitals and Related Institutions
AGNES H. DONAHUE
Office on Women's Health: u.s.
PUblic Health service/HHS
JERRY BENNET
PHS, Office of Population Affairs
CAROL GALATZ
MCHB/HRSA/PHS
KATHY BASSET
46
�RONALD J. VOGEL
JACKIE NOYES
ANNE SEGAL
EJ.I.EN BATISTILLI
B:ILL HAIULTOH
CAROL REGAN
ADOLPH P. FALCON
EJ.I.mt YUHG-FATAH
FREDERICK C. FOARD
LEROY ROBINSON
B:ILL CBAIIBRES
LUCY ALLEN
RUTH SHINN
Department of Agriculture/Food &
NutritionjWIC
American Academy of Pediatrics
ASPE/HHS
Planned Parenthood Federation
Planned Parenthood Federation
Children's Defense Fund
National Coalition of Hispanic
Health
&
Human
Services
orqanizations
Chief,
OUtpatient Services,
DC
Department
of
Consumer
and
Requlatory Affairs
Chair, National Operations Board,
National Minority Health Association
Executive
Director,
National
Minority Health Association
KMBA Meetinq & Conference Planner,
Newsletter Editor
Council on Economic Advisors
Women's Bureau, Department of Labor
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
30092, 30093.
See Tab 33 attached to the Memorandum.
Workinq Group
22,
Subpart D, "Population-Based Public Health
and Prevention", of Cluster Group VI:I:I, consisted of the following
members:
GROUP
22 -
GROUP
22
GROUP
22 co-LEADER
SUPGROUP
HEALTH
POLICY
UNDERSERVED
LEADER
D-
:IN:IT:IAT:IVES
FOR
THE
BONNIE LEFKOWITZ, BHS-FTE
Vice President, Kaiser
Family Foundation (1546)-SGE (1678);
Consultant ( 526)
MARK SIUTH,
POPULATION-BASED
PREVENTION
PUBLIC
HEALTH
AND
JOANKE 'LUKOMN:IK, MD JIYC Phone NUDber Given--Private
Physician (BBS) (525)-SGE (1678)COnsultant ( 545)
SUSAN MATHER, MD
OMB-FTE
LUCY ALLEN
CEA-FTE
KEN LINK
Veterans Affairs
NAMPEO McKENNEY
Census-FTE
ROSEHBAOII, SARAH
Georqe Washinqton University Center
for Health Policy Research; Listed
as "others to Wham :Information
Should be sent" (545); Listed as
47
�•White House• on 1546, but Phone
Number Listed is for the GWU CHPR;
Signs in as "White House", but Gives
Phone Number for GWU CHPR ( 30150,
30151) ; Same Phone Number as Ann
Zuvekas Below
Johns Hopkins University, Kaiser
Commission
on
the
Future
of
Medicaid; Listed Among "Others to
Whom Information Should be Sent• on
545; Listed as SGE-White House
(1678)
Rep. Slaughter (CD, Vol. I, P.
),
Women's Task Subgroup-FTE (847)
Labor (526)-FTE
Jackson-Hinds COmprehensive Health
Center (526)-SGE (1678)
Vice
President,
Kaiser
Family
Foundation (526); consultant (526,
1312); SGE-HHS (1678)
Defense-FTE
Veterans Affairs-FTE
Formerly House Select Committee on
Aging,
Appropriations
Expired
3/31/93; Rot Listed as FTE 840-840,
Listed as Consultant ( 526)
Rep. Abercrombie (CD, Vol • I , P.
436)-FTE
Rep. Strickland (CD, Vol. I, P.
654)-FTE
George Washington University Center
for Health Policy 296-6922 (527);
Listed as COnsultant ( 545) ; Ro
Official Status in Any of the
Responses
CDC Phone Number Given-FTE
CDC Phone Number Given-FTE
CDC Phone Number Given-FTE
HHS Phone Number-FTE
Sen. Bingaman (CD, Vol. I, P. 271)FTE
ROWLAND I DIANE
RYAN, ELAINE
SHINN, RUTH
SHIRLEY I AARON
SIIITH I
MARK
SOBEL I LARRY
STEELE I PAMELA
VEIDZ I IUCBARD
YAMAMOTO, ALAN
ZETTLER, SUSAN
ZUVEKAS I
AHR
JEFF KOPLAN
KATZ
BOB KEEGAN
CHERYL AUSTEIN
CARRIE, BILLY
MARTHA
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
1546, 1547, 30036.
See Tab 34 attached to the
Memorandum.
Cluster Group XX, •Mental Health", consisted of Working Group
23,
"Benefits Package",
Working Group 25,
Working Group
24,
Children's Services•,
"Public System Impact/Special Populations•.
48
"Substance Abuse",
and Working Group 26,
See Tab 35 attached to
�the Memorandum.
Cluster Group IX, "Mental Health", and its leader are listed
as follows:
CLUSTER IX -
MENTAL HEALTH
CLUSTER IX LEADER - BERNARD ARONS, HHS-NIMH-FTE
Working Group
23,
"Benefits Package", of Cluster Group IX,
consisted of the following:
GROUP 23 -
GROUP
23
BENEFIT PACKAGE
LEADER -
ARONS, BERNARD
BARSTOW SCOTT
BOORSTIN, ROBERT
BROCK, PETER
FRANK, RICHARD
GOLDMAN, HOWARD
GORE, TIPPER
GUST,
STEVER
NONE LISTED (1761)
HHS-NIMH-FTE
Rep. Kopetski (CD, Vol. I, P. 570)FTE
White House Communications-FTE
Defense-FTE
(566) Mental Health Economist, Johns
Hopkins University
BBS CMHS-SGE (1678)
Office of the Vice President
BBS-HIH, Rep. Strickland-r.l'E (842):
Part-time
COngressional
Liaison
(1626)
BARRIS, SIULA
HAYES, CBARLOT'l'E
HORVATH, THOMAS
IIELKAH,LORI
MELNICK, DANIEL
NORQUIST, GRAYSON
PIRES, SHEILA
ROSENMAN, PAT
SCHUSTER, JAMES
STEPHENS, SHARMAN
STOLID, AHHE, liD
Office of the Vice President
Office of the Vice President
Veterans Affairs
IDIS-SGE ( 1678) : Part-time Volunteer
(1626)
HHS-FTE (846)
HHS-FTE (846)
Part-time COnsultant, BBS (1627):
202/333/1892,
Human
Services
COllaborative (1692) - See Sign-in
List (30038}: Hot in Directory:
Responses Say She Works for Riegle:
Riegle's Office Rever Heard of Her
HHS-FTE (847)
Rep. Strickland (Hot in Directory) Law Student from George Washington
University: How Back at SChool
According to Strickland's Office at
10:45 a.m. on 1/27/94 - He was an
Intern
HHS-FTE
Psychiatrist at Springfield State
49
�Hospital, Maryland (867); Classified
as "White House" on 796 and as a
Full-time Volunteer from the State
of Maryland (572, 1627)
Part-time Consultant to HHS (1627);
SGE-IUIS-CMHS
( 1679) : Dimensions,
Inc., According to Phone Number on
30041
HHS-FTE
Sen. Labor and HR Committee (CD,
Vol. I, P. 1137)-FTE
Rep. Strickland (CD, Vol. I, P.
654)-FTE
STROUL, BETH
TIMS, FRANK
WEICH, RONALD
ZETTLER, SUSAN
ON 566 THE FOLIDWING NAMES ARB ADDED TO THE GROUP:
SPECIAL AREAS:
EFFECTIVENESS ( 566)
FULLER, DICK
HAVERKOS, HARRY
KEITH, SAM
TIMS, FRANK
DATA AND QUANTITATIVE ANALYSIS
FRANK, RICHARD
MELNICK, DAN
MANDRSCHIED, RON
REFIER, DARRELL
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
537-580, 796, 1140, 1240, 1241, 1338, 1549, 1550, 16261630, 30034-30037, 30111, 30145-30167, 30178. See Tab 36
attached to the Memorandum.
Working Group 24, "Substance Abuse", of Cluster Group IX,
consisted of the following Members:
GROUP 24 -
SUBSTANCE ABUSE
GROUP 24 LEADER -
NONE LISTED (1761)
ARONS, BERNARD
BLOSS, GREGORY
BROCK I PETER
GOPLERUD I ERIC
GUST, STEVE
HHS-NIMH-FTE
HHS-FTE
DOD-FTE
HHS-FTE
BBS-NIB (First Responses)-FTE-Rep.
Strickland ( 841) : Rep. Strickland's
Office Never Beard of Him; nor Sen.
Wellstone's Office
OVP-FTE
Montgomery County Department of
Addiction Services ( 537, 539 1 543)
HARRIS, SKILA
BOLT I HERBERT
50
�MELMAN, LORI
MELNICK, DANIEL
NOBLE, JONATHAN
ROUSE, BEATRICE
SCHECKEL, LISA
STEPHENS, SHARMA
STOLINE, ANNE
TRACHTENBERT I ALAN
WOODWARD 1 ALAN
HHS-Not Listed as FTE on 846; Listed
as SGE (1678); Listed as Part-time
Volunteer (1626)
HHS-FTE
NIAAA/HHS-FTE (846)
HHS-FTE
HHS-FTE
HHS-FTE
Psychiatrist at Springfield State
Hospital, Maryland (867); Courtesy
staff Psychiatrist, Sheppard-Pratt
Hospital,
Baltimore
(764)-SGE
(1695); Full-time Volunteer, State
of Maryland ( 1627)
HHS-FTE
HHS-FTE
SOURCES: Declarations o:f Marjorie Tarmey, Documents Nos.
552, 556, 569, 578, 795, 1316, 1317. See Tab 37 attached
to the Memorandum.
Working Group 25, "Children's Services•, of Cluster Group· IX,
consisted of the foilowing members:
GROUP 25-
CHILDREN'S SERVICES
GROUP 25 LEADER -
NONE LISTED (1761)
ARONS I BERNARD
GOLDMAN, SYBIL
HHS-NIMH-FTE
Georgetown
University
Child
Deveopment Center ( 538)
Office of the Vice President
Office of the Vice President
HHS
BBS-Not Listed as PTE; Listed as SGE
( 1678) ;
Listed
as
Part-time
Volunteer ( 1627)
HHS-FTE
Human Service Collaborative (538)
Sen. Riegle - Office Never Beard of
Her
HHS-FTE
Psychiatrist,
Springfield
State
Bospital, Maryland ( 867)
Management Training & Innovations,
Inc. (703/790-0990) (538)
GORE, TIPPER
HARRIS, SKILA
KATZ-LEAVY I JUDITH
KELMAN, LORI
MELNICK, DANIEL
PIRES, SBElLA
RICKEL, ANNETTE
STEPHENS, SHARMAN
S'l'OLINE, ANNE
STROUL, BETH
SOURCES: Declarations o:f Marjorie Tarmey, Documents Nos.
558, 563, 567, 576, 797.
See Tab 38 attached to the
Memorandum.
51
�Working Group 26, "Public System Impact/Special Populations•,
of Cluster Group IX, consisted of the following members:
GROUP 26 -
PUBLIC SYSTEM IMPACT/SPECIAL POPULATIONS
GROUP 26 LEADER -
NONE LISTED (1761)
ARONS, BERNARD
GUST, STEVEN
HHS-NIMH-FTE
HHS-NIH, Rep. Strickland-FTE (842):
Part-time
congressional
Liaison
(1626)
HHS: Part-time (1627): Listed as FTE
(843)
Office of the Vice President
Office of the Vice President
Veterans Affairs
BBS-SGE. (1678): Part-time Volunteer
(1626)
HHS-FTE (846)
HHS-FTE
Psychiatrist at Springfield State
Hospital, Maryland (867): Classified
as "White Bouse• on 796, and as
Full-time Volunteer from the State
of Maryland (572, 1627)
HARPER I
MARY
HARRIS I SKILA
HAYES, CHARLOTTE
HORVATH, THOMAS
IIELMAH,LORI
MELNICK I DANIEL
STEPHENS, SHARMAN
S'l'OLIHE I ARHE I liD
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
557, 562, 568, 577, 812, 813. See Tab 39 attached to the
Memorandum.
Cluster Group X, •Long Term care•, consists of Working Group
27 I "Long Term Care-Background• I Working Group 28 I "Long Term carePUblic Options•, Working Group 29, •Long Term Private Options•, and
Working Group 30, •cost and Revenue•.
See Tab 40 attached to the
Memorandum.
Cluster Group X , "Long Term care•, and its leader was as
follows:
CLUSTER LEADER -
ROBYR S'l'OHE, Project HOPE (584)
STAFF -
ATUL GAWANDE, "ASPE Staff Assistant.
Can Provide the Latest Master
Calendar." (585)
Working Group 27, "Long Term care - Background•, of Cluster
Group X, consisted of the following members:
52
�GROUP 27 -
LOifG TERM CARE -
CHAIR -
MARY HARAHAN, (591) HHS-FTE
ALTMIRE, JASON
ADLER, MICHELE
ASH, SHERRY
BLOOM, FELICIA
BODE, HOLLY
CLARK, ROBERT
CLAUSER, STEVEN
DANIELS, SUSAN
DONESKI, ELLEN
DOTY, PAMELA
DRABEK, JOHN L.
ECKERT I KEVIIf
GOODWIN, MARSHA
HARAHAN, MARY
KATZ, RUTH
KELLEY, . LAUREN
LIPNER, ROBYN
MILLER; NANCY
OTRIIf I
SUSAif
SIMON, MARSHA
SMITH, BETH
SOCHALSKI: I
JOI..7E
STORE I ROBYif
YBLOZ
I
RICHARD
BACKGROUifD
Rep. Peterson (CD, Vol. I, P. 921)FTE
HHS-ASPE-FTE (840)
HHS-FTE (840)
Rep. Slaughter (CD, Vol. I, P. 647)FTE
Senate committee on Aging-FTE
HHS-ASPE-FTE (841)
HHS-HCFA (781)-FTE (841)
HHS-ACF-ADD-FTE (841)
(781) Sen. Rockefeller (CD, Vol. I,
P. 352)-FTE
HHS-FTE
HHS-ASPE (No Official Status Given)
Robert
Wood
Johnson
Fellow,
Sponsored by University of Maryland
in the Office of Sen. Wofford (D-PA)
[See Tab 56 attached to the
llmaorandum] : ri'E-841
Veterans Affairs-PTE
HHS-ASPE-FTE
HHS-ASPE-FTE
(585) Policy Assistant -·WHo- SGE
· (First
Responses);
Columbia
University (732)
Sen. Mikulski (CD, Vol. I, P. 395)FTE
HHS-HCFA-FTE
( 585) WHO - Policy Assistant - SGE
(First
Responses):
Columbia
University (732)
Sen. Kennedy (CD, Vol. I, P. 395)FTE
.
Veterans Affairs-PTE
Robert
Wood
Johnson
Fellow,
Sponsored by Columbia University in
Sen. Bradley's Office [See Tab 56
attached to the Memorandum] : FTE
(846)
Project HOPE-SGE ( 1679)
Rot Listed as PTE: Formerly Staff
Director, House Select COlaJDi.ttee on
Aqing, Lost Funding 3/31/93. (Gives
Home Address and Phone lflDiber as
Task Force Contact ( 584) )
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
581-686, 781, 1309, 1552. See Tab 41 attached to the
Memorandum.
53
�Working Group 28,
nLong Term care -
Public Optionsn,
of
Cluster Group X, consisted of the following members:
LONG TERM CARE - PUBL:IC OPT:IOHS
GROUP 28 CHAIR -
PETER KEMPER, AHCPR (659)-PTE
BODE, HOLLY
Sen. Pryor (Senate Aging Committee)
(840)-FTE
HHS-PTE (841)
Sen. Rockefeller (CD, Vol. I, P.
352)-FTE
HHS-ASPE-PTE (842)
HHS-FTE (843)
Senate Aging Committee (CD, Vol. I,
P. 401)-PTE
HHS-ASPE-FTE (844)
Rep. Collins (CD, Vol. I, P. 1019)PTE
Council on Economic Advisors
OMB-PTE (844)
State of Arkansas
Veterans Affairs-PTE
Project HOPE-BBS SGE ( 1678)
OMB-FTE
Brookings :Institution (Gives Phone
Humber - 797-6266) ( 1553) - SGE
(1679)
DANIELS, SUSAN
DONESKI, ELLEN
HARAHAN, M.
HARVELL, J.
HOGUE, BONNIE
RUTH
KEENE, BRAD
KATZ,
LUCAS, DEBBIE
McCONNELL, S.
SIMPSON I BOBB:IE
SMITH, MARY B.
STORE I ROBYN
WASSERMAN, M.
W:IEHER, JOSH
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
782, 1553. See Tab 42 attached to.the Memorandum.
Working Group 29,
nLong Term care -
Cluster Group X, consisted of the following
GROUP 29 -
Private Optionsn, of
m~mbers:
LOlfG TERM CARE - PR:IVATE OPT:IOlfS
GROUP CIIA:IR -
PETER ICEIIPER ( 659)
DANIELS I SUSAN
DONESKI, ELLEN
HHS-FTE (841)
Sen. Rockefeller (CD, Vol. I, P.
352)-FTE
Veterans Affairs-FTE
HHS-FTE (843)
Rep. Collins (CD, Vol. I, P. 1019)PTE
Council on Economic Advisors
OMB-FTE (844)
Veterans Affairs-PTE
Project BOPE-BBS-SGE ( 1678)
OMB-FTE
Brookings :Institution (Gives Phone
GOODWIN I MARSHA
HARVELL I J.
KEENE, BRAD
LUCAS, DEBBIE
McCONNELL, s.
SMITH I MARY B.
STORE I ROBYN
WASSERMAN, M.
W:IEHER, JOSH
54
�Humber 797-6266) (1553)-SGE {1679)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
783, 1554, 30045. See Tab 43 attached to the Memorandum.
Working Group 30, "Long Term Care - Cost and Revenue•, of
Cluster Group X, consisted of the following members:
GROUP
LONG
30 -
BLOOM, FELICIA
BROWH I MARY L.
BUCK, JEFF
DANIELS, SUSAN
ENGLISH, MIKE
FRANK, RICHARD
FRIEDHOLM, DEARH
McNAMEE, NIKKI
SIMON I MARSHA
SMITH, BARBARA
STONE,
VOLPE,
ROBYN
CARL
TERM CARE -
COST
AND REVENUE
Rep. Slaughter (CD, Vol. I, P. 647)FTE
National
Governors
Association
{30138): No Official Status
HHS-HCFA-FTE (840)
HHS-FTE
HHS-FTE. (841)
Johns Hopkins University-SGE (1678)
National Governors Association (TX) :
Representative of Intergovernmental
organization, Assigned to Group 8
(1787): No Official Status
National Governors Association (SC):
No Official Status - Representative
of Interqovernmental organization Assigned to Group 3 (1787)
Sen. Kennedy (CD, Vol. I, P. 395)FTE
National Governors Association ( SD) :
No Official status - Representative
of Interqovernmental organization,
Assigned to Group 22 ( 1787)
Project BOPE-SGE (1679)
National Governors Association: No
Official status: Representative of
Intergovernmental · Organization,
Assigned to Groups 28 and 30 ( 1787)
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
784, 1551, 30046, 30138.
See Tab 44 attached to the
Memorandum.
Cluster Group XI, "EconoDdc Impacts•, consisted of one (1)
Working Group, that being Working Group 31, •Economic Impacts.•
Working Group
31,
"EconODi.c
Impacts•,
consisted of the following members:
CLUSTER XI GROUP
31 -
ECONOMIC IMPACTS
ECONOMIC IMPACTS
55
of
Cluster Group
XI,
�GROUP LEADER -
DAVID CUTLER, OMB (971)-FTE
ANDERSON, ROBERT
BAKER, LAURENCE
OMB (695)-FTE
Princeton University (687, 695, 697)
(Office Number and FAX Number at
Princeton) (697) - Listed as "SGE"
(1678)
Census Bureau (695)-FTE
Treasury (695)-FTE
CEA-FTE
BEA/Commerce (695)-FTE
Princeton University (687, 691,
694)-SGE-BBS (1678)
OMB (695)-FTE
Policy Assistant (695) White Bouse
SGE (1678)
Princeton University (687, 691,
694);
Ho
Official
Status;
Participation Hot Acknowledged in
First Responses
Joint Tax Committee (CD, Vol. I, P.
) (695)-FTE
Sen. Wofford (CD, Vol. I, P. 1115)
(695)-FTE
HHS (696)-FTE
HHS (696)-FTE
HHS-HCFA (696)-FTE
Sen.· Dingell (CD, Vol. I, P. 710)
(696)-FTE
CAMPBELL, PAUL
DINKELACKER, BILL
GLIED, SHERRY
KASS, DAVID
KRUEGER, ALAN
NICHOLS, LEN
PI CILLO I THERESA
REINHARDT I UWE
SHEINER, LOUISE
SOLOMON 1 DAN
TAYLOR, AMY
THORPE, KEN
WALDO, DAN
WOO, MICHAEL
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
687-698, 785, 1555.
See Tab 45 attached to the
Memorandum.
Cluster Group XII, "Quantitative Analysis•, consisted of one
( 1) Working Group, that being Working Group 32, •Quantitative
Analysis•.
Working Group 32, •Quantitative Analysis•, of Cluster
Group XII, consisted of the following members:
CLOSTER XII
QUANTITATIVE AHALYSIS
GROUP 32 -
QUANTITATIVE AHALYSIS
CLUSTER/GROUP LEADER
ALECXIH,LISA
ANDERSON, ROBERT
ARNETT I ROSS
BANTHIN, JESSICA
BURNER, SALLY
KEN THORPE, HHS-FTE (971)
Lewin ( 1335) ; Ho Official Status
Given
OMB (699)-FTE
HHS-HCFA (699)-FTE
HHS-ACHPR (699)-FTE
HHS-HCFA (699)-FTE
56
�CALAHAN, CATIII
COHEN, JOEL
CUTLER, DAVID
FRANK,
RICHARD
FREELAND, MARK
HOLAIIAN, JOliN
HOLTZBLATT, JANET
HUNTER, GILLIAN
ILLSTON, LAURA
KASS, DAVID
DAVJ:D
KEMNELL,
KING, ROLAND
LONG, STEPHEN
KRUEGER, ALAN
MAXFIELD, KYLES
llcKUSICK, DAVJ:D
NELSON, CHUCK
NICHOLS, LEN
SHELDON, GEORGE
SHEINER, LOUISE
Actuarial Research Corporation ( 699)
- Consultant (First Responses)
HHS-AHCPR (699)-FTE
council on Economic Advisors (699)FTE
Johns Hopkins University (1334) CSIII
(699) - SGE HHS NIMH (1678)
HHS-HCFA (699)-FTE
Urban Institute (1333): No Official
status Given
Treasury (699)-FTE
Treasury (699)-FTE
Lewin ( 1335) : No Official Status
Given
BEA/Commerce (699)-FTE
Lewin (1335): No Official Status
Given
HHS-HCFA (699)-FTE
Rand Corporation ( 1333) : No Official
Status Given
Princeton
University
(702)-SGE
(1678): Consultant (First Responses)
KatbDiatical Policy Research (1333):
Mo Official Status Given
Actuarial
Research
Corporation
( 699) : No Official Status: No
Participation Acknowledged (First
Responses)
Census (699)-FTE
OMB (699)-FTE
Veterans Affairs-FTE
Joint Taxation committee (CD, Vol.
I, P.
SHORT, PAMELA F.
TAUBER, CYNTHIA
THORPE, KEN
TRAPNELL, GORDON
VISTRIES, JESSICA
WALDO, DAN
WASSERMAN, MARK
WIENER, JOSH
ZBDLEWSKI, SHEILA
)
HHS-AHCPR (699)-FTE
Census (699)-FTE
HHS-FTE
Actuarial Research Corporation ( 699)
- consultant (First Responses)
HHS-AHCPR (699)-FTE
HHS-HCFA (699)-FTE
OMB
Brookings (1335) - SGE (1679
Urban Institute: No Official Status
Given (1333)
SOURCES: Declarations o~ Marjorie Tarmey, Documents Nos.
699-703, 713' 714, 786, 1333-1337, 1556, 1557, 1633,
30047. See Tab 46 attached to the Memorandum.
Cluster Group XIII I
"Legal Audit• I
consisted of one
( 1)
Working Group, that being Working Group 33, "Legal Audit•. working
Group 33, "Legal Audit•, of Cluster Group XIII, consisted of the
57
�following members:
CLUSTER XIII - LEGAL AUDIT
LEGAL AUDIT
GROUP 33 -
ANTHONY I BARBARA
BARNES I MARK
BIDDLE I BARBARA
BRIFFAULT I RICHRAD
GOLDMAK, ED
GRAETZ I MICHAEL
HOLDER, AHGELA
McGAREY I
BARBARA
MEYER I KATIIRYR
MILLOCK, PETER
RYAH I BETSY
SCHULTZ I MARJORIE
SLOWES I
RICK
ZELHER, BARBARA
Office of the Massachusetts Attorney
General: No Official Status
NYC
Department
of
Health:
No
Official Status
DOJ-Civil {30149)-FTE
Columbia Law School: Ho Official
status
university of Michigan Hospitals: Ho
Official Status
Yale Law School: No Official Status
Yale University School of Medicine:
No Official Status
National Institutes of Health-PTE
Beth Israel Medical Center: No
Official Status
Hew York State Department of Health:
Ro Official status
Hew Jersey Department of Health: Ro
Official status
Boalt
Hall School of Law:
No
Official status
Office of the Attorney General of
Minnesota: Ro Official Status
Rational Association of Attorneys
General (30149): Ro Official status
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
1558, 30149, unnumbered page, "Legal Issues". See Tab 47
attached to the Memorandum.
Cluster Group XIV I
Working Group,
•Numbers Audit• I
consisted of one
that being Working Group 34,
8
( 1)
RUDibers Audit•.
Working Group 34, •Numbers Audi t•, of Cluster Group XIV, consisted
of the following members:
CLUSTER XIV -
IIOIIBERS AUDIT
GROUP 34 -
IIOIIBERS AUDIT
ATiaRSOM I HOWARD
BERTKO I JOHN
DORAN I PHYLLIS .
GREENWOOD I BRENT
BELliS I
DICK
osrow 1 RICH
Atkinson & co. 1 Inc.
COOpers & Lybrand
llill:man & Robertson
TillinghastjTowers Perrin
Tbe Principal Financial Group
Towers Perrin
58
�The DuPont Co.
Price Waterhouse
PORTER, KEH
RODGERS, JACK
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
1559, unnumbered page, "Cost Issues".
See Tab 48
attached to the Memorandum.
Cluster Group XV, "The Drafting Group•, consisted of one (1)
Working Group, that being Working Group 35, "The Drafting Group•.
Working Group
35,
"The Drafting Group•
of Cluster Group XV,
consisted of the following members:
CLUSTER XV-
THE DRAFTIHG GROUP
GROUP 35 -
THE DRAFTING. GROUP
OMB (738)
STEVE BANDEAIAN
BETTE BRIGGS
SHIRLEY SAGAWA
MARINA WEISS
SOURCES:
738-761.
DOL (739)
?? (756)
Treasury (761)
Declarations of Marjorie Tarmey, Documents Nos.
See Tab 49 attached to the Memorandum.
Working Group 36, "Disability cross-cutting Work Group•, was
not part of any Cluster Group, but 1 rather, was free-standing.
Working Group
36 1
"Disability cross-cutting Work Group, •
composed of the following members:
GROUP 36 LEADER -
SIMI LITVAK,
Disability
BROWH I
UCLAf.Rand COrpo~ation - SGE {1678)
Rational
Rehabilitation Bospital
Research Center; Ho Official Status
Assigned
(671)-HHS-ASPE-FTE (1672)
Representative of Interqovernmental
Orqanization ( 1786) ; Signed in as
•Texas Medicaid/Task Force• ( 30080) ;
Assigned to Group 8, Underserved
( 1786) ; Ho Official Status Assigned
HHS-Office of Disability Policy-FTE
(842)
.
(30080)
State
of
california
Department
of
Health
services,
Chief, Children's Medical Services;
Ho Official Status
lUCK
DeJOHG, GERBER
DOTY, PAMELA
PRIBDBOLM, DEAH.If
GOLD, MARTHA
GREGORY, II.
59
World
Institute
on
was
�GRISS I ROBERT
JENSEN I ALAN
JOHNSON, DON
LITVAK I SIMI
McGRALY, KATHLEEN
O'KEEFE, JANET
OTRI:N I
SUSAN
SCJDaDT I
BILL
SELTMAN I
PAUL
SILVERSTEIN, BOB
STONE I ROBYN
STRAHAN, IIAIUE
SYLVESTER, GREG
THOMAS I PETER
THOMPSON I GERI
WODATCH, JOHN
United Cerebral Palsy (30080); No
Official Status
Georqe washinqton University, Center
for Health Policy Research; No
Official Status Assiqned
HHS-HCFA-FTE (843)
World Institute on Disability - SGE
(First Responses) ; Not Listed as SGE
on 1678-1679
(30080) The Association of Retarded
Citizens; No Official Status
American Psychological Association,
Assistant
Director
for
Public
Interest Policy; No Official Status
Assiqned
WHo-Policy Assistant
Columbia
university (732) (30174)
(30080)
Epilepsy
Foundation
of
America; No Official Status
House Education & Labor Committee
(CD, Vol. I, P. 1106)
U.s.
Senate
Subcommittee
on
Disability
Project HOPE (671)
ADD/Protection & Advocacy ( 30080);
No Official Status
u.s.
Senate,
Subcommittee
on
Disability
Amputee
COalition
of
America
(30080); No Official Status
National
Chronic
Care
Consortium/Beth
Israel
Hospital
(3008); No Official Status
American
Speech-Lanquaqe-Hearinq
Association (30080); No Official
Status
Department of Justice, Civil Riqhts
Division
FTEs:
ASH, SHERR!
BROWN, RICK
CLAUSER I STEVE
DANIELS 1 SUSAN
DOTY I PAMELA
HARAHAN I MARY
KATZ, RUTH
MANDERSCHEID, RON
PARADISE, JULIA
REINECKE, PETER ·
HHS-ACF
UCLA
HHS-HCFA
HHS-ACF
HHS-ASPE
HHS-ASPE
HHS-ASPE
HHS-PHS
HHS-ASPE
Sen. Harkin (CD, Vol. I, P. 396)
60
�SIGN-IN LIST (UNDATED):
BILLY WEBSTER
ELAINE HOLLAND
ANITA BICKSTELL
WILLIAM MODZOLESKI
AARON SHIRLEY
DEBORAH LEVINE
CONNIE GARAU
GAIL HOULE
JUDITH KATZ-LEAVY
CAROLYif BANDY
SHEILA PIRES
PAT ROSENMAN
SHIRLEY JACKSON
CHARLOTTE BEASON
SUSAN OTRIN
JULIA TILLMAN
CHERYL AUSTEIN
SUSAN DANIELS
SHERR! ASH
MARGERY GEHAH
RUTH SHINN
LARRY SOBEL
CARRIE BILLY
BLANCA RODRIGUEZ
FRANK CORRIGAN
JON WADE
KIMMON RICHARDS
Chief of Staff, Department of
Education
Department
of
Education,
Intergovernmental Office
Department of Education
Department of Education
Jackson-Hinds Comprehensive Health
Center
WHO-Policy Assistant - Unemployed
(732) - SGE (1678)
Department of Education, Office of
Special Education and Rehabilitation
Department of Education, Office of
Special Education and Rehabilitation
co-Chair,
Child
Mental
Health
Workgroup - HHS, Center for Mental
Health Services
CEO, Blacks Educate Blacks About
sexual Health Issues (Cluster III,
New System Infrastructure, Group 12,
Health care Workforce)
Human service Collaborative: coChair, Mental Health and Substance
Abuse Work Groups
HHS (Substance Abuse Work· Group)
Department of Education
HHS-Cluster
III,
New
System
Infrastructure, Group 12, Health
Care Workforce)
Health care POlicy Analyst - SGE
(First
Responses):
Columbia
University (732): Not Listed 16781679: Assistant to Cluster X, Long
Term care
HHS/PHS
HHS/PHS
HHS - LTC Work Group
HHS - LTC Work Group
WHO - Health care Policy Assistant
to Clusters rv (Integration of
Govermaent Health Programs Into New
System) , V (Ethical Foundations of
the New System), and VII (Financing)
Department of Labor, Women's Bureau
Department of Defense
Sen. Bingaman (CD, Vol. I, P. 271)FTE
White House on Education Excellence
for Hispanic Americans
Department of Education
Department of Education
Department of Education
61
�VAL KISKO
.
Department of Education
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
671, 717-718, 1068, 30128, 30141, 30048, 30051, 30174,
30175. See Tab 50 attached to the Memorandum.
Working Group 3 7, "Rural Cross-cutting Group•, was not part of
any Cluster Group, but, rather was free-standing.
37,
Working Group
"Rural Cross-cutting Group", was composed of the following
members:
. RURAL CROSS-CUTTING GROUP
GROUP 37 -
ADLER, MICHELE
ALBERGHINI, THERESA
ALLEN, LUCY
ARCADOZ, RICHARD
BOEHM, JENNIFER
COHEN, RIMA
CLAY, JIMMY
DENTON, ·DENISE
EVANS, JENNIFER
FALETTI, TOM
FRANTZ, MOLLY
KEPNER, COLLEEN
MANDERSCHEID, RON
MANTEL, LEWIS
KILLER, CAROL
MINTZER, CAROL
MURGUIA, JANET
O'BRIEN,
MARY
JO
PUSKIN, DENA
QUAM, LOIS
REINECKE, PETER
RICHARDSON, SALLY
HHS/ASPE-FTE (840)
Sen. Leahy (CD, Vol. I, P. 327)
CEA-FTE (840)
BBS (709): No Official Status Given
Rep. Long (CD, Vol. I, P. 581)
Sen. Daschle (CD, Vol. I, P. 942)
Veterans Affairs-FTE (841)
Colorado
Rural
Health
Resource
Center-SGE (First Responses) : Not
Listed 1678-1679
Sen. Campbell (CD, Vol. Ii P. 282)FTE
Sen. Durbin (CD, Vol. I, P. 969)-FTE
Rep. Pomeroy (CD, Vol. I, P. 705)FTE
Rep. Stenholm (CD, Vol. I, P. 768)FTE
HHS-CMHS-FTE (844)
Veterans Affairs-FTE (844)
Mountain
Management
Co. ,
NM
(Handwritten Note, •MM•, BHS Phone
Number Given)
(709)-SGE
(First
Responses, Not Listed 1678-1679)
Public Health Service (Not Listed as
a Public Employee)
Rep. Slattery (CD, Vol. I, P. 741)FTE
National
Governors
Association
( 709) ; SGE (First Responses, Not
Listed on 1678-1679)
PHS-FTE (847)
Handwritten Note •u. o• (709), VP,
United
Health
care
Corp.,
Minneapolis:
SGE
( 1678,
First
Responses)
Sen. Harkin (CD, Vol. I, P. 396)-FTE
West Virginia Health care Planning
Commission: SGE (First Responses,
62
�Not Listed 1678-1679)
Iowa Department of Public Health Consultant (First Responses)
Jackson-Hinds Comprehensive Health
SHIRLEY I AARON
center; SGE (1678)
National
Governors
Association
SMITH I BARBARA
(1787); No Official Status
Veterans Affairs-FTE
STEELE, PAMELA
Rep. Obey (CD, Vol. I, P. 1122)-FTE
SYKES, KATHLEEN
Sen. Baucus (CD, Vol. I, P. 268)-FTE
TESTORI, MAUREEN
National Association of Counties
UYEDA, MARY
(1787); No Official Status Given
Sen. Mitchell (CD, Vol. I, P. 338)WILLIAMS, CHRISTINE
FTE
HHS-FTE (848)
WOODWARD, ALBERT
SCHADLE I JANE
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
709-712, 1634, 1635.
See Tab 51 attached to the
Memorandum.
Working Group 38, "Benefits Coordination", was not part of any
Cluster Group, but, rather, was free-standing.
Working Group 38,
"Benefits Coordination", was composed of the following members:
GROUP
BROWN I
38 -
BENEFJ:TS COORDJ:HATJ:ON
LEFKOWITZ, BONNIE
GATZ I CAROLYN
PUSKIN, DEENA
SOFAER, SHOSHANA
RJ:CHARDSON I
SALLY
IIANOWJ:TZ I IIJ:CIJET.T.E
BERGTHOLD I LJ:NDA
VALDEZ, BOB
SMJ:TR, MARK
SChool of Public Health
(Group 22) Practicing Physician from
New York City; SGE (1678)
(Group 22) HHS, Bureau of Primary
Health care
Louisville - COmmerce - Louisville
Mayor's Office (First Responses
only): Ro Official status Assigned.
Rote That She Was BirSd by Commerce,
Employed in Whi.te Bouse
(Group 2) HRSA (Earlier, PROPAC)
(Group
8)
George
washington
University Medical Center:
SGE
(1678)
(Groups 2 & 22) West Virginia
Department
of
Health
Public
Employees J:nsurance COmmission: SGE
(First Responses) : Rot Listed in
1678-1679
The Johns Hopkins University (732)
(Group 6) wm.. Mercer (SF)-SGE (1678)
(Group 6) UCLA SChool of Public
Health; SGE (1679)
(Group 22) Vice President, Kaiser
Family Foundation: SGE ( 1678)
UCLA
RJ:CK
LUKOIINJ:K I JOANNE
63
�JOHNSON, DON
FISKE, MARY BETH
RICE, CHERI
(Group 8) HCFA - Medicaid DivisionPTE
(Groups 6 & 8) Labor Committee
(Previous: HCFA)-FTE
(Group 8) OMB-FTE
SOURCES: Declarations of Marjorie Tarmey, Document No.
30129, "Sign-in Sheet".
See Tab 52 attached to the
Memorandum.
Workinq Group 39, nMinority Issues Review Group•, was not part
of any Cluster Group, but, rather, was free-standing.
Group 39,
Workinq
•Minority Issues Review Group• was composed of the
following members:
KINORITY ISSUES REVIEW GROUP
JAKES ACEVEDO
JESSE BARBER
PHILLIP BROOKS
RICHARD BUTCHER
KICIIAEL BYRD
PAMELA CASHEW
LIIfDA CLAYTON
ROSEMARY DAVIS
SU~ D~
ADOLPH FALCON
KAlUA ELENA FLOOD
HECTOR FLORES
JOYCE ESSIEN
Assistant
Director,
American
Healthcare Management, Huntington
Park, CA
National Medical Association, Chair
of council Medical Legislation,
Washinqton, DC
National Black Hospital Association,
President,
Norfolk
Community
Hospital, lforfolk, VA
President,
National
Medical
Association, El cajon, CA
Research
Fellow,
Department
of
Health Policy & llanaqement, Harvard
School of Public Health, Boston, IIA
Assistant Administrator, Riverside
General Hospital, Houston, TX
Research
Fellow,
Department
of
Health Policy & Management, Harvard
School of Public Health, Boston, IIA
National
Medical
Association,
Washington, DC
Senior
Attorney,
National
IDIIIliqration Law Center, Los Angeles,
CA
National
COalition
of
Hispanic
Health
&
Human
Services
orqanizations, Washinqton, DC
Proqrua Director, Health Sciences
Center, Texas Tech, El Paso, TX
co-Director,
Family
Practice
Residency Proqrua, Wb.i te Memorial
Medical Center, Los Anqeles, CA
Director, Office of Public Health
Practice, School of Public Health,
64
�LUIS ESTEVEZ
THURMAN EVANS
ERNEST GIBSON III
TESSIE GUILLERMO
HAZEL HARPER
JOSEPH HEMRY
ANNE BILL
SADAKO HOLMES
ELIZABETH KING
DAPHNE
JOHN
B. WAINE .KONG
OSVALDO LOPEZ
RANDALL MAXEY
RAMONA MCCARTHY
LAURIN MAYENO
TER1U SMITH MOORE
VERNELLIA RANDALL
ELENA RIOS
RENE
RODRIGUEZ
Emory University, Atlanta, GA
Medical
Director,
Segundo
Ruiz
Belvis, Neiqbborhood Family Care
Center, Bronx, lfY
President
&
CEO,
WholeLife
Associates, Elkins Park, PA
Administrator/CEO, Riverside General
Hospital, Houston, TX
Executive Director, Asian American
Health Forum, San Francisco, CA
National
Dental
Association,
Washinqton, DC
Associate Dean, Harvard School of
Dental Medicine, Boston, MA
National Urban Leaque, New York, lfY
Executive Director, National Black
Nurses'
Association,
Inc.,
Washinqton, DC
National
COuncil
of
La
Raza,
Washinqton, DC
Medical Director, Queens Villaqe
CO:mmunity for Mental Health, St.
Albany, lfY
Riverside General Hospital, Houston,
TX
Executive Director, The Association
of Black Cardioloqists, Miami, FL
Chairman, Department of Opthomoloqy,
Chicaqo, IL
President,
CEO,
BealthQuest,
Hawthorne, CA
President, lfational Pharmaceutical
Association, Silver Sprinq, MD
Association
of
Asian
Pacific
Community
Health
organizations,
oakland, CA
National PharmaceutiCal Association,
Washinqton, DC
Assistant Professor of Law, SChool
of Law,
University of Dayton,
Dayton, OR
President,
The
ChicanojLatino
Medical Association of california,
Buntinqton Park, CA
President, Interamerican COlleqe of
Physicians and Surqeons, Washinqton,
DC
DIANE SANCHEZ
FRANK SESSOMS
WES SHOLES
SAMUEL
SDIMOlfS
PAUL SDIIIS
Women's Medical Arts, Milpitas, CA
Pittsburqh, PA
National Association of Black County
Officials, Rancho Palos Verdes, CA
caucus and Center on Black Aqed,
Washinqton, DC
Department of Health Services, San
65
�Diego, CA
National Association of Hispanic
Nurses, College of Nursing - USF,
Tampa, FL
Family Practice Center, Memorial
Medical Center, Corpus Christi, TX
Administrator
&
CEO,
Southwest
Hospital & Medical Center, Atlanta,
SARA ToRRES
DAVID VALDEZ
HERBERT WELDON
GA
SOURCES:
Declarations of Marjorie Tarmey, "Minority
Issues Review Group", unnumbered-. See Tab 53 attached to
the Memorandum.
Working Group 40, •Academic Health Centers•, was not part of
any Cluster Group, but, rather, was free-standing.
40,
"Academic Health Centers•,
was
Working Group
composed of the
following
members:
ACADEIIIC HEALTH CENTERS
GROUP 40 -
GROUP 40 LEADER AL'l'MAH I
DAVID
BERENSON I
BOB
CLARK, WILLIAM
DAUMIT I GAIL.
DAVIES, MONICA
EDDY, DAVID
EKANUEL, EZEKIAL
ELIZABETH SHORT, Veterans AffairsFTE (846)
Robert
Wood
Johnson
Fellow,
Sponsored by UCSF Center for Health
Professionals
{704);
in
Sen.
Rockefeller's Office [See Tab 56
Attached to this MemorandUDl] (Also
on Group 12)
Rational capital Preferred Provider
Organization ( 704) (Also on Groups 11
and 1A)
Robert
Wood
Johnson
Fellow,
Sponsored by University.of Florida;
in Sen. Bmapers Office (708) [See Tab
56 Attached to this MemorandlDl]
White House ( 704) ; Also on Groups 15;
Elllory University School of
Medicine, Medical Student ( 734) ;
Internal Medicine KGB Intern 6/93
{30049)
Massachusetts
General
Hospital
Legislative
Fellow
in
Sen.
Bingaman's Office {708); Bot in
Directory-PTE {841)
Senior
Policy
Advisor,
Kaiser
Permanente; Duke University Medical
School Professor (708)-SGE {1678)
Harvard
Medical
School
{704)
{30049); Also on Cluster V, Group
66
�EPSTEIN 1 ARMOLD
HANDY I CAROLYN
HORVATH TOM
LASKER, ROZ
MEYERS I
GREGG
MIN, NANCY
MULLAN, FITZHUGH
NEXON, DAVID
PAUL, KARER
PYLE, THOMAS
REDLENER, IRWIR
SAGE I WILLIAM
STEELE, PAMELA
STOLID I ARRE
stJIIAYA, CIRO
WALTERS I
FARAH
17; Dana Farber Cancer Institute
(1587)-SGE (First Responses)
Robert
Wood
Johnson
Fellow,
Sponsored by Harvard Medical School
&
Briqham
&
Women's
Hospital;
Servinq Sen. Kennedy on Senate Labor
Committee (704) [See Tab 56 attached
to the Memorandum]
CEO, Blacks Educate Blacks on Sexual
Health Issues (704) (Also on Groups
8 & 12)
Veterans Affairs (704)
Physician Payment Review Commission
(704); SGE {1678)
Massachusetts
General
Hospital
Fellow,
Senate
Labor
& Human
Resources Committee (Sen. Kennedy)
and
SGE,
Accordinq
to
First
Responses; Rot Listed 1678-1679
OMB
HHS (704) (Also on Group 12)-FTE
Sen. Labor (CD, Vol. I, P. 395)
(Also on Groups 1-5)
White House {704) (Also on Groups 15) cornell Medical School ( 30049)
Harvard
Community
Health
Plan:
Boston
Consultinq
Group
( 704) :
consultant (First Responses) ; SGE
(1678)
8 HPRG•
{704);
Pediatrician,
Montefiore Hospital
{See Health
Professions! Review Group, Tab
);
Signs in as •Liaison to Health
Professions! Review Group•) ( 30049) ;
Ro Official Status
White House {704); Stanford, Hopkins
{30049); SGE {1678) .
OMB (Also on Group 22)-FTE
Volunteer; Psychiatrist {704) (Also
on Groups 23 and 26) (Graduate of
Johns Hopkins Medical SChool, 1992)
{30049)
Dean, University of Texas Medical
School {704); SGE {1679)
University Hospitals of Cleveland
{704)
(Also on Groups 1,
20);
Consultant, First Responses.
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
704, 705, 707, 708, 1242, 1243, 1244, 706, 1587, 30048,
30050. See Tab·54 attached to the Memorandum.
67
�Working Group 41, nworkers' Compensation Task Forcen, was not
part of any Cluster Group, but, rather, was free-standing.
Working
Group 41, nworkers' Compensation Task Forcen, was composed of the
following members:
WORKERS' COMPERSATI:ON TASK FORCE (30090)
GROUP 41 -
GROUP 41 LEADER -
GARY CLAXTON, Rational Association
of I:nsurance Commissioners ( 1345) ;
SGE (1678)
BAKER, LAWRENCE
BATEMAN,
KEI:TH
BORZI, PHYLLIS
BRODBECK, L.
BURTON, JOHN
CLAXTON I
GARY
CLAYTOR, AlUf
DUGGAN, JAMES
ELLENBERGER, J.
GRANlfEMARlf, T.
GREENWOOD,
BAUGH 1
JUDI:TB
KEVI:R
KREUGER, ALAR
LEVITT LARRY
LLEWELLYN, BARRY
KATHLEEN
MOLLOY I JANE
MEANS,
Princeton University; No Official
status ( 30133)
Alliance
of
American
I:nsurers
(1344); No Official Status
House
Subcommittee
on
Labor/Management Relations-FTE ( 841)
Rep. McCurdy (CD, Vol. I, P. 589)FTE
Editor,
John Burton's Workers'
Compensation Monitor ( 1285) , Rutqers
University;
No Official Status
(1270, 1271, 1344) (ROTE: on 1285,
in
Typewritten
Comment
Below
Burton's RaJDe, it says, 11Kreuqer
Indicated
That
Burton
can
Participate."
Does This Convey
Leadership Status on Kreuqer??)
Rational Association of I:nsurance
Commissioners (1345); SGE (1678)
Florida I:nsurance COllai.ssion ( 1285) ;
No Official status
Treasury-FTE (842)
AFL-ciO; No Official Status
Workers'
Compensation
Researcch
Institute
(30133);
No Official
Status
Workers' Compensation Fund, West
Virqinia; No Official Status (1344)
I:nstitute
for
Health
Policy
SOlutions; No Official Status
Princeton Univarsity - Consultant
(First Responses); SGE (1678)
(1272)
Staff
of
california
Department
of
I:nsurance,
Commissioner's Health care Advisory
Commission; SGE (1678)
·
National Council on Compensation
Insurance (1344); No Official Status
HHS-HCFA-FTE
Treasury-FTE
68
�NELSON, WILLIAM
MOTH, DAVID
PAYNE, MARY ELLA
SISKIND, FRED
TBORHQUIST I LISA
VICTOR, RICHARD
WEEKS, GARY
WERNER, MICHAEL
SSA-Office of Research & Statistics
(1270); Not Listed as FTE, 840-849
Johnson
&
Higgins
(1344);
No
Official status
Sen. Rockefeller (CD, Vol. I, P.
352)-FTE
Department of Labor-FTE
Minnesota
Workers'
Compensation
Research (1270); No Official Status
Workers'
Compensation
Research
Institute ( 1344) ; No Official Status
oreqon Insurance Commission ( 1270) ;
No Official status
Sen. Democratic Policy Committee
(CD, Vol. I, P. 403)-FTE
SOURCES: Declarations of Marjorie Tarmey, Documents Nos.
1270-1276, 1285, 1344, 1345, 30069, 30085, 30090, 30115,
30132, 30133. See Tab 55 attached to the Memorandum.
13.
The "Interdepartmental Working Group", and its Cluster
Groups, Working Groups and Subgroups met regularly since January
25, 1993.
14.
(Declaration of Ira Magaziner, paragraphs 10 and 19.)
The work of the TASK FORCE and its "Interdepartmental
Working Group" and its Cluster Groups the Working Groups ·and
Subgroups was to be completed within one hundred ( 100) days of
January 20, 1993.
15.
(Second Amended Complaint, Ex. A)
By letters to the First Lady, representatives of the
Plaintiff organizations requested to be permitted to attend and
participate in all of the meetings of the TASK FORCE, pursuant to
the Federal Advisory Committee Act, (FACA) 5 u.s.c. App., Section
10.
(Second Amended Complaint, Exs. B, c and D)
16.
of the
Bernard Nussbaum, counsel to the President, and on behalf
First Lady and the Task Force,
advised each of the
Plaintiffs in writing that they could not attend or participate in
all of the meetings· of the TASK FORCE,
and that the Federal
Advisory Committee Act did not ·apply to the TASK FORCE.
69
He further
�asserted that the presence of the First Lady did not trigger the
application of the Federal Advisory committee Act.
(Second Amended
Complaint, Exs. E, F and G).
17.
By letter to Bernard Nussbaum, representatives of the
Plaintiffs organizations requested to inspect and copy the records,
reports, transcripts, minutes, appendixes, working papers, drafts,
studies, agenda and other documents which were made available to
and prepared for or by the TASK FORCE,
the Interdepartmental
Working Group and its Cluster Groups, Working Groups and Subgroups,
pursuant to the Federal Advisory Committee Act, 5 u.s.c. App. §10
that the Freedom of Information Act,
5 u.s.c.
§552a.
(Second
Amended Complaint, Exs. H, I, and J).
18.
By letters dated April 1, 1993, the defendants and the
defendant Task Force,
denied the
FOIA and
FACA requests of
plaintiffs Association of American Physicians and Surgeons, Inc.
and American Council for Health Care
Reform~
plaintiff National
Legal & Policy Center never received a response to its FOIA and
FACA request.
19.
The
(Second Amended complaint Exs. K and L)
individuals
identified in paragraph 12 of this
Statement of Material Facts, who were non full-time officers or
employees of the federal government, participated as members of the
Interdepartmental Working Group and its Cluster Groups, Working
Groups,
and the Subgroups,
and participated in the meetings,
deliberations,· and recommendations of those groups.
20.
The Interdepartmental Working Group of the Task Force and
its Cluster Groups, Working Groups and Subgroups aforementioned was
established in January 25, 1993 by the President, through the
70
�Defendant Ira Magaziner, to "[gather] information concerning the
impact of existing health care policies and delivery services, and
possible alternatives to those policies.
The information that
[was] gathered and analyzed by the aforesaid Interdepartmental
Working Group of the Task Force and its Cluster Groups, Working
Groups
and
Subgroups
aforesaid
was
used
to
formulate
recommendations to the President" regarding national health reform
legislation. Declaration of Ira Magaziner March 3, 1993, paragraph
5.
21.
Plaintiffs have submitted to the Court, under seal, a
section of their Memorandum of Points and Authorities that further
delineates and references sealed documents that demonstrate that
non full-time officers or employees of the federal government
participated as members of the Interdepartmental Working Group and
its Cluster Groups, Working Groups, and Subgroups.
The sealed
documents further demonstrate that there was a formal structure to
those groups.
The Interdepartmental Working Group and its Cluster
Groups, Working Groups and Subgroups had a fixed membership, an
organized structure and a specific purpose. ··They were cohesive,
well-planned and well-integrated committees which interfaced with
one another regularly and which met at multiple . "tollgates" in
order to reach consensus on the recommendations for health reform
legislation for the President: to wit, the Health Security Act of
1993.
(All of the specific facts cannot be set forth in detail
here as
some are privileged under the order of this court.
Declaration of Marjorie Tarmey, Document Nos. 10030, 10034, 10036,
100371 100391 100401 101391 1004 71 200211 200241
71
200281
200351
�200401
200501 200491 200501 200551 200561 100571 200691 200101
200731 200121 200181 200191
200801
200991
201101 201191 201201
20129, 20134.
22.
The Interdepartmental Working Group of the Task Force and
its Cluster Groups, Working Groups and Subgroups were "established"
and "utilized by the President, and made recommendations to the
President on national heath reform legislation, to wit, the Health
Security Act of 1993.
Ad.: Declaration of Ira Magaziner, March 3,
1993, !5.
Respectfully submitted,
KENT MASTERSON BROWN, ESQ.
CHRISTOPHER J. SHAUGHNESSY 1 ESQ.
BROWN & BROWN
1114 First National Building
167 West Main Street
Lexington, KY 40507
(606) 233-7879
(606) 252-6791 - facsimile
J~z IY\ ~Pk._.FRANK M. NORTHAM, ESQ
WEBSTER, CHAMBERLAIN & BEAN
1747 Pennsylvania Avenue, N.W.
Suite 1000
Washington, D.C. 20006
(202) 785-9500
72
�CERTIFICATE OF SERVICE
This is to certify that a true and correct copy of the
foregoing Plaintiffs' Statement of Material Facts As To Which There
is No Genuine Dispute has been served upon Defendants by handdelivering a copy of same to Defendants' counsel of record, Jeffrey
Gutman, Esq., David Andersen, Esq., u.s. Department of Justice,
Civil Division, 901 E street, N.W., Room 952, Washington, D.C.
20004-2037 on this
:'" r;!.day of March, 1994.
~~
~..;2/v
Frank M. Northam
73
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
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Paper
Dublin Core
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Title
A name given to the resource
American Physicians Lawsuit HCTF (Health Care Task Force); March 23, 1994 [1] [1]
Creator
An entity primarily responsible for making the resource
First Lady's Office
Maggie Williams
Evan Ryan
Melanne Verveer
Identifier
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2006-0223-F
Is Part Of
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Box 5
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
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Clinton Presidential Records: White House Staff and Office Files
Publisher
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William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Reproduction-Reference
Date Created
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1/8/2015
Source
A related resource from which the described resource is derived
42-t-2194630-20060223F-005-007-2015
2194630
-
https://clinton.presidentiallibraries.us/files/original/8a7b44f1d837a346f267528bae12f95d.pdf
0556999ab50fb56e2615e3164e7eab1f
PDF Text
Text
Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
Publications have not been scanned in their entirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
�.
. :~-.~ .
··~ . . .
The Need for Health Care Reform
..
.
'
~f ,;;~
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
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Title
A name given to the resource
Health Care Task Force [2]
Creator
An entity primarily responsible for making the resource
First Lady's Office
Maggie Williams
Evan Ryan
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 5
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-2194630-20060223F-005-006-2015
2194630
-
https://clinton.presidentiallibraries.us/files/original/f6165e7d588a7807507f37b1077d7a0a.pdf
26fae9358e8e3dff6015b7b5c5c76b79
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
First Lady's Office
Series/Staff Member:
Maggie Williams; Evan Ryan
Subseries:
Misc. Subject Files
OA/ID Number:
12735
FolderiD:
Folder Title:
Health Care Task Force
Stack:
Row:
Section:
Shelf:
Position:
s
59
4
6
1
�THE WHITE HOUSE
Dear Friend:
I
Thank you for writing and sharing your views on health care reform.
President Clinton is committed to reforming our nation's health care
system-controlling runaway costs and providing security to every
American family.
I
It won't be easy and it won't happen overnight, but with your help, we
will bring costs under control while maintaining quality medical care
and preserving the choice so important to us all.
Thank you again for your views and for your support.
THE WHITE HOUSE
Dear Friend:
[
Thank you for writing and sharing your views on health care reform.
President Clinton is committed to reforming our nation's health care
system-controlling runaway costs and providing security to every
American family.
It won't be easy and it won't happen overnight, but with your help, we
will bring costs under control while maintaining quality medical care
and preserving the choice so important to us all.
Thank you again for your views and for your support.
I
�THE WHITE HOUSE
Dear Friend:
I
Thank you for writing and sharing your views on health care reform.
President Clinton is committed to reforming our nation's health care
system-controlling runaway costs and providing security to every
American family.
l
It won't be easy and it won't happen overnight, but with your help, we
will bring costs under control while maintaining quality medical care
and preserving the choice so important to us all.
Thank you again for your views and for your support.
THE WHITE HOUSE
Dear Friend:
Thank you for writing and sharing your views on health care reform.
President Clinton is committed to reforming our nation's health care
system-controlling runaway costs and providing security to every
American family.
l
It won't be easy and it won't happen overnight, but with your help, we
will bring costs under control while maintaining quality medical care
and preserving the choice so important to us all.
Thank you again for your views and for your support.
1
�-.
NAME
HEALTH CARE WORKING GROUPS
SORTED BY STATUS
PAGE:l
r-
ORGANIZATION
, BENAVIDES, ELLEN
WHO-HENNEPIN COUNTY, MN BUREAU OF HEALTH, DIR.
HEALTH POLICY
WHO-PA COUNTY COMMISSIONERS
WHO-NGA-GOVERNOR'S COMMISSION ON OKLAHOMA HEALTH
I
f
I
BENEDICT, ROBERT
BROWN, MARY
CARE
: CORONADO, DAVID
. EGBERT, MARCIA
FRIEDHOLM, DEANN
GARCIA, JOSEPH
I
HEATH, ALFRED
HOLT, HERBERT
JOSEPH, THOMAS
MCNAMEE, NIKKI
MILLIKEN, CHRISTINE
I
MYERS, EMILY
O'~RIEN, MARY JO
O'MEARA, JANIS
PETERSON, DOUGLAS
' QUIST, JANET
RADER, ANYA
RILEY, IRENE
SCHEPPACH, RAY
SMITH, BARBARA
; UYEDA, MARY
VAZQUEZ-QUINTAN, ENRIQUE
VOLPE, LANE
.. WADA, ROYLINNE
WEIL, ALAN
HHS-DC DEPARTMENT OF HUMAN SERVICES
WHO-CUYAHOGA CTY, OHIO-BRD OF COMMISSIONERSINTERGOV'TL AFF.
WHO-NGA-TEXAS MEDICAID DIRECTOR
WHO-CUYAHOGA COUNTY, OHIO-DEPARTMENT OF HUMAN
SERVICES
WHO-COMMISSIONER OF HEALTH-U.S. VIRGIN ISLANDS
WHO-DIR. DEPT. OF ADDT'N, VICTIM & MEN. HLTH
SVCS-MONTGY. CO
NATIONAL ASSOCIATION OF COUNTIES
WHO-NATIONAL GOVERNORS ASSOCIATION
WHO-NAT' L ASSOC. ATTORNEY GENERALS-EXECUTIVE
DIRECTOR
WHO-NATIONAL ASSOCIATION OF ATTORNEY GENERALS
WHO-DEPUTY COMMISSIONER-MINNESOTA DEPARTMENT OF
HEALTH
WHO-INTERGOVERNMENTAL AFFAIRS
WHO-NATIONAL LEAGUE OF CITIES
NATIONAL LEAGUE OF CITIES
WHO-DEP. COS & SPEC. ASST.\HEALTH CARE POL. FOR
GOV. DEAN
WHO-LOS ANGELES COUNTY-DEPARTMENT OF HEALTH
SERVICES
WHO-NATIONAL GOVERNORS ASSOCIATION-EXECUTIVE
DIR.-VIRGINIA
WHO-NGA-SEC'TY /HEALTH-SOUTH DAKOTA DEPARTMENT OF
HEALTH
WHO-DIR. CTY HEALTH POL. PROJECT-NAT'L ASSOC. OF
COUNTIES
WHO-SECRETARY OF HEALTH/PUERTO RICO
WHO-NATIONAL GOVERNORS ASSOCIATION
WHO-PACIFIC ISLAND HEALTH OFFICERS ASSOC.
(PIHOA)-EXEC. DIR.
WHO-GOVERNOR'S OFFICE-COLORADO-HEALTH POLICY
ADVISER
�HEALTH CARE WORKING GROUPS
SORTED BY STATUS
NAME
CONSULTANT
AIKEN, LINDA
CALLAHAN, CATHI
HILLMAN, ALAN
HIX, WILLIAM
JONES, STANLEY
KRUEGER, ALAN
LOHR, KATHERINE
MAYS, JAMES
PYLE, THOMAS
SATCHER, DAVID
SCHADLE, JANE
SMITH, MARK
TRAPNELL, GORDON
WALTERS, FARAH
PAGE:l
ORGANIZATION
HHS-UNIV. OF PENN.-PROF. NURSING-DIRECTOR-CTR.
HEALTH SVCS
HHS-ACTUARIAL RESEARCH CORP. (ASPE)
HHS-UNIV. OF PENNSYLVANIA-ASSISTANT PROFESSOR
DOD-RAND
.
OFFICE OF PERSONNEL MANAGEMENT-INDEPENDENT
CONSULTANT
HHS-PRINCETON UNIVERSITY
HHS-HEALTH CARE SVCS-INST. OF MEDICINE/NAS
HHS-ACTUARIAL RESEARCH CORPORATION
HHS-HARVARD COMMUNITY HEALTH PLAN/BOSTON
CONSULTING GROUP
HHS-PRESIDENT-MEHARRY MEDICAL COLLEGE-TENNESSEE
HHS-IOWA DEPT. PUBLIC HEALTH-HEALTH PROGRAM
ANALYST
HHS-KAISER FAMILY FOUNDATION-VICE PRESIDENT
HHS-ACTUARIAL RESEARCH CORPORATION
HHS-UNIVERSITY HOSPITALS OF CLEVELAND, ORPRESIDENT & CEO
�HEALTH CARE WORKING CROUPS
SORTED BY STATUS
,NAME
,_
,FULL TIME GOV'T EMPLOYEE
iADAMSKE, STEVEN
!ADDISON-BURTON, LAVARNE
:ADLER, MICHELE
.AGUILERA, ESTHER
• ALBERGHINI, THERESA
i ALBERT, SUSAN
. ALLEN, LUCY
i ALLISON, ROBERT
. ALMENDAREZ, ISABEL
ALPERT, CYNTHIA
, ALTMAN, DAVID
I ALTMIRE, JASON
. ANDERSON, ROBERT
j ANTOS,
JOSEPH
. ARNETT, ROSS
; ARONS, BERNIE
ASH, SHERRI
ATKINSON, LESLIE
AUKERMAN, GLEN
I
AUSTEIN, CHERYL
BACO·SANCHEZ, LUIS
BAILY, SARAH
BALL, JUDY
.· BANDEIAN, STEPHEN
I
BANTHIN, JESSICA
BAQUET, CLAUDIA
BARBOUR, GALEN
BARSTOW, SCOTT
BATES, JAMES
BAUM, NANCY
BAYNE, CHRISTY
BEASON, CHARLOTTE
BERMINGHAM, MAYA
BERNER, JOHN
BERRY, ROGER
BEVERLY, JOHN
BIERWIRTH, MARGARET
BILLY, CARRIE
BLAUWET, ROGER
, BLICKSTEIN, JILL
BLOCK, ABBY
BLOOM, FELICIA
BLOSS, GREGORY
BLUMENTHAL, SUSAN
BODE, HOLLY
BOEHM, JENNIFER
BOERUM, DENISE
I
PACB:l
ORGANIZATION
HHS-SPECIAL ASSISTANT
HOUSE BUDGET COMMITTEE
HEALTH & HUMAN SERVICES(HHS)-OFC. ASST SEC'Y PLAN
& EVAL
CONGRESSIONAL HISPANIC CAUCUS
SENATOR PATRICK J. LEAHY
SENATOR CHARLES ROBB
COUNCIL OF ECONOMIC ADVISORS (CEA)
OFFICE OF MANAGEMENT & BUDGET ( OMB)
REPRESENTATIVE CRAIG A. WASHINGTON
VETERANS AFFAIRS (VA)
SENATOR JAY ROCKEFELLER
REPRESENTATIVE DOUGLAS "PETE" PETERSON
OMB
HHS-HEALTH CARE FINANCING ADMINISTRATION (HCFA)
HHS-HCFA
HHS-NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH)
HHS
REP. LOUIS STOKES
HHS-HEALTH RESOURCES & SERVICES ADMINISTRATION
(HRSA)
HHS-ASPE
RESIDENT COMMISSIONER CARLOS ROMERO-BARCELO
SENATOR DONALD W. RIEGLE, JR.
HHS-AGENCY FOR HEALTH CARE POLICY AND RESEARCH
(AHCPR)
OMB
HHS-AHCPR
HHS
VETERANS AFFAIRS
REPRESENTATIVE MIKE KOPETSKI
DEPARTMENT OF DEFENSE-NAVY BUREAU OF MEDICINE &
SURGERY
HHS-HCFA
HHS
VETERANS AFFAIRS
SENATE FINANCE COMMITTEE
COUNCIL OF ECONOMIC ADVISORS
REPRESENTATIVE HARRY JOHNSTON
DEPARTMENT OF LABOR
REPRESENTATIVE SAM GEJDENSEN
SENATOR JEFF BINGAMAN
REPRESENTATIVE PETER HOAGLAND
OMB
OFFICE OF PERSONNEL MANAGEMENT
REPRESENTATIVE LOUISE SLAUGHTER
HHS-PHS
HHS-NIMH
SENATE-SPECIAL COMMITTEE ON AGING
REPRESENTATIVE JILL LONG
SEN. GOV'L AFFAIRS CMTE, SUBCMTE FED. SVCS,
�HEALTH CARE WORKING GROUPS
SORTED BY STATUS
·~
PAGB:2
ORGANIZATION
FULL TIME GOV'T EMPLOYEE
BORZI, PHYLLIS
I BOWEN, GEORGE
! BOYER, THOMAS
BREW, WILLIAM
. BRIGGS, BETTE
: BROCK, CHARLES
' BRODBECK, LAURA
! BRODNITZ, PETER
• BROSTROM, MOLLY
BRUNS, KEVIN
I
I
. BUCK, JEFFREY
: BUCKINGHAM, I I I , WARREN
BUFFINGTON, MAX
BUONORA, DAVID
BURNER, SALLY
BURNETT, LAIRD
BURNEY, IRA
BUTO, KATHLEEN
CADE, DAVID
CAMPBELL, LAURENCE
CAMPBELL, PAUL
CARLSON, RONALD
CASCIOTTI, JOHN
CAVANAUGH, SEAN
CHAMBERS, CAROLINE
CHANG, DEBORAH
CHARLES, GERALD
CHILDRESS, MARK
CHUN, CHISUN
CLARK, WILLIAM
CLARK, ROBERT
CLAUSER, STEVEN
CLAY JIMMIE
CLAYPOOL, ROBERT
CLEMENTE, FRANK
I
COHEN, RIMA
COHEN, ALAN
COHEN, JOEL
CONTRERAS, HENRY
COOK, FRANCESCA
COOPER, DAVID
COOPER, PHILIP
COOPER, BARBARA
• . COPELAND, ROBERT
COSTER, JOHN
COX, KENNETH
CRUMP I JANICE
POST/CIVIL SVCS
HOUSE EDUCATION/LABOR COMMITTEE
HHS-HRSA
REPRESENTATIVE BLANCHE LAMBERT
SENATE.VETERANS AFFAIRS COMMITTEE
LABOR
DEPARTMENT OF DEFENSE (DOD)
REPRESENTATIVE DAVE MCCURDY
REPRESENATIVE THOMAS FOGLIETTA
HHS-SPECIAL ASSISTANT
REP. BILL CLAY-HOUSE CMTE ON POST OFFICE & CIVIL
SERVICE
HHS-HCFA
HHS-PHS
HHS-HCFA
REPRESENTATIVE BARBARA KENNELLY
HHS
SENATOR JOHN BREAUX
HHS-HCFA
HHS-HCFA
HHS-OFFICE OF GENERAL COUNSEL
DEPARTMENT OF COMMERCE
DEPARTMENT OF COMMERCE-BUREAU OF THE CENSUS
HHS-HRSA
DOD
REPRESENTATIVE BEN CARDIN
REPRESENTATIVE JIM COOPER
SENATOR DONALD W. RIEGLE
VETERANS AFFAIRS
SENATE LABOR & HUMAN RESOURCES COMMITTEE
HHS-PUBLIC HEALTH SERVICE-HRSA
SENATOR DALE BUMPERS
HHS-OFFICE OF ASST. SEC'Y FOR PLANNING &
EVALUATION
HHS-HCFA
VETERANS AFFAIRS
DOD-U.S. ARMY SURGEON GENERAL
REPRESENTATIVE JOHN CONYERS-HOUSE CMTE ON GOV'T
OPERATIONS
SENATOR TOM DASCHLE
SENATE FINANCE COMMITTEE
HHS-AHCPR
REPRESENTATIVE LUCILLE ROYBAL-ALLARD'
SENATOR CAROL MOSELEY-BRAUN
HHS-ASPE
HHS-AHCPR
HHS-HCFA
LABOR
SENATE-SPECIAL COMMITTEE ON AGING
DOD
REPRESENTATIVE EVA CLAYTON
..............._______________________________
�HEALTH CARE WORKING CROUPS
SORTED BY STATUS
:NAME
PACE:3
ORGANIZATION
I
; FULL TIME GOV'T EMPLOYEE
CUTLER, DAVID
: DANIELS, SUSAN
• DAVENPORT, KAREN
: DAVIES, MONICA
. DAV.IS, LOUIS
DEIGNAN, KATHLEEN
I DELEW, NANCY
' DEMLO, LINDA
1 DENHAM, LORI
DEWANE, MARY
DINKELACKER, E. WILLIAM
DONESKI, ELLEN
DOONAN, MICHAEL
DOROTINSKY, WILLIAM
DOTY, PAMELA
DOYLE, PATRICIA
DRABEK, LEONARD
DRUMMOND, FAYE
· DUGGAN, JAMES
DUNN, VAN
I
I
I
DURAN, ANTONIO
DUZOR, DEIRDRE
ECKERT, J. KEVIN
EDELSTEIN, STEVEN
EDGELL, JOHN
EGAN, JAMES
EINHORN, THEODORE
ELLIS, GARY
EMANUELS, KRISTINA
EMMER, SUSAN
ENGLISH, MICHAEL
ERMANN, DAN
EULER, JOHN
EVANS, JENNIFER
EYDT, ALLISON
FALETTI, THOMAS
FARLEY, DEAN
FEDER, JUDY
FIEDELHOLTZ, JENNIFER
FINAN, STEVEN
FINIGAN, THOMAS
FISH, JAMES
FISKE, MARY BETH
FITZMAURICE, J. MICHAEL
FLYNN, WILLIAM
FORBES, RIPLEY
FORTIER, JULIA
FRANTZ, MOLLY
FRASCHE, MARY
CEA
HHS-ADMINISTRATION ON DEVELOPMENTAL DISABILITIES
HHS-HCFA
SENATOR JEFF BINGAMAN
REPRESENTATIVE JOSE E. SERRANO
SENATE BUDGET COMMITTEE
HHS-ASPE
HHS-AHCPR
REPRESENTATIVE CALVIN DOOLEY
HHS-HCFA
TREASURY
SENATOR JAY ROCKEFELLER
HHS-ASPE
OMB
HHS-ASPE
HHS-AHCPR
HHS-ASPE
SENATE FINANCE COMMITTEE
TREASURY
SENATOR EDWARD KENNEDY-SEN. CMTE ON LABOR & HUMAN
RESOURCES
HHS-HRSA-BUREAU OF PRIMARY HEALTH CARE
HHS-HCFA
SENATOR HARRIS WOFFORD
HHS-SPECIAL ASSISTANT
COMMERCE
FEDERAL TRADE COMMISSION
REPRESENTATIVE PETER DEUTSCH
NIH
OMB
SENATOR BOB GRAHAM
HHS
HHS-HCFA
JUSTICE
SENATOR BEN CAMPBELL
OMB
REPRESENTATIVE DICK DURBIN
HHS-ACHPR
HHS
HHS-PHS
LABOR
SENATOR MAX BAUCUS
OMB
.
SEN. EDWARD KENNEDY-SEN. CMTE ON LABOR & HUMAN
RESOURCES
HHS-AHCPR
.
OFFICE OF PERSONNEL MANAGEMENT ( OPM)
REP. HENRY A. WAXMAN-HOUSE CMTE ENERGY/COMMERCE
REP. HENRY A. WAXMAN-HOUSE CMTE EMERGY/COMMERCE
REPRESENTATIVE EARL POMEROY
REPRESENTATIVE DAN GLIC~
�HEALTH CARE WORKING GROUPS
SORTED BY STATUS
·~
: FULL TIME GOV'T EMPLOYEE
: FREDERICK, PAUL
j FREELAND, MARK
i FRIEDMAN, BERNARD
! FUENTES, JENNICE
~ GAGEL, BARBARA
GALE, JOSEPH
I
I
I
I
I
GASTON, MARILYN
GAUDETTE, SYLVIA
GAWANDE, ATUL
GILLINGHAM, ROBERT
GLAZE, STEVEN
GLEIMAN, EDWARD
GLIED, SHERRY
GOLD, MARTHE
GOLDSTEIN, ELAINA
GOLDSTONE, DONALD
GOLDWATER, DAVID
GOODELL, JEFFREY
GOODMAN, NANCY
GOODWIN, MARSHA
GOODY, BRIGID
GOPLERUD, ERIC
GORMAN, JOHN
GOVAN, REGINALD
GRABEL, LINDA
GRAFF, TOBY
GRAMS, TODD
GREENBERG, GEORGE
GREENWALD, LESLIE
GRODEN, JEFFREY
GROSS, MARCY
GROSS, LAUREN
GRUNDMANN, MARTHA
GUST, STEVEN
HADLEY, JAMES
HADLEY, ELIZABETH
HAHON, MELINDA
HALL, ANNE
HAMERSCHLAG, ART
HAND, LUCY
HARAHAN, MARY
HARDOCK, RANDY
HARPER, MARY
HARRIS, SKILA
HARVELL, JENNIFER
HARVEY, PATRICIA
HASH, MICHAEL
HASTINGS, KATHLEEN
HATTON, MELINDA
PAGB:4
ORGANIZATION
DOD-OFFICE OF ASSISTANT SECRETARY OF DEFENSE
HHS-HCFA
HHS-AHCPR
REPRESENTATIVE LUIS GUTIERREZ
HHS-HCFA
SENATOR DANIEL P. MOYNIHAN-SENATE FINANCE
COMMITTEE
HHS-HRSA
REPRESENTATIVE JOHN OLVER
HHS
TREASURY
SENATOR DAVID PRYOR
SENATE GOVERNMENT AFFAIRS COMMITTEE
CEA
HHS-PHS
HOUSE SELECT COMMITTEE ON AGING
HHS
REPRESENTATIVE JIM BILBRAY
REPRESENTATIVE WILLIAM LIPINSKI
JUSTICE
VETERANS AFFAIRS
HHS-HCFA
HHS-SUB. ABUSE & MENTAL HEALTH SERVICES
ADMINISTRATION
REPRESENTATIVE JOHN CONYERS
HOUSE COMMITTEE ON EDUCATION AND LABOR
HHS-OFFICE OF GENERAL COUNSEL
HHS-SPECIAL ASSISTANT
OMB
HHS-ASPE
HHS-HCFA
DOD
HHS
SENATOR CLAIBORNE PELL
REPRESENTATIVE MARTIN SABO-HOUSE BUDGET COMMITTEE
HHS-NIH
HHS-HCFA
HHS-ASPE
JUDICIARY COMMITTEE-ANTITRUST SUBCOMMITTEE
HHS
VA
REPRESENTATIVE JOSE SERRANO
HHS-ASPE
TREASURY
HHS-NIMH
OFFICE OF THE VICE PRESIDENT
HHS-HCFA
HHS-AHCPR
REP. HENRY A. WAXMAN-HOUSE CMTE ENERGY/COMMERCE
HHS-PHS-AHCPR
SENATE JUDICIARY COMMITTEE-ANTITRUST SUBCOMMITTEE
�HEALTH CARE WORK%HO GROUPS
SORTED BY STATUS
I NAME
; FULL TIME GOV'T EMPLOYEE
1HAYES, CHARLOTTE
HAYES, SHERRY
! HEADLEY, ELWOOD
; HEATH, KAREN
. HEENAN, CHRISTINE
; HELLINGER, FRED
; HENRY, CHRISTOPHE
! HERRELL, ILEANA
HERTZ, THOMAS
' HICKMAN, PETER
: HIGGINS, MICHAEL
ORGANIZATION
I
I
. HIGHT, JOSEPH
HILL, TIMOTHY
. HINZ, RICHARD
HOFFMAN, ALAN
HOGUE, BONNIE
HOLTON, DWIGHT
HOLTZBLATT, JANET
HORVATH, JANE
HORVATH, THOMAS
HUCKABY, MICHELLE
' HUMAN, CLARKSON
HUNTER, GILLIAN
IBSEN, RALPH
IRWIN, JEAN
ISKOWITZ, MICHAEL
IWRY, J. MARK
JACKSON, MORGAN
JACKSON, PAUL
JACOBS, TERRY
JACOBSON, LAURENCE
JARBOE, KENAN.
I
JENCKS, STEPHEN
JENNINGS, CHRISTOPHE
JODREY, DARREL
JOHNSON, ERIK
JOHNSON, JAMES
JOHNSON, K. SCHELEE
JOHNSON, PATRICIA
JOHNSON, DONALD
JONES, MARCIA
JONES, SANDRA
JORLING, JAMES
JOSEPH-FOX, YVETTE
I
KANE, BRAD
KASS, DAVID
~TTAN, AZAR
PAOB:S
/
OFFICE OF THE VICE PRESIDENT
SENATOR HERB KOHL
VETERANS AFFAIRS
HOUSE ARMED SERVICES COMMITTEE
WHITE HOUSE POLICY ANALYST
HHS-AHCPR
REPRESENTATIVE FLOYD H. FLAKE
HHS-HRSA
HHS-ASPE
HHS-HCFA
REP. RONALD DELLUMS-HOUSE ARMED SERVICES
COMMITTEE
LABOR
HHS-HCFA
LABOR
HHS-SPECIAL ASSISTANT
SENATE SPECIAL COMMITTEE ON AGING
WHITE HOUSE
TREASURY
SENATE FINANCE COMMITTEE
VETERANS AFFAIRS
REPRESENTATIVE BOB CLEMENT
HHS-OFFICE OF RURAL HEALTH POLICY
TREASURY
HOUSE VETERANS AFFAIRS COMMITTEE
REPRESENTATIVE MARIA CANTWELL
SENATOR EDWARD KENNEDY-SEN. OMTE ON LABOR & HUMAN
RESOURCES
TREASURY
HHS-AHCPR
HHS-PHS
TREASURY
OMB
SENATOR DONALD RIEGLE-SEN. BANK, HOUSING & URBAN
AFF. OMTE.
HHS-HCFA
HHS
SENATOR HARRIS WOFFORD
OMB
REPRESENTATIVE L.F. PAYNE
REPRESENTATIVE JOHN BRYANT
COMMERCE-BUREAU OF THE CENSUS
HHS-HCFA
SENATOR JOHN BREAUX
VETERANS AFFAIRS
HHS-POLICY ASSISTANT
SENATOR DANIEL K. INOUYE-SENATE COMMITTEE ON
INDIAN AFFAIRS
REPRESENTATIVE CARDISS COLLINS
COMMERCE
REPRESENTATIVE ROBERT MATSUI
�-
HEALTH CARE WORKINC CROUPS
SORTED BY STATUS
·NAME
;-
PACE:&
ORGANIZATION
I
; FULL TIME GOV' T EMPLOYEE
!KATZ, RUTH
:KATZ-LEAVY, JUDITH
' KAVANAGH, GARY
IKAZDIN, ROBERT
'KEARNS, III, WILLIAM
, KEITH, SAMUEL
· KEMPER, PETER
'KENDALL, DAVID
' KENYON, MARY
, KEPNER, COLLEEN
: KERY, PATRICIA
; KICHAK, NANCY
; KIM, DAVID
: KING, ANDREA
! ·KING, KATHLEEN
KING, ROLAND
KNIGHT, RICHARD
KOLODNER, ROBERT
KOPLAN, JEFFREY
KOSS, SHANNAH
KOVNER, RONNIE
KRAKAUER, HENRY
I
I
I
1
KRESS, JACK
KUZMACK, RICHARD
LANGENBRUNNER, JOHN
LAVIZZO-MOUREY, RISA
LAWSON, KURT
LEATHERS, HOWARD
LEFKOWITZ, BONNIE
LEHMANN, LAURENT
LEMASURIER, JEAN
LEVINE, DEBORAH
LEVINE, GREGORY
LEVY, HELEN
LEWIS, JOHN
LIDBURY, CHRISTINE
LILLIE, STEVEN
LINCOLN, MICHEL
LIND, KEITH
LINDREW, GERALD
LINK, KENNETH
LIPNER, ROBYN
LIU, ERIC
LOPATIN, ALAN
LOTFI, MOHAMED
LUBITZ, JAMES
LUCAS, DEBORAH
LUTTBEG, CAROLINE
LUTTER, RANDALL
LYON, ANDREW
HHS-ASPE
HHS-CENTER FOR MENTAL HEALTH SERVICES
HHS-HCFA
TREASURY-OTS
OOD-OASD HEALTH AFFAIRS
HHS-NIMH
HHS-AHCPR
REPRESENTATIVE MICHAEL ANDREWS
FEDERAL TRADE COMMISSION
REPRESENTATIVE CHARLES STENHOLM
REPRESENTATIVE BARBARA KENNELLY
OPM
REPRESENTATIVE XAVIER BECERRA
REPRESENTATIVE RICHARD GEPHARDT
SENATE FINANCE COMMITTEE
HHS-HCFA
REPRESENTATIVE GARY FRANKS
VETERANS AFFAIRS
HHS-CDC
OMB
REPRESENTATIVE JACK REED
HHS-PHS-UNIFORMED SERVICES UNIVERSITY OF HEALTH
SCIENCES
HHS
OMB
OMB
HHS-AHCPR
TREASURY
CEA
HHS-PHS
VETERANS AFFAIRS
HHS-HCFA
HHS-POLICY ASSISTANT
REPRESENTATIVE ROSA DELAURO
HHS-AHCPR
SENATE LABOR & HUMAN RESOURCES COMMITTEE
OMB
DOD
HHS-INDIAN HEALTH SERVICES (IHS)
REPRESENTATIVE GERRY STUDDS
LABOR
VETERANS AFFAIRS
SENATOR BARBARA MIKULSKI
SENATOR DAVID BOREN
HOUSE EDUCATION AND LABOR COMMITTEE
CEA
HHS-HCFA
CEA
REPRESENTATIVE RON COLEMAN
0~
CEA
�IIEALTB CARE WORKING GROUPS
SORTED BY STATUS
:NAME
.-
PAGE:7
ORGANIZATION
I
FULL TIME GOV'T EMPLOYEE
;LYON, RANDOLPH
;MAGAZINER, IRA
i MAGUIRE,
DANIEL
' MALDONADO DE OM, MAGALI
. MALONEY, DANIEL
; MANDERSCHEID, RONALD
· MANTEL, LEWIS
1 MARCONI,
KATHERINE
i MARGHERIO, LYNN
: MARQUEZ, MIGUEL
i MARTINEZ,
FELIX
: MAXWELL, CELIA
, MCCLENNEY-ELLIO, LUCRETIA
MCCLOUD, MARMADUKE
MCDONOUGH, DONEG
MCKEE, TIMOTHY
MCKENNEY, NAMPEO
MEADOW, CYNTHIA
1
1
'
I
,
,
.
1
I
MEANS, KATHLEEN
MILLER, BERNARD
MILLER, MELANIE
MILLER, MICHAEL
MILLER, EDWARD
MILLER, NANCY
MILLMAN, MICHAEL
MILLS, JOHN
MIN, NANCY-ANN
MINK, DOUGLAS
MITCHELL, MARLOW
MOELLER, JONATHAN
MOLLOY, JANE
MONHEIT, ALAN
MONTES, JESS
MORGAN, JACQUELINE
MORRISSETTE, KAREN
MULLAN, FITZHUGH
MUNNELL, ALICIA
MURGUIA, JANET
MURPHY, SHEILA
MYERS, BARBARA
NAKAHATA, PETER
NARROW, DAVID
NELSON, CHARLES
NELSON, KAREN
NEUMAN, TRICIA
NEXON, DAVID
NICHOLS, LEN
NICHOLS, LINDA
OMB
WHITE HOUSE
LABOR
HHS-HCFA
VETERANS AFFAIRS
HHS-CMHS
VETERANS AFFAIRS
HHS-HRSA
WHITE HOUSE-POLICY ANALYST
REPRESENTATIVE BILL RICHARDSON
REPRESENTATIVE JIM BILBRAY
HHS-FDA
DOD-OASD HEALTH AFFAIRS
HHS-OFFICE OF GENERAL COUNSEL
REPRESENTATIVE PETE STARK
DOD
COMMERCE-BUREAU OF THE CENSUS
REPRESENTATIVE JACK BROOKS-HOUSE JUDICIARY
COMMITTEE
HHS-HCFA
DOD
REPRESENTATIVE MIKE ANDREWS
REPRESENTATIVE SANDER LEVIN
DOD
HHS-HCFA
HHS-NATIONAL ACADEMY OF SCIENCES
REPRESENTATIVE ELIOT ENGEL
OMB
REPRESENTATIVE EDDIE BERNICE JOHNSON
REPRESENTATIVE JULIAN DIXON
HHS-AHCPR
COMMERCE
HHS-AHCPR
HHS-CENTER FOR DISEASE CONTROL & PREVENTION
DOD-AIRFORCE
JUSTICE
HHS-PHS
TREASURY
REPRESENTATIVE JIM SLATTERY
SENATOR BOB KERREY
· HHS-OFFICE OF GENERAL COUNSEL
OMB
FEDERAL TRADE COMMISSION
COMMERCE-BUREAU OF THE CENSUS
REP. HENRY A. WAXMAN-HOUSE CMTE. ENERGY &
COMMERCE
HOUSE WAYS AND MEANS COMMITTEE
SEN. EDWARD M. KENNEDY-SENATE LABOR & EDUCATION
COMMITTEE
HHS-AHCPR
VETERANS AFFAIRS
�HEALTH CARE WORKING GROUPS
SORTED BY STATUS
I
I
NAME
:-
: FULL TIME GOV' T EMPLOYEE
: NIX, SHEILA
, NOBLE, JOHN
NORMAN, ALLINE
NORQUIST, GRAYSON
O'NEIL, PATRICIA
: O'NEILL, KIMBERLY
OBEY, CRAIG
OFFNER, PAUL
OLIVER, JUDITH
OLSEN, WILLIAM
OSHER, FREDERICK
PANG, FREDERICK
PARADISE, JULIA
PATEL, PARASHAR
PAYNE, MARY ELLA
PETERSON, MARVELU
PIGEON, STEVEN
PILLORS, BRENDA
PLAUT, THOMAS
POLLITZ, KAREN
PORTMAN, ROBERT
POSEY, KENDALL
POTETZ, LISA
POWELL, KEITH
PRATT, DONALD
PRICE, ANDREA
PUSKIN, DENA
RADACK, LAURA
RAFUSE, JR, ROBERT
RAYMOND, VICTOR
REEVES, LINDA
REGIER, DARREL
REINECKE, PETER
REYES, LUANA
RICE, CHERI
RICKEL, ANNETTE
RICKETSON, DENISE
RIVO, MARC
ROBINSON, SANDRA
RODGERS, JUDITH
RODRIGUEZ, LOUISE
RODRIGUEZ; GLADYS
RODRIGUEZ, SUSANA
ROMAGUERA, RAUL
ROSENMAN, PATRICIA
ROSS, SHEILA
ROSS-ROBINSON, HAZEL
ROSWELL, ROBERT
ROUSE, BEATRICE
ROVIN, LISA
i
PAGB:8
ORGANIZATION
SENATOR ROBERT KERREY
HHS-NATIONAL INSTITUTE ON ALCOHOL ABUSE &
ALCOHOLISM
VETERANS AFFAIRS
HHS-NIMH
VETERANS AFFAIRS
CEA
SENATOR KENT CONRAD
SENATE FINANCE COMMITTEE
HHS
REPRESENTATIVE DAN GLICKMAN
HHS-CMHS
SENATE ARMED SERVICES COMMITTEE
HHS
OMB
SENATOR JAY ROCKEFELLER
VETERANS AFFAIRS
HHS
REPRESENTATIVE EDOLPHUS TOWNS
HHS-NIMH
HHS
LABOR
VETERANS AFFAIRS
SENATE FINANCE COMMITTEE
SENATE LABOR & HUMAN RESOURCES COMMITEEE (FELLOW)
VETERANS AFFAIRS
REPRESENTATIVE LEWIS PAYNE
HHS-HRSA
JUSTICE
TREASURY
VETERANS AFFAIRS
HHS-AHCPR
HHS-NIMH-NIH
SENATOR TOM HARKIN
HHS-IHS
OMB
SENATOR DONALD W. RIEGLE
HHS-SPECIAL ASSISTANT
HHS-HRSA
HHS-AHCPR
HHS-HRSA
VETERANS AFFAIRS
REPRESENTATIVE ED PASTOR
REPRESENTATIVE CYNTHIA MCKINNEY
HHS-HRSA
HHS-NATIONAL INSTITUTE ON DRUG ABUSE
DELEGATE RON DE LUGO
REPRESENTATIVE BILL CLAY
VETERANS AFFAIRS
HHS-SAMHSA
HHS-HCFA
�'
.
NAME
!FULL TIME GOV'T EMPLOYEE
ROZEN, ROBERT
RYAN, ELAINE
. SALMON, MARLA
SAMUELSON, ELLEN
· SANDERSON, NICHOLE
i SANDLER, ·DAVID
: SCHECKEL, LISA
SCHIEBER, GEORGE
: SCHMID, STUART
: SCHNEIDER, ANDREAS
, SCHOENING, ATHENA
SCHULKE, DAVID
I SCHULTZ,
WILLIAM
SCHUMANN, BETH
· SCHUNEMAN, MARY
SCHUSTER, JAMES
SEGARRA, MARIA
SELTMAN, PAUL
J
SHAFFER, ELLEN
SHEEHAN, KATHLEEN
, SHEINER, JONATHAN
SHEINER, LOUISE
SHEINGOLD, STEVEN
SHELDON, GEORGE
SHINN, RUTH
SHORT, ELIZABETH
SHORT, PAMELA
SHRIBER, DONALD
SILVA, JOHN
i
1
SILVER, JONATHAN
SIMMONS, NICOLE
SIMON, MARSHA
SIMPSON, NANCY
SISKIND, FREDERIC
SLACKMAN I JOEL
SLOVER, GEORGE
SMITH, CURTIS
SMITH, ELMER
SMITH, MARY
SMITH, PHILLIP
: SOBEL, LAWRENCE
SOCHALSKI, JULIE
SOLOMON, LOEL
SOLOMON, DANIEL
SPAULDING,,VERNON
SPIELBERG, DEBORAH
SPRINGER, MICHAEL
HEALTH CARE WORKING CROUPS
SORTED BY STATUS
PACE:9
ORGANIZATION
SENATOR GEORGE MITCHELL
REPRESENTATIVE LOUISE SLAUGHTER
HHS-HRSA
REPRESENTATIVE MARTIN SABO
OMB
SENATOR DANIEL AKAKA
HHS-SAMHSA
HHS-HCFA
HHS-ASPE
REP. HENRY A. WAXMAN-HOUSE CMTE ENERGY/COMMERCE
HHS-IHS
REPRESENTATIVE RON WYDEN
REP. HENRY A. WAXMAN-HOUSE CMTE ENERGY/COMMERCE
DEPARTMENT OF LABOR
HHS-SPECIAL ASSISTANT
REPRESENTATIVE TED STRICKLAND
HHS-OFFICE OF MINORITY HEALTH
HOUSE EDUC. & LABOR CMTE-SELECT EDUC. & CIVIL
RIGHTS SUBCMTE
SENATOR PAUL WELLSTONE
REPRESENTATIVE BRUCE VENTO
REPRESENTATIVE CHARLES RANGEL
JOINT TAXATION COMMITTEE
HHS-HCFA
VETERANS AFFAIRS
LABOR
VETERANS AFFAIRS
HHS-AHCPR
HOUSE COMMITTEE ON ENERGY AND COMMERCE
DOD-UNIFORMED SERVICES UNIVERSITY OF THE HEALTH
SCIENCES
COMMERCE
HHS-HCFA
SEN. EDWARD KENNEDY-SEN. CMTE. ON LABOR & HUMAN
RESOURCES
HHS-NATIONAL CANCER INSTITUTE
LABOR
DOD
HOUSE JUDICIARY COMMITTEE
OPM
HHS-HCFA
VETERANS AFFAIRS
HHS-PHS-IHS
DOD
SENATOR BILL BRADLEY
SEN. EDWARD KENNEDY-SEN. CMTE ON LABOR AND HUMAN
RESOURCES
SENATOR HARRIS WOFFORD
DOD
REPRE$ENTATIVE JOHN LEWIS
TREASURY
�HEALTH CARE WORKING CROUPS
SORTED BY STATUS
INAME
,-
JFULL TIME GOV' T EMPLOYEE
,STACHELBERG, CYNTHIA
;STANTON, TAMERA
,STEELE, PAMELA
'STEFOS, THEODORE
:STEINAUER, DENNIS
,STEPHENS, SHARMAN
SUCHINSKY, RICHARD
:SULFRIDGE, HERSHELL
SULLIVAN, TIMOTHY
SVENONIUS, DIANE
:SWIRE, ANDREW
;SYKES, KATHERINE
;TAEUBER, CYNTHIA
:TAPLIN, CAROLINE
TARMEY, MARJORIE
, TAYLOR, AMY
;TESTONI, MAUREEN
!THORNTON, DANIEL
THORPE, KENNETH
: TIBBITS, PAUL
TILLMAN, JULIA
• TIMS, FRANK
I TINTARY,
RUTH
, TITUS, FRANK
' TOMLINSON,, LISA
, TRACHTENBERG, ALAN
: TRACY, JUNE
; TRUJILLO, THOMAS
' TURMAN, RICHARD
UKOCKIS, JAMES
, VAGLEY, KAREN
, VARMA, VIVEK
VARNHAGEN, MICHELE
VEAZEY, BRENDA
VISTNES, GREG
VISTNES, JESSICA
WALDO, DANIEL
WALKER, EDWIN
WALTERS, KAREN
WARD, TIMOTHY
WASSERMAN, MARK
WEICH, RONALD
WEISS, MARINA
WEISS, GAIL
WERNER, MICHAEL
WESTFALL, ELIZABETH
WESTMORELAND, TIMOTHY
1
I
I
I
I
WHANG, JUDY
WHITT, JOHN
WIGGINS, CLIFTON
WILLIAMS, CHRISTINE
PAGE:lO
ORGANIZATION
OMB
SENATOR JAY ROCKEFELLER
VETERANS AFFAIRS
VETERANS AFFAIRS
COMMERCE
HHS-ASPE
VETERANS AFFAIRS
HHS
IRS
LABOR
OMB
REPRESENTATIVE DAVID OBEY
COMMERCE
HHS-PHS
HHS-SPECIAL ASSISTANT
HHS
SENATOR MAX BAUCUS
HHS-OFFICE OF GENERAL COUNSEL
HHS
DOD
HHS-PHS-HRSA
HHS-NIH-NATIONAL INSTITUTE ON DRUG ABUSE
REPRESENTATIVE ESTEBAN E. TORRES
OPM
REPRESENTATIVE BARBARA-ROSE COLLINS
HHS
REPRESENTATIVE DENNIS DECONCINI
VETERANS ADMININISTRATION
OMB
TREASURY
HOUSE COMMITTEE ON EDUCATION & LABOR
REPRESENTATIVE MIKE SYNAR
SENATOR HOWARD METZENBAUM
HHS-ASPE
JUSTICE
HHS-AHCPR
HHS-HCFA
HHS
VETERANS AFFAIRS
DOD
OMB
SENATE LABOR AND HUMAN RESOURCES COMMITTEE
TREASURY
HOUSE COMMITTEE ON POST OFFICE & CIVIL SERVICE
SENATE DEMOCRATIC POLICY COMMITTEE
REPRESENTATIVE BILL RICHARDSON
REP. HENRY A. WAXMAN-HOUSE CMTE ENERGY/COMMERCE
HHS-POLICY ANALYST
REPRESENTATIVE ROBERT A. UNDERWOOD
HHS-IHS
SENATOR GEORGE MITCHELL
�i
..
HEALTH CARE WORKING GROUPS
SORTED BY STATUS
I
'NAME
ORGANIZATION
jFULL TIME GOV'T EMPLOYEE
!WILLIAMSON, JOHN
WILSON, DIXON
1
,WILSON, FRANK
WITTER, JONATHAN
,WOO, MICHAEL
: WOOD, SUSAN
'WOODWARD, ALBERT
:woOLEY, BARBARA.
!WREN, ROBERT
:WYLER, ROBERT
:YAMAMOTO, ALAN
YOSHIKAWA, THOMAS
' YOUKET PAUL
ZAFRA, VICTOR
: ZARABOZO, CARLOS
ZAWISTOWICH, LUDMILA
ZETTLER, SUSAN
I
I
PAGB:ll
VETERANS AFFAIRS
LABOR
LABOR
HHS-AHCPR
HOUSE ENERGY & COMMERCE COMMITTEE
CONGRESSIONAL CAUCUS FOR WOMEN'S ISSUES
HHS-PHS
HHS-SPECIAL ASSISTANT
HHS-HCFA
OMB
REPRESENTATIVE NEIL ABERCROMBIE
VETERANS AFFAIRS
WHITE HOUSE
OMB
HHS-HCFA
HHS-HCFA
REPRESENTATIVE TED STRICKLAND
�~~NT
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ror Imma41ate R•laaae
llai.'Ob 21, 111J
Attached is a list of the membara of the working
President's Task Forca on Health eare Reform.
-30-
g~oupa
tor tha
�HEAr.m CARE REFORM WORKING GROUPS
The attached list\ sets fotth the participants tn the health care reform working grouJ)s. There
m three categories, and only tuU time government employees and specialaovemment
employees are members of the workina groups. Congressional staff OA this Ust serve as
liaison for their Member or Congress to the workina IJ'OUp. ConNltants ate not members or
the working groups.
ne three categories of participants are:
1. Full-Time Government Employees··
Individuals who work for the Executive Office of the President, for fe4eral
qencics, Cor Members of Congress or Senate and House committees. Federal employees are
subject to the conflict of interest provisions in 18 U.S.C. Section 102-209 and Standards of
Ethical Conduct for Employees of the Executive Branch ana all related ethica laws and
regulations.
2. Special Goverument Employees-·
a. Individuals who are employed by any asenoy or the Executive Oftlee of the
President for less than 130 days in a 365 da.y period either with ur without compensation.
Such individuals are aubject t.o a limhed versiOn of the conflict of interest provisions in 18
U.S.C. Section 202·2~ and Standards of Ethical Conduct for Employee~ of the Executive
Branch and all related ethics laws and regulations for the period of time they serve on the
working group. Furthermore, they are required to abide by Umitad.ona on public: speaklna
and by post-employment restrictions. Such individuals may serve as workinaaroup leaders •
...
b. Consultants-Individuals who· are consulted by the working aroup and who attend
working group meetin1s on an intermittent buis with or without oompensation. These
consultants are subject to some provisions of 18 U.S.C. Section 201-208 and Standards of
Ethical Conduct for Employees of the Executive Branch and all related ethics laws and
n:¥ulations. Such individuals have no decision-making authority within the w.grldnggroups
and may not serve as worldnaaroup leaders and have other limitations on their participation.
�..
''
BIIL!H CARl WORKING CROUPS
IOR~ED BY ST&IUS
ORGANIZA'l'lON
~
FULL
PaGI:l
fl~ ~V'T
IMPLOYIB
ADDISON-BU4TON, LAVARNE
ADI!IR, MICHELS
ALBBRGHINI, THERESA
ALLIN. LUO'
ALP2RT, OYN"!'H.IA
ALTMAN, DAV%D
ALTMIRI, .:JASON
ANTOS, JOSBPH
AOILUA, SOLOMONA
ARNI'l''l', ROSS
ARONS, SBRNIJt
ASH, SHIRR%
ATKINSON, LESwiB
AtJ1tllitMAN, Gt.BN
AUSTIUN, CHBRYL
8Altit, SARAH
BALI., JUDY
BAN'l'HIN, JISSICA
BAQUIT, CLAUDIA
BARBOUR, GALEN
BARSTOW, SCOTT
BAUM, NANCY
BAYN_I, CHRIS'l'Y
BIASON, CHARLOTTE
BDN2R,
JoHN
BERRY, ROCJIR
BIVBRLV, JONATHAN
BIIRUM, DBNISB
BIERWIRTH, MARGARET
BILLY, CAM%E
BLAUWIT, ROGIR
BLOCK, AB::tGAlt.
BLOOM, FILlCIA
BLOSS, GUGCRY
BODii, HOLLY
BOIKM, JBNNIFBR
BCftZI, PHYLLIS
BOW, WILLIAM
BRIGGS, BIT'l'l
CHRMN.M. SABO HOUSE BUDGET COMMITTEE
HHG, ASPE
SENATOR LEAHY
COUNCIL ON ICONCMIC ADVISORS
VB'l'DANS ATFAXRS
SIN. ROCUf'ELLIR
RIP. PITE PITIRSON
KH5
COMMERCE
HHS, HCPA
HHS NIMH
HHS
RIP,. LOUIS STOkES
HHS .. HRSA ·
HHS
CONGRESSIONAL - SBNAfa/SBN. RIEGBL
RHS
HHS
HHS•PHS
VETERANS AFFAIRS
RBP. MIV.E KOPITSKI
HHS - HCFA
HHS
VBTIMANS AFFAIRS
COUNC::tL ON ICONOMIC ADVISORS
RBP. HARRY JOHNS~ON
LABOI(
SBNATI COMMITTIE
RIP. SAM GIJDINSIN
SBNATOR BINGHAM
RBP. PITIR HOAGLAND
OPM
UP, LOUISE SLAUtniTD
HHS
SINATI AGING COMMlTTBB
RIP. JILL LONC
HOUSE EDUCATION/tABOR COMMITTE!
HOUSE VITIRANS AFFAIRS COMMlTTIE
LABOR
BROCK, CHARLBS
BRODBECK,. LAURA
DOD
BROSTROM, MOtLY
BRUNS, KEVIN
HHS
lUCK, JBFP'RBY
BUCICINOHAM, II.!, WARREN
BUFPING'l'ON, MAX
IUONORA, DAVID
BURNER, SALLY
BURNK'l''l', LA%RD
BURNEY, IRA
BU'l'O, ICATHLBBN
HCFA
HRI
UP • DAVB MCCURDY
RIP .. :lULL GM.Y
HHS • KCFA
RIP. BARBARA KENNELLY
KHS
SINATOR BREAUX
KKS, HCFA
HKS, HCFA
,
�HBILTH CIRI WORKINC GROUPS
IOR'IID BY I'IA'l'UI
-
HAM!i
FULL TlMB GOV'T EMPLQYEE
dltiE, DAVID
CALLAHAN, CATHI
CAMPBILL, LAURENCE
CAMPBELL. PAUL
CAPLAN, ARTHUR
CARLSON, RONALD
CAVANAUGH, SIAN
CHAMBERS, CAROLINE
CHANG, DEBORAH
CHARLES, QbALD
CLARJ(, W% L:t.l.AM
CLARK, ROBERT
CLAUSER, S'l'IVSN
CLAY, JIMM%B
Ct.AYPCOL, ROBERT
CLBMINTI, FRANK
COHEN, JOISL
HHS
oe
I:!OMMBRCI
CBNSUS - COMMIRCB
UNtYIRSI'l'Y OF NIW MEXICO
HHS
RIP, BBN CARDlN
RIP. JIM COOPIR
SENATOR DONA~ W. RIEGLE
VITIRANS AFFAIRS
SIMATCR DALE BUMPERS
HHS, ASPI
lUIS, HCFA
VITBRANS AFFAIRS
U.S. ARMY SURGEON OINIRAL
CHR. JOHN CONYERS
COIIBN, RIMA
HHS
SINATOR TOM DASCHLB
COHBN, ALLAN
COOP&R, Ml:CHABL
'l'RIASURY
INTAKE CENTER
COOPER, PHIL
HHS
COOPIR, DAVID
COOPIR, BARBARA
HRS
IlKS,
COPILAND, ROBERT
COS'l'BR, 30HN
COX, KINNITH
CRUMP, JANICE
CUTLER, DAVID
DANIILS,
SUSAN
DAVBNPORT, kARIN
DAVXKS, MONICA
DEIGNAN, KATH~!IN
HC:I'A
LABOR
SBLICT COMM.ON AGING
I)()I)
RIP. CI.IAYTON
CIA
HHI, ACF, ADD
SIN. BOB KBRRIY
SIMATOR JBFF BINGAMAN
SINATI BUDGET COMMITTEE
DBLIW, NANCY
DIMLO, LlNDA
DINHAM, I.aORl
niiWANB, MARY
HHS
DIKKSLACKBR, I. WILLIA
TRIASURY
SENATOR ROCKEFELLER
OMB
DONI!iSKI, IL.t.BN
DOROTINSKY, WlLLIAM
D0'1'Y, PAMBLA
DOYLE, PATRICIA
DRUMMOND, FAYE
DUOOAN, 3AMBS
DUNN, VAN
DUZOR, DIIRDRB
ECICIR'l', XIV IN
IDCBLL, JONATHAN
lOAN, JJ\MIS
IINHORN. THBODORR
IMMIR, SUSAN
INGLISH, MtCHABL
HHB, AHCPR
RIP. DOOLEY
HCPA
HMS .. ASP!
HHS, AHCPR
I'INANCS COMHITTSB
SBNA~B
~RU.SURY
SINA'l'OR ICKNNEDY
MRS, Hei'A
SIN. HARRIS WOPPORD
COMMIRCI
PIDBRAL TRADE COMM%SSION
RIP. PITBR DEUTSCH
SBN. BOB GRM»t
HHS
.
PAG8:2
�1 I.............. I...... 0
..
,..
• • ""T ....... TT"
••
,..._
r
r
r
- ,..._r11•1
'
IIDL'l'H CIRI WORKING GROUPS
SOR!ID BY ITATUA
NAME
- 'l'IMB GOV' T IMPIQYBE
FULL
BRMANN, DAN
PAG8;3
ORQ»>lZATION
HHS,. HCF.A
IULIR, JOHN
JU8TlCI
EVANS, DAVID
BVANS, JINNIJI'BR
EYDT ~ ALLISON
FALIT'l'I, THOMAS
HH8
FARLEY, DIAN
PID2R, JUDY
HK8
HHS
KHS
I.AIOR
SBN, MAX BAUCUS
OMS
FI!DBLHOLTZ, JBNNIFBR
FINAN, STBVIN
J'%N%GAN, 'l'HOMAS
li'%SH, JAMBS
F%8KI, MARY BETH
Ft'l'ZMAURXCB, J. MICHAEL
FLYNN, WXLLIAM
FORBSS, IUPLBY
FRANTZ, MOLLY
FMSCKB, MARY
P'RIDIRICK, PAUL
FRBILAND, MA1UC
BIN, BBN CAMPBILL
OHB
RIP, DICk DURBIN
SENATOR KBNNIDY
HHS - AHCPR
OFFICE OF PIRSONNIL MANA.CEMIN'l'
RBP, HIHRY A. WAXMAN
RIP. RARL POMIROY
RIP. OLlCICMAN
OPVlCI OF ASSIST. SECRBTAftY OF OEFKNSB
HHS
FRIBDMAN I IIRNARD
KRS, AHCPR
HHS
HHS, HCFA
GAUDITTI, SYLVIA
RIP. .70HN Or..VIR
GILLINGHAM, ROBIRT
GLAZE, S'l'IVIN
HHS
TftiASUR't
SINA'l'OR PRYOR
I'UY, GIORGI
GAGIL, BARBARA
GALl, JOSIPH
CANANDI, ATUL
GtBIMAN, IDWARD
GLlBC, SHBRRY
COLD, MAR'l'HI
CCLDSTONS, DONALJ)
OOLDWATBR, DAVID
OOODMAN, NAMC:Y
CJOODWtK, MARSHA
GOODY, BRlOlD
GOPLIRUD, BRIC
GRAMS, TODD
GRBBNBIRG, OIORCJB
CJUBNWALD, LBSL%1
QROSS, MARCY
OROSI, LAURIN
GRUNDMAN I MARTHA
GUST, STIVBH
HADLBY. ILJ:IABBTH
HADLIY, JAMBS
HAMON I MBLINDA
HAI.L. ANNE
SBNA'l'OR MOYN%KAN
SBNATB OOVIRNMBNT AFFAXRS COMMXTTBB
CIA
.
HilS, PHS, ODPHP
HHS, AHCPR
RIP. JIM BII.BRAY
JU8'1'1CB
VBTBRANS AFFAIRS
HHS
HHS, SAMHSA
OMB
RHS, AIPB
HHS, HCFA
HHS/OASH
SBN. CU.lBOMB PILI.
UP. MMT:tM &ABO • CHAIRMAN
RIP. STRICKLAND
HHS, AIPB
HBS
SBNATB ANTITRUST CCMMITTBB
HHS
HAMIRSCHLAG. AR'l'
HARAHAN, MARY
.VA
HHS, ASPB
HARDOCX, RANDY
'mBASURY
..
�... _,.....,.,n"
•.
.·
HEALTH CARl WORICXHO CROUPS
SORTED BY StATUS
-
ORGANIZATION
RXRPBR, NARY
HARVBLL, JINNIPER
HHS, NIMH
OVP
HHS, HCFA, OLP
HASTINGS, KATHLIEN
RIP. WAXMAN
HHS, PHS, .AHCPR
HAYBS, SHERRY
HAYES, OHARLO'l''l'l
PAGI:4
OVP
NAMB
FULL TIME GOy' T EMPLOYER
HARRIS , SKit.A
HASH, MICHAEL
MBADLSY, Ji:LWOOD
HEATH, KARIN
HIENAN, CHRISTINB
HBLtiNGIR, FRID
HD'l'Z, THOMAS
HlCICMAN I PITU
HlGOXNI, MlCHAJU,
HICJH'l', 30SIPH
HILL, TIMOTHY
HINZ, ftlCHARD
HOGUE, BONNIE
HOLTON, DWIGHT
HOLTZBLATT, JANET
HORVATH~
'l'HOMAS
HORVATH, JANI
HUCKABY, MICHILLE
HUNAN, JIFFREY
HUN'I'IR 1 CILtlAN
S!iN, KBRB KOHL
VETERANS AFFAIRS
HOU51 ARMED SERVICES C·OMMI'l'TE
HHS
HHS
HHS, ASPI
HHS, HCFA
CHR. RONALD DELLUMS/ARMED SERVICES
LABOR
HKS, HCPA
LABOR
SBN. AGING CM'l'E.
WHITS HOUSE
TREASURY
VITIRANS AFFAIRS
SENATB FINANCI COMMIT~EB
RIP. 808 CLIMBNT
SBNA!I
COMMlT~EB
ON AGING
'l'RBAIURY
IBIIN, RALPH
IRWIN, JIAN
VB'l'BMANS
ISKOWITZ, MICHAEL
SEN. KBNNBDY
IWRY, J. MARIC
J'AelCSON, PAUL
JACOBS I 'l'SRRY
JACOBSON, LAURINCI
JMBOI, XBNAN
31NCKS, STIPHIN
JBNNINGS, CHRISTOPHE
JODRBY, OAMIL
JOHNSON, K. BCHEI.II
JOHNSON, IRIK
JOHNSON, PATRICIA
JOHNSON, DONALD
JOHNSON, JAMBS
JONIS, MIERCIA
JONIS, SANDRA
JOSIPH-FOX
I
JUNG, PAUL
YVBTTE
KANE, BRAD
ICASS, DAVID
ICA'l''l'AN, AZAR
KATZ, RUTH
ICA'l'Z, RUTH
KATZ•LIAVY, 3UD1TH
ftiP,MARlA CANTWELL
'l'RIASURY
HHS, PHS
TREASURY
OMI
SBNTOR RIEGLE
HHS, HCPA
HHS
SINATOR WOFFOilD
REP. JOHN BRYANT
OMB
COMMERCE, CENSUS
HKS, KCFA
RBP. L.P.
PAYNB
SBN.BREAUX
VITiRANS AFFAIRS
asN, DANIBL K. INOUYE
NIH, DHP
CONGRI88IONAL • HOUSE
COMMIRCB
RBP, ROBiftT MATSUI
RIP. WAXMAN
HHS, A&PE
HKS, CIN'l'ER FOR MENTAL HEALTH SERVICES
I
�HZIL!H CUI WORKIKC GROUPS
PACB:5
SOR'l'ID BY l'.l'A'IVI
NAME
- TIME GOV'
FULl!
KAVANAGH, GARY
KAZDIN, ROBBRT
ORQANIZJ\TI~
'I' EMPLOYEE
ICIINE I BRAD
HCll'l'
TREASURY
REP. COLtlNS/BNSRGY & COMMIRCE SUSCMTE.
lCIMPIR, PITBR
KINDALL, DAVID
HHS, AHCPR
KINYON. MARY
FIDBML TRADI! COMMI&810N.
ICIPNBR, COLLJ!!IN
RIP. H%CHABL ANDREWS
UP. CHMLBS S'l'INHOLM
RIP. BARBARA KINNBLt.Y
KIRY11 PATRtOIA
ICICHAK, NANCY
OPM
KING, A.NDRD
RIP. GBPHARD'l' • HOUSE MAJORITY LEADER
KING, ROUND
KtNG, KATHLBBN
XOLODNIR, ROBERT
HKS, HCl'A
SINATI FINANCE COMMITTEE
VITIRANS AFrAXRS
HHS, CDC • ATLANTA
KOPLAN, "BJ'FRIY
KOIS, SHANNNI
KRAKAUBR, HBNRY
OMB
KRESS, JACK
HHS
ICUZMACX, RICHARD
HHS, PHPA
OMB
LANGBNBRUNNBR, JACk
LAVIZZO•MOURIY, RISA
OMB
LEATHERS, HOWARD
LI~ITZ, BONNII
LIBMAN, LAURINCI
TRIASURY
CIA
HHS, PHS
VITERANS AFFAIRS
VETERANS AFPAIRS
LAWSON, KURT
LIIIMANN, LAURIN'l'
LBMASURIER .. JEAN
L!VINB. GREGORY
LBYY. HILBN
LBWIS·InRMA, DEBORAH
LILL!!, STIVRN
LINCOLN, M%CHASL
HHS~
AHCPR
HHS, HCFA
RBP. ROSA DBLAURO
HHS, AHCPft
HHS
IX)D
HHS,IHS
LINDABW, GBRALD
LMOR
Ll:NK, KINNBTH
t.lPNh, ROBYN
VBTIRANS AFFAIRS
LXU, BRIO
SIN. DAVID BORIN
HOUII EDUCATION AND LABOR
LOPATIN, A~
t.UDI'l'Z, JAMES
LUCAS, DBIORAM
LURll, ALIXANOER
LUTTBIG, CAROLINB
LUTTSR, RANDALL
LYON, ANDRBW
LYON, RANDOLPH
MAGAZINIR, IRA
MAGUIRI, DAHilL
SINATOR MIKULSKI
HCFA
COUNCIL ON BCONOMie ADVISORS
SBNA'l'OR
RIP. RON COLEMAN
OMB
CKA
OMB
.
WHITE HOUII
LABOR
MANDBRSCHIID, RONALD
VBTERANS AFFAIRS
HHS
MARCONI, KA'l'HY
HH8
MALONBY, DANIBL
MAN'l'IL, LIWIS
MARGHBRIO, LYNN
MAR'l'INIZ, FELIX
VE'l'R!UN$ AFFAIRS
WHl'l'l HOUSE
RIP. JlM BILBRAY
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ORGANIZATION'
~
fULL TIME
GOV'~
EMPLOYEE
MATHER, SUSAN
MceLINNEY-BLL%0,
MCCONNELL, BRUCE
LUORET~A
. MCKEE, TIMOTHY
MCKENNEY, NAHPBO
MEADOW, CYNTHIA
MEANS, ICATHLBBN
MELNICK, DAN%2:11
MIRQHEAY, JANET
MILt.BR, NANCY
MU.,LBR, HE:t.ANIB
MlitLER, MlCHAII.
VSTBRANS AFFAIRS
DOP
OMB
DOD
COMMERCE
RIP. JACK BROOKS
HHS
HHS
KIP. SLAUGHTER
HHS
RIP. MIKE ANDREWS
RIP. SANDER LEVIN
MILLER, BDWARD
MILLMAN, MICHAEL
MlN, NANCY-ANN
OASD
MINK, DOUGLAS
RIP. JOHNSON
MCILLBR, JONATHAN
MOLLOY, JANE
MONHBIT I ALAN
MORGAN, JACQUELINE
MULLAN, FITZHUGH
MUNNELL, ALICIA
MURPHY. SHEI LtA
NAIWIATA, PITBR
NARROW. DAVID
NILSON, CHUCK
NILSON, KAREN
NBUMAN, TRICIA
NIXON, OAVID
NICHOLS, I.IN
NICHOLS, LINDA
HHS
OMS
KHS
COMMERCE
HHS, AHCPR
DOD
HHS.
TREASURY
IENA'fOR I<BRREY
OMB
PBDIRAL TRADB COMMISSION
USBC
RBP. WAXMAN
HOUSE WAYS AND MEANS
SIKATQR K.IMNEDY
OMI
NIX, SHEILA
VITIRANS AFFAIRS
SBNATOR KIRREY
NORQUIST, GRA'rSON
VITIRANS AFFAIRS
HHS
NOBLB, .:JONATHAN
NORMAN, ALt.%NB
HIAAA
O'NBZLL, KlM
O'NEILL, PATRlCIA
OBBY, CftAIG
CIA
VBTIRANS AFFAIRS
OFFN!R, PAUL
SBNATE FINANCE
OLlVBR, JUDITH
OSHIR, FRBDIRICK
PANG, FRIDil\ICK
PMADtSB, JULIA
PATEL, PARASHAR
PAYNI, MARY BLLA
PIDGEON, STEVIN
Pt.AUT, THOMAS
POL.Ll'l'Z, KARBN
PORTMAN I ROBIR'l'
POSEY, KBNCAI..L
PO'l'ITZ, LISA
SENATOR CONRAD
HHS
HHS
SENATE ARMED S!RVICIS
HHS
OMB
SENATOR ROCKBF&LL2R
tiHS
HMS
HMS
LABOR
CIA
SENATE FINANCB COMMITTEE
PAGIU6
�.. .·
HEALTH CARl WORKING GROUPS
SORTED IY STATUS
ORGANIZATION
~
FULL TIME GOV 1 T EMPLOYEE
PRAT'l', DONALD
PRICE, ANDQA
VA
RBP. LEWIS PAYNE
PUSJCIN, DINA
HHS
kADAC:K I LAURA
RAJ'USE, ROIBRT
JUSTICE
TREASURY
VITERANS AFFAIRS
HKS
RAYHOND, YIC'l'OR
REEYBS,
LINDA
RBGISR, DARREL
REINBCKB, Pl'l'ER
RBYBEI, LUANA
RIC!, CHIRI
RICX!L, ANNE'l''l'l!i
RlCKl!iTSON, DBNISE
RIVO, MARC
RODGERS,
JUDI'l'H
RODRIQUEZ, LCUISB
ROSIN, ROBERT
ROSENMAN, PAT
ROSWBLL, ROBIR'l'
ROU&B, BIA'l'RICB
ROVIN, LISA
ROZIN, ROBBR'l'
RYAN, BLAINE
SALMON, MARLA
SAMUELSON, ILLIN
SCHECDL, LISA
SCHIE!IR, GIOJtCE
SCHMID, S'l'UART
SCHNEIDER, ANDRIW
SCHPININQ, ATHINA
SCHU'LQ, DAVID
HKS
SS:NATOR HARKIN
HHS, IHS
OM!
SENATOR RIEGLE
KHS
HHS/HRSA
HHS
VA
SEN. GEORGE MITC:HBLL
HHS
VETERANS AFFAIRS
HHS
HHS
SENATOR MITCHELL
REP. L. SLAUGHTER
HHS/HIRSA
REP. MAR~IN SADO - CHAIRMAN
MKS
HHG, HCFA
HHS
RBP. WAXMAN
HHS, IHS
R!P. WIDMAN
SCHULTZ, WILL%AM
SCHUSTER, JAMBS
RBP. WAXMAN
SHAFPB~,
BLLIN
SH!lNBR, t.OUISB
SBN. WELLSTON!
SKilNGOt.D, ITIVB
SKILDON, GBOKGB
SHINN, RUTH
HCFA
SHORT, 8LIZABITH
SHRIBER, DONALD
SILVA, JOHN
SILYIR, JONATHAN
SIMMONS, NICOLE
SIMON, MARSHA
RBP. 5TfttCltLA.ND
JOINT TAX COMMITTEE
VBTBRANS
LABOR
AFFAIRS
VA
RBP.
USUHS
COMMERCE
HCFA
SMITH, ILMIR
SLACICMAN, JOEL
SIN. TED KENNEDY
LABOR
DOD
HHS
SMI'l'H I CURT%S
OPM
SISKIND, FRIEJ
SMITH, MARY BETH
SOBEL, LAWRBNC:!
•. SOCHALSKI, JULIE
VETERANS AFFAIRS
DEFENSE .
SENATOR BRADLEY
PAOI:7
�HIAL~H
CARE WORKIMO CROUPS
SOR'flb BY STATUS
PAGE:&
ORCANIZA'fiON
~LL
TIME
GOV'~
EMPLOYEE
LOMON, LOlL
SBN. KSNNBDY
SPAULDING, VERNON
DOl)
SPBRANDBO REEVE, LINDA JO
SPRINGBR, MICHAEL
HHS/PHS/ACHPft
STANTON, TAMiRA
SBN. JAY ROCKEFEL~ER
VETERANS AFFAlRS
S'l'IEL!, PAMELA
STEINAUER, DINNIS
STIPHENS, SHARMAN
SUCHINSRY, RICHARD
SVISNONIUS, DIANB
SWIRE, ANDRBW
SYKBS, KATHERINE
TAPLIN, CAROLINE
TARMBY, MA~JORIE
TAUEBER, CYNTHIA
TAYLOR, AMY
TERRY, DONALD
Tlii8TONI, MAUREEN
THORP!, KBN
TIBBITS, PAUL
'riMS, FRANK
ll'ORRBS-QIL, FERNANDO
TOWNSBND, JESSICA'
r.RACHTBNBBRG. ALAN
'I'RAPNILt, GORDON
UkOCKIS, JAMBS
VARMA, VIVEK
VARNHAOEN. MICHELE
VDZIY, BRENDA
VE'l'TLD,
SUSAN
VIITNIS, QRBO
VISTRIBS, JBSSICA
'l'R;-ASURY
COMM~RCE
HH&
VBT8RANS AFFAIRS
l.ABOR
OMB
RIP.OBEY
HHS
HHS
COHM!RC!
HHS
CHR. J. LAFALCB/CMTE. ON SMALL BUSINESS
SENATOR
HHS
DEFENSE
HHS
HHS
HHS
HHS
KOUSI WAYS AND MEANS
TREASURY
RIP.
SENATOR MITZZNBAUM
HHS
REP. STRICKLANtJ
JUSTICE
HKS
WAJ:.DO, DANIBL
HHS
WAL'l'BRS, KARBN
VETERANS AFFAIRS
HHS
WARD, TIM
WASSERMAN, MAM
WBICJI, ftONALD
WBISS, MARlNA
WIISS, GAIL
WERNER, MICHAEL
WESTMORELAND, TIM
WI~~lAMB, CHRISTINE
Wl~~lAMSON, JONATHAN
WI Lta, DARRYL
Wll.IBON, FRANK
WILSON, MAFtiC
WITTIER, JONATHAN
WOO, MICHAEL
WOOl), SUSAN
WOODWARD, ALAN
WYLER, ROBERT
OMB
SBNATI HEALTH AND HUMAN RESOURCES
TREASURY
HOUSE 'l'RBASURY/POSTAt CM~E.
SINA'l'B DEMOCRATIC POLICY COMMITTEE
RIP. HENRY WAXMAN
SINA'l'OR MITCHELL
VETERANS AFFAIRS
CBA
LABOR
LASOR
HHS
HOUSE ENERGY & COMMERCE
CONGRESSIONAL CAUCUS-WOMEN'S ISSUES
HHS
OMB
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SOR~BD
S~ATUI
ORGANIZA'l'lON
NAME:
FULL tiME
It
~ !MPLOY~E
YAMAMOTO. A
YOSHIKAWA, THOMAS
ZARABOZO, CARLOS
ZITTLIR, SUSAN
RIP. Nllt
AB~RCROMBIE
VITIRANS AFFAIRS
HHS HCPA
RBP. T. STRICKLAND
PAGI:9
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'
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HEALTH eARE WORKING GROUPS
SORTED BY
S~ATUS
PAGI:l
ORGANIZATION
SPECIAL GOV'T EMPLOYEE
ADAMSICE, STEVEN
ASCHB, ADIUINNR
BAJCS:R LAURENCE
BERENSON, ROBIR'l'
BIRO'l'HOUI, LINDA
BROCIC, DAN
BROWN, £. RICHARD
CLAXTON, GARY
CROW, SHBLLBY
CURTIS, RlCHA!tD
I
DANIELS,
NOJitMAN
DAUMt'l', GAIL
DENTON, DBNIS!
DUBLER, NANCY
EDDY, DAVID
BDDY, JUt»ITH
EDBLSTBIN, STBVIN
EPS'l'IIN, ARNOLD
FAHEY, CHARLES
FRANK, RICHARD
CJATZ, CAROLYN
GEHAN, MARGERY
GIBSON, JOAN
CJLBASON, STIPHEN
GOLDMAN, SYII L
IN-TAKE
BOSTON UNIVERSITY
KHS
HHS
HHS
BROWN UNIVBRSITY
HHS
HHS
HHS
HHS
TUFTS UNIVERSITY
POLICY ASSISTANT
HHS
EINSTEIN UNIVERSITY
HHS
HHS
HHS
HHS
FORDHAM UNIVERSITY
HKS N!MH
OOSTIN, LAWRENCI
GRAFF, TOBY
COMMERCE
POLICY ASSISTANT·
UNIVIRSITY OF NBW MBX1CO
MBRCY MEDICAL C~INIC
HHS
HHS, NIMH, PHS
AHBR. SOCIETY OF LAW, MEDICINE & iTHICS
INTAKB CBNTBft
MANDY, CAROLYN
HHS
HARRY, PATIU:CIA
HARVEY, PATR%C%A
HHS, AHCPR
QOLDMAN, HOWARD
INTAKE CINT!iR
Hl:X, W:tLLIAM
DOD/RAND
HOFFMAN, ALJ.N
HHS
JORtlNG, JAMES
KBLLBY, LAUREN
KLEIN, JBNNIFIR
KftONlCK, RICKARD
HHS
POLICY ASSISTANT
POLICY ASSISTANT
HKS
ICRU!GIR, AI.aAN
HHS
LAHTOS, JOHN
LASKER, ROZ
UNIVERSITY OF CHICAGO
LAWLER, GREGORY
POLICY ASSISTANT
POLICY ASSISTANT
ORPHAN PROJECT/NEW YORK CITY
HHS
HHS
LEVINE, ORBORAH
LIVINI, CAROL
LBVITT, LAWRINCE
LITVAK, SIMI
t.O,· BERNARD
WKOMNlK, JOANNE
MANOWITZ, MICHELE
MEZEY, MATHY
MILES, S'I'IVI
MILLER, CAROL
HHS
UNIVERSITY
0~
CALIFORNIA
HHS, BPHC, HRA"
POLICY ASSISTANT
NEW YORK UNtVBRSITY
HENNIMSN COUNTY I
KHS
MN
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SOR!ID BY S~ATUS
ORGANIZATION
~
SPECIAL GOV' T EMPLOYE! .
ktii'l'HA,
DONALD
O'CONNELL, LAURBNCB
OSSOIUO, PILAR
O'l'JU:N, SUSAN
PlClt.tO, THBRESA
PlRIS, SHBII.A
QUAM, LOIS
RICHARDSON, SALLY
ROSS, MARJORIE
RUBSCH!MBYSR, SIMONE
SAGS, WILLIAM
SCKUNIMAN,
MA~Y
INTAKE CENTISft
THB PARK RIDGZ CBNTER - CHICAGO
YALE UNIVERSITY
POLICY ASSISTANT
POLICY ASSISTANT
HilS CMHS
MHS
HHS
POLICY ASSISTANT
COMMERCB
WHITS ROUSE
HHS
&ICUNDY, MARIAN
&HBBBS CROW, &HILLY
SHIRLEY, AARON
HOWARD UNIVERSITY
SMI 'l'H, MARK
HHS
SOFAIR,. SHOSHANA
STAIR, PAUL
STCLINI, ANNE
STONE, ROBYN
STROUL. ELIZABETH
HKS
HHS
HHS
HHS
POLICY ASSISTANT
HHS
HHS CMHS
SUMAYA.. CIRO
HHI
VILOZ, RICHARD
HHS
VALDEZ, ROIIRT
WAt'l'IRS, lPARRAH
WELCH, WILLIAM PIE
WELLFORD, SUSANNAH
WHANO, JUDY
WilNER, JOSH
WOOLLEY, BMBARA
Zlt.MAN, WALTER
KHS
HHB
OHB
POLICY ASSlSTANT
HHS
HH8
HHS
HH8
P&GI&Z·
�·".
RIALTH CARl WORKlNG GROUPS
IORTig IY ITATUS
NAME
-
ORGANIZATION
A!iCiN, LINDA
BINBCICT, RCBIRT
HHS
C::ONSULTANT
PA COUN~Y COMMISSIONER
NGA
HHS
BROWN, MARY
CHAPMAN, THOMAS
FRIBDHOLM, DIANNE
HILLMAN I ALAN
NQA
HHS
I.OHR, KA'l'HIRINB
MCNAMBI I NIKKI
HMS
NQA
O'BRIEN, MARY JO
NCA
PYLE I THOMAS
HARVARD COMMUN:ETY HBAt.TH PLAN
RADIR. ANYA
NQA
SATCHER. DAVtD
HHS
HHS
SCHADBL, JAN!
SCHBPPACH, RAY
SMITH, BARBARA
VOLPE, CARL
Witt. I At.AN
-
NGA
NGA
NOA
NGA
PAGE:l
�•
•
The following is a key to the acronyms used in the list;
ASI'E, Office or the AsslsWtt Secretary of Planning and Evaluation. HHS
HRSA, Health Resources and Services Administration, HHS
PHS, Publlc Health Service, HRS .
AHCPR, Agency for Health Care PoUc;y and
lte,!~euch,
HHS
ODPHP, Office of Disease Prevention and Health Promotion, HHS
SAMHSA, Substance Abuse and Mental Health Services Adm;r.l.stra.tion, HHS
OASH, Office of the Assistant Secretary for Health, HHS
CDC. Centers for DiMase Control, HHS
OPM, Office of PersOMel Manaaemcnt
OVP, Offtcc of the Vicr;.PRsident
CEA, CuuncU of Economic Advisers
ARC, Appalachian Regional Commission
USBC, United States Bureau of the Census
NIAAA, National Inatitutc on Alcohol Abuse and Alcoholism
�contact: Dee Dee Myers
(202) 456-2100
Lisa Caputo
(202) 456-6266
POR IMMEDIATE RELEASE
Monday, January 25, 1993
PRESIDENT CLINTON PORMS HEALTH CARE TASKFORCE
WASHINGTON, D.c. -- In effort to develop a plan for high quality,
affordable health care for all Americans, the President today
announced the formation of a taskforce to develop legislation for
comprehensive health care reform.
"It's time to
time to bring
secure in the
will not mean
bring quality
paperwork and
privilege."
make America's health care system make sense. It's
costs under control -- so that every family can be
thought that a medical emergency or a long illness
bankruptcy," the President said. "And it•s time to
coverage to every American -- to cut back on the
the excuses and make health care a right, not a
The President's taskforce, which is expected to report a plan by
the end of May, will be chaired by First Lady Hillary Rodham
Clinton. The health care taskforce will include Secretary of the
Treasury Lloyd Bentsen, Secretary of Defense Les Aspin, Secretary
of Commerce Ron Brown, Secretary of Labor Robert Reich, Secretary
of Health and Human Services Donna Shalala, Secretary of v~terans
Affairs Jesse Brown, Office of Management and Budget Direc~or
Leon Panetta, Assistant to the President for Domestic Policy
Carol Rasco, Assistant to the President for Economic Policy
Robert Rubin, council of Economic Advisors Chair Laura Tyson and
Senior Advisor to the President for.Policy Development Ira
Magaziner.
Magaziner will lead an interdepartmental working group which will
coordinate policy development for the taskforce. Health care
transition director Judith Feder will assist Magaziner and other
senior transition officials will be members of the working group.
The taskforce will work cooperatively with members of Congress as
well as with state, city and county officials in developing its
proposals. It will conduct an outreach program to seek verbal
input and formal written submissions from interested citizens and
groups across the country.
The process will seek advice from people like the many the
President met during the campaign, for whom rising health care
costs and lack of adequate health care coverage are causing
severe hardship.
-- more --
�The President said the legislation will be based on the following
principles:
o
To slow the growth of national health care spending.
o
To provide universal access to high quality care for
all Americans.
o
To ensure consumer choice.
o
To maintain a private, competitive health care system.
o
To cut the health care bureaucracy.
While her husband was Governor of Arkansas, Mrs. Clinton chaired
the Arkansas Education Standards Committee, which in 1984 created
public school accreditation standards that have since become a
model for national reform. In 1984-1985, Mrs. Clinton served as
her husband's designee on the Southern Regional Taskforce on
Infant Mortality. She served as the chair of the Arkansas Rural
Health Committee in 1979-1980, and has served on the board of the
Arkansas Children's Hospital, where she helped establish the
state's first ne~-natal unit. In addition, Mrs. Clinton
introduced a pioneering program that trained parents to work with
their children in pre-school preparedness and literacy through
Arkansas• Home Instruction Program (HIPPY).
Those interested in submitting ideas should write to:
President's Health Care Taskforce
The White House
Washington, o.c. 20500
###
�...
Contact: Dee Dee Myers
(202) 456-2100
Lisa caputo
(202) 456-6266
FOR IMMEDIATE RBLEASB
Monday, January 25, 1993
PRESIDENT CLINTON FORMS HEALTH CARE TASKFORCE
WASHINGTON, D.C. -- In effort to develop a plan for high quality,
affordable health care for all Americans, the President today
announced the formation of a taskforce to develop legislation for
comprehensive health care reform.
"It's time to
time to bring
secure in the
will not mean
bring quality
paperwork and
privilege."
make America's health care system make sense. It's
costs under control -- so that every family can be
thought that a medical emergency or a long illness
bankruptcy," the President said. "And it's time to
coverage to every American -- to cut back on the
the excuses and make health care a right, not a
The President's taskforce, which is expected to report a plan by
the end of May, will be chaired by First Lady Hillary Rodham
Clinton. The health care taskforce will include Secretary of the
Treasury Lloyd Bentsen, Secretary of Defense Les Aspin, Secretary
of Commerce Ron Brown, Secretary of Labor Robert Reich, Secretary
of Health and Human Services Donna Shalala, Secretary of v~terans
Affairs Jesse Brown, Office of Management and Budget Direc~or
Leon Panetta, Assistant to the President for Domestic Policy
Carol Rasco, Assistant to the President for Economic Policy
Robert Rubin, Council of Economic Advisors Chair Laura Tyson and
Senior Advisor to the President for.Policy Development Ira
Magaziner.
Magaziner will lead an interdepartmental working group which will
coordinate policy development for the taskforce. Health care
transition director Judith Feder will assist Magaziner and other
senior transition officials will be members of the working group.
The taskforce will work cooperatively with members of Congress as
well as with state, city and county officials in developing its
proposals. It will conduct an outreach program to seek verbal
input and formal written submissions from interested citizens and
groups across the country.
The process will seek advice from people like the many the
President met during the campaign, for whom rising health care
costs and lack of adequate health care coverage are causing
severe hardship.
-- more --
.................____________________________
�The President said the legislation will be based on the following
principles:
o
To slow the growth of national health care spending.
o
To provide universal access to high quality care for
all Americans.
o
To ensure consumer choice.
o
To maintain a private, competitive health care system.
o
To cut the health care bureaucracy.
While her husband was Governor of Arkansas, Mrs. Clinton chaired
the Arkansas Education Standards committee, which in 1984 created
public school accreditation standards that have since become a
model for national reform. In 1984-1985, Mrs. Clinton served as
her husband's designee on the Southern Regional Taskforce on
Infant Mortality. She served as the chair of the Arkansas Rural
Health Committee in 1979-1980, and has served on the board of the
Arkansas Children's Hospital, where she helped establish the
state's first ne~-natal unit. In addition, Mrs. Clinton
introduced a pioneering program that trained parents to work with
their children in pre-school preparedness and literacy through
Arkansas• Home Instruction Program (HIPPY).
Those interested in submitting ideas should write to:
President's Health Care Taskforce
The White House
Washington, D.C. 20500
###
�MEDIA ADVISORY
MEDIA ADVISORY
FOR IMMEDIATE RELEASE
MARCH 23, 1993
MEDIA ADVISORY
CONTACT:
LISA CAPUTO
NEEL LATTIMORE
KAREN FINNEY
202-456-2960
PRESIDENT'S HEALTH CARE TASK FORCE TO HOLD MEETING ON MONDAY,
MARCH 29 1 1993
The President's Health Care Task Force will hold
WASHINGTON, DC -it's first meeting on Monday, March 29, 1993. The meeting will take
place at The Smith Center on the campus of George Washington
University. First Lady Hillary Rodham Clinton will chair the meeting.
Task Force members are: Secretary of the Treasury Lloyd Bentsen,
Secretary of Defense Les Aspin, Secretary of Commerce Ron Brown,
Secretary of Labor Robert Reich, Secretary Health and Human Services
Donna Shalala, Secretary of Veterans Affairs Jesse Brown, Office of
Management and Budget Director Leon Panetta, Assistant to the
President for Domestic Policy Carol Rasco, Assistant to the President
for Economic Policy Robert Rubin, Council of Economic Advisors Chair
Laura Tyson and Senior Advisor to the President to the President for
Policy Development Ira Magaziner.
PRESIDENT'S HEALTH CARE TASK FORCE MEETING:
DATE:
TIME:
LOCATION:
Monday, March 29
8:00 AM - 8:00 PM
The Smith Center
George Washington University
22 and G Street, NW
Washington, DC
TO REQUEST CREDENTIALS: To cover the President's Health Care Task
Force fax, on your media organization's letterhead, the full name,
date of birth and social security ndmber of all persons wishing to be
credentialed to 202-456-7805. To revise your credential request call
202-456-7787. Credentials will be available, at the Smith Center, the
day of the meeting.
TO ORDER PHONES:
There are a limited number of phone lines that can
be dropped in the press room of the Smith Center. To order phone
lines fax your request to Lisa Edsel, with George Washington
Unversity, at 202-994-6818.
Each phone line will cost approximately
$70. A calling card will be required to make long distance calls from
these ordered phones. Phone orders must be placed by close of
business Wednesday, March 24.
�PRESS NOTE:
Additional information regarding the meeting of
the President's Health Care Task Force will be released as it
becomes available.
###
�MEDIA ADVISORY
MEDIA ADVISORY
FOR IMMEDIATE RELEASE
MARCH 25, 1993
MEDIA ADVISORY
CONTACT:
LISA CAPUTO
NEEL LATTIMORE
KAREN FINNEY
202-456-2960
PRESIDENT'S HEALTH CARE TASK FORCE TO BOLD .MEETING ON MONDAY,
MARCH 29 1 1993
WASHINGTON, DC -The President's Health Care Task Force will hold
its first meetinq on Monday, March 29, 1993. The meetinq will take
place at The Smith center on the campus of Georqe Washinqton
University. First Lady Hillary Rodham Clinton will chair the meetinq.
REQUEST CREDENTIALS:
To cover the President's Health Care Task
Force fax, on your media orqanization's letterhead, the full name,
date of; birth and social security number of all persons wishinq to be
credentialed to 202-456-7805. To revise your credential request call
202-456-7787. Credentials will be available, at the Smith Center, the
day of the meetinq.
The followinq is a TENTATIVE SCHEDULE of orqanizations expected to
participate:
Panel 1: 8:05 - 9:05
National Council of Senior Citizens
Families USA
National Committee to Preserve Social Security/Medicare
Consortium of Citizens with Disabilities
American Association of Retired Persons
Panel 2: 9:10 - 10:10
National Federation of Independent Businesses
small Business Leqislative Council
National Small Business United
National Association of Women Business Owners
Minority Contractors Association
National Restaurant Association
Panel 3: 10:15 - 11:15
National Association of County Orqanizations
Urban Leaque
National Farmers Union
United Farm Workers
National Council of La Raza
National conqress of American Indians
-more-
�page 2
Panel 4:
American
American
American
American
National
American
Panel 5:
American
American
National
American
American
American
11:20 - 12:20
Nurses Association
Dental Association
Academy of Physicians Assistants
Chiropractic Association
Association of Social Workers
Psychological Association
12:35 - 1:35
Medical Association
Association of Physicians and Surgeons
Medical Association
Academy of Family Physicians
Academy of Pediatrics
Psychiatric Association
Panel 6:
1:40 - 2:40
Panel 7:
2:45 - 3:35
Health Insurance Association of America
Independent Insurance Agents of America
Blue cross Blue Shield Association
Alliance for Managed Competition
Group Health Association of America
Pharmaceutical Manufacturers Association
Generic Pharmaceutical Industry Association
National Association of Retail Druggists
Industrial Biotechnoloqy Association
a:
3:40 - 4:40
Panel 9:
4:55 - 5:45
Panel
American Hospital Association
Federation of American Health Systems
American Protestant Health Association
Catholic Health Association
National Association of Children's Hospitals
National Association for Home Care
American Health Care Association (Nursing Homes)
National Hospice Association
Health Industry Manufacturers Association
Panel 10: 5:50- 6:50
AFL-CIO
Service Employees International Union
American Federation of State, County and Municipal Employees
International Brotherhood of Teamsters
Building and Construction Trade Council of the AFL-CIO
United Auto Workers
Panel 11: 6:55 - 7:55
Citizen Action
Children's Defense Fund
National Council of Churches
Mental Health Liaison Group
Campaign for Women's Health
National Health Care Council
�page 3
Panel 12:
a:oo -
9:00
National Association of Manufacturers
Business Roundtable
Chamber of Commerce
National Retail Federation
Washington Business Group on Health
American Private Pension and Welfare Plans
Task Force members are: Secretary of the Treasury Lloyd Bentsen,
Secretary of Defense Les Aspin, Secretary of Commerce Ron Brown,
Secretary of Labor Robert Reich, Secretary Health and Human Services
Donna Shalala, Secretary of Veterans Affairs Jesse Brown, Office of
Management and Budget Director Leon Panetta, Assistant to the
President for Domestic Policy Carol Rasco, Assistant to the President
for Economic Policy Robert Rubin, Council of Economic Advisors Chair
Laura Tyson and Senior Advisor to the President to the President for
Policy Development Ira Magaziner.
PRESIDENT'S HEALTH CARE TASK FORCE MEETING:
DATE:
TIME:
LOCATION:
Press Entrance:
Monday, March 29
8:00 AM - 9:00 PM
The Smith Center
George Washington University
22 and G Street, NW
Washington, DC
22 and F Street, NW
###
�contact: Dee Dee Myers
FOR IMMEDIATE RELEASE
Monday, January 25, 1993
(202) .456-2100
Lisa caputo
(202) 456-6266
PRESIDENT CLINTON FORMS HEALTH CARE TASKFORCE
WASHINGTON, D.c. -- In effort to develop a plan for high quality,
affordable health care for all Americans, the President today
announced the formati-on of a taskforce to develop legislation for
comprehensive health care reform.
"It's time to
time to bring
secure in the
will not mean
bring quality
paperwork and
privilege."
make America's health care system make sense. It's
costs under control -- so that every family can be
thought that a medical emergency or a long illness
bankruptcy," the President said. "And it's time to
coverage to every American -- to cut back on the
the excuses and make health care a right, not a
The President's taskforce, which is expected to report a plan by
the end of May, will be chaired by First Lady Hillary Rodham
Clinton. The health care taskforce will include Secretary of the
Treasury Lloyd Bentsen, Secretary of Defense Les Aspin, Secretary
of Commerce Ron Brown, Secretary of Labor Robert Reich, Secretary
of Health and Human Services Donna Shalala, Secretary of Veterans
Affairs Jesse Brown, Office of Management and Budget Director
Leon Panetta, Assistant to the President for Domestic Policy
Carol Rasco, Assistant to the President for Economic Policy
Robert Rubin, Council of Economic Advisors Chair Laura Tyson and
Senior Advisor to the President for Policy Development Ira
Magaziner.
Magaziner will lead an interdepartmental working group which will
coordinate policy development for th~ taskforce. Health care
transition director Judith Feder will assist Magaziner and other
senior transition officials will be members of the working group.
The taskforce will work cooperatively with members of Congress as
well as with state, city and county officials in developing its
proposals. It will conduct an outreach program to seek verbal
input and formal written submissions from interested citizens and
groups across the country.
The process will seek advice from people like the many the
President met during the campaign, for whom rising health care
costs and lack of adequate health care coverage are causing
severe hardship.
-- !':lore --
�The President said the legislation will be based on the following
principles:
o
To slow the growth of national health care spending.
o
To provide universal access to high quality care for
all Americans.
o
To ensure consumer choice.
o
To maintain a private, competitive health care system.
o
To cut the health care bureaucracy.
While her husband was Governor of Arkansas, Mrs. Clinton chaired
the Arkansas Education Standards Committee, which in 1984 created
public school accreditation standards that have since become a
model for national reform. In 1984-1985, Mrs. Clinton served as
her husband's designee on the southern Regional Taskforce on
Infant Mortality. She served as the chair of the Arkansas Rural
Health Committee in 1979-1980, and has served on the board of the
Arkansas Children's Hospital, where she helped establish the
state's first neo-natal unit. In addition, Mrs. Clinton
introduced a pioneering program that trained parents to work with
their children in pre-school preparedness and literacy through
Arkansas• Home Instruction Program (HIPPY).
Those interested in submitting ideas should write to:
President's Health Care Taskforce
The White House
Washington, D.C. 20500
###
�SCHEDULE OF AITENDANCE
Members of Health Care Task Force
Public Meeting
March 29, 1993
~
Group
8:05-9:05
Consumers
HRC, Shalala, Magaziner,
Rasco
9:10-10:10
Business
HRC, Magaziner, Rasco,
Shalala, Rubin
10:15-11:15
Underserved
HRC, Magaziner, Rasco,
Shalala, Rubin, Reno
11:20-12:20
Gen. Health Care
Providers
HRC, Magaziner, Rasco,
MEG, Reno
12:35-1:35
Physicians
HRC, Magaziner, Rasco,
Tyson, MEG
1:40-2:40
Insurance
HRC, Magaziner, Rasco,
Tyson, Bentsen
2:45-3:35
Pharmaceuticals
HRC, Shalala, Magaziner,
Rasco, Tyson, Bentsen, Jesse Brown
3:40-4:40
Hospitals
HRC, Shalala, Magaziner,
Rasco, Jesse Brown
4:55-5:45
Gen. Health
HRC, Shalala, Magaziner,
Rasco, Jesse Brown, Reich
5:50-6:50
Labor
Shalala, Magaziner, Rasco,
MEG
6:55-7:55
Consumer
Shalala, Magaziner, Rasco,
MEG
8:00-9:00
Business (Large)
Magaziner, Rasco, Shalala,
MEG
To Attend
�PANEL 2: 9:10 - 10:10
Business
Gary Frank Petty
Treasurer and Member of the Board of Directors
Small Business Legislative Council
Margaret Smith
Chair, Legislation
National Small Business United
Samuel Carradine
Executive Director
Minority Contractors Association
Stephen Elmont
Vice President
National Restaurant Association
Andra Bennett
Executive Director
National Association of Private Enterprise
�Agenda
8:00 - 8:05
Opening Statement - HRC
PANEL 1: 8:05- 9:05
Consumers
Daniel Schulder
Director of Legislation
National Council of Senior Citizens
Phyllis Torda
Director of Health and Social Policy
Families USA
Max I. Richtman
Executive Vice President
National Committee to Preserve Social Security/Medicare
Peter Thomas
Attorney, Representing Members of CCD
Consortium for Citizens with Disabilities
Lavola Burgess
President
American Association of Retired Persons
Bill Keane
Board member of coalition member organization (on behalf of)
Long-Term Care Campaign
�THE WHITE HOUSE
WASHINGTON
RE:
Health Care Task Force Reading Room
DATE:
March 30, 1993
FOR PUBLIC INFORMATION:
THE HEALTH CARE TASK FORCE HAS ESTABLISHED A READING ROOM IN THE
FOLLOWING LOCATION:
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ROOM 101-G
200 INDEPENDENCE AVE., S.W.
WASHINGTON, DC 20201
MANY DEPARTMENTS HAVE RECEIVED INQUIRIES FROM THE PUBLIC
PERTAINING TO THE AVAILABILITY OF THE AGENDA AND TRANSCRIPTS FROM
YESTERDAY'S PUBLIC HEARING AT G/W UNIVERSITY. THIS INFORMATION,
AND ALL MATERIALS PERTAINING TO THE WORK AND PROGRESS OF THE TASK
FORCE, ARE AVAILABLE TO THE PUBLIC FOR REVIEW IN THE READING ROOM
BETWEEN THE HOURS OF 9 AM. - 5 PM. COPIES OF ANY INFORMATION MAY
BE MADE IN THE READING ROOM AT THE COST OF .10/each.
IF ANY ADDITIONAL INFORMATION ABOUT THE READING ROOM IS REQUIRED
PLEASE DIRECT YOUR CALLER TO (202) 690-7000.
THANK YOU,
HEALTH CARE TASK FORCE
INTAKE CENTER
�THE: WHITE: HOUSE:
WASHINGTON
RE:
Health Care Task Force Reading Room
DATE:
March 30, 1993
FOR PUBLIC INFORMATION:
THE HEALTH CARE TASK FORCE HAS ESTABLISHED A READING ROOM IN THE
FOLLOWING LOCATION:
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ROOM 101-G
200 INDEPENDENCE AVE., S.W.
WASHINGTON, DC 20201
MANY DEPARTMENTS HAVE RECEIVED INQUIRIES FROM THE PUBLIC
PERTAINING TO THE AVAILABILITY OF THE AGENDA AND TRANSCRIPTS FROM
YESTERDAY'S PUBLIC HEARING AT G/W UNIVERSITY. THIS INFORMATION,
AND ALL MATERIALS PERTAINING TO THE WORK AND PROGRESS OF THE TASK
FORCE, ARE AVAILABLE TO THE PUBLIC FOR REVIEW IN THE READING ROOM
BETWEEN THE HOURS OF 9 AM. - 5 PM. COPIES OF ANY INFORMATION MAY
BE MADE IN THE READING ROOM AT THE COST OF .10/each.
IF ANY ADDITIONAL INFORMATION ABOUT THE READING ROOM IS REQUIRED
PLEASE DIRECT YOUR CALLER TO (202) 690-7000.
THANK YOU,
HEALTH CARE TASK FORCE
INTAKE CENTER
�THE WHITE HOUSE
WASHINGTON
RE:
Health Care Task Force Reading Room
DATE:
March 30, 1993
FOR PUBLIC INFORMATION:
THE HEALTH CARE TASK FORCE HAS ESTABLISHED A READING ROOM IN THE
FOLLOWING LOCATION:
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ROOM 101-G
200 INDEPENDENCE AVE., S.W.
WASHINGTON, DC 20201
MANY DEPARTMENTS HAVE RECEIVED INQUIRIES FROM THE PUBLIC
PERTAINING TO THE AVAILABILITY OF THE AGENDA AND TRANSCRIPTS FROM
YESTERDAY'S PUBLIC HEARING AT G/W UNIVERSITY. THIS INFORMATION,
AND ALL MATERIALS PERTAINING TO THE WORK AND PROGRESS OF THE TASK
FORCE, ARE AVAILABLE TO THE PUBLIC FOR REVIEW IN THE READING ROOM
BETWEEN THE HOURS OF 9 AM. - 5 PM. COPIES OF ANY INFORMATION MAY
BE MADE IN THE READING ROOM AT THE COST OF .10/each.
IF ANY ADDITIONAL INFORMATION ABOUT THE READING ROOM IS REQUIRED
PLEASE DIRECT YOUR CALLER TO (202) 690-7000.
THANK YOU,
HEALTH CARE TASK FORCE
INTAKE CENTER
�THE WHITE HOUSE
WASHINGTON
RE:
Health Care Task Force Reading Room
DATE:
March 30, 1993
FOR PUBLIC INFORMATION:
THE HEALTH CARE TASK FORCE HAS ESTABLISHED A READING ROOM IN THE
FOLLOWING LOCATION:
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ROOM 101-G
200 INDEPENDENCE AVE., S.W.
WASHINGTON, DC 20201
MANY DEPARTMENTS HAVE RECEIVED INQUIRIES FROM THE PUBLIC
PERTAINING TO THE AVAILABILITY OF THE AGENDA AND TRANSCRIPTS FROM
YESTERDAY'S PUBLIC HEARING AT G/W UNIVERSITY. THIS INFORMATION,
AND ALL MATERIALS PERTAINING TO THE WORK AND PROGRESS OF THE TASK
FORCE, ARE AVAILABLE TO THE PUBLIC FOR REVIEW IN THE READING ROOM
BETWEEN THE HOURS OF 9 AM. - 5 PM. COPIES OF ANY INFORMATION MAY
BE MADE IN THE READING ROOM AT THE COST OF .10/each.
IF ANY ADDITIONAL INFORMATION ABOUT THE READING ROOM IS REQUIRED
PLEASE DIRECT YOUR CALLER TO (202) 690-7000.
THANK YOU,
HEALTH CARE TASK FORCE
INTAKE CENTER
�..
THE WHITE HOUSE
WASHINGTON
RE:
Health Care Task Force Reading Room
DATE:
March 30, 1993
FOR PUBLIC INFORMATION:
THE HEALTH CARE TASK FORCE HAS ESTABLISHED A READING ROOM IN THE
FOLLOWING LOCATION:
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ROOM 101-G
200 INDEPENDENCE AVE., S.W.
WASHINGTON, DC 20201
MANY DEPARTMENTS HAVE RECEIVED INQUIRIES FROM THE PUBLIC
PERTAINING TO THE AVAILABILITY OF THE AGENDA AND TRANSCRIPTS FROM
YESTERDAY'S PUBLIC HEARING AT G/W UNIVERSITY. THIS INFORMATION,
AND ALL MATERIALS PERTAINING TO THE WORK AND PROGRESS OF THE TASK
FORCE, ARE AVAILABLE TO THE PUBLIC FOR REVIEW IN THE READING ROOM
BETWEEN THE HOURS OF 9 AM. - 5 PM. COPIES OF ANY INFORMATION MAY
BE MADE IN THE READING ROOM AT THE COST OF .10/each.
IF ANY ADDITIONAL INFORMATION ABOUT THE READING ROOM IS REQUIRED
PLEASE DIRECT YOUR CALLER TO (202) 690-7000.
THANK YOU,
HEALTH CARE TASK FORCE
INTAKE CENTER
�THE WHITE HOUSE
WASHINGTON
RE:
Health Care Task Force Reading Room
DATE:
March 30, 1993.
FOR PUBLIC INFORMATION:
THE HEALTH CARE TASK FORCE HAS ESTABLISHED A READING ROOM IN THE
FOLLOWING LOCATION:
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ROOM 101-G
200 INDEPENDENCE AVE., S.W.
WASHINGTON, DC 20201
MANY DEPARTMENTS HAVE RECEIVED INQUIRIES FROM THE PUBLIC
PERTAINING TO THE AVAILABILITY OF THE AGENDA AND TRANSCRIPTS FROM
YESTERDAY'S PUBLIC HEARING AT G/W UNIVERSITY. THIS INFORMATION,
AND ALL MATERIALS PERTAINING TO THE WORK AND PROGRESS OF THE TASK
FORCE, ARE AVAILABLE TO THE PUBLIC FOR REVIEW IN THE READING ROOM
BETWEEN THE HOURS OF 9 AM. - 5 PM. COPIES OF ANY INFORMATION MAY
BE MADE IN THE READING ROOM AT THE COST OF .10/each.
IF ANY ADDITIONAL INFORMATION ABOUT THE READING ROOM IS REQUIRED
PLEASE DIRECT YOUR CALLER TO (202) 690-7000.
THANK YOU,
HEALTH CARE TASK FORCE
INTAKE CENTER
�THE WHITE HOUSE
WASHINGTON
RE:
Health Care Task Force Reading Room
DATE:
March 30, 1993
FOR PUBLIC INFORMATION:
THE HEALTH CARE TASK FORCE HAS ESTABLISHED A READING ROOM IN THE
FOLLOWING LOCATION:
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ROOM 101-G
200 INDEPENDENCE AVE., S.W.
WASHINGTON, DC 20201
MANY DEPARTMENTS HAVE RECEIVED INQUIRIES FROM THE PUBLIC
PERTAINING TO THE AVAILABILITY OF THE AGENDA AND TRANSCRIPTS FROM
YESTERDAY'S PUBLIC HEARING AT G/W UNIVERSITY. THIS INFORMATION,
AND ALL MATERIALS PERTAINING TO THE WORK AND PROGRESS OF THE TASK
FORCE, ARE AVAILABLE TO THE PUBLIC FOR REVIEW IN THE READING ROOM
BETWEEN THE HOURS OF 9 AM. - 5 PM. COPIES OF ANY INFORMATION MAY
BE MADE IN THE READING ROOM AT THE COST OF .10/each.
IF ANY ADDITIONAL INFORMATION ABOUT THE READING ROOM IS REQUIRED
PLEASE DIRECT YOUR CALLER TO (202) 690-7000.
THANK YOU,
HEALTH CARE TASK FORCE
INTAKE CENTER
�Health Care Task Force
Public BeariDB
Mardi 2P, 19f3
8:00 - 8:05
PANil. 1;
Opening Pl'oc«dinp
8;05
9:05
CQnwmeg
Daald Sl:bulcllr, Director CJf Lepalaticm, NatioDal Coi2DCil of SeDlar Qdzeu
1'11¥1111 TDI'IIa, Dinctor of Health IDCI Social Polley, PamWca USA
Mu L lUdiiiDU, BDcuti~e Vice President, NatiODil Commiuee 10
rreaetvt Social Secmity/Medlcare
:rater Tbom~ Anorbey. RepJeiCiltiQg Membcn of CCD, OmaonJum fot Citiza with Disabilities
LBVDia Burgess, Prealdema Americm Alloclatioa of Reti:cd Ptuom
BW Eea~t Board Member of Coalition Member O:pniza1icm an boba1f of, LaDs-Tean Caie Clmpaisll
PANEl,
2·
0;10 -10;10
Bualpcas
Gaq Fnak PM~)'. ntasmr md Member of tbe Baud of DirectoR. Small BtlliDees uplatlve Co1mcil
ltlarprH 8Ddtll, Cbait, l.e&11l&tioa, NatioDil Small Buhle• UDited
Samuel C8rradiDe, Bxec1nive Dheatot,
Minori~
Conuacto11 Aasodatlcm
SCepllea Elmoat. VIce Pnlidcllt, NadcnW R.est&Utut .AiaodatiDD
All4ra llelmelt, PDcattve Director, Naticmal Auodatloa of Private Eatwpriee
PANBJ. 3:
10•1 ~ .. 1l :lJ
Updonseryed
Aaae Bill, Dlnaat of Program Devclopmat. Nadoual Urban IMp
N•cr DaaieiHII. Lepta'live
~tl•o.
Natiozaal Famlea 'UDfou
Raal Y•gulrn, Prealdeld, Natimlal CooDcil of La llza
Mlcllael Aadmo' E:recutiVe Di!K10r, Natioaal
c::oqr. of AmcdcaD IDdla
�<
.•
PANBL 7; Z:4S - 3;35
l'hanuaceudcals
Dee l'eJUtenr, Pretldeat, GeDeric Pha=aoelltioal lalduatry Allaoc:iadOD
Dr. (.."'uadea W•t. Bztoulivo Vieo Prcsidcm_ Natioual Auociatiw ol ~ Drvglt11
c. ICidc Raab, Board ot Dbcctora. C2:aak OD Healtb Cr.l~ aarunu. IDdaelrill B1otedmol08)' AlaocilliOD
PANBL 8: 3:40 - 4;40
Hmpitals
Dick Da'ridsoJa. President. American Rnspital Assoeiadcm
Mlcllael Bnmbera, BYeet1tivto Direetor, FederatioD of AmedoaJl Health
Slat llenllee
~
~
ConU. SeDior Vloe Prtaidem, CathoUo Hoaltla Aaaoc:iatiOD
A. Mc.b•NWa. PrecideDt, Natioml AslodatlOD of Olihttca'e Hospillla
PANEJd 9; 4;SS - 5;45
Gtmora1 Health em Pmyidm
Val BaiiiiiUdaria. Presidem, Nadonal Allloclati01 for Home Care
Dr. Paal Wllabl&. EDcutive Vioe Preaidem.Ameticaa
.Jolaa MallOUJ, Preaidcm. Naticmal Hospice
Health C".ate Assoclatioa
Orp11iutioll
Stuart Ellealtlt. O:maultant. Hultlt IDdumy ~m AuociatioD
PANBI 10;
c
S:SO -
6;50
Llhm:
Kana Jpal, Dhec:tor ot Employee Beacfita. AFL-aO
JoJua J. aw....,. IDtematloual Pzeaidet, Stlvic:e Employees ID=at1oul VDion
Gerald McEntee. IDtematiDDal President, AmeriCID Pec1eraticm of State. Coumy, a:.od Mumcfpal "..mptoyees
Qady Zebader, Isatemational ~"'• IDtemadonal :Brotberhood of Teamatars
Rabert Geoqbae, Prtaidelll. Buildiq Tradea
AlaD bather. Leafalative DUec:tor. UAW
Q)uaci1
�PANE', 4: 11 :20 - 11:20 General Hr.alth Oarc Providm
'VU1iJala
TI'Otttl' Betta, Ples!dent, Amerlc.n Nuraet Aaoeiati=
Dr. Jack a..m.. Presidem. AmerioaD Dental AssoNtiGD
ADa I'Merlda, Pn:alcbt Bloct. AmClidoaD kadomy vf l'byatclaa Aaailtal:lta
a...e Askew,
M~,
Doant of Oo\'onaot~, American Cbitopraetio AlsociadOD
SbeldDa Golcll&ela. E&wutlv" Dim.1ur6 Na1luual ~(ldaUUil ut Sodal Wotbrs
Joha M. Tador,
~-- Anlerica Acadomy of Famny Ph)'llioiaa
Boward ....... Plo61dolt, Amed~
PANBic 6;
1;40 - 2;40
~demy
ot Pedlatric:e
Jn&ur8ftCe
BUI Gndl1011, Preaiclem, Heal'lb lne1ft1lce Aaociatlan nf America
liCk M0)'8illaa, ~\"c ViGC Prcaldcm, Oroap fDauraaco. MotropolitaD Ltfo Co:pcrrAdcm
(OD behalf of) AlliiiiCI for Mallapd Campeti!fml
J~m•
Doll.eJV, President, Group Health Asaodaticm of AmeriQ
�PA~
11: 6:SS - 7:55
Consunw
Calby HllrwJU. Leaillalive DJreclor, Cfti7.en Actfnt:
O.ral Rlapa. Directm nf Health. Osildn='•
:)efeDse
FUDd
Jau Xaariu~Jq1 BuoatiYo Dilocto:, Campaicu 1or Womm'a Health
WIIUut Slaalrar, Bxocutivo Dlroc&or, Amcr&lca
PANEL 12; 8;00 - 9:0Q
Cwzlgit
lor lkaltb Ca:e btcmll
Bmdnosa
Tracy M..W., PresideD!. Govcnmat aad
.
~bllc Affeb Dlvlaioss, Natio.W
P.ot.U Federation
Patrtala N......... DU.otot of S.ctitle Xcroz C'.mporatioD em WWf of w~~~~ B...U..CA <kwp
.mea Goldsteta, Dboctar of Hoatrb J'ollGT IIDd
Oommual"tkl~~~t
OD
Ha&l.1h
Alilluwuiuu o! Pdvaw PCDilon and Weltaro
'P1IDI
Task Force on Nadonal Health Care Reform
PresideDt Clinton established the fask Force on National Health Cam Reform to
develop a proposal tha' would briDJ spiraling healtll care C08t8 undet control and give
American families the peace of mind and security they deserve. The Task Force is chaiTed hy
Fir8t Lad)' Hillary Rodham Clinton. 1be task force also includes the Secretaries of Health
and Human Services. Labor. Trcasuty, Comm()rcc, Det'cuo &lld Vctc.nms Affairs u woll as
senior White House offidals.
�THE WHITE HOUSE
WASHINGTON
June 29, 1993
MEMORANDUM TO THE STAFF
FROM:
MAGGIE WILLIAMS
SUBJECT:
Health Care
As you all know, the Health Care Task Force and the health care
reform working groups no longer exist. Calls related to health
care are being directed to Health Care Communications at
(202) 456-2566. Health Care Communications is located in the War
Room. The fax number is (202) 456-2362.
Correspondence is being directed to:
Office of Domestic Policy
ATTN: Health Care Correspondence
Old Executive Office Building
Room 410
Washington, DC 20500
Standard language for outgoing correspondence should include the
following paragraph:
L _ __ _ _ _ _ _ _ _ _ _
At this point, the Health Care Task Force and the
health care reform working groups have terminated. You
should forward in writing any policy suggestions or
opinions to the Office of Domestic Policy at the White
House.
- - - - -
-------------
-------------
�THE WHITE HOUSE
WASHINGTON
June 29, 1993
MEMORANDUM TO THE STAFF
FROM:
MAGGIE WILLIAMS
SUBJECT:
Health Care
As you all know, the Health Care Task Force and the health care
reform working groups no longer exist. Calls related to health
care are being directed to Health Care Communications at
(202) 456-2566. Health Care Communications is located in the War
Room. The fax number is (202) 456-2362.
Correspondence is being directed to:
Office of Domestic Policy
ATTN: Health Care Correspondence
Old Executive Office Building
Room 410
Washington, DC 20500
standard language for outgoing correspondence should include the
following paragraph:
At this point, the Health Care Task Force and the
health care reform working groups have terminated. You
should forward in writing any policy suggestions or
opinions to the Office of Domestic Policy at the White
House.
�The White Hottse
Health Care Reform Today
July 2,1993
•
concerned Americans are already gearing up to help spread the word about the need
for health care reform. ThP. Wn.thinetrm Pnst reports that more than a rlo7.en groups
representing more than 50 million Americans have come together to coordinate a
nationwide, grassroots campai~ tor health retbnn. Called The Health Project, the coalition
brings together groups representing every side of the health care debate-- business, labor,
uoclors, nurses~ seniors, anu a vera.ge Americans s~k.ing llea.llll car~ secwity. Tlris group
will combat the rhetoric of the special interest lobbyist opposed to change, and will help
President Clinton and the Congress solve this country's health care crisis once and for all by
helping pass comprehensive health refonn legislation.
+
First Lady I Iillary Rodham Clinton, appearing yesterday by satellite, applauded
Missouri's etlorts providing improved health care to the residents of that state.
Speakin~
at the
bill signing of Missouri's new health care reform law, !Y.r:rs. Clinton said: 'ThtJ country will btJ
able to look to you us u :stute thut i:s coming to ierm:s with the :slwrtc.:omings of our pre:sent
health care system and beginning to implement the form which will benefit the people of
Afissouri, no·w CIJ2d into the future for generations to come."
•
St11.rt.ing next week, we'll he senciing ont these information
sheet~ nn
MoncUI.y anrl
Wednesday nights. If there is a need to respond on an issue, you'll hear from us quickly.
In the meantime, don't hesitate to give us a call at 202-456-2256 or tax us at 202-456-2362.
+
Tl1t= Prt=siut=nl a.uu lht= Firsl La.U)' will bt= in Japa.u a.l Lht= G-7 mt=t=ling a.uu Kort=a.
starting on Monday. In the meantime. the health care effort will continue here at the "White
House. Have a safe and fun holiday!
Health Care Reform Today • The White House •202-456-2566 • Fax: 202-456-2362
J
- - - - -
-------------~---
- - - - - - - - - -
~
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force [1]
Creator
An entity primarily responsible for making the resource
First Lady's Office
Maggie Williams
Evan Ryan
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 5
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-2194630-20060223F-005-005-2015
2194630
-
https://clinton.presidentiallibraries.us/files/original/9401949d5cbbbf3beef7fc241feed449.pdf
867b284073e181bd007b65beba1042ca
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
MAR~~R
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
First Lady's Office
Series/Staff Member:
Maggie Williams
Subseries:
Misc. Subject Files
OAIID Number:
10813
FolderiD:
Folder Title:
Interagency Health Team Binder
Stack:
Row:
Section:
Shelf:
Position:
s
59
4
2
3
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECfffiTLE
RESTRICTION
001. resume
Kelly F. O'Connor. [partial] (3 pages)
05/24/1993
P6/b(6)
002a. map
The Old Executive Office Building (5 pages)
[none]
b(2), b(7)(E)
002b.map
The Old Executive Office Building (1 page)
[none]
b(2), b(7)(E)
003. fax
Letter from Collin Peterson to Charles Bowsher. [partial] (1 page)
05/14/1993
P5
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number: 10813
FOLDER TITLE:
Interagency Health Team Binder
2006-0223-F
ab621
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a))
Freedom of Information Act -IS U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(J) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would diselose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(J) Release would violate a Federal statute ((b)(J) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
.b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�PERSONNEL
\
.
.
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�JOHN 0. ROCKEFELLER IV
•
W5$T VI"CliNIA
ilnittd
~rates ~mate
WASHINGTON, OC 20510-4802
Office:
From:
fv'\n.... C.lintu"'
Lt(N..
B,.; I~
Senator Rockefeller's P~s Office
Date: --~~~........;;;:::......=z.. .s'-~-,_1,..._'1-.,_;.1=---.
Number of pages, including cover _'3
__
Please call 224-6101 if you have any questions, or if there are any
problems with the transmission.
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�COORDINAilQN PROJECT
I. Functions
Clle)tcle~h.. ~.
Planning and targeting
Regular communication (and feedback) with White House, DNC,
Congressionalleadersh1p1 any Republican organizations etc.
Rapid response
CeePeiluatien •••• laEeer.~ard asai:lst cr;.u~traai~tio-A
.
Vehicle foi poeliHA res'"'eee for specific projects, ~~~41 ,~~ C....UO~ .,. ._,
oftl!cmit ueov pe:ttieiJilliR~B iR i99nii~a•iea eneM
f'Act v~o~ •
~otO"""\(•
9:
E.
P.
II. Options:
A. t='orm 501 £ 4
Strictly non-partisan
Structure:
Board of Directors (legally required)- could be just three people,
with little authority, or could be full coordinating counsel.
Coordinating Council- made up uf fuunding members
plus those added with the agreement of the founding
members. All 11invested" in the project. Weekly/Daily
meetings. All authority of the c 4 rests with these
members.
General Council •• made up of founding members + other groups
wishing to join to coordinate and communicate their activities on
health care reform. Meetings held monthly/weekly.
Infrastructure- Sub·groups meet weekly. Include:
1. Media/communications taskforce (w/ CC l.hair)
2. Grassroots taskforce (w I CC Chair)
3. Lobbying taskforce (w I CC Chair)
Other detajls
Independent office space (in kind contribution). Probably
3 rooms. Phones and faxes. Computers and copier. Other
• equipment.
1 to 5 staff people including a Project Manager, with flexibility
to use others on special projects. Work with member organizations.
•
�...... ·
.-...
.
Funding
From private donations (JDR lead the effort)
Member organizations make minimum donations, if
possible (not 501 c 3 groups).
Su:gcstcd names
''41 :iF '
5
I
a
"The Health Project''
Others
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••
•
DETE~~1f~F.D TO BE A~ AD:\1I~ISTRATIVE
MARI{I:\G Per E.O.l29S8 as amended, Sec. 3.3 (c)
Initials: pte...~
Date: O'i /of( /11
.
TO: Distribution
June 1, 1993
FR: Chris Jennings
RE: Proposed Congressional Meeting Schedule
•
To create an environment best suited for a positive Congressional
reception to the President's health proposal, it will be necessary to hold a
series of intense, substantive consultations with key Members of Congress.
Attached for your review and for planning purposes is a proposed schedule of
meetings that was prepared for the First Lady. The Legislative Affairs offices of
both the White House and the Department of Health and Human Services have
reviewed and approved this document.
The proposed schedule assumes an admittedly ambitious June 23rd
target date for the plan's unveiling. In so doing, we are also assuming that
final first cut decisions will be made by late this week in order to assure that
substantive meetings can take place beginning early next week. We are,
however, waiting until this assumption becomes more of a reality before
formally scheduling these meetings. Please don't hesitate to call me at X-2645
with any questions.
DISTRIBUTION:
Bob Boorstin
Susan Brophy
Steve Edelstein
Jeff Eller
Judy Feder
Skila Harris
John Hart
Shirley Sagawa
•
Charlotte Hayes
Jerry Klepner
Mike Lux
Ira Magaziner
Lorraine Miller
Howard Paster
Karen Pollitz
Kim Tilley
Carol Rasco
Steve Rlcchetti
Patti Solis
Marge Tarmey
Melanne Verveer
Maggie Williams
Christine Heenan
�••
• • • • PRMLEGED AND CONFIDENTIAL • • • •
MEMORANDUM
TO:
FR:
RE:
cc:
Hillary Rodham Clinton
June 1, 1993
Chris Jennings I Steve Ricchetti
Proposed Schedule for Congressional Consultative Meetings and Preintroduction Briefings for a Scheduled June 23rd Release Date
Distribution
In discussions with the staff of the House and Senate Majority Leaders,
it has become clear that it is advisable to implement a two step Congressional
outreach process aftm: the first cut on final policy decisions has been made.
With this in mind, the attached schedule of consultative meetings and preintroduction briefings was developed.
The first series of meetings would be detailed policy discussions with
Members of Congress, the purpose of which would be to advise Members of the
initial decisions made and to obtain their political reads and suggestions for
improvement. The second series of briefing sessions would be used to describe
the President's final decisions on the plan and to help make the Members more
comfortable in explaining it to their constituents and local media. This would
occur immediately prior to the unvelling of the proposal.
Four Points About Timing. Consultation. Communications and Hearings:
(1)
(2)
•
Timetable Needs to be Finalized. As the attached list clearly
illustrates, the necessary amount of consultation can only take place if
we squeeze it into a very brief period of time. If the policy is delayed
beyond this week, however, it will be literally impossible to have a
sufticient amount of time to conduct adequate consultations prior
to June 23rd. Should the policy be unavailable, we need to immediately
revisit and restructure what is already a very ambitious timetable.
Substantive Consultation Must Occur. We understand the concerns
about leaks and the general frustration with working with many
Members of Congress. However. it would be extremely counterproductive to attempt to release a package in which the Members have
little or no investment.
�•
It is important to remember that consultations will be signlftcantly more
fruitful and constructive when we have a policy as a basis for discussion.
To protect the process from problematic leaks, all discussions can be
accurately characterized as purely exploratory, with no FINAL decisions
yet made.
If we do not engage in signlftcant consultation, the Congress will almost
invariably wllt in the face of the inevitable concerns that will be raised.
Moreover. the Members -- particularly those in the House -- have made
it clear that they believe that this legislation will be "dead on arrival" if
unless substantive consultations occur as the President makes his final
decisions. Lastly, it is important to note that those Members who
advise no further consultation are generally those who are afraid of
being -- or perceived as being -- coopted.
(3)
•
•
Senator Daschle's Outreach Proposals Should Be limplemented. We
believe that Senator Daschle's suggestions for a message/whip group
and a focus group are very constructive. We believe that we should get
started on these meetings as soon as the Members return from recess
regardless of the final decision on the timing of the unvelling. These
meetings can be interspersed with the attached schedule of consultative
meetings OR conducted on a separate track .
(4)
Appropriate Witnesses Should Be Prepared for Inevitable Hearings.
Immediately after the unveiling, numerous Committees will request that
the Administration supply witnesses for their inevitable series of
hearings. We need to carefully consider where we should testify first,
who we believe are the most appropriate people to send, and begin to
develop the message(s) we want delivered .
�-~·
SCHEDULE FOR CONGRESSIONAL CONSULTATIVE MEETINGS AND BRIEFINGS
CONSULTATIVE MEETINGS:
Sunday, June 6th:
House Leadership and Committees of Jurisdiction Staff
IM, JF
(To help staff prepare members for meeting with First Lady)
Senate Leadership and Committees of Jurisdiction Staff
IM, JF
(To help staff prepare members for meeting with First Lady)
June 8th:
•
House Leadership and Chairmen of Committee of Jursidiction
HRC, IM, JF
Location: White House
(To brief Members and set up consultative process)
Foley
Gephardt
Bonier
Rostenkowski
Stark
Dingell
Waxman
Ford
Williams
Senate Leadership and Chairmen of Committees of Jurisdiction
HRC, IM, JF
Location: White House
(To brief Members and set up consultative process)
•
Mitchell
Ford
Pryor
Daschle
Moynihan
Kennedy
Rockefeller
Riegle
Mikulski
Breaux
�..
Wednesday, June 9th:
Congressional Republican Leadership - HRC, IM, JF
Location: White House
Dole and designees
Michel and designees
Daschle Message/Whip Group:
Rockefeller, Pryor, Daschle, Kerrey, Wofford, Bonier,
Gephardt (if available and willing), and other House Member
"friends." (WEEKLY MEETING)
Staff: Jeff Eller, Bob Boorstin, Steve Ricchetti, Chris
Jennings, Melanne Verveer, Jerry Klepner, Karen Pollitz
Thursday, June lOth:
Single Payer Leaders - HRC, IM, JF
Location: Capitol Hill (Gephardt to Host)
•
McDermott
Conyers
Wells tone
Conservative Democratic Forum - HRC, IM, JF
Location: Capitol Hill (Gephardt to Host)
Cooper
Andrews
Stenholm
Breaux
Boren
Daschle Focus Group:
Daschle/Pryor and moderate/conservative Democrats:
Breaux, Reid, Exon, and Conrad
Staff: Ricchetti, Jennings, Klepner, Pollitz
Bryan,
Friday, June 11th (Possibly Saturday. June 12th. as well):
House Leadership and Committees of Jurisdiction Staff
IM, JF
(Ongoing detailed staff-level discussions)
•
Senate Leadership and Committees of Jurisdiction Staff
IM, JF
(Ongoing detailed staff-level discussions)
�~.
Monday, June 14:
House Ways and Means Committee - HRC, IM, JF
Location: Capitol Hill
(Chairman determines attendees and whether bipartisan)
Senate Finance Committee - HRC, IM, JF
Location: Capitol Hill
(Bipartisan)
House Energy and Commerce Committee - HRC, IM, JF
Location: Capitol Hill
(Chairman determines attendees and whether bipartisan)
Daschle Message/Whip Group:
Rockefeller, Pryor, Daschle, Kerrey, Wofford, Bonier,
Gephardt (if available and willing), and other House Member
"friends." (WEEKLY MEETING)
Staff: Jeff Eller, Bob Boorstin, Steve Ricchetti, Chris
Jennings, Melanne Verveer, Jerry Klepner, Karen Pollitz
•
Tuesday, June 15th:
Senate Labor and Human Resources Committee - HRC, IM, JF
Location: Capitol Hill
(Bipartisan)
House Education and Labor Committee - HRC, IM, JF
Location: Capitol Hill
(Chairman determines attendees and whether bipartisan)
House Caucuses - IM, JF
Congressional Black Caucus
Congressional Caucus on Women's Issues
Wednesday, June 16th:
House Democratic Whip Organization - HRC, IM, JF
Location: Capitol Hill
House Republican Health Care Task Force - HRC, IM, JF
Location: Capitol Hill
•
u.s.
Senate (Bipartisan) - HRC, IM, JF
Location: Capitol Hill
House Caucuses - IM, JF
Congressional Hispanic Caucus
�To Be Scheduled:
Other Meetings with Committees as Needed Location: Capitol Hill
Biden, Judiciary
Rockefeller, Veterans
Nunn, Armed Services
Bumpers, Small Business
Glenn, Governmental Affairs
Inouye, Indian Affairs
:•
•
IM, JF, Other Staff
Brooks, Judiciary
Montgomery, Veterans
Dellums, Armed Services
LaFalce, Small Business
Clay, Post Office
Miller, Natural Resources
�••
PRE-UNVEILING BRIEFINGS:
Saturday, June 19th:
House Leadership and Committees of Jurisdiction Staff
IM, JF
(Ongoing detailed discussions and to help staff prepare
members for meeting with President and First Lady)
Senate Leadership and Committees of Jurisdiction Staff
IM, JF
(Ongoing detatiled disscussions and to help staff prepare
members for meeting with President and First Lady)
Sunday, June 20th:
House Leadership and Chairmen of Committee of Jursidiction
HRC, BC(?)
Location: White House
•
Foley
Gephardt
Bonior
Rostenkowski
Stark
Dingell
Waxman
Ford
Williams
Senate Leadership and Chairmen of Committees of Jurisdiction
HRC, BC(?)
Location: White House
Mitchell
Ford
Pryor
Daschle
Moynihan
Kennedy
Rockefeller
Riegle
Mikulski
Breaux
•
Congressional Republican Leadership - HRC, BC (?)
Location: White House
Dole and designees
Michel and designees
�Monday. June 21st:
Senate Democratic Policy Committee - BC?, HRC, IM, JF
Location: Capitol Hill
House Democratic Caucus - HRC, IM, JF
Location: Capitol Hill
Tuesday, June 22nd:
House Republican Caucus - HRC, IM, JF
Location: Capitol Hill
Senate Republican Policy Committee - HRC, IM, JF
Location: Capitol Hill
House Democratic Staff Briefing - IM, JF or appropriate surrogate
Location: Capitol Hill
House Republican Staff Briefing - IM, JF or appropriate surrogate
Location: Capitol Hill
•
•
Senate Staff Briefing - IM, JF or appropriate surrogate
Location: Capitol Hill
Other Meetings with Committees and Members as Needed
�•
•
•
SCHEDULE FOR CONGRESSIONAL CONSULTATIVE MEETINGS AND BRIEFINGS
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
6/6
6/7
6/8
6/9
6/10
6/11
6/12
House
Leadership
and Cmte
of Jdx
Staff
House
Leadership
and Chmn of
Cmtes of
Jdx
Cong.
Republican
Leadership
Single
Payer
Leaders
HRC/IM/JF
HRC/IM/JF
House
Leadership
and Cmtes
of Jdx
Staff
IM/JF
HRC/IM/JF
Senate
Leadership
and Cmte
of Jdx
Staff
Senate
Leadership
and Chmn of
Cmtes of
Jdx
IM/JF
HRC/IM/JF
IM/JF
Daschle
Message/
Whip Group
CDF
HRC/IM/JF
Eller/SR/CJ
et. al.
IM/JF
Daschle
Focus Group
SR/CJ
et. al.
*
Senate
Leadership
and Cmtes
of Jdx
Staff
Other Meetings with Administration Staff to be Scheduled.
�•
•
•
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
6/13
6/14
6/15
6/16
6/17
6/18
6/19
Senate
Finance
Committee
Senate
Labor and
Human
Resources
Committee
House
Democratic
Whip Org.
HRC/IM/JF
HRC/IM/JF
HRC/IM/JF
House
Leadership
and Cmtes
of Jdx
Staff
IM/JF
House
Energy and
Commerce
Committee
House
Education
and Labor
Committee
House
Republican
Health Care
Task Force
HRC/IM/JF
HRC/IM/JF
HRC/IM/JF
Senate
Leadership
and Cmtes
of Jdx
Staff
IM/JF
Ways and
Means
Committee
Cong.
Caucus on
Women's
Issues
u.s.
Senate
Bipartisan
HRC/IM/JF
HRC/IM/JF
IM/JF
Daschle
Message/
Whip Group
Cong. Black
Caucus
Cong.
Hispanic
Caucus
IM/JF
Eller/SR/CJ
IM/JF
�•
•
•
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
6/20
6/21
6/22
6/23
6/24
6/25
6/26
House
Leadership
and Chmn
of Cmtes
of Jdx
Senate DPC
House
Republican
Caucus
BC(?)/HRC/
IM/JF
HRC/IM/JF
HRC/BC(?)
Senate
Leadership
and Chmn
of Cmtes
of Jdx
House
Democratic
Caucus
Senate
Republican
Policy
Committee
HRC/IM/JF
HRC/IM/JF
HRC/BC(?)
Cong.
Republican
Leadership
House
Democratic
Staff
Briefing
HRC/BC(?)
Staff
House
Republican
Staff
Briefing
Staff
Senate
Staff
Briefing
Staff
1
•.
�,
June 2, 1993
MEMORANDUM FOR MAGGIE WILLIAMS
FROM:
JEFF ELLER
RE:
'f---
Personnel
1.
Don't forget our plans for Jock Gill. If possible, I'd like this
wrapped up with other personnel stuff.
2.
Meg Offit from Ag. Are we close on this?
3.
Attached is a memo that Ira and I collaborated on.
�I
-2-
Administration
carolyn Gatz
Position:
Location:
Payroll:
Communications liaison
OEOB
Commerce/120 days
Christine Heenan
Position:
Liaison with communications, public liaison and
intergovernmental
OEOB
Location:
·Domestic Policy
Payroll:
Jennifer Klein
Position:
Drafting
Location:
OEOB
Payroll:
Volunteer (would like to keep)
Greg Lawler
Position:
Location:
Payroll:
Drafting/legislative negotiating
OEOB
(resume sent to Bernie Nussbaum for Counsel's
office)
Lynn Margherio
Policy Development
Position:
OEOB
Location:
Domestic Policy
Payroll:
Denise Ricketson
Position:
Administration Assistant
Location:
OEOB
Payroll:
HHS
Marjorie Tarmey
Position:
Special Assistant
Location:
OEOB
Payroll:
HHS
Policy Assistant (Simone Rueschemeyer or equivalent)
Position:
Location:
Payroll:
Commerce/120 days (Can we renew?)
Secretary
Position:
Location:
Payroll:
Assignee from another agency
�-3-
Policy Experts
Gary Claxton
Position:
Location:
Payroll:
Insurance Reform
HHS
HHS full time hire (assigned to Task Force)
Judy Feder
Position:
Location:
Payroll:
Deputy Secretary/liaison to the Task Force
HHS
HHS full time hire (assigned to Task Force)
Roz Lasker
Position:
Location:
Payroll:
Quality and Information system
HHS
HHS full time hire (assigned to Task Force)
Risa Lavizzo-Mourey
Position:
Quality
Location:
HHS
Payroll:
HHS full time hire (assigned to Task Force)
'
Lois Quam
Position:
Location:
Payroll:
Underserved and rural issues
OEOB
HHS contract
Paul Starr
Position:
Location:
Payroll:
General Communication of the plan
Robyn Stone
Position:
Location:
Payroll:
Long Term Care
HHS
HHS full time hire (assignee to Task Force)
Walter Zelman
Position:
Location:
Payroll:
OEOB
HHS contract
New Systems Development
OEOB
HHS contract (contract may extend until end of
year)
�e
•
-4-
communications
Boorstin, Bob
Position:
Location:
Payroll:
Cohen, Steve
Position:
Location:
Payroll:
National Press Scheduling
OEOB
White House
Jones, Arthur
Position:
Location:
Payroll:
:'
Communications Director
OEOB
White House
Deputy Press Secretary 1 2nd Spokesperson - HHS
OEOB
White House
Muscatine, Allison (not hired yet)
Speechwriter
Position:
OEOB
Location:
Payroll:
White House
Offit, Meg
Position:
Location:
Payroll:
Specialty Press
Department of Agriculture {Can we assign?)
Prunti, Meeghan
Position:
Researcher
Location:
OEOB
Payroll:
White House
Solomon, Jason
Position:
Communication Aide
Location:
OEOB
Payroll:
White House
Slot/News Analysis
(on loan from a Department Slot/News Analysis
(on loan from a Department)
Slot/News Analysis
(on loan from a Department)
Slot/Researcher
(on loan from a Department)
Susannah Wellford, commerce)
�I
-5-
consultants
Begala, Paul -- DNC
Greenberg, Stan
DNC
Grunwald, Mandy
DNC
Schedulinq
Hayes, Charlotte
Position:
Surrogate Scheduling/Minority Outreach
Location:
OEOB
Payroll:
White House/VP
Hoffman, Alan
Position:
Location:
Payroll:
Surrogate Scheduling
OEOB
HHS (half/time)
Holton, Dwight
Surrogate Scheduling/Coordinator
Position:
Location:
OEOB
Payroll:
White House/Deputy Chief of Staff Office
Moffett, Julia
Position:
Location:
Payroll:
??
Event/Principles
OEOB
White House/Communication
Draftinq
Budetti, Peter
Position:
Drafter
Location:
Payroll:
HHS
Rosenbaum, Sara
Drafter
Position:
Location:
Payroll:
Through contract with HHS/Renegotiated
(in Sara's contract Greg Lawler)
•
*Rowland, Diane
Position:
Drafter
Location:
Payroll:
Kaiser Foundation VP through John Hopkins - free -
�I
-6-
Leqislative
Edelstein, Steve
Position:
Data Bank Project
Location:
OEOB
Payroll:
120 Days/White House
Jenninqs, Chris
Position:
Leqislative strateqist
Location:
OEOB
Payroll:
HHS
Correspondence
Slot/Correspondence
Position:
Director of Health Care Correspondence
Location:
Payroll:
(Included in budget submitted to David Watkins)
Slot/Correspondence
(on loan from a Department)
'
Slot/Correspondence
(on loan from a Department)
Slot/Correspondence
(on loan from a Department)
Slot/Correspondence
(on loan from a Department)
•
�-7-
Public Liaison/Political/Intergovernmental
Mike Lux
Position:
Location:
Payroll:
Interest Group Coordinator/Outreach
OEOB
White House/Public Liaison
Molly Brostrom
Interest Groups
Position:
Location:
Payroll:
John Hart
Position:
Location:
Payroll:
Liaison to the Governors
OEOB
White House/Intergovernmental
Karen Politz
Position:
Location:
Payroll:
Liaison to Interest Groups
HHS
HHS
Barbara Wooley
Interest Groups/Health
Position:
OEOB
Location:
HHS 120 day
Payroll:
Slot/Business
Position:
Location:
Payroll:
Liaison to business
OEOB
Slot/Mayors
Position:
Location:
Payroll:
Liaison to Mayors
OEOB
Slot/Counties/State Legislators
Position:
Liaison to county and state officials
Location:
Payroll:
�I
-8-
Additional Requests
Jock Gill
Position:
Location:
Payroll:
Computer/technical assistance
Stan Gorsky
Position:
Location:
Payroll:
Telephone/technical assistance
AT&T
Additional positions
Policy Assistant (Susan Otrin or equivalent)
Position:
Location:
Payroll:
I
:\
•
I
Rick Miller (or equivalent)
Business negotiations
Position:
OEOB
Location:
Payroll:
Jeff Davis (or equivalent)
Position:
Attorney/Negotiations and legislative drafting
Location:
OEOB
Payroll:
�.
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. resume
SUBJECTffiTLE
DATE
Kelly F. O'Connor. [partial] (3 pages)
05/24/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number: l 0813
FOLDER TITLE:
Interagency Health Team Binder
2006-0223-F
ab62l
RESTRICTION CODES
Presidential Records Act - (44 U.S.C. ll04(a))
Freedom of Information Act - (5 U.S.C. 55l(b))
PI National Security Classified Information ((aXI) ofthe PRA)
Pl Relating to the appointment to Federal office ((aXl) of the PRA)
P3 Release would violate a Federal statute ((aX3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
fmancial information [(aX4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (aXS) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(bXI) of the FOIA)
b(l) Release would disclose internal personnel rules and practices of
an agency [(bXl) of the FOIA)
b(3) Release would violate a Federal statute ((bX3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(bX4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((bX6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(bX7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs [(bX9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfde defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�;
MA'!"-~4-1993,
17: 13,
FROI'I
TO
vJ
4561655
P.01
i
:I
I
he Clinton/Gore Administration
i~o management o~ logistics. My commitment,
au4 skills will mupport the naeas ot ~he White
'
.!
,I
I
a
WID DOIOI alii
,DC/Little Rock,Arkansas ·
hrouqh April 1993
possible for assisting in the assessment,
!dation and -shipment of remaining assets
the transition/campaign.
·
isted in distribution of correspondence
the expeditinq process for the White House and
cutive Branch staff.
CL npl/
'PRIIlDBUIAL CIMPAIQ'If
Li tle Ro k, Arkansas
Ap il, 19 2 - NOVember,. 1992
• Pr ority Handler: mxpaditer
,, Re
nsible for all Airborne, UPS and Paderal Expres11
shipments
r, Headquarters Ralooation Staff
011 OOR.PORA~XOII•· \1~ I'IORIS, l.C.•
, Arkan:aas
g - Rovamber, 1992
ping ~d Ree•iving
r Processing Clerk
I
'•
Audi~or
)
TOTAL P.01
�..
MRY-24-199J
..
17:14
..
.·[
FROM
TO
4561655
P.01
I
page t:wo
s~.
St.
May,
19.88
ial and res14ent1al property maintenance
lee corporation
ed, sold, serviced and maintained over
y corporate accounts.
EDUCUIOlfa !
STITUTI; MIDLAnD, MICHIGAN
84 - May, 1985
ess Management
• ST·. I LAIR
PORT HtJRON, MICHIGAN
May ·1983
Maj
: Gen al Business
Psi Business fraternity
ian, Distributive Educational Clubs
a
dar, United Way, 1989
, Esq.
Frye, Esq.
TOTAL P.01
�..
e
Vff\.NON
E. }OP.DAN, JR.
CHAIRMAN
February 19, 1993
'1'0 WHOM I'l' HAY CONCERN'
I am pleased to warmly endorse Kelley O'Connor a candidate
for a position within the Clinton Administration. Under
challen~ing and often hectic circumstances, Kelley's
·
·
profess1onalism and willingness to give mo~ than 100 percent
enabled the Transition to accomplish its i111portant tasks·.
His work was always thorough and often done under extreme
deadlines. Kelley has strong organizational as well as
communication skills which can be applied to a host of positions
in any number ot agencies or the White House staff.
Kelley 4id an,exemplary job for the Transition. He is
anxious to continue to serve President Clinton and I believe
he has earned the most serious consideration for a position with
the administration.
Sin erely,
OfFICE OF THE PP.ESIOENTIAL AND
VIC£ PRESIDENTIAL TRANSITION
1120
VERMONT AvENUE:.
WASHJNCTON,
D. C. 20270 (202) 973·2600
�..
..
OBJIIClfl
To gain a position within the Clinton/Gore Administration
in ehe ~ield of facilities management or log1st1os.
BXPBRIBHCBI
C11DtOD/Gore W1D4 DOWD
washington,DC/L1ttle Rock,AR
February,March & 1 l993
-Responsible for liquidating all computers,TV's
and remaining assets. (including shippment of
assets.)
·
-Assisted in mail distribution and expediting
for The White House and OEOB.
Presidential Transition Offioe
Little Rock,AR
November 1992-January 1993
Clin~on/Cora
of Shipping & Receiving
-Responsible for all mail distribution
-Handled all priority expediting
Di~eo~o~
I
!
,
I
I
I
I
Clinton/Oo~e P~esidential
Little Rock,AR
April 1992- November 1992
Campaign
Priority Bxpe4iter
•Responsible for all Airborne,Federal Express, and
United Parcel services.
-Member headquarters relocation staff
~arget
Stores, lnc., Distribution Center
Little Rock,AR
Auqust 1989- November 1992
warehouse Auditor
•Shipping & Receiving auditor
-order processing clerk
�...
..
.,
Continue
lxpa~periencea
St. Clair Maintenance Co.
St. Clair,MI
May 1981- November 1gaa
owne~/Ope~ator
•Residential & Commercial interior & exterior
building maintenance. (lawn care, snow removal,
and cleaning services.)
-Sold,serviced, and maintained over 60 accounts
on a regular basis
Bcluaationa
Northwood Institute, February 1984- May 1985
Major: Business Management
St. Clair County Community College September 1982May 1983
Major: General Business
References Available Upon Request
I
- -
- - - - - - - - - - -
-----
----
-
�---·--·--·----~-----~ ~----~-
.•
}
To whom it may concern:
I am submittina my resume and a brief note of my experience with the campaian. I
was responsible for all outside expediting during the auupaign. My main responsibility was
to expedite any materials which needed to be delivered ~ithln two to forty-eight hours.
During transition. J was the director of all written materials for Little Rock
operations. Thic Included distribution of all incoming mail and parcels. I was responsible
for all outgoing mail and expediti111.
I am simply looking to serve the administration in a capacity ror which my skills may
best be suited. I feel that a position in any form of shipping and receiving would best suit
my abilities and interests.
)
j
�TO:
Christine Varney
FR:
Mary
DT:
5/20/93
RB:
Detailees from Veterans Affairs
Schuneman~~
Maggie Williams
Marge Tarmey
Patricia Campbell and Jane Hawkins have been detailed from
Veterans Affairs to the health care task force intake center for
the past four weeks. Tomorrow, May 21, will be their last day on
assignment to the intake center as per Martha Bertrand in the VA
personnel office. Pat and Jane have been very hard workers and
have expressed interest in continuing with the intake center. I
think that they should be considered to return to the intake
center when it is reorganized after May 30.
Martha can be reached at 233-2694.
extension is 2813.
I
If you have any questions, my
/
�Intergovernmental Working Group
Special Government Employees
Gary Claxton
Roz Lasker
Lois Quam
Paul Starr
Robyn Stone
Walter Zelman
Larry Levitt
Arnold Epstein
Richard Veloz
�Schedule C
Denice Ricketson
Marjorie Tarmey
Steve Edlestein
Chris Jennings
Molly Brostrom
Barbara Wooley
�Commerce
Carolyn Gatz/ Communication Liaison
Simone Rueschemeyer/ Policy Assistant
Susannah Wellford/ News Analysis
�ASPE
Sara Rosenbaum
Peter Budetti
Diane Rowland
.e
�Additional Positions
Drafting (Jennifer Klein)
Drafting /Legislative negotiating Greg Lawler
Policy Assistant (Susan Otrin)
Business Negotiation (Rick Miller)
Attorney/negotiations and legislative drafting (Jeff Davis)
.e
I
'
�Slots Needed
Secretary
News Analysis
News Analysis
Researcher
Correspondence, Director
Correspondence
Correspondence
Correspondence
Correspondence
Mayors/Intergovernmental
Counties -State Legislators/ Intergovernmental
�Agency Representatives
White House
Ira Magaziner
Jeff Eller
Bob Boorstin
Steve Cohen
Arthur Jones
Allison Muscatine
Jason Solomon
Dwight Holton
Julia Moffett
Mike Lux
John Hart
Meeghan Prunty
Jock Gill
Domestic Policy
Christine Heenan
Lynn Margherio
OVP
Charlotte Hayes
Agriculture
Meg Offit
DHHS
Judy Feder
Alan Hoffman
Karen Politz
Risa Lavizzo-Mourey
�SPACE
�THE WHITE HOUSE
WASHINGTON
May 27, 1993
MEMORANDUM FOR PATSY THOMASSON
Director, Office of Administration
FROM:
Jeff EllrrC
Deputy Ui~t to the President
Director of Media Affairs
CC:
Maggie Williams
Assistant to the President
Chief of Staff to the First Lady
Roy Neel
Assistant to the President
Deputy Chief of Staff
Peter Siegal
Health Care Budget Officer
RE:
Health Care Coordination
This is to update you on the status of decisions made concerning the
formation of a central location to coordinate the passage of the Health Care
package.
We are now ready to proceed with the installation of telephones and
computers. We need to have Room 160 in the OEOB outfitted by June 4,
ready for operation on June 7. Peter Siegal has plans from both AT&T,
IRMD and facilities management to accomplish this task.
To that end, in consultation with the Office of the First Lady, I am
requesting that the computer system for Room 160 be an extension of the
Communications Office Pilot Project and that installation begin
immediately.
I am requesting that Jerry Carlsen and Jim McDonald from IRMD be
assigned to this task through completion. They have been involved from
the beginning of the project.
�Have tried to call you back yesterday and today ... no luck in
qettinq a phone answered.
As to space •••• we need for Domestic Policy Council the following
rooms which have been utilized by Health Care Reformt
210, 213, 213 1/2.
plan to utilize space if you need ... thanks .
•
•
205, 207,
I can go over full plan with you of how we
�Withdrawal/Redaction Marker
"''
DOCUMENT NO.
AND TYPE
002a.map
Clinton Library
SUBJECTffiTLE
DATE
The Old Executive Office Building (5 pages)
[none]
RESTRICTION
b(2), b(7)(E)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number:
I 0813
FOLDER TITLE:
Interagency Health Team Binder
2006-0223-F
ab621
RESTRICTION CODES
Presidential Records Act - (44 U.S.C. ll04(a))
Freedom of Information Act -IS U.S.C. SSl(b))
PI National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office ((a)(l) of the PRA)
P3 Release would violate a Federal statute ((a)(3) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(l) Release would disclose internal personnel rules and practices of
an agency ((b)(l) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfUe defmed in accordance with 44 U.S.C.
ll01(3).
RR. Document will be reviewed upon request.
�)
.
)
-1\ ••
....
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-
-
_______ _ _ _ _ _ _ j
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002b. map
DATE
SuBJECTffiTLE
The Old Executive Office Building (1 page)
[none]
RESTRICTION
b(2), b(7)(E)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number: 10813
FOLDER TITLE:
Interagency Health Team Binder
2006-0223-F
ab621
RESTRICTION CODES
Presidential Records Aet- [44 U.S.C. 1104(a)]
Freedom of Information Aet- [5 U.S.C. 551(b))
PI National Security Classified Information [(a)(l) of the PRA]
Pl Relating to the appointment to Federal office [(a)(1) of the PRA]
P3 Release would violate a Federal statute ((a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information ((b)(l) of the FOIA)
b(1) Release would disclose Internal personnel rules and practices of
an agency ((b)(1) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
Information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy [(b)(6) of the FOIAJ
b(7) Release would disclose Information complied for law enforcement
purposes((b)(7) of the FOIAJ
b(8) Release would disclose Information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
1101(3).
RR. Document wiD be reviewed upon request.
�•
BUDGET SCHEDULE
1. PERSONNEL
2. SPACE
3. COMPUTERS
4. TELEPHONES
5. SATTELITE AND RADIO
6. PRINTING
7. FURNITURE
8. TRAVEL
9. SUPPLIES
•
•
10. POSTAGE & FEDERAL EXPRESS
11. OTHER CONTRACTS
�BUDGET
�•
\.
EMPLOYEE
SALARY
'
IRA MAGAZINER
~
BOB BOO~STIN
\
STEVE COHEN
•
..
ARTHUR JONES
MEEGHAN
PRU~TY
-
\
JASON SOLOMO~
I
\
ALLISON MUSCA~INE
(TO BE HIRED) \
;
I
/
CHARL9TTE HAYES\
OVP ~F
DWiGHT HOLTON
, 'MIKE LUX
\
,
~
JOHN HART
'JULIS MOFFETT
JEFF .. ELLER
•
..
/
I
�•
DENISE RICKETSON
MARJORIE TARMEY
-
LOIS QUAM
PAUL STARR
WALTER ZELMAN
PB'I'8R BtJBE'f"f I
•
••
DOMESTIC POLICY
EMPLOYEE
CHRISTINE HEENAN
LYNN MARGHERIO
SALARY
�•
AGENCY NOT DETERMINED
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AGRICULTURE
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NEWS ANALYSIS
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DNC
PAUL BEGALA
STAN GREENBERG
MANDY GRUNWALD
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·,
•
May 14, 1993
MEMORANDUM FOR ROY NEEL
FROM:
Jeff Eller
SUBJECT:
Resource Inventory Request
CC:
Maggie Williams
Here is what I would like to request to set up the war-room for
the health care plan.
In the initial stages, I would like a full-time AT&T person
allocated to get the phones up an running. In addition, a full
time computer person·needs to be allocated to get the computer
resources functioning and communicating with the rest of the
White House complex.
I will need help from the people who deal with desks and
furniture, etc.
••
There also needs to be some money set aside for satellites and
radio feeds. As of now, we do not have an actuality service.
I've been waiting o~ the.new phone system in order to accomodate
this without a· lot of cost. I can't wait for the phone system
with health care.pending:
From a budget standpoint, I think that $100,000 should cover
satellites and radio through the end of this fiscal year, october
1.
That's the first cut ••. more to follow.
''
•••
----
-
- - - - - - -
�•
May 12, 1993
MEMORANDUM FOR Hillary Clinton
FROM:
Ira C. Magaziner
SUBJECT:
Staffing
We anticipate taking responsibility for:
•
•
Translating the policy into drafting of the bill.
•
Making sure that the policy remains viable as it
evolves during congressional debate. Developing policy
options to amend the bill in response to the legitimate
concerns of congress, interest groups and the public.
•
Conducting negotiations and communications with
congress, states and interest groups as policy evolves
during congressional debate.
•
Providing policy experts to speak around the country to
testify and assist the communication strategy.
•
•
Finalizing initial policy.
Working with communications, legislative affairs,
intergovernmental and public liaison in the
implementation of the program as necessary.
In order to accomplish this we need the following positions:
•
�•
•
•
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�STRATEGIES
�·--
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·-···-
. -·~
HEALTH CARE PROJECT LIST
··~Zsj
617/93
Project Name
Dept. Responsible
Person
Responsible
Targeting List
Policy
Materials List
Est.
Start
Est.
Finish
Chris Jennings
6-7-93
6-9-93
Research
Meegh~
6-7-93
6-10-93
.Ira Magaziner Press Packet
Policy
Carolyn Gatz
6-7-93
6-11-93
Talking Points List
Public Liaisoin
· Mike Lux & Chris
6-7-93
6-11-93
Communications Strategy·
Research
Meeghan Prunty
6-7-93
6-11-93
Scheduling
Alan Hoffman
6-7-93
6-14-93
Bob Boorstin
6-7-93
6-14-93
· Surrogate Strategy
Network T~levision Strategy
· Communications
Prunty
Daytime Television Strategy
Lisa Caputo
6-7-93
6-14-93
Morning Show Strategy
Communications
Bob Boorstin
6-7-93
6-14-93
Local Television Strategy
Media Affairs
David Anderson
6-7-93
6-14-93
Radio Talk Show Strategy
Media Affairs
Richard Strauss
6-7-93
6-14-93
Madison Avenue Ad Group
Communications
Mandy Grundwald
6-7-93
6-14-93
Health Care Dictionary
Conimunications
Bob Boorstin
6-7-93
6-14-93
Health Care University
Policy
Chris Jennings
6-7-93
6-14-93
Supporters List
Public Liaison
Mike Lux
6-7-93
6-14-93
Health Care Press Packet
Communications
Bob Boorstin
6-7-93
6-15-93
Graphics Package
•
First Lady
Research
Meeghan Prunty
6-7-93
6-15-93
•
Page 1
�.-.r
. _,,..
· Targeting List
•
Information Sheet
White House Health Care Campaign
Targeting List
Project Name
Schedule Status
6-7-93
6-9-93
Est. Finish Date
Est. Start Date
Responsibility
Policy
Chris Jennings
Dept. Responsible
Person Responsible
Description
Prepare the best guess list of swing states and congressional districts needed for passage of health care.
••
••
Future Requirements
List
�...
.~
. _r:·
Materials List
•
Information Sheet
White House Health Care Campaign
Materials List
Project Name
Schedule ·Status
6-7-93
6-10-93
Est. Finish Date
Est. Start Date
Responsibility
Research
Meeghan Prunty .
Dept. Responsible ·
Person Responsible
Description
Prepare list of materials needed for Health Care Campaign
•
Future Requirements
List
Projected Costs
�-·
Ira Magaziner · Press Packet
~
•
"
Information Sheet
White House Health Care Campaign
Ira Magaziner Press Packet
Project Name
Schedule Status
6-7-93
6-11-93
Est. Finish Date
Est. Start Date
Responsibility
Policy
Carolyn Gatz
Dept. Responsible
Person Responsible
Description
Prepare press packet on Ira Magaziner. Should include B&W photo, bio, comments from the President.
•
•
Future Requirements
_ Get Photo Taken and Reproduced
Printing
�·-· ..
·~
•
..,
Talking Points List
.
Information Sheet
White House Health Care Campaign
Talking Points List
Project Name
Schedule Status
6-7-93
6-11-93
Est. Finish Date
Est. Start Date
Responsibility
Public Liaisoin
Mike Lux & Chris Jennings
Dept. Responsible
Person Responsible
Description
Prepare a list of fax numbers of people and organizations that would need to get a daily set of health care
talking points
Future Requirements
••
.
•.
_
Fax List
·
�.-...
.~.···
Communications Strategy Memo ·
Information Sheet
White House Health Care Campaign·
Communications Strategy Memo
Project Name
Schedule Status
6-7-93
6-11-93
Est. Finish Date
Est. Start Date
Responsibility
~R~e~se~M~c~h----~--------------------~M_e_e~gh_a~n~P_ru_n~ty~~------------------Dept. Responsible
Description
Best of Rockefeller plus the best of our meetings
•
•
Future Requirements
Written Plan
Person Responsible
�. ~.--·
__
....
• _.r>-
Surrogate Strategy .
•
Information Sheet
White House Health Care Campaign
Surrogate Strategy
Ahead
Project Name
Schedule Status
6-7-93
6-14-93
Est. Finish Date
Est. · Start Date
Responsibility
-=S=-c_he=-d~u=-li_.ng~--:~---------- ·Alan Hoffman
Dept. Responsible
Person Responsible
Description
Concieve and write a strategy for placing health care surrogates .in targeted media markets beginning
10-days prior to the announcement and continuing 2-weeks after.
•
•
Future Requirements
Writen Plan
Calendar
�,;!_......
.....
Network ·Television Strategy
Information Sheet
White House Health Care Campaign
Network Television Strategy
Project . Name
Schedule Status
6-7-93
6-14-93
Est. Finish Date
Est. Start Date
Responsibility
Communications
Bob Boorstin
Dept. Responsible
Person Responsible
Description
Concieve and write a strategy for selling health care on network television starting 10-days prior to the
announcement and continuing for 2-weeks following the announcement.
•
•••
Future Requirements
Written Plan
Calendar
�·-.··
.~
Daytime Television Strategy
•
Information Sheet
White House Health Care Campaign
Daytime Television Strategy
Project Name
Schedule Status
6-7-93
6-14-93
Est. Finish Date
Est. Start Date
. Responsibility
First Lady
Lisa Caputo
Dept. Responsible
Person Responsible
Description
Concieve and write a strategy for dealing with daytime television, re: Donahue, Ophra, beginning
10-days prior to the announcement and continuing 2-weeks after.
•
Future Requirements .
Written Plan
Calendar
�·-.~·
. --~
Morning Show Strategy
•
.
· Information Sheet
White House Health Care Campaign
Morning Show Strategy
Schedule Status
. Project Name
6-14-93
6-7-93
Est. Finish Date
Est. Start Date
Responsibility
Communications
Bob Boorstin
Dept. Responsible
Person Responsible
Description
Concieve and write a strategy for having a presence on the network morning shows beginning 10-days
prior·to the announcement and continuing 2-weeks after.
••
•••
Future Requirements
Written Plan
Calendar
�........
. ..,§
...
. __ ,..
___...
Local Television Strategy
•
Information Sheet
White House Health Care Campaign·
Local Television Strategy
Project Name
Schedule Status
6-7-93
6-14-93
Est. Finish Date
Est. Start · Date
Responsibility
Media Affairs
David Anderson
Dept. Responsible
Person Responsible
Description
Concieve and write a strategy for placing health care surrogates in targeted media markets on local
television beginning 10-days prior to the ai:mouncement and continuing 2-weeks after: The focus should
be on health care reporters as well as on local television talk/variety shows.
•
•
Future Requirements
Written Plan
Calendar
�.
-.......
-~
Radio .T-alk Show Strategy
Information Sheet
White House Health Care Campaign
Radio Talk Show Strategy
Project Name
Schedule Status
6-7-93
6-14-93
Est. Finish Date
Est. Start Date
Responsibility
Media Affairs
Richard Strauss
Dept. Responsible
Person Responsible
Description
Concieve and write a strategy for deaJing with TaJk Radio and for placing surrogates on these shows
beginning 10-days prior to the announcement and continuing 2-weeks after.
••
•
Future Requirements
Written Plan
Calendar
�:~--
...,,;·
.. --~·
Madison- Avenue Ad Group
•
Information Sheet
White House Health Care Campaign
Madison A venue Ad Group
Project Name
Schedule Status
6-7-93
6-14-93
Est. Finish Date
Est. Start Date
Responsibility
· Communications
Dept. Responsible
Mandy Grundwald
Person Responsible
Description
Pull together the campaign group of ad executives on how to talk about health care
•
••
Future Requirements
Meeting Schedule
�:;!..... -
.-,il
Health· Care· Dictionary·
•
Information Sheet
White House Health Care Campaign
Health Care Dictionary
Project Name .
Schedule Status
6-7-93
6-14-93
Est. Finish Date
Est. Start Date
Responsibility
Communications
Bob Boorstin
Dept. Responsible
Person Responsible
Description
Prepare a dictionary of terms to be used to explain health care plan.
•
•
Future Requirements
Glossary of Terms
Printing Cost
�:;L -.
__ ...
·-.oi
Health.. Care University
•
Information Sheet
White House Health Care Campaign
Health Care University
Project Name
Schedule Status
6-7-93
6-14-93
Est. Finish Date
Est. Start Date
Responsibility
Policy
Chris Jennings
Dept. Responsible
Person Responsible
Description
Prepare curriculum and schedule for education House, Senate and White House staff on the health care
plan. Work with Rockefeller and Daschle staff on logistics
••
•••
Future Requirements
Written Plan
Calendar
�.Z... ....
·"'···
. _.r
·Supporters. List
••
Information Sheet
White House Health Care Campaign
Supporters List
Project Name
Schedule Status
6-7-93
6-14-93
Est. Finish Date
Est. Start Date
Responsibility
Public Liaison
Mike Lux
Dept. Responsible
Person Responsible
Description
Prepare early list of groups that will support the health care plan. Indicate degree of support
•
•
Future Requirements
List
�---6~
.....
.--...
·-..-·
• ..-1':"
Health- Care Press Packet·
•
Information Sheet
White Hotf,se Health Care Campaign
Health Care Press Packet
Project Name
Schedule Status
6-7-93
6-15-93
Est. Finish Date
Est. Start Date
Responsibility
· Communications
Dept. Responsible
Bob Boorstin
Person Responsible
Description
Prepare a generic press packet that can be sent out upon demand by the WH Press Office and Media
Affairs
·
••
Future Requirements
Prepare Packet
Printing
�·-...
.-;::........
. _.r
A
Graphics Package
•
Information Sheet
White House Health Care Campaign
Graphics Package
Project Name
Schedule Status
6-7-93
6-15-93
Est. Finish Date
Est. Start Date
Responsibility
Research
Meeghan Prunty ·
Dept. Responsible
Person Responsible
Description
Per Boorstin, work up a graphics package for both print and television.
•
'
.•
·Future Requirements
Plan
Materials and resources needed
�•
TO:
Maggt..! Williams
FR:
Mary Schuneman
DT:
6/5/93
R7
Despite the risk of my repu tatlon of correspondence genius being dispelled
forever, I have outlined the current operation in the health care
correspondence office. This will enable the new director to have some form of
training without my being here. It is self-explanatory and should provide
answers to the questions that one would ask upon taking such headacheprone responsibility considering the mountains and mountains of paper
involved. I Wish everyone involved well. And I am happy to offer my consulting
services (pro bono) if necessary.
Thank you for your guidance and assistance throughout the last seven
months. This has been a very interesting and exciting opportunity that I will
never forget. I look forward to having the chance to visit soon.
- - - -
--·-------
�•
TO:
Magsie Williams
Marge Tarmey
Helaine Greenfeld
FR:
Mary
DT:
6/4/9:-i
RE:
Health Care Correspondence Procedures
Schuneman~!?
Following is a brief description of supervisory responsibilities and the people who
are currently serving in these roles:
1. Director -
e
.Supervises daily operations; serves as liaison to First
Lady's office, First Lady's correspondence, Ira's office,
First Lady's personal correspondence, Volunteer office,
and Communications; provides status reports to and
troubleshoots with Ira's and First Lady's offices;
authority for ordering supplies, stationery and printed
postcards for responses (need approval from First Lady's
office for print language), contact to IlllS reading room,
Department of Justice, and Administration.
2. Helaine 0reenfeld -
responsible for VIP mail, emptying in-box, forwarding
unrelated mail, determining response for letterhead
mail, maintaining log of letterhead letter responses for
Mike Lux
3. Mike Cooper -
special stories project, assisting with volunteer
recruitment
4. Holly Nelson -
maintains and updates volunteer list, responsible for
phone schedule, assists with in-box
5. Mike Mudha-
responsible for opening, inventory of mail, assists Mike
Cooper with special projects
6. Barbara Allen -
recruits volunteers, assists Holly with list upkeep and
volunteer files
7. Geoff TiLbetts -
supervises data entry and printer output of physicians
and policy mail
More detailed descriptions of these roles are attached. The number in the left
column corr-=sponds with the attachment.
�lJ_)
.e
DIRECTOR·~;
OVERVIEW
ARRIVAL
Mail room delivers mail addressed to First Lady and/or Health Care Task Force
daily to intake center. Incoming mail is either placed in IN -BOX or arrives in
boxes with number of pieces marked on outside of box on white address label that
are placed outside the door. Incoming mail is moved to back room where it is
placed on sl.elf for mail to be opened. Box is marked in black marker with date
and type of mail (#10, flat, bulky, etc.).
OPENING
Mail is open~d in order of date received. (i.e. mail received 3/2/93 must be opened
before mail received 5/15/93.) Letter is retreived from envelope and scanned for
full return Qddress. If a full return address is included with the letter, then the
envelope may be discarded. If full address is not on the letter but is on the
envelope, the envelope should be stapled to the left corner behind the letter. If
there is no address on either the letter or the envelope, the envelope may be
thrown away and the letter should be marked "NRN" in the top right corner.
Mter the letter is scanned for the address, a coding sheet should be stapled to the
left corner of the letter "back-to-hack" with the type facing outward. The letter
should then be pre-coded as either "light," "heavy," "physicians," or "letter
campaign," o.md placed in the appropriate box. When the light and heavy boxes
are full, the.>' are placed on the shelf for mail to be coded. Presorted letter
campaign and physician mail should be moved to the appropriate boxes in the
"needs respo.1se" area. Letter campaign letters do not receive a response -therefore, wl1en there are more than five boxes of letter campaign stacked in this
area, the bo.-::es need to be moved to the reading room at HHS. (See Reading
Room belO\v.) The physicians mail is ready for inputting by the data entry
workers.
CODING
Mail coded Light and Heavy is read thoroughly to deterP.Hzte in which cat&gory on
the coding sl1eet it belongs. (See attached for definition~and coding shee'e.J After
the proper cuding category is marked on the coding sheet, the mail is sorted by
category intu the appropriate boxes in the "needs response" area. The exceptions
to this are U.e categories in the "ReRoute" section of the coding sheet:
Casework - l'eroute via interoffice mail to Jenny McCarthy in OEOB 91.
Scheduling - reroute via interoffice mail to Alan Hoffman in OEOB 160.
President's mail - reroute via interoffice mail to Correspondence in OEOB 90.
61
Other mail, including VIP mail- see attacheamemo from Helaine.
�.e
RESPOND:.iNG
The mail in the boxes in the "needs response" area is responded to with either a
postcard or iorm letter:
POSTCARDS - General mail, personal stories and letterhead mail marked
with a "P" all receives postcard 1 -- with the First Lady's signature on it.
Offers to help and resumes receive postcard 2 -- signed by the Health Care
Task Force. Postcards are hand-addressed by volunteers. The letters in
each category should be individually date-stamped and kept together for
filing after the responses are generated. The group of letters in each
category should be placed in the appropriate boxes in the "FILE" area.
FORM LETI'ERS - Physicians, policy and letterhead mail marked with an
"L" all receive~ form letter. Letterhead is handled by Helaine (see her
attach2d me~) Policy and physicians letters are inP._Rtted into a
name/address list in wordperfect. (See attached me~from Geoff.) The
letterB in each category should be individually date-stamped and kept
togeth2r for filing after the responses are generated. The group of letters in
each category should be placed in the appropriate boxes in the "FILE" area.
** The language in the letters and the postcards has evolved since the
task force Legan. New language should be drafted now that the task
force has dissolved and the effort to introduce and pass the legislation is
underway. Contact Melanne Verveer, Jeff Eller, and Bob Boorstin for
informatioJ, to include in the language as well as for f"mal approval before
the language can be printed and sent out.
FILING
The letters already responded to and marked with a date-stamp, should be filed
by category in an archives box. Letters should be filed standing up, sideways
{they fit best this way) until the box is filled. The filled box should be labeled
with the date, category, and which response it received. The category decides
where it goes:
Personal Stories are stored in our offices for special projects.
PoliC)', Letterhead and Letter Campaign are sent to the HHS reading
room. (See next paragraph detailing this procedure.)
Gene1·al mail, other health providers, offers to help/resumes, and
physidans are sent to Archives. Call the office of records management at
x2242 and request a pick-up of boxes to be archived.
�w--
·•
HHS HEALiNG ROOM
The health care correspondence office is required by law to make selected
materials available to the public. A reading room has been set up at the
Department of Health and Human Services for the public to view these selected
documents.
After they huve been responded to, policy, letterhead and letter campaign letters
should be stnt to the reading room. But first, the coding sheet must be removed
and bate-stamped along with the letter. Jeff Gutman, Dept. of Justice, 514-4775,
is your contact for detailing DoJ employees for bate-stamping the documents.
Stacia Croprjer, EOP administration, 395-6963, is your contact for requesting a
pick-up of the boxes. The boxes should have an outside cover sheet identifying
what is inside. (See attached.~our contact at the reading room is Meghan, 6906797. You should be in touch with her and/or Stacia when the reading room is
closing <TBD) to arrange for the return of the boxes to Archives.
ADMINISTH.ATION
Any requirements or problems with office supplies, equipment and furniture,
WAVES, etc. shuuld be directed to Peter Siegel at x3133.
�MEMORANDUM
TO:
FROM:
SUBJECT:
DATE:
Mary Schuneman
Helaine Greenfeld
My duties in the Intake Center
May 24, 1993
My duties at the Intake Center have evolved into six main
categories, most of which involve identifying mail that needs
special treatment or responses.
1}
Congressional Mail
I handle all incoming mail from members of Congress. This
mail generally falls into 3 categories:
o Member advocating her/his own position on health care
o Member forwarding mail/ suggestion/ policy of
constituent on health care
o Member recommending someone for position with task
force
Letters in the first category are sent directly to Shirley
Sagawa - WW/2FL. For letters in the other two categories, I
prepare pre-approved form letters for autopen signature and send
them, along with a copy of the first page of the letter I am
responding to, to Mr. Everett Hauser in Room 76. He has the
autopen sign the letters and sends them out. (If I make a
mistake, or forget to enclose a copy of a letter, he will send
the mistake back for correction}. The originals of the letters
in the last two categories then get sent on to Shirley, with my
initials on the top of the page so she knows they've been
responded to.
3)
Intergovernmental Mail
Any mail on health care from a state or local government
elected official gets routed to Michael Sussmann in the Office of
Intergovernmental Affairs - 106 OEOB. He handles this
correspondence for John Hart in IGA.
3)
HRC Personal Mail
This is mail that we identify either as it comes in the "In
Box" or through coding as VIP mail, and should be mail from
people who actually know Mrs. Clinton. I send these letters to
Millie Alston - EW/2FL, Mrs. Clinton's personal secretary.
Sometimes it is difficult to tell whether or not Mrs. Clinton
actually knows the correspondent, but I usually err in their
favor, with a cautionary note to Millie telling her to send back
any mail HRC does not want to answer.
Sometimes Millie routes the responses and the originals back
through me. If the letter she has written says that the letter/
policy/ suggestions, etc., have been given to the task force, I
take it to Susannah Wellford in Ira Magaziner's office. If no
such promise has been made, I file them in a box eventually bound
for storage in the archives or the reading room.
�Memo to Mary
Helaine's duties
4)
Other "Special Handling"/ Reroute
Most of the other mail that ends up in the special handling
box is miscoded, and can be receded more properly as general mail
or letterhead. Some of it is casework, which I simply place on
the casework shelf in the third room. Any other special mail
usually falls into the categories of HRC mail, Presidential mail
or HRC Personal mail. The HRC mail gets rerouted (without the
Intake Center coding sheets) to First Lady Correspondence - 19
OEOB; Presidential mail, i.e., all mail addressed to the
President, gets rerouted to Presidential Correspondence - 94
OEOB.
5)
Letterhead
Letterhead mail gets divided into two categories: Letter
and Postcard. I have been trying to get to the letterhead mail
after it has been coded and mark each piece as either L or P.
The P mail receives the regular postcard response, while the L
mail gets a form letter directed to the associations. L mail is
usually from national associations, unions, non-profits, and
other politically sensitive groups. After I type in the names
and addresses of the L mail correspondents, I send a list of them
down to Mike Lux - 116 OEOB, for his approval. A day later I
mail the letters out.
Sometimes there are L letterhead letters that should not get
a form response. These include major labor unions, major medical
or nursing associations, major non-profits, major religious
organizations, and letters from groups who explain that they have
already met with representatives of the task force, and are
sending requested follow up information. These types of letters
get sent directly to Mike Lux.
6)
In Box
I have also become the unofficial keeper of the In Box
whenever I am here. This simply means that I open and sort the
mail delivered through the interoffice system. I try to
categorize as much of it as I can before giving it to the back
room as "raw mail." This is a time when the person opening the
in box mail should be on the lookout for mail addressed to
specific people on the task force, for scheduling mail, or for
letter campaigns. It is also a good time to weed out and reroute
letters addressed to the President or Vice-President (the latter
go to 263 OEOB).
And • . . 7) Miscellaneous
I also address postcards, answer the phone, and sort through
mystery piles which accumulate around the office.
-2-
�HCTF Intake Center
Assistant, Special Projects
1.) Supervise recruitment and retention of volunteers for office
operations, telephones coverage, mail coding/sorting, data entry.
Troubleshoot personnel issues.
2.) Coordinate volunteer managers' supervision of day/evening
shifts of intake operations. Assist Correspondence Director to
obtain shifts coverage and in communication of daily priorities.
3.) Assist in-house volunteer coordinator to welcome new
volunteers, process necessary security-clearance paperwork,
facilitate daily access of volunteers into OEOB, liaison with
OEOB Volunteers Operations Center (Rooms 77 & 39), search for new
recruits, and develop activities aimed at retaining existing
volunteers pool.
4.) Establish databases of correspondence in coordination with
Director of the Intake Center pertaining to priority political
issues including potential witnesses for public testimony,
documentation from clinical personnel, issues of specific
regional importance, policy positions of interest groups, and
personal stories. Respond to requests from Task Force or Members
of Congress for primary sources of these issues.
5.) Maintain a sense of humor about the enormity of the task,
and enthusiastically communicate the same to those around me.
�.41t
Update volunteer list
The volunteer list is on the disk marked "volunteers," in
the file named "masterls." For each entry, we note the
exact name the person uses for identification (put nickname
in parentheses), the time they will be here (for 9:30, put
9:) in the correct column to indicate the day, the person's
date of birth, the social security number, the phone number
(home phone listed first, office phone beneath), and "f" for
completed White House Office Supplemental Information Sheet
for Personnel Action form and "r" for resume. Note if the
form has not been filled out ("no form yet") and indicate
the date the person has agreed to start. I make three
copies, one for Barbara Allen, a Master List to tack to the
bulletin board, and one for myself.
New name list for room 77: Each time I add a name to the
volunteer list for whom we also have a completed form, I add
that name to a "new name" list. I create a new name list for
each day I update the master list. I simply block the first
two lines of the entry on the volunteer list and copy it to
a second document ("newnames.603" for June 3). You can also
indicate deletions for those who are no longer volunteering.
I make two copies of this list, one for our file and the
other for room 77. Take this copy to room 77 and hand it to
Claude or another in-charge-looking person and be sure he or
she knows this is for updates to the Health Care Task Force
volunteer list.
Encourage people to write changes on the Master List and try
to update it weekly.
Phones
'
Answer the phone by saying 1t•••II!SII&ii&'IS··••t £•1iiiif"health care correspondence."
/
Review carefully the instructions "Guidelines for Health
Care Task Force Calls." This is on the disk in the file
,.. named "HCTF" and should be on the wall next to the phone.
Persons trained to answer the phones are listed on the
"Telephone Schedule" found on the disk as "Phones."
�.e
INTAKE CENTER
WORK ROOM SUPERVISOR
The overall responsibility of the work room supervisor is to
identify and keep track of all correspondence and related
materials, from the time it is received at the drop-off site
outside the Intake Center until it has been coded and placed in the
hallway for pick-up and further processing, and to supervise and
direct the work of the volunteer staff throughout the mail opening
and coding procedures. Typical duties for the work room supervisor
include the following:
A.
Preparing Mail for Processing
Performing the various steps in the Mail Preparation task as
outlined in Mail Processing Procedures. This is appropriately
a supervisory function since it is important for the mail to
be organized, packed and stored in a manner which best
facilitates further processing, and because of the opportunity
this provides to determine the quantity and nature of the
incoming mail.
B.
supervising Triage Procedures
Selecting and positioning the stock of mail for use by
volunteers, organizing or directing the organizing of work
materials, orienting new volunteers, generally overseeing the
work of the volunteers on the triage activity as outlined in
the procedures, answering volunteer questions and dealing with
unusual correspondence, packing or supervising the packing of
filled storage boxes, the transfer of filled boxes to the
storage area, and the preparation of replacement boxes.
c.
supervising Regular Coding Procedures
Selecting and positioning the stock of mail for use by
volunteers, working with veteran volunteers to ensure that
work materials are available and that new volunteers are
oriented and supervised, generally overseeing the coding
activity following the procedures as outlined, supervising the
transfer of coded materials to storage in the hallway, packing
or supervising the packing of General Mail and Other Health
Care Provider boxes and arranging for them to be placed in the
appropriate location in the hallway.
�.e
WORK ROOM SUPERVISOR continued
D.
supervising Special Coding Activities
Selecting materials for special coding projects, supervising
the transfer of materials to the special coding site,
orienting and supervising volunteers in the coding activity,
answering questions and dealing with unusual situations as
they occur, supervising the repacking and return of coded and
uncoded materials to storage in the work area, supervising the
subsequent sorting of coded materials.
E.
Processing Flat and Irregular Mail
Either personally processing the mail or supervising the work
of one or more experienced volunteers, following the outlined
procedures, arranging for the collection and storage of books,
videotapes, audio tapes and health artifacts, notifying the
Director of the Intake Center of any unusual materials
received, transferring or supervising the transfer of filled
boxes of materials to the hallway.
F.
Ordering supplies and Materials
Informally or formally inventorying available supplies and
work materials, supervising the requisitioning of replacement
supplies, as needed, placing order for the printing of new
coding sheets, working with the print shop on the completion
of the order, transporting newly printed coding sheets to the
work area.
G.
working with Volunteers
Informally monitoring and evaluating the work of the
volunteers in the mail processing area, providing assistance
to any volunteers that appear to experiencing difficulty and
identifying the most successful performers, selecting and
orienting volunteers for special assignments or supervisory
functions.
B.
controlling the Work Flow
Monitoring the flow of correspondence within the work place,
including making a daily inventory of the number of boxes of
new incoming mail, the backlog of unopened #10 mail and
unprocessed letter mail, and the backlog of opened but uncoded
mail. Reporting to senior staff and adjusting the mail
processing procedures and priorities as needed.
-----------------
-
--~----
----------
-~------
-
-
-------~
- - - - - - - - -
�.e
MEMORANDUll
TO:
Mary Schuneman
FR:
Barbara Allen
RE:
HCTF Responsibilities
In addition to assisting Mary Schuneman with the day-to-day
operations of the office, I have been primarily responsible for
the recruitment, retention and training of volunteers for the
Health Care Task Force Intake Center.
Currently, the Health Care Task Force Intake Center has 183
active volunteers who assist with the opening, coding and
responding to HFTC-related mail.
Recruitment
Recruitment of new volunteers fall into two categories:
individuals and groups.
Many individuals who are working on the Task Force have been
recommended to us by Task Force members, while others may have
contacted the Task Force directly to inquire as to volunteer
opportunities. Due to the specificity of the work and the need
for confidentiality, groups contacted to assist us have primarily
come from traditional Democratic sources: Democratic National
Committee, Women's Democratic Club, College Democrats at various
local colleges, etc. Now that the working groups have completed
their work, we are now expanding our recruitment to groups such
as Older Women's League, Women's Information Network, Teen
Democrats, Black Social Workers of DC, church and social
organizations.
For individuals contacting the HCTF to volunteer, ~ resume
is required as well as a pre-screening interview, usually over
the phone. This pre-screening is designed to remove any question
of a conflict of interest on behalf of the volunteer. Following
the initial contact and interview, an appointment is scheduled
for the volunteer to complete the appropriate security forms,
attend a briefing on access requirements and the HCTF operation.
Training is coordinated with available staff.
To handle the great volume of mail, we periodically have
"mail marathons" on Saturdays where we bring in groups of
volunteers, assemble in a conference room and code opened and
pre-sorted mail.
Retention
We have been extremely fortunate with consistency of our
volunteers. We have a core group of volunteers that have been
the mainstay of the HCTF Intake Center. With recruitment running
�.e
an averag~ of 5-10 new volunteers per week, this seems to have
kept our numbers at about 20-25 volunteers per day which is what
we can accommodate in our space currently. Summer and vacations
are taking its toll in the last week. Greater emphasis is being
placed on planning and coordination during this critical summer
months to ensure that our numbers of volunteers remain
consistent.
In addition, we have tried to provide unique opportunities
to our volunteers that are only available at the White House.
For example, special White House tours, attendance on the South
Lawn for Presidential departures, tours of the OEOB, etc. On
special "mail marathon" days, lunch/snacks are provided.
Incentives are very important for morale and consistency.
Training
Training in each of the operations of the mail opening,
coding and postcard/letter responses is done on an individual
basis with oversight by a number of staff. It is my
understanding that this process has been described in detail in
another section.
�MEMO
To:
From:
Re:
Mary ::;chuneman
Geoff Tibbetts
Supervision in printing HCTF letters
A process for printing task force correspondence has been
established Hith designated "policy" or "physician" letters. These
letters have been identified in the coding process, and have been set
aside in boxes marked either "policy" or "physician."
Among the responsibilties in supervising this section include:
(1) training capable volunteers in the art of accurate data entry; (2)
providing oversight in editing and spell-checking of the data-files;
and (3) managing the printing of the letters/envelopes on White House
stationery. In general, these responsibilities should expect a high
degree of "quality control" because of the visibility these letters
will recieve once they are mailed.
The procedure for printing the letters is as follows:
First, a volunteer data-enters the names and addresses of
individuals using the Merge-format in Wordperfect. Only two merge
fields are utilized, so this process is fairly simple. Other than a
correct format-entry, the most important thing is to ensure the data
includes an accurate spelling of names, titles, organizations,
residences, states, zip codes, etc.
After data entry, the file is saved on the hard-drive or a
specified diskette, and the file should be named by date, letter-type,
and the volunteer's initials. This system denotes an easy recognition
of the lette£-type and also helps establish printing priority.
For printing, simply merge the "policy" or "physician" letter with
the name and address files. Before the merge, visually scan the file
and check fo£ spelling errors and correct format usage. Prior to
printing the file, place White House letterhead in the print tray. Use
the same merge format for printing labels for the envelopes. If there
are questions as to computer commands for this function, please refer
to the attached the Data-Entry Instruction Sheet.
Finally, enter all files in the notebook designated "Print Log."
This log giv8s a systematic record of the files printed to date, and
also provides the number of letters printed on a daily basis.
�,,·
HEALTH CARE TASK FORCE DATA-ENTRY INSTRUCTIONS
.e
LOGGING ON AND SETTING LABELS FORMAT
1. Logging on to the Computer & Entering WordPerfect
A. When the user name appears; HH Enter twice
B. When the password appears; Type 123456
C. When the menu appears; Hit Enter twice
D. You are now in a blank WordPerfect document
2. Setting up Labels Format
A. Hold down Shift, Hit FB
B. Choose 2, page
C.
•
7, paper size
D. When the list of labels appear Choose the appropriate size
label with your cursor, and Hit Enter
Note: We only use two types of labels (4 x 1 1/3; 14 and 2 5/8 x 1; 30)
E. Hit F7, until you are back at the blank document
F. Hold down
Ct~.
Hit FB
G. Choose F, Font
H. Choose Swiss Narrow; Hit Enter
I. Enter 12, for point; Hit Enter
J. Hit F7, unitl you are back at the blank document
�.e
--------
LABELS FORMAT
3. Entering Labels
A. Type the name of the constituent, Use prefixes for Dr.'s Q
NOTE: Do not type any suffix, e.g. Ph.D, M.D., R.N.
1. Type the title if applicable.
2. Type name of business if applicable
B. Type the street address of the constituent; when possible spell out all information, abbreviate
when necessary to make label fit.
NOTE: Abbreviate words such as, North & South, etc.; Street & Road,
Always abbreviate "Apartment"; Apt.
C. Type the city and state; Only use 2 letter postal codes for states
D. Type Zip Code; Hit F9
E. Type Salutation (Policy Letter Only); Hit F9
NOTE: Do not add any punctuation, No Commas or Semi Colons
F. Hold Down Ctrl, Hit F9
G. Choose 2, for End Record
EXAMPLE OF LABELS:
Home Address
John R. Smith
111 Anywhere Street, Apt. 23
Anytown, XX 11111-1111
Mr. Smith
Business Address
John R. Smnh
Head Hauncho
Health Care ke Us
111 Anywhere Street, Suite 222
Anytown, XX 11111-1111
Mr. Smith
REFER TO THE STYLE GUIDE WHENEVER YOU FEEL THAT YOUR LABEL DOES
NOT FIT THE GENERAL FORMATS ILLUSTRATED ABOVE.
-------------------------------------
�SAVING AND RETREIVING LABEL DOCUMENTS
1. SAVING LABELS DOCUMENT AND EXITING WORDPERFECT
A Hit F7
B. Hit Y, for Yes save document; Hit Enter
C. Type in the name of the document
Note: Do not specify a drive name, the system bas a default
D. Hit Enter
E. Hit N, for No to Exit WordPerfect
1a. SAVING LABELS DOCUMENT WITHOUT EXITING WORDPERFECT
A Hit F10, Follow Instructions of 4A-4D
2. RETREIVING LABELS DOCUMENT (2 methods)
Method 1:
A Hit FS (twice)
B. Place cursor on your document; Hit 1, to retrieve document
C. Document will then load and appear on your screen
Method 2: Use only when you know the document name
A Hold down Shift; Hit F1 0
B. Type the name of the document; Hit Enter
C. Document will then load and appear on your screen
�PRINTING LABEL DOCUMENTS
1. PRINTING LABELS AND LETTER DOCUMENT FOR PROOFING
A. Hold down Shift, Hit F7
B. Hit 1, Full Document
C. Pick-up Labels in Printer and deliver to proofers
1a. PRINTING LABELS AND LETTER DOCUMENTS (FINAL)
A. Hold down Ctrl, Hit F9
B. Choose 1, Merge
C. For Labels: Type "Label.pf", for primary file; Hit Enter
• Letters: Type "policy.let, for primary file; Hit Enter
D. Type Your Label file name, for Secondary file; Hit Enter
E. Hold down Shift, Hit F7
F. Hit 1, Full Document
G. Pick up the labels from printer and deliver to proofers and stuffers
�CATEGORY DEFINITIONS
POSTCARD 1
GENERAL MAIL
General correspondence to the Task Force related to health care that
does no.t merit special attention and does .run fit Into another category
PERSONAL STORIES
Sharing experiences with health care system and
Intervention or assistance
nm asking for
OTHER HEALTH PROVIDERS
Any writer who works In the health profession who Is nat an M.D. or Its
equivalent
LEnER CAMPAIGN
Form letter advocating specific Interests (I.e. chiropractic coverage,
medicare reform)
POSTCARD 2
OFFERS TO HELP/EMPLOYMENT
Seek to volunteer or gain employment
FORM LEUERS
LEnERHEAO
Interest groups, organizations, companies, etc. related to health care
POLICY
Well-researched solutions for reform
PHYSICIANS
Any writer who Is an M.D. or Its equivalent
REROUTE
•
•
•
•
•
VIP/Prlorlty- Elected officials, celebrities, friends
Scheduling Requests - Invitation to event or to set up meeting
Casework - Personal story requesting help for •crisis• situation
President's Mall - Mall addressed to President Clinton
Other mall (not related to health care)- Doesn't fit any other category
�CODER: _ _
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:._ _
GENERAL SORT:
_General mail
__Personal stories
__Other Health Providers
POSTCARD 1:
_Letter Campaign
POSTCARD 2:
_Offers to help/Employment
FORM LETTER:
_Letterhead
_Polley
REROUTE:
_Casework
_Scheduling _President
_Ph)'llicians
__Other
POLICY AND PERSONAL STORIES:
_ORGANIZATION (I)
_COST ISSUES (VI)
_drug prices
__physician fees
_hospital fees
_medical equipment
_fraud &: abuse
_insurance premiums
_insurance reform
_insurance pools
_boards and oversight
_COVERAGE (II)
_working families
_unemployed/low income
_benefits
__providers
_FINANCING (VII)
_MENTAL HEALTH (IX)
_INFRASTRUCTURE/WORKFORCE
_quality assurance (guidelines)
_administration, reimbursement
&: information systems
_malpractice &: tort reform
_manpower issues (training)
_unnecessary procedures
_GOVERNMENT PROGRAMS
_medicare
_medicaid
_veterans
_DoD
_Indian health
(IV)
em>
_LONG-TERM CARE (X)
_PUBLIC HEALTH/
SPECIAL POPULATIONS (XII)
__prevention
_AIDS
_women's health
_immunizations/children
_rural
_urban
_OT.HER~-----------------------
�TO:
DATE:
~·
~• FROM:
OFFICE OF RECORDS MANAGEMENT
Room/ v Extension 2- 2.-t-j'?--
E3
File
Drawer
DO:
So you want to retire office files!
Here are ten simple Do's and Dont's to make your task easier.
Put each carton together correctly.
Press the bottom flaps down inside the carton.
·
Tuck the top flaps when full.
Don't leaue the bottom flaps upright.
Don't tape the bottom or top flaps.
DO:
Use manila file or accordian folders.
Don't use ,.handing folders" or binders.
DO:
Send security classified documents separately.
Don't mix with nonclassified material, .
DO:
Place the files upright in the carton.
Don't lay them down.
DO:
111
Arrange the files in the carton as they are in the file drawer.
Arranged
"---c::=F=ile::::s=::..J
Don't rearrange them.
DO:
Prepare an inventory with ~taff and office name describing the
file arrangement and listing the file folder labels.
Don't send without inuentory.
DO:
Inventory
. List
Place a copy of the inventory inside the carton.
Don't tape it to the outside.
DO:
l\Iark the carton with the staff member's name and
office and the c~n's number.
#001
"-~----'
Don't send the carton unidentified.
DO:
Call regarding carton(s) pick up.
Don't send without aduance notice.
DO:
CALi. \VITH ANY QUESTIONS.
Jane Smith
Memorandum
of Call
�,
TO:
Maggie Williams /
Marge Tarmey
Bob Boorstin
Pam Barnett
Kelly Carnes
FR:
Mary Schuneman
DT:
6/4/93
RE:
Health Care Correspondence
CC:
Helaine Greenfeld
V9?
Beginning Monday, June 7th, Helaine Greenfeld will serve as the acting director
of the health care correspondence offices, now located in OEOB 410 and 412. Any
questions related to health care correspondence should be directed to her at x2813.
Beginning Tuesday, June 8th, I will be working for Anne Lewis at the Department
of Labor. I can be reached at 219-8211.
�THE WHITE HOUSE
WASHINGTON
May 17, 1993
MEMORANDUM FOR HILLARY RODHAM CLINTON
Through
Maggie Williams
FROM:
Jeff Eller
RE:
Susan Thomases Ideas and
I
Acti~m-r.-an--~
-
=================================================================
Susan Thomases and I talked at length on Sunday night about the
health care roll-out. Here are those ideas with an action plan
for implementation.
1.
Magazine Strategy
Goal:
To put forth the President and health care in women's magazines.
End result would by to have a salvo of magazine covers running
from July through September.
~
Action to be taken:
susan, through Ellen Levine at Redbook would set up an informal
lunch with the President and yourself to talk generally about
health care. That would be followed by separate editorial
interviews with the President. Minimum time required for each
sit down interview and photo would be one hour.
Timing:
Lunch during week of 5/24.
Interviews during week of
5/30.
Lead:
Bob Boorstin - George Stephanopoulos
2.
Health-Speak - Ten Hot Words
Goal:
~
To develop a common glossary of terms to be used when discussing
health care. This would be used by WH staff, surrogates and
supporters. It would be a road map for the speech writers and
message developers to promote consistency. From that will come
the "ten hot words", the words we think will best describe what
the health care plan is and means to people. Those words will be
taped to people's computers as a reference guide to health care.
susan indicated that wordsmiths from the advertising world would
be willing to lend a hand.
�•
Action to be taken:
Three meetings.
1.
Outlines of project.
Initial cut on terms.
2.
Revisions, changes corrections.
3.
Final product.
Needed in those meetings: Ad folks, Boorstin, Dreyer,
Grunwald, Eskew, Greenburg, Caputo, HHS rep.,
Christine, Lux, Hart, Michael Sheehan
Timinq:
5/24
5/26
5/28
Bob Boorstin - Mandy Grunwald
Lead:
3.
Meeting 1:
Meeting 2:
Meeting 3:
Media Training
Goal:
Train staff and surrogates to more effectively communicate the
message of health care.
Action to be taken:
Determine from Michael Sheehan if he can provide this service and
for what fee. Determine if there are funds to pay for this.
First cut on list would be Rubin, Sperling, Shalala, Riley,
Brown, top 10-task force members as determined by Boorstin.
Timinq:
Sheehan inquiry on 5/18.
Lead:
Jeff Eller
- - - - ------------
----
- - - - - - - - - - - - - - - - - - - - - - - '
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. fax
SUBJECTffiTLE
DATE
Letter from Collin Peterson to Charles Bowsher. [partial] (1 page)
05/14/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number: I 0813
FOLDER TITLE:
Interagency Health Team Binder
2006-0223-F
ab621
RESTRICTION CODES
Presidential Reeords Aet -144 U.S.C. 2104(a))
Freedom of Information Aet -IS U.S.C. SS2(b))
PI National Seeurity Classified Information [(aXl) of the PRA)
Pl Relating to the appointment to Federal offiee [(aX2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would diselose trade seerets or eonfidential eommereial or
finaneial information [(a)(4) of the PRA)
PS Release would diselose eonfidential adviee between the President
and his advisors, or between sueh advisors (aXS) of the PRA)
P6 Release would eonstitute a dearly unwarranted invasion of
personal prlvaey ((a)(6) of the PRA)
b(l) National seeurity elassified information ((b)(l) ofthe FOIA)
b(2) Release would disdose internal personnel rules and praetiees of
an agency l(bX2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would diselose trade seerets or eonfidential or finaneial
information ((b)(4) of the FOIA)
b(6) Release would eonstitute a dearly unwarranted invasion of
personal privaey ((b)(6) oftbe FOIA)
b(7) Release would diselose information eompiled for law enforeement
purposes [(bX7) ofthe FOIA)
b(8) Release would diselose information eoneerning the regulation of
finaneial institutions [(b)(8) of the FOIA)
b(9) Release would disdose geologieal or geophysieal information
eoneerning weDs ((bX9)oftbe FOIAJ
C. Closed in aeeordanee with restrietions eontained in donor's deed
of gift.
PRM. Personal reeord misfile defined in aeeordanee with 44 U.S.C.
2201(3).
RR. Doeument will be reviewed upon request.
-----------------------
�·~MWV
14 '93 15:83
or
~onp•
tht ttnittd ~tatrs
IUnJJt or tlrpracacalta
COMMITTlll otC GOVERNMIHT OrEMTION8
2111 fiAYIIUIIII Hova ()RiiCa 8~
w~.DCaoe, ... •••
Charles Bovaher
Coapt.z911el: Gene&-al
u.s.
Geheral Account!Dv Office
st., K.W.
washington, p.e.
441 G
20548
Daar 11r. Bowsher a
on xay
12, 19t3,
~sad.o.:-
~-ntativo, ai\DOUftOeel tn a press
,
••
Oft t:ha ~:~~~.
or the United states Tract• Representative
•tonatloD ot tba leadership qroup of Bleoted Of'ficial•
t:he ottice
a l)lpartiaan group or higlaly :respeote4 eta~ UMS local 1.81~-.~•
• • [Who) will work to CJ&nerate support for the
Meric:an Free 'll:ada AcJx"eeMI\'t). The Coali~lon•a 11111JDbeZ'BJil1D
oontd.hue to expmct. • It: vas aecompaniecl by statemMU
'""larllll
officials on why tbay favored NAFTA.
•Aabaasadar
Mickey
lantor
(S.. attached
Announoee
l.eadarsb.ip Group ot Blectad Offloial.a tor HAFTA,"
--~i~ed
'ltrli!•-
z,a~j8Mie
11J3).
The press :release li•tad three osn .aploreaa
peraona and provi4e4 an tJSTR telepboDe nwaber.
A call
SubOODittee etaff to that. DWIDer vas ru~ecs -t.o an 8lllliP~o.ne
US'l'R • • 1Dtarvovermaenta1 s~icm.
Tbat call
infOdl&tioD that tila aoal.ition ~ been cn:qaaizecs !)ecauae aataa
looal elected offiolale bacl called vsm Ud asked wbat. i:bey FV'&4u
do to euppo.ct !IUTA. It wu14 be expanded by the a44it.ion of ~at:~.ar
e18Gted off 1oiale Who
alp~ co~ VSD aid
aiCJb~ join upon
Uat• aJI4 also by those who
•would be .D\It
tbe peracmal nllUGtllt
bY bbaasaclor ltantor.
lleiiJ)ers would be enoouaged
.au~ar1a1 articles to~ local a041a aid uu otheE'
encourap &\IPJIOrt of RM'ft.
Based on this ~elhdDary lnqld~ by tJle
appears that the pro-KAnA lea4usbip 9l'OUP will J>e '%1UI
U&ft • • ~~ioea. '!he level. o~ 'JOV•rnaent. auppon to ba _ ..........._
this grassroots lobbyinfJ QrOUP ia as yet unclear.
t'beae act1v1ties xaise ser1o\l8 queaticme aboG~
etbi.cal v1olat.1ons an4 poas1ble arimlnel act1vit.1ea ou tlle
.,.
.......... ,.,
...
�MAY 14 '93 15:04
FROM DEC
---- PRGt. I::Ho;,:,
•
Ch~rlee
BovoheJ:
Hay 14, 1.993
Page Tvo
US'l'R official&' and employees.
section 1913 of Title 18 of
t1nited Statu COde declaras that.
No part of the money appropriated by any enactmen~ of
conqrass shall, in tha absence of express authorization
by Con<Jress be used direci:ly or indirectly to pay for IDY
pereona.l •~rvigo. a.c!vertis~111.vnt. tel em:.am. telephone,
letter. printed or written mptter 1 or other gevica.
intendgd or designed to influence in any manner a Member
2f congress. to fayor ~ qepose, by vqtc or oth•rwi•t·
anv legislation • • . wbethe~ before or after the
illtrodYction ot any bill or resolution pr9Rosinq sugh
legislation. (Emphasis added)
vio1:..t.ion of this provision of the criminal COde by govet"n11110n
offioia.ls is a misdemeanor, punishable by a fine of not more
$500 and/Or impt"isonment of not more than one year and,
notice and hearing, removal from offioe
o~
those orficials.
A1t.hough officers of the Executive Branch are free to co
Members of Congress to urge the introc1uct1on, JJASSaCJ• or dete
any leg-islation which affects their proqrams, very serious pro
arlsa wb.arl they bc!ccme 1nvolvad in ertorts to induce or· enCO'\b
aeahers of the public to lobby members of Conqrasa OJI
l8CJ1slat1on.
A GAO publication,
•PJ:>inciples of F
Approp~:iatd.oJUS LAw," de£:i.r~os such 0 graAaroots lobbying• aa fol
As you )mow, the HAl"TA agreement i:~ cxpeGtecl to J:,o 111
to Congress tol" approval sometl11\e later th1a year.
'J.'here
great deal of opposition to the agreement aa written in bo1:h
o~ CoJlgresa an<l 1n both parties, and Alllba.aaaclor Xantor haa ·
passage one
o~
his prioritias.
:I
can only assume t:hat tile
nu~~~
'see also. Committee on Axaed servicea, Su):,commJ.tt
Invuti;at:ions, "Allegations of Improper Lobbying by Depa
Defense Personnel of the e-sB and B-11 Aircraft and Sale to au4i
Arabia of the· Airborne Wa%1\iftCJ and Control systu, " c011111ttea Print
23, Dec. 30, 1982, pp. 1'-17.
�(
.
: MAY 14 '93 15:04
rl•
FROM DEC
PAGE.004
'
•
Cbarlea aovsher
14, 1993
Hay
Page Tbree
of OTR 1 s efforts in forminq this pro-RAFTA group is to
Members of congress to vote in favor of MArtA.
KoJ:"eover
appears that government appropriations have already boon us
produce printed materia1s aDd provide administrative
tbia effort, anct that more such axpenditures are P.&.IUlJlLea.
coming weeks.
Therefore, I aa rQquestinc;r tbat the General AceountinCJ
conduct a full 1nveatig<ion of these ac:tions by the Office of the
Otlited States Tracie Representative to c.!etermine ancl report
to
the S\ll)Committee whether there has been a use of appropriated
by the Offic::a of the Trade Representative to establish a tJr•o-JfA.B
lobbying qroup in possible viol<ion of 18 o.s.c. 1913.
of hea'V'Y lobbyin9 ourrently underway on thia issue ancl
expoo~tion tba~ ~o Administration will submit 4 NAFrA aq.~~~E~~
to congress by August or early septembor of this year,
•
requesting tbat this work he dono on an expedited basis •
Please have your staff contact Bdith Holleman,
staff director, at (202) 225-6751 to discuss a work
obtain any other information you may need for th1s
YO\U" ...ssi&tance in this
IHCa
•
~~a~~wLel
matter is 9'l'eatly appreciated.
�-------------------~
ORGANIZATIONS
�'
June 1, 1993
MEMORANDUM FOR HILLARY RODHAM CLINTON
FROM:
IRA MAGAZINER
JEFF ELLER
RE:
HEALTH CARE REFORM STRUCTURE
The purpose of this memo is to outline the working structure for the next phase of health
care reform. This structure assumes that we will have the full attention of senior White
House Staff at crucial times and that we will need full time coordination from within the
White House both for marketing the plan and guiding the policy through Congress. This
memo is broken into two parts; communications and policy.
POLICY
The policy we send to Congress will undergo substantial challenges, even by strong
supporters. Some members will offer amendments. Others will offer substitute bills.
Interest groups will urge battles on almost every issue in the bill.
As we work through this process, there must be tight, integrated coordination among
Legislative, Public Liaison, Intergovernmental Affairs and Policy Analysis. Coordination
should flow through the health care war room where negotiating strategies are established
and revised on a day to day basis.
Teams must be organized around issue areas to guide the progress of each set of issues
through the relevant committees. These teams should include policy, congressional, public
liaison, intergovernmental and communications.
A coordinating group should tie together these separate groups to consistently take the
temperature of the bill, its policy and political viability.
The policy coordinating group should help organize the issues to be brought to the
President and First Lady; should prepare materials for cabinet officials and respond to their
concerns; prepare materials for Members of Congress; and provide a liaison with the
marketing/communications effort.
This organization should form soon to coordinate the final drafting of the bill, the
Congressional briefings, the final interest group negotiations and final write up of the
policy. Jurisdictional issues must be decided soon as well as issues related to the interest
group coalition we expect to build.
An accompanying chart breaks down the staffing required. It should be staffed as soon as
possible so a coordinated timetable can be established.
1
�PAGE TWO
COMMUNICATIONS
The war room, based in room 160 of the OEOB, will function as the information center for
White House staff as well as be the focal point for rapid response, for both proactive and
reactive press. Within the war room, there will be a representative of each relevant White
House department as well as HHS. They will feed information back to their departments
as well as be a daily contact point for people within the White House and interested parties
from outside the White House.
The key to the war room will be information sharing and communication.
Everyone in the war room will have cross connections to various working groups. Policy,
legislative drafters and congressional relations are linked. Communications, press,
research and scheduling are linked. Each war room representative will be responsible for
reaching out to those people in the White House who are both directly and indirectly
involved with health care. Here is the breakdown of the war room structure:
Policy:
The policy representative will be responsible for
communicating the health care policy to the war room group, preparing response
information and being the chief translator between the message people and the policy
people.
HHS:
Responsible for keeping close ties with the primary
health care cabinet officials. Track what is done on a daily basis in HS and provide
information back to HS.
Surrogate Scheduling:
Surrogate scheduling will continue to place
surrogates as well as influence the scheduling of the cabinet secretaries. They will also
provide comprehensive tracking information and correlate it to targeting.
Public Liaison:
Track interest groups, manage briefing schedule and
provide information on where resources need to be targeted.
Congressional :Relations:
Manage briefmg schedule, provide daily hard count
of votes and provide daily targeting list of states and congressional districts in play.
Intergovernmental:
Track interest groups, manage briefing schedule and
provide information on where resources need to be targeted.
Communications:
Be liaison between White House Press Office, Media
Affairs, Research, Speech Writing and Planning
News Analysis:
Provide daily health care clips, analyze news trends,
do daily briefing on hot spots and positive stories.
Administration:
Make sure the trains run on time.
2
�PAGE THREE
Proposed Policy Organization
Coordinator: Ira Magaziner
Legislative Group
Greg Lawler
Karen Politz HHS
? Labor
? DOD
Policy Oversight
Judy Feder
Paul Starr
Robyn Stone
Sherry Gleid
Drafters
Melanne Veveer WH Steve Ricchetti WH
Chris Jennings HHS Mike Levy Treas.
? Commerce
? Justice
Charlotte Hayes OVP
Rick Kronick
Louis Quam
Larry Levitt
Ken Thorpe
Lynn Margherio
Arnie Epstein
Richard Veloz
Len Nichols
Marilyn Yeager
? Business Liaison
Intergovernmental
John Hart
??
Public Liaison
Mike Lux
Policy Liaison
Christine Heenan
Communications Liaison
Carolyn Gatz
3
Jerry Klepner HHS
Nancy Ann Min OMB
? Veterans
Walter Zelman
Risa Lavizzo-Mourey
David Cutler
Randy Hardock
�..
•
PAGE FOUR
Proposed War Room Staff
Coordinator: Jeff Eller
Christine Heenan
TBD
TBD
Alan Hoffman
Barbara Wooley
Chris Jennings
Steve Edelstein
Simone Rueschemeyer
Jason Soloman
Meeghan Prunty
Julie Oppenheimer
Policy
HHS
Intergovernmental
Surrogate Scheduling
Public Liaison
Congressional Relations
Congressional Relations
Administration
Communications
Communications/Research
News Analysis
Additional Communications Staff
Julia Moffett
Bob Boorstin
Josh Silverman
Steve Cohen
Lorraine Voles
Arthur Jones
Strategic Scheduling
Communications Director
Regional Press
National Press
National Press
National Press
Current plans are to have 160 OEOB up and running by Monday, June 7th.
4
�..
•
·-
MEMORANDUM TO MAGGIE WD..LIAMS
DATE:
June l, 1993
FROM:
OuutoUe Hayes
SUBJECf:
Ongoing Participation in the Health Care Refonn Effort--Risa Lavisso-Mourey
Like you, I am concerned that we have adequate staff to assist Ira and the principals work on
the underlying policy and passage of the health care reform plan. To ensure success in this
regard, retaining Risa Lavisso-Mourey in the effort is critical. She has extensive knowledge
of more than the quality issues she addressed during the working group phase and can give us
a good deal of assistance with many constituencies as she has done throughout. I know that
Ira requested that she be assigned to help here on site for the next six months. Her
experience and wisdom have been of great help and should continue to be so with her
presence here.
�.•·
•
June 1, 1993
MEMORANDUM FOR HILLARY RODHAM CLINTON
FROM:
IRA MAGAZINER
JEFF ELLER
RE:
HEALTH CARE REFORM STRUCTURE
The purpose of this memo is to outline the working structure for the next phase of health
care reform. This structure assumes that we will have the full attention of senior White
House Staff at crucial times and that we will need full time coordination from within the
White House both for marketing the plan and guiding the policy through Congress. This
memo is broken into two parts; communications and policy.
POLICY
The policy we send to Congress will undergo substantial challenges, even by strong
supporters. Some members will offer amendments. Others will offer substitute bills.
Interest groups will urge battles on almost every issue in the bill.
••
.e
I
As we work through this process, there must be tight, integrated coordination among
Legislative, Public Liaison, Intergovernmental Affairs and Policy Analysis. Coordination
should flow through the health care war room where negotiating strategies are established
and revised on a day to day basis .
Teams must be organized around issue areas to guide the progress of each set of issues
through the relevant committees. These teams should include policy, congressional, public
liaison, intergovernmental and communications.
A coordinating group should tie together these separate groups to consistently take the
temperature of the bill, its policy and political viability.
The policy coordinating group should help organize the issues to be brought to the
President and First Lady; should prepare materials for cabinet officials and respond to their
concerns; prepare materials for Members of Congress; and provide a liaison with the
marketing/communications effort.
This organization should form soon to coordinate the final drafting of the bill, the
Congressional briefings, the final interest group negotiations and final write up of the
policy. Jurisdictional issues must be decided soon as well as issues related to the interest
group coalition we expect to build.
An accompanying chart breaks down the staffing required. It should be staffed as soon as
possible so a coordinated timetable can be established.
1
�•
PAGE TWO
COMMUNICATIONS
The war room, based in room 160 of the OEOB, will function as the information center for
White House staff as well as be the focal point for rapid response, for both proactive and
reactive press. Within the war room, there will be a representative of each relevant White
House department as well as HHS. They will feed information back to their departments
as well as be a daily contact point for people within the White House and interested parties
from outside the White House.
The key to the war room will be information sharing and communication.
Everyone in the war room will have cross connections to various working groups. Policy,
legislative drafters and congressional relations are linked. Communications, press,
research and scheduling are linked. Each war room representative will be responsible for
reaching out to those people in the White House who are both directly and indirectly
involved with health care. Here is the breakdown of the war room structure:
Policy:
The policy representative will be responsible for
communicating the health care policy to the war room group, preparing response
information and being the chief translator between the message people and the policy
people.
HHS:
Responsible for keeping close ties with the primary
health care cabinet officials. Track what is done on a daily basis in HS and provide
information back to HS.
Surrogate Scheduling:
Surrogate scheduling will continue to place
surrogates as well as influence the scheduling of the cabinet secretaries. They will also
provide comprehensive tracking information and correlate it to targeting.
Public Liaison:
Track interest groups, manage briefing schedule and
provide information on where resources need to be targeted.
Congressional Relations:
Manage briefmg schedule, provide daily hard count
of votes and provide daily targeting list of states and congressional districts in play.
Intergovernmental:
Track interest groups, manage briefing schedule and
provide information on where resources need to be targeted.
Communications:
Be liaison between White House Press Office, Media
Affairs, Research, Speech Writing and Planning
News Analysis:
Provide daily health care clips, analyze news trends,
do daily briefing on hot spots and positive stories.
•
Administration:
Make sure the trains run on time .
2
--~----------------
---
------------
�•
PAGE THREE
Proposed Policy Organization
Coordinator: Ira Magaziner
( Le~islative Group
Greg Lawler
~elanne Veveer WH Steve Ricchetti WH
Chris Jennings HHS Mike Levy Treas.
1 Karen Politz HHS
? Commerce
? Justice
? Labor
? DOD
• Charlotte Hayes OVP
Jerry Klepner HHS
Nancy Ann Min OMB
? Veterans
Policy Oversi~ht
Judy Feder
Paul Starr
, Robyn Stone~
..Sherry Gleid
Drafters
Walter Zelman.
Risa Lavizzo-Mourey •
David Cutler
Randy Hardock
Rick Kronick
Lois Quam 1
Larry Levitt·
•Ken Thorpe
!
Lynn Margherio
Arnie Epstein ·
Richard Veloz
Len Nichols ()~6
Inter~ovemmental
John Hart
??
•
•
Public Liaison
Mike Lux
? Business Liaison
Marilyn Yeager
Policy Liaison
Christine Heenan
Communications Liaison
Carolyn Gatz
3
~st f'\.<J
�•
PAGE FOUR
Proposed War Room Staff
Coordinator: Jeff Eller
Christine Heenan
TBD
TBD
·=JT
Alan Hoffman
'1
·~nings
teve Edelstein ~
Simone Rueschemeyer
Jason Soloman
Meeghan Prunty
Julie Oppenheimer
Policy
r
'·" "'\
HHS - ~e4)
\,U()A ~oofY\ \.3u.cbj 'V&l'\~j
Intergovernmental-1\J~ DA ~k-1 t'\ )
Surrogate Scheduling- _,.f\ct~ ~dx- Oif~+
Public Liaison C
U 0·
Congressional Relations
Congressional Relations
Administration
Communications
Communications/Research
News Analysis
tcJt.
Additional Communications Staff
•
•
Julia Moffett
Bob Boorstin
Josh Silverman
Steve Cohen
Lorraine Voles
Arthur Jones
Strategic Scheduling
Communications Director
Regional Press
National Press
National Press
National Press
Current plans are to have 160 OEOB up and running by Monday, June 7th .
4
�THE WHITE HOUSE
WASHINGTON
May 18, 1993
MEMORANDUM FOR MELANNE VERVEER
SUBJECT:
National Health Policy Council
FROM:
Mike LUX
The National Health Policy Council is an educational based
foundation consisting of both providers and consumers, whose
leadership and steering committee include several key activists
who supported and participated in the health care efforts during
the campaign. They are currently holding the keynote speech of
their conference in hopes that Mrs. Clinton will speak. (Friday
May 21, anytime between 12:30 and 2PM, at the Grand Hyatt.)
The purpose of the two-day conference is to bring together
grassroots provider and consumer health activists, representing
urban and rural communities and diverse socio-economic and ethnic
backgrounds.
Delegates represent almost every state, as well as
state leaders of health projects, academic leaders, and a variety
of providers and hospital and clinic administrators, state
legislators, union members, and consumers.
NHPC has a national network of over 8,000, mostly pro-Clinton
providers and consumers. I think this is a great opportunity to
start mobilizing those who are pro-reform and whose support will
be essential for a successful national campaign for health
reform.
Thanks for your consideration. If you would more information or
details on the conference, please let me know.
�THE WHITE HOUSE
I
WASHINGTON
May 17, 1993
MEMORANDUM FOR MAGGIE WILLIAMS, MELANNE VERVEER AND PATTI SOLIS
FROM:
Mike Lux
SUBJECT:
Attached Invitation
Attached is the invite from SEIU for Mrs. Clinton to come speak.
SEIU is the biggest health care union, and critical for our
future success. I would strongly urge her acceptance of this
invitation. Thanks for your consideration.
�SERVICE
EMPimEES
INTERNATIONAL UNION. AFL·CIO. CI.C
'313 L
JOHN J. SWEENE'f
"i~EFI'•.U
RICI-!AAC W. CORCTZ
01•11- "I:I~'S·t:£', •
'IITI'R~onii,IIIAI
'ilt;CI&nA• ':lll.r.L.ctll:l
March 2, 1993
The President
The White House
Washington, DC
20500
Oaar Mr. Praaidantt
Let me be9in by offe~in9 my personal con;ratulat1ona on your
victory in November. This was not only a victory for you, but a
vio~o~ £oz eve~ wo~kin; family in this country.
I would l1ke to extend an invitation to you to attend and
address the Service Bmployeea International Union's 1993
Le;1alat1ve Confe:ence. We wguld like for you to addreBs the
group Monday, May 24, sometime in the mcrnin;. Of cou~se, if you
are not availa~le at that time, we would welcome you~ attendance
at any time Monday, May 24 through Wednesday, May 26 .
The SIIU Le9ielative Conference will take place at the Omnishoreham Kotel, 2500 calvert st~eet, RW, Washington, D.C.
We
are anticipatin; at least 500 SllU mambe~a, from acroaa the
countzy, all veterans of you~ campaign, will attend the
confa~ence.
With mora than one million mambara, working in a wide
aervice occup•tiona, SBIU 11 the fourth·largeat,
faateat·g~owLng and ao1t diversified affiliate of tha AFL-CIO.
And with 400,000 of those membe~• employed in hospitals, nu~aing
homes, HNOa and clin!ca in tha UnltGd States, eanada and Puerto
Rico, SI!U is the biggest union of healthcara workers in Harth
va~iety o~
AmariCJa.
SIIU ia a ma~o~ auppo~•~ of the Demoo~atic National
Committee and the other national and state party committees. In
addition, we have a very auaae•sful COPI p~ov~am and •uppo~ted
the candidacies of over 200 confreaaional and gubernatorial
aandidatea 1n 1992.
..
\
~
'
�....
~
•
- 2 -
II
Finalli, thousands of SIIU officers, atatf, and members from
!nclud~ng moat of the
International staff volunteered thei~ personal time to support
you: candidacy.
I cannot tell you how thrilled they wa~e when
their dream of having a President who stands up fo~ workers
~iiht• came true.
That enthusiasm continues today. I cannot
stress enough how honored and excited our memba~s would be to
witne11 first hand, the continuing effort on your part of puttin;
people first.
state counc la and local union•,
The ieaues that concern our members. include health care
reform, atr1ker replacement, the balanced budget amendment,
family and medical leave, civil ri;hta, worker health and safety,
and support of state and local public services.
Please have your ataff contact Jane Hall in our Politieal
Department and aha will be happy to work out the details. She
can be reached at 202/898-336L. Thank you for your
consideration.
J'JS/jeh
cc1
Nanay Hezn:eLoh, Deputy AB•1•tant to the President for
Appointment• and Scheduling
gavid Wilhela, Chairman of the gemoora~ic National Co.mmittee
Howe~ Paator, ~eistant to the Praai~ent and Director for
Leii•lative Alfaire
Rahm Immanuel, Aaa1etant to the Preai4ent and Director for
Political Affairs
�JUNE 1, 1993
TO:
HEALTHCARE STAFF
FROM:
IRA C. MAGAZINER
SUBJECT:
THE HEALTHCARE PLAN
Now that we have received some guidance on the Healthcare
Policy, we must specify policy details in a number of areas so
that final legislative drafting can proceed.
I will schedule meetings this coming week with people
responsible for each area.
,
"/
The attached schedule must be met to incorporate each of
these section into the final plan.
�••
RESPONSIBLE
PEOPLE
INITIAL
MEETING
INTERIM
REVIEW
DUE
DATE
1. PAYROLL PREMIUM
WALTER ZELMAN
612
614
6/7
2. UNEARNED INCOME ASSESSMENT
RICK KRONICK
612
614
6/7
3. TOBACCO TAX
RANDY HARDOCK
5126
RANDY HARDOCK
5126
5. UNCOMPENSATED CARE RECAPTURE
BRUCE VLADECK I
RANDY HARDOCK
5126
-
614
4. FUTA WAGE BASE ADJUSTMENT
6. RULES FOR LARGE COMPANIES OUTSIDE OF
ALLIANCE
WALTER ZELMAN
612
614
6/7
7. INSURANCE REFORMS DURING TRANSITION
GARY CLAXTON
LOIS QUAM
612
6/6
618
8. WORKERS COMP AND AUTO REFORM
GARY CLAXTON
GREGG LAWLER
5119
611
613
9.
LEN NICHOLS
GARY CLAXTON
RANDY LUTTER
BRUCE VLADECK
612
6/7
6111
10. BUDGET DEVELOPMENT AND ENFORCEMENT
LARRY LEVITT
BRUCE VLADECK
5125
611
6111
11. ANTITRUST
AMY STEWART
GREG LAWLER
5127
611
6111
12. MALPRACTICE
'
TOPIC
AMY STEWART
VINCE FOSTER
BOB BERENSON
5117
5/28
614
13. FRAUD AND ABUSE
AMY STEWART
GREG LAWLER
5117
5/30
6/4
14. MEDICARE SAVINGS I INTEGRATION
JUDY FEDER
BRUCE VLADECK
NANCY ANN MIN
612
614
618
15. MEDICAID SAVINGS I INTEGRATION
JUDY FEDER
BRUCE VLADECK
NANCY ANN MIN
612
614
618
16. FINAL BENEFIT PACKAGE DESIGN
ATUL GAWANDE
KEN THORPE
PHIL LEE
612
616
619
17. ADMINISTRATIVE SAVINGS
LYNN MARGHERIO
BRUCE VLADECK
NANCY ANN MIN
612
616
619
18. QUALITY ASSURANCE
RISA LAVIZZOMOUREY
ARNIE EPSTEIN
LYNN MARGHERIO
PHIL LEE
612
616
6/9
JUDY FEDER
BONNIE
LEFKOWITZ
PHIL LEE
5119
5127
614
20. MENTAL HEALTH
BERNIE ARONS
KEN THORPE
5128
613
616
21. ECONOMIC IMPACT
DAVOD CUTLER
SHERRY GLEID
LABOR
612
6110
6113
SHORT TERM CONTROLS (PREMIUM)
19. PUBLIC HEALTH I
UNDERSERVED
RESEARCH INVESTMENT I
~---------
-
614
614
~-~----~---~----~----~-----
_ _ _ _ _ _ _ _ _ _ _ _ _ _ __ j
�•
••
22. LONGTERM CARE
ROBYN STONE
JOSH WEINER
5/20
5/30
6/3
23. MEDICARE DRUG BENEFIT
CHRIS JENNINGS
5/20
5/31
6/3
24. COST OF INSURING UNINSURED AND
UNDERINSURED
KEN THORPE
LEN NICHOLS
RANDY HARDOCK
DAVID CUTLER
5/27
6/1
6/8
25. SAVINGS
RICK KRONICK
5/20
6/1
6/8
26. FINAL COSTING OF PROGRAM
IRA MAGAZINER
QUANTITATIVE
5/20
6/1
6/8
6/8
6/10
6/13
TEAM
27. INTERALLIANCE BANK
••
GARY CLAXTON
�June 14, 1993
MEMORANDUM FOR MAGGIE WILLIAMS
MELANNE VERVEER
FROM:
JEFF ELLER
RE:
Health Care Items
Here is an C'~sbme items discus
on Sunday with HRC.
1.
The operational date t
e war-room is Friday, June 18. HRC
indicated she would like gather all relevant health care staff on Friday to
tell them how import this job is and that this moving into a new phase
will be very i m r t to the White Hous~.
.
2.
That would call for us to have the
p1eces of staffing put~ n
together by Thursday. We hav
esolve the surrogate schedulingl\ a)V\
operation now that AI · etuming to HHS. If Andre Oliver is that
option, we need
to Gearan about that transfer and get him with Alan
this week.
SIS CRUCIAL.
(Uf/.
\
\
3. ~HRC indicated she
ed the three of us to meet with Gearan and
Gergen on health c C<?mmunications. That will need to happen today or
Tuesday.
01. ~ l (\.
·-----~
ongly recommend that fhe timing meeting be held this week wit
enior staff. Too many people are languishing and we dont' have clear
direction. There's a lot riding on this .... .let's make it happen.
/
�I
�~~~
-~J'~'f
MEMORANDUM
TO:
Maggie Williams
FROM:
Bob Boorstin
Meeghan Prunty
CC:
Mr. Steve Jewell
DATE:
May 10, 1993
RE:
·PUBLISHING DOCUMENTS FOR RELEASE OF HEALTH PLAN
Please find attached the estimates we received from Steve Jewell, the Printing and
Publishing Production Manager, pertaining to the production and publication of the
three main documents we have discussed releasing upon the announcement of the
Health Reform plan.
1.
Report to Congress: A 100-page document -- similar to the OMB report
produced for the day after the Joint Session Address-- that outlines the current
situation and the way in which our reform solves these problems. It will be
detailed yet written for more popular consumption -- with color graphs, sidebars,
charts, black and white photos, etc.
We initially estimated 4,000 copies at a cost of $9,752 (and $2,268 for each
additional thousand).
2.
Booklet: A 20 to 30-page document for health professionals that write in asking
for information about the plan. Mr. Jewell included an estimate for color and for
black and white.
We initially estimated 4,000 copies at a cost of $2,304 (and $433 for each
additional thousand). This rises to $3,557 (and $549 for additional) if we use
color.
3.
Pamphlet: An 8-16 page document to be very widely distributed -- at rallies,
speeches, in letters, etc. It will be printed in black and white.
We initially estimated 20,000 copies at a cost of $3,071 (and $132 for each
additional thousand).
We have also recently discussed a couple of other items (such as ''breast cards" for
Congresspeople and surrogate speakers which contain talking points for different
constituencies and issue areas) for which we may need to request further funding.
�Memo to Maggie
May 10, 1993
Page Two
The Graphics Department has also agreed to produce most of the graphs that will be
needed for speeches, releases to print and news media, etc. as well as large format
props for speeches. Costs for these will be assessed on a case by case basis.
Mr. Jewell says that the nest step is to get these approved by Chris Vein -- also in the
Office of Administration at x2500 -- well before we need to get these produced. H you
need any further information from us, please let us know.
UNRELATED TOPIC •• NUMBERS FOR RELEASE OF PLAN (FYI):
We have been working with the people who are doing all the numbers for the plan (Ken
Thorpe et al.) on a response to the Daschle OpEd.
Daschle, as you'll recall, argued that people do· not realize how much they really pay for
health care -- because they only see their direct health care costs while the majority of
health spending is funded indirectly (taxes, cost-shifting). He asked if anyone could
figure out what people really pay now so that they will be able to honestly compare what
they might pay in a reformed system.
We have decided, if it's O.K. with you, to hold off on this project until we have numbers
that everyone -- the numbers people, Ira, Judy, Mrs. Clinton -- is equally comfortable
with.
�REQUEST FOR INFORMAL ESTIMATE
Date:
To:
Meeghan Prunty/WHO
From:
Steve Jewell/OA
Subject:
5/5/93
Estimate - Health Pamphlet
20.000
Copies, Self-cover ••••.• $3.071.00
________________copies, Paper Bound .•••.
________________Copies, Case Bound ••••••
Added Thousands:
Self-cover ••••••••••••••••••••
%$~1~3~2~·~3~0____________
Paper Bound ••••••••••••••••••
Case Bound ••....••••..•.••...
Specifications;
Quantity:
20,000
No. pages:
16
Trim size:
8 1/2 11 X 5 1/2 11
Quality Level:
III
Material furnished:
camera copy
Halftones:
none
Method of printing:
offset
Paper:
Text:
Cover:
60 lb. matte coated text (recycled)
Ink:
Text:
Cover:
black
Binding:
saddle stitch
Delivery:
one destination in the Washington area
Remarks;
this estimate is based on a 3-4 day work
schedule
�REQUEST FOR INFORMAL ESTIMATE
To:
From:
5/5/93
Steve Jewell/OA
Subject:
Date:
Meeghan Prunty/WHO
Estimate - Booklet
~4~·=o=o=o___________ Copies,
Self-cover
$2.304.00
________________Copies, Paper Bound ••••.
------------~--Copies,
Case Bound ••.•••
Added Thousands:
Self-cover ••...•.•••....•••.•.
~$-4=3=3~·=2=0____________
Paper Bound •..•••••••••••••••
Case Bound .••.....•.••..•••..
specifications;
Quantity:
4,000
No. pages:
32
Trim size:
8 1/2 11 X 11 11
Quality Level:
III
Material furnished:
camera copy
Halftones:
none
Method of printing:
offset
Paper:
Text:
cover:
70 lb. matte coated text (recycled)
Ink:
Text:
Cover:
black
Binding:
saddle stitch
Delivery:
one destination in the Washington area
Remarks;
this estimate is based on a 3-4 day work
schedule
�.
. ..
REQUEST FOR INFORMAL ESTIMATE
Date:
To:
Meeghan Prunty/WHO
From:
Steve Jewell/OA
Subject:
5/5/93
Estimate - Booklet (2 colors)
Copies, Self-cover ....•• $3,557.00
4 000
________________Copies, Paper Bound •...•
________________copies, Case Bound ••...•
Added Thousands:
Self-cover •.•••••..••••..•••••
~$=5~4=9~·=0=0____________
Paper Bound •••••••••••••.••••
case Bound •••..••..••.•...•..
Specifications;
Quantity:
4,000
No. pages:
32
Trim size:
8 1/2 11 X 11 11
Quality Level:
III
Material furnished:
camera copy
Halftones:
none
Method of printing:
offset
Paper:
Text:
Cover:
70
lb. matte coated text (recycled)
Ink:
Text:
Cover:
black plus one additional color
Binding:
saddle stitch
Delivery:
one destination in the washington area
Remarks;
this estimate is based on a 3-4 day work
schedule
�CABINET
�'
...
•
October 8, 1993
·e
MEMORANDUM
FOR:
Christine Varney
FROM:
Dana Hyde
Jennifer O'Connor
SUBJECT:
Cabinet involvement in Health Care Reform
We have been working with Charlotte Hayes this week to get the
Cabinet on the air on health care. We have drafted some ideas
for further developing a strategy for Cabinet involvement in
health care reform efforts.
1.
Control Message & Events
Regular hours per week on regional media
1 or 2 trips before Thanksgiving
(fly-around at time of legislation introduction;
another trip?)
Daily talking points on Chief of Staff conference call
(brief synopsis of daily talking points)
Calendar of themes -- 3 or 4 weeks out -- to prepare them
for media and trips and to ask for their ideas on what
events they might do that would fit with each theme.
Schedule one-on-one briefings for each Secretary (general
or theme related)
2.
Utilize agency resources to promote Health Care Reform
Objective:
use agency resources to reach consumers
(Replicate SBA effort)
Survey agencies about calls, mail, questions regarding
health care to determine demand for information
Survey agencies about regular avenues of communication
with 11 clients 11 (e.g. field offices, regular mailings, answer
lines, etc. )
Survey agencies about which staff are working on health
care -- names, phone numbers, titles
Ask agency to draft a plan, in consultation with War Room
staff, for how to disseminate information and answer
�consumer concerns via existing means or means that we can
create. (e.g., development of tailored pamphlets, creation
of answer lines, posters in field offices with pamphlets,
info-pamphlets with mailings of Treasury checks, IRS
mailings, etc.)
Agencies for this effort: VA, HHS, Commerce, Treasury,
Labor, Agriculture, Justice, Interior, BUD, Energy,
Education, GSA
3.
Internal Agency Education-
Mo~
.{1/ef,f
Objective: federal government employees become informed
about the benefits of the plan
Ask each agency to develop, in consultation with War
Room, a plan for dissemination of health care reform
information to its employees. (e.g. lunch time discussions,
pamphlets circulated throughout agency, internal answer
center, seminars, etc.)
Ask them to develop (or offer to develop for them)
materials to be used in this effort.
Agencies for this effort:
Agriculture, large ones.
4.
Hill Lobbyinq
all, but especially DOD,
",ki!(..(MJ1~/~ 1 LuJ ~~~
At whatever point it makes sense\to start this eftort,
create pairings among Cabinet Secretaries and targeted Hill
Members. We're targeting their districts and media markets
now. When will we want one-on-one contacts to begin?
----------....... Coordination
Interagency
exc~ges
Set up meetings/ message
for linked agencfeR
DOD & VA, HHS & VA, HHS & Education, HHS & Labor)
6.
Division of responsibilities
AM War Room meetings: Jen
PM War Room Meetings: Dana (sometimes)
Ask Eller for a desk in the War Room to rotate out of
Split agency responsibilities:
Jen
HHS
BUD
VA
ONDCP
1~
Dana
DOD
GSA
SBA
Labor
:J
�•
•
Justice
commerce
Energy
Aqriculture
Interior
EPA
Education
Treasury
�\
STRUCTURE
\
I
�e
e
ECONOMIC RESPONSE
I. STRUCTURE:
1. Response to all Events in Paper and throughout the day.
8:30 meeting with HC/economic staff
Monitoring throughout the day
Review following evening meeting at 7:30p.m.
2. Coordinate All Major Stories:
Kevin A., etc and all NEC would call into us whenever notified of any story
about HC economic issues in NYT, WSJ, WP, AP, IAT, NBC, CBS, ABC,
CNN, Consult with others Kevin, Bob B. and Ira on response strategy
3. Keep Centralized Books and Info on What would go Out to Administration speakers,
surrogate etc.
Monitor status of numbers and consult with
Ira and economists on tentative numbers
4. Monitor Statements and Events by NFIB a~ Q~~
5. Update and Inform NEC and Surrogates:
Provide quick Q&A responses to immediate events for speakers that day.
II. VALIDATION:
• Collect all Positive Quotes
• Current Jobs Studies
• Economists
(:_
CEOs -
(M_jJ _ A(Q~~~
lli. COORDINATE ECONOMIC OP-EDS:
IV. ECONOMIST OUTREACH:
• Economist Specific Strategy
• Princeton Conference _ t)c}o~ ~~
-
V: MAJOR STRATEGIC ISSUES
e
e
• Legislation Announcement/Changes?
• What are later possibilities to consider when responding
• Process for substantive decisions
�e
e
e
e
�I
CONFIDENTIAL
DETERMI~EO
TO BE A~ AO~ISISTR.\TIH:
MARKISG Per E.O. 12958 as amended, S~. 3.3 ~~·;
Initials: A.c. 3
Date: 0 'i I o"1-/ ll
Here are three models for a centralized coalition that does not
require a multi-million dollar budget. I did not list models
that have been discussed by some people at either extreme: the
$37 million, fifty staff person, Presidential campaign style
coalition originally suggested by the DNC, or the completely
decentralized "get one of us to just call weekly meetings" model
suggested by some of the groups (although model 2 is closest to
that approach.) Based on our conversation I have also not listed
the model where we pick one group that is our designee to lead
the charge and ask all other groups to take direction from them.
I have tried to base the models on discussions over the last
three days about coalitions that have worked in the past, such as
the Bork battle and the 1986 tax reform battle (model 3 is most
similar to how they structured the tax reform coalition.)
I wanted to show these models to you before I sent them to
Tamara. We probably all have our preferences (mine is model 1),
but the key thing we need to decide is whether any of the three
is acceptable to us if it is adapted, since we won't be there for
the discussion.
�tit
MODELS
1.
Co-Conveners
A. To be a convener, you must contribute resources to the common
effort. You must contribute at least three of the following five
things:
$10, 000
Full-time D.C. staff (lobbying, communications, field
direction, administrative)
Part-time consulting (legal, polling, communications)
Field staff (outside of D.C.) devoted exclusively to
health reform
Office resources (space, equipment, phones, faxes,
postage, computer hardware or software)
B.
Organization would have as staff:
Executive Director
Legislative Director
Communications Director
Field Director
3 to 5 administrative assistants
•
c. Decisions on raising money for media buys or other major
commitments of resources would be made later.
2.
Secretariat
A. One senior level person, along with support staff, would be
hired to call and staff the following sets of meetings, and
provide necessary follow-up and accountability:
1. Steering committee, which would meet weekly to provide
overall strategy.
2.
Communications committee, which would meet weekly.
3.
Field committee, which would meet weekly.
4. House lobbying committee and Senate lobbying committee,
which would have weekly meetings during the summer, but
probably move to daily meetings in the fall.
B. Organizations with the resources to do it would be asked to
buy newspaper, radio or tv advertising in strategic markets at
strategic times.
3.
Lobbying/consulting Firm Hired to Coordinate
A major D.C. lobbying/consulting firm would be hired to
coordinate activities and staff the necessary weekly meetings.
�•
•
·Each big group supporting health reform would be asked to pay a
portion of the costs necessary to retain the firm. The same
committees listed in model 2 would be formed and would meet
regularly. Decisions on media buys would be made in the fall •
�I
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�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Interagency Health Team Binder
Creator
An entity primarily responsible for making the resource
First Lady's Office
Maggie Williams
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 5
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-2194630-20060223F-005-004-2015
2194630
-
https://clinton.presidentiallibraries.us/files/original/fe4c7c6e4bc3c5e5cb5806c14d067804.pdf
74c1401ee20553aa4f72fb3cedb85512
PDF Text
Text
CODER:~
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:_ _
GENERAL SORT:
POSTCARD 2:
FORM LE'ITER:
REROUTE:
_General mall
__Personal stories
--~er
POSTCARD 1:
_Letter Campaign
Health Providel'8
_Offei'S to help/Employment
X
Letterhead
_Casework
_Policy
_Physicians
_Scheduling _President
__Other
POLICY AND PERSONAL STORIES:
_ORGANIZATION (I)
_insurance premiums
_insurance reform
_insurance pools
_boards and oversight
_COVERAGE (ll)
_working families
_unemployed/low income
_benefits
____providers
_INFRASTRUCTURE/WORKFORCE (ill)
_quality assurance (guidelines)
_administration, reimbursement
& information systems
_malpractice & tort reform
_manpower issues (training)
_unnecessary procedures
_GOVERNMENT PROGRAMS (IV)
_medicare
_medicaid
_veterans
_DoD
_Indian health
_COST ISSUES (VI)
_drug prices
____physician fees
_hospital fees
_medical equipment
_fraud & abuse
_FINANCING (VII)
. _MENTAL HEALTH (IX)
_LONG-TERM CARE (X)
_PUBLIC HEALTH/
SPECIAL POPULATIONS (XII)
____prevention
_AIDS
_women's health
_immunizations/children
_rural
_urban
_OTHER~-----------------------
�CX>DER:4 --.,
HEALTH CARE TASK FORCE SORTING SHEET
_General mail
_Personal stories
_Letterhead
~era
_Letter Campaign
_Polley
\/-..
_Casework
to help
_Requests:
_Employment
__Advociu:y ··-
-speech
-meeting
··--·~Other
Explanation:,.L~~~
~=...;;-~__;;;;,-~...=~:;;;....;..-~....;;;.:;.......;~~~..;;;....."'7't;,.M.~~-~.;.;....;;;;.;;;;;;..........;;...=..._
~
~
ADVISORY PANEL?
_physician
_Jarte emplo)'81'8
_other health provider
ExpiiiDilti""'
amall business
_aeniors
..,)Cother COD&mDer&
~ 1 ~ ~ ey .£L..d.I5Le ~.
PRIMARY iNTEREST:
COST ISSUES
_Drug Prices
_Physician Fees
_Hospital Fees
_
UDDecessary Procedures
_
Medical Equipment
Fraud and Abuse
_PUBLIC HEALTBISPECIAL POPULATIONS
PJeV'ellti.On
_AIDS
_Women's Health
Immunizations
·--..: ..--. --=- -·-·- -----=- . .... ·-;
_Rural
Ul'ban
COVERAGE
_Working Families
_
Unemployed/Low Income
Benefits
Providers
_GOVERNMENT PROGBAMS
ORGANIZATION
Insurance Premiums
__..:_ Insurance Reform
Insurance Pools
_Boards and Oversight
_INFRASTRUC'nJRE/WOBKFORCE
_
Quality Assurance (Guidelines)
~dmiDiatrat!on, ReimbU1'8e11lent
A Patient llllformatlcm. 8)'8tems
_Malpractice A Tort Reform
-
MediC8l"e
Medicaid
_Veterans
_DoD
_llaDpower lames ('l'rabdng)
_MENTAL HEALTH
LONG-TERM CARE
OTHER._______________
Explanation:._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
PLAN PREFERENCE· (Support=+; Oppose=-)
CP
SP
OP
Clinton Plan
Single Payer
Other Plan
MC
PP
CV
Managed Competition
Pay or Play
Credits, Vouchers,
Medical SaviDp Accts.
CA
BR
GE
Canadian
British
German
•
�LAW OFFICES
HILFMAN
&
FoGEL,
P.C.
First Lady Hillary Rodham Clinton
Page Two
January 26, 1993
I am offering to serve on the Task Force or assist in any
way possible in its analysis and development of a new Health Care
Reform.- proposal.
I be]. ieve I can contribute in a unique way to
your efforts.
Very truly yourks, ..
.,
"
:
·;
}
(flv,(i:f.
/'
Rdbert L. Fogel
RLF:keb
cc: Amy Zisook
Special Assistant to the President
Executive Office Building
Washington, D.C. 20500
.,
tr(
/
'
-
/
l
;
�LAW
OFFICES
FhLFMAN& FooEL,P.C.
LOUIS HILFMAN
33 NORTH DEARBORN STREET
ROBERT L. FOGEL
CHICAGO, ILLINOIS 60602
PATRICK .J. SULLIVAN
.JOHN M. KOVAC
WILLIAM F. MARTIN
January 26, 1993
TELEPHONE
(312) 236-5207
FAX
MICHAEL I. STARKMAN
(312) 236-2321
STEVEN C. FUOCO
OF COUNSEL
.JEFFREY M. GOLDBERG
ZENON .J. BtDZINSKt•
• ADMITTED IN ILLINOIS AND COLORADO
First Lady Hillary Rodham Clinton
National Health Care Task Force
The White House
1600 Pennsylvania Avenue
Washington, D.C. 20510
0
Dear Hillary:
As a father of three and an employer, I am personally aware
of health care costs.
As a litigation attorney, I am acutely
aware of the importance of quality health care to my injured
clients and those who are victims of substandard health care. As
an early supporter, member of the National Finance Committee, and
a new trustee of the DNC, I am eager to assist the Clinton/Gore
Administration in any way to assure success in its policies.
Unfortunately, there has been unwarranted attention and
focus on medical malpractice as the scape goat of ever-increasing
health care costs.
However,
there are numerous studies
evidencing that malpractice represents less than 1 percent of
total health care costs.
Moreover, recent studies confirm that
malpractice claim filings are decreasing and that almost all
lawsuits have a reasonable and meritorious basis for being filed.
In those States where purported tort reforms, such as caps
on damages have been established, there has been no measurable
decrease in malpractice premiums or claims of malpractice.
Perhaps most importantly is the appreciation of an
individual State's right to manage and control its civil justice
system. Intervention andjor preemption by the federal government
would represent an unnecessary, unjustified and costly intrusion
into a system long revered for its ability to serve the public
interest and good.
Health care reform is too critical an issue
to be subverted by efforts to tag on tort reform features.
�)
.I
THE WHITE HOUSE
WASHINGTON
March 23, 1993
Robert L. Fogel, Esquire
Hilfman & Fogel, P.C.
33 North Dearborn Street
Chicago, Dlinois 60602
Dear Robert:
Thank you for your offer of assistance to the Health Care Task Force. The Task
Force includes the Secretaries of the Treasury, Defense, Commerce, Labor, Health and
Human Services, and Veterans Affairs; the Director of the Office of Management and
Budget; the Assistant to the President for Domestic Policy; the Assistant to the President for
Economic Policy; the Chair of the Council of Economic Advisors; and the Senior Advisor to
the President for Policy Development.
In addition, the Senior Advisor to the President for Policy Development will lead
interdepartmental working groups which will gather information for, and provide information
to, the Task Force. The working groups, which are working closely with Members of
Congress and their staffs, are comprised of government employees.
While the working groups have begun the process of preparing policy options for
reforming our health care system, their work is an ongoing process. The members of the
Task Force are anxious to consult with knowledgeable and concerned people. I especially
appreciated receiving your suggestions and am directing a copy of your letter to the
appropriate working group.
Again, .thank you for your offer of assistance and your continued support for the
success of our endeavor.
Sincerely yours,
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECTffiTLE
DATE
RESTRICTION
001. resume
Curriculum Vitae. Margaret Thaler Singer. [partial] (1 page)
[none]
P6/b(6)
002.letter
Hillary Clinton to Carol Dodson. [partial] (1 page)
04/06/ 1993
P6/b(6)
003. letter
Carol Dodson to Hillary Clinton. (2 pages)
03/01/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number:
I 0813
FOLDER TITLE:
HRC Healthcare Correspondence [5]
2006-0223-F
ab620
RESTRICTION CODES
Presidential Records Ad- (44 U.S.C. 2204(a)(
Freedom of Information Ad- (S U.S.C. SS2(b)J
Pl National Security Classified Information ((a)(l) of the PRAJ
P2 Relating to the appointment to Federal office ((a)(2) of the PRAJ
P3 Release would violate a Federal statute ((a)(3) of the PRAJ
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRAJ
P6 Release would constitute a dearly unwarranted Invasion of
personal privacy ((a)(6) of the PRAJ
b(l) National security classified Information ((b)(l) of the FOIAJ
b(2) Release would disclose Internal personnel rules and practices of
an agency ((b)(2) of the FOIAJ
b(3) Release would violate a Federal statute ((b)(3) of the FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIAJ
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy ((b)(6) of the FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIAJ
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIAJ
C. Closed in accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�'
'
~-· ~
THE WHITE HOUSE
March 24, 1993
Margaret T. Singer, Ph.D.
17 E1 camino Real
Berkley, California 94705
Dear Dr. Singer:
Thank you for your letter forwarded to me by David J.
Bardin, in which you enclosed your statement sharing experiences in
working with cult veterans and your concern about the unique
problems they face regarding health care. I appreciate your calling
this to my attention and am directing it to the Task Force for
inclusion in its considerations.
President Clinton is committed to reforming our nation's
health care system -- controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
Thank you again for your views and for your support as we
seek solutions to this incredibly complex issue.
Sincerely yours,
cc: David J. Bardin
�.
'
DAVID j. BARDIN
1050 Connecticut Avenue, N.W.
Washington, D.C. 20036-5339
Phone: 202-857-6089; Fax: 202-857-6395
March 16, 1993
By Messenger
Hillary Rodham Clinton
Health Care Task Force
The White House
Washington, D.C.
Dear Mrs. Clinton:
Professor Margaret Singer has asked me to deliver the enclosed statement of support for the work
of the Task Force and offer to testify at a public hearing, if you so desire. The Statement focusses
on unmet and uninsured health care (including mental health care) needs of ex-members of
destructive cults.
Dr. Singer is an outstanding expert and frequent, excellent speaker on cult phenomena. Her
perpsective may seem especially timely because of current media attention to the Waco situation.
However, it is really another year-round illustration of why your work is so important.
Enclosures:
Singer letter to Mrs. Clinton
Singer statement to Task Force
Singer c.v,
cc:
Margaret T. Singer, Ph.D.
�..
- ----
--- -----
-·
--
.
MARGARET T. SINGER, Ph.D.,.Inc.
A
Profi.'J;J;inn>~l
C".l1fl01'8tion
17 EL CAMINO REAL
BERKELEY, California 94705
(510) 848 3863
FAX: (510) 84R 86/R
Mrs. Hilary Rodham Clinton
Office of the First Lady
The White House
1600 Pennsylvania Avenue, N.W.
FAX: (202) 456-2461
Ooar Mrs. Clinton:
Con9ratulations and warmest wishes. I feel great enthusiasm
your leadershiP in studvinc:r our nation's health care neec:ls
and rectifyinq omissions and injustices. I am writing to help
you make the record of need in respect to a vulnerbale group with
desperate needs that lacks health insurance but is often
overlooked: thousands of people who exit from the numerous
destructive cult groups each year.
These cult veterans exi.t -- somtimes after many years
with no insurance and, of~en, with physical and mental health
needs. Needs may have accumulated unattended during the period
of cult membership. New needs may arise after exit. In some
cases there are no ~amily or friends available to help.
Because I have counseled and befriended roughly 3000 cult
veterans, both personally and professionally, over the past 24
years, I am acutely troubled by their problems in securing
medical and mental health care, including residential and
outpatient help as needed. I have prepared the enclosed
statement, summari2ing experience and concerns and request that
you share it with members of your Task Force and include it in
the record of your p~oceedings. Should you wish to take live
testimony from me, please have me contacted by fax at 510-8488618 or phone at 510-848-1855, and I shall make every effort to
appear either in the Berkeley-San Francisco area or in
Washington, D.C. T. also enclose my c.v. for your Task Force file.
Again, best wishes for your vital enterprise.
~hnnt:
Sincerely yours,
•
Margaret T. Singer, Ph.D.
Enclosures
.........
~o ·d._~.o.o···o·N·O·v·:·g...
£.6.'S•T--J•~.w..........~sS~8~T~8~v~8~S~T~v-·~oN:_l~3~1~------------~~~3;9NIS
�..
STATEMENT OF MARGARET T. SINGER, Ph.D.
TO THE CLINTON HEALTH CARE TASK FORCE
I want to thank President and Mrs. Clinton and the members of the Task Force for
your leadership in studying our nation's health care needs and rectifying serious ommissions
and injustices. I have been a clinical psychologist for over 40 years. I am an emeritus
adjunct professor of psychology in the psychology department of the University of
California, Berkeley, a former President of the American Psychosomatic Society, a member
of the American Psychological Association and a recipient of the NIMH Research Scientist
Award. My curriculum vitae is attached to this statement.
My present purpose is to call attention to a most wlnerable, ·often-overlooked
segment of the population that desperately needs health care of many kinds but totally lacks
health insurance. I refer to thousands of people who exit from the numerous destructive
cult groups each year, sometimes after a dozen or more years outside of mainstream society.
In recent years, we have seen not only individuals but whole families emerge together,
ranging in age from grandparents to small children.
I have counseled, befriended and worked with roughly 3,000 cult veterans, both
personally and professionally, over the past 24 years, probably more than any other
individual health care professional in the United States or elsewhere. As a result, I am
acutely troubled by cult veterans' problems in securing medical and mental health care,
including residential and outpatient help as needed.
Many people in cult groups regress as to their independence of thought and action
and become highly dependent on their group and its leaders for day to day decisions and
arrangements of all kinds. Virtually none of these groups arranges any kind of medical or
dental
insuranc~
or retirement plan for members. Rarely do these groups attend to medical
and dental needs of members. Cult leaders may regard expenditures on health care to be
"wasteful;" they commonly blame illnesses of members or their children on their own faulty
behavior.
As a result, cult veterans exit with no insurance coverage. All too often, they suffer
from physical and mental health problems. In many cases, needs may have accumulated
unattended during the period of cult membership. In any event, when needs may arise after
�-2exit there is no insurance coverage and, very often, little grasp of how to go about securing
help.
To illustrate these problems of cult veterans, let me offer two cases (changing the
names in order to preserve annonymity):
KAREN: A twenty-five year old woman with two young children fathered by
the leader of the small cult she had been in for eight years, ran away during the
night because of her fear of the cult leader who beat her, the various children and
his other "wives." He recently had enforced his demands by shooting guns off inside
the large building the group occupied and had begun to use street drugs. Earlier,
Karen had renounced her parents at the behest of the cult leader and lost contact
with them.
With the children, she had run to an all-night diner where a trucker gave
them a ride to another city, as Karen feared the cult leader would be looking for her.
The trucker left her at a police station, as be told Karen she needed someone to
look after her. She and the children were taken to a women's shelter. Both she and
the children were not well. Residency and other requirements precluded Karen from
getting help. Karen learned of my name as someone who helped people who had
been in cults. She visited my office and we were able to reach her mother by phone
and reestablish that family tie. Karen stayed at the shelter a few days until her mother arrived by car from another state and took Karen home. Karen called to thank
me and asked how she might get medical help in her mother's state. As with many
cult vete~ans, she bad no idea of how to seek help, etc. I suggested several agencies.
After some months, I received a phone call from an agency to discuss with me the
cult leader and the potential danger he posed to Karen and the children if he knew
where they were.
MARK: Mark at age 27 left a cult he had been in nine years. Since leaving
the cult some months before he first met with me, he had been living in an old car,
working at odd jobs, and was given small stipends by a private charitable
organization which referred him to me. He looked emaciated, had a hacking cough,
�-3and said he had not felt well for a long time. In addition to his physical needs, I felt
that he needed psychiatric evaluation, for his severe depression. But he had no
insurance, no money, and had long been estranged from his family at the orders of
his cult leader who had told him to "disconnect" from them. We did not succeed in
reestablishing family ties. When last heard from, Mark had abandoned the car and
hitchhiked to another state. Mark wrote that he was still ill, depressed and unable
to get help.
Lucky cult veterans have families from whom to seek help. Others have to rely on
welfare -- if they can find it -- until they can establish themselves. Often they have no
where to go, no family or friends available to help. In some cases the cult veteran doesn't
understand how to enlist help.
Most seek minimum wage jobs and temporary work because life in the cult group
ended education and significant job training, their work in the cult having consisted of
seeking contnbutions, recruiting others and the simplest forms of labor.
Help available now to cult veterans is all volunteer and mainly educational and psychologically supportive help. The degree of need varies, of course, from veteran to veteran.
No adequate survey has ever been undertaken of the degree of exposure to such cult
groups. There are about 5,000 such groups in the United States, some large, some very
small. I estimate that about 10-20 million people have at some point in recent years been
in one or more of such groups.
It is extremely important to the well-being of these cult veterans that a new program
.
cover their emotional and mental rehabilitation needs, as well as continuing health needs
of all kinds, including preventive, out-patient and residential treatments. It is extremely
important that the program include social work guidance that will help the regressed,
immature cult veteran regain or develop an adult competence to manage day to day affairs.
It is extremely important that such workers understand how cultic influence and control
impacted the ex-members. Ex-cultists need psycho-educational and social work help, not
ordinary psychotherapy except in rare circumstances.
�-4In closing, let me note that these so-called cults are by no means all religiously
oriented. Cults form around many themes, including political, racial, and psychotherapy
themes. Common threads include loss of independence and critical thinking skills and extreme reliance on leaders. The end result for you to consider is a desperate lack of vital
health care.
I will be happy to provide any further information the Task Force may need. Thank
you again for all your important work and for considering this statement.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. resume
SUBJECTfi'ITLE
DATE
Curriculum Vitae. Margaret Thaler Singer. [partial] (1 page)
[none]
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [5]
2006-0223-F
ab620
RESTRICTION CODES
Presidential Records Act -(44 U.S.C. 2204(a)l
Freedom of Information Act -IS U.S.C. SS2(b)J
PI National Security Classified Information ((a)(l) of the PRAJ
P2 Relating to the appointment to Federal office ((a)(2) of the PRAJ
P3 Release would violate a Federal statute ((a)(3) of the PRAJ
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRAI
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRAJ
b(l) National security classified information ((b)(l) of the FOIAJ
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIAJ
b(3) Release would violate a Federal statute ((b)(3) of the FOIAI
b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) of the FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Curriculum Vltaa
Naaa1
Margarat Thal ~er fH nger, Ph. D.
lRS
Addr1111SU
!'tart tal Status a Marr11!HS
t ,Jqrome R.
51 nger, Ph. D.
Phy1iiic:ist., tJ.C., Berkeley,Emttl"'it:us Pro.fs&sor
Licensure• Clinical Psyr.holoqy,
Cali~ornia,
1959,~1740
Educatton1 19:59-43 IJniv&rsity of Denver, B.A. Speech
1944-45 Univer~ity of DRnver, M.A. Speech
Patholoogy. Spacial
1950-52 University of
Denv~r,
Educati~l
Ph.D. Clinical
Puycholagy
Honors a Ho·fhaimar Prt 7.AI .fnr REtsearch. American Psychiatric
Assa~iation,
t96b
Stanley R. Oean Award ·for Research in Schizophrenia,
American College of Psychiatrists, 1976
McAlpin Award for Achiev~mP.nt in Research, Mental
Health As•ociation of the United States, 1~77
Research Scientist Award, National
of Mental Haalth, 1977
lnstitl.lte
American Family Therapy Associ01tion Award ·for
Distinguished Achievement in Family Therapy
Research., 191::11
Ryan MP.mnr\~1 Award .for Research on Cults.
Citizens Freedom Founrtr.ltion., 1961
L.9o .l.
Distinguished Teaching Award., Northern California
Society of
Pr~sident,
Clintr::.~l
Hypnosis, 1992
Amarican Psychosomatic Society, 1972-1973
President Ford's Biomedical Re~e~rch Panal 7 Social
and Developmental Section, 1975
Amari can Anc;nr=i. r..'ti .,n .fnr Marriage and Famt 1 y Therapy
Award for Cumulative Contributions to Research in
Family Therapy, 1991
SS8l8~8S1~'0N
l31
~39tH·
�Edita~1al
Boards•
Editorial
Board~
Psychoaamat1c
Madicin•~1963-1973
Advisory Editor 7 Family Proeass,
19~8-1975
Editorial Baard and Secretary-Treasurar 1 FaMily
Pr-ac:ess 7 197b tM flr''':u:;~nt:
Editorial Board, Familiendynam1k,
Entwtclclung,
197~
t.o
Thar~ia,Forschung,
1987
Editorial Soard, Rasaarch Communt~attons in
Psychalaoy,Psychiatry, and B•hav1or,1975 to present
Editorial Board,Cultic Studt•• Journa1,1984 to
pregent
Editorial Congul tc:u1t. Jaurnal of Fami 1 y Psyt:hal aoy,
198b to present
s.,..vtc:••
National Insti tube o-f f1ental Health Proqram Projects
Review Committee, 1972-1975
Council Member~ American Psycho9omat1~ Society, 1966bS;1972-73; Program Committee 1971,1977; Membership Committed 1971-74; President 1972-1973
Kaiser Foundation Research Instit.ut.Q
Review Board .1978 to present
ln~titutional
Board o.f Advisors,American Family Foundation 19801989; Bo•.,·d of Directors 1989 to pr-Q~&nt
Board of Directors, American Family Therapy AsGociation~ 1981 to 19Bb
Tru'Stee, The Wright Institute, Berkeley, C.ali·fornia,
1985 to present
Honorary Patron, Cult Project Resource and Education
Center. MQntreal, Canada
Con~ultant~
Americ.an Psychiatric Assor:iat.ion Task
Force on Treatment
o~
Psychiatric Disorder$
Chairperson: American Psychological
A~~ociatton
Task Force on thooJ tnd.irect and Deceptive
Uses o~ Psyc:hol oqi c:.~l Toc:hni ques
Advisory Board, Cult. Awareness Network
Scientific and Profes~ional Advisory Board,
False Momory Syndrome Foundation
~39NI
�-·
3
?articipant: Conference to Explora the Psychological
Effect~ of Chemic~! and Biological Warfare. Airliey
Virginia.,December, 1986, Uniform Services University
of the Health Scienceq.
Parttcpant: Conference to EKplore Training for
Operatianal and Medi~a1 Personnel for Coping,
Adaptation and Perfor·cnanr:e in the High Stre5s
Environment of ChP.mtc:al and Biological Warfat"e.
A1rl1e, Virginia,1987, Uniformed Services University
of the Health Sciences.
Member: Committee to Survey the Health Effects of
Mustard G~~ and Lewisite~ Institute of Medi~ine,
National Academy of Sciences, 1992.
Board of Regent5, American Board of Forensic
Ha11dwrittng Analy'!:lts, tnc., 1992.
Advisory Board, Maynard Bernstein Resource Center
an Cults
rlllmbarshipsl AfQeri c:an Psy(;hosomati. c Stlt=i et:.y (Past President)
American Psychological Association
Internat.ional Soci.aty elf Political Psyc:halogy
World Federation of Mental Health Committee on
Needs o~ Victims ( Charter Member)
National Conference on Treatment and Rehabilitation o-f Survivors of Torture., Terrorism,
and Hostage-Taking
Northern Californ;.:. !=iociety of Clinical Hypnosis
Hono..-ary Member East 9ay Psychiatric Ass~iation
Honorary Member Tit.uc;; Harris Psychiatric Assoc.
Society for Clinical and Experimental Hypnosis
American Boar•J of Forensic Handwriting Analysts
P~af•sstonal
Int•~•sts•
Language and communir:ation
persuasion,thought reform
rel ati "ns i'"\~; c;;c:hizoohrenics
Psychosomatic research
Cults,brainwashing.,co~r~\ve
Fami 1 y
I.
I
'.
Paslttan••
1~42-1945
Th•rapist: Hi 11·-Young School., University of Denver;
Fitzsimons Army Hospital, .and Denver
Public Schools; Spaach.,reading and
writing training for blind ,daaf,and
aphaGic children,adults and war casualties.
Univargity of Colorado School
of Medir.ine:aseessment,therapy.,te•ching,
rese.ar·c:h in Hedic:al Center and
supervi~ing p~yehological services ~or
P•y~hologist:
. .
.
IIIIIIIII~ITI"Ii'li~~n~n~·~~n~.,~~n~h~.i·I011.~ ~.·-~-T ~J·P·I··'. . . . . . . . . . . . .~~-~c~~~·T~.~~·~~~~~C~T~"~·~·~o~~·~l~l~1jl._______________________~~39NI~
..
..
�-·
4
Consultant• Dl!nver Public:: Schools
Psychology Staff
Fami 1 y lolel-f.,.re Servi c:e
Children's Aid So~ie~y
V.A. Hospital,Fort Sheridan,
Wycming
Colorado Sta~e Ho~pital
1953-1958 88nior Investigator;
Collaborative
Labora~cry of Clinical
Psychology,Naltar Reed
Army ln~titute o~ Research,
Washington, D.C.
Resear~ha
Division of Clinical
Science, National
Ins~i~u~e
of Men~al Health, Bethesda,
Maryland
Cl inj.c::al Psychology., Albert
Einstein College of
Medicine,N•w York
Washington Schnal of
Psychiatry,and Howard
Uni vertii ty
United Statile Military
Academy,West Point,N.Y.
USAF S~ress and Fatigue Laboratory,Wright-Pattereon
AFB,Ohio
AMA Committee on Aging
University o-f Colorado
School a·F Medicine
un;vero;;ity of Maryland
School o-f Medi~ine
1958-1973 Bp•etal Consultant <Rasaarch Aascciat•l• Adult
Psychiatry Branch, National Instltu~e
of Mental He~lth, Bethesda, Maryland
Ccn•ultent: and r-t!llsearch
asao~i•t•• Univer-si~y o.f
C.ar-tHOV-"'t;':C:Ul.-;ar Resa.ar-eh
tnstitut.e, San Francisco 1958-1964,
C~li.f:orni~,
1971
L.ac:turar-1
University o-f Ca.li-forni.a 7 Berkeley
Psycholo9y D_,part:mctnt:,19h4-l973
�Cant~ult.antl
Massar.ht. l~P.tts In-stitute o.f TQ«::hnology,
Schofll o·f I ndustr t a 1 Management;
CaliJornia Youth Authority; C.alifornia
State Department of Educationp United
States Air Force, Travis Field; Langley
Port~r Neuropgychiatric Institute;
Kaiser Foundation Hospitals; V.A.
Oakland ~nd V.A. Martinez,Cali.forniaJ
At:.a,;ca.dero,N.ap<"• and Stockton Stata
Hospital~, California
1973-1977 Clinical Prof•••orl Dep~rtment of Psychiatry,
<Clinical PsychologyJ,University of
Rochester Sr:hocJl a.f ME!dic:ine,
Roc:hestar, New York
La~turer1
University of California, Berkeley,
Psychology Department
Univeruit.y Df California,Los Angeles
Psychology Department
Univ~r~ity of California~ San
Francisco, Dept. o+ Psy~hiatry
Wright Institute, 9er-keley.,California
R••••rc:h
ProJo~t
Director•
Schizophreni~s
and their
familias.Wright
lnstitute,8erkeley,
Cali~ornia. Grant
Foundation Awa~da@
Boston Universi~y
School of Medicine
Studies of Air Traffic
Cont.rollctr-s
VI si tlnQ Pr-o~assor-: Departn1ent of P~yr:holagical and
Social Medlcine,1975. Pacific
Coneultont•
EK•~uttv•
Medical Centctr,San Francisco
Committe•• West Coast Cancer Foundation,
San Francisc~T1975-76
Vt•lting Sc:holar tn
R••••~ch
Ra•id~tn~••
Scl•nttst Award•
Prof•••ar in
Aasidan~••
UCLA, Summer- . . 1976
l977-1982
National
Health
Institute of Mental
Department of Psychiatry,University
Cali~ornia, San Francisco
Prof•••ar in Rasidanc•= Department of Pgychology,
~~R18v8Stv"ON
l31
... __ .. _. -·.
~39N:
�Clinical
P~~f•••a~•
OepartmQnt
of
o~
Roc:he~·tar
P~ychiatry,
School
o~
Univar'Sity
l"'adicine
1982 to 19Bb:
Prof•••ar in Ra•idanca•
University
o·~
f)pp,:;art:m~nt
C.;;\ I i
fo~ni
of Psychology,
a, Ba~kel ay
Prafeasor in Raaidanca ;
fJ~partment o.f Psychiatry,
University of California, San Fr~ncisc:a
Clinical Profawaor1 Department o·F Psychiatry, University
of Rochest.er School o-f Medicine
Adjunct Professor•
California School of Professional Psychology
Sayb~ook Instit.'-'tA
California Graduata School of Marital and Family
ThE!rapy
1996
'=a
Adjunct
p~asanb
P~of•••a~•
09-par~men~
of Psychology,
o~ California, Berkeley
Emaritu"O status sinca 1991
Univer~ity
California School of
Psychology
Saybrook
P~ofessional
lnsti~uta
Cali ·Forni. a. School o-F Marital aJ'\d
Family Therapy
Cllnleal
P~~f•••a~=
Oep~rtment
Untv~r~ity
o~ Psyr.hiatry <Psychology)
of Rochector School of
M@dicine and Dentistry
Privat• Practtc••
D-iagnosis, therapy < individual ,marital,
and family), r~sear~h,~uparvisionT
forensic c:onsult.at:ion, in-service training~
teaching ~ld lecturing
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7
PUBLICATIONS
1. Henrilf.son, E.H. and Thaler, M. (1944). Assump~ions
underlying speech drills. American Journal of Bpe•ch.
2.
Htr~chberg,
C.,Coleman, J •• Rogers,R.L.,Stubbl&field,R.L.,Thaler,
ilnd Princi, F. ( 1950) .A study o·f miners in relation to the
a~cidant probl9m. American Journal of Orthopsychiatry,552559.
M.
3. Th.alar, M. U950> THe role o·F a. psycholot~ist in
psychiatric clinic.Mental Hyqtena, 219-227.
4. Mulder, D.,Parrott, M.,
~nd
western @quine encephalitis.
.11.
traveling
Thaler, M. (1951). Sequelae of
Neuralogy,1.3tB-327.
5. Frost, L .. , Thaler, 1'1. ,9•..u;sg 7 E.W • ., .lind Shy,G.M. ( 19:52).
St.udi •• in th• prn~e~s of ag i nQ: I I • Rorscl1ach f i nd i ngs as
correla~ed with physiological chant~es of the aging process.
Jaurnal af &eP"antalaav.7.479.
b. Silverman, A.J.,Bu~se, E.W., Barnes. R.H •• Fros~, L • ., and
Thaler, M. (19S3>.Studies in the process of aging: IV.
Physiological in-fluanc:gs on psychic .functioning in elderly
people.B•riatrics, B,370-:~76.
7. Busse, E.W.,Barnes, R.H. ,Silverman, A.J.,Thaler, M., and
Fro•t, L. <1954>. Studies in the pro~es§ of aging:Faetors
that influanc• the psycha o-f elderly persons. Ameri~.n
Jaurnal oof Payc:htatry, 110,897-9,)3.
8. Thaler,M.
(1954>. Culture and
medi~al
t;.;are. Military
Mwdicin• and Alltad Science, Volume 1954. Washington,
D.C.IArey Medical Service Graduate School.
Thal~r, M. <1954>. Communi-ty psychi•~ry• The t.rav•ling
p•y~hiatric clinic. Topeka~Kansas: Menninger Fcundation-
9.
t<ansas State Department. of Public Welfare Publ icati.ons.
I
I'
10. Raiser, M.F.,Thaler, M., and Neiner,H. (195:5). 'The
experim•ntal manipulation of proiective s~imuli in the study
of psychophys• ological r·espon!!lt!S. P•yc:hasamatic
ttwdtctn•,17,480.
11. BussR, E.W., Barn&!;, B.H. ,Silverman,A.J • ., ihaler,M., and
Frost, L. (1955). Studies in the prQcess oi aging: X. The
strengths ~nd weakna~~es of psychie functioning in ~he ag•d.
Am.rtcan Journal ai Psychi•try,tt1,896-90t.
12. Thalar-,M.(1956).
Psychtat~ic
49J.Washing~an, D.C.:
l•arning.
of stressful situations an
Rasaarch Raparts.3,<pp.46American Psychiatric Association.
Effect:5
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•.
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13. Strassman, H. B., ·rhaler, M., and Schein, E. H. <1956). A
prisoner af war syndrome= Ap~thy as a reaction to gQvere
stress. Amertean Journal of Psychiatry, 112,998-1003.
14. Thaler,M. (1956). RPl~~innships amon9 WechslQr,
Waigl,Rorsch.ac::h and EES fil'u:lin•J~ and abstract-c:om:rete
behavior in a group o.f normal aged sub.iects.Journal of
•ron~ology,11,404-409.
Thaler, M. <195bl.
15.
Foundations of
p5ychcso~Gatic
resaarc:h.Radto Untvareity Seri_ag,Na.46-a. Washington,D.C.c
Voice of America, ·united States Information
Agency,December,1956.
16.
Note~ on three theories of personality
the Rorschar.h test. Semlkea,10,121-154.
Thaler 9 M.(l9~bl.
applied
~o
17. Price, D., Th~ler, H.,and Mason, J.W. (1957). Studies of
preoperative emo~i~nal stateG and adrenal cortical activity
in cardiac and pulmonary ~"rgery patients.Archives of
N8urolooy end Psychiatry,77,646-656.
lB. Thaler, M.<1957). Review:Psychological aspects of
a9ining: Proceeding~ of a conference on planning
research.Jcurnal ol Garan~aloQY•
19. Thaler, M.,Reiser, M.F., and Weiner, H. (1957). An
e)(plot"at:ion of the doctor-pa.t:i.ent relationship through
prajecttva t:achniques:-Their use in psychosomati~ illness.
P•ychasanaat:h: l'l•dt.c:lne, t9,2:ZS-239.
20. Wainer, H.,Thaler, M., Reiser, M.F.,and Mirsky,I.A.
<19'57). Etiology o-f dundP.t'\Al ulc:er:Relation of specific
psychological charactaristir.~ to rate of g.astric: secretion
<c;eruta pepsinogen) .Psychoeomattc Medicina,19, 1-10.
21. Singer. M.T. and Schein. E.H. <1958>. Projective tast
responses of prisoners of w«r following
repatri at ian. Psychletry, 21 ,S7!5-:sss.
22. Loveland, N.T. and Singer. M.T. (1959). ProjRCtive test
as•assmant of the a-f-fet:f:s f7l·F c;leep deprivation. Journal of
ProJwctlve Tachn1quas.23,323-334.
E.H.~Coolev,W.E. 7 and Sing~r. M.T. (1960). A
psychalOQtcal fallaw-up of former prison•r• of w.r of tha
Chin••• cammunletsa Part I. R•sult• of in~•rvtew study. (pp.l-
23. Schain,
91l.C:ambridge7 Massachuc;ett'c;;: Massachusetts Institute of
Technology.
24.Stnger, M. T and Spei5rnan .. J.C. <19bll Rorschach
correlates in five groups wtth organic pathology. Journal of
ProJective Tachniques,2~ 1 356-359 •
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2'5 .. Morris, G.O. and Singer. M. 1'. <1961). Sleep depr-ivation:
Transactional and subje~tivg obGervations. Ar~hiv•• of
General Psych1atry,S,4S3-461.
26. Schein, E. H • .,Singer, M. T • ., and Cooley, W.E.
<1'i61>. A
psychalagical fallow-up of ~armar- p~tsanars of war of th•
Chin•. . communis~•• Part II. Result• of p•ycholOQl~Al tasta.
Cambridge, Massachusett~tMassachusetts Institute of
Technology.
27. Schein, E.H. and Singer, M.T. (1962>. Follow-up
in~elligence test dat~ nn prisoners repat~iatad from North
Korea. Psychalogical Reports,11,193-194.
2S.Weiner, H.,Singer, M.T. and Reiser? M.F. (1962).
Cardiovascular respons~s and their phy$iological ~orralatas:
A study in healthy young adults and patients with pepti~
ulcer and hypertension. Psychosomatic "adtcina,24,447-4~a.
29. Feingold, B.F.,Gorman, F • .,Singer, M.T. and S~hlesinger,
K. (1962>. Psychological studies of allergi~ women1 The
relation between sk;n reactivity and
per•onality.Psychoaomattc Madtcin•,24,19b-202.
30. Hardyck, C., Singer, H.·r., and Harris, R.E.U962>.
Tran~ient ~hanges in affoct and
blood pressu~e .. Archiv•• of
General Psychiatry, 7, 15··7.t),.
31. Singer, M.T.U963). A Rot-·~ch~ch view of the family. In D ..
Rosenthal, <Ed.).Th• Ganain quadruplets; A ca. . study and
theor-•tical analyaia of heredity and environment in
schtzophrania. (pp.3t~-326>. New York; Basic Books.
32.Wynne 1 L.C. and Sinqer, M. T. <1963). Tha ~r-ansc:ultural
study of schi:u,phrc;mics and t:h'=!'ir families. Proceedings of
Joint meeting of the American Psychiatric Association and the
Japan•~• Society of P~ychiatry and Neurology.Folia
Psychiatr-ic at Nauralagtca Japonica,.Suppl•ment No. ?,28-39.
33. Singer., M.T. (19~3). P9r~onality measurement in thR aged.
J. Birr@n <Ed.).Human agtng1 A blOlDQi~al and behavioral
study.(pp-159-217). Washington, O.C.; Publi~ H.alth Service
Publication No.9B6. U.S.Government Printing Offi~e.
34. Loveland, N.T.,Singer 1 M.r., and Wynne,L.C.
~~mily
Ro~sehach=
A new
m~~hori
of 9tUdY1ng
<1963)~
The
~amily
inter.action. Family Pr-ac11'1s,2, 187--:215.
35 .. Singer, M.T. and Wynne, L.C. (1963). Differentiatinq
characte~istics of the parents of childhood
schizophreni~g,childhood n~urotics and young adult
schi~o~hrenics.Amerlcan Journal of Psychtat~y,120,234-243.
�10
36. Wynne, L.C. and Singer, M.T. (196.3). Thought. dh;ordar- .and
f•mily relations of schizophrenic~: I. A raseareh gtrategy.
Archives of Ben•ral P•v~hiatry,9.191-19B.
37. Wynne, L.C. and Singer, M.T. <1963>. Thought disorder and
family relations of sc:hi;:opa,re•1ics: II.A classi-fication o-f
forms of thtnkin~. Archtves of Saneral Psychtatry,9,1~9-206.
38. Nynne,L~C- and Stnger, M.T. (1964).ThinklnQ dtsarders and
f . .tly tran•acttans. K~ynote address: Joint Meeting of tha
American Psychiatric As60Ciation and the American
Posychoanalytic Association.
39. Singer., M.·T. and Wynn~, L.G. t19b:SJ. Thcn.,ght dl$order and
family relations of ~r-hizophrenics; Ili.Methodology using
projective te~hniques. Archives a-f eanaral Psy~hiat.ry, 12.
197-200.
Singar, M. T- and Wynne, I_. C. (1965). Thouqnt disorder and
family relatton5 of schizophreni~s: IV. Results and
implications. Arehtvas of General Psychlatry,12, 201-212.
4c"l.
41. Singer, M.T. and Wynne, L.C. <1964).9~ylistlc variablas
In family r••••rch.Milwaukae.W"isconsinc Marquette UniversityMilwaukee Psychiatric Hospital.
42. Wild., C., s;.nger, M.T •• Rosman,B •• Ric~t.J.,and
Lidz,T.t19b5).Measuring disordered styles of thinking: Using
the object sorting tegt- on pa,..ent!5 o-f schizophrenic
p~tiants.Arehiv•• of General Psychiatry, 13,471-476.
43. Singer., M.T. and Wynne. L.C. (1965>. Communication styles
in parents of normal9 7 neurotie~ and schizohrenics: Some
findings using a new Ror9ch~ch manual.Psychlatri~ R•. .arch
Ftapart 20,<pp.25-3B). Washinqtcn,D.C.: American PSychiatric
A~tsaciation •
.
44.Wynne, L.C. and Singer, M.T. <1966). Schizophrenic
impairments of shared focal attention:: A strategic concept.
far research and therapy. Tenth Annual Ber-tram Roberts
Mamartal L•ctu~e. New Haven. Connec:ticut~Yal~ University.
45. Singer, M.T. and Wynne, L.C. <1966). Principles for
scoring communication rle-f~cts and deviances in paran~s of
schizopohrenics: Rorschach qnd TAT scaring manuals.
Psychiat~y,29,260-298.
4b. Feingold, B.F. 7 Singer, M.T.,Freeman, ~.H., and Daskin$,
A. (1966).Psychological variables in allergic di$eage: A
cri~ieal appraisal of mqthodology.Journal of Allergy,38,143155.
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47. Freeman, E.H.,Gorman,F.J., Singer, M.T., Affelder. M.A.,
arid Feingold, B.F. (1967). F'eroonatity variables and allergic:
skin reactivity' A cro~~-validation study. Psychosomatic
Medteina,29,~t2-322.
~a. Singer, M.T. <1967>. Family tran~actions and
gchizophrenia: I. Recq,nt research ~indinqs. In J.
Ro•ano<Ed.>, Origins of Schizophrenia (pp.147-164l.
Am~tardam, Holland~ E~~er~ta Medi~a International Congress
Series, No. 1::11 •.
49. Morris, G.O. and Sin~Rr, M.T. <1967). Sleep
daprivation1The context o~ ronsciousness. Journal af N.rvau•
and .._ni:al Dl••••ee, 143, Z91··304.
50. Stngar, M.T. (1967>. Endurtnq personality styles and
ra$ponses to stra•~- Tran•action• of i:h• Assactattan af Lif•
In•uranca Madtcal Directors of America,31,150-173.
5t. Harris, R.E.and Singer, M.T. (1968). Interaction of
personality and stress in the pathogenesis of esaential
hypertan5ian~ Hyparten•lan, XYI, Neural Cdn~~al af Art.rial
Pr•••u~•· American Heart A•.;soc:iation .. 104-115.
52. Singer~ M.T. C1969>. The consensus Rorschach and family
transactions. Journal of Projective Techniqu•••32 1 348-351.
53.
Singer~
M.T. anrl
quiz. Playboy.,.
Fr~eman
7 E.H.
(1970).
Distaf~
ss~
54. Wynne, L.C.~Caudill. W.,Ka5ahara.Y •• Kuromaru. S., Singer,
M.T., and Higa~ M. (1971). rranslation problems in the crass~vl~ural study of p~ychopathology; A comparison g~ Japane~o
and American disorders a~ thinking ~nd communication. In
Man-tal H•IUth Resa.arch in A4Dta and the Pacific. Honolul1J.
Hawaii~ University of Hawaii •
.
Singer, M.T. <1973). Scoring manual for communication
d•vlenc•• seen in individually adminl•~•r•d Ror•eha~h•.
Revision,1973 <mimeographed 100 ~p.).
5~.
56. Singer, M.T. (1974>. Enqagement-involvement: A central
phenomenon in psychophysiological re~earc:h. < Presidential
addreas>. Paychoso•ati~ M•dicina,36,1-17.
~7. Hurst, M.W. and Singer~ M.T.
Ct974>. PsychalaQlcal te•t•
d••19n•d for Air Traffic Controll•r•. Progress report to
Federal Aviation Administr~tion.
59. Hur90t, M.W. and
Sint}~•--, M. T. <19741 8ubJ•ct-tva dif~icul~y
in al,. traf.fic control. Progr·est; report to Federal Aviation
Ad111inistrat1on.
�l.
I
12
Gunderson, J.G. and Sinqer. M.T. ( 1975). De~inin9
borderline patients: An overviaw. American Journal of
P•yehiatrv,l32,1-tO.
5~.
Wvnne,. L.C.,Singer, M.·r., Bartko; J., and Toohey, M.L~
<l«i76). Sc:hizoohrenic:s and their ~~milie!;l R•saarch on
parental c:ommuncat'i.on. In J.M. Tanner <Ed.)., D•velap...,t• tn
P•vchiatrtc: Ra•erch .. SI!venoal<.s, Kent, England: Hodder and
Stoughton, Ltd. A revised for~ o~ the Sir GQof~rey Vieker~
Lec:turu.
60.
61. Singer, M.T. <197bl. S~htzophranta, f.mtlla• and
cammuneatian dl•arder•• I. Ovarviaw and reeearch ftndtnga.
Stanley R. Dean Award Lecture, American Collega of
Psyc;hiatrists.
62. Wynne, L.C • .,Singer. M.T., and Toohey, M.L..• <1976).
Ca.•unicatian of the ddopttve parentg of schizophranic:s. In
J. Jorstad and E. Ugelstad lEds.), Schizophrenia 7~1
Psychath.,..apy.,fam11Y studies and resaarch .. Cpp.413-431). O!ilo.,
Norway• UniversitQt-forlaqet.
63. Sin9er, M.T. <1977>. The Rorschach as a transaction. In
M.A. Rickers-Ovsiankina <ed.>. Rorschach psychology.
Huntington,N~w York,45S-495.
64. Singet",. H.T. <19"17>. ThP. borderline diagnosis and
psychalog1cal test§: RP.view and ~aaearch. In P.
Hartccollis,<Ed.>.Bardarline p•r•onallty dt.ardar•• The
cance~t,tha syndrame, the patient. New York: International
Universitias Prass 9 193-212.
65.
Singer. ".T. (1977). P~ycholo9ical dimensions in
psychosomatic patiants.Psychatharapy and Psychasamatlcs,2S,l327.
66.
S"inger, M.T. {1978>. Communieation disorders and tha
of ~chi~ophrenics. In L.t. Wynne,R.L. Cromwell, and
S.Matthvsse <Eds.>.Tha natura of schtzophr.n1aa N.w
appraech•• ta r••••rch end treetmant. New York: Wiley.,499~a.ilies
::i11.
67.
Singer, H.T. (197B>.Attentional processes in varbal
behavior. In L.C. Wynne,R.L. Cromwell,and s. Matthysse
<Eds. >.The nature of schizophrent.:u New apprOACh•• to
resear~h and treatment. New York: Wiley,329-33b.
bB.
Wynne, L.C., Singer, M.T. and Toohey, M.L. (1977>.
Kommunikatian von adoptiv9ltern ~chizophrener.
Famill•ndynamik~2,125-t58.
�13
69.
Singer, M.T.C1978). Projective testing and psychiatric
dioa9nosis:: Validity and the future.
In R.L. Spitzer and D.F.
Klein, Eds. C~ttt~al Issues in Psychiatri~ Dlagno•ia. New
York: Raven Press.14-1S.
Singar, M.T. <1978>. Therapy with ax-cult merabers.
af tha National Assactatton of Private P•yehlatrlc
Haspttal•. 91 <4),14-18.
70.
~ou~nal
71.
Sinqer,M.T.<1978). Processi di at.t.an2ione nal
camportament.o varbale. Tarapia Familiae. 3,95-105.
72.
Singer, M.T. (1979>. Cominq out of the cults. PaycholOQY
Today .12 • January,. 7?.··97.
73.
Singer, M.T.(1979). Topics on Target: Cults. Foreea•t•
Schol act t c: l'lavaz i n•, May, :-s7.
74.
Singer, M.T.(1979>. Coer~ive persuasian un die proble.e
dar "e)C-cult cnambers." In 11. Muller-Kuppers and F. Specht
<Eds.> Nau• Jugend-relioionen. Gottingen, Germ~ny:
Vanderhoec:k and Ruprecht, 104-120..
I ;
75.
Singer, M.T. (1980). Teenage suicides: A growing
problem. Far•c~st1 Schalas~ic Maga%ina,January,~4-35,S5.
I;
:~
1b.
West, L.J. ~nd Singer, M.T. (1~80). Cul~s, quacks, and
nonprofe!isional psychotherapies.
In H. I. •~aplan,A.M.
Freedman, and B.J. Sadock tEds.) Camp~•h•nsiv• T•Mtboak of
P•vchiatrv III. Balttmorer William~ and Wilkins.
;
'I
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I
~
77.
SinQe~. M.T. and Largon 9 D.G. <1991>. The borderline
per!ianality and the r~orschac:h: A compar-ison wi~h ac:uta and
chronic: sc:hizophrenics.normals and neurotics. Archivea of
Elener.al Psychi .atry, 38, 69:3-698.
(l
78.
Singer, M.T. <1981). Viet Nam priaoners of war, stress,
personality resilien~y. Amart~an Journal of Psychiatry,
1'3813,345-346.
~'d
I:
I.
I;
I i
19. Rit~ler. B., G~vll,S.~ Kiecolt-Glaser, J., Jane•, F.,
and Singer, M. (1981). Predicting off5pring vulnerability to
psychopathology from parents' test data. Journal of
P•~•anal i t:y Assessment, 45,6. 600·-607.
'I
i
''
I;
80.
Doane 7 J.A., Jones,J.E., Fisher, L.,
Rit~lar,B •
.,Singer,
M.T. and Wynne, L.C. (1982>. Parental communi~ation deviance
as a predt~tor o~ competence in children at ~iak ~or
adult psychiatri~ disorder. Family Pracasw. 21,211-223.
n7
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7
n n • n ~-' n" · o
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T
1P 1.1
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81.
Singer, M.T. (1982). Comm~nts:Re&earch on intrafa•ilial
risk factors related to offspring vulnerability. In
Michael J. Goldstein,<Ed.), Preventive Intarvant1on
in S~hizaphr•ni•• Are We Ready.
u.s. Department a.f
Health and Human Services, National ln!ltitute o.f
Mental HC!al th., 173-'75.
Jone•, J.E.,Wynne., L..r.:., Al-Khayal,M.,
Daana,.J • .,Ri tzler, B • .,Singer, M. T. and Fisher., L. ( 1984)Predicting current school competen~e o~ high rish children
with a composite cros~-situational measure af parental
~ommunciation.
In Childr•n at Risk for S~htzophr•niaa A
Longitudinal Perspective. Norman Watt, E.J. Anthony,L.C.
WYnne., and J. Rolf., eds. New Vork: Cambridge l.Jniversity
B2.
Pre~s.
83. Sa5s, L.A., Gunderson, J.C., Singer., M.·r., and Wynne,
L.C. <1984). Parental eommunication deviance and farms of
thinking in mala 9Chizaphrer\1c: of-Fspring.
Jaurnal of N41rvauw
and rlantal Diseases, 172.,513·-520.
84. Singer. M. T. and Wynne, 1... r:. ct9B5l.
SchiZOClhrenics,families and communic:ation disordariit. In
Robert Cancroy<Ed.), R•••areh in th• schlzaph~anic disorder••
Th• Stanley R. D•an award lacturae.,Valuma 1. ( pp. 231-249).
New York: Spectrum Publications.
85.
Singer, M.T. ( 1986).
Consultation with faiAilies of
cultists. In L.C. Wvnne,S.H. Me Daniel, and T.T. Weber (Eds.>
Syat. .• Consultation• A Naw Parspactiva far Fa•tly Tharapy.
( pp.27Q-2B:SJ.
Ne"" Yor-k: 8uil.ford Prsss.
66. Ofshe,R. and Singer, M.T. ( 1986). Attacks on peripharal
versus e•ntral elements of self and the impa~t of thought
reforming t~chniques1 Revigw ~nd analysis.Culttc 9tudi••
Journal. 3, 3-24 •
.
87. Ditton, P.,Green, R.J. and SingerT M.T. (1997>.
Communi~ation deviances: A comparison betwaan parents of
laarning di~abled and normally achieving studen~s.F.-ily
Process. 26, 75-87.
88.
Singnr-., M.T. and Nievod. A.< 1'187). Consulting and
testtfy1nq in court. In Irving 8. WRtner. and Allen HmssT
<Eda.>, H•ndbaok af Faren•ic Psychology. New York: John Wil@y
and Sans, Inc.
Sinqer, M.T. ( 1987). Group fl~Yt:hodynamic&.
In
Manual. Rahway.,New Jarsey:Mer~k Sharp
and Dahma Research l ..=~.boratories.
99.
R.Berkaw.<Ed.)~Harck
_,__~_,_l""''r-T,_
•
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-,-,I
'J"JC:HI T r
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15
90. Singer. H.T. ( 1988). From Hungarianm ~o Hmangs.
A
v.riant of the ostrich syndrome. < Review of R•fuv•• Man~al
~lth in R•settlem•nt Countries.) Contampar•ry Psychology.
33,231-232.
91.
Singer, M.T.
(1989>
Book Review: Marc oalanter: Cultw,
Ox~ord Univermity
Prems~ 19a9.
ln Cult Awaranaga Network New•~ September.19B9.
Reprin~ed tn Cultic Studia• Journal,
<1989) 6,1,107-116.
Faith, Ha•ltng •nd Coercion. New York:
92.
Schuldberg. D., Sinqar. M.T. and Wynne, L.C. < 1990)
Compatence-enhancing cccnmunic:ation by parents of
hiqh-risk children.
Journal of FamilY PsycholDOY• 3, 255·272.
93. Singer, M.T. and Ofshe, R.
(1~0)
Thought Raform
and the Production of Psy~htatric C•sualties.
Psychiatric Annals, 20: 188--1~?:~.
Progra~$
94. Singer, M.T.
(1990)
People and paths along
the way: A trek through words and imaqes.
In Vale•• in
Fa.llv Psychalo~y. Florencs w. Kaslow < ed.>
Newbury Park,
California: Sage Publ icat.lons, 192-206.
95.
TE!mr.~rlin, M.
( 1991).
Studtaa Journal,71 101-125.
Singer, M.T., Langone!, M., and
Psy~hotherapy
Cults.
Culti~
96.
Singer. M.T. ( 1991). Book review:
M. H. Erickson and
E. L. Rossi C1989) • The Febr·uary Man: Evcl vi ng Consciousness
and ldenti ty in Hypno·therapy. New Yorke Brunner/Mazel.
AMerican Journal af Hypnosis.
97. 51m~er, M. T. ~ 1991). Book review: F. J. l"'ac:Hc:lvec <1999).
Cult!ii and Per"»onality. Spr"ing·Ueld. Illinois: Charles C.
Thomas.
In Intarnattonal Journal of Clinical •nd
EMperlmantal Hypna9is.
98. Singer, M.T. (1992). Cults. In Canaprwhenslva Adoleacant
Health Carg. S.B. Friedman. M. Fisher, and 9.k. Schonber9
(ads.). St. Louis, Misso'-.lri: Quality Medical Publishing, Inc.
69Y-704.
99. Singer, M.·r. and Addi!:i,M.E. <1992>. Cults, Coercion and
Contumely. In The Mosaic of Contemporary Psychiatry in
P•raepctiva. A. Kales, C.M. Pier~e and M.Greenblatt <eds.>.
Zuri~hll
Springer Verlag.
t:,.O-t42.
100. Singer, M.T. and Ofshe. R.J. ( 1992~ in prass).
Psychiatric Injuries Caused by a Large aroup A~acene.~~
Training1 Li-fespr:ing. Amartc-A .l'GUFAAl
Psyehiat~v~ .
ef
tOl·
••ne.r. M.T. Cl992t.
AsfMic~s.
~~due
In~lu~c••Psychalaoical
,...,.,.., O.f Gluliatl.,t._ .,..uaunt INPinat.tan.
1, 4-13.
--------------------------------------------------~-~-~-~--· - - - · - · ~~·
~---'--------------------~-~_Q_~_I_T_r~
�__
,_
16
102. Singer. M.T. (1992). Field research in high to maximal
situationss A commentary. Journal a* Applied Baetal
Psyeholagy,22, 1625-1630.
~tress
103. Singer, M.T. and Nievod. A. < !993 7 in press).
Psychological casualties of extreme influence in office,
factory and workplace. Cultt~ Studias Journal.
104. Singsr, M.T. (1992) Book review: R. Enroth (1992).
Churches That Abuse. Grand Rapids, Mi~higan: Zondervan
Publishing House. RadtK Ma9aztne,21, 24,25,31.
105. Singer, M.T. < 1993). Relaticnsnip of mustard agent and
Lewisite exposure to p5ychologir.~l dysfunction.
In Y•~ar•n• at Riskl Tha Health Effact• af Mustard Sa• ~
L..,:lsU:w. Committee "to Sur·vev the 1-tealt.h Effects of Mustard
Gas and L~isite, Division of Health Promotion and Disaa~
Prevention, Institute of Medicine. Washinoton, D.C. National
Acadeny of Science. Chapter 11.
'!
'I
'
~
106. Singer. M.T. <1«193,. in pregs). Cults and Familia!;. In
R.H. Mikesall~ D.D. Lusterman~ and S.H. McDaniel,<Eds.).
Family P•vehalogy •nd Systems Therapy• A Handbock.Washinqton,
D.c •• American Psychological A~sociation Press.
107. Sinc;JI!r, M.T. and Ofshe. R. (1993,in pres&) ..
With and withou~ hypnQsis. Intarnattonal
Journal of Cllnteal and Expartmen~al Hypnaet•.
Pseudom~mories:
4
l"lar~h
93
......................................................--~-~-~-~·~-~-~·~·--==-~·------------------~~~~-~-"_r_J_
�THE WHITE HOUSE
March 29, 1993
Doris C. Graham, R.N.
Pulaski County Special School District
P. 0. Box 8601
Little Rock, Arkansas 72216
Dear Doris:
Thank you for writing and sharing your suggestions about the
need for children to receive eye examinations and glasses. I will
share your letter with the Task Force for consideration in its work.
President Clinton is committed to reforming our nation's
health care system -- controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
Again, thank you for your views and for your support for the
success of our endeavor.
Sincerely yours,
�PULASKI COUNTY SPECIAL SCHOOL DISTRICT
925 East Dixon Road/P.O. Box 8601
Little Rock, Arkansas 72216
(501) 490-2000
March 14, 1993
Hillary Rodham Clinton, The First Lady
Task Force on Health Care Refo:rm
The White House
Washington, D.C. 20500
Dear Mrs. Clinton:
This is my second year as a school nurse for the Pulaski County Special School
District. I do all the vision rescreening (using the Tibnus Optical machine),
for 24 elementary schools.
I am writing to draw your attention to an .important, unmet medical need. The
greatest health problem I see for our children is the need for eye examinations
and glasses. The Lion 1 s Club and United Way rronies can meet a small percentage
of these needs. The same children are screened year after year, fail and do not
receive follow-ups. These children ultimately have difficulty with school work.
The Pulaski County School District (PTA rrothers) screened 8,109 students during
the 1991-92 school year, of which 1,059 were rescreened by a school nurse with 576
referred. There were 229 children seen by a physician and roost needed glasses.
This means that 47% received eye examinations.
The principals, teachers and other school nurses and I believe the vision follow-ups
fall into one of the following categories:
1.
Parents who can afford to take their children for an exam ( including
Medicaid).
2.
Parents who can afford to take their children, but won 1 t.
3.
Parents who would like to provide eye exams, but can't afford the cost.
We estimate that 34%, or 196 children, in this group will not have exams.
I have talked with other health and school personnel and have found vision referrals
and follow-ups are unrnet needs in their areas.
Your interest in education and health services is apppreciated by alJ of us. This
vision problem involves both the health and education of our children. As head of
the President's Task Force on Health Care Refo:rm, your consideration of this problem
would be greatly appreciated.
Sincerely,
4~ t . .~~
Doris C. Graham, R.N.
DCG:rnn
.-<.1/.
�....
THE WHITE HOUSE
WASHINGTON
March 29, 1993
Clare O'Callaghan, R.N., Ed.D.
1419 Beacon Street, Suite 33
Brookline, Massachusetts 02146
Dear Clare:
Thank you for your offer of assistance to the Health Care Task Force. The Task
Force includes the Secretaries of the Treasury, Defense, Commerce, Labor, Health and
Human Services, and Veterans Affairs; the Director of the Office of Management and
Budget; the Assistant to the President for Domestic Policy; the Assistant to the President for
Economic Policy; the Chair of the Council of Economic Advisors; and the Senior Advisor to
the President for Policy Development.
In addition, the Senior Advisor to the President for Policy Development will lead
interdepartmental working groups which will gather information for, and provide information
to, the Task Force. The working groups, which are working closely with Members of
Congress and their staffs, are comprised of government employees.
While the working groups have begun the process of preparing policy options for
reforming our health care system, their work is an ongoing process. The members of the
Task Force are anxious to consult with knowledgeable and concerned people. I am sending
your letter and curriculum vitae along to the appropriate working group. Again, thank you
for your offer of assistance and your continued support for the success of our endeavor.
Sincerely yours,
�CLARE O'CALLAGHAN,
R.N .. ED.D.
PSYCHOLOGIST
1419 BEACON STREET. SUITE 33
BROOKLINE. MASSACHUSETTS 02 146
(6 1 71 232· 1 505
March 15, 1993
Mrs. Hillary R. Clinton
Room 100
Office of the First Lady
Old Executive Office Building
Washington, DC 20500
Dear Hillary:
I had originally given my resume to Eldie Acheson to bring to the
Transition Team, but since I am not sure if you ever received it, I
thought I would forward another copy to you and Steven Eddlestein. I
am still interested in helping with the Health Care Task Force. I
have been working as a neuropsychologist/psychotherapist in private
practice with children and adults for the past 15+ years. I have also
continued to work in an inner city community mental health center
outpatient department (now managed by the South End Community Health
Center) for the past 20 years.
Thus, as both a nurse and a
psychologist, I have some familiarity with the delivery of health
care services, especially mental health services, in both the
private and public sector (and have seen countless cases of underinsured and uninsured patients). In both situations, I have also
done consultations with public and private schools.
Prior to the convention, I was asked by the Boston Clinton Headquarters to deliver a synopsis of Bill's Health Care Policy to a
community meeting in Hyde Park, MA. Later, I was invited by a Boston
women's group of health care administrators to discuss the same
topic.
If I can help in any way, please let me know. Best of 1uck with your
fterculean undertaking. I think you are doing a great job.
Sincerely, ·
~
Clare O'Callaghan, R.N., Ed.D.
COC/M&E
Enc.
cc: Mr. Steven Eddlestein
PS: I suggested to my sister, Joan O'Callaghan, who has been working
for many years as a writer/editor for EPA and now with a private firm,
to also send a copy of her resume. She might be of some help in
pulling together some of the deliberations from the meetings.
�CURRICULUM VITAE
CLARE O'CALLAGHAN
HOME:
42 Old Quarry Drive
Weymouth, MA 02188
(617) 337-2118
WORK:
1419 Beacon Street
Brookline, MA 02146
(617) 232-1505
EDUCATION
Doctoral Degree in Special Education - May 1976
BOSTON UNIVERSITY, SCHOOL OF EDUCATION
Dissertation:
A General Systems Theory Approach to the Diagnosis of
Emo~1onal, Behavioral, and Learning "Disorders of Childhood.
Master's Degree in Child Psychiatric Nursing - May 1970
BOSTON UNIYERSITY, SCHOOL OF NURSING
Thesis:
A Study of the Nature and Frequency of Tactile Contacts in
an Activity Group for Autistic Children.
Bachelor of S~ience Degree in Nursing - June 1968
GEORGETOWN UNIVERSITY, SCHOOL OF NURSING
ADDITIONAL PROFESSIONAL TRAINING
1981 - 1983
BOSTON VETERANS' ADMINISTRATION HOSPITAL
Post-Doctoral Fellowship in Neuropsychology
Supervisor: Dr. Edith Kaplan
19821 - 1981
BOSTON VETERANS' ADMINISTRATION HOSPITAL
Weekly Seminars in NeuropsychoLogical Testing and
Neurobehavioral Rounds
-
PROFESSIONAL EXPERIENCE
·,
!. '
••
1979 Present
PRIVATE PRACTICE -- NEUROPSYCHOLOGY/PSYCHOTHERAPY
Practice includes.children, adults, and families,
con~ultation and individual supervision.
1973 Present
BOSTON UNIVERSITY, CHILD PSYCHIATRY DEPARTMENT, CHILDREN'S
SERVICES, OUTPATIENT DEPARTMENT, SOLOMON CARTER FULLER
MENTAL HEALTH CENTER (CURRENTLY THE SOUTH END COMMUNITY
HEALTH CENTER AT S. C. FULLER MENTAL HEALTH CENTER)
Chief Psychiatric Nurse ('73 -Present), Chief Psychologist ('92 - Present)
Position has included the following responsibilities:
o Leading a child/family diagnostic team doing family and
individual assessments;
o teaching and supervising the work of an interdisciplinary team comprised of staff psychiatrists, psychiatric nurses, psychiatric social workers, psychologists,
and trainees in the same disciplines;
�CURRICULUM VITAE
o
o
o
o
o
o
CLARE O'CALLAGHAN
PAGE TWO
Conducting neuropsychological evaluations;
Providing individual, family, and group therapy for
children and their families;
Supervising the clinical work and testing of certain
staff psychologists and trainees;
Presenting seminars on various topics in child
psychiatry;
Consulting to public and private schools, health
delivery systems, and day care centers;
Performing certain administrative functions,
including program development and participation
in grant writing.
(Supervisors have included Drs. JoAnn Fineman, Samuel
Kaplan, William Malamud, Jr., Evaleen Rexford, Judith
Singer, Gerald Stechler, and Suzanne·van Amerongen.)
1981 Present
BOSTON UNIVERSITY, DEPT. OF SIC-BEHAVIORAL SCIENCES
Conducting a research project, in collaboration with
Dr. Deborah Fein, on autistic children.
1987 Present
SIMMONS COLLEGE, SCHOOL OF SOCIAL W6RK
Periodically present a series of seminars to Boston
Public School psychologists on various top~cs in
neuropsychology and psychotherapy.
1989-91
UNIVERSITY OF MASSACHUSETTS, DEPT. OF SCHOOL PSYCHOLOGY
Instructor, Neuropsychology
1984-85
MASSACHUSETTS SCHOOL OF PROFESSIONAL PSYCHOLOGY
Directed-study seminar on Developmental Neuropsychology
I. .
1976-83
: .'
..
BOSTON CITY HOSPITAL
Psychiatric Consultant for Pediatric E~ergency Room.
Served as a member of a team covering psychiatric
emergencies on nights and weekends; evaluated and
made dispositions for children and adolescents (and
their families) in crises (mostly suicide attempts),
while providing consultation to the E. R. staff.
198~
CHARLES RIVER COUNSELLING CENTER
Consulting Supervisor
197~-73
BOSTON UNIVERSITY, SCHOOL OF NURSING
GRADUATE PSYCHIATRIC NURSING DEPARTMENT
Instructor.
Position included teaching clinical and
theoretical seminars in psychiatric nursing and supervising students in their clinical placement at the J. J.
Putnam Children's Center. Also provided direct service
to pre-schoolers and their families, which included individual, group, and family treatment as well as consultation to a day care center.
•
�CURRICULUM VITAE
CLARE O'CALLAGHAN
PAGE THREE
summers
l97Ql-72
CAMP BAIRD, Buzzards Bay, MA
Clinical Director of camp for 8-13 year old, emotionallydisturbed children. Position included individual and
group supervision of counsellors, direct intervention
with children (especially in crises), consultation with
parents and referring professionals, and some administrative and programming responsibilities.
197~-71
BOSTON CHILDREN'& SERVICES ASSOCIATION
Consultant
·
Position focused primarily on follow-up of Camp Baird
children and planning for upcoming summer program; also
involved group therapy for school-aged boys and girls.
1969-73
BOSTON UNIVERSITY
Graduate School Field Placements:
1972 - 1973: Massachusetts General Hospital, Pediatric
Neurology Department, Learning Disabilities Clinic
19.71 - 1972:
Boston University, Psychoeducational Clinic
1969 - 197~: Boston University, Boston City Hospital
Child Guidance Center
1968 - 197~: Metropolitan State Hospital, Children's Unit
summer
1968
SAINT FRANCIS HOSPITAL, Roslyn, NY
Staff Nurse in Cardiac Intensive Care Unit
PAPERS/PUBLICATIONS
l.-.
Schreiber, H., O'Callaghan, c.
Neuropsychological Aspects of
Psychiatric Diagnoses in Adolescent· Inpatien~s. ' :P"oster paper
•
presented at New York Neuropsychology Group Conference, 7/11/92:
O'Callaghan, c., Schreiber, H.
Neuropsychological Subtypes of
Behaviorally Disordered Adolescents. Paper presented at Boston
University Department of Psychiatry Grand Rounds, 5/23/9~.
variability in
Fein, D., Lucci, D., O'Callaghan, c., Waterhouse, L.
Autistic Children's Social Responsiveness.
Paper presented at
International Neuropsychological Society meeting, Orlando, FL,
2/9~.
O'Callaghan, c.
Lateral Elongation in the Rey-Osterrieth Drawings of
Patients with Temporal Lobe Epilepsy. Paper presented at International Neuropsychological Society meeting, San Diego, CA,
2/85.
Fein, D., Lucci, D., O'Callaghan, c., Waterhouse, L. Auditory
Orienting in Autistic Children.
Paper presented at International Neuropsychological Society meeting, Mexico City, 2/83.
�CURRICULUM VITAE
CLARE O'CALLAGHAN
PAGE FOUR
Kaplan, s., O'Callaghan, c., Stechler, G. A Holistic Approach to
Child Psychiatry. Unpublished manuscript.
Chisholm, M., Hamilton, G., O'Callaghan, c., Rosenberger, c.
Psychiatric Community Mental Health Nursing Case Studies.
Flushing,
NY: Medical Examination Publishing Company, Inc., 1976.
O'Callaghan, C.
The Diagnosis ands Treatment of Emotional, Behavioral and Learning Disorders of Childhood According to a General
Systems Approach.
Pape~ presented at meeting co-sponsored by
The Society for General Systems Research and Groome Center,
washington, D.C., 9/19/75.
O'Callaghan, c.
The Diagnosis and Treatment of a Child with a
Learning Problem: Violet. Paper presented at Boston University
Department of Psychiatry Grand Rounds, 3/19/75.
CURRENT RESEARCH
o
o
o
Auditory Orienting in Autistic and Developmentallr-Delayed
Children
Elongation in Rey-Osterrieth Drawings of Right and Left Hemisphere
Temporal Lobe Epileptics
Neuropsychological Subtypes of Inpatient Conduct-Disordered
Adolescents
APPOINTMENTS
1988 - Present
1988 - Present
1976 - 1989
1981 - 1983
r.~.
. ' .·
BOSTON UNIVERSITY MEDICAL SCHOOL, DEP~~TMENT OF
CHILD PSYCHIATRY, Assistant Profe~~or·
CHARLES RIVER HOSPITAL, Wellesley, MA, Consulting
Psychologist
BOSTON UNIVERSITY, SCHOOL OF NURSING, DEPARTMENT OF
GRADUATE PSYCHIATRIC NURSING, Associate Clinical
Professor
BOSTON UNIVERSITY MEDICAL SCHOOL, DEPARTMENT OF
NEUROLOGY, Teaching Fellow
PROFESSIONAL ORGANIZATIONS
1986
1983
1979
1975
-
Present
Present
Present
Present
AMERICAN PSYCHOLOGICAL ASSOCIATION
INTERNATIONAL NEUROPSYCHOLOGICAL SOCIETY
AMERICAN ORTHOPSYCHIATRIC ASSOCIATION
SOCIETY FOR GENERAL SYSTEMS RESEARCH
••
�CURRICULUM VITAE
CLARE O'CALLAGHAN
PAGE FIVE
OTHER
1992 - Present
1992 - Present
1991 - Present
CLINTON/GORE MASS. HEALTH CARE COALITION
CLINTON/GORE NEW ENGLAND WOMEN'S LEADERSHIP GROUP.
CLINTON/GORE NEW ENGLAND FINANCE COMMITTEE
1991 - Present
THE CHARITABLE IRISH SOCIETY
1986 - Present
BOARD OF TRUSTEES, STONELEDGE CONDOMINIUM TRUST,
Weymouth, MA
Treasurer (1986 - 199e)
Trustee (199e - P~esent)
1984 - Present
ST. FRANCIS XAVIER PARISH GENESIAN PLAYERS
Weymouth, MA
Play Reading Committee Cha~rperson
1975 - Present
GEORGETOWN UNIVERSITY ALUMNI INTERVIEWING COMMITTEE
1991 - Present:
International Board of Alumni
Interviewing Committee
1985 - Present: Chairperson, Boston Metro South
1975 - Present:
Interviewer
•
�...
...
'>·
••
THE WHITE HOUSE
March 29, 1993
Ava Burkard
Burkard Industries, Inc.
P. 0. Box 116
Fraser, Michigan 48026
Dear Ava:
Thank you for writing and sharing your additional suggestions
on health care reform. President Clinton is committed to reforming
our nation's health care system -- controlling runaway costs and
providing security to every American family. It won't be easy and it
won't happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
I will pass along a copy of your letter to the Task Force for
further review and consideration. Again, thank you for your views
and especially for your continued support as we develop solutions to
this incredibly complex issue.
Sincerely yours,
ili~amwn
�Burkard Industries,.-=.;In:...:.:c;.:_._ _ _ _ _ _ _ _ _ _ __
Powder Coating • Chrome Plating • Zinc Die Casting
35300 Kellv Road
P.O. Box l16
Fraser, Michigan 48026
(313) 791-6520 FAX (313) 791-8980
January 25, 1993
Ms. Hillary R. Clinton
1600 Pennsylvania Avenue
Washington, D. C. 20500
Dear Hillary,
I was elated to
e your handwritten no e··· fr
tle Rock in
response to my-on uni versa! he
are.
elated to read in the newspaper that health care policy is your
first project. How fortunate we are, that even if foreign crises
conspire to delay the President's attention to domestic issues,
you are giving your full concentration to this vital area.
In the two months since I wrote to you, I've refined my ideas
through further study and discussion, as well as correspondence,
with health care experts and business people, and I'd like to
share them again. Bernice Reagan, (pronounced Reegan, please) on
the Inauguration Day MACNEIL/LEHRER NEWSHOUR, said something to
the effect that the electorate elected itself for a change, and I
confess, I believe it.
So: It is my impression that policy makers realize that, although
a one-payer system is clearly the economical and efficient way to
go, a multi-payer system such as pay-or-play, has a better chance
of getting through Congress, is less drastic a shock to all
parties, and we can move to something better later on. This is a
terrible mistake, doomed to cost too much because it will only
expand the miserably wasteful and socially inequitable present
set-up. "Global budget targets" as the sole cost cutting measure
will inevitably translate into health care rationing, which will
be criticized unmercifully. A sour first experience may just
preclude moving on to that better system later.
Many of the traditionally anti-government-involvement business
people are at this moment ready for a really good solution.
·Don't alldW the momentum to dissipate. Since business is the
logical source of funding, give them a meaningful reward: Free
them of the immense burdens of selecting and administering health
insurance programs for employees and retirees. This, by itself,
has to increase national productivity.
The second incentive
which will win business over is to include the purely medical
part of workers' compensation. Even the most negative old
grouches among my business acquaintances perk up at the mention
of this. And why not, if business pays most of the costs? Of
course, it wouldn't affect lost worktime compensation, longterm
disability payments, or any negligence penalties.
�.
A tax on business of approximately 10% of payroll (capped at a
generous level) would effect a saving over health insurance and
related costs for most businesses, particularly with the associated reduction in workers' compensation insurance premiums, and
the elimination of Medicare tax. Don't fret about those businesses who are now doing nothing about health insurance and will
oppose coughing up under any program.
An employee contribution is essential. Comparing social security
to welfare, or Medicare to Medicaid, it becomes obvious that we
do not respect programs to which we don't contribute. A contribution of 3% of payroll seems right for workers; however, if no
new personal tax is politically feasible, the 1.45% now collected
from employees for Medicare will suffice to start. These payroll
taxes will even apply to federal, state, and local governments
and their employees, as government will also be relieved of
employee and retiree insurance programs. We won't repeat the
mistakes of social security in that regard. The public highly
resents legislators exempting themselves from programs.
The funds are off-budget, as social security was meant to be, and
deficit neutral (or better, as there are assorted savings).
After a few adjustment years, each year's tax rate for employee
and employer will be determined exactly by the previous year's
expense, a great incentive to all parties to contain costs.
Since we are nearly the last modern country to develop a health
care program, we have the amazing advantage of hindsight at the
good and bad of other countries' systems. Canada's program works
quite well, much better than is sometimes reported, and is economical, but they have a more parsimonious national character.
Americans have a different personality, we are profligate
spenders of other people's money, as well as our own, as taxpayers. As a nation we have demonstrated that fact from the time
that health insurance became common and health costs skyrocketed.
We don't care how expensive or unnecessary tests and treatments
are if they are "covered". We passively accept that "defensive
medicine" means not defense against disease but defense against
lawsuits targeted at the caregiver, hospital or pharmaceutical
maker: no matter, it's free. Our "what, me worry?" attitude is
the main cause of spiraling costs that made uninsured health care
impossibly unaffordable.
There is a simple solution to cost control, which is obvious to
the buyer ef group plans that cannot discriminate by risk, and it
is NOT managed care. Managed care is good but not cheap. Did
you know that managed care systems such as HMOs and PPOs, which
are cheaper at their inception than traditional programs, tend to
rival traditional plans in price after about two years. The only
way for an employer-buyer of group plans to significantly reduce
costs without cutting benefits is to adopt high deductibles. The
premiums are surprisingly lower;
unfortunately, many people
cannot afford $500 or $1000 deductible, and employers or insurance companies cannot discriminate by income. Who can? The
IRS, that's who.
�Insurers know that the key to cost saving is deductibles. If the
consumer puts up the first money, if it's not "free", he notices
what he's being charged, whether the service is necessary, and if
he even received the service. Government can utilize the deductible in a unique, fair, and amazingly easy to administer plan.
Best of all, it applies only to adults with adequate income.
Neither the care provider nor the insurance company has a right
to know your income but the IRS does.
The individual visits the doctor, hospital or pharmacy of his
choice, with a plastic social security card. No money changes
hands, but a computer generated informational billing goes to the
consumer (who can dispute it with the provider) and to the administrator of that state, who is likely to be the same insurance
company presently administering Medicare. The administrator pays
the provider and every payment is accounted for on some individual's annual tabulation, avoiding phantom billings from providers.
After year end, the administrator sends each individual the
tabulation of his usage, along with a form similar to a W-2,
listing the total only, with copy to the IRS. That is the extent
of the basic paperwork!
The individual can easily compute his own deductible on his April
15th tax return according to the following schedule, which is
combined for couples, children have none. It is paid along with
taxes, or deducted from refunds. The amount would not be liable
for under-withholding penalties, as it is in no way a tax. If he
has little or no usage that year, he pays little or no deductible.
1% of income to $25000
(up to $250 deductible)
2% of income of $25001 to $50000
(up to $250 + $500)
3% of income above $50001, such as $75,000 = $250 + $500 + $750
$100,000 = $2250
$150,000 = $3750
capped at $250,000 = $6750
Exempt from deductible:
Minors
Those below the poverty level
All pre-natal and·well-baby care
Selected cost effective preventive care
The amounts are selected to be significant at every level of
income, in order to create a careful attitude towards health care
consumption. This will impact fiscal responsibility even more
than the actual amounts collected--which will, of course, go into
the health budget, not general funds. There are absolutely no
co-pays or those little percentage add-ons that Medicare is so
fond of, and which completely confuse elderly recipients. Simplicity is the key to the consumer's understanding of the system
and involvement in its success.
�It is no vice to want to make everyone happy, for how do you
enlist their cooperation without satisfying them with mutually
beneficial trade-offs?
Here, we have provided the health care that the PUBLIC needs, at
a price, but it is a price each person can afford.
We have asked BUSINESS to pick up most of the tab; in return we
have relieved large and small business of some enormous burdens.
We have taken STATES out of the Medicaid business, and relieved
them of state employee and retiree health insurance premiums, in
return for participating like any other employer in our program.
We have relieved our DOCTORS of bothersome and costly paperwork:
at least half of their employees deal with insurance, not patients. We must negotiate mutually satisfactory rates with
doctors and other providers, probably on a state by state basis.
Government must assist PHARMACEUTICAL COMPANIES in bringing drug
costs closer to the levels enjoyed in Canada and elsewhere.
We must encourage the administrating insurer in each state to
contract the excess work of plan administration and scrutiny of
costs to other HEALTH INSURERS instead of expanding their own
facilities, minimizing upheaval in that industry.
The actual transition will be mind-boggling, but nothing could be
more worthwhile. Hillary, I wish you success with all my heart.
You are an inspiration.
Sincerely,
.Avae:~
��I~~~ chiefs urge
~d against Japan
"'\'
BIG:.1;~
Paae 1A
Po!ini Earoli outlined, for the first·
time in publiC, a set d principles the
three· companies will support as they
~·for natiQnal health care !egisla-
. Those priol;iples include univelsa1
.- . quality 11SSUr311Ce, adminis·.,..,;simplita·ble·fundingcity,_
cost_
oonlaimnent
-..-
think the first 100..120 days are fairly
aitil:aL
Despite recent gains in market
share, the three leaders portrayed the
domestic auto industry as troubled,
with anemic U.S.
and massive
investmeots needed to meet competitive pressures and new govetment
regulations.
Healthcosts,Cbrysler'sEatonsaid,
now accmmt for one-oeventh of JUOSS.
domestic product, but will represent
vne-thirdin 25 years if present trends
D
sales
peciliqllly. the three companies
ocate: A national health care budbald down costs; managed com- amlinue..
,in.whicbpriwtesectorprovid"Beeieve me, that will break the
must. abide by federal guidelines, oounlry,0 Eaton said. "But long before
mliversaJ aooess to coverage, ei- it breaks the eountry, it would break
iherihroug!J.einploymeot-basediusur- the oounlry's largest employers, in~ m- goverment programs.
duding the· three of us."
1:·
and Ford have advocated
Friday's meeting was less bombasj;ilnilar principles.for years. Officials at ti&tban last year's auto show !untbeon,
both Companifs acknowledged Friday wbeniormer CbcysTer O!ainnan Lee
they're. delighted that GM bas 1acocca issued a broadside against ]ajoined them, since disparate p8n, which be said was "besting our
l!Y Big Three autnmakers bas brains ~ and needed to be restrainbeen viewed-as an impediment to ed on trade.
lObbying effectiveness in WashBut Poling. in less strident terms,
, -~-.Brothers ···'-- joseph picked up laoocca's theme. accnsing
...,.....,.
~~~
Japanese manufacturers or tcying to
~ said, however; "for the first take over the U.S. auto, teleoommunipne the Big Three .automakers are cations and computer industries. He
!IDted on major issues,n and are advo- caDed for setting weiHielined targets
~tingthe kind of oollaboratillereltinu tolimitJapanesemarketpenetratinuin
lilit' automakers in Europe and Japan autamobiJes, and <!lldmsed similar
~Y. with their government.
. measures in EUrope.
·
BlebersaiiiFridsy'sEoonamicC!ub, • ~ TheJaJ!l!llese. said Poling, "under-
91IJS}er
t:f
~
UAWPresident OWen Bieber secondfrmn right, andmeadlers of the Michigan congressional delegation
speak with the DeWS mediaafter meeting with the leaders of the Big Three automakers Friday .at Cobo
HaiL Bieber hailed the camaraderie .shown at the Ecenomic Club of Detroit luncheon that brought
together the CEO&
.
••
- --
.
• ·.
.
·,
~~~i ==1r.:::=::. ·Trade, hffilth care,· cooperation
~~=~do~ £{r~:~":~r:sto=..:d~ are automakers' top '93 p··riorities
·• ·
that Ibis domestic auto by Clinton's position "that the United
tubes.
.
Japaneseautomakerslladalow-lrey
Smith, Poling and Eaton were also reactionFrida .m their response to Big
. . in their praise~ Clinton,~ Thnie. ~
whomtlieymetfor90mmuteson
Toynta 8p9kesman John McQmd.
eday in~ Rock. Ark._ Bieber less said, "It'S good to see hig!Herel
Vtce President AI Gore also .at- cooperation betweeltgovemmen!, the
ile!L
· ·
companies and the IDiion. But they
··Sinitbdre.w•!augh:fmlllthecrowd sbouldo't ignore 3~ peroent of the
Cobo Hall. Oil Friday when he said, people in Ibis COUDIIy who buy cars
t was an iiiteresting meeting; with made by foreign-based automakers.
president-elect getting us roffee."
"We're a solid part of the U.$.
The Big ~leaderasaid Clinton ecoJIO!DY. There~s no questinu that we
k off his toaf; rolled 1lP his sleeves contribute to the U.S."
•
d engaged in an intimate, free.
DespiletheirpleasurewithCiinton,
• discussion. They <lescribed the Big_ Three sliD haven't OODYinced •
3
'!l'>
dro1>
•.
•as ~~!hi. ~
.~ Closely10
blems, and detemlined to help. lt
·
But~Bilnrre
.
~=~
The Big Three's Wasbingtoil wish!
list focuses on three issues: trade pol>-
cy,healtlu:ar~andregulaton'eo<>pera.-
I.""ant theleaders
U.S.
ndristry
·"'
government to
$
want:
mandate a 5·
biffi'on to $1().
TRADf: The gap between what Japan
sells tollS and what we seB to them is
billioll annual
swellin d"--'"urtbs.of•~ .. •
•
·
g an """':'"
~...... • reduction m the .
~ ~ ~goal of~ ~~rn!.;!t~em: _. trade.ga'p with
llllllllllwn fuel-economy standards to
¥elllllleDt to mandate a $&billion to
.
40 miles per galbm, from tbe current ~().billiml-mmual reduction. If Japan
1apan.
· 21.5. .
•
.
Smith sai!l Friday tbeautomakera
• lhis.....,..;...n"""·--·" ,.,., hope. II! ~-tougher "!aJldsrdaJinby
tm . -~·-· \"'!"!'........, "'" Ollll!lJICDlg .,...ton to ~ gaso e
weditlbegiii;Jll.! . ·.
. . . ·:y : '"' ~ ''"-"'7-'k -- ""
L'-- .. ·:·.,~~f::~:~{""t~:-:J:
-~: ~ ,._;c~~~
~
, ..... to.telljust· :.
.
'"
'.-:7-¢ :
WfoundunitywillV • ··: '' .J':,.~>-; ,._. ,r·-"~ ;, ·.;·~. -'~'
tiOIL
Here~
a S1llllJlJ3IY of what ·they
doesn't meet the goal, if,woukUace
higher tariffs or some oi!Jei: jleD8Icy OD
imported goods.
.
WJJat'snewistbatGenera!MOtora,
traditinnallytheBigThree'sfiee..trade
boldout,now':"Pportslhisapj)roach.
EAI.11I
An three believe. the
take
tro1
em.
~ea~j' ~,· ,Qur..·~~-~~~f.~~··:;,:_;<.~:~;
~soi::O..that':ers
A~~, ~.b. r:::z,.}ii:):tjT:#.f::i..~';~DllfYi4·'''
older workem and· retirees. That
~.four touy~;res ~ ~ C<!llts~~~
'_ -Asem)Siet
~=~· ~~~:~~·Etr~. :~E.:;!?!
·~y~~t:::·:.:~~:-~~ttii0~~-f~~:~~~:·~ =:~==-~
CliiiiJD3iiRooert Ea-
.
�.lt~~f~J
1 ()u,._J_ ry.-av JJ
~lNn~
~b
('Z..b
T~--f-8
\
>
DAY I
<9
j
�~~~chiefs urge_
f
..
·~nd against.Japan
BIG.:. :mm "-. lA
_,
~..
p~ Eaton· outlined, fur the fust
~in public, a set of principles the
.three' Clllll)lallies will support as they
J)rl!!ls'for nationallrealtli care, IegiS!alion. :•
'Fliose principles include ~
ooverage, qnality JISStJ[3J]Cil, admini9trative: simplicity, cost ·cnntainment
I aild e<jUitable funding.
.
Spej:itically, the three COIDjlllllleS.
·
adVOcate: A national health care bud1 ·1!0! td ·hold down cum; lllal!aged Clliii' potitit'in, in which privatesector.provid· .ers must.abJde by feder.il guiilelineS,
: and' Universal access to' coverage, ei.l!llertfuougbemployment-basedinsur-·
ance or·govennent ~- ·
. 'Chrysler and' Ford have advncated
; ~principlesforyears,Officia!sat
t. 'bo!:h·companies. acknawledged.Fnday
' iha~ they're delighted that GM has.
joined them, since dispar.lre
: -views by Big Three automakers ~
long·9ein viewed as.11J!_inlpediment.til
:\!leil"-ltlbi;ying -effectiVeness-m, wam..
.
I.
,
I
'···y'
;~iilgtnn.' ·
i, ,
·
·
Lehman Brothers aoalyst Joseph.
,
·
ever, ''fr!r the firSt
.autolna:Rers are
•
..
tbirik.tbe fiist 1$-120days are.falrfy
.critical."
Desp~ reoont gains in marlp!t
sbaie, thetllreeJeaders-]lorttayedlhe
tlomestic auto- industry- a ·trnubled.
with $ernie U.S. .sales and'-massil>e
investmenlllneeded tu·meetoompe!i.
trle pressures .and.- gOverment
regulations.
Healthcosts, Clleysler'sEaton.said,
now aa:onntlor one-se\lenth of goss
domestic product, but will n;present
orie-tbirdin 25~-if present trends:
continue.
"Believe me, that willltteak the
ooun!IY," Eaton .said..''Biit)ong before
it breaks t!ul· country, "it would break
the muntey's largest- employen;, incluq the three of m."
.. Friday'<~ meeting was less homba&"lic.thanlastyear's.antoabowlmu:hoon,
when fonner ~ Clllinnan Lee
•
1acocca issued a limaaside agaJnst Japan, wbil:b he said was "beating 0111:
brains out" and needed tn 1leres!r.iin· ed m trade.
· But Pnling, iii less strident termS,
piclred np Iacoo:a's theme, ~g
Japanese manufiu;tnrers or tcyin.g to. .
takeover !De U.S. auto, telecoiimnmiations
computer ioc!Ustrles; He
caDed.fiJr setting well-defined tlrgels
ann·
issues." andare'!dvo: ·,.ling1:he kindofcollaborativerelatioa !61imit]apanesemarketpeoetrationm
• .thar ll11\<lllJalrei in. Europe and Jap;m, automobileor, and iOI!dtirsed similar
·
·
measures in .EilroJJe:
...,.- _
.,~
,.-·...,;:..· _
!'
•
, 0•
·e•f'm
•
p.
Trade, liealth Care, ~oo~rat1o~
: ye,, 1)Ut: eveeymreihas CO!""'. f!i ~
!· r~ that this dbJiieS!!c aii!Q
; ·industry bas to- be a lyne
1: eell!l\lliiY, ana we baire to
way 'leSt we see om econom
' the ttibes."
JapaireseauteJnalim:badalow•
· smith, PQ]ing and &.ton were also readi!mF1idayiQ1heirresponselollig
' enth.tic in their praisefor Clinton. Three leaders;
BY GREG Gill!DNER
witfiwbomtbeymetfor.90ininuteson
Toyotal!)lllkesmanJ()ImMi:Cand-. ilao{'roso-\Vriior
,
Wei>ieday fu Little Rock, Ark. Biebel: less said, "'t's. good to see high-level
The Big Three'" Washington wishand·'Vice I'Iesideut AI Gm:e also at- 'ooopemtiruH>etweengovemment.tlle lm..fucases<m.tbreelssaes:'tradepoli-.
tendetl.
ctliilpallies
the union. But. they cy-,Dealtbc;n-eandregulatoi:yMOpera- Sinith drew" a:lllugh.fromthe'crowd !!houldn'Ugnore 30 J)e1'Ceut at- tire lion.
·
· ·
at Cobo Hall"" Friday -when he said. Pe<>!>le in this emmtry Who buy cars
llere~s a ~ at. What t1!"l'
"fl was an interesting meeting, with made by foreign-f>ased autmnalrexs;
~
•
thepiesident-electgetting us toffee."
"WI!.re a solid pm af the U.S.
The Big Three leaders sald Clinton eamomy, There's no question tllllt1¥e TRADE:- The gap betlveen what ]liJlO!l
!Jlok off his cctat. rolled up his sleo:ves- contribute to the U.S."
sellS to us an<lwlia! wellell to _theilris ·
and engaged in au intimate, freeDespitetheirpleasurewith,. ~ -"'-and tm:ee-fourtlm"of~Rlo
~g discussion. They described the Big Three still haven t ~ · ;'~ $33 billion-a year, is autu-him,.,;s well-Wormed-about the auto him to drop his goal of maeasmt .relllted.JnQuslrylead='!'i"'tthe u.s:_
ro~try;willin~listencloselytolts minimum fue1-eamomy sbmdatils-tu - - ·- · !O.;w,aatea'$5'1iillfonm
Jl!Qblems, ann detennined to help it 40 miles per gallon; from the current ~aminal reducti!m. If Japan
succeed.
·
· 27.5.
..
.
doesn't meet the goal, it wcilld- fate
·~ have not yet bad that kind af
Smith .said Friday the antomill<ers higher tariffs or some othei:-penaltyon
~between lmsine!lsandgovem- hope_ 1'! derai! tuugber ~_by . imported gtjOds;
.
•
ment:in this C()11Iltry,'' Polingsaid. ''it's comrmcmg Clinton to rmse g;moline
What's new is that-~ Motors.
time we.did .begin. and !think we have taXes, thereby ecCQuraging<:OilS1IIIIelS traditionally the Big Three'sfiee-trade
a start."
todrivelessandbuyfuel-elficient<aiS; boldout,now'SllppOrt!l this 3pproadi.
• But !he Big Three officili1s said it's
''In our elqlerience,'' Smith said;
too soo~ to tell just what impact their ~:the. greatest gains in vehicle fuel
EAm CARE: Ail three bEiljeve the
newfound lllliljwillhaveon thetrenc:h~ilfficieccy came about whee gasOline fedenl ~must take oontrol
. war(are. Clinton is snre to'- ignite irr ·priceswereincreasingmel(pected fD 'inaaftingabroadsolutiOnthatCO'IetS
·· Washington when he makes specllic increase."
,
·
every American. amtaiua costs,. ~
:·',proposals onlsslles such as. health tare
Smith:secdcrseme!)t.afa 2$- fDSl)- videaqUij]ity .:are and dQesn't penalize
aild fpreigu trade.
,cent ~-in gas taxes is lligber ~like them those'with lllllliY
· A lot <fupends on Clinton's 9')er311 than what Clihton'a eamomica<Mset:s · e£ wor1rers
retirees. ·That'
eoonl>mi¢ l!trategy, whid! is ~ WI- bad nmsideteQ :eailier this week in
doesn't~ mean
of6lalng.- ·
· . - "I..ittleRock. They-~ a 15-cent tyj1¢lla!i~ ~ealth ~system, but'
_ "My guess is the pr~dent-elect increase in t11e lliUTeDt tax af· lU ~~~~
Will select !bur to five issues ~~ be centspe-gallon,.~in over several . ~ ~.Qliiiiilllli Robert ~:
consiQers fu)portant." said Polfug.. ''I years.
•
_.
· · .. .
are automaliers' top '93 priorities
ndustrf US
1 theleaders
,want
• •
«overnment to
ana
ami.
a
et
mandate a $5billion to $10-
billidn annual
redueti'"on m' the.
trade'gap with
·
·
Japail..
•
..
t..-~--------~
ton -ted Fridl!y,lrealtli eire costs
for dOmestic~ are $600per
higher than lor their Japanese .
COIIqlelitors. They JI3!!S that bill c11t tc> ~~!~~:.;~~~=~
COIISIIIlrerS•
1
RtctliAURJ 1:00PDIA11011: :Baskally,
this means the. indUstry WOn't f!gbt
environmental or safetlr ~
:nnlesstheyadd oostB. Thev've..saidtbis ·
car
•befin.-but therearelob~in.Wash-
fugton whowill continilelightiugautomairers on thl$e'issue&.
For damp!e, Galifumia and New
Yorkhive mandatea that twO pefeent
�...
...
THE WHITE HOUSE
April 5, 1993
Ms. Joan Murray
Bergen County Member
Democratic State Committee
of New Jersey
One Franklin Street
Mahwah, New Jersey 07430
Dear Joan:
Thank you for taking the time to write regarding the
problem of medical fraud. The Health Care Task Force has
received many similar complaints, and it is one of the major
problems we will be considering in the weeks to come.
The President and I appreciate your encouragement
and support, and we will continue to need your help as we
meet the tremendous challenges ahead.
Hope our paths cross again soon.
Sincerely yours,
�,..
Democratic State Conunittee
of New Jersey
,..__:
'f
&......,___
//'•'
--<--6> ..· .
'
'I !"'i7'T'~- -~/
~~-;,..;
February 4, 1993
Mrs. Hilary Clinto1•
The White House
Hashington, D.C. 20500
Dear Mrs. Clinton:
Our mutual friend Susan Thanases introduced us when you came
to campaign in Fair Lawn, New Jersey one stmny · day last sUlliiler.
On the day that you were appointed as the head of the Health
Task Force, I was watching the news and I hereby pass on to
you what I consider an interesting fact.
The
her
she
The
canmentator told the viewers about the wanan who questioned
medicare bill because it contained charges for procedures.
did not have fran doctors who ~vere totally unknown to her.
government agency persuaded the woman fran further complaints.
The canmentator \vent on to say, for each one dollar spent in
investigating,eleven dollars P.re recovered. They estimate the
total amount 6f medical fraud of this type is in the neighborhood of 100 million dollars per year.
I hope this inifo,lilation will be of sane help to you.
it ~11 give you another starting point.
Perhaps
Good Luck ... Go get 'en ... we lmow you can do it!
JU1/hs
0111~
fr<Hlklill St.rH!I.,
M;JIIWilll.
I'J .J ()7.-1:111
201/891 21131
�THE WHITE HOUSE
AprilS, 1993
Curtis B. Clark, M.D.
Department of Family Medicine
University of Tennessee
24 Pepper Ridge
Jackson, Tennessee 38305
Dear Dr. Clark:
Thank you for taking the time to write and share with me
your thoughts on health care reform, with specific comments about
physicians whom you consider to charge excessively and not give
their patients adequate attention and care. Although most physicians,
hopefully, have chosen the profession for the right reasons, it is
unfortunate that there are some with purely selfish, monetary
motives.
President Clinton is committed to reforming our nation's
health care system -- controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
Again, thank you for your views and for your support as we
seek solutions to this incredibly complex issue.
·
Sincerely yours,
I~ .it
·
~~Clinton
�RETIRED
UNIVERSITY OF TENNESSEE DEPT. OF
FAMILY MEDICINE: GERIATRICS; GERIATRIC
ADVOCACY; AND ELDER ABUSE.
24 PEPPER RIDGE. JACKSON, TN 38305
(90 I) 668-1369
March 14, 1993
Mrs. Hillary Rodharn Clinton
The White House
Washington, D. c. 20500-2000
Dear Mrs. Clinton,
First, I would like to say that I am very glad you were
chosen and have accepted the challenge to lead the change in
our health care system. The reason I chose to support President
Clinton and your effort to go to the White House was the great
need for change.
I did read and study " The Inside Story."
Frankly, my concern is not for self but to see a better way of
life for the "forgotten Americans."
You have wisely chosen not to allow organized medicine to
be involved in the policy change. Even though I had paid dues
to medical societies for 37 years, needs for patients and my needs
as a primary care physician have largely been ignored. Many
of the physicians have served in a dedicated way, but their voice
has not been heard. Last year I received regular regular requests from the PAC of Tennessee Medical Society and as I
continued to i~nore the requests, the letters became more abusive.
A few days ago an internist and a cardiologist expressed their
displeasure with similar letters when they failed re respond.
Both are tops in their fields and serve patients in a kind and
compassionate manner.
I know that they serve the best interest
of patien~s and not solely for personal gain.
I speak form two viewpoints.
First, as a family physician
in Sheridan, Arkansas, Grant County.
As you know we are some
what isolated, economically deprived and have some of the best
people on the. ·face of the earth.
I worked in Sheridan, Which
is my horne town, as a family physician for 23 years. When I
chose to leave private practice and take a job with the Department o'f Family Medicine, University of Tennessee, Jackson, Tennessee,
it appeared that we would not have adequate numbers to carry on
the work.
It has been a busy, challenging 15 years helping train
family physicians. My professional career carne to an abrupt end
when, during a medical procedure, an injury ended my gainful
employment.
In retrospect I would chose to spend my professional
career in the same manner.
�-2-
Some 10 years ago we were summoned to Memphis to be told that
the University would reduce the number of medical students.
I was
heartsick because I felt the number of family doctors would be reduced.
That has been exactly what has happened.
One other reason
for the reduction of primary care physicians in the hostility of
many super specialists who discredit our work and the salary we command.
By example I tried to show our residents that our work is
challenging, personally satisfying, and worthy. Let me assure you
that I deeply admire and sppreciate my collegues,but I also feel
that many of them have lost the human touch and make charges that
are outrageous.
Just today the average cost for the same medical
procedure in Miami was reported to be $1,800 and in San Francisco $800.
There has to be a reason.
During the past year a major surgical procedure and a medical
injury has allowed me to experience first hand our medical system
as a patient.
It has been wonderful at times and at others cold
and indifferent. My medical insurance has been a nightmare. After
deligent payment of insurance premiums for years, claims were denied,
insuraNCE companies fought, while claims were not paid and threats
of law suits were made because of non-pament.
Over the last 25 to 30 years a lot of work has been done in
my special interest, Geriatrics. Last year there was a 20% decreas.e
in the number of physicians that were willing to go to nursing homes,
to see patients.
I still do some consultation work in nursing homes.
There are many things that need to be changed. MOre physician
participation would be a big start.
Physicians use the excuse of poor
payment fur services, but just "throwing money'' to a problem will
not solve the problem.
I have worked with a geriatric nurse practioner for several years.
The patients and families were very responsive to her, as well as
the nursing home administrator and other members of the health care
team.
Such an arrangement allowed more prompt treatment and less
expensive hospital care. The quality of care is better and the cost
is less.
Rather than have 50 of 75 different doctors for a nursing
home, we need full time physicians and nurse practioners who spend
all of their time in the facility.
While making rounds a few days ago, I became frustrated because
of physicians who would not visit their patients for the 60 day,recertification. When the assistant director of nursing was questioned,
she agreed that many physicians give the patient a "lick and a promise."
That is a country quote my mother gove to me when I failed to carry
out a task she had assigned.
Research has shown that physicians spent less time with their
elderly patients than then do with their younger patients. This is
spite of the fact that older patients tend to have more complicated
medical problems. A study I did several years ago that included
�..
-3150 physicians in primary care indicated the majority of these
physicians would like to refer the older patient.
There is good evidence that many physicians have taken the
attitude "we will make all the money we can before controls are
placed on our income." It is embarassing that such am attitude
has been apparently very common.
We must find some way to reduce the greed, the double billing
and outright fraud that has become so prevelant in the health
care services.
I will not enter into a long explanation fo the
abuses that we kno~ are so common.
If these wasteful abuses
could be controlled, we probably would not need additional funding
to take care of all America's health care needs.
A few years ago several million dollars were spent to
evaluate fair and equitable charges for physicians.
It is called
The Harvard Study and would serve a useful guideline for your
committee.
Since I had started this "epistle'', restraints have b~en
set into action to restrain or de-fuse your committee. No doubt
the special interests are at work in this matter.
Finally, I wish you and your health care committee success in
this most pertinent and difficult task.
Respectfully yours,
~dttvlo(?
Curtis B. Clark, M.D.
�..
THE WHITE HOUSE
WASHINGTON
April 2, 1993
Carol Schwartz
Counseling & Psychotherapy Associates
269 Walpole Street
Norwood, Massachusetts 02062
Dear Carol:
Thank you for recommending Dr. Mary Lee Ingbar for participation in the work of
the Health Care Task Force. I value your judgment and appreciate your interest and support.
The Task Force includes the Secretaries of the Treasury, Defense, Commerce Labor, Health
and Human Services, and Veterans Affairs; the Director of the Office of Management and
Budget; the Assistant to the President for Domestic Policy; the Assistant to the President for
Economic Policy; the Chair of the Council of Economic Advisors; and the Senior Advisor to
the President for Policy Development.
In addition, the Senior Advisor to the President for Policy Development will lead
interdepartmental working groups which will gather information for, and provide information
to, the Task Force. The working groups, which are working closely with Members of
Congress and their staffs, are comprised of government employees.
While the working groups have begun the process of preparing policy options for
reforming our health care system, their work is an ongoing process. The members of the
Task Force are anxious to consult with knowledgeable and concerned people. I am directing
a copy of your letter with Dr. lngbar's letter to the appropriate working group.
The ~ident and I will appreciate your support for the success of our endeavor. He
is committed to reforming our nation's health care system -- controlling runaway costs and
providing security to every American family. It won't be easy and it won't happen
overnight, but we can bring costs under control while maintaining quality medical care and
preserving the choice so important to us all.
Sincerely yours,
�CQ{j~SELING
& PSYCHOTHER-\PY ASSOCL-\TES
2ti9 ~1./afpofi 5tTeet. :\._orwoott: ~'\{:~ 02062
i ti17)
7ti9-ti834
March 25, 1993
Mrs. Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue
Washington, D.C. 20500-2000
Dear Hillary,
Mary Lee Ingbar is uniquely qualified to contribute to the planning, design,
and assessment of a national health care program. She has worked at many levels
of the health care system -- with providers, academic institutions, and state
programs involved in rate setting and planning. Her-background in public health
and economics is supplemented by a detailed knowledge of the medical profession
acquired by virtue of her late husband's involvement with academic medicine and
medical research. She would be particularly skilled at organizing the various
disciplines and interests concerned with the interface between payment structures
and the health management information system(s) required for administration.
She views the ability to interrelate institutional costs and measures of the
quality and appropriateness of care as critical to the development of more effective and efficient programs that truly serve the ihterests of society in the long
run, Her expertise would be useful in a review capacity, on appropriate connnittees,
or on a full-time consulting basis. Her perspective needs to oe introduced early
in the planning, design, and implementation of new programs.
Enclosed, Mary Lee has written a distillation of her ideas regarding the cost
factors of the health care delivery system. She was one of the earliest cost
containment economists at Harvard and teacher/mentor of Joe Newhouse.
Fondly,
c·~·
Carol Schwartz
CS/jm
Enclosure
�Mary Lee Jngbar, Ph.D.
305 Dudley Street, Brookline, MA 02146-5935: (617) 566 6m7, (617) 566 6313 FAX
March 20, 1993
Mrs. Carol Schwartz
241 Perkins Street, I 402
Jamaica Plain, MA 02130
Dear Carol:
As you requested following our delightful evening together, I have tried to codify some
of my reactions to the thought provoking presentations that I heard at the two-day meeting
entitled, National Health Reform: Ethical, Economic, and Political Considerations, which was
sponsored by the Division of Medical Ethics of the Harvard Medical School. I was discouraged
by the gaps in our knowledge of many aspects of health care systems, both biologic and manmade, about which we should know more. I was also struck again by the essential impossibility
of satisfying for all citizens the demand for medical care at reasonable cost. Market imbalance
and skyrocketing costs pervade all reports -- in Britain, these range from the White Papers of the
thirties to the subsequent Beveridge Reports and on to the present revamping of the National
Health Service; in the United States, they start with the political agenda of Theodore Roosevelt
and go on to the reports of the Committee on the Costs of Medical Care in the late twenties and
early thirties to legislative proposals of the late 1940s and the mid-1970s.
Despite the lament of history, I believe new tools provide health care systems -irrespective of their organizational and benefit patterns -- with opportunities for delivering
services more effectively, efficiently and economically. I refer particularly to computer hardware
and software and to the expanding communication capabilities encompassed by the broader field
of informatics and artificial intelligence. If the potentials of these instruments are to be realized,
however, it is essential to understand that current market defects reflect innate characteristics of
the health care "product." Results or outcomes of care are not absolutely predictable and are not
always in direct proportion to the quantity or quality of resburces expended. This may reflect
variations in competency, organizational or professional. It ~so reflects the clinical ambiguities
confronting the diagnostician and the consequent uncertainties associated with the response of
man as a complex biological being to specific therapies or regimes. Whatever the cause, the effect
is that any "purchase" of service.ftas only a "probability'' of being effective-- much as a weather
forecast has a known likelihood of being accurate. Patients feeling helpless because the services
they receive do not solve their problems may look for more care. The inherent market imbalance
from unmet needs and unsatiated demands will then be acted upon if the price or out-of-pocket
costs are right.
Because of the uncertainties in the linkage between service and outcome and the
consequent sensitivity of demand to cost considerations, it will be impossible to create a single
universal affordable benefit and coverage package that satisfies everyone. Rather, it will be
necessary, on the one hand, to provide basic coverage to all for those treatments and therapies
known to be most effective in improving health, and, on the other hand, to devise ways of
permitting the delivery of care that may be more probabilistic in outcome and benefits. Quite
apart from issues of consumer satisfaction, without such duality in the system, innovation would
be impossible because there would be no ongoing way to finaf\ce the "testing" of new procedures,
�,
therapies or drugs. The dividing lines between such ''basic" and "less essential" care are obviously
in flux and continually changing, so any public system must pe dynamic and capable of shifting
these lines. The Oregon system of "rationing'' Medicaid dollars is the most recent example of a
system for determining these lines, albeit the aU-or-nothing policy of inclusion of services appears
crude.
The key to the development of better systems will be to link payment schemes with
assessment of effectiveness and efficiency. A detailed data base must be continually created and
maintained that can be used: 1) after services have been rendered, to assess their appropriateness
and effectiveness of services; 2) as care is being delivered, to help physicians and other providers
make choices and improve decision-making; and 3) to define and monitor the line between ''basic"
and "less" essential care. The work by Robert Brook, M.D. of 1The Rand Corporation and UCLA,
for example, illustrates the potential savings to be achieved by improving quality and eliminating
less appropriate care within a variety of procedures, each of which requires the application of
different guidelines.
The realization of the potential of technology, outcome, and process assessment in medical
care requires imaginative linkages to payment systems and vica-versa. Payment systems can
create incentives to provide the care thought to be most worthwhile on the basis of ethical,
medical, public health, effectiveness, or other considerations formulated by a variety of groups.
They can also be linked to requirements to report data from medical records that will be useful
in multivariate statistical enquiries into system effectiveness and efficiency for selected groups of
patients, providers, diagnoses, or treatments. Such a policy may offer the risk of infringing on
patient and provider privacy, especially if longitudinal data over time are to be generated in order
to assess lifetime costs and benefits. Nevertheless, I would argue that, with appropriate
safeguards, the creation of comprehensive data bases from information about individual patients
is essential if we are to improve the performance of our health care system.
The same sophistication must also be applied to data concerning costs. Policies must force
providers to ask more detailed questions about how they are providing services and spending
institutional resources. This goes beyond merely asking how to maximize provider revenues and
minimize annual third party expenditures. For example, payment systems could separate
reimbursement for direct expenses associated with medical services from those covering general
expenditures associated with overhead or general and administrative service departments. The
so-called indirect non-revenue producing departmental expenditures could then be subjected to
ceili.'"tgs or could be paid fot on the ba!is of average nuinbet of admi8siol\s, beds, or days of care
(adjusted for levels of outpatient care). Such units of payment should be designed to encourage
inter-hospital cooperation and efficient use of capital facilities, institutional or technological.
Direct expenses, in contrast, could be paid for in a variety of ways -- fee-for-service, diagnostic
related group admissions, capitation, or any other criteria promoting quality of care. These units
of payments should be selected to promote both equitable levels of payments to providers and
the generation of appropriate services and the associated information required to appraise in
detail their specific appropriateness, efficiency and effectiveness.
I hope this helps to clarify some of the ideas we began to discuss. I shall look forward
to future explorations.
Best regards,
Mary Lee
Je_ •
~Ph.D., M.P.H.
�THE WHITE HOUSE
April 1, 1993
Dorothy Sherwood Berner, M.D.
Assistant Director, Internal Medicine
Presbyterian Hospital of Dallas
8200 Walnut Hill
Dallas, Texas 75231
Dear Dr. Berner:
Thank you for your letter forwarded to me by Ann Sentilles in
which you share your perceptive suggestions for health care reform.
We are soliciting dialogue throughout the country from all segments
of the health care industry in this tremendous undertaking to find
solutions to the incredibly complex health care problems facing us. I
am passing along your letter to the appropriate working group of the
Task Force for review and consideration.
President Clinton is committed to reforming our nation's
health care system -- controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
Again, thank you for your views and for your support of this
endeavor.
Sincerely yours,
·,-.·
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�Dorothy Sherwood Berner, M.D.
Asst. Director,
Internal Medicine
Presbyterian Hospital of Dallas
8200 Walnut Hill
Dallas, Texas 75231
March 8, 199 3
Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue
Washington, D. C. 20016
Dear Hillary:
As a practicing physician, I have several ideas about the
reform of America's health care system which I presume to
share with you because I, like you, have grave concerns about
health care and the delivery of adequate health care in this
country.
After six years in private practice and two years as
director of a hospital residency program where I care for the
indigent,
I see three fundamental challenges:
1)
How to provide adequate health care for the
indigent;
2)
How to provide adequate health care for the
elderly; and
3)
The development and enforcement of an acceptable
"standard of care" .
How do we, as a nation, as professionals and public servants,
address these challenges?
I have the following suggestions:
With regard to the indigent and the elderly, I recommend that
any individuals who meet the current criteria for Medicaid or
Medicare be given vouchers with which they can "purchase"
their own insurance.
Currently, a family of four can be
adequately covered at a cost of about $6000 a year.
To
provide for routine office care not covered by insurance, I
would give these individuals $500 worth of "Doctor Stamps".
These options would preserve the element of choice for all
individuals, regardless of income or age, and it would
eliminate the discrepancy between Medicare/Medicaid and
private pay patients, both in terms of the payment received
by the physicians and the availability of those physicians to
the community.
At present,
I remind you, there are
communities (and I live in one of them, Plano, Texas) where
�,
there are no internists who are willing to accept new
Medicare patients into their practices.
A voucher/stamp
program would ensure access to medical care for all citizens,
regardless of their ability to pay.
It would markedly
decrease the administrative costs associated with Medicare
and Medicaid.
And, it would force insurance companies and
physicians to work together to establish appropriate and
equitable payment
schedules, eliminating, for the most part,
the role of the government in this determination.
With regard to standards of care, there is a compelling need
in this day of rapidly advancing medical knowledge and
technology, for well-designed criteria.
I recommend that
these standards be developed by physicians within each
specialty, and reviewed by experts in each field.
I believe
the dual goal of achieving an acceptably high standard of
care for all Americans while protecting physicians who comply
with the standards from expensive and unwarranted lawsuits
would mitigate medical costs substantially.
Finally, with regard to cost containment, I encourage you to
examine the widespread practice of physicians owning their
own high-tech diagnostic equipment.
I believe this practice
contributes significantly to increased medical costs in two
ways:
first, physician-owned equipment is used far more
often than hospital-based equipment, escalating costs for
tests that may not be necessary;
and secondly,
physicianowned equipment causes hospital-based equipment to be used
less, driving up the per-cost use.
It has long been thought
to be a conflict of interest for physicians to own their own
pharmacies;
owning their own extremely expensive diagnostic
equipment poses the same conflict in my view.
The physicians I know and respect want most of all to provide
competent care to patients.
While there is, clearly, greed
in the medical profession, I hate it, and find that many
caring doctors disavow it.
I urge you to pursue reform of
our health care system, to stop its abuse by both patients
and providers, and to work with responsible physicians,
insurers and consumers to assess and, when appropriate,
implement changes such as those I have been so bold as to
suggest above.
With sincere thanks,
~'1 ~tr/V~ -~I'Jtrl-lf"J
~:o:hy
co:
Sherwood Berner, M.
D.
Dr. Ron Anderson
Dr. Barry Brooks,President, Physicians for Patient Power
�THE WHITE HOUSE
April 2, 1993
George G. Moran, M.D.
Drs. Moran & Moran, S.C.
1400 West 47th Street
La Grange, Dlinois 60525
Dear Dr. Moran:
Thank you for writing and sharing your views on health care
refonn and the need for malpractrice refonn to be a part of the
solution. I do appreciate hearing from you, as we are soliciting
dialogue throughout the country from all segments of the health care
industry in our efforts to find viable solutions to the incredibly
complex health care problems facing us. I am passing along your
letter to the appropriate working group of the Task Force.
President Clinton is committed to reforming our nation's
health care system -- controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
Thank you again for your suggestions and for your support of
our endeavor.
Sincerely yours,
I~-Tl~L
Hillary R~ Clinton
�DRS. MORAN & MORAN, S.C.
UROLOGY AND UROLOGIC SURGERY
1400 W. 47TH ST.
LA GRANGE, ILLINOIS 60525
GEORGE G. MORAN, M.D.
MICHAEL J. MORAN, M.D.
Telephone: (708) 354-2550
March 26, 1993
Hillary Rodham Clinton
The White House
1600 Pennsylvania Ave.
Washington, D.C.
20500-2000
Dear Ms. Clinton:
After listening to President Clinton's State of the Union
Address, I too am deeply concerned about health reform. I
also believe that there is a health care crisis and that all
of us must work together to provide comprehensive quality
care for all Americans. As a physician in the state of
Illinois, I try to do my best to provide care for those who
can not afford it, as well as trying to help curb some of the
costs for providing health care.
As we know, there is some
"waste" in the system and it is the job of the health care
providers to minimize unnecessary tests and health care that
is nonessential.
However, as part of this health care reform and as part of
attempting to tackle this issue of health care crisis, I
strongly believe that we can not achieve any meaning reform
without also having malpractice reform.
Any health care
reform that does not include significant and meaningful
malpractice reform will do nothing to eliminate the crisis.
As members from the medical profession approach you over the
upcoming months, and members from the legal profession also,
please keep in mind that this is an issue that needs reform
at many levels.
I know that the physicians are willing to do
their part, but are the lawyers and courts willing to reform
as well? This is a very serious concern on our part.
I hope
that you will keep this issue of malpractice reform foremost
in your thoughts when these issues confront you.
In advance, I thank you for your consideration.
Sincerely,
\J~v~~~
George
GGM/pac
b..Moran,
M.D.
�THE WHITE HOUSE
April 6, 1993
Deloss Walker
Walker & Associates, Inc.
1100 Morgan Keegan Tower
50 North Front Street
Memphis, TN 38103
Dear Deloss:
Thank you for your thoughtful note. I am gratified by your
expression of confidence in me as we develop solutions to the
incredibly complex health care issue.
The President is committed to reforming our nation's health
care system -- controlling runaway costs and providing security to
every American family. It won't be easy and it won't happen
overnight, but we can bring costs under control while maintaining
quality medical care and preserving the choice so important to us all.
We will appreciate your continuing support for the success of
our endeavor.
Sincerely yours,
�...
-
.
-
.
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.
.
.
'
Walker &Associates, Inc.
MEMPHIS • ATLANTA • LITTLE ROCK
1100 Morgan Keegan Tower, 50 Front Street, Memphis, TN 38103
·,
'·
�THE WHITE HOUSE
April 6, 1993
The Honorable Patricia S. Ticer
Mayor, City of Alexandria
301 King Street, Suite 2300
Alexandria, Virginia 22314
Dear Patsy:
Thank you for writing and bringing to my attention the needs
of those with multiple sclerosis for consideration in health care
reform. Long-term care is one of the areas which must be addressed
as solutions are developed for this incredibly complex issue. I
welcome your comments and am directing a copy of your letter to the
Task Force.
President Clinton is committed to reforming our nation's
health care system - controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
\
Again, thank you for taking time to share your ideas. We
will appreciate your ongoing interest and support in this enormous
endeavor.
Sincerely yours,
I~ ll
Hillaiy
~ Clinton
�.J()1
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March 9, 1993
Mrs. Hillary Rodham Clinton
Director
Task Force on Health Care
The White House
Washington, D.C. 20500
Dear Mrs. Clinton:
A comprehensive long-term care system for people of all
ages is essential for the hundreds of thousands of young adults
with multiple sclerosis (MS) in this country.
Multiple sclerosis is the most common disabling
neurological disorder of young adults. There is no known cause
or cure. Most often its first symptoms are experienced between
the ages of twenty and forty and it is characterized by an
unpredictable course of remissions and relapses.
Home and community based programs that should be
providing the health, social and personal care services needed by
this population are not available, not affordable, and not
accessible for persons under age 65. As a result, families are
forced to become impoverished in order to qualify for some
services and young, disabled people may have no option but to be
institutionalized in geriatric nursing homes.
Th~ Task Fore~ on HeRlth·Care. and its working group on
long-term care, represents the hopes and dreams of young adults
with MS. I urge your support for the development of a system for
long-term care that addresses the needs
ople of all ages.
PT/pap
�THE WHITE HOUSE
AprilS, 1993
Betty A. Lowe, M.D.
Arkansas Children's Hospital
800 Marshall Street
Little Rock, Arkansas 72202
Dear Betty:
As we are involved in the enormous task of finding viable
solutions to the incredibly complex issue of health care, I have asked
that you be contacted for your input and suggestions regarding health
care fur children. I know of no one whom we could call upon with
expertise to better provide the Task Force with the kind of advice,
guidance and direction which you can offer.
Your leadership in Arkansas and now on a national scale is
exemplary. I genuinely appreciate and value your experience, your
views and any suggestions you can offer.
Sincerely yours,
�Amer~n
Acaaemy of
Pediatrics
141 Northwest Point Blvd
PO Box 927
Elk Grove Village, IL 60009-0927
Phone 708/228-5005
Fax 708/228-5097
Reply To:
Betty A. Lowe, MD
Arkansas Children's Hospital
800 Marshall Street
Little Rock, AR 72202
501/320·1401
November 30, 1992
Hillary RodluL'?l Clinton
Governor's Mansion
1800 Center St.
Little Rock, AR 72206
Dear Hillary:
President
Howard A. Pearson, MD
VIce President
Betty A. Lowe, MD
Past President
Daniel W. Shea, MD
Executive Director
James E. Strain, MD
I'm sure you are aware how pleased and excited we are
with our new "Presitlent" and "First Lady". Bill and yourself
have do11e so much for Arkansas in the past. Now, if the rest
of us can do our part, Arkansas can become truly outstanding.
Certainly knowing how much you both care about children will
stimulate all of us at rt.CH to continue to improve and enhance
health care for children in Arkansas and the United States.
Board of Directors
Gilbert L. Fuld, MD
Keene, New Hampshire
David Annunziato, MD
East Meadow, New York
Anthony DeSpirito, MD
Interlaken, New Jersey
Joseph R. Zanga, MD
Richmond, Virginia
As President-Elect ofthe ~4.merican Academy of Pediatrics,
I would like to arrange a meeting of Academy representatives
"H'ith tlze Healtlz Care Transition Team to discuss our concerns
about the current status of cllildren 's health ill tile United States.
Children are not "little adults" and their health care needs
should be specifically addressed in any health care reform.
Robert E. Hannemann, MD
Lafayette, Indiana
Thomas F. Tonniges, MD
Hastings, Nebraska
Carden Johnston, MD
Birmingham, Alabama
George D. Comerci, MD
Tucson, Arizona
Leonard A. Kutnik, MD
San Diego, California
I 11eed your advise as how to approach the Health Care
Transition Team. The AAP represents 40,000 pediatricians.
Oitr major goal for the last four years has been to insure access
�Page Two
Hillary Rodham Clinton
November 30, 1992
to health care for all children. We are pushing legislative
change, enhanced public "health education" and multiple
community projects. We would like to discuss these issues with
the Health Care Transition Team.
~you~~iiJ
Betty~e,
M.D.
Professor Pediatrics, UAMS
Medical Director, ACH
Vice President, AAP
BALlsam
�THE WHITE HOUSE
April 7, 1993
Mr. Linus Pauling
Linus Pauling Institute
of Science and Medicine
440 Page Mill Road
Palo Alto, California 94306-2025
Dear Mr. Pauling:
Thank you for writing and sharing with me your views about
the benefits of orthomolecular medicine. Obviously, there is much
yet to be learned about healthful habits and control of disease in the
human body, and I do appreciate your taking the time to write. I
have directed a copy of your letter to the Task Force.
President Clinton is committed to reforming our nation's
health care system - controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
· important to us all.
Thank you again for your suggestions and for your support of
our endeavor.
Sincerely yours,
�LINUS PAULING INSTITUTE of SCIENCE and MEDICINE
440 Page Mill Road, Palo Alto, California 94306-2025
Telephone: (415) 327-4064
Facsimile: (415) 327-8564
17 March 1993
Hillary Rodham Clinton
The White House
Washington, D.C. 20500
Dear Hillary Clinton:
I am writing to you about a way of taking
immediate steps to decrease the cost of medical
care for the American people and to extend this
care to everyone.
First, I may say that I know what I am
writing about. During the last 25 years I have
devoted most of my time to the effort to determine
the intakes of vitamins and other orthomolecular
substances that lead to the best of health and the
lowest incidence of and mortality from disease.
My reputation among scientists is excellent, and
among physicians is beginning to get better during
recent years.
My suggestion is that a campaign be launched
to get physicians to encourage patients to take large
amounts of vitamin C, other vitmins, and certain other
orthomolecuiar substances, for both prophylaxis and
therapeusis (as an adjunct to appropriate conventional
therapy). The basis for my belief that a great decrease
in medical care could be achieved in this way is
summarized in my book "How to Live Longer and Feel Better,"
in my other publications, and in many books by physicians
.................._________________________
�.
2.
and other writers who are knowledgeable. about
orthomolecular medicine. The official attitude
of the medical authorities, however, continues to
be that vitamin supplements and other similar
nutritional measures should not be resorted to,
despite the fact that these authorities recommend
that people search out foods that are high in
vitamin C, vitamin E, and beta-carotene.
Dr. Ralph Crawshaw of Portland, Oregon, who
devised th Oregon plan of administering health funds
among patients, recently in a -letter to me stated that
"I have for a good number of years had the belief that
if vitamin C and other nutrients were recommended by
physicians, it might well be that the control of disease
would be potentiated to such an extent as to reduce greatly
the cost of medical treatment."
Recently I have formed the opinion that some rather
simple and inexpensive measures, developed partially through
our own discoveries, might well come close to eliminating
cardiovascular disease as the principal cause in the United
States of disability and death. I shall not attempt in this
letter to discuss this question and related questions in
detail.
I suggest that you and your associates should look
into this matter with care. I may mention that you may
get from some medical authorities a quite negative reaction.
It is important that this question not be ignored.
Sincerely,
,·~~·
LP:dm
------------------•
�THE WHITE HOUSE
April 7, 1993
Carol L. Schwartz
Counseling & Psychotherapy Associates
269 Walpole Street
Norwood, Massachusetts 02062
Dear Carol:
I appreciated your forwarding to me Robert Restuccia's
materials on "Health Care for All" and have written to him today.
Thank you for your concern about my father. Obviously, this
is an extremely difficult experience for our family, but the strong
support of our many friends who continue to show their love and
care is most uplifting.
Sincerely yours,
'·
�COt:~SELING & PSYCHOTHERAPY ASSOCL.\TES
2,;9 'lt/afpou Street. '!{_orwooa: ~'l{q 02062
1bli)
ib9-b834
March 25, 1993
Mrs. Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue
Washington, D.C. 20500-2000
Dear Hillary,
Last week I attended an all day symposium on "The Health Care Revolution:
Designing the Health Care System of the Future." I was very excited to learn
about a new program in Massachusetts, "Health Care for All" that I feel strongly
that you should know about and am enclosing all of their information.
I seem to be having a daily correspondence with you arid your cosmic endeavor.
Fondly,
~.teL~
Carol Schwartz
CS/jm
Enclosure
�COlJNSELING & PSYCHOTHERAPY ASSOCIATES
269 Wafpofe Street. N_orwooa: ~q 02062
i 617) i69-6834
April 1, 1993
Mrs. Hillary Rodham Clinton
The White House
Washington, D.C. 20500-2000
Dear Hillary,
Mr. Robert Restuccia has called me a few times inquiring
if I had heard from you regarding the material I had previously
sent to you on "Health Care for All". I am resending the
material to you just in case the information was not received.
Since the deadline is fast approaching, Mr. Restuccia is
eagerly awaiting your response.
I am aware that you are in Little Rock with your father,
and I send my thoughts of concern.
With warm affection,
~:~.u~
Carol L. Schwartz
CS/jm
Enclosure
�THE WHITE HOUSE
WASHINGTON
April 7, 1993
Mr. Donald R. Sweitzer
Capitol Associates, Incorporated
425 C Street, NE
Washington, D C 20002
Dear Don:
Thank you for recommending Terry Lierman for participation in the work of the
Health Care Task Force. I appreciate your interest and support and especially your passing
along his qualifications. The Task Force includes the Secretaries of the Treasury, Defense,
Commerce Labor, Health and Human Services, and Veterans Affairs; the Director of the
Office of Management and Budget; the Assistant to the President for Domestic Policy; the
Assistant to the President for Economic Policy; the Chair of the Council of Economic
Advisors; and the Senior Advisor to the President for Policy Development.
In addition, the Senior Advisor to the President for Policy Development will lead
interdepartmental working groups which will gather information for, and provide information
to, the Task Force. The working groups, which are working closely with Members of
Congress and their staffs, are comprised of government employees.
While the working groups have begun the process of preparing policy options for
reforming our health care system, their work is an ongoing process. The members of the
Task Force are anxious to consult with knowledgeable and concerned people. I am directing
a copy of your letter with his bio to the appropriate working group.
The President and I will appreciate your support for the success of our endeavor. He
is committed to reforming our nation's health care system- controlling runaway costs and
providing security" to every American family. It won't be easy and it won't happen
overnight, but we can bring costs under control while maintaining quality medical care and
preserving the choice so important to us all.
I am pleased you enjoyed your first visit to the White House to witness the signing of
the Family Leave Bill and certainly hope it will not be your last.
Sincerely yours,
�--v~
•
l
~ rl-RC
~~?
CMITOL ~OCWfS
INC OK
- "-(z_
r 0 Ki\T[D
1~~)
~<.A- ~t-r,
~~
Washington Office
Stanton Park • 426 C Street, NE • Washington, DC 20002 • (202) 544-1880 • FAX: (202) 543-2565
February 9, 1993
Hillary Rodham Clinton, Esq.
Chair, President's Task Force on Health Reform
Old Executive Office Building, Room 100
Washington, D.C. 20501
Dear Hillary,
It was great to see you again on Friday at the historic signing of the Family Leave Bill.
The morning had special meaning for me because, although I have been involved in politics and
presidential campaigns for many years, I had never been to the White House before in my life. My
thanks to you and the White House staff for the invitation.
When I am not taking time out for political campaigns as I did last year, I am a vice president
of Capitol Associates, Inc. (CAl). CAl is a government relations finn specializing in legislative and
policy efforts in the areas of health, education and human resource programs.
I would like to recommend for your consideration the president and.co-founder of CAl, Terry
Lierman, to be a chair, co-chair or participant of one of your health care reform groups in the areas of
prevention and medical research.
· ·
·· ·
Terry is a nationally recognized expert in the field of health care. He is the former chief of staff
of the Senate Appropriations Committee and began his career at the National Institutes of Health. He
has a close relationship with many groups in the research and regulatory field. He is a founder of the
National Coalition for Cancer Research, the FDA Council and the Biotechnology Policy Forum.
Terry would add valuable depth and talent as a volunteer to your important group. I hope that
you will reach out to him and make him part of your health care reform task force. I am enclosing a
copy of his bio. if you need any additional information or wish to contact either Terry or me, please call
us at 202-544-1880.
Once again, thank you for the opportunity to share in Friday's historic signing. Please call me
if I can be helpful to you on any matters.
Sincerely yo
~~
Donald R. Sweitzer
Enclosure
�TERRY L. LIERMAN
President
Capitol Associates, Inc.
426 C Street, NE
Washington, DC 20002
(202) 544-1880
PROFESSIONAL EXPERIENCE
1984Present
President. Capitol Associates. Incorporated
Founder and President of a consulting firm providing government and public relations
services for individuals, universities, non-profit organizations, hospitals and corporations
in a variety of fields, but especially health and human resources, environment, education,
and food and drugs. Specific areas of expertise include: health research, drug
development and approval; reimbursement; health care reform; construction; constituency
development; Federal budget and appropriations processes; regulatory affairs;
identification of public and private funding opportunities; and development and
management of national networks to promote medical research, health care and health
education programs.
Activities include: frequent interaction with Congressional ·and Executive Branch
policymakers and staff on federal health programs and policy, interpretation of rules and
regulations, providing assistance in identifying and pursuing grants and contracts, and
strategic planning for Washington, D.C. visibility and public relations.
1991 - 1992
Americans for Harkin. Issues Coordinator and Domestic Policy advisor for the
1992 National Presidential Campai&n
1981 - 1984
Director of Washin&ton Office. Carley Capital Group
Joint ventures, business start-up, public/private real estate developments, financing
through venture capital.
1979 - 1981
Staff Director/Chief Clerk. United States Senate Committee on Appropriations
Senate Appropriations Committee, comprised of 23 Senators and over 90 staff divided
among 13 subcommittees, is responsible for allocation of the Federal Budget, including
each federal program and department. Duties included policy development, supervision
of the Committee, funding recommendations and development of Federal Budget.
Major responsibilities were: liaison with the White House, the Office of Management
and Budget, and the various Executive Branch agencies regarding budgetary matters;
determining funding recommendations for all federal departments and agencies; briefing
Members of Congress on appropriations issues; coordination of Senate t1oor activities
including debates, amendments and various legislative negotiations; developing and
staffing Committee hearings; and, carrying out programmatic oversight and evaluation
functions; coordination of all Committee business with Members of Congress and the
other Congressional committees such as Budget and. authorization.
�.
"
1976 - 1979
Staff Director, U.S. Senate. Subcommittee on Labor Health and Human Services.
and Education Appropriations
Responsibilities similar to those as described above but specialized in the Subcommittee
issues and programs. Specific responsibilities included ensuring that the appropriations
bill for the Departments of Labor, Health and Human Services, Education and Related
Agencies was properly managed and was expeditiously passed by Congress in
coordination with other Congressional Committees and appropriate funding level
recommendations were made for all programs contained within the bill. The Labor,
HHS, Education Appropriations bill represents 42 percent of the entire Federal budget
and more than 1,800 federal programs.
1975 - 1977
Professional Staff Member, Subcommittee on Labor - HHS Appropriations. United
States Senate. Washineton. DC
Primarily responsible for the health program contained in the Labor-HHS Appropriations
bill, as well as liaison to the Senate Budget Committee.
1973- 1975
Office of the Director. National Cancer Institute
Budget and policy development, administration, grants and contracts.
1972 - 1973
Administrative Officer. for Drue Research and Development. National Cancer
Institute. National Institutes of Health. Bethesda. MD
1971- 1972
Manaeement Intern. National Institutes of Health. Bethesda. MD
EDUCATION
M.A., University of Wisconsin, Madison, 1971
Center for the Study of Public Policy and Administration
(La Follette Center)
University of Minnesota, Minneapolis, St. Paul, 1969
Administration and Public Relations
B.A., Winona State University, Winona, Minnesota, 1969, Political Science
Clinton Community High School, Clinton, Wisconsin, 1966
�'
..
Community Service & Boards
Advocacy Institute, Board of Directors
Children's Research Institute, Chairman
Children's Hospital National Medical Center, Washington, DC, Parent Board
Friends of the National Library of Medicine, Board of Directors
Hollings Oncology Center, Board of Directors
Mainstay Mutual Fund, N.Y. Life Insurance, Board of Directors
National Association of Southern Poor, Board of Directors
National Commission on the Role of the School and the Community in Improving Adolescent Health
National Institutes of Health Alumni Association, Board of Directors
National Organization on Fetal Alcohol Syndrome, Board of Directors
Research! America, Founder
UNICEF, Washington Council, Vice Chairman
University of Wisconsin Clinical Cancer Center, Board of Directors
Honors
Ford Foundation Fellow, La Follette School, University of Wisconsin
Honors Student, Winona State University
Distinguished Alumni Award, Winona State University
Scholarship, Winona State University, Wisconsin Education Association
Performance Award, Department of Health and Human Services
Scholarship, Public Relations, Public Administration, University of Minnesota
Publications
Lierman, T.L., ed. 1992. 2nd Edition, Building a Healthy America
Lierman, T.L. November 1989. Federal Public Policy, Pannerships in Education: Toward a Literate
America. Contributing author and ed. B.A. Stewart.
Lierman, T.L., ed. 1987. Building a Healthy America: Conquering Disease and Disability.
Liebert Publishers.
M.A.
Lierman, T.L. 19.83. Health Resource Funding: Politics, Promise, and Priorities. Cancer Investigation
Vol. 1, No. 3: 281-287.
Numerous articles in multiple journals and newsletters.
�.t
"
THE WHITE HOUSE
April 7, 1993
Mr. Robert Restuccia
Health Care For All
30 Winter Street, Suite 1007
Boston, Massachusetts
Dear Mr. Restuccia:
Carol Schwartz has forwarded to me your memo regarding
your views on health care reform. I do appreciate hearing from you,
as we are soliciting dialogue throughout the country from all
segments of the health care industry in our efforts to find viable
solutions to the incredibly complex health care problems facing us. I
am passing along your memo, "Health Care For All," "Health Care
For Consumers" and the additional articles you included to the
appropriate working group of the Task Force.
President Clinton is committed to reforming our nation's
health care system -- controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
Thank you again for your suggestions and for your support of
our endeavor.
Sincerely yours,
�·-----
-
----------------
�H
March 22, 1993
To: The Health Care Task Force
From: Robert Restuccia, Health Care For All
RE: Institutionalizing the Role of Consumers in the Implementation of National Health Reform
For everyone concerned with access to health care these are exciting times. Finally, health
care reform is on the national agenda. The Clinton Administration will be proposing reform
legislation in May and if all goes as planned, it will be enacted this year.
Although a great deal of progress has been made in building a consensus for reform, the
power of the vested interests to derail legislation remains daunting. Nationally syndicated
columnist, Robert Kuttner recently said, "The only conceivable countervailing force to the special
interests is the people." The need for this "countervailing force" will not disappear after the
passage of federal legislation.
Reform of the health care system is a dynamic process that is likely to take many years.
Organized consumers will have an important role to play both during debate and after the passage
of national health insurance legislation. For consumers to provide an effective counter-weight to
other interest groups, the role of consumer-based groups must be institutionalized under the new
system. If this does not happen, the legislation's achievements could be undone in the
implementation phase.
In order to ensure that the momentum for reform continues, Health Care For All (HCFA) is
proposing that federal legislation support the institutionalization of consumer health organizations.
I. 'The Role of Consumers in the New System
Consumer organizations will have important roles to play under a reformed health care
system. First, consumer organizations will be needed to build constituencies to defend the gains of
any new law. Access programs will most likely be phased-in over a period of years. As time
elapses and public attention fades, the law will face attack from various hostile interests. These
attacks will intensify as the implementation deadlines approach. Consumer organization will be
necessary to rally those who stand to benefit from full implementation and to ensure that programs
are not repealed or watered down.
Additionally, consumers must also play a watch-dog role to ensure that programs operate
as intended and future legislation gets refined in a way that meets people's needs. Legislative
intent can be thwarted by disinterested or hostile administrations. This is particularly important
given the likelihood legislation will need continual refinement and that states will play a significant
role in implementation.
'
Finally, informed consumers, organized on a local level, will need to be integrated into a
system of managed competition that emphasizes consumer choice. Consumers will have to be
prepared to represent themselves in new governance structures and address numerous issues,
including discrimination by insurers, underservice, and quality assessment.
Health Care For All- 30 Winter Slreet, Suite 1007, Boston, MA 02108 Phone: (617) 350..7279 FAX: (617) 451-5838
�There has been much discussion about the need for consumer representation on HIPICs
and various other boards and policy making groups. To. be meaningful, consumer participation .
must extend beyond this formal role. The HIPICs, which will represent the blended interests of
business, consumers, and possibly insurers and providers as well, cannot effectively play the roles
of advocate, watchdog, and educator. Too often consumer representation is ineffective because
individual consumers, even if well informed and committed, lack an organized constituency.
The history of health planning illustrates the need to ensure that there is support for an
organized and independent consumer presence. Participation by a small number of individuals on
bodies that also represent all the other interest groups is an inadequate mechanism to generate the
type of broad public participation necessary to keep health care reform on track. The essential
ingredient of connection to an organized base is missing.
II. Health Care For All's Experience
.
The Massachusetts experience in health care reform offers valuable lessons as we pursue
national reform. In many ways Health Care For All (HCFA) is a prototype that illustrates the roles
consumer organizations will be required to play once a federal reform bill is passed.
A Defending Access Programs
Efforts to repeal the access programs of the Massachusetts Universal Health Care law
began only months after the law's passage. HCFA successfully built constituent support for many
of these programs and mobilized this support to defeat efforts to repeal the entire access program.
Despite a dramatic recession and a hostile governor, all efforts to date·to repeal the statute have
been defeated.
HCFA's work around the Health Security Plan (HSP)~ which provides health benefits for
the unemployed, illustrates how organized consumers can defend an access program. Prior to its
start-up in July 1990, there were numerous attempts to repeal the HSP, which is funded by a per
employee surcharge on employers. Health Care For All repeatedly organized consumets tO block
repeal. Once the program was implemented, HCFA promoted the program and build a strong
constituency against repeal. The attacks ceased almost immediately. ·
B. Overseeing Program Implementation and Revising Legislation
HCFA has focused on the regulation and enforcement of all access programs of the
Universal Health Care Law and has proposed revised legislation. For example, after the start of the .
HSP, HCFA continued follow the program's implementation. HCFA organized among the
unemployed and exposed the Weld administration's mismanagement of the program. HCFA then
developed legislation that result in expanded eligibility and benefits for unemployed Massachusetts
workers. Today HSP is secure politically and enjoys broad public support.
C. A Broader Consumer Voice
Health Care For All is the kind of independent consumer voice that will be necessary in a
managed competition system. Health Care For All has provided information to thousands of ~
Massachusetts consumers through educational outreach campaigns, a·telephone helpline, media
work, and widely distributed public education materials. Recently, HCFA published a consumer
guide that explains all of the health access programs available in Massachusetts. HCFA monitors
the health care system on an ongoing basis. We are currently conducting a survey of small nonprofit organizations with regard to their health insurance costs and are also surveying Medicaid
recipients with respect to implementation of the Weld administration's managed care program. In a
�refonned system, the collection of this type of infonnation will continue to be necessary. It must
be available from a source that has no fmancial interest in the health care system.
HCFA has represented consumers on numerous policy making boards and study
commissions. HCFA's success as a consumer representative stems from our close link with
Massachusetts health care consumers and the two way communication we have established
between consumers and the organization.
Defending access, overseeing implementation, and representing and educating consumers,
are complimentary components, An organization that is engaged in providing infonnation and
assistance to consumers and is grounded in real life problems is also well positioned to promote
implementation. H we are going to successfully reform the health care system organizations like
these need to flourish.
lll. HCFA Proposal for Funding Model for Consumer Participatiqn
To build consumer health organizations in all states, federal support is necessary. Without
this support, consumer organizations will not have the financial base necessary to do all that is
necessary in a refonned system.
There are examples of successful federal support of citizen participation accompanying new
legislation. The New Directions program is perhaps the most relevant to health care reform. This
program was implemented during the Carter Administration. Ula lJingham, Director of OSHA,
recognizing that there was only very fragile constituency for OSHA, proposed that the federal
government, through New Directions grants, fund worker-supported health and safety coalitions.
Bingham saw that these coalitions were vital to protecting the OSHA during its implementation
phase and would create an infrastructure that would be the local focus of worker education and
involvement in health and safety issues. New Directions resulted in the creation of many new
health and safety organization and strengthening of the existing groups throughout the country.
An additional funding sources could also come from allowing consumers to designate a
small portion of their health care premiums to support independent representation of their interests.
This funding model is similar to that employed by Citizen Utility Boards. As a funding source it
has the advantage of being publicly established, but not requiring annual appropriations, thereby,
maximizing independence while minimizing the drain on public dollars.
In order to institutionalize consumers' role in health care reform, there should be a
program, similar to New Directions, which can capitalize on consumer health organizations in all
fifty states, with ongoing funding provided via the CUB method. The existence of these programs
will allow consumers to participate in the health care debate on equal footing with providers and
insurers. The amount of funding needed is extremely small, perhaps $30 million per year over
several years, in comparison to our $1 trillion annual health care spending. The dividend, in tenns
of promoting and safeguarding health care refonn, will be enonnous.
We understand that time is short but we believe that this approach could make a large
difference in the direction of health care reform. I have enclosed some support material.
Thank you for your consideration.
�THE BOSTON GLOBE • FRIDAY, OCTOBER 4, 1991
Bill is rued to inform
jobless of health insurance
,.
By Richard A Knox
GLOBE 8l'AFF
. , ·The· cb:hairmen of the Legisla"
ture's health care commit.Ule yester-·
day filed emergeney legislation -designed to force the Weld administration to sign up more unemployed
people for sta~finrmeed health insuranee.
;, '
:·-·.
:~.
A 16-mOftth..old state trust fund
set up to provide health eoverage'for
the unemployed luis· accumulated
mora-tblaPmillioD t.broUgb a uew
Linda Lundgren of Danve~. a.
41-year-old teacher and single moth-,
er of two, also would become eligible
un~r;: the proposed bill. When she
was employed as a middle school
teacher in North Andover, her
$3'1.26' income also put her abOut
$4,000 over the Health Security
Plan's current guideliDes.
·
Lundgren said she struggled to
pay the premiums to.~ her
Blue Cross-Blue Shield coverage
after she was lai~,:~:ln~~ .But
this week she -"~.l';to.;:pre,.np ber
meant to be.adversarial vis-a-vis the
Weld administration... .It's an embarrassment to all of us in state government that this legislation is not
working very well."
I
However, Burke subsequently i
1
charged that the Weld administration's failure to reeroit. eligible bene- '
ficiaries reflects "an ugly set of
priorities"
said the pilrpoae of
his and__~e!J:s pro~~ !A> foree
the administration to do something."
.The BneD-Bnrke- bill, to be dis. CDBBed at a eornridttee 1u.~.;.;.... next.
and
~I~ could'
COV: $332 weekly. unemtiie:·- ;,nonthly
premiums on her
of It in administraployment cheek. ,:\·:L
and admin-.·
.•agree. that --~~~~== ·.:~~=&~~!' . the ~-PoVertY 1~ -~·
won't require a doetc~f.. ~ii~·"·
~tat~=·!.
day,-~ JBDII'8ID bas paicf out'o~
$13 mfllioD, most
-~.~i.~fl,larp
Thnrildi&y;: ·wOiild· -~--~oilitY
eriteri& for the He<h Seeurlty Plan
and also waive any ouwf-pocket ,
payments for hospitals, doctors or \
healt1l
no longer
istratiaa olkiiJi]~llply
~~~~~ :--~~-~n would notch~-- ~.......... ........, ·:~;~l·;·
·.·.; . .....
the requirement'~- beneflriarii:i&' ! ~·~
':..''~: ,~:
r:a.··
prolralla.• ,.
1-'"
.•
• ·•
~
...
;,: .
-~
~-~~--
om,--~ workers
.
...::
300 ·~··-of'"'"- 1
. fed._eral poverty.st~~!f4.~: That·
woi'kB out to· SBSt420·tci :
,of ·
.
_.~
.
mcomenot~
are~ ~m the Health
is
~ eaDed, while 80,000 to 40,000-are be-
"
Seeurltf fi~W· ·• -tbe?'progioam
thlee....
, Heved ~iiildi'inSUranee.
'
· !:;_:{' ~:r,
.
.·.
'
't·'
...
J.
'\·
::·;~ '
.. ·..
4~
'c"- •
)JIIV~~~··J.!·~:1}.~1~
:'~ 1~'' •
'\
·. ··.,~
'l:
·
. ' ; tmlidmmisteringtite'li~.Secmi-
. 'JrJaft
. . . ·~
· ~·· ....... : 88 ~~--~e~
. :~
'\ 1 ,:;.• ·• • · t of M ..... ~y;.
·-,; ·
'·-=·
·
.
. ti.~-~, ~~lld.e.cl~~~~, r- IKM'~eqmnskm oM.1i::)rOgta1b s
I
I
i
\
·-.elijliilitl.and beneflt.8: W'qa1d affect
its fiahonnctness
_.-·
benefits ...Currently the
...1 welcome the debate as to what
program considers'incmne in. the 12 1 ought to be done," Ritter aid, "·but
months prior to the job;loss.
.
legislation .is a step tllat
"What I made last year doesn't
we don't yet need to take."
.,
have a damn thing to do with what
Larry Collins, the •department's
I'm making now." said Patricia Perspokesman, said critics "are absory of Rehoboth, who was tumed
-lutely correct in saying there are
down for the Health Seeurity Plan
thousands of folks eligible out there.
beeause her prior income was about
Our task is to get message out, not
$4,000 above the eligibility standard.
to broaden the program so that the
$40 million in reserves is depleted
overnight."
a~_ce
emergency
1
·. ·
become·-·.:'
=··. RittB,1Ir».Jii '. ruBble'
~~
~:~
~-·
Jllnanelal slniD
.. "· ; .
.
· A~'tbe~~'Would.re-'
.• ~...,.:·'7-'·-::r;..• . · · IH~- .... ·anap·
~t.he.p~anrto
pliCant•&:'~.in·"
. months
. t.O-~ his · ·
'~Jmt the
_pnor. ~--or_ . ,. · i' 'r:::,
six .months of nnE!IIlplo1Jnent ~
--~~~~=;
~~-~who~
·.
Buell and Burke said .they did
· · · -·. ·
.not know how~-~~ peo::;we would
..
·under
1
•
· .,. ••,.. •
.~·~ -")~}.~
,
: 1asta as Joigu.~yment benefits, CWiall,y six months.
:House· tba1rmataof the health care
panel ··; ::
Reading to one administration
offiei8l'a ·published eomment that
ehaDgel are planned in the program
by J111111111"1, Buell said: •Jt's inexcusable for the administration to say
they must wait until next year to fix
the problem. Unemployed people
can't wait untJI next year."
Sen. Edward L. Burke, a Democrat from Framingham, said at a
State House press conference that
the emergency legislation was "not
-J
I
I
I
I
!
I
\
�1
,..
•
•
•
MONDAY, FEBRUARY
10.
1992
State funds
,for health
coverage
untapped
At a time when state programs all over the country are
suffering for -lack of money.- a
Massachusetts health insurance plan for unemployed people faces a different dilemma:
too much money and too few
takers.
.- ·
.
·Two years· after the novel
Health Security· Plan began,
officials and advocates say
they are disappointed with. the
results. And for the second
time Gov. Wllliam F ..Weld has
urged his staff to go back to
the drawing board.
Expected to have an enrollment of ao;ooo, the plan has
never topped 12,000. A state
bank account holds $50 million
for the needy.
Meanwhile, thousands of
out-of-work residents go with·
out health coverage.
And a private insurer, John
Hancock Mutual Life Insurance Co. is benefiting from a
contract making it sole provider· of the coverage. The
company has charged the
state $16.7 million, more than
half of it for administrative
costs.
..We are perplexed. It's one
of the worst recessions ever
this is ·a program. there'~
clearly a need for:• said Mark
Rukavina, of the · watchdog ·
group Health Care for All. ·
A remnant. of former Gov ~
Michael S. Dukakis' universal
health care law, the _plan collects about $34 mlllion a year
through a special business
tax.
·
Thus far, Hancock has issued just 31,000 policies. Peo~le leave the plan when they
find work or lose jobless benefits.
Even allowing for people
who might have insurance
through a family member or
. previous job, the number is far
short of the 430,000 people who
c~llected unemployment in
1991.
Melvin Glasser, director of
the Committee for National
~ealth Insurance, called it a
dtsgrace that 54 percent of
Hancock's fee went for clerical work.
"Administrative costs
should certainly not run above
18 to 20 percent," he said.
Last - fall, state officials
promised to revamp the program and promote it more;
heavily.·
· But many acknowledged
last week that little has im·
proved in its overall impact.
They pointed the finger at
each other, John H.:.:-.::~ .:k ::.:::!:!
even the would-be recipients.
""This is a difficult population for us to communicate
with, to get the word out," said
Charles Taylor, the man overseeing the program for John
Hancock.
The agency responsible for
the program, the Department
of Medical Security. "is very,
very small," said spokesman
Larry Coll~s. "We don't have
the people" to staff unemployment offices.
-AP
�ELEGRAM&
MONDAY, MARCH 2,1992
Insurance
guidelines
broadened
Unemployed get relief
By Pamela H. Sacks
StaiT Reporter
FITCHBURG - For the first time since
last May Nikkie Gary, an unemployed
mother oftwo, can breathe a sigh of relief.
Today is the day the guidelines change
for a state health insurance program for
the unemployed, making her and her sons,
Adam, 14, and Anthony, 12, eligible for coverage.
This is no small thing to Gary, who has
worried constantly about Adam because he
is asthmatic.
"I always felt if he got sick I'd take him to
the hospital and pay $5 a week to pay it
off," Gary, 31, said from her small apart·
ment on Pleasant Street
$50M SITTING UNSPENT
State officials have come under fire in
the last six months because the insurance
plan has $50 million sitting unspent as un·
employment rolls have lengthened.
Gary and thousands of others applied,
only to be told that their incomes during
the year before they were laid off were too
, high to qualifY.
In D~cember, 5,000 people were enrolled
in the insurance plan out of248,900 unem·
ployed across the state. Extended unem·
ployment benefits increased the number of
enrollees to 13,000 last month.
After fending off. an attempt by Health
Care for All, a watchdog
group, to change the guidelines
through legislation, Weld adminis·
tration officials reduced the pro·
gram's deductibles and co-payments as of Jan. 1.
Then in February, following a
heated legislative hearing, officials
of the Department of Health Security, which oversees the program,
announced that as of the beginning
of March the income guidelines
would be broadened.
The new standards raise eliglbil·
ity from 300 to 400 percent of the
federal poverty level. Gary's former
$27,000 salary as a residential
counselor for the mentally retard·
ed puts her well within the new
standards for family income:
$27,240 for a single person; $36,760
for a family of two; $46,280 for a
family of three; $55,800 for a family
of four.
TAX ON BUSINESSES
The plan is supported through a
tax on businesses that brinp in
about $34 million a year.
Meanwhile, John Hancock Mutual Life Insurance Co. is benefiting
from a contract making it the sole
provider of coverage.
For fiscal 1992, Hancock has
been paid a base monthly fee of
$421,562 to process claims, which
have ranged from a low of about
$450,000 a month to a high of
$779,000. That base fee covers up to
10,500 primary enrollees, or those
who hold the insurance rather than
family members who are covered
under the policy. Beyond that number, the, company is to be· paid an
additional $30.06 per primary enrollee.
. Over the life of the program, the
· state has paid out $8 million to
Hancock for administrative ser- '
vices and another $8 million for
claims. The Department of Em·
ployment and Training also has
received more than $2 million to
cover administrative costs incurred
In informing people they might
qualifY.
Gary said that what most disturbs
her is the lack of information available about the program. She found
out about it four months after she
lost her job when she went to the
local DET office to seek job opportunities and happened to pick up a
flier.
Health Care for All is holding a
public information meeting at the
Fitchburg Public Library at·7 p.m.
Thursday, and Mark Rukavina, a ·
community organizer, said the .
group also is backing legislation
that would open up the Insurance
plan to even more people.
Nikkie Gary ·
�£ 7' o~ton
Health care access at new low1
Bay Staters are hit by cuts
in programs, soaring costs
1
, · _The statistical measures include:
number of people being
served by the Mayor's Health Line
in Boston jumped 24 percent in the
first six months of 1992, compared
~th the same period last year.
"Our volume now is running
about 890 calls a month," said Susan
Dale, staff director for the Health
Line, the highest level in the six
since Mayor Flynn established
.'lPe hot line to help people seeking
neatth coverage and assistance.
• A US Census survey last
month estimated that 11 percent of
the state's residents, more than
600,000 people, have no health insurance, up from an estimated 8 percent
m:l990.
r ~~Massachusetts is feeling the
liealth care crisis more acutely than
other states because mecJic!d costs
are higher here and the economy has
sUnk lower, said Alan Sager, a health
policy specialist at Boston UniversitY. 'School of Public Health who advo·c&tes for some form of universal
health insurance system.
·_ . "We're leading the pack," said
:~.adding that, "health care ••.
:~ accelerating toward medical melt-dawn in this state, in the whole nation."
LatTy Collins, director of e>."ter-;
nal affairs for the state Department:
of Medical Security, which takes!
calls from"the uninsured who mighti
qualifyAor the health programs it'
administers, said, "If you have ani
idea of how many phone calls I get:
eV-ery single day.
"I'm telling you, I hear some of
the most painful stories. We tn· to i
help these people, but the fact of the I
matter is, it's not a question of peo-j
ple falling through the cracks any-!
more. They're hurtling into a'
;t. • The
By Dolores Kong
GLOBE STAFF
1
David Arsenault has $16,000 in unpaid medical bills
and is five months behind on his mortgage, all because
.he tore his Achilles' tendon in a softball game in Sep-.
tember and had no health insurance.
The 35-year-old Leominster man had discontinued
his policy a few months earlier because he could no
·longer afford the $200 monthly premium.
·
John could not get a surgical opening in his colon:
closed for a year because he had no insurance and at
Boston teaching hospital demanded that he come upj·
.with a $3,000 prepayment
. ,
. The 20-year-old disc jockey, who did not want his: .
i"ea1 name used, already had an unpaid $25,000 hospitali
~ill for a colostomy and other treatment for a bullet!
:wound he suffered when he was caught in the middle o~
a gang shooting at a party.
· · Measured by individual stories like these and a vari:ety of statistical indicators, access to health care in
·Massachusetts bas reached the lowest point in memory,
1
~say a number of policy analysts and consumer advo-·
:Qtes. It is a situation aggravated by a weak economy,!
.:skyrocketing health insurance premiums and medical'
. -costs, and cutbacks in public assistance programs.
·
Years
chasm."
!
~Gj.OOp
...
GLOBE STAFF
:
The Department of Medical Se-!
curity was formed under the Dukakis administration to implement
universal health insurance system,;
but key components have been dis-j
mantled under Gov. Weld. Instead,:
the·Weld administration has shifted
to a policy of relying on cOmpetition
.among hospitals and other health
pfoviders to hold costs down, but
critics say the approach will further!
limit access to coverage.
,
a'
.- ...
decries "holnu...........
..................J
(
' ·•• · "The level of inhumanity that is
~g allowed to happen is beyond
'htir comprehension," said Rob Restuccia, executive director of Health
Qare for All, a consmner group that
w,8s contacted for help by both Arsehault and John's mother. It also
advocates for sweeping reform of the
he'alth care system. "What kind of
society allows us to do this?" Restuccia asked.
Earlier this year, Sager and his
colleagues studied the effects of inflation and health costs on state
workers' incomes, and found that by
the year 2014, a family health insurance policy will cost more than a
state worker makes in a year.
If the calls to advocacy and government offices are an indication,
health insurance is already unaffordable for
JULY 15, 1992
'
I
'
;
i
i
l
·
Weld's ap)Jl'CNicll defended
Collins, however, defended
Weld's approach.
·.
. !
"This administration is attempt-!
ing to address the problem through l ·
a variety of means," he said. "The
critical point is getting costs under
controL I mean, if tomorrow we all
woke up and everybody was insured,
the problems wo~dn't be solved be-;
cause the costs would keep going
through the roof. In order to address
the problem of adequate access.
somewhere along the line, the cost
situation is going to have to come U!lder control . . . The bottom line i~
there's not a short-term solution w
this thing."
· In the meanwhile, phones arf
ringing off the hook in the office_s o:
private and public agencies.
"Middle-income people are car
ing us now. It's frightening," sai
Mark Rukavina, organizing directr·
for Health Care for All. ''We're <-.
one illness away from being unir
sured."
�FEBRUARY 10, 1992
Coverage
eligibility
standards
Here are the eligibility guide- ·
lines and fees associated with
· the state's Health Security
Plan. The deductible and cOpayment charges were revised down this year.
Officials Sa.y they are considering .adjusting the income
er.gibility standards.
e A person must be a
Massachusetts resident who
previously worked in the state
and is now receiving unemployment benefits. .
e Total family income for
the year prior to unemploy-ment must be less than the
following:
1 person - $19,860
2 people - $26,640
3 people - $33,420
4 people - $40,200 .
5 people - $46,980
6 people - $53,760
7 .people ~ $60,540
8 people - $67,320
In rnos1 instances. clients
must pay a deductible and a
small portion of medical costs.
Some examples:
·
etnpatient hospital ·care:
$300 deductible·· and 20 percent of costs.
• Doctor's. office visits: $50
deductible and 20 percent.
e Prenatal care: 20 percent
of charges.
.
• DeliVery of baby: $300
deductible and 20 percent
e Prescription drugs: any
amounts to meet a $150 majOr mediCal care deductible
plus $10 per presaiption.
• There are no monthly
premiums.
~
�Comparing the Family Health Plan to Likely National Legislation
Discussion
1. Both plans rely on revenue from individuals and businesses. By moving from
a flat premium to a contribution scaled to income, the Family Health Plan
reduces the burden placed on low wage workers.
2. Both plans create a large purchasing pool. The Family Health Plan's inclusion
of large groups in the pool increases purchasing power for both small and large
groups.
3. Under both plans, networks ofproviders are paid a risk adjusted premium for
their enrollees. The difference between the Family Health Plan .and some other
proposals is that the FliP requires all networks to offer the·core benefit package ·
and does not allow supplemental piemiums for that package. This prevents the
segregation of low income people into a cut rate, lower quality plan.
4. At this time it is unclear whether the national proposal will rely on a fee
schedule like Medicare, will allow free contracting by at-risk managed care
networks, or some combination of the two. The FHP does not allow hospital
contracting because we believe that it stifles competition and innovation to
improved delivery of services by giving too much weight to bulk purchasing.
Under a plan that allows discounting, large networks will obtain the best
discounts, while small, but potentially innovative plans will be unable to
compete. The FHP uses the pooled purchasing power of all groups to obtain the
best prices and uses competition to encourage innovation and quality.
fhpnatcompare/~9-93/oldmac
�H
Comparing the Family Health Plan
to Likely National Legislation
Features
Probable National Plan
Family Health Plan
1. Raising Revenue
Mandated employer
contribution
Employee premium
Employer payroll tax
Personal income tax
share(addUtional~oney
to be raised by "sin" taxes
2. Pooling Purchasing
Power and Containing
Costs
HIPIC pools incuviduals,
Mecucaid recipients, and
small groups into a large
purchasing pool. .Large
groups negotiate on their
own. Purchasing power
is (probably)
supplemented by a
global cap to restrain the
rate of growth.
Health Resources
Corporation pools all
groups into a single pool.
Purchasing power is
supple~ented by a
. global cap to restrain the ..
rate of growth.
3. Paying Managed Care HIPICs pay managed
Networks
care network a risk
adjusted premium
HRC pays managed care
networks a risk adjusted
premium
4. Provider Payment
Hospital budgets are set
by the HRC. Networks
negotiate their own
payment arrangements
with physicians, but a fee
schedule is established
for the fee-for -service
plan. Labs, health
centers, etc. can be paid
on budget or fee for
service.
National position on
payment to providersvia regulation, contract,
or some combinationnot yet determined at this
time
(more)
Health Care For All- 30 WinterSR«:t, Suite 1007, Boston, MA 02108 Phone: (617) 350-7279 FAX: (617) 451-5838
�..
.
Unemployed bit hard
Most people who call are referred to one of the patchwork
health insurance programs designed
to. help the disabled, the unemployed, low-income people or those
with pre-existing medical conditions.!
But other times, there is nowhere·
else to turn.
''It is so frustrating not to be able
to help. That's the hard part," said:
Cheryl Gresek, who works for
Health Care for All. "There's got to,
be an answer someplace."
$1,367 moothly premium
·
I
Gresek had to confront the coverage crisis herself in 1988, when her!
and her husband's health insurance'
premium was raised to an unafforda- i
ble $1,367 a month because their son,
Daniel had been treated for a rare i
heart defect. Without health insur-:
ance, the Greseks were told by Chil-l
dren's Hospital, they would have to I
come up with $50,000 up front before 1
doctors would do medically necessary but nonemergency surgery on .
their son.
I
A Children's H~spital spoke~- 'I
woman said the hospital makes deCIsions on a case-by-case basis and
could not say whether the hospital I
ever requires patients to come up
with money. up front for nonemergency care. She said the hospital
tries to help families figure out all
options to pay for care. ''We work
with each family to get coverage to
cover admission to the hospital, said
the spokeswoman, who did not want
to be named, adding, "We would
never refuse admission for emergency care to a Massachusetts resident,
regardless of the financial situation."
Through_a ~to Health Care for ·.
All, Gresek learned of a program approved in 1988 to insure disabled
children and adults, called CommonHealth. Daniel is now insured under
the program, one of the intact com- .
ponents of the universal health sys- '
tern begun under Dukakis. The rest
of the family has been able to get
insurance at an affordable price once
again.
For others, there are no simple
answers. even when there are supposedly programs to provide a safet;y
net for people who have lost jobs or
do not qualify for Medicaid or other
forms of public health insurance.
1
Of the estimated 279,000 people
unemployed in Massachusetts in
June, only 93,200 were still collecting .
. unemployment, said Wallace Graham, a spokesman for the Depart-,·
ment of Employment and Training.
That means most are without health.
insurance, because state and federal
programs provide coverage onl_y until the unemployed exhaust thetr un-:
employment be~!fits.
....:...1
Arsen~~it and John found they!
lacked coverage even though they
both qualified for the state's socalled free care pool, set up to catch :
those who would otherwise fall.
through the cracks. The state reim- !
burses hospitals for care they pro- ,
vide to people who are uninsured 1
and cannot afford to pay, but who do;
not qualify for Medicaid or other
public assistance.
I
After Arsenault went to the Leo- :
minster Hospital .emergency room I
for treatment of his injured Achilles'
tendon, he received a "Dear patient"
letter informing him that he qualified for "total free care." But it
turned out that the coverage
amounted to just $269.33, the price
of a pair of crutches and a shot of
morphine.
:
The rest of his bills, even the I
emergency room physician costs,
were not covered by the pool since it
applies only to hospital charges, not
physician charges, Arsenault was
1
told.
'
"This is a horror show," said Ar- 1
senault, who has been unable to con-·
tinue his construction business or
find another job. "What the hell are
you going to do? I can'~ walk, I'm on
crutches. I lost my insurance, plain
and simple, because of the amount of :
the fees."
!
1
1
I
1
I
State free care poUey
Leslie Kolterman, director of
public relations for the hospital, said,
"The Leominster Hospital policy is
the state free care policy. We are fully within what the state free care
guidelines are."
In the case of John, the disc jockey, the hospitallo~t his free care application. As a result, when he went
to have his colostomy closed, the
hospital demanded a $.'3,000 prepayment or settlement of the previous
$25,000 bill.
His mother, }<'Iorence, had given 1
him her last $20 for the week for the
cab fare to the hospital. When the
hospital sent him home, the colostomy still open, "I was furious," she re1
called.
1
Only after she found out about '
Health,Care for All in April, and the
group contacted the hospital, did s~e
learn that her son did indeed qualify
for
care. She said her son did
not want ~..name the hospital since
he still gets care there.
A year after his injury and eight •
months after he was originally;
scheduled, John had his colostomy
closed.
•
i
I
free
Where uninsured ;I
may eall for help l
I
These organizations provide
as~
i
I
1
sistance and referral for individuals
who lack medical coverage:
·
•Health Care far AU, 617-35fP.'
6207, 9 a.m.-5 p.m., Moruin,y through
Frida~
.
•Mayar's Health Line, 617-594~.
to 5 p.m., Monday'
5050, 9 a.m.
through Friday.
;:
• Depa:rtmenJ, of Medical Securi7 :
ty, 1-800-238-()990 ar 617-727-8900, 9 •
a.m. -5 p.m., Moruin,y through Friday; '
ask for Larry Collins, directm of~ :
ternal affairs. Far questions on til£ ,
Health Seeurity Pla,n for tJze unem; :
ployed, call t-800-967-7781.
i '
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002.letter
SUBJECTffiTLE
DATE
Hillary Clinton to Carol Dodson. [partial] (1 page)
04/06/ 1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [5]
2006-0223-F
ab620
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)[
Freedom of Information Act- [S U.S.C. SS2(b))
PI
P2
P3
P4
b(l) National security classified information [(b)(l) of the FOIA[
b(2) Release would disclose Internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information [(b)(4) ofthe FOIA(
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA[
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA[
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
National Security Classified Information [(a)(l) of the PRA)
Relating to the appointment to Federal office [(a)(2) of the PRA)
Release would violate a Federal statute [(a)(3) of the PRA)
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�·,
THE WHITE HOUSE
April 6, 1993
Ms. Carol Dodson
I
I
I
I
I
Dear Carol:
I appreciate your sharing your views on health care
reform. I will pass your letter on to the appropriate working
group ~f the Health Care Task Force.
This administration is deeply committed to the goal
of quality health care for all our citizens, and we welcome
the ideas and suggestions of people like you who have had
many years of experience in the field. I agree with you that
quality health care should be a right, and not a privilege in
our country.
Best wishes.
Sincerely yours,
�..
~Ylr' 1/~~5w~
?vt9-1 k.
s
~
~e_
o4r(~.:l~- h)~ t.v.· (( la-eJo:~7 Ri.'Jt C!.Yot-v.,. 's
. l~ee St.u-;s--r't YL~t~ '1-1,.,. •
fd I It /Is/< e d 11-c. e._
10 kw-~ ~
7
;4-
~~
~
1¥~ I /4.4" ~ s '7- 1-k--... f../ 0n. .
(J
~~...v
�..
FROM THE DESK OF
Carol Dodson
ANDERSON CLINIC
2445 Army Navy Drive, Arlington, VA 22206
(703) 892-6500
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. letter
SUBJECTffiTLE
DATE
Carol Dodson to Hillary Clinton. (2 pages)
03/01/1993
RESTRICTION
P6/b(6)
[P4~fl4c...]
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence (5]
2006-0223-F
ab620
RESTRICTION CODES
Presidential Records Aet- (44 U.S.C. 2204(a)(
Freedom of Information Aet -(5 U.S.C. 552(b))
PI
P2
P3
P4
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(J) Release would violate a Federal statute [(b)(J) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
National Security Classified Information ((a)(l) of the PRA)
Relating to the appointment to Federal office ((a)(2) of the PRA)
Release would violate a Federal statute [(a)(J) of the PRA)
Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
C. Closed In accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U;S.C.
2201(3).
RR. Document will be reviewed upon request.
�Dear Mrs. Clinton,
I am a Nurse/Medical Secretary for an orthopaedic surgeon,
who specializes in Joint Replacement surgery, i.e. Hips
and Knee disorders. I am a Licensed Practical Nurse, with
a unique background. I hope that the knowledge I have
gained from my years as a Health Care Provider can assist
you in your planning for health care reform.
I
I
.I
I nursed in a hospital for 10 years giving direct patient
care. As a nurse, your main objective is to help the
patient. It is very difficult to help the sick, and at the
same time remind yourself to save money, etc. Fortunately,
during the time I was nursing this was never an issue. I
understand ~hat in todays• time, nurses are encouraged to
keep cost containment in mind when caring for patients.
Hospital charges compared to costs are excessive. However,
physicians are expected to practice medicine and be
fiscally responsible, to keep the hospitals from "losing"
money on Medicare patients. Since Medicare pays a hospital
based on a DRG, a patient begins their hospital stay with
a preestablished fee in a "bank account". Once that money
is used up~ each additional day the patient remains in the
hospital, costs the hospital money. This is a big burden
to place on a physician who wants the best for their patient.
Sometimes a "knee replacement", i.e.the knee prosthesis
charge uses up 1/2 of the DRG. That does not leave much
money for the remainder of the patient's hospital stay.
I then worked at a local hospital, National Hospital for
orthopaedics and Rehabilitation, for 7 years. Here, I was
the Assistant Director of Quality Assurance and the Med~cal
Staff. This job entailed reviewing all of the files of current
members(physicians) of the medical staff of the hospital for
compliance with Joint commission for the Accreditation of Hospital
organizations, (JCAHO). Physicians must maintain very strict
adherence to the guidel-ines established,· in order for them to
continue to have "privileges" to practice at any facility. They
are reviewed not only for the quality of care that is delivered
to the patient, but also for utilization of hospital services·,
length of stay, unnecessary tests or procedures ordered, etc.
In addition, care given to patients fr'om nurses, lab technicians,
and all other care givers is reviewed for quality and
�..
appropriateness. Today, physicians are really being pressured to
give good care, in order to meet requirements of JCAHO, but are
being forced to do this in the "most economical" way possible.
My work in the physicians office has exposed me to another side
of health care. My job is to assist patients from start to finish
with the planning process of a surgical procedure. In dealing with
most insurance companies, the patient and the physicians staff is
required to report to the insurance company the plan of treatment
for a patient. If you meet their "standards" of care and your
physician plans to treat them as their pre-established criteria
demands, then the patient may proceed with surgery.
Of course,
they also will "guide" you as to the number of days that patient
may stay in the hospital. Next, the company will determine what
fee they feel is appropriate for the procedure you are going to
perform. In most instances, my physician will agree to accept
their fee schedule. My physician, like most others, participates
in many HMO's, PPO's, and other Managed Care Programs, so rarely
does he receive "full" fees for any given service. In addition,
my physician would not turn away a patient, just because their
insurance does not pay what he charges. I think given the opportunity to make a decision, few physicians would not agree to "work"
with a patient and their financial restrictions.
I feel very
strongly that insurance companies are spending a lot of money on
employees, (nurses and physicians) who via telephone "review" a
patients status. They determine "how, when and where" care is
delivered and also how much is paid. This is a duplication of
effort. These review functions are already taking place in hospital
facilities and are furthermore required to take place. If the
JCAHO guidelines are not met, hospitals are not accredited and most
insurance companies will not pay for hospital stays. So, when all
the reviews are being done, why pay more salaries, which only
leads to higher premiums for the patient. In addition, it becomes
increasingly difficult as a physician to try to practice good
medicine and be governed by the hospital to try to save money, but
also by the insurance company. Perhaps an organization much like
the JCAHO -could be established to help monitor the quality and
appropriateness of care delivered in physicians offices.
This
would be more cost effective than the insurance company reviewing
care of a patient they do not even see.
Finally, speaking from a personal side, I have experienced the side
of a patient who is in a HMO (MD-IPA) because that is the plan
his work offered him. My father has cancer of his lung. He was
diagnosed in May of 1992. He had a chest x-ray in February, 1992
that showed a tumor the size of a fist. Because his primary care
physician, or the gatekeeper, would not "open the gate" for him to
start care, his diagnosis and treatment did not begin until
May.
We could not prevent the delays which occured in the HMO
programs because neither my Dad or I could afford to pay for the
�care had he gone out of the system. In our society .waiting three
months to begin treating an individual with cancer is totally
unacceptable. I feel that had I not directed him in his care he
certainly would have suffered even more than he did.
Finally,
after I lost my temper, called people I know from working in this
practice, and did everything I could to facilitate his care; he
began to receive adequate care. But, what if I had not been here
to help him? How unfortunate it is for the average person who
knows nothing about health care and how to receive the maximum
benefits available to them.
Even then, sometimes the benefits
available are not necessarily the standard of care. I think that
the most important thing to remember is that in most cases, a
"sick" pati~nt is the person who is in need of health care. At
that time, the patient needs the assurance of being able to go to
a physician and receive the care he needs. We have to think about
the PATIENT when we think about health care. Most people who need
health care do not have the luxury of being a health care worker
who knows all the in's and out's of receiving health care.
I realize that you have a group of very experienced individuals
with a great deal of knowledge about health care appointed to help
you. But, I feel so strongly about this that I felt that I should
give you this information.
I want for myself and every other
American citizen the opportunity to have the great health care that
is available. This should be a right, not a privilege.
I am glad that YOU have taken on this massive task, that will take
so much time to 11 cure 11 • I feel that you have empathy and will be
a patient advocate. If you read the article.in the Washington Post
Health Section by Arthur Ashe, you can see that even he realized
that he was "privileged" by being financially able to seek health
care that his insurance plan did not permit.
I hope that you are able to read this letter and review the
information I have given to you. I would be happy to speak to you.
If you, your husband or daughter are ever in need of orthopaedic
care, please do not hesitate to contact me for a referral. My
boss is the best "joint specialist" on the East coast.
Sincerely,
carol Dodson
Home # I
.· <t:@l,),,;, · ;
I
Work # 703-920-6700 Ext. 4041
�...
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�THE WHITE HOUSE
April 6, 1993
Mr. William M. Ryerson
5313 Garry Owen Road
El Paso, Texas 79903
Dear Bill:
It was good to hear from you. I'm pleased to get a
positive report on Russ Denham. I hope his health continues
to improve.
Thank you for the information concerning medical
cost-comparison studies between civilian and military
facilities. I will pass your letter on to the Health Care Task
Force for their consideration.
I appreciate your kind words of support. Best
wishes.
Sincerely yours,
�William f.'\. Ryerson
5 313 Garry Owen Rd.
El Paso, Texas 79903
. !'f
'fflt..
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- 22 February 1993 Dear Hillary, ·
Our mutual acquaintance, Russ Denham, with whom you
exchanged letters last year in regard to "notch babies"
and other subjects, was released from William Beaumont
Army Medical Center (WBAMC) last Friday evening, following
more than two weeks of intensive care. At the hospital,
it was discovered that he suffers from failure of both
kidneys. He was also anemic because something had been
destroying his red corpuscles. Had he not been in such
excellent physical condition because of his tennisplaying and his running, he might not have come through
this ordeal at all.
Russ wants you to know that he received the very best
of care at WBAMC.
The hospital commander and key staff
members paid several visits to his room to demonstrate
their concern for this alumnus of Arkansas Tech, who is
one of our most politically active retirees.
This brings up a point for consideration as you go
about the tremendous task of developing a cost-conscious
national health plan. When it became known that Letterman
AMC was facing base closure, a cost-comparison study was
made.
The study revealed that, in the San Francisco Bay
Area, it was costing the federal government almost twice
as much to treat a CHAMPUS patient in a civilian facility
as it cost for the same treatment in a military facility.
The exact ratio was $1.83 to $1.00.
Additional studies indicated that, on a nationwide
basis, the ratio of civilian costs to military costs was
on an average of $1.37 to $1.00. From a cost-containment
standpoint, therefore, it would appear that keeping
military hospitals in place and adequately staffed
-wherever the number of eligible beneficiaries (including
active duty personnel, dependents, military retirees, and
military widows) is large enough to justify such action,
would save dollars and make sense.
In addition to being a good thing for the taxpayers
and maintaining our military medical readiness posture,
keeping such MTFs as WBAMC fully operational would be a
blessing for those career veterans who have relied for
many years on the government's providing the medical care
that had been promised to them. This is especially true
for Medicare-enrolled military retirees, like Russ Denham
�and myself, as well as for military widows, many of whom
have very limited incomes.
On a more personal note, let me add that my wife
(Meg) and I share the Denhams' enthusiasm about the
Clinton administration.
I was pleased to be among the
early contributors to the Clinton campaign, and I am
especially proud of having been appointed and certified as
a charter member in good standing of the "Americans for
Change" Presidential Task Force. We all honestly feel
that the nation is very fortunate in having both you and
President Clinton in the service of our country at the
highest level. We wish you both Godspeed.
Sincerely,
~
~
,;@f:f~~, 7~·
P.S. I'm sure that you have Russ Denham's address in your
file, but as a matter of convenience, here it is again:
Russell B. Denham, 4709 Guadalupe, El Paso, TX 79904.
His phone number is (915) 751-3374.
�•
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�
Dublin Core
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Title
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Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
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White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
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1993
Identifier
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2006-0223-F
Description
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This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
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72 files in 6 boxes
Provenance
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Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
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William J. Clinton Presidential Library & Museum
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<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
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HRC - Health Care Correspondence [5]
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First Lady's Office
Maggie Williams
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2006-0223-F
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Box 5
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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William J. Clinton Presidential Library & Museum
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42-t-2194630-20060223F-005-003-2015
2194630
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https://clinton.presidentiallibraries.us/files/original/1c4aa8b40a0964258670133e56fa2987.pdf
cd06463566a8f9c4ab01cc49d61b054e
PDF Text
Text
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECTffiTLE
DATE
RESTRICTION
001. letter
Virginia D. "Cissi" Hamilton to Ms. Hillary Rodham Clinton. [partial]
(1 page)
03/14/1993
P6/b(6)
002. letter
Hillary Clinton to Frank Smusz [partial] (1 page)
03/22/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number:
10813
FOLDER TITLE:
HRC Healthcare Correspondence [4]
2006-0223-F
ab619
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom oflnformatlon Act- (5 u.s.c. 552(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 R~lease would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified Information ((b)(l) of the FOIA)
b(2) Release would disclose Internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�...
THE WHITE HOUSE
March 24, 1993
Mr. Roy C. Turner, ill
Vice President
Stephens Inc.
111 Center Street - Suite 2400
Little Rock, Arkansas 72203
Dear Te:
Vince Foster has directed to my attention the paper on health
care reform sent to you by National Diagnostic Systems, Inc. We
are soliciting dialogue throughout the country from all segments of
the health care industry in this tremendous undertaking to find
solutions to the incredibly complex health care problems facing us. I
am passing along this paper to the working groups of the Task Force
for further review and consideration.
/
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President Clinton is committed to reforming our nation's
health care system -- making affordable health care accessible and
providing security to every American family. It won't be easy and it
won't happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
I hope we can count on your support for the success of this
enormous and challenging endeavor.
Sincerely yours,
�THE WHITE HOUSE
WASHINGTON
March 10, 1993
Mr. Roy c. Turner, III
Vice President
Stephens Inc.
111 center Street
Suite 2400
Little Rock, Arkansas 72203
Dear Te:
Thanks for your very nice letter of congratulations.
As you can imagine, life has been quite hectic here in
Washington since January 20. After representing so many
clients in my life, I am now down to only one, but that one
the President -- does generate a fair amount of work for a
lawyer. What is most important is that when you do a good job
for him, you are doing a good job for all the people of
our great country. And that is the opportunity and challenge of
a lifetime.
My involvement concerning the Health care Task Force has
been strictly on the legal side. I'm not involved in policy.
have, however, passed on the report of National Diagnostic
Systems, Inc.
I
I a~preciate your sensitivity to the personal sacrifice and
particularly your prayers.
Sincerely,
Vincent w. Foster
Deputy Counsel to the President
�•
Stephens Inc.
Roy c. Thmer, m
93 MAR l All : 51
Vice President
February 25, 1993
Mr. Vince Foster
Deputy Counsel to the President
Office of Counsel to the President
1600 Pennsylvania Avenue, N. W.
Washington, D.C. 20500
Dear Vince,
I'm sorry I didn't get a chance to wish you bon voyage before you departed for the White House
but I hope you are enjoying your new duties. I want you to know that I sincerely appreciate
your willingness to incur the personal economic sacrifice required to give up your law practice
in order to go help "our friends". I know you'll do well.
Of course, I do have an ulterior motive for writing you. As you may be aware, I spend a
significant amount of my time dealing with companies in the health care industry. One of them
sent me the attached analysis which is easily the most thought provoking piece I've read on
health care reform. So I have two favors to ask of you:
1)
2)
read the attached white paper; and
pass it along to the First Lady. Although I have no assurance she'll read it at
least it will get past her censors. I'm also betting that if you read it, you'll
recommend it to her.
Again best of luck in D.C. I pray for y'all often.
Sincerely,
~
/kjh
Enclosure
Investment Bankers
111 Center Street Suite 2400 P.O. Box 3507 Little Rock, Arkansas 72203 501-377-2ll4
National Wats 1-800-643-9691
Arkansas Wats 1-800-482-6355
Fax 1-501-377-2674
�THE WHITE HOUSE
March 24, 1993
Peter A. Fotinakes, M.D.
Joyce A. Kakkis, M.D.
Women's Gynecology &
Invertility Medical Group
1043 Elm Avenue - Suite 402
Long Beach, California 90813
Dear Drs. Fotinakes and Kakkis:
Thank you for your letter of suggestions regarding health care
issues which was forwarded to me by my friend, C1ssi Hamilton, of
Hot Springs, Arkansas. Working groups comprised of government
employees are engaged in an ongoing process of consultation with
people like you -- people with firsthand experience or particular
expertise in the health care field -- to gather information for, and
provide information to, the Task Force. I will pass along your
knowledgeable suggestions to the appropriate working group.
The President is committed to reforming our nation's health
care system -- controlling runaway costs and providing security to
every American family. It won't be easy and it won't happen
overnight, but we can bring costs under control while maintaining
quality medical care and preserving the choice so important to us all.
Again, thank you for your views and for your support in this
tremendous endeavor to find solutions to an incredibly complex issue.
Sincerely yours,
~~l~
Hillary Rod\wn Clinton
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. letter
DATE
SUBJECTffiTLE
Virginia D. "Cissi" Hamilton to Ms. Hillary Rodham Clinton. [partial]
(1 page)
03/14/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number:
10813
FOLDER TITLE:
HRC Healthcare Correspondence [4]
2006-0223-F
ab619
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [S U.S.C. SS2(b))
PI
P2
PJ
P4
b(l) National security classified Information l(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(J) Release would violate a Federal statute l(b)(J) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) of the FOIA(
b(8) Release would disclose Information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
National Security Classified Information [(a)(l) of the PRA)
Relating to the appointment to Federal office [(a)(2) of the PRA)
Release would violate a Federal statute ((a)(J) of the PRAJ
Release would disclose trade secrets or confidential commercial or
financial information l(a)(4) of the PRAI
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy l(a)(6) of the PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Virg
14 March 1993
Ms. Hillary Rodham CLINTON
c\o Healthcare Task Force
The White House
Washington, D. c. 20500
Encl:
Ltr by Joyce A. KAKKIS, M.D. and Peter A. FONTINAKES, M.D.
Hillary:
Please find time for the enclosed letter written to you by
my dear friend, Joyce KAKKIS, and her husband, Peter, concerning
the national healthcare crisis. It is sincere, objective, and
without avarice.
I know that you are very busy.
Good luck to you, and
Kindest regards,
~·
,..·""
11
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Virg~=--D. "Cissi" HAMILTON
�Dear Ms. Clinton:
WOMEN 1S
GyNecoloqy &
I
1
INfERTiliTy
MediCAl GRoup
104' ElM
SuiTE
Ms. Ci~sy Hami!tcn enccuragad us to writa after hearing our heartfelt
comments regarding the current healthcara ctisis. We know that you are
probably being ;nundated by correspondence and requests from all sides.
Piease tina the time to consider the views of several physicians in the
trenches ot private practice. We &re the grass-roots of American healthcare,
and speak from experience not theory.
Most physicians enter tha fiald with real idealism and determination, having
survived an average of sixteen years training, personal and financial
sacrifice. They are a valuable commodity. Many have become discouraged
from the growing trends and are giving up the demanding practice of
medicine for other ventures. Soma continue with a bad attitude, providing
less care and supervision. Many will stay even in the face of adversity, the
best will be lost in the continuing trend of producing physician scapegoats in
a failing system. Of greater importance, the best will no longer enter the field
in the future.
AVENUE
402
LONG 8EACit,
Over zealous bureaucratic regulations will not effect the few who abuse the
system. It will inhibit patient care delivery by the majority of caring
individuals who would like to retain their dignity and continue in a worthy
profession.
·we have outlinad some suggestions that address nealthcare issues which
ara oi
par~itular
importance.
CAlifORNiA, 9081 '
1) Take the middle man out of the healthcare system.
(JlO) 4J7.. 102J
A middle man does nothing to provide higher quality or better access. he
redirects funds to private business profits. and away from the patient and
provider alike. 'vVe are specifically talking about the HMO's, PPO's, and
IPA's. Under the guise of pmviding cheaper haalth care, they are becoming
rich. Neither tha physician or patient profit trom these institutions. The
participating physicians earn reasonable salaries, while a third party makes
a profit, yet the patient's c:ost ..appears" less. The profits to pay this third
partner arises from r51tjuoing !J~allh ~.ar.Et. The middle mar. prevents
physicians, health insurance companies, 01 the government from taking the
blame of rationing care. We need to face up to the limitations of medicine
and provide care only where it is mo~t needed, and shouldn't shouldn•t pay
extortion to a midd 1ame.n in order tc· avcid the blame of rationing care. The
�2
GyNecoloqy &
bottom line is made to fit in order to contain costs and prevent competition.
Many of these organizations keep willing hospitals and physicians from
participating due to political concerns, rather that to optimize health care
delivery. Healthcare must be divided across large, mixed populations to
lower individual cost. It is unfair to burden any healthcare delivery system
with critically ill patients, while HMO's absorb healthy patients at lower costs.
Both will spend too much on terminal care without a return.
2) Health insurance should be. mandatory for all people.
INfERTility
MediCAl GRoup
104' ElM
AvENUE
SuiTE 402
loNG BEAcli,
CAlifoRNiA, 9081 '
It shouldn't be necessary for an individual to be exceedingly wealthy to buy
medical insurance, or exceedingly poor to go on a Medi-Cal program should
they have a preexisting or· catastrophic disease. A void has been created
where there are many patient's who would iike to have health insurance, but
can't afford it, or simply can't obtain it because of a preexisting condition. At
the other extreme, individuals who have healthcare options provided
through their employment, may choose to be uninsured in favor of an
increasea salary. This shifts the burden of responsibility to the remainder of
society.
3) Malpractice reform.
The threat of litigation inflates healthcare costs, detracts 1rom the
physiciaoipatisnt n-tJationship, yet does not benefit the healthcare system as
a whole. Society has a creatad legal-lottery system for people who want to
get rich quick. Litigation creates a mode of revenge should there be an
untores~en, yet unavoidable outcome. True malpractice continues to occur,
a.llowing incompetent physician to pay off the system. I am confident that
physicians would gladly accept lower reimbursement if a third of their
income didn't go to malpractice premiums; Mandatory arbitration with an
improved peer review system wil! provide the necessary quality of care.
The estimated C'.Osts of practicing legal medicine are grossly understated.
The· moiass ot paper-vorl<; and extm testing produced to protect providers in
~he avant in the avant of litigation i!3 overwhelming. The system of medical
'lttality assurance should be expanded. 'Nhen malpractice is suspected, a
patient wouid bt:t sncouragad to report their impressions to a board of
physicians and !agal repmsamatives who can make swift, fair, and
!nexpensive intervention. !f it is determined that malpractice has occurred,
then the physicia'l may undergo rstraining, or even expulsion from practice.
Fines rna~' be ievied, and these revenues returned to continue quality
assurance rather that filiing the p-:>ct-:ets of an individual and their attorney.
This would ~liminate revenge suhs and get-rich~quick schemes. It would
also provid~ ·fru contlr.ued excallanca i:1 medic:ai pfactice.
�3
The healthcare providers of this country woul.d be very discouraged and
unwilling to sacrifice in a system which does not provide significant
malpract.ice reform. Very little has been mentioned regarding this issue
which should be a cornerstone of restructuring the healthcare system.
GyNECOlOGY &
INfERTility
MediCAl GRoup
4) Universal insurance form.
Develop a universal medical insurance form which would be used for all
forms of medical reimbursement. Duplication wastes time and money.
Decrease utilization review for lower cost services, and have physicians of
equivalent levels of training substantiate the need of costly procedures, and
long-term care. Most physicians do procedures because they are warranted
for the welfare of their patients. They involve judgment, experience, and
patient input. Overutilization can be tracked and reviewed locally.
5) Healthcare reimbursement.
104J ElM
AVENUE
SuiTE 402
LONG BEACit,
CAlifoRNiA, 9081 J
Insure that healthcare payments are dispersed in a timely manner. We are
faced with insurance companies and government healthcare systems kiting
money by delaying reimbursements for months and sometimes years. We
consider providing care for Medi-Cal patients in California charity work.
Reimbursements are so often denied or extended they are no longer
profitable to pursue. Medicare denies our claims without adequate
explanations. Medicare has sent letters to our patients stating that we are
grossly overcharging them or they encourage them to join HMO's to avoid
such medical bills. We are represented in a disrespectful manner with little
or no recourse. Instead of playing these games, third party payors should be
honest with eyer:yone, and indicate that the reason for limiting
reimbursements is availability of funds. No one seems to want to take the
blame for limiting health care delivery.
6) Gate Keepers.
•
(J10) 4J7.. 102J
Don't be seduced by the so-called gate keeper concept. General
practitioners should provide general and preventive care with health
maintenance. They are not qualified to direct specialty care. Either an
inappropriate work-up is performed or they directly refer to the specialist after
some harm is already done. We withdrew from such a system after
continually being harassed by paperwork, authorization requests and
inadequate patient care. Specialty care may seem more expensive because
it often involves adva.nced technology and complex patients. General care is
less expensive because it involves simple problems and healthy patients.
Often a single specialty evaluation avoids many general visits.
�4
7) Patient respons1bil:ty.
GyNEcoloqy &
I
Copaymants should be a part of every health system to prevent
overutilizatioli by patients for insignificant illness. Eliminating cost barriers to
prevantativa health care is critical to iower long term costs. Provide
incentives tor maintenance of good health habits.
Advances in reproductive choice and prevention .of sexually transmitted
disease is badly needed. Prenatal care is available and underutilized now,
because of poor compliance, bad health habits, socio/cultural pressure, and
ignorance ... In addition to aggressive prenatai care, emphasis should be
placed on contraception and preconceptional education.
INfERTiliTY
MEdiCAl GRoup
8) Physician ventures.
104J ElM
AVENUE
SuiTE 402
LONG BEAClt,
CAlifoRNiA, 9081 J
There is significant rhetoric regarding physicians profiting from medical .
enterpriSe, yet it is perfectly fine for an outside interest to make unlimited
profits~ Perhaps some. phys;cia.'ls may abuse the ·system, but outside
en~erprise would be much mora lik~iy to do so~ !t is discouraging to
continually encounter new government regulations to prevent physician
· abuse·, f't'hen niost physicians are innocent of wron·gdoing and are
overwhelmed with red tape.
9) Phys!cian incentives.
Most pJ';ysiclans donata e).ionsiva amounts of time !n prcv!ding free care.
Cteata incer;tives to &ncour&~e ;nvoivement in medica! education and
Indigent caret. Our hospital has an !ndigent ·care t;iinic where many of its
ptaysicians see patients for tree or at greatly reduced fees while providing
tea9hing to young dot.1ors.
(J10) 4H .. l02J
It would ha a pleasure to work ih a heaithcare system where we do not have
to, worry about a person's healthcara .coverage, where we wouldn't be
plagued· ·Mt.h endless threats of litigation, and where a rational estimate of
what medical Cflre car. and cannot picv!de is at%-epted. We spend more
time shuffling pap$r~ becoming frustrated, and juggiing n~gulations than
providing care. We are considering i.:raving our medicai careers behind after
decncatin.g many !ong years of tre.ining, saciince, and financial risk. We
ramain patier.t for .new ar.1 hopefu! tor responsible change.
\AJe will hG at·y<.'lur riisposa! 7or ciarmcation ot discussion. and invite you to
�.
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spend time in our healthC'.are network to focus on specific problems. We
appreciate the difficulty of your task and stand ready to help you in any way
we can.
WoMEN 1S
GyNecoloqy &
INfERTility
MediCAl GRoup
104) ElM AvENUE
SuitE 402
LONG 8EACit,
CAlifoRNiA, 9081 )
(JlO) 4J7 .. 102J
Yours Truly,
-YJIJ~I4~
Peter A. Fotinakes, M.D.
Associate Clinical Professor
Dept. of Neurology, UCIMC.
Associate of tha American
Academy of Neurology
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(A
a~ e/)
A Kakkis, M.D.
"Associate Clinical Professor
Dept of Ob/Gyn, UCIMC.
Fellow of the American Board
ofOB/Gyn
�.
.
THE WHITE HOUSE
March 22, 1993
Mary Ellen Schattman
Director of Government Relations
Tarrant County Hospital District
1500 South Main Street
Fort Worth, TX 76104
Dear Mary Ellen:
i- __ ....-·-·- -
Thank you for your promptness in sending me the citations
for the earlier information you had shared. They will be very helpful
to me and the Task Force. I hope getting it together it did not cause
you too much inconvenience.
I am grateful for Tarrant County Hospital District's
willingness to host a hearing, but the sites for the hearings have
already been determined and scheduled. We will appreciate your
support, however, in our ongoing focus of this critical issue affecting
all Americans.
Perhaps we will get to see you and Mike in June.
Sincerely yours,
�t HOSPITAL DIVISION
John Peter Smith Hospital
Outpatient Clinic
®_T_A_RRA_N_T_C_O_U_N_T_Y_H_O_S_P_IT_A_L_D_IS_T_R_IC_T_
: ~[}
1500 South Main Street+ Fort Worth. Texas 76104 +817/921-3431
,
817/921-3431
t PSYCHIATRIC DIVISION I
Trinity Springs Pavilion
817/927·3636
!
I
March 16, 1993
t COMMUNITY HEALTH
DIVISION
Family Health Center
817/927-1215
Hillary Rodham Clinton
The White House
1600 Pennsylvania Ave. NW
washington, D.C. 20500-2000
Arlington Community
Health Center
817/861-0095
Dear
Polytechnic
Community Health Center
817/531-3314
Thank you for your letter of March 1 which I just
received. I think the postal service is a little slower
since they laid off my brother, but I could be biased.
New Lives Health Center
817/922-6840
Northeast Community
Health Center
817/285-0075
At this point I have sent you two letters with a total of
twelve comments. Since your request for citations did
not specify which you were most interested in I will do
my best to provide them all as quickly as possible. I
know what its like to be buried alive in paper. I am
tempted to send you the actual documents so that I can
once again see the floor in my office. But in the spirit
of sacrifice so important to our country's future, I will
do the documentations as an order form. You can check
off what want and fax to us. We will fax or express mail
back.
Central Clinic
for the Homeless
817/870-2803
UNDER DEVELOPMENT
Stop-Six Community
Health Center
Diamond Hill Community
Health Center
t CORRECTIONAL
HEALTH DIVISION
817/884-3060
t HEALTH EDUCATION
DIVISION
School of
Vocational Nursing
School of
Radiologic Technology
817/921-3431
• MEDICAL RESIDENCIES
'
Family Practice
Obstetrics/Gynecology
'
Orthopedics
Podiatry
Transitional
M~~- .jjd£~/j//
First though, I must do my chamber of consumer campaign
for a public hearing in Fort Worth. The Tarrant County
Hospital District is willing to host a hearing for your
task force. We believe we are the perfect choice. As a
public teaching hospital, a large number of our patients
are the working uninsured. We are also a major Medicaid
provider.
What makes us unique is that we have the
nation's largest single site family practice residency
programs with 63 residents. We don't just talk about
primary care, we live it. More than 400 family doctors
have trained through our primary care network.
Our
alumni are heavily recruited into rural areas, because
they have the professional skills needed to function as
the only doctor for a whole county. Dr. Patti Wetzel,
one of the "Faces of Hope," is a graduate of our program
and on our staff.
Her husband, one of our emergency
physicians, also trained here. Obviously, we produce very
special graduates.
817/921-3431
+ Tarrant County's Major Health Care & Education Resource +
�March 16, 1993
Page 2
Besides being the mother lode of family practice doctors so
essential for the success of managed care, we have practical
experience with large public hearings and dealing with the Secret
Service.
We can deliver "an event" on very short notice.
Shoestring budgets are our specialty.
If you can't come to Fort Worth, I'll see you in Washington in
June. Mike and I are in charge of recruiting volunteers for the
Habitat for Humanity project at the G. U. reunion.
Details to
follow.
Best regards to the President.
Sincerely,
Mary Ellen Schattman
MES:dsg
Encl.
�Citations requested by Hillary Rodham Clinton.
To secure documents cited please call Mary Ellen Schattman at
817-927-1251 or fax 817-927-1664.
-----------------------------------------------------------------FROM JANUARY 25, 1993 LETTER
1.
Integrated supply system
Conclusion drawn from testimony before the Texas Health
Policy Task Force access subcommittee.
For Solutions see
Interim Report to Governor Booth Gardner and the
Washington State Legislature, washington Health Care
Commission (December 1, 1991).
Lynne Cohen, "Health-Policy Research Becoming a Growth
Industry in Canada," Can Med Assoc J 1992: 146 (1).
Principle II, Health Policy Task Force Draft
2.
u.s. Doctors move to Canada
Video Tape of 1992 PBS Show, "Condition Critical Public
Health Care Forum, quote from Jane Fultan, Ottawa,
Canada.
3.
Example of global budgeting
Tarrant County Hospital District budget is an example of
global budgeting.
Current budget is $162 million.
'Annual tax increases have ranged from 0% to 18%.
4.
West German versus American women
I read an article in the "New York Times"on the different
life styles of East and West German women published after
the Berlin wall fell. (The story can probably be
retrieved but I can't find it in my files.) I had not
realized how different the women's situations were.
American health insurance has to mesh with the American
wage earner lifestyle.
If insurance is through the
employer,
whose
employer?
Must
your
employer
automatically insure you if you get a divorce? The car
insurance/personal income tax approach is just simpler.
No one expects their employee to share insurance on a
car.
�5.
Medical Residency Training System
Numerous documents available on many aspects.
Rosemary Stevens, In Sickness and in Wealth American
Hospitals in the Twentieth Century (Basic Books, Inc.
1989).
William G. Rothstein, American Medical Schools and the
Practice of Medicine (Oxford University Press 1987).
Irving J. Lewis and Cecil G. Sheps, M.D., The Sick
Citadel The American Academic Medical Center and the
Public Interest (Oelgeschlager, Gunn & Hain, Publishers,
Inc. Cambridge, Massachusetts 1983).
Michael E. Whitcomb, M.D., Thomas J. Cullen, Ph.D.,
L. Gary Hart, Ph.D., Denise M. Lishner, M.s.w., and Roger
A. Rosenblatt, M.D., M.P.H., nrmpact of Federal Funding
for Primary Care Medical Education on Medical Student
Specialty Choices and Practice Location 1976-1985, n Rural
Health Working Paper Series, Working Paper tl3, April
1991 (WAMI Rural Health Research Center, Department of
Family Medicine,
Research Section University of
Washington HQ-30, Seattle, Washington 98195).
Larry s. Gage J.D., Virginia B. weslowski M.F.A., Dennis
P. Andrulis, Ph.D., Elizabeth Hintz, M.H.S.A., and Anne
B. Camper, J.D. America's Safety Net Hospitals (National
Association of Public Hospitals, January, 1991).
Community Teaching Hospitals: Developing A Common Agenda
(April 19, 1990, Atlanta, GA).
nAvoiding the Next Crisis in Health Caren AHC Association
of Academic Health Centers (Recommendations of the AHC
Task force on Human Resources for Health).
David C. Warner, Ph.D. and Phyllis G. Warner, M.F.A.
Report to the John Peter Smith Hospital Medical Staff on
Additional Residency Programs (October 1991).
There is no American formula or computer model or even a
rule to determine if a hospital should add a residency
program, determine what it will cost or judge whether it
is a cost effective way to deliver services. We need to
review how medical education is accomplished in other
countries.
�6.
Managed Care/Health Care usage
This is based on common sense. What would it take to
enroll every American with a family physician? Divide
population of u.s. by the total number of practicing
family practice doctors (factor in new graduates and
retirees each year). Even if you could cluster every one
geographically there just would not be enough primary
care doctors, unless we drastically overhaul the
production system.
A good analogy is the decline in Catholic confessions.
Their simply are not enough priest for every Catholic to
go to confession weekly, monthly or even yearly.
A
sacrament has become practically extinct due to a
manpower shortage.
On a less theological level, Texas sends you a driver's
license renewal by mail if you've been a •compliant"
driver. Kids no longer take a road test to get a license
if they have passed driver's education. These are cost
containment solutions.
Of course, as self referral studies show, sometimes the
physician is the over utilizer.
7.
9-5 Doctors in a 7-11 World
Report of the Emergency Health Services Committee,
Ottawa-Carleton Regional District Health Council;
•Assessment
of
the
Utilization
Pattern
and
Appropriateness of Use of the Emergency Departments in
the Six Acute Care Hospitals in the Regional Municipality
of Ottawa-Carleton• (October 1987).
The idea of doctor shift differential was suggested by a
witness at a Task force Hearing in Arlington, Texas. A
common sense idea no one had ever suggested before. This
is really amazing since all other hospital personnel get
shift differentials.
8.
Cost of gun related trauma
9.
Border problems
More of a question than an answer, I will try to develop
some data for you.
Lou Chapman and Hollace Weiner, •Border Health Issues,•
Fort Worth Star Telegram (Series, Sunday, February 7,
1993 and Monday, February 8, 1993).
�..
Phillip J. Hilts, "Quality and Low Cost of Medical Care
Lure Americans on Border to Mexico," The New York Times
National (Monday, November 23, 1992).
Patricia c. Fogarty, "Testimony Prepared for
Govenor's Health Policy Task Force" (April 1992)
10.
the
Deductibles/Co-payments
Theodore R. Marmor and Michael s. Barr, "Making sense of
the National Health Insurance Reform Debate," (Yale Law
& Policy Review, Volume 10, Number 2, 1992).
FROM FEBRUARY 16, 1993, LETTER
A.
Hepatitis B
Alan R. Hinman, M.D., M.P.H., "What Will It Take to Fully
Protect All American Children With Vaccines?n (AJDC -Vol
145, May 1991) •
Cheryl L. Goodwater, M.D., nimmunizationsn (Parenting in
the 90's, August 1992).
Laura Beil, nTwo Area Hospitals Plan Program to Stem
Hepatitis" (The Dallas Morning News, August 1992).
Flyer from SmithKline Beecham Pharmaceuticals, "Know the
Risk of Hepatitis B," (SmithKline Beecham, 1990).
B.
•oregon Plan• for drugs
This is my idea.
I know they did not consider it in
Oregon because I have discussed it with Dick Ladd,
formerly of Oregon and now Commissioner of the Texas
Health & Human Services Commission. In the seventies I
worked at the federally funded Drug Abuse Epidemiology
Data Center at Texas Christian University.
I read
thousands of articles on drugs, both legal and illegal,
all scheduled. In my concept, drugs would be scheduled
by their relative value.
With computers, it will be
possible to give the same drug different values by
diagnosis, an improvement on the inflexible Oregon plan.
This would be a rational conceptual basis for a national
formulary.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002.letter
SUBJECTffiTLE
DATE
Hillary Clinton to Frank Smusz [partial] ( 1 page)
03/22/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Healthe are Correspondence [4]
2006-0223-F
ab619
RESTRICTION CODES
Presidential Records Ac(- [44 U.S.C. 2204(a)[
Freedom of Information Act- [5 U.S.C. 552(b)[
Pl National Security Classified Information [(a)(l) of the PRA[
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA[
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed In accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�THE WHITE HOUSE
March 22, 1993
Mr. Frank M. Smusz
Dear Mr.
Smusz:
Thank you for writing and sending the numerous articles
documenting your long and difficult journey regarding your wife's
battle with breast cancer, the problems you experienced with
insurance coverage for her treatments, and your determination and
personal commitment to continue lobbying efforts. I do remember
meeting you in Williamsburg and appreciate receiving this detailed
information, which I am passing along to the Health Care Task Force
for review.
I hope you, Brian and Kevin are doing well. . Your sons are
indeed fortunate to have a dad like you.
.
.
Sincerely yours,
cc: Task Force
�January 6, 1993
Dear Hillary,
Let me start by saying congratulations to you and Bill on your
recent victory. I'm sure you both must be very excited. I was also
happy to hear that Sherry Kholenburg was invited to the
inauguration. She is certainly a wonderful person! Sherry and I had
lobbied together last year in Richmond on a bone marrow transplant
bill until she discovered her disease had returned.
I met you at the Breast Cancer meeting in Williamsburg, I was
one of the few men who had attended. I talked with you briefly and
gave you a copy of a newspaper article on my lobbying efforts. I
appreciate the time you took to write back. It was certainly a nice
surprise.
As you can see from the enclosed news accounts and Senate
resolution my family has been busy with the issues of Healthcare and
Insurance. I am hopeful that I may be able to be a helpful source
with you and Bill on these issues in some small way. I intend to
continue my efforts in Richmond and remain active this upcoming
legislative session. Please do try and keep in touch, it would mean
so much.
Again, congratulations, good luck, and God bless you.
Sincerely,
Frank M. Smusz
Route 2 Box 165A
Buchanan, Virginia 24066
( 703 ) 473 - 2542
�Smusz finds a new, way
to continue his battle ·
WHEN LORRAINE SMUSZ died fast March,
her husband was left to cope with single
W:arenthood and wondering whether he /
mwauld be able to continue lobbying the _
(fJ
mGeneralAssembly.
~
J>
By MARK MORRISON
--!
STAFFWRITER
lobbyists all worked for associations, corporations
or special-interest groups.·
·
Although no insurance mandate ·was passed,
Smusz was enconraged by the reception he got
·from state legislators. He came away feeling that
an outsider - an electrician, no less - without
powerful ties to big business can make a difference
in government.
He vowed to return to the General Assembly
again this year..
.
.
FINCASTLE _ He was worried he wouldn't,
But last ~ch, Lorraine di~d afte~ her cancer
Frank Smusz found his angle.
re~umed, leavmg her ~usband wtth a dilemma. Jie
. ,
·
· still wanted to champion her caU$e. The question
"0 . A year ago, ~e didn t need a~ angle. ~musz was could he without Lorraine alive as his sponIsimply drove to Richmond and registered wtth the
r1
• '
~Vir~a General Assembly as a lobb~ist. rhe only so ·
.
.
.
orequirement was that he had to list either an
. Smusz, 35,. searched for options, contacttngOorganization or individual that he was represent- vanous breast-cancer gro~ps and others who had a
~i~g.
·
stake in health insurance policy.f!e hoped .ma~be
-< Lobbyists are not allowed to lobby on behalf someone would not c;>nlY SPOJ?-SOr him.' but hrre him .
of themselves.
·
as well. Smusz lobbied on his own time last year.
So Smusz listed. his wife, Lorraine, who was
~o such luck. All the groups that needed a
then recovering from a controversial breast-cancer ·. lobbytst already had one,
treatment that the couple had battled their insurMeanwhile, Smusz also coped with the sudden
· ance company to cover.
and unexpected loss of Lorraine, whose c~cer had
He. wanted to lobby for legislation that woulq come ~ack -~detected, and. single parent~ood.
· require insurance companies to cover the treat- Smusz ts reanng two so~s: Bnan, 7, andK.evtn, 4.
"At first I tried to maintain too much. It was
ment, which can cost more than $150,000. He also
wanted to send a message to their insurance ~om.:. tot> stressful;'' he adqti~¢d.
pany,_Bl~e ~r?ss and. Blue Shi~ld of~!r.Jinia, tha~
Bet_ween w'?rking f~-time as buiidii?gs-andhe wasn t gtvmg up the fight,..
:- grounds supervtSor for ~otetourt County, sbllf·
Smusz also has sued Blue Cross over the cov- fling his children between day care and Little
CINDY PINKSTON!Staff
.
erage.
League games, ~ultivatinJ his lobbying contacts
Even though Frank Smusz and his sons Kevin, 4, .and Brian, 7.,
The lobbying effort distinguished him as the and doing private electriCal jobs on· the side, he .
only registered lobbyist in the state to represent ··
are spending the holidays with family New York, they
just one person, let alone a spouse. The other.850- ··.
· PLEASE..SEfSMUSZ/84 ~ecorated their Botetourt County home for Christmas.
o
2 but
in
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----------~~~~···
- · - - · - ·_ _ ,.._-:__!.•
�.. -~--~-~-~-~ ............
.
.
.
,- ..."··
'1
· at 35 years old seems strange. ''Re- <: •· ~
·member, I wasn't divorced/' he . . . ;..\
'1
.
: . sat'd . "I was happt y m.arne. d ,"
.
· ' ~: :}t'
'FROM PAGE .9.1 · .
, He remams comqutted to lob~ , · .
1
,;,::·.I.
. hying for Lorraine, however.
$aid there was no tlnie left for any.
Up until just a few weeks ago,
· · ·~
thing else.
·.
· · ·too,. he was ready to continue his · ··-·~ 1
. · Then there was the added pre~· efforts .-- whether registered when . ·,::-: ~j
·· sure of being both mother and fa- . . the General Assembly meets nex.t · :· .,v
··· ther. "Kevin bas hM the most trou- month or not. But that was before a
. · ble comprehending the permanence friend suggested he may be able to 1' .. ·
.' of this. Brian· .understands,'' •he represent Lorrairte· by representing· · .-:;:~}:
.,said.
·
ber.estate;
·
· .r~i~'~·
;"· · ·. ''When Kevin gets really e~cih · . . .. . Smusz checked with the Gener~ ..:.~~:·;' 'r
· "~d still, he'll' come running and say; ,a_l A~sembly. Sure, .en~vgh, , , __
'. w~\:;:
·. Morttmy, D~ddy! Mom!lly, Dad~ ' ·.. "l found an angle. I found a 1,,;\;:d
~ dy!'It'sfunny."Smuszsatdtheboi~· ..:.. wayto do. it arid keep it in :the·:·-·~;'
:, idays have been particularly hard_, "'fap1ily/l· . · · · . : " · ·<: · ·
';·''t/1:~:,'
:One bright spot was· tQ!lt they ~;·
A! the· samethn~• Smusz also ~_:;r~~~>
. ; ~ecorated the ho\;'se for Chrlstm~s. ;. has (hscussed lobt>ymg sotne fdr,.'~->:1:·~·
·:even thoti~ they.ar~ ·spending the, :..Valley Concerned qti:zens, th~.:··. .' ~
:·· ·holiday W1th fahidy tn. New 'Yor~.. ·.Botetourt group fightlng hazard~ ·. ·· ''· ..
,; .:Smusz even ·:tacked . Lorrain&l·s. ··91JS•',Va~te,burnin& at cement plartt$· -t· / '1.'t1
. ·: stocking above the fi:replace, after .~.. Ul.'·Vtrgmta. .
,. •· •. ::... · ·
• · -.::.·:, ..,.:,_;/j
,~-~ fi':lding. i} :~mop.~1.t)1* Christmas .. . , , He remains· active·~n th~ Vir~ , ;:.:::~>.j;
(\'decorat.rQns.' .} · · · .. ~ · · . .·· . ·.· ..·,,g1n1a Breast Cancer Foul)datton, '>.'·J
'}/;.4. · B'riart; .·a~q ·~e.vin' tal}(ed hint" ·,:·~··.· His laws.uit ~gainst ~hie Cross .·',~/t' .1
y-:·'·•nto it,. ~e ·satd•~ ,, c ' ~: 1'' ' •• ·~ • ' . ' ' -~. and atue Shtel~ IS conttpuing:.
<:.:>. i
Smusz also quit ~is_ job: .for· . ·· ·. He-· may ~v~n pursue politi~s· '"~:-.~·~:.~1
1.: .. Botetourt and opened hts own elec~· ·I .hunself;· he satd1 · · .· ,~ . ., ··. ~. ··· ~r.]·1
.
!' :..t~ical-conttac~hig business, which·· ·, . First, though~ he wants a. mee~ .~ · J ·'(!
\.·.· aU~ws hi'm"~· tn<:?re fle~ible .sch~dule: . :i~g wi.tb Bill Clinto1;1 anq· believes .: :;->:~._::!'1
• · around the demands of htS·ktds. , . .,. there ·1s. an .outsid~ chan~ be ..will~·> >.: · •
'!::": ,, ~··>·B:eiltso Is;piay~rtg.ih a~tn:en'·~ h::e :· ~et o~e. to(?. He ha~.a chance meet.- :.-:::: .... -·
r::·:,··~ockey league,:• J,Jria~ i_s . pla'}i!ng . tng ',Vltb ~~ll~ry 9~nton before. the ' ''7'/ ·j
· . youth.~ockey f'n4 Kevm ts learnmg . pre~tdenyal eJecttqn .th~l sbe fo~t, •, , .1_
( . to skate. The tJuee have been regu; .. · I~wed wtth a handwntten note to . ,.: _ 1,
>
f· ···tarS' at .ri'lost of the Roanoke Valley ' htm- a few weeks .later.
: · . ·, _:·,. : ( /'·
i· ·:· R.ampage ho. rru; $aines th.is. seasot}: ·..· · . He J?l~ns to.a* ber fqr a Wh!te J .. :··
·
·
· ·-··. H4 · ''·d· h' .1 . . dJ.·'·t' ... 1 . th. ·. "· H{)use,YJSll· sometime after.. the·~~, .... •f';i •.
'· ..,. · · ·.!'sat . ~ sa ....s t~g o ,.· .e~~ :·. augUI:atJon~ ,''l'd lp~e fof tpY..chth , , ,·r..,:l;'
.new ltfest~l~, :, .~... .. . . .
· ·•. ,•;· :... ·dren to tneet the bext Ftr!it Famh · ._.;: \:·: ,'
1
.
'\.';• ··,·
SqtU.sz :. ha~. ev~n d~te.d- SOQl,e;: :;,···ty;~:.·.·he. ·saidt ' 'J. think it, Would., be a.·. <': · J:'
...
...•
. ~alt;boug? ,l;i~ ~a~q l;lemg. smgl~ Jl~at~ ·. ,:;tpr~J.\.,'' ,,.1::.: ·. · ,:,·· •.• : -:i: . . : : ,· · ,;..<. ~;:"·:~ · :i !
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PRESERVATION PHOTOCOPY
f
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�- latte
By LAURENCE HAMMACK
·
STAFFWRITER
MONETA- Inmates in the crowded
jails of Lynchburg and Bedford and
Campbell . counties soon will get some
breathing room.
Starting this week, some P-risoners
will be moved from cramped jall cells to
the more spacious confines of the former
·smith Mountain Lake Correctional Field
Unit, also known as Camp 24.
The prison camp, closed by the state
in April to meet budget cuts, is being
leased to Bedford County, which will operate it as a jail annex. .
Standing outside the prison Thursday
afternoon to announce its reopening, Bedford County Sheriff Carl Wells said the
facility offers barracks-style living quarters and ouidoor recreation areas not
found in most jails.
"I think you will find that most inmates would much prefer to be someplace
where they can get out and do something," Wells said.
Of six prison camps closed this year
by the state Department of Corrections,
Camp 24 is the first one to be converted
into a local jail to limit overcrowding.
The jail annex will hold up to I00
prisoners. More than half will be from
Lynchburg, which has a jail so overcrowded that a federal judge recently ordered officials to reduce its population.
With the Bedford and Campbell
i
..
,.
~"-c:r"'-<..._j·
peup.
t-.
..
'.
.!
By MARK MORRISON
STAFF WRITER
. Ii
.I
Frank Smusz - electrician, grass~roots lobbyist, fighter of big insurance, husband of the late
. Lorraine Smusz and single parent of two young
boys - hoped to add another hat to his collec. tion Wednesday:
Confidant to a possible future president, Bill
.. Ointon.
Or so he thought.
It turned out differently, his brush with the
.:political big league. He didn't get an audience
I
!
I
.
with the Democratic candidate. But Smusz's uti~
expected trip to Williamsburg on·the eve of the ·
second presidential debate still was rewarding. ~,.
He did get to chat with Hillary Clinton. '/::.
It all started Wednesday
·:
'35, was at his home in Fincastle
written proposal to do some electrical COIIltra•ctltll
for Botetourt County. Afterward, he ola.nnc~dkllo
finish a job on a new bouse i#, Lexington.
Presidential politics were fat· from his
··
· ' , IJ· .....
PLEASE S~E . SMlJSZIJa2
say~
By MADELYN RO~
HIGHER EDUCATION\
One in three stu
ates from the state's r
sities in four years, al
report released Thu ·
State Council of High.
The figures are ir.
tional statistics, said F
author of the study.
And while some s
as Norfolk State's gr
of 19 percent after se·
Don't
'.
l,'
! ..
r'· .
I·, . '
,
The traditional
'.
I
temoon barbecues a
j'
ture's were canceled.
tied over the place.
Finally, the host
sued their demand a
em patrons rose to tl
They pooled their cl
their dollar bills anc
$92.18 for the Muse
phy Association, lee
they were that Bessi
returned after the J{
Labor Day telethon
Happy ending?
know better.
Bessie has becoi
those hostages we fc
The windowsill at C.
I:
'
dowr.
struc
mon.
crac··
banh
PLEASE SEE .JAILJB3 whit(
·.·~~
i·
;
the gll.
ty," sl
paign
and gt
4-yec
·;:Smusz takes case to Clinton ,. Author
lO \~ ')
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PLEASESE
Olin cautions·..:~~gainst term limit
.
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·---· --- -----·--:-·::: t:; -- -'t
~
�. . :.
ihe was a
1e Eastern
s survived
t Buchan~ner, Ha·
II Vickers,
olbert,Pu·
and Erline
grandchll·
ill be held'
:OOnoonat
~the
Rev.
(:iating. InlOci Memoill receive
'.m. Friday
I.
Irs. Gracie
>rmerly of
onday, Oct, N.J. Surlest nieces,
:kett; a derdy, all of
1er nieces,.
md friends.
held Saturrtis Chapel
Memorial
11 receive
-day at the
ession will
her niece;
N.
W.
liS
RN,age61,
sday,Octolved by her
ibble; two
law, Mary
Sowers ·of
roland Ar·
esville; two
ard Sowers
Sowers; her
cCoy Cook;
~k, Jr. of
e attended
;a graduate
s Hospital
Z. She was a
for the U.S.
30 years of
the Bennett
ltsbaW Avethe family
to 9:00p.m.
ices wlll be
aturday, Oc1 be in Wes·
1rk in Rich·
.. '
no-show, opting instead to rest his
voice and practice for Thursday.
night's debate in Richmond. But. :
FROM PAGE 81
as a replacement, Hillary Clinton:.
attended.
··
.
Then the telephone rang. It was
After the Secret Service-·
Phoebe Antrim with the Virginia
Breast Cancer Foundation, a breast brought in a dog to sniff aroun& .cancer policy advocacy group. the conference room at the Will"-''
Smusz once served on the founda· iamsburg Lodge ·and Convention .Center, she was ushered into ·die:.,.
tion's executive board.
room and seated at a table. SmtfSz..·,.
Antrim invited him to attend a
said women from the breast canlast-minute meeting arranged
among the foundation, the Nation- cer groups then gave presentati6Dsr!:
· o._:-rt.;.:
al Breast Cancer Coalition and for 90 minutes.
He sat quietly along a wall~~~
Clinton in Williamsburg - for that
•J.
hind Clinton. About 40 people atl.l ·
afternoon.
.
~
Not someone to pass up a tended.
·-'
···'
He said he was impres~i(
chance to push the breast cancer issue, much less before a possible that, this close to the election ant[ •;
president, Smusz dropped his work with s'? many issuc::s to ~nsi~r( •
New River Valley
plans for the day, changed into a the Chnton ~amp took time t~ ·~,
DUBLIN
suit and jumped in the car.
hear from these two groups. '-'To'.-~. PALMER, Jack Edward, 59,
Smusz bas become well-known me, it shows their interest,")~e:·:_
said •
'
-' ..,I.L•
died Thursday. Funeral Saturday at since the well·
.
•
'
'1
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II a.m., Thomas M. Seagle & Sons publicized battle
"She was very ·receptive." --~' ~ c.
Funeral Home, Pulaski.
his wife; LorDuring the meetin& sh~,f.~.i
ELLETT
raine,
waged
plaude4 the work .of ,the -Niff!~::
,I
·
against
breast
.groups and said it was impo~... ~' 't~
h AKERS, Lee J, Sr., died Wednes- cancer and her
\..·,:·
for grass-roots orsanizations 'and
day. Graveside service Saturday at · insurance compa2:~0 p.m., Akers family cemetery, ny, Blue Cross
individuals to become activ·t.~
such issues. On this, Smusz
Faig. Arrangements by McCoy Fu- and Blue Shield
neral Home, Blacksburg.
of Virginia. The
his ears pricked up. · .. : "'· .·.
·. 1 . ~1
'· ·
company refused·
When the I.Jl~t;tin'J 6rot<e,.. ·.
was introduced ·-£9 Oititon,~d ~. ,.
. . BedfOrd·Franklin
to cover a conto speak with her for ·l;1feW m$H ( '
. Smith. Mountain Lake troversial treat-,
ment she under- Smusz
utes. He told her about Lorraine. :.. ''
went to fight the
and their struggle with Blue C~:.,
FERRUM
disease.
and his efforts in the General J¥Sl.-1, f..YOUNG, Jimmy Roger, 45, died
··
~~ of,
. ~~
She died earlier this year, but sembly.
Thursday. Funeral Saturday at 2
he · has continued to advocate the
"I told her why l was· ~t~
p.m., Flora Funeral Chapel.
~merits of her treatment - high- and the importance of tbese..
.... ,
~~..
dose chemotherapy with a bone- sues."
·
,··
marrow transplant - and the
He banded her his lobbyi~{'
need for insurance companies to
cover it. His efforts have included card and a copy of a Roat\o~ :
LEXINGTON
Times &. World-News story ab.Quf'
. AMOS. Mark Dillard, 84, died lobbying the Virginia General As- his mai~en ~obbying trip to : ~sJ
sembly to mandate the benefit.
Thursday. Graveside service Saturstate cap1tal 10 February.
. rri:Jrj
Blue Cross contends the highday at 2 p.m., Rockbridge Memorial
"My hope is they'll read it
Gardens. Arrangements by Harrison dose treatment, which many doc- and say here's a guy who ca~~;-;
tors say is the leading wa't to treat
Funeral Home.
advanced breast cancer, ts experi- enough to d9 all this." Maybe ~: {
LEWIS. James Howard Sr., 76, mental. The insurance company is will ask r~~ .~~~ ,h~p somewh~,<
died Thursday. Graveside service helping to fund a study on the ' down the hne, 1ie satd.
._.!:.. ·._
Monday at 11 a.m., Stonewall Jack- treatment, however.
"You think ahead. What-irr·-~
son Cemetery. Arrangements by HarIn Williamsburg, Smusz said Why not? I've been involved this:·:
rison Funeral Home.
he didn't know what to expect. far .... "
RICHMOND
Would he get a one-on-one diaHe wasn't disappointed abottt- ·~
TRIBBLE, Joyce Cook, 61, Iogue with the candidate? Would missing the possible future pr~J;; ;_
mother of Walter David Cook Jr. of Clinton be receptive or would he dent, either. "Hillary Clinton·'·iS!-:.
Newport, died Wednesday. Funeral be distracted on the day before his just as good. I mean, well, she's b~ ~~
·Saturday at 2 p.m., Bennett Funeral second debate? During the four- wife," Smusz said. Plus, being' ·at:
Home.
hour drive, Smusz said his mind woman, the issue might hit closef -:
WYTHJ::VILLE
raced.
to home with her, he noted. He
feels the exchange y.oas worthwhile-.•
PHIWPPI, Richard E. Sr., 80,
"I was a wreck."
"It just puts it on another lev- ~
died Wednesday. Funeral Saturday at
When he arrived, however, he·
11 a.m., St. Paul United Methodist learned Clinton ·would be a
el."
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~-··..ncnlviui -- .
Ited Meth-
•'
BUCHANAN-
.
SCHUlZ, Loretta J., dted Tuesday. Graveside service Monday at II
a.m., George Washington Cemetery,
Paramus, N.J. Arrangements by Rader Funeral Home, Troutville.
DALEVILLE
WOLFE, Michael Leslie, 49,
died Wednesday. Graveside service
today at 4 p.m., Mount Zion Cemetery, Augusta, W.Va. Arrangements
by McKee Funeral Home, Augusta.
EAGLE ROCK
YOUNG, Paul Edward Sr., 85,
died Wednesday. Funeral Saturday at
2 p.m., Eagle Rock Funeral Home
Chapel.
;5mUSZ
;
.'' f
1s:·
State
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.
Buchanan Man Meets Mrs.· Clinton
Frank Smusz of Buchanan had and broader Insurance coverage Smusz did not testify, but had th~
an unexpected brush wtth presi- since his wife died from the dis- opportunity to speak briefly With
dential politics last Wednesday ease last spring, said he was Ms. Cllnton following the meeting.
when he attended a special meet- thrilled at the opportunity to meet
·uwassigntftcantfortheCUnton
ing in WUllarnsburg wtth Htllary With Mrs. Clinton.
campaign to take the time out to
CUnton, wlfe of Presidential hope•tt's such a tribute to Lorraine talk wtth a small group of people:
for me to be asked,· he said. Prior he said, noting that the meeting
ful, 8111 Cllnton.
· Clinton himself was originally to Lorraine's death the Smuszes was not covered by the national
scheduled to appear before the 40 had waged a public campaign to press.
plus representatives of the Vir- raise the money needed for a bone
-ntis is National Breast Cancer
ginia Breast Cancer Association marrow transplant, a treatment ·Awareness niorith. The purpose of
and the National Breast Cancer herdoctorsrecommendedandher. the meeting was to open a·diaCoalition, but sent his wlfe in- insurance company, Blue Cross & Iogue should the Clinton-Gore
stead so he could rest his voice Blue Shield of Virginia, refused to ticket get elected. We hope to form
before last Thursday night's presi- cover.
·a partnership wtth the admlnisdential debate in Richmond.
SmuszsaldMs.Clintonlistened tration and to have some say in
Smusz, who has continued to receptively to the presentations by how the $300 million recently
advocate breast cancer research a number of different women.
(continued on page 2A)
I
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. Hilla}y---. (contln~cl from page 1Al
added to the federal budget for
breast cancer research wUl be
spent.•
Smusz sald Ms. Cllnton carne
across as "concerned, sincere and·
doesn't seem like a phony· during
. .the meeting last week.
.................___________________________
�1:
SENATE OF VIRGINIA
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�The Fincas1
Botetourt County ~
'f"~·
8
ut
Boar 's ecision to include
ABMT coverage is victory
for Lorraine Smusz's family
By Kathleen Morra-8loan
MaffWrtter
•tt made my day: It literally sent
chUls down my splne, • Buchanan
resident Frank Smusz said when
he heard that the Botetourt County
School Board had voted August 6
to add coverage for Autologous
Bone Marrow Transplant (ABM"Jl
treatment (Qr breast cancer to Its
Blue CJ'088 & Blue Shield of VIr-
gln1a (BC&BSVA) health Insurance
plan. The plan covers schoolemployees and their families.
•t was overcome with a real
feeling of satlSfacUon: It was;llke
part or Lorraine,. he conUnued.
Although Smusz and h1& fainiJy
are not cOvered by the Sc~ool
Board's health plan, the board's
acUon struck a deep, perlqnal ·
chord. 'Ibe 35-year-old lndepen·
state Senator Bo Trumbo (right) preeented Prank Bmuu a
dent electrical contractor lost his
wtfe, Lorraine, to breast cancer In
March amidst a public struggle to
get ABMT covered under the
couple's BC&BSVA group health
Insurance policy.
Ms. Smusz had been told by her
doctors that ABMT treatment was
heronlyhopeofswvMngtheStage
IV breast cancer that had Invaded
her bones and Uver. She ultimately
got her treatment, but not until
she'd waged a massive public relations and fund-raising effort to
raise the $160,000 to $180,000
needed for the treatment.
BC&BSVAdenled theSmuszes'
requestforcoverageon the grounds
that the ABMT treatment was experimental. Smusz Is suing
BC&BSVA for $2.35 mllUon. The .
Insurance company has asked that
the case be dismissed, and a pre- ·
trial hearing Is set for September 3
In Botetourt County Circuit Court
to detennlne If the case has a
future.
· BC&BSVA announced ln May
that In July It would begin offering
group customers the opportunity
to obtain coveraghtghefor the treatment known as
dose chemotherapy with autologous bone
marrow transplantation (ABM11 for
breast cancer. •Autologous• means
that the bone marrow Is harvested
from the patlentherselfratherthan
an outside donor.
The optional coverage costs $5
per person per· month for buslJiesses with 2-49 employees and
costs less for larger groups. The
Botetourt County SChool Board
added the coverage .when It renewed Its annual contract. The
s·
: . ·:
t1
·i
~·.~f.
.,
jt
P:
seei:
framed Joint Resolution from the General Assembly moUI'IliDg and
honoring LorralJle Smuu for her struggle with cancer anci her
to
Inspiration to thouaan4a ofvtrglnlana clurblg that atruate whlcla
the .
.... made pubUc by her ancl her huebamcl'a efforts to have ABMT
'-.f- ·
- · ·•-ry--• · w:ar...t..hv·Blue CI'Ofl8 • Blue Ethlel4_of._~~~~ ·~~~}!!_coverage-~ cost~.... . •.
�nts of the cJuiens'
esta for prohibition
waste bumlng?
ve once ogaln had to
log for the cotpmu·
·re Ia a poaelble con·
t. 1bl8 would not be
public official, such
ng commlaeton, hal
)(Interest and there·
. to remove hlmaelf
1 the laaue.
to start doing your
:fore making rash,
temen ta, unleu eell·
-egardleu of Integ·
•nly goal.
ABMT ~coverage
9
-t>~-~r&;;.;::o~-~,..r.~.-'·;;_Y_ _ _ _ _ _ _ _ _ __
fro~...,. 1·~
anceandwaaareglateredlobbylat lng ftne after much longer."
people have cii1Dculty getUng CfN·
Five months after ble wlfe'a ered.HeeUllgetacallefrompeople
on hla wlte'e behalf during thla
month !or lndl\lldual eubecrtber yeate ~e~~lon or the Oeneral Aa· death, he~ thefamllyleadjuat· In VIrginia and elaewhere who are
coverage and w1 coat employees eembly, t)llnka the eO'orta o! hla lng, but that •Ingle parenthood Ia having trouble With Insurance CfN·
erage.
·
With family c
e an additional wtJ'e, hlmllelt. other breut cancer IWd.
.1.20 per month.
vtctlml and VIrginia eublcrtbera,
·~married oouplea out there
"ljuat want people to be given a
Botetourt Co ty School Su· also had an Impact on the thlnklnf. about wanung to be fair ahake." he aald. When he re·
perlntendentDr. c
nceMcClure company'• declalon•
lingle, ld adVIIe them to work It ftectaonwhatheandLorralnedld,
"'lbey (BC&BSVA) won't pub- outandataymarrled," Smuaz eatd. the experiences they had, and now
attributed the boa 'a Interest In
the opUon, In part,\to Ita know!· llcly admit that their declalon had He eald the aupport he's receiVed on life Without her, be admits that
edge o! Ma. Smuaz'll etrugglea to anything to do With the eO'orta o! from the community haa meant lt'a a remarkable atory.
obtain the treatment.
Lorraine and me, • he aald. "It had everything to him.
"WetookauchanegaUYethlng"'lbbaopportunlty~came avail·
everything to do With the publicity
"WithoUt ft1end1 In the com· dlaeue, a young mother, an In·
able, and we Celt we fleeded to act aurroundlng the cue and the el· munlty and the church, 1 would aurance company that wouldn't
CGrol Lenach on It Immediately,• M~lure aald. forte of Lorraine and the VIrginia never have gotten through all thta. pay." he recalled. "It could have
n-outum.
devutated us, but It made us
Jim Ooaa, director offibllc af· aubecrtbera who wrote on behalf I can't thank people enough."
raJra for BC&BSVA. eaya that 110 ofthla."
Smuaz Ia trying to l(et till elec· atronger and brought ua together."
far, 10 groupe atatew1de, clud·
Smuaz eaya BC&BSVA Ia on trlcal contracUn& bualneu going
Physicians or coneumere who
I"
lng the "Botetourt County hool the r1ght track With optional CfN· 10 he can have more Ume With hl8 would like morelnfonnaUonabout
lfY
Board, have taken advantage of erageofABMTbuthalnotgonefar boya.Hehopeatoremalnanactlve the NCI breut cancer study can
the opUonal coverage, He ~t enough.
·
· ·
-- ,parUclpant In Richmond and con· . ~call the Blue Crou & Blue Shield
waa Interest on the part of~~
"'lbbataaetepln theri&btcllrec· Unue Ills fbcue on health lniUJ'o ABMTBreut Cancer Hotline atl·
of their youth must aumers that prompted the com·
Uon, but It's expensive lor small ance and other treatment& that 600·226-2268.
• balancing act With, pany to oO'er the optional crNer· \ groupa."beaald. "It would be much
or percepUon every age.
·
·
,- feu expensive lflt wu oO'ered u
1111 the tracks.
"We'd heard from eome con·
standard ccweraae, then It would
thlatlea have always aumere that they wen= Interested only coat pennlea a day. •
·the town'• habit-If In obtaining the coverage regard·
WestVJrglnlaCongreumanNick
Oolaeaya hll company ll"aev· (CoDtla1104 from .... 1·~
:r houaea, we tune leu of whether or not It was ex·
era! yean away" from maldng a
Written Into the Code of West Rahall'eactlon to have a 19.4-mlle
te are at a CI'OIIIIIng, perlmental," he aald. "We haven't
atandard ccwera&e declllon and II VIrginia Ia the Criterion that the eecUon of the New River studied
tocroaa.
changed our poaiUon: we main·
waiting for the reaulta of a Na· llne"...WIIIreeultlntheacceptable for poeelble deeJgnaUon u Wild
have been lost on taln that the treatment Ia still ex· -Uonal Cancer lnaUtute study, par· ba1anc:e between reasonable power and ecenlc coulcl more dama.!!e
rain tracks In the perlmental. We're simply creaung
tlally funded byBC&BSVAand 14 needaandreaaonableenvtronmen· to the propoaal Cor the line. While
e whlatlea blowing, an opUon for a group to oO'er thla
other BC&BS companlea, that tal factors. •
It will not alfect any declllon the
tlow many more Will crNer&getothelremployeea."Ooaa
Accordlna to a releaae from Ap- two commlaalons must make on
comparee the long-term aurvtval
r abeence. Croeslng aaya hla company lnaurea "thou·
ratea of women who receive ABMT palachlan, ~ce President Charles the need of the line, It Will draaU·
the Ideal aoluUon, sands of groupe• across the state.
treatment With thoaereceMngcon· Simmon• aald the company Ia caliY alfect the route.
1 structures can be
The bill called for a federal study
Ooll eaya BC&BSVA plana to
venUonaltreatmentforbreutcan· pleaaed to cooperate With the liSe
ln't we better v.oel· oO'er similar opUonal crNerage for
andtheWithdrawaloftheappllca· .of the New River. It puaed the
cer.
~ whlatles that have
lndMdual (non-group) cuatomen
"We think ABMT Ia a worth· Uon Will not advel'8ely all'ect the Houee of RepreaentaUvea and Ia
1us of the approach later thla year. Goaa eald he didn't
whUe procedure and crNer It for Intended project compleUon date now slated fora vote In the Senate.
BUenky aald If the Senate apseveral otherdlaeaaee for which It of 1998.
know what the coat of that lndl·
' a terrible prtce to vidual coverage might be.
halprovedaafeandefl'ecttve,"Ooaa
By WithdraWing the application proves It, t!)at aectlon of the New
night's sleep.
Frank Smuaz, who teeWled at
aald. "Wedon'tthlnkltlleafeand In West Vlrllnla and reftlln& It River - I n c = the locaUon
Ranse Ransone heartngs In Richmond lut spring
llnecroeeeaeO'ecUVe for breaat cancer. The after January 1, the PSC wllfbe wherethepro
Buchanan before the etate Bureau 'of lnaur·
study Will determine whether the able to lndude results from the a Will be cloeed to any developmenL
"'lbe federal government Ill not
treatment Ia better than. equal to prellmlnuyreportfromtheForeat
or wone than conventional treat· Servtce'a environmental Impact going to allow any degradation of
etatement (EIS) In the decillion.
the land once It Ia approved for
-'mentforbreutcancer.·
The porUon of the line In Weat study." Bllenky aald. •If the bill
In theNCietudy, women have a
50/50 chance of receiving the ex- VJralnla, running from Oceana to comes out of Congreu, then the
the border on Potts Mountain In route II dead for all lntente and
: county. They have Cement Co. potentially could) by perimental ABMT treatment or Monroe County, II the only eec· p'urpoeea. •
aVIJ'onmentallawyer burning hazardous wutes. No, conventional chemotherapy treat· · Uon afl'ected by the wlthc&awal,
VIrginia Tech reaeon:her Ben
ral&lng efforts. They VCCHMA members are, lnatead. ment. Smuez eaya once women but the VIrginia State Corporation Johnson. whoheadedastudyteam
etters to the editors drtYen by their concern for ue all- hear the eurvtval rates for conven· Commlealon(SCC)Iagolngtohave charged With elung the route for
ra. 'nley have been our health: the quality of our air, Uonal chemotherapy, which are to take a hard look at the action In the propoeed line. aald hl8 group
lower than those
ABMT. they
rganlzaUons andre· water and agricultural values: our are not lntereeted for partlelpotlng the Mountaineer State.
18 re-evaluating other potential
In
Yant the hazardous property values, and the tremen· In the etudy and try to get the
The SCC 18 In the proc:e11 of croulngs of the New River In an·
-eaented to them "In dous lack or regulatory enforce· ABMT on their own.
tranacrtblng and reviewing tesU· . UelpaUon of a change In the route.
·hen the story 18 ac· ment.
Ooaa would not confirm that mony from the heartngs held In
"'lbere were other placea where
We are Indeed fortunate that we
ompllcated and re·
clatm, but acknowledged that Richmond on the VIrginia portion a croaelng would be much more
tl analyall to be prop- don't have to rely on Tarmac alone women have been slow to algn up. of the line. Bill Bllenky, attorney Impacting.• Johnaon aald. "If we
for Information on hazardous
xl.
"Franlrly, there'a not a lot of
Preeerva·
embers of the group waste burning. Becauee VCCHMA Interest In parUCipaUng In the Cor the Cltlzena for theaald he 11 no longer have that u an option
t1on oC Craig County,
weWillbavetolookataltemattvea.
f taken the Ume to keepe tabs on the latest happen·
study." he aald. So far, two VIr· revtewlng hla alternatlvea for poa· We have reopened and begun ecor·
selvea and the pub·
lngs In thla Reid, we can get aelen· glnla women are partiCipating In alble acuon, baaed on recent de· 1ng other possible croaalnga of the
his vital concern.
Wlc data from other pointe of view
program. There Ia potenUal
•ates these people to bealdea Tarmac's. Looking at thla the 40 VIrginia womena to rec:etve velopmenta In West VIrginia. That ' rtYer which were originally ruled
for
me and energy per· Important llsue from as many tranaplants u parUclpants In the acuonmtght be torequeet the sec out because they were too tmpact·
delay or diamlaa further action on Jng. •
acUvllles. Certainly angles u posalble would eeem to
study. Ools eaya eevera1 hundred
Bllenky aald hll plane Will not
hat they Will rake In be the Intelligent way to make women acroaa the country_ are the VIrginia portion of the line.
Bllenkyaakedforacontlnuance be finaliZed until next week. He
:r year (as Roanoke needed declllona for our county,
currently participating In the of the hearlnge In VIrginia before eakl uklng the sec todllmllls the
and thus allow us to do what II study.
they opened July 1. He aald hll propoaal Will uiUmately be very
neceasazy to protect the lntereata
BC&BSVA II not oO'erlng the request was baaed on three fac· expenelve, becauee when It Ia
or the citizens of Botetourt.
optional crNer&ge to Ita own em· tora-theprojecthadnot~tbeen reJiled, the enUre proc:e11 Will be
What about you? Have you ployees. "That would be lnconsll· R1ed In West VIrginia. 110 there was repeated. He aald aaklng the sec
made an effort to learn aa much aa tent With our company policy." no way to know what would hap· to merely delay further acuon
possible about thll lasue whUe aald Ooaa. "We don't believe thatlt pen there: a bill wu pending In would be preferable, based on de·
keeping an open mind? If you (the treatment) II eafe and elfec· Congreu which could draaUcally velopments In Weat VIrginia. But
need more Information, !suggest UVe."
aO'ect the designated line route: heaaldtheSCCdenledhtarequeat
you contact VCCHMA. locally, or
Lorraine Smuaz lived one year and the ElS from the Foreet Ser· to eeparate the approval proc:eu
theCitiZensCieartnghowie!orHaz· after her ABMT treatmenL Her vice wu atlll a year away from a Into sections of need and route
location - a move which wu ap·
ardous Wastes, P.O. Box 926. Ar· husband II convinced ahe only prellmlruuy report.
BllenkyaaldhllmoUonwaadJ8. piVIIed In Weat VIrginia.
llngton, Va. 22216; phone (703) had that year because of ABMT.
.........PabUaher
miSled by hearing examiner
SCCetaiTattorneyWayneSmlth
276·7070. The Roanoke paper and Smusz says the year was a pre·
.••••.••••.•.Editor
Howard.Andenul because theCae· aald any delaying acUon In Rich·
1V etaUons need to be aaked re· ctous gift.
·
.....Copy Editor
peatedly for more In-depth CfNer·
mond Will only be Initiated If such
"Kevin 18 four now and he aWl tora were contingent.
tlon Supemaor
He aald the PSC action, and a request by Blle"nky Ill approved
age of this Issue•
plcturea Mom up In heaven With a
•••••• Advcrtlai.Dg
I am confident that once JOU'Ve aultcaae. Brtan Ia seven: he knew Appalachlan'eaubeequentremoval by Anderaon. He aald Anderson
taken the Ume to look c:areful1y at about hll mom before I even told ol ihe application, hal made the Will gtve It run consideration. HJ
.bUshed weeldy for
aald he was unaware of developboth aides of thll lasue that you him. • Smuaz confides. "'lbey had flret factor 1eaa conUngent.
t counties ancf $24
Will want to support VCCHMA'e an extra year With their mother
'1be process hal come run circle mente In West VIrginia.
a1n St., Salem. VA
effot18 to ban hazardoua waate and we did a lot. Even thcaugh In West VIrginia,• Bllenky lllld. · Anderaon, because he Ia acUng
VA. and additional
waan'tllled, then.Ap- · With authority and power similar
burning In Botetourt.
Lorralneon!Ymadeltayear,people
changes to THE
Sheme N. Andrews, RN shouldn't be dllcouraged. I know
rued lt. and now It's no . to a Jud«e In thla caae. does not
'A24090.
r rued..
(CoDtlaucl- ..... 8-A)
Daleullle ao many women that are atlll do(CoDtbauocl
board an addltfonal 60 centa a
.ath sties
·Power line
ao
VCCHMA dedI•cat"I0 n
=
�'
. .
~
·.
STATEMENT TO THE
STATE CORPORATION COMMISSION'S
BUREAU OF INSURANCE
ON HOUSE JOINT RESOLUTION NUMBER 432
July 9. 1991
Frank M. smusz
Route 2. Box 165A
Buchanan. Virqinia
(703) 473-2542
24066
�Page 1
The information contained herein will discuss the
issue of autologous bone marrow transplantation and high
dose chemotherapy (ABMT) with its relevance to House Joint
Resolution Number (HJR) 432.
ABMT treatment for breast cancer is ·the treatment of
choice for women today. The average age of women receiving this treatment is 36 years old.
ABMT treatment for breast cancer should not be looked
upon as some exotic and unusual treatment for this
disease. Simply put, ABMT trea~ment uses high dose chemotherapy drugs much hiqher than standard chemotherapy to
eradicate cancer cells. The idea is that if standard dose
chemotherapy can kill cancer cells, then high dose or dose
intensive chemotherapy will kill more if not all cancer
cells.
While dose intensive chemotherapy kills the cancer
cells, one side effect is that it also kills the bone
marrow and leaves the body's own immune system defenseless. Shortly after the dose intensive chemotherapy is
qiven the patient's own bone marrow (which was previously
stored and sometimes treated) is qiven back. Along with
growth factors or "fertilizers", the bone mairow quickly
regenerates and the patient begins to recover. The results using this procedure in the battle against advanced
stage breast cancer and those whose cancer is likely to
reoccur, clearly and largely overshadows conventional
standard chemotherapy.
74\ of women who have breast cancer with 10 or more
axillary nodes involved who underwent the ABMT treatment
have remained disease-free for at least 4 years compared
to only as few as 30\ who remained disease free at 5
yearS • \,t)I.U,., s+er.~~~rl) c.\.w~rt... ~,
For advanced stage breast cancer patients (Stage IV),
those whose cancer has metastasized, as many as 68\ become
disease free and about one third will remain disease free
over four years.
�Page 2
Standard chemotherapy offers only a 10\ - 20\ chance
of becoming disease free and of those who achieve disease
free status, only 5\ - 15\ remain so for 5 years.
ABMT for breast cancer is not without risks. Eight
to 15 percent of patients who receive the ABMT treatment
for breast cancer will die as a result of the treatment.
By comparison, 80\ to 90\ who do not receive this treatment will probably die soon anyway from the cancer itself.
The choice to receive standard chemotherapy vs. ABMT
treatment should be made bet~een the patient and their
doctor.
ABMT for breast cancer is not for everyone. Many
medical facilities of higher education have strict guidelines to be eligible to receive the treatment. They do
not treat everyone, only those meeting the criteria to be
accepted.
Included in this statement is a list of 42 insurance
companies who will or have covered ABMT for breast cancer:
some on a case-by-base basis. Other pertinent information
is also enclosed. As you will notice, most Blue CrossBlue Shield plans surrounding Virginia will pay for the
ABMT treatment relative to breast cancer, but Blue CrossBlue Shield of Virginia (BCBSVA) will not.
It becomes
evident and clear that the largest health insurance company in Virginia, BCBSVA, which appears to almost have a
monopoly of the subscribers in this state, is restricting
the access of medical care Virginians may be able to receive.
BCBSVA is helping to fund a National Cancer Institute
(NCI) sponsored study along with about 15 other BC-BS
plans nationwide to determine the effectiveness of ABMT
treatment for breast cancer.
These announcements were
· made in October and December of 1990.
As of this writing, only some Stage II breast cancer
patients have received the ABMT treatment.
�.•
Page 3
Patient selection for Stage III breast cancer
patients is just beginning and Stage IV patient selection
has not yet begun.
While the study itself is of great importance in the
medical community, it should not impede the health insurance companies from providing coverage for treatment such
as ABMT for breast cancer. It may be that in the future
insurance companies shall direct funding of studies before
covering medical procedures which would greatly reduce
the availability of ·lifesaving medical procedures and
techniques to patients.
Additionally, are the BC-BS plans participating in
the NCI sponsored study guilty of prejudice or discrimination toward other procedures they now exempt from coveraqe?
BCBSVA has also established a medical research
foundation to fund research that is relevant to issues
such as ABMT for breast cancer but none of this money
will be used toward the ABMT/breast cancer issue. Even
though the NCI sponsored study has not even bequn to treat
Stage IV breast cancer patients, these women are being
left alone to die.
While ABMT for breast cancer may seem expensive, the
BC-BS plans around the country and in Virginia have fared
extremely well financially in 1990. In 1990, the National
Association of Blue Cross with about 72 member-plans
nationwide had a collective record setting net gain to
cash reserves of over $2.2 billion, despite the loss of
over 500,000 subscribers. In Virqinia, BC-BS had a net
gain to cash reserves of over $53 million.
Many cases have come to litigation over the ABMT
treatment for breast cancer across the country and in
Virginia and the vast majority have been won by the
patients. Despite the many losses in court by BCBSVA,
they continue to deny coverage on this issue.
�Page 4
I'
It would appear that BCBSVA is now acting in bad
faith.
Some of the remedies to the issue of coverage for
ABMT for breast cancer can include the following:
1. An appeals process such as is being investigated now.
2. Litigation against the insurance carrier and
their medical experts both jointly, individually, criminal and civil. Some examples are:
medical malpractice, contributory negligence,
criminal negligence and wrongful death, to name
a few.
Old laws can be changed and new ones
can be made.
I do not have all the answers to issues that are as
complex as ABMT for breast cancer. It certainly is not
unrealistic to expect the health insurance companies to
pay for a hospital stay and all related costs of the medical care if the patient • s physician has concluded it
would be in his or her best interest.
Thank you for your time and interest on this matter.
Sincerely,
~L 'Jh. rt.?Frank M. Smusz
Enclosures (3)
�\
)
..
()Jfw o/lht Dilrrlur
hlilnl Attetlllll Strvltrl
Mr. Franlc Smusz
Rt. 2, Elc)( 1ASA
Buc:hana.n , VA
2•1·066
:::r'::•
9:::::~7
. . .• >\Hi:;;.·.
in~urance ccmp~niae l~st~d ~~low;hav~ ~aid or h-va inrlic:atad
tn•t tha=y w111 p&y for· .olutQlcgou?J ·. .banr! n\;.arrow
t:ranspl antts f~r· brcaalit c.:~nc:or Con ·". C:t'U\e-hy-c:4\ .. S b11!='i m).
The
9.:An.;~;n'"15
L.i of c:
... :
:f<:. ·/·:·: :. BC~S
of M,'lr yl.ar\d
!:·;.:>::·.T"nnlit&Ei&Q BCEIB ·
.
MutLlal D~nftfit l.i·fe
.
Tt·~:mtnport L.i.C:1o1
, . ·.L .:·:· . r=-rovicJc~r•t t..ifca
Pri nc:ipal Fi ncnc:.1 tAl Gnno~p ' ·:.
f'\1 ta H~.al th StrAtegies
Emplcyeuf Bene·Ht.u Ar-suranc:m ':J.:">.,: LLfe elf Gel'.lrgii:.l.
Metrcpolitililrl l..1h3
·
:
...... :. lr~vr..•larow
North Carolina acas
·. :T:::·~::. ·· '· Hi l b, Rog,i\1 lc Hami 1 ton
BCSS of Flc•r!d.a
,:: ..' :!<·'·)·.·· · C::u.-r·dian
BCBS of Wiililhi r1gton/Al &&slcti ,; ·~ :t,:f:·;' ;'..::· ..TC>I·ffernon Pilot
Comm1.mi ty Mutual BCF&S <OhiO) :f :: .; . ,· OHlr., <Ciln"di .:1n)
EcCBS of Ala.bu.mL'\
:· ·:· ··(· ·.
.F'rin<:ipa~ Mull.\ill. l~ f.:
DCE':IS oof G~orc;~ia <ColunlbU&) ..;·,::);.::'·:.::-::·. C.:app CAra
EICBS of South C;v·olina.
: ·> ~.1:·:,:.:.··-: .. EiC(.t f.\dmirlitJtratartii·
J: ; ·'· ·.
BCBS·of
Iow~
·
.
::.
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.,· .. Hartford Ineur•nco
....·.
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John Hti>.ru:e~~l<
....... .... ,. ·.
,· ·.· :: ;
at .ate Mul"' it Systam oof· Sa.
: ,·./1:;.<0:::• .·.· Ne"" ·vcr~< L.ifc-:t
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A\litUJc:J. at.i an Li fc.:t
... ; .:.;,.:{:.::·: .. :: Partnt:-tri\ H~Ml th f'l an c:~f
Equic:or;
.; ... ··.i •. f::,.·:.
fU.lbt&mil
Amed, c: .. n:i Her) ta~e
·.·· ::,.. i·: :·.'1::.:{.; ,.
.
! : '·~:• :: ,.'·. ~ ~w:: (·:':.•:; ': •'
l hope t.hi !I 11 Gt wi 11 bw c:t·f •••:I.'Gt6\nC:Q to yau.
~·~ ... · : >·:. <::·~·~. >:!
: . ·.::/: ;•::. SS nc:eJ-e1 y ·y Jurn •
BCBS o·f WestGtrn Pa,
Cl13NA
1"1utual of Omaha
Haw1 t t-C::ol etnlilllll
· GGmer~l t:admin1wt.rat6rc
Li bPrty Mutual
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�STATE OF MARYLAND
DEPARTMENT.OF PERSONNEL ·
i
..
Hilda E. Ford
WIIRam Donald Schaefer
.
Qowrnor
StctetlfY
Donna B. Price
Deputy Sec:tellfY
301 West Preston Street Baltimore,
Maryland 21201
Area Code 301 • 225. .
. !
. ; ..
·. . ·
;,.,.: . ; ·. ·~.
: :,-;:
__
.;._ .. :-.
January: 30,' 1991
Dear State Employee or Retiree:
Effective February 1, 1991, autologous bone marrow transplants will be
inc 1uded among those procedures requiring a second surgi ca 1 opinion under the
health care programs administered by Blue Cross.and Blue Shield of Maryland.
An auto 1ogous bone marrow transplant is used in the treatment of advanc.ed
breast cancer. The procedure is expensive, averaging $250,000 per patient and
is the subject of intense debate within the medical and legal communities as to
its medical usefulness. Because of the high cost of the procedure and this
uncertainty, the State has added the procedure· to the list of surgical
procedures which require confirming second opinions. It is our sincere hope
that you will never have to consider this procedure, but, if you do we caution
you to be sure to obtain the necessary authorization prior to treatment.
Information on the procedure to follow to obtain a confirming second opinion
may be obtained by calling your agency benefits coordinator, the State
Operations Center at (301) ·581-3601 ·(Baltimore) or 1-800-225·0131 (Outside
Baltimore) or the Department of Personnel's Benefits Division at (301) 225-4775,
4765, 4768 (Baltimore Area), 1-800-638-8844 (Outside Baltimore) or
1-800-562-9400 (Outside Maryland).
:secretary of Personnel
HEF:db
AN EQUAL OPPORTUNITY EMPLOYER
lTY .for Deaf: Ballo. Area 225-4006
D.C. Metro 565-0451
�I
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. , ;·L ~:--<-~~. ·? ·;<-= :·~. ·~: <· .;:·:':::.}~: ~: -~-!.!~; ..·
ln ~hia· opininn,·:;& .-,~~liroro
"PUBLIC'S RICH'.I' 'rO KN()W .A(,'T, ·
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. .nur rea&onnbly se•-anani tQ &uact anuLh&lr or
··.&l.ppeuall C:Ot.lr~ revet'$8d :~·-' t.ri~l c:cmrt nrder
. aand nnnundctd. C.ht c'aH With instr~&:·
of 1.ho initi"tivu. _;,' · '' . . .
Inc. v. OeukmejiQn, .No. All4R4iUl,
OiviMin_':' Thrr~tt, · F~~ruar)' Si 19~ 1
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t.he nbjcc:~ · uf. t.hu .•n~t.mcnt.. ~which hACJi cl_,niad I& pot.it.iun· for, 8
c.ion to iaaQC ·a writ nf mttndttnUU\
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l'wed that- "" i11jLiaLlve entithtd L~
.· t~tt. Klnifl~·subject rult 'of ~nO. 6Ltlt~ constitu·
.... aections, ~ovt~rnlng dlaclosures nl"ting l4:
· · . pulicie~i (3) nursinG hom11 _inf,lrmatlon;
init.iativ~s n'r rttlt.lllnd,a;· and (5) t.rJ£d~
.nr HCutlLles in Cftlifom_iia ,and. Lhd aovem-
t\on. Tho :ehalle•i.Ged initia~ivc ·~ '
(1) housohO.ld toxic produet~ir(2)_
(4) fundint: of adverUfkl_mcnts.· .
rc:l"tionships J:H:twtacn. .buaJ~eeae.e, '
manL of SouY\ ~Arrica Qr ~n1.
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Vi&llt&tesd tl\e .aln~lo·subjcct
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ware "nulLhcr fwu:~_iCin~lly· relat-ed. W.
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P.nna,ylvania Appeals Cc,ui1. Hold&t
·lna_urer l..iable ror Onpi"IJ M~i~l EacponaQS
of Jnourcd Who. WAD Rendered -~Q· ~-'II}J~.tfJI~.:,.
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uniraHUI1'd drunkcm' driver.. Ohio.
insurAnce ·'cov.ertlgtt ·tur.· Lh• ·
··.
Vchic:lu ln~.t"r"~o Act•. Jn •ddi~_ion~.
cmn= exponaos which oxcoeded
..
In Juno .l986, Spcnot Will( · · · ·
the dQi ly aQry_ioca. or llctnaed
dors. In Augua~ l 080, Ohi.n.
minat.ion· Lh4C, i~ wua:'no
Tha · triul .:court· held -~hat.·'
appeal.,d.j:;:,;/:::_._ ·:.-r.~···:)::~:·._;:~_·_:>~~Y,::·~: .
· · At ,ile.U. oa(APP.o"l. was .
reiwblli~"ative, or. cudLocl4Ll. :Tho
lii'ble for "ptofaau;i~.r\..it: medi9&!' ''
bili,aLion__ ;~~i~"·.'~·/;!;:'.~~~;·~:~::~&l~;
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whc:n ·he wu ast.ruc:k by
un
nc., Compl\ny ("Ohio. C"aualt~") pruvided
.· puratuant w P"J').nlfylvania'at .. N:o·F&&ult. Moten·
. lc.,y pald (or t.htt anedicaJJ~nd rehllbllit.nt.lve
'bancfil.at frum hbt p~mat")' heidt.h ina~turct·.
home, whtJr:t ho r.ontinu~d t4 rtCluira
. :.f\lafftlU8' l\idce~ And OLhor bo&ll&.h Cl£te pruvl·
.. rn 14t¥ j udgmtan'. ac.:Licm,· it,ulclnl( a dc:ter•
. .·.t.ha no·f~ulL a.r.L to pa¥ tor-.l.hcse ~~e:rviced. ·
. ·:.~o.ntin&Ains _Jiabilib, ~n.d.:.ota.io Casuult,v ·
·:·>
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...t ad provided IJutL Lhct n~~r,utt iraau•·vl' w£&:;
•'' llnd lilt' ' 1 me~dic"J and yQc"Li.cuu:&l rcshu•
t.in~J tho
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p~\~~~-o,_l)ad hald
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·,
�Treatment
FROM PAGE A3
Cross was ignoring what the medical community had embraced as
the leading treatment for women in
th~ late stages of breast cancer, like
Lorraine.
She was able to have the treatment only after raising the money
through public donations. She underwent the transplant last year,
but died in March when her cancer
returned.
Frank Smusz has lobbied the
General Assembly to mandate that
Blue·Cross provide coverage for the
treatment, but it appears that the
legislature will not pass such a requirement.
Smusz said he believed Lorraine's public battle against cancer
and Blue Cross. and his lobbying ·
efforts, may have at least partly
prompted the company to offer the
new coverage option.
Blue Cross spokesman Goss
said that the publicity surrounding
Lorraine Smusz wasn't a factor in
the company's decision. He said in-
tj
qott\,'\'P
terest in the treatment in general
and the attention the- issue has received in the national media played
larger roles.
"We wanted to give groups the
=
Mary Jo Kahn, chairman of the
Virginia Breast Cancer Foundation, a group that advocates breastcancer education and research, suggested that Blue Cross was responding more to medical-industiy opinion that indicates the transplants
are becoming the preferred treatBlue Cross spokesman
ment for women in the late stages of
Goss said that the
breast cancer.
publicity surrounding
She also praised Blue Cross for
Lorraine Smusz wasn't a making the option available, but
factor in the company's said it falls short of ideal. "Our
decision. He said interest organization still feels that it should
be part of inclusive coverage,"
in the treatment in
Kahn said.
general and the attention
Goss pointed to the National
the issue has received in Cancer Institute study,. which is expected to take several years. The
the national media played
study will compare long-term sur· larger roles.
vival rates of women who have con- - - - - - - - - - - - ventional breast-cancer treatment
with those who undergo high-dose
option to decide whether the exper- chemotherapy and bone-marrow
imental treatment is appropriate transplants.
for their employees," Goss said
when pressed on why Blue Cross
"We've said this before; if it's
had decided to offer the coverage proved better, we'll add it to our
option.
~.
coverage," Goss said..
- ------ ----' -· . ---i
�UVa women's team advances; Wallace, Worley win at Martinsville/81
PARTLY
SUNNY
Highs near 50.
Details on A2.
Roanoke limes & World-News
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Business
Classlfled
Deaths
LoCal
Sports
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·:Transplant recipient Lorraif1e Smusz dies of cancer
By NEAL THOMPSON
STAFF-
·,··
Fdephoto
l...orTalne Smusz holds her son,
Kevin, last May.
Lorraine Smusz bad a good year.
An extra year.
Sbe died Saturday bavina known ber twa
SODS - Brian, 6, and Kevin, 3 -just a little
bit better.
Smusz bad been diaanosed with breast
canoer. A little over a year ago, ber only hope
was a costly bone-IIUIJTOW transplant.
But ber insurance comJii&!IY - Blue
Cross and Blue Shield of ViiJpnia - denied
coveraae of tbe treatment, saying it was exIM'rimental. So Smusz and ber husband,
Fnmk, went DUblic witb their rt&bt apinst tbe
company. Along tbe way, they raised nearly
S 130,000 in doaationa - enou&b to ~Y for
most or tbe S180,000 transplant, wb•cb was
performed last April.
.
· Since then, Smusz bad been disease-free.
"We've bad au excellent year," Flllllk Smusz
said Sullday. "She tbou&bt so, too. . . . She
USAirjet
·crash kills
at least 15
Plane explodes in takeoff
ort In
w
just got to do everything that a normal person
would bave done."
Her death came ~expectedly. Tbe
Smuszes bad been prepared for death in tbe
past, but not this time.. ''
On Friday, I.orrBhic felt some back
pains. Later, in tbe hospital, doctors found
that the cancer bad retnmed. By Saturday,
ber blood pressure bad.~
Sbe was still talkins and joking with her
family when she went to deep Saturday evening. She died in ber sleep.
"And sbe died with dignity," Frank
Smusz said.
, ~;
lbe success of ~f year's treatment ·
meant that, in recent liliiiitiu, Lorraine was
free from the frequent .l:bcmotberapy that
bad caused her tow.-· hair and bad
compromised ber · • •. rank Smusz said
it was almost as if God
..wanted to spare
PLEASE~ CANCER/A 10
-El
Her husband still has plans
By ~!,~RISON
Friday, Flllllk Smusz bad plans.
Planning bis wife's funeral wasn't
one of them.
I talked to Frank on Friday after
bearing him on a call·in show on WF1R
radio. He bad called in to pose a question
to the ·show's guests, two officials from
Blue Cross and Blue Shield of VirsiDia.
He didn't &ive bis name wben be
called the show, but there was· no mistak·
~ Frank's Long Island accent. His was a
voace I knew weD, from doing dozcDS of
interviews with him about his wife, Lorraine, and her fiSht apinst canoer, and
their battle apinst Blue Cross to cover
ber treatment.
In January, I even wrote a story
about Frank bimself', and his efforts to
become a one-man lobbying machine
apinst Blue Cross and bi& insurance to
ensure that other women won't bave to
go tbrou&b similar insuraDc:e woes.
So, when I beard Flllllk's voice on
tbe radio, I knew that be was about to
tum the screws on the Blue Cross boys.
Good old rdcntlcss Frank, I tbnu&bt.
Who would have biown that the
.r "·,
PLEASE SEE PLANS/A tO
1
�A10
Roanoke Times & World-News; Monday, March 23, 1992
Couple
FROM PAGE A1
both are unemployed.
.
The family's sad, strange odys- sey apparently began late Thursday
or early Friday when, leaving the
lights of their town house blazing,
they loaded into their 198S red
Chevrolet Cavalier and headed toward Fort Mill, S.C., on an unannounced visit to Cassandra Cooper's great-aunt and great-uncle.
The relatives, who live at the New
Heritage USA religious complex
built by fallen evange)ist Jim Bakker, said the Coopers arrived at
their home about S:30 a.m. Satur' day, frantic for "scriptural advice,"
the great-aunt told police.
"She said they were real agitated, that they almost seemed euphoric, like they were on something,
but
they
weren't,"
Whittemore said. "They said they
bad been on a fast the last week,
and they had been praying all the
time. But they never really· said
what the problem was."
Two hours later, again without
explanation, the family decided to
take off, leaving a note that said,
according to police: "We have
come if only for a moment. Thank
you for showing me the truth."
Later, Candice told police that
her parents began talking about a
suicide pact as they entered Virginia from North Carolina on Interstate 77, and soon asked her if she
wanted to join them in death. When
she was dropped off on the side of
the road, her mother handed her
5even journals that she had been
keeping for several years, full of
life
Cancer
Not forever. But how can you put a
poems and thoughts about
that
price on a year?'' be said. "I have no
she had addressed to her daughter,
~ on anything." · .
police said. Lome Cooper gave her
Bone-marrow transplants suchis wallet, which contained his FROM PAGE A1
driver's license and about $200 in Lorraine and the fllmily a lengthy, ceed in 68 percent of the' women
who receive it. For the Smuszes, it
cash.
·
painful death.
.
boul!ht an extra year they· likely
Candice left most of the things ·
Yet Smusz thinks some people would not have had.
on the roadside, Whittemore said, -particularly those arguing on beThey vacationed. Had Christand began walking south on the in- half of Blue Cross and Blue Shield's · mas together. And Brian and Kevin
continued denial of. coverage ~ each aged a year with their mom.
terstate, where she was picked up
immediately by the minister. He might look at Lorraine's death and
''That is a significant amoilnt
took her to state police headquar- say: See, the treatment didn't wort. of time for them to remember mom
He says they will be wrong.
ters and later bought her a bamand to have a good time with her,"
burger and a pait of shoes. She was·
"No. The treatment worked. Smusz said.
not crying and appeared cabD, joking with police officers as the afternoon wore on and occasionally ask• ,_.. ':'
00,
ing about her parents, "Where are·
~e ~ thing was that she
they? Have you heard anytbing'l"
•was alive.
·
All the child could tell police
.·,
. ·· A. year befoR; 'things hadn't
was that the Coopers had said they FROM PAGE A 1
been so promising. . . .
were "going to the mountains" to
;
·
· ··
·· '·
' A year before; Lorraine ·had
carry out their plan. Police sent out very next day Lorraine, wOuld lie been.
'ici'.""'.'_, a rigor~r
search units, notified authorities in dying in Roanoke Memorial Hospital, a victim of the equally relent- · ous chemotl!.erapy: ··repmen 'and
nearby West Virginia and diS:. less cancer that she; and Frank bone-marrow. transplant that was·
patched a helicopter to look for the thought bad been licked.
her last hope. at. beating breast canred ·car. When it was found, the
But the Blue Cmss guys
·
Coopers were beaded south on In- on to the next caller before moved cer. It was a· '·.
Frank
·
tieatment Blue Cross
terstate 77, but police could not say got up a full bead of steam. Too refused to cover, saying it W1IS still ·
where they were going.
bad. He might, have made the show experimental. About I 0 IJClCC!.It of
Candice, who briefly was in the more lively. Having spent 16 hours the women who baveothe treatment
custody of the Bland County, Va., shadowing Frank on his first lobby- die from radiation poisoning before
· Social Services Department; was re- ing trip to Richmond I knew well it's. done.
··Lorraine, however, was willing
leased Saturday night to her bow be could have stirred things
·
to take her chances.
'
great-aunt and great-uncle. The rel- up.
As it was, most of the callers
·.I wrote a story, several stories
atives are trying to get custody of
Jacob, who was in the care Sunday called to say how wonderful they actually, about bow she needed this
of the Raleigh County, W.Va., Hu- thought it was thal Blue Cmss was. treatment. but didn't have the
expandiniJ its Roanoke operation · money. And about why Blue Cross
man Services Department.
and bringmg in 160 new jobs.
wouldn't cover her. Other members
The Coopers, who do not yet
I called Frank up myself.
of the news .media also ran stories.
have an attorney, have said they
It bad been a week or so since· · 1 Not···_surprisingly, donations
will waive extradition to Virginia, we last talked, when I ran into him .j)ounid ·in,: S130,000 .worth.
police said.
in Fincastle w~e~ be lives and.···
En(,up to ·cover most of the
works as the buildtngs and grounds. $180 000 ·proCeduri which Lorsupervisor for Botetourt County,_;·' raine~undCrwent ~}.pro and had
On that day in Fincastle;· he beeli reqovcring from ..- successfulwas. celebrating his 3Sth birtbd!ly ly, her doctors. had thought and feeling good. He joked ·about . since. · .
. : ;· ·.
·
the fron~-page stol)' I bad written : Friday,' whcth ;called Frank, I
about. him. He said be bad_. be_en 8sked about Lorraine, as 1 aJways
ed that pilots were distracted by e~dunng a lot ~fgood-~~.nb-. do when we:talk.·.Here; I am not
procedures and didn't immediately b_mg about htS celebntt.;.~tatus 1_;·alone. AnybOdy· who knows Frank
notice a drop in airspeed that led to stnq:.
. • '! ·. ·
''always asks ·about Lorraine.
the Feb. 6 crash. The Courier quotA co-~orker earlier tn the day '· ·They .won't anymore.
ed military sources it did not name. bad ·even Jabbed that the Roanoke · ·
·
.
•
fi
Radio station WIKY, also Times & World-News ibould have ~ . Frank 1181~ Lorraine was tne
quoting military sources, reported sent. a photographer .O.'·sbilol pic- ;~.Fnday•. She. still. bad the flu, but
the crew was practicing an engine tures of the little birthday party the . othet'WISC she was fine. He was as
failure maneuver when an air traf- county· st.ilff,:Jw&>. surPrised him '/UPbeat as ~e~.been the week_befic controller told them the Nation- witb, .be said. . . ,_,. . . . ,._;~ · . · .fore, and· Wben:We went to Richal Guard wanted them to return to
The notoriety . ·uiae, ·what . ·.mood ~ther 10 January.
.
Standiford Field in Louisville, Ky. Frank was really happy about was · ·
And as usual, be was plotttng
The crew forgot one of four Lorraine. She- was altve and well, strategy.
engines was still intentionally idled other than what they thought was a
First, be told me be was scbedan<l the plane flipped sideways typical bout with. the flu.
uled to be the guest on Wednesday
when a crewman turned the rudder
in the direction of the stalled engine, the radio station reported.
~ •·••~.
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America's youth are more likely to live in poverty and die because
of violence than ever before, according to a report to be issued
today by a Washington think tank.
The report prepared by the
Center for the Study of Social Policy found that between 1988 and
1989 alone, the teen death rate rose
II percent, driven almost entirely
by a rise in suicides and homicides.
By the beginning of the 1990s,
over 20
of nation's youth
th~ "nvrrtv li""
TO ALL ROANOKE
CITY REAL ESTATE
OWNERS
The Board of Equalization of
Real Estate Assessments for
the City of Roanoke has been
appointed to serve for a term
beginning March 1, 1992.
The function of the Board Is to
equalize property assessments in the City and to hear
and give consideration to complaints in order that the burden
of real estate taxes shall rest
equally upon the owners.
The Board will receive appeals
from property owners tl)rough
April 24, 1992. All appeals to
the Board of Equalization must
be received by April24, 1992.
The board will hear complaints
and will equalize assessments
by raising. lowerlgs or sustainby the OfIng yaluationsfix
fice of Real Estate Valuations.
Information pertaining to assessments on comparable
properties Is available In Room
250, Municipal Building and
may be obtained by property
owners or others Interested
persons.
The Office of Real Estate Valuations will furnish forms to be
used in filing appeals to the
Equalization Board and will assist In preparing such forms.
The board will make appointments to meet with property
owners at the property on
which an appeal has been
filed. For appeal forms and appointment Information call
981-2017 from 9 A.M. to 5 P.M.
Monday-Friday.
live."
•·•
Plans
p r e p a n •.
ng·
-.
IN THE NATION
U.S. youth
increasingly
face poverty
·FINAL
NOTICE
·Lorraine's death, though,
won't $low her husband in his ongoing fight against Blue Cross and
Blue Shield. A lawsuit against the
company is still pending, and be
will continue lobbying state legislators for their help.
Frank Smusz said there are too
many others out there like Lorraine: a private, quiet person forced
to take on big business to save her
life.
"She was thrown into the arena
out of necessity. To survive. To
on the same WAR call-in show I
bad beard him on that morning.
(Sunday night, Frank said be still
plans to appear on the show, which
airs Wednesday at 9 a.m.)
Second, be said be was planniDi some. more trips to Richmond
tO lobby the governor's commission
on insurance and health care.
Frank wants the commission
to require all insurance companies
to cover bone-marrow transplants
for breast cancer patients.
uistly, be said be was organizing a grass-roots association that
would advocate the rights of the
consumer in insurance and healthcare issues. Just from the publicity
of the story back in January, Frank
said be was getting several telephone calls each week from people
with health-care horror stories of
their own.
"I'm not going to let this die,"
he vowed to me.
Two moments come to mind
that I will never forget. One was in
January, when Frank was introduced to the full Virginia Senate,
the pride in his face beaming as be
stood and waved from the balcony
above.
The other was when I visited
Lorraine shortly after she arrived
home from her bone-marrow transplant last spripg. She was weak, but
hopeful as her sons, Brian and
Keviri, bounced on her knee,
. bugged her and played ~tb toys
By: W.G. (Billl Light, Chairman
around her feet.
R.W. Robertson. II, Vice Chairman
What I saw there was a woman
R.E. Harrison. Jr.. Secretary
·
savoring moments with her children that she never knew for sure . - - - - - - - - - - - she would have.
Nothing was being taken for
Outgrown your homer
granted.
Sell It fast In classified.
How many of us can say the
Call us today, 981-3311.
same?
BOARD OF EOUALIZAnON
OF REAL ESTATE ASSESSMENTS
FOR THE CITY OF ROANOKE
..-----'--------"---------------------------....1.------------
- Associated Press
Weather threatens
today's shuttle launch
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3l~rt£r:>;
·
Smusz spot on rad1o show postponed
By MARK MORRISON
STAFF WRITER
Frank Smusz got a telephone
call Tuesday during his wife's funeral.
It was from Charlene Cochran
at WFIR radio, telling him the station had decided to postpone his
. guest spot on her morning call-in .
show about ·insurance coverage.
The show was scheduled for this
morning at 9.
Cochran· left a message on his
home answering machine, while a
few miles away in Fincastle about
200 people were attending Lorraine
Smusz's funeral. Smusz died unexpectedly Saturday niJitt after it was
thought she was wmning a long
public fight against cancer.
WFIR had decided to postpone
this morning's _show because the
station wanted to do more research
into the debate surrounding Lorraine Smusz's medical treatment
and insurance coverage. · The sta- ·
tion also wanted representatives
from Blue Cro~s and Blue Shield of
Virginia to appear on the show, but
the company would not send anyone.
Still, Frank Smusz said Tuesday, he was surprised by the show's
postponement.
Despite his wife's death and
the timing of her funeral, he had
planned to go on the show. He said
he had talked to Cochran about it
Monday, and she told him she was
happy he still wanted to do the program.
·In addition, he understood that
·representatives from Blue Cross
would be on the call-in show, and
he said he was looking forward to
the face-to-face encounter as a forum for debating insurance issues.
He said his wife would have
wanted him to.
More ~an a year ago, she had
gone public in her battle against
Blue Cross to cover a controversial
cancer treatment that the company
said was experimental and bad refused to pay for.
Smusz said he wanted to go on
the radio with the memory of Lorraine's story still fresh in people's
minds. He hoped it would help
bring in more listeners and more
attention to the plight of other families facing huge medical bills and
no insurance coverage.
Smusz bad planned to bring
along Susan Ferris, the wife of Garry Ferris, a Bedford County man
with Hodgkin's disease who died
this month before be could undergo
the same treatment that Lorraine
had: high-dose chemotherapy and a
bone-marrow transplant The Ferrises also bad been ·battling Blue
Cross.
·
But Smusz said ·Cochran told
·him the station decided to postpone
the show because it wanted to do
more research into the debate over
which medical treatments are considered experimental an4 which
. treatments aren't.
"I was like, man, yesterday it
was all set," Smusz said.
He also said Cochran told him
Blue Cross had decided to pull out
of the show because it came so soon
after Lorraine , Smusz's death.
Frank Smusz said he was told that
Blue Cross officials felt it was too
sensitive an issue right now to talk .
about on a radio show.
Reached at WFIR Tuesday,
Cochran referred questions to program director Bill Bratton, who
confirmed that the station wanted
to do more research before having
Smusz and Ferris and Blue Cross all
on the show together.
·
Bratton also said Blue Cross
never had agreed tO do the show,
and he had been awaiting a decision .
from the company when Lt,rraine·
Smusz died; He said the company
now believes it would be better to
do the show another time.
"Two of their customers had ·
died, and tbey didn't think it would
be proper to go on the air," he said.
The program has not been resched- ..
uled.
To Our Dear Friends: .
Thank you 50 much for your endless oomfort during such a diffu:ult time. My
family and I have been so deeply moved by your kindness. I cannot adequately put
into words how much your suppon has meant to us. · .
.
Although I am terribly saddened by thedealhofLorraine,l amcomfoned wtth
the knowledge that she had gently touched so many lives and inspired so many
people ohll faiths to join together in hope and prayer.
Lorraine and I enjoyed a wonderful life together. We shared so much, both good
and bad, happy and sad. I have been blessed by Lomine with two wonderful
children, very precious memories of a lifetime.
Our extta year together gave us time to prepare for any obstacle in our path, to
bring people, communities and churches togelher in a very special way. I think
Lorraine took oomfort in knowing this. and I thank God for iL
I cannot recall amoment where Lorraine ever complained about having cancer.
She always turned to Jesus for strength and oourage.l found this note Lorraine had
written recently wJWe I was going through some things. It reads. ..
•'
I will walk in the ligltl ofJesus
No matter what they say.
If they tell me the CllliCer's retiUned,
Jesus will wash the tears away.·
With coiUage I willftgltl it--with dignity all the way.
. No pity do I ask for--or tears along the way.
For I walk in the ligltl ofJesus!
I hope and pray that Jesus gives me the same strength and oourage as Lorraine.
Thank you and Qod bless you.
Sincerely,
Frank Sumsz
�'Where does Blue Cross draw the line?
Judge hears dispute ·between SinUsz, ins.·urance carrier
.
By MARK MORRISON
STAFF WRITER
FINCASTLE - For nearly
two years now, Frank Smusz has
charged that Blue Cross and Blue
Shield of Virginia
had no right to
deny coverage of
a costly and con·
troversial cancer
· treatment for his
late wife, Lorraine.
At the same
time, Blue Cross
has contended
that it did have
the right because
the treatment has Smusz
yet to be proven
safe and effective, and it was specif·
ically excluded from the Smuszes'
group insurance plan.
Thursday, both sides finally
for the treatment to gtoup PQli
holders - at an additional fee.
company began ofTerins the opti
this summer.
·
But more sisnificant is the
elusion-clause issue, Mann · a
Greer argued. They said Blue Cro
broke State Corporation Commi
sion policy in implementins thee
· elusion; therefore it should be ·ru1
.invalid.
.·Blue Cross notified Boteto
County of the bone marrow excl
sion for breast· cancer. patients
,. ·
took their arsuments before a from the late stases of breast can- line?" Honts asked.
judse.
cer, was insured through Botetourt
Spahn said Blue Cross accepts
At issue is a $2.35 million law- County, where Frank worked as di· · a procedure as safe and efTect1ve
wlien it is the accepted and stan·
suit against Blue Cross filed by the rector of maintenance.
Smuszes that Blue Cross wants disBob Mann, the Smuszes' attor- dard practice at most ~or hospimissed. Thomas Spahn, an attorney ·ney, arsued that Blue Cross denied · ta1s, and not just research centers.
for Blue Cross, arsued Thutsday Lorraine the 'treatment before the . He said that 10 percent of women
that the lawsuit, which claims exclusion went into effect•· He·said' ' with breast cancer who unclerso the
. breach of contract, is imfounded. · . · the compan_y should have honored::· hisb~ose chemothet;aPY· and bone
Spahn said ~lu~ Cross .could.; her·claiDL' Further~ be arauec1 that' · Jl!lli!OW transplant d1e from th~. ra~
.
. ..
. not have broken Its ~urance con- .. the. can~ treatment\ wblcb costa . cliauon levels alone.
Mann and his assistantt:arter
'tract with Lorraine.Smusz because . more:tban·$150,000~·as notconsid····
the cancer· treatment,' bip.<fose ·.. ered :experimental by the ·medical' · Greer, countered that" the pr0ce- · fore the exclusion was siven fin
chemotherapy with a bone marrow.' community and Blue Cross. sbould · · dure ts·not limited'to research hos- ·approval froll) the·scc, a violati
transplant, was excluded from her not be allowed to deny its coverase · • pitals' and. is considered the leadins ·· of SCC rules, Greer said. ·
sroup plan.
arbitrarily. . · ·1
·. ·
treatment for many women in the
Then, Blue Cross denied Lo
He compared the exclusion to
· That was a point that Circuit· late stases of breast cancer.
·- raine Smusz coverase, based
other specific exclusions written in- Judie George E. Honts Ill pressed
· They said Blue Cross of Virgin- that exclusion, three days befo
to most sroup plans for cosmetic Spaliil on before takins Spahn's r:e- ia is one of the few mlijor insurance the exclusion went into effec
surgery and sex chanse operations · quest for dismissal under advise- companies in the country that does Greer argued that the exclusion w
that Blue Cross also does not cover. ment. "What I want to know is: not cover the procedure. In fact,
PLEASE SEE SMUSZI
Lorraine Smusz, who suffered ~ere does Blue Cross draw the Blue Cross does now offer coverase
City gives. snub-nosed school buses
--
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·a run '82
·---:-·--·----~--...:;
___ , _______ ·;--·=-----~--
-- 1··---
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Smusz
FROM PAGE 81
not in effect and should not have
applied to her case.
.
Spahn defended the early notification. He said Blu~ <;:ro~sshould
not be punished for gavlD~ tts group
policy holders early wammg of coverage changes.
He also said that Smusz was
not denied coverage before the exelusion went into ~ffe~. She was
denied pre-authonzatto~. Spahn
said there is a significant dtfference.
Decisions about claims are not
made at pre-authorization. They
a re determined when the treatment
d
is provided, and base on an~ exelusions in effect at that ttme,
Spahn said.
d
When Lorraine Smusz un erwent the high-dose chemotherapy
and bone marrow transplant, he
"It's a natural
said it was several t;n~nths after the human tendency," tende~cy; it's a
he satd.
exclusion had gone mto efT~:
ns
Spahn said those. pro":ISIO
Honts is expected. to rui~~~9~·
were specifically outlined 1R her Spahn's dismissal mouon today., ...
policy.
Therefore, he said there ":as no
Lorraine Smusz died earlier..
breach of contract and h.e cauuo~ed this year when her cancer ret~~·
the court about extendmg m~dlcal after she underwent the chemo.t.berbener.ltS beyond what h.er pobcy at- apy and bone marrow treat~~nt.
u
ready specified. He sat~ th~t some- She and her husband. paid. foJ; ..\bjt
times can be a teniptatton .lD em~ procedure with d<?nat1.ons gavep !\1~..
tt'onal cases involving termtnally tll ter she ~ent pubhc w1th her story(.·
. people.
.
Ck~~ i~~~ <\\'-\\01
•
�.
.ft~. L~-CJlQ_
9Jq/Cf2-
Court clears way for
Smusz's suit against
insurance company
i
i
l
I
\
ment for breast cancer-high dose
chemotherapy wlth autologous
atatrwrller
Frank Smusz wtll have his day bone marrow transplant lHDCTI·
tn court wlth Blue Cross/Blue ABM'I1. Smusz maintains that the
Shield ofVlrgtnla (BC/BSVA) fol- treatment. recommended to Mrs.
lowing a ruling Frtday by Circuit . Smusz by her attending physicians as the onlyvtable treatment
Court Judge George E. Honts III.
·1 was extremely happy when I for her Stage IV breast can~. ts
got the news,· said Smusz. •1 was not eX:pertmental aild should not
have been excluded from coverage
oveljoyed-lt was a big relief:
Hontsrefused todlsmlssa$2.35 under their group Insurance plan.
BC/BSVAmalntalns Ute treatm1111on lawsuit filed against BC/
: BSVA by Smusz and his late wife, ment Is sttll experimental and has
r . Lorraine, over coverage of an ex- not been prOven safe and effective
(Contlllued on Page 8-A)
1
pensive and controversial treatBy Kathleen Morra-810811
•. . .
-. --·- .. ·-··
---···
~
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Lawsutt Page l·Al · .. - . ·.
(Colltllluecllrom
:
·
for the treatment ofbreast cimcer
andlsthereforertghtfullyexcluded
from the group Insurance plan.
Thursday, Honts heard two
hours of arguments from lawyers
for both parties. He took the case
under advisement and Issued his
six-page ruling Friday.
!
Honts sustained two of the six
; counts tn the suit-()ne alleging
. Lbreach of contract and the other a
bad faith breach ofcontract. Smusz
was gtven leave to replead wlthtn ·
21 days a third count alleging tntentional tntllctlng of emotional
distress.
Honts addressed most of his
remarks to the count alleging bad
faith breach of contract. He cites
the criteria the company Is using
" to detenntne whether. a treatment
Is experimental or Investigative In
Its amendment to the group policy
. andnotesthatonlyoneofthefour
criterion Is oblectlve.
· ""' · ,..
. "''beamendmentreadsfurther,.
•any seivtce Judged to be Expert.:
mental/lnvestlgaUve by the Plan, ·
In Its sole discretion' wlll be eXeluded from coverage, • Honts
wrote.
·
"While It probably Is true that
Blue Cross has the resources, Information and expertise to evaJuate and todetenntne Ifa treabnent
Is In fact a valid option, there also
flows from the judgmental criteria
set out an enlianced duty to act
fairly and In good faith since there
ts no dlscemlble avenue available
to an Insured to challenge a determtnatlon made by Blue Cross,
absent an expensive, frustrating
and time-consuming recourse to
litigation. •
.
Honts continued, "When the
power of determination of a crltlcal_provlslon of a contract ves~.
I
absolutely and unilaterally In the
hands of one party to a contract.
then Juatice demands Ui~ i1ght to
review and evaluate the good faith
character of acUons taken by that
party be afforded the other party.
•1 am of the opinion that the
acUon Is maintainable, subject to
sL;ct proof. and that In proper,
narrow circumstances wOl be reco~ In this Commonwealth;.
· Smtisz Is happy just to'be able
to continue. "We are looking forward to our day In court, • he said.
"We've still go~ a long way to go,
J>ut this allows us to proceed:
. BC/BSVAattomeys had asked
the court to dismiss all six counts
tn the ctvll sutt. and Honts dismissed clalms that BC/BSVA was
fraudulent In lts dental of coverage. He also dismissed claims that
the Insurance company was In
Violation of unfair trade practices.
l
\
r
�FH
**B
9/30/94
James J Madine
P 0 Box 189
Fincastle
VA 24090
WEDNESDAY
MARCH 25,1992
35 CENTS
~raid
..--------
(USPS 160-680) Fincastle, VA
Volume 127 • Number 13
2 Sections •16 Pages
Plus Supplements
~incastle
Botetourt County News
He
...·
Lorraine Smusz's battle. with
cancer ends quietly with f~mily
8J Kathleen Morra-&loan
.
ltalr 'llhlhr
Although death lurked In the
shadows of Lorraine Smusz's life
since she was diagnosed with ter·
mlnal breast cancer In September
1990, when It finally came last
Saturday n~t. It arrtved unex·
pecteclly•.
'"lbere was no warning,· said
her husband, Frank. "We just
didn't lmow. •
Hospitalized at Roanoke Me·
mortal Hospital last Friday with
back patn, Lotratne learned Sat·
urday that the tests and X-rays
her doctor, Stephen Kennedy, had
run revealed spots of cancer In her
spine that were actiVely growing.
After a year of disease-free life
following a controversial bone
marrow transplant, Lorraine's cancer had returned.
"We lmew It would be a matter
ofttme,"saidFrank, "butwhatshe
had was not life-threatening. The
plan was to radiate those areas on
Monday, come home, and go from
there. No one thought tt would lx
this soon-even Dr. Kennedy told
me he wished he could have given
me some forewarning. We kn~
death was coming. but there hadn't
even been a discussion ofwhen.·
Death came peacefully for
Lorraine, In her sleep, with her
famtly gathered around her.
·up until she went to sleep,
she'd been talking and joking."
Frank said. Her two young sons
Brian, 6, and Kevin, 3, had been
with her all afternoon. Inexplicably, her blood pressure had been
dropping aU day and she gradually
weakened. Frank said she didn't
gtve any indication that she knew
she was so close to death.
Lorraine Smuu with her famJJJo before she began the ABMT tl'eatments early last year.
"She died with dignity; I'm
really thankful for that, • said
Frank. Doctors are sUD debating
the actual cause of LorralRe's
death. but Frank has his own
theory:
"I think God just said, 'Look, If
the cancer's back, you've had a
good year-anotheryearwlth your
children. And you've touched so
many Uvea.' Her work was done
here, God wasn't going to let her'·
suJTer anymore. It was tlme to
come home.·
Death came 12 months after
Lorraine received the high dose
chemotherapy and autologous
bone marrow transplant (HDCT/
ABM"n that thrust the soft-spoken
mother of two Into the publtc eye.
The 34-year-old Ftncastle resident
had already battled breast cancer
once before when It was first dlag;
nosed" In September 1988._'She
had gone through rigorous chemotherapy then and lost all her
wavy, brown hair, but In 1990
doctors told her ABMT was her
only hope for battling the Stage IV
breast cancer that was now In her
bones and llver.
Her Insurer, Blue Cross & Blue
Shield of VIrginia (BC&BSVA), refused to cover the treatment on
the gr!?~ds that tt was expert-
�Lorraine Smusz - - - - - - - - - - Doctors determined that Reed(Lorralne'sfamlly)clanshave
time when a bout with the flu
Lorraine had lung damage from relocated to Botetourt and Bedford
really took Its toll.
"She got· the flu at Christmas the high dose chemotherapy she Counties from their natlve Long
and It really knocked the heck out received prior to the bone marrow Island over the last six years. The
famllles have been a tremendous
of her, • Frank recalled. "Then 1n transplant.
"But there's no sign of cancer, • source of help and strength for the
Janwuy, shewashospltallzedwith
~ethefocusofnewspaper~ead
a bronchial Infection, then again she'd exclalmed exuberantly over couple during their ordeal.
llnes and radio talk shows. The with a bronchial Infection and . the phone just after her recent
"Without Lorraine's famlly, we
publlc responded to her plight and pneumonia, then she began to retum from Duke. "I'm more llke never would have gotten this far, •
contributed close to $130,000 to- experience shortness of breath. •
an asthmatic now and I have to be Frank said.
.
ward the procedure's $180,000
lt'slateafternoonandthephone
The couple thought an extended careful. but I can live with that.•
cost. making the treatment a real- stay two and a half weeks ago at
Frank says he has nothing but lsringlngevetyftvemlnutes. Frank
ity for Lorraine.
Duke University Hospital, where praise for all the doctors, nurses Videotapes a local newscast that
Recovery was slower than she . the ABMT had been performed, and medical personnel at both Includes a story about Lorraine.
would have llked, but she was had finally gotten to the root of Duke and Roanoke Memorial.
Someone from the VIrginia Breast
progressing 'Well untll Christmas Lorraine's problem.
"''beywere great through It all," CancerAssociation calls with conhe said.
dolences and wants directions to
Hashechangedhlsmlnd'about Fincastle for TUesday's 1 p.m. futhe ABMT? Absolutely not. "I'm a neral. F'rar),k Is appreclatlve of evvocal proponent of the treatment.~ ery caller's thoughtfulness and Is
he said. "I know what it did for my cordial and patient.
family and for Lorraine. In Sepf{e 'wants to say something to
tember 1990, she was diagnosed the congregation that will gather
as terminally ill. Without this treat- for Lorraine's funeral at the CathoEconomlc measures needed to of the act on private landowners, • . ment I know she would have been llc Church of the Transfiguration,
stimulate Investment 1n agricul- he said; With respect to wetlands dead this time last year. It gave us housed 1n the Fincastle United
ture, forestJy and rural economies Issues Taliaferro said the group Is a wonderful year. I have no regrets Methodist Church, to say thank
headed the llst of concerns of VIr- concerned about the federal deft- and I know she didn't either. •
you, but he's not sure he could get
gtnla Agribusiness Counc11 lead- nltlon of wetlands. The group beWhat about the couple's pend- through It without breaking down.
ers who met with members of lleves a definition more reason- lng lawsuit against BC&BSVA?
Looking through Lorraine's
Vlrginla'sCongresslonaldelegatlon able than the ortglnal can be found "Nothing's changed, • he sald. Bible, his control fades as he runs
on Capitol H1ll on March 17.
which would avoid what is essen- "''bat's a contractual issue and It's across long-forgotten photographs
"'lbe Counc11supports a reduc- tlally conflscatlon of private prop- still on.·
and othe.~ loVingly placed memenUon In the capital gatns tax to erty. The co1inc11 also opposes the
What about his personal lobby- toes 1n the well-worn pages. Lines
stimulate Investment, especially abridgement of projlerty rights lng efforts on Lorraine's behalf to from poems· or. prayers that
1n the rural economy, and an ln· such as often occurs 1n deslgnat- getlnsurancecarrterstocaverbone Lorraine evt~ently found partlcu- ·
vestment tax credit must ·be en- lng historic areas.
marrowtransplantsforbreastcan- larly comforting mark favorite
acted quickly, now, to get our
The group also urged the del- cer patients?
scripture passages. This Is all new
economy going, • Bryan Taliaferro, egatlon to work together to get one
"Lorraine was very supporUve to Frank. he's never looked 1n here ·
Center Cross, Vice-chairman of the of six commercial research cen- of what I was doing, • Frank said. before. A folded yellow paper. with
coundl'sNationaiAffalrs Commit- ters allowed for 1n the 1990 Farm "I'm 1n lt and 1f finances permit me llnes scrawled by Lorraine on
tee, told the delegation at a break- Bill located 1n Vlrglnla. The cen- 1 want to keep pursuing it. I get March 2, 1992 brings tears to his
fast meeting 1n the Russell Senate ters will focus on new technology several calls and letters every week eyes. It begins, "It's been a year
Office Building.
and commercial uses of agricul- about that and I re&lly want to get since my bOne marrow transplant
Senior Senator 'John Warner tural products.
that consumer health and'lnsur- and I am so 'thankful .... • ·
and Congressman George Allen,
'rallaferro said the group op- ance association going.·
"''bat's what I shoUld read,· he
~ormanSlslsky,OwenPlckett.Jlm
posesthedeslgnaUonofaddltional
He says there's a real need for munnurs.
Olin. L. F. Payne and Herbert portlonsofnat1onalforests1nV1r- anorgantzationthatcanadvocate
Another prayer, placed ln
Bateman were 1n attendance to glnla as wilderness areas, and at- for the consumer 1n health care Lorraine's Bible, seems to illusVIsit with the state group.
tempts to reduce the llmlt on fann and Insurance issues. Monday, he trate the strong faith and quiet
"We see these measures as hav- exemptions provided 1n estate tax ·stlll planned to appear on a WFlR dignity with which she confronted
1ng a positlve, long term effect on Jaws. He said the council supports call .In radio program, due to a1r her Wness and lived her llfe.
our chronic budget deftclt prob- leglslatlontoprotectconscientlous. Wednesday morning, with Susan
"I wlllllft my head h1gh 1n His
.lem. We also belleve that budget animal care givers from radical Ferris, who lost her husband, direction. As I bring Him my dis"
deficits comprise our number orie actions by extremist groups, and Garry, tocancerseveralweeksago. appointments, broken dreams,
economic problem and we want to efforts to allt>w farmers to deduct
Frank stlll has big plans and and unanswered questions; In His
be part of the solution, • Tallaferro the full .cost of health Insurance as
things he hopes he can accom- strength I can stand tall, because
said.
·
a business expense, something pllsh, but for right now, he Is uy- God's timing is better than mlne.
Dairyman Lacy Smith of that large businesses currently lng to get through the next few In God's Ume I will understand all
Buchanan was 1n the group repre- enjoy.
days, comfort his sons and His plans for my llfe. And I'll be
sentlng Dalrymen Inc.
Taliaferro also urged the del- Lorraine's family and think about thankful. I take all my tomorrows
The group also urged the del- . egatlon to peer through· the emo- the new llfe he must forge for him- and place them 1n God's hands. •
egatlon to work to preserve private tional cloud surrounding many self and his ch11dren.
The family requests that mepropertyrlghtswhlch they felt were Issues of national pollcy, require
The family's home has been for mortal donations be made to: The
threatened on a number of fronts. thoughtful analysis and demand . sale for a month or so and he Lorraine SmuszDonatlonAccount,
"We .believe private property thorough, reproducible sclenUftc hopes It sells fast: he needs the Bank of Fincastle, P.O. Box 107,
rights essential to agriculture are data to support laws and regula- money for unpaid medical bllls. Fincastle, 24090 or to. the Buildbeing steadily eroded· by regula-. tlon dealing with technological Is~
Lorraine had no llfe Insurance, lng Fund, Church of the Transtory processes, and threatened by sues. "''bese principles bear on·. andhe'snotst:trewherethemoney figuration Cathollc Church, P.O.
legislation, • Taliaferro said. "We env.lronmental matters, food safety for additional child care wlll. come Box 416, Fincastle, 24090.
oppo~Je any efforts to broaden the and pesticide use. Another 'ALAR' from, but he knows he11 m~~g_~ llliRiiilffiiii·-··- - - - - - - - - -
(Continued from Page 1-A)
1;11ental.
Her decision to take her sltuaUon before the publlc 1n December
1990 made her a famlllar face on
the six o'clock news and made her
Ag Council meets
with legislators
A
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�Roanoke Times &World-News, Saturday, Sept. 5, 1992 AS .
Judge refuses to dismiss suit By MARK MORRISON
STAFF WRITER
Breast cancer treatment debate
will get its day in ·court
FINCASTLE - A . Botetourt
County judge refused Friday to dismiss a lawsuit against Blue Cross
and Blue Shield of Virginia in its therapy with a bone-marrow transdispute over coverage of a contro- plant, is not experimental and that
versial and costly breast cancer it should not have been excluded
treatment for Lorraine Smusz.
from coverage.
Thursday, a la'!Yer for Blue
The lawsuit claims breach of
Cross had asked C1rcuit Judge contract..
George E. Honts III to dismiss the
c·ITCUlt Judge George E. Honts
·
$2.35 million lawsuit, arguing that
Blue Cross bad every right to deny III took the dispute under adviseSmusz the treatment because it was . ment Thursday and issued a decistill experimental and was excluded sion Friday. Honts said in his ruling
from her group insurance plan.
not to dismiss the case and that
Smusz and her husband, Smusz has the right to challenge
Frank, contended, however, that Blue Cross on the experimental is. the treatment, high-dose chemo- sue.
:
.
:.
.:
He said that when such a dekr~ ~mination rests "absolutely and uni!~te~lly" with Blue C_ross, then ::
~ustice demands,the nght to. re- :_
':lew and evaluate that determma-· '~
t10n.
.
. .
~;
Smusz has 5!Ud that h~gh-dose .
chemotherapy With a bone-marrow··
transplant, which costs more than·:
$150,000, is widely accepted by the:
medical community and consid~
ered the best treatment for manf·
women in the late stages of breaSt
cancer.
·~~
Blue Cross bas maintained ~i
the procedure has not been proven
safe and effective. About I 0 percent
of women with breast cancer who
get the treatment die from the radi- .
ation levels.
Lorraine .Smusz died earlier ·
this year when her cancer returned :
after she underwent the chemotherapy and bone marrow treatment in;
1991. She and Frank paid for the .
procedure with donations given to;
them after she went public with her
sto
·
ry.
Friday, Frank Smusz hailed :
Honts' ruling. "I'm just really excit- ·
ed, just so happy. I've been on pins ·
and needles since we were here yes- '
terday," he said. "Now we can look·
forward to our day in court."
·
�POSTAL
_P~TRO_N·
LOCAL
~r. Rt.Sort
Bulk Rate· , ·~
.~.Jhe Largest:Qrculation ~::·
Ne~spa~e~.la_The: : . . .-·
u.s. _Postaie
Paid . .·
,.. _,: ·_
Covington..::.
Virgi~la_
..
Permltl17; ·
.'
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-p
-~:- -~';_;:_ ~f:Aii4! 9 ~~ny Highlands:._
.
Vol. 9 No. 37··. :;. ·.
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Serving Covington; Clifton Forge,
:--_··_:,Aneghany,aatb,Botetourt · .
·· '· ·Craig and White Sulphur SJM in.S
·:. Saturday, December 22, 1990 ..
FhiCftStleWonlan Fighting Breast Caneer
Neet& $96,ooOBy jtfu:-31 TO SurVive ·.. •.
•
• }_;:-.,·""";!
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•'
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FINCASTLE ..:... .; For. Lorraine· ;,,the Dec;. 12 issue of The Fincastle·.
Smusz,ayounginotherWithadva'nc- .. , Herald. The insurer contended the·
ed breast cancer which has invaded needed treatment. is. "investiga-.
her bones and liver, the best holiday · tional" (meaning the·company con--gift for her herself, her husband; and siders it experimental) and
Iheir sons would be just t~ live to sometimes caused the deaths of pawatch her sons grow up.
· :
tientsin itself and therefore was not
To do that means finding lhe eligible for insurancecoverage.
money to continue the· expensive
Msc Smusz and her husband,
treatment on which her only chance · Frank, have been married nine
nf survival depends.
years, and live near Fincastle in · ·
Since the Smuszs were denied in- · Botetourt County with their sons, agsurance coverage for the needed ed five and two. Ms. Smusz told the
treatment as of Dec. 6, her only Fincastle paper she wants to. live so
. . chance of continuing it is to raise her sons will remember her as per$96,000 by Jan. 30, or she will be son and not just a vague memory.
dri>pped from the therapy program . . Ms. Smusz has been told that the
she is in; according to an article in
only hope for curing her Stage IV· .
•''
,-.
metastatic breast cancer is high.
dose . chemotheraphy
with·
autologous bone marrow traruiplant.
Her breast cancer first appeared in
September, 1988; disappeared after
chemotherapy and radiation; but
recurred in an even· more
devastating form· iD' September of
this year, when the cancer spread to
her bones and liver.
Although the treatment Ms. Smusz
needs, abbreviated as HDCT-ABMT,
is available at several .leading
medical centers -in the nation, the·
nearest of these is the Duke University Medical Center in Durham, N.C.
The procedure involves several
21-day cycles . of high-dose
chemotherapy designed to shrink · ·
existing tumors followed by removal '
of two to four quarts of the patients ·
bone marrow and 'blood; which- is·
then· treated with high· levels of.
chemotherapy to kill, any tumor iii .
the marrow. The marrow is later·
reinjected in the patient to give the_
body a chance to regenerate healthy .
bone marrow.
·
·
· Duke University's. program for
this type of treatment averageS
$132,000 in cost but can cost as much
as high as $180,000. Although the process is painful, lengthy, and can
itself be life-treatening, it represents
Ms. Smusz~s only hope. ·. ·
Published_ By
· ~ Covington, va.
343 N. Monroe Avenue
962·2121
·
c;~lngton'vlrglnan Inc.
-·to. Pages·
�Mari'"QW p splant
deadline loOming
By MARK MORRISON
It may take five years. It may
take two. It may take much less, but
eventually, the breast cancer that is
FINCASTLE . Lorraine spreading through her body will
Smusz is $96,000 away from a new win out.
lease on life.
Her husband, Frank, will lose
That's what Duke University his wife of nine years and their
Medical Center in Durham, N.C., is
asking as a deposit to perform a boys, Brian and Kevin, will lose a
bone-marrow transplant that could mother.
It's as simple as that. ·
save her from terminal cancer.
Duke is requiring the deposit
But Lorraine Smusz doesn't
have that kind of cash - and time· because the Smuszes' health insurance company, Blue Cross and Blue
is running out.
If she doesn't have ihe bone- Shield of Virginia, has denied covmarrow transplant within the. next erage of the transplant procedure.
month, her doctors say it can't be
Blue Cross says the treatment
done at all.
·And she will die.
PLEASE SEE DEADUNEIA8
STAFF WRITER
<---------------·- -----·-------- ·-·- ....
�.AI Roanokelimes&World·News, Thursday,Dec.21,1!1'JO
.Deadline
FROM PAGE AI
illlill "investiaational" and hasn't
been studied enoush.
·'
Plu1, it'1 hish·rilk.
·:;: EishtY percent or those who
underao the transplant 1urvive.
Thirty percent arc cancer-free aner
11 two-year period.
I
/
I
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I
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/
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/
/
• ·, "I can undentand why tbe inIUrliDce company doesn't want to
cover it," Frank Smusz.uid. '"It's
not cheap."
': · After all, the $96,000 up front
Ia merely a depoait, The total cost is
likely to· be nearly twice that
amount.
~
But the same treatment is cov·
ercd for most leukemia and lym·
pboma patients, accordina to a rc·
cent Newsweek article, and
continues to show promi1e for
breast-cancer victims.
.: Altboush less than 30 percent
., of tbe women in tbc late lta8CI Of
breast cancer recover from the
treatment, that's still better than
the only 5 percent who ourvive
when treated with chemotherapy
ilione.
" "This isn't some kind or love
you act in Mexipotion or quick
rut
CD;" Smusz said. "This Is scientir-
~"·•·
..
:~.'··some
Jnsuraoce companies
Will even cover the procedure, in·
cludina Blue Cross and Blue Shield
tif North Carolina.
;: "We're fully aware that thio
liutment misht not work, but we'd
like the opporlunity to try it out.
My wife could be in that 2S or 30
percent," Smusz uid.
;: He uid it'• their !all hope.
: · "Wiien it comes down to your
Ufe, if there'• an)'lhlna out there
that can be done, you want to take a
&bot at it," Lorraine Smusz said.
. Since September, she hu been
iutderaolns intensive chemotheraPY to prepare for the treatment, and
llow therc'o no lumina back.
:;· The transplant involve• reinovins some or her bone-marrow,
ilosina it with more radiation to kill
iiny remainina cancer oells, then retumina it to her body - a proceu
that takCI 6-8 weeki.
.
;:· I! it wu postponed, then she
would need additional cbemntherajiy, which she cannot have if obe
already hu reached her uturation
poinL
·
. . "rve aotie tbil rar," obe llid.
"It seem• like I should be able to ao
ihroush with it all the way."
· . Meanwhile, her neishbon in
tbi1 nual Botetourt County town
bave rallied in support.
County Administrator John
• !"!~~::nth:-:.b~~s:~~i:.:!:i~
Lonaine'1 Smusz's "!'f!l" to help
·:·pay for the lrliDsplant .. •·. ·, · '
1
' ·~' 'Since' tlieii: contributioiis bave
lieen pourina in, but a •mall com·
1~ ri\unily can aenerate only so· much
money.
~!' far, .S 13,000 bas been col·
1
:c Still. the Smuszes uid it ha1
URed their spinto.
~
"II makCI you feel better that
there arc people out there and they
ilo care. You don't realize bow
much until you're in a ailuation like
this,'' Lonaine Smusz uld.
- lbe Botetourt County Sherif!'•
!)epartment helped by collectina
money so the Smusz01 could buy
their two children, ~es S and 2,
Chri1tmu presenU thtl year.
... · ~·tt'a a touab situation all
around, but it makCI it a lot caoier
knowina there'• aupport in the c:cim·
munily," Frank Smull uid.
~~
lbil isn't the rmt time, either.
In September, when word
;
•pread arouod Fincaolle tbat Smusz
III'U ill, word also apread that she
wanted to take her kids to see Disney World before abe died.
~
Within houn, S 1,150 bad been
collected - much or the money
fi'om Frank Smusz'a co-worken in
the county, where be Ia mainte·
· baocc supervisor- and within the
week, the family was on a plane to
.~orida.
·
.:
"We were rc&JJy able to forset
he
Ahnnt nnr nrnhiPmllli for A werk:'
Meanwhile, be believes thai if
they can raise half the amount
Duke is askina. then maybe the hospital will aarcc to treat his wife and
let them pay tbe difference later.
"In my heart, I would like to
think they would do Ibis thinJ. Oth·
erwiae, this woman is aoina to die,"
hopina to do somethinB tor olher
people."" be said. '"This is an issue
that affects a lot of people. II could
be anybody."
The Smuszcs also say they arc
considerina suina Blue Cross and
Blue Shield in hopei of forcina the
company to cover the treatment.
he uid.
Similar lawsuill have been won
That •till puu tbe price taa at elsewhere, they uid, but there is no
nearly S50,000. "But if SO 000 peo- auarantec one will be successful
ple could contribute just
or $3, here, and it won'I help them before
we'd be there," he uid.
tbe January deadline.
However, be doesn't really exIf it is successful, thoush, they
peel that kind or aenerosity.
plan to use any money donated to
In fact. he uid the money· it them to pay for leP.' fees and then
only one rcuon why they have aone to establish a •pec•al fund for helpIna other breast-cancer vlctim1.
public with their lllory.
"Nobody should have to ao
"We've aot two little children
that need their mom, but ~·re also throush tbi1," Frank Smusz uid.
b
r-----:::::::::::;;;;;;;.-ii
�--
FINCASTLE, Va. CUPI) _ A Botetc••.trt County wornaro is wi 11 irog teo ~mder·go
a costly, painful bone-marrow transplant to fight breast cancer, but
Blue Crotss and Blue Shield of Virgiroia woro't pay fc•r it because it still
considers the treatment experimental.
So Lorraine Smusz arod har husband Frank, both trarosplanted Yankees
who abandoned the f.ast pace of New York to live a simpler life in the
Roanoke Valley, are turning to their church, the Church c•f the
Transfiguration, and neighbors for help.
So far, S:SO,OOO has bean raised for her treatm1mt at Duke University
Medical Center, but Frank Smusz estimates the entire procedure will cost
between $1:50 1 000 and $180 1 000.
"We have beer,. given a lot of support, a lot of prayers," Frank
Smusz, a mairotenance supervisor for Botetourt County, said Monday.
"Really, l' ve been driven by this thirog. I'm really focused."
The financial gifts will alleviate some of the problems the Smusz
family faces in the coming months aa Lorraine, 33, battles a recurrence
of the breast cancer that first surfaced in September 1988. The cancer
has spread to her liver and bona.
But tha Smuszes would like to break ground and persuade irosurance
companies such as Blue Cross and Bl•Je Shield of Virginia to cover the
treatment known as a~ttologous bone-marrow transplant with high-dose
chemotherapy, or ABMT.
The treatment involves eKtracting several quarts of the patierot' s
bone_marrow. After that procedure, the patient is bombarded with high
doses of chernotherapy over three days; once the chernotherapy clears from
the body the bone marrow is then transplanted and hopefully begins
replicating healthy blood cells.
Their plight has beero featured in a local roewspaper and on WVTF,
Roanoke's public radio station;.Smusz hopes that will encourage others
who also need the treatment to cc•rotact Blue Cr-oss and persuade the
company to chang·e its policy.
If Lorraine Smusz lived across the border in North Carolina, her
treatment would be covered by- Blue Cross and Blue Shield c•f North
Carolina, one of a handful of companies in the United States that pays
for the treatment.
While Blue Cross and Blue Shield of Virginia is willing to
participate in a national breast cancer study undertaken by the National
Cancer- Institute, the company won't pay for ABMT until it is proven to
be safe, public affairs director public affairs director Jim Goss said.
"We pay for treatments that are proved safe and effective," he
said. "When a treatment is not proved safe and effective we do rrot pay.
II
Blue Cross and Blue Shield does approve claims for bone-marrow
transplants in cases .of lymphoma, certain forms of leukemia and a rare
childhood cancer knowro as neuroblastoma, Goss said.
"We are trying to make decisions that are financially responsible
for the whole customer base
not just approving one treatment for one
custon1er," Goss said. "Ten to 20 percent die from the treatrnent
itself."
·
But Stephanie Bass, spokeswoman for the Duke Cornprehem~ive Cancer
Center, said the mortality rate is high because the patients who undergo
the procedure are generally in the final stages of cancer.
Dr. Williarn Peters, who has been perforrning bone-marrc•w transplants
since 1984, estimates from 15 to 25 percent of his patients with
metastatic cancer have remained disease-free with follow-up for as long
as seven years, she said. Metastatic cancer is that which has spread to
other organs.
The statistics provide some cornfort to the Srnuszs, who moved to
Botetourt County to live what Frank called the "old-fashioned life,"
where Lorraine could stay at home and raise their two children, Brian,
:S, and Kevin, 2.
The couple has considered the pos~ibility of a lawsuit but Frank
Smusz acknowledged that has its drawbacks as well in terms of money and
emotional distress. Blue Cross has been sued twicet one state circuit
court sided with the insurer, while a federal court ordered Blue Cross
to pay for the treatments.
"We hope this helps other women in this particular situation," he
said. "Nobody should have to go through this. If your doctor's
prescribing -this treatmerot and it is medically roece_ssary, yc•u ought to
have it.
"My wife may die with the treatrnerot. These are the hard facts, the
treatment may hot wo~k," he said. "And then again it may work. It may
give her quality living for a few ~xtra years."
Those interested in contributing to the Lorraine Smusz Treatment Fund
may write the Bank of Fincastle, P. D. BoK BoK 107, Fincastle, Va.
24090 •
.
--------ttr'li
Ot-09-<;11
09:55
P"'o;:
�Area. [JiVes
financial,
.,
emotional
support
'
.
;
.
.
I
.
By Kathleen Morra.Sioan · · ·
,
--~
..
1·.•
00 ~-
ct1.~
,. "\ :a~
'-'
0
fllll!lt·. ~-
~ 1)"
•....t
....
m
~~'
.. .'
~
N
~:".
'I.
...=
E-t.·
eta.«Wrkcr
.
· Life has been "hecuc· for Frank ant! Lor·
rafne Smusz offlncastle and their two young .
soris since a story about their struggle to of>.
taJn a possibly 11fe-sa1.1ng medical treatment
for Lorraine appeared In the De~mbe'" 12
Issue of The Fincastle Herald. . . · ·~
;'Lorraine has Stage IV metastatic· breast :·
.
.
cancer and h~s been told by her doctors ~at: .. R~ora. that the commwdtY had ~dy raised enoup moiley for the Smasz family
~lyonecurrentmedicaltreatmento.lrersany .·to make a down payment on Lorraine'• cancer treatment"Ue unloundecl. Tueaclay
hope of arresting the disease wlllch _has now . morning, the Lorraine Smuaz Funclwu atlll nearly $40,000aby ·of the $96,000 the famUy
Invaded her bones and Uver.
neecla.
.
·
·
.: -' · · •~
. ·' ·
· .. ;. '""''··· . · · · · '
.
·
··High ""dose chemotherapy ·and autologous ·· ·.. .. ····.: ". "··· ·-:.· -"• · ...; ·. · . . · · • · .-"· . . · · · ··. ' ' .·· · .:;, ...,. . ·. ·. ·
..
·
bone marrow transplant (HDCT-,ABMI) Is a.:. .. This year .Jn the United States. apprnxl· public affairs program on Sunday. and In an
Procedure perfonned at leading medical cen- -. mately 144,000 women wUl get breast cancer In-depth story broadcast Monday on PubUc
ters across the country. Although the proce- · . and an estimated 44,000 wUl die from IL Radio WVIF~FM 89. . ,
.·
· _
dure has been accepted as the treatment of · ·_ABMTisaproCedurethathasshownremark-._. On Monday,_ ~rank was contacted by the
choice for this disease by much of the medical -: able success with advanced stage breast cancer ;:._1Jplt~d. ~~ss _)n ter:natlon!ll. reporter In
community, some Insurance caiTiers classify .· patients In recent years. "More than 30 per-. Rlclunond~ .:~.,... ....- '~ .
. .·
the tceatment as ."InvestJgaUve" and refuse to cent of wamen wtth late-stag~ breast cancer, .. • _BCJBS ofVa. demanded equal Ume Colcover lt. · . ·· · ·
.
· ·. :.
are alive and disease-free up to~ years after .. lowing the Smuszes' appearan~ on the Cary
J.orrafne has been accepted Into Duke Unl· : ABMT, compared wtth only 5 percent on stan- . .Minter. show and the company's medical
versity Medical Center's HDCT·ABMT pro- dard chemotherapy,· reported a December . _·director was lnten1ewed on that program
gram and her doctors feel she Is a good candl- · 10. 1990 Newsweek article on the current . the following day. ·. ·- ·· · ·
·
.
date for the treatment because of the early • status ofbreast cancer treatment In the coun- · ·
:·
stages of her bone and llver cancer.
··
try. ·.
-: .
.
.
Theyoungcoupie thinks the response has
The treabnenCls very expensive (Duke's .· SlncetheSmuszesdeddedtogopubllcwtth .. beenoverwhelmlng. '"We'vehadlotsofmedla
program averages $132,000, but can go as
thelrsltuaUon, which theymalntalncouldaf- .·:attention.· said Frank. "lfsgtVen us a lot of
high as $180,000), painful and not Without feet any woman lnsuredbyBC/BSofVa., they ·~ hope. I never expected It to be this powerful.
risks, but It Is Lorraine's best and oJ11y hope.
have received a great deal of media attention. , _We've received support from people all aver
She has begun the ~gh dose chemotherapy Both WSLS-1V 10 and WDBJ-1V '?did filmed · ··the state and even out of state. but 1 flnnly
that Is prepartngherbOdyfor the bone marrow . nports on the family and their predicament. , .· beUeve that lflt wasn't for the good Lord all
transplantshemustrecelvelnearlyFebruary. · The Channel 10 report was re-broadcast In . these doors wouldn't be opening and we
'IhJngs were proceeding well untU she learned
Richmond just before Christmas. The Roanoke ,. wouldn't be getting all this help. •
Tfmes & World ·News also ran a front-page
In early December that her Insurance carrier,
Blue Cross/Blue Shield of VIrginia (BC/BS of story which has generated a numberofletters
The media attention has helped bring In
Va.).wouldnotcovertheABMTonthegrounds. to the editor and the story has appeared In . financial and emoUonal support from all
that It Is stW experimental and tnvestJgaUve. .,both a Covington and Richmond newspaper. aver the Roanoke Valley and the state. The
The Smuszes also learned that without lnsur· · Frank and Lorraine have also been the sub- Botetourt County community has been
ance coverage, Duke requires a $96,000 down ject of three local radio broadcasts In the past seemingly galvanized In support of the young
payment before the bone marrow transplant
two weeks. They were Interviewed on the Cary
.
(Continued
Page 2-AJ
process can begin.·
Minter show on WFlR last week. on a K-92
·~ ~
........
.
·· . . . . .
.
~
.
on
I
�!
I
~;
i!
Smuszes
people that we've gotten. I ~;ant to
thank all the people who have sent
cards and are praying for me and
who have sent donations - It's
been very helpful.·
Frank says the positive response
they've received has gtven hlm the
drtve to coatinue what has almost
become a full-Urne occupation. He
says he has become •focused· on
changing this situation for other
people. ·r really think we're makIng a difference,· he said. "We want
to help Lorraine, but we want to
help other people, too, so that they
can get this treatment when they
need lt.··
-'This has snowballed Into such
a big thing.· said Lorraine. •J think
It will help other women because It
has brought the Issue of breast
cancer to the public's attention.
Maybe It '111>111 make women check
their policies - I didn't know I
wasn't covered. I guess a lot of
good Is going to come out of this.·.
Frank agrees and ponders other
lhe"Smusz.es did ~cetve word questions, one of which he's
several weeks ago that a large brought to the attention of Del. Bo
donation that might pay for Trumbo. A major contention for
Lorraine's treatment '~~>"aS coming.. the Smuszes In their argument
.AS of this lwTitlng. no such dana- 'With BC/BS of Va. Is that other
. tion has been received and only Blue Cross/Blue Shield carrle~
halfthe do'~~>n payment of$96,000 In the country cover ABMT. In·
(which Is a third or le~ of the total eluding BC/BS of North Carolina.
cost of treatment) has been re- Frank thinks that II there are re·
celved. The rumor that has clrcu· strlctions keeping the North Carolated in the Fincastle area that lina company from bidding In VIrLorraine's treatment has already ginia they should be changed since
been paid for Is, unfortunately. a the coverage Is not available to
false one.
· BC/BS ofVa. patrons.
He also wonders II not covering
But the Smuszes are optlmlstiC:
and filled with hope that Lorraine's this treatment Isn't a dlscrlmlnatreatment may be a reality after toryact against women, though he
all. ·1 beUeve It's going to happen admits the potential number of
now,· revealed Lorraine. ·1 had women who may need the treat·
hoped we'd get some response but ment Is a large one and would be
never, never did I beUeve we 'llt"ould e.'Cpenslve for the Insurance carrl·
get the support and help from ers. He thinks that's '~~>·hy the In·
(Continued from Page l·Al
couple. In churches of all denominations, and In schools and clubs
throughout the county, donations
. . large and small have· been col. lected and deposited In the ·Lorraine Smusz Fund· at The Bank of
F1ncastle. TheChurt:hoftheTrans·
figuration, the small Fincastle
Roman Catholic congregation
J
where the Smuszes are members,
. has organized a ra.file and a le_tter
· Wl1tlng campaign to raise money
5
for Lortalne's treatment The~ Is
5
word o(a petition and letter from
~
Blue Ridge to ~/BS ofVa. urging
r a change In poUcy and a walk-a~
than fund raiser for the Smuszes.
I»
· As of Tuesday momlng. the~
) was $58,443.79 In The Bank of
It
Fincastle account and donations
e continue to arrtve dally. Included
• lnthatamountlsa$10,000anong ymous donation received New
Year's Eve, as well as countless
0
It other lndMdual donations.
T
e
~
s
n
e
t-
.e
;;
:s
[e
le
I·
;~
surance earners don't want to
cover the procedure despite the
medical evidence. ·a·s a money
thing: he said.
For now, Frank continues rallyIng all the forces he can to gel the
treatment that may save his wtfe's
Walk-A-Thon
to benent
sinusz fund
A group of Blue Ridge area
cltliens Is sponsoring a fundraising walk·a-thon to benefit
the Lorraine Smusz Fund.
The walk-a-than '~~>111 be held
Saturday, .Jan. 26. The
Inclement weather date Is
February 2.
.. Pledge sponsorship forms.
are available at The Bank of
Fincastle branches In Blue
Ridge. Fincastle and Dale\1lle.
at the Bank of Buchanan
branches In Buchanan and
· Daleville and at Royal Jewelers
In Valley VIew Mall. Roanoke.
For more Information or to
help. call 977 ·0426.
life and gathers Information for a
suit he hopes to wage against&./
BS of Va. He Is workJng wllh the
Alexandria attorney who success·
fully argued a similar case In federal court In April 1990. '
He laughs when he recalls an
Inspirational message scrawled on
a ·post- a-note• that accompanied
a donation several weeks ago.
·Hang tough·was the note's simple
message.
Lorraine and Frank Smusz have
taken that ad\ice to heart.
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�Roanoke Tames &World-News
GIN~
.DEATHSB2
•sPORTSB4
• ClASSIAED 88
WEDNESDAY MORNING, JAN. 9, 1991
·Treatment to start
for cancer patient
dures, but enough to persuade the
hospital to treat her anyway.
She likely will undergo the
FINCASTLE- Tuesday began bone-marrow transplant treatment
with Lorraine Smusz believing she in about six weeks.
was still $38,000 away from the canSmusz was diagnosed with
cer treatment that could save her breast cancer in September and
Jife.
·
learned in December that her health
By late afternoon, she had · insurance company, Blue Cross and
learned otherwise.
Blue Shield of Virginia, had denied
her coverage, saying that the proce"I'm a little shocked. I didn't dure was still experimental arid
think they· would do this," Smusz needed further testing.
·
said after learning that Duke University Medical Center had agreed
, Since then, Smusz and her hu.&:to begin treating her for breast can- . band; Frailk; ·have been trying to
raise enough cash to cover the bills
cer.
Smusz, a 33-year-old mother of themselves.
two, has received $58,000 in donaTuesday started as a typical
tions over the past month - still day.
short of the $96,000 deposit normally required by Duke for such proceBy MARK MORRISON
STAFF WRITER
:.Treatment
:.FROM PAGE 81
They spent much of their time
on the telephone, arranging media
: interviews to publicize their story
and appeal to people for donations.
They checked in periodically
with the Bank of Fincastle, where a
fund has been set up in Lorraine
Smusz's name. The total was up to
$58,000, but time was running out.
Smusz has been undergoing intensive chemotherapy since Septem.ber to prepare for the treatment, and
if she doesn't have the transplant
within the next six weeks or so, her
doctors say it cannot be done at all
and the disease will be terminal.
Then, they learned that Duke
had agreed Tuesday to accept
$58,000 as their deposit and treat
Smusz on schedule. "This will cer. tainly make us breathe easier,"
Frank Smusz said.
However, they will be required
to pay the balance, said Duke Cancer Center spokeswoman Stephanie
Bass.
Plus, they also will have to pay
any additional hospital and doctor
fees above the deposit. That total is
expected to exceed $160,000.
Bass said that Duke is willing to
work out a long-range payment plan
with the Botetourt County couple.
Still, his wife said she never
dreamed that so much money would
be donated. With luck, she had
hoped for maybe $20,000.
"I just can't believe it," she
said. "The money just keeps coming
in and coming in. It's like a miracle."
Meanwhile, a friend and fellow
Botetourt County resident, Vernon
Meador of Blue Ridge, has organized a walkathon to raise money
for Smusz from 7 to 10 a.m. Jan. 27
inside Valley View Mall. Pledge
forms will be available at all three
Bank of Fincastle locations, the
Bank of Buchanan and Royal Diamond Jewelers at Valley View.
�Roan~:l\e Times &World-News
GIN~.
:9, 1991
l
Treatment to start
for cancer patient
By MARK MORRISON
STAFF WRITER
.
.
.
FINCASTLE- Tuesday began
with Lorraine Smusz believing she
was still $38,000 away from the cancer treatment that could save her
life.
· . By late afternoon, she had
learned otherwise.
"I'm a little shocked. I didn't
think they would do this," Smusz
said after learning that Duke University Medical Center had agreed
to begin treating her for breast cancer.
Smusz, a 33-year-old mother of
two, has received $58,000 in donations over the past month - still
short of the $96,000 deposit normal'ly required by Duke for such proce-
dures, but enough to persuade the
hospital to treat her anyway.
She likely will undergo the
bone-marrow transplant treatment
. in about six weeks.
Smusz was diagnosed with
breast cancer in September and
learned in December that her health
insurance company, Blue Cross and
Blue Shield of Virginia, had denied
her coverage, saying that the procedure was still experimental and
needed further testing.
Since then, Smusz and her husband, Frank, have been trying to
raise enough cash to cover the bills
themselves.
·
Tuesday started as a typical
day.
~Treatment
~
~
FROM PAGE 81
.
.
They spent much of the1r ume
~ on the telephone, arranging media
~ interviews to publicize their story
and appeal to people for donations.
They checked in periodically
n with the Bank of Fincastle, where a
fund has been set up in Lorraine
Smusz's name. The total was up to
$58,000, but time was running out.
·
Smusz has been undergoing intensive chemotherapy since Septem. ber to prepare for the treatment, and
if she doesn't have the transplant
• • within the next six weeks or so, her
h.1 doctors say it cannot be done at all
w and the disease will be terminal.
In
Then, they learned that Duke
~~ had agreed Tuesday to accept
$58 000 as their deposit and treat
d Sm~sz on schedule. "This will cerse tainly make us breathe easier,"
m Frank Smusz said.
t
However, they will be required
I
PLEASE SEE TREATMENT/83
to pay the balance, said Duke Cancer Center spokeswoman Stephanie
Bass.
Plus, they also will have to pay
any additional hospital and doctor
fees above the deposit. That total is
expected to exceed $160,000.
Bass said that Duke is willing to
work out a long-ra~ge payment plan
with the Botetourt County couple.
Still, his wife said she never
dreamed that so much money would
be donated. With luck, she had
hoped for maybe $20,000.
"1 just can't believe it," she
said. "The money just keeps coming
in and coming in. It's like a miracle."
Meanwhile, a friend and fellow
Botetourt County resident, Vernon
Meador of Blue Ridge, has organized a walkathon to raise money
for Smusz from 7 to 10 a.m. Jan. 27
inside Valley View Mall. Pledge
forms will be available at all three
Bank of Fincastle locations, the
Bank of Buchanan and Royal Diamond Jewelers at Valley View.
----
___!
I
I·
I
�Smuszes· get
goo·g·.~e:ws,
Lorraine.· Smusz
..
. ·...
.
.
Walk·A~Thon
. The Lorraine Smtisz WrukA-Thon Committee will.meet·
at 6:30 p.m. Tht,~rsday, Jan.
17 In the library at Colonial
Elementary School In Blue
.•
Ridge. Anyone Interested ln.
helping with the walk-a-thon;
· which. wtll be held at 7. a.m. .
. By Kathleen Mo·ri-a-sioan
January 26 In ..Valley Vie\v
· ·.. · ·
· ·. · · u· · ·-• ..
Mall, Is Invited to attend. ·. · ..
. : F~~~tl~ ;~d=ri~\r.ink and . . . Reglstratio~
.the day;of
the walk-a-thon will be ~t the,
LOrraine: smusz had .some good
news late lastiTuesday when they
entrance of the mall·· near.
learned· that Duke ;University
Spinnaker's: .Sponsorship
Medical Center .will ·accept less
forms are available' at· all
than $96;000 as a down,'payment
branches of The Bank of Ftn-'
for bOrie marrow transplant that
castle, BankofBuchanan and
could save Lorraine's life.·. :.. :
at the Valley View location of.
· Duke· has agreed to work out a
Royal Diamond .J~welers. · .; ·• :
payment plan with, them, but the
·· Anyone linable to partlci- .
pate on the5Jay o(.the walk_.a-·. 1
'jo.ung ·couple'is :stUl.res·po·ilslble. ~
·
thon who would like to make a ·
for' paying for. the procedure In
contribution can contact The •
·
· . full--:-a :figure estimated at
Bank of Fincastle w.,_ere the· .. ASTLE HERALD.,~DNESDAY, j.AN, 16, 199:i-PAGE 3-A·
$l~~lh~.·
klt'(the'cha~·g~hiD~e·~ Lorraine Smtisz account has.
been established.
..
·
position) • said. Frank. the media
was· due to They have
. For more Information on· ·~ ' - - - - - - - - - - - - - - - - - : - - - - attenti~n.
receiVesl'·a great deal· of media·
the walk-a-thon, ·call 977-; _
04 2 6
·. (Contbiued on Page 3-A) r.:-::~"'!":·-~~-~~!!!!!!!!!!!!!!!!!!~.1
----rcontlnued &Om Page l~Al
the treatment ofbrea.St cancer as SmuszFund.
~osure In the last month as they •experimental and Investigative·
The •Lorraine Smusz Walk-A-·
have taken her battle with Stage . and refuses to cover il'
·Thon; organized by a committee
IV metastatic breast cancer-and
·Thanks to the generosity of of concerned Blue Ridge citizens,
her battle with Blue Cross/Blue people from all over VIrginia and will be held January 26 at 7 a.m. at:
Shield of Virginia (BC/BS ofVa.), many from outside of, the state, as Valley VIew Mall. The committee!
which refuses to cover her of Tuesday morning $87,974.30 will meet at 6:30p.m. Thursday 1nj
treatment-to the public.
·
had been donated to a special the Colonial Elementary School
I.orralne has been told by her account set up In Lorraine's name library and Invites anyone Inter-!
doctors that her only hope of sur- at The Bank of Fincastle: and ested In helping to attend. .
· vtval from the breast cancer that money continues to pour ln. Over
Meanwhile, I.orraine prepares:
has metasticlzed to her bones and 1.000 checks have come In and an herself for the treatment which·
liver is high-dose chemotherapy average of 50 envelopes a day-are · will remove from two to four quarts:
and autologous bone marrow received atthe bank for the Smusz · of her blood and bone marrow and
1
transplant (HDCT-ABM'Il. This account. ·
· ·
treat It with high levels of chemo: i
procedure is performed In leading
In addition to a donation, most therapy.
medical centers around the coun-. of the envelopes contain notes of
She has begun her third 21-day
try and has shown remarkable supportandencouragementwhich cycle of pre-treatment chemothersuccess with advanced stage the bank forwards to Lorraine and apy and Is responding as her docbreast cancer patients in recen~ Frank.
tors hoped she would. After this .
years.
MWe've had letters from doctors, treatment, she wlll be re-evalu- •
Although BC/BS ofVa. covers nurses, patients who have gone ated to see if she needs another:
the procedure for several other through the procedure-even em- cycle of chemotherapy before the '
forms of cancer, it views ABMT In ployees of BC/BS of Va.-and all HDCT-ABMT procedure begins.
are supportive; Frank said. Mit's
The Smuszes hope they can
been just incredible. •
raise enough money so they can
The larger Botetourt commu- sue BS/BS of Va. for coverage of
nity has really taken the cause to the procedure, but similar cases
heart. A raffle to benefit I.orratne, . have been averaging $30,000 In
coordinated by members of the legal fees.
Catholic Church of the TransfiguStill. the couple remains optiration in Fincastle, will be drawn mistic.
y this Saturday and has 'been very
MWe want to open the door for
:1 successful.
·
others, M
Frank said. MWe want the
Western Sizzlin' in Daleville Is public to be aware that there are
donating a portion of Its sales many women who are dytng who
January 14-20 to the Lorraine could be helped by this treatment.·
Quk.e. okays
treatment
ori
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�THE FINCASTLE HERALD-WEDNESDAY, JAN. 18, 1991-PAGE 3·A
Smuszes-----(Continued from Page 1-A)
exposure In the last mon\h as they
have taken her battle with Stage
IV metastatic breast cancer-and
her battle with Blue Cross/Blue
Shield of VIrginia (BC/BS ofVa.),
which refuses to cover her
treatment-to the public.
Lorraine has been told by her
doctors that her only hope of survival from the breast cancer that
has metastlclzed to her bones and
liver Is high-dose chemotherapy
and autologous bone marrow
transplant (HDCT-ABM11. This
procedure Is performed In leading
medical centers around the country and has shown remarkable
success with advanced stage
breast cancer patients In recent
years.
·
. Although BC/BS ofVa. covers
the procedure for several other
forms of cancer, It views ABMT In
the treatment of breast cancer as
"experimental and Investigative•
and refuses to cover lt.
Thanks to the generosity of
people from all over VIrginia and
many from outside of the state, as
of Tuesday morning $87,974.30
had been donated to a special
acc~>Unt set up In Lorraine's name
at The Bank of Fincastle; and
money continues to pour ln. Over
1,000 checks have come In and an
average of 50 envelopes a day are
received at the bank for the Smusz
account.
In addition to a donation, most
of the envelopes contain notes of
support and encouragement which
the bank forwards to Lorraine and
Frank.
"We've had letters from doctors,
nurses, patients who have gone
through the procedure-even employees of BC/BS of Va.-and all
are supportive; Frank said. "It's
been just Incredible. •
The larger Botetourt community has really taken the cause to
heart. A raffle to benefit Lorraine,
coordinated by members of the
Catholic Church of the Transfiguration In Fincastle, will be drawn
this Saturday and has been very
successful.
Western Slzzlln' In Daleville Is
· donating a portion of Its sales
January 14-20 to the Lorraine
Smusz Fund.
The "Lorraine Smusz Walk-A· ·
Thon." organized by a committee
of concerned Blue Ridge citizens,
willbeheldJanuary26at 7 a.m. at
Valley VIew Mall. The committee
willmeetat6:30p.m. Thursday In
the Colonial Elementary School
library and Invites anyone Interested In helping to attend.
Meanwhile, Lorraine prepares
herself for the treatment which
willremovefromtwotofourquarts
of her blood and bone marrow and
treat It with high levels of chemotherapy. ·
She has begun her third 21-day
cycle of pre-treatment chemotherapy and Is responding as her doctors hoped she would. Aller this
treatment, she will be re-evaluated to see If she needs another
cycle of chemotherapy before the
HDCT·ABMT procedure begins.
The Smuszes hope they can
raise enough money so they can
sue BS/HS of Va. for coverage of
the procedure. but similar cases
have been averaging $30,000 In
legal fees.
Still, the couple remains optimistic;.
·we want to open the door for
others; Frank said. ·we want the
public to be aware that there are
many wome11 who are dytng who
could be helped by this treatment. •
Smuszes g~t
good news,
Duke okays
treatment
By Kathleen Morra-8loan
atall'Wrtter
Fincastle residents Frank and
Lorraine Smusz had some good
news late last Tuesday when they
learned that· Duke University
Medical Center will accept less
than $96,000 as a down payment
for il bone marrow transplant that
could save Lorraine's life.
·
Duke has agreed to work out a
payment plan with them, but the
yo_ung couple Is still responsible
for paying for the procedure In
full-a figure estimated at
$16o;ooo.
.
"l thlnk·lt (the change In Duke's
position) was due to the media
attention, • said Frank. They have
. received a great deal of media
(Continued on Page 3-A)
Lorraine Smusz
Walk-A-Thon
· The Lorraine Smusz Walk-'
A-Thon Committee will meet
at 6:30 p.m. Thursday. Jan.
17 In the library at Colonial
Elementary School In Blue
Ridge.. Anyone Interested In
helping with thewalk-a-thon,
which will be held at 7 a.m.
January 26 In Valley VIew
Mall, Is Invited to attend.
Registration on the day of
the walk-a-thon will be at the
entrance of the mall near
Spinnaker's. 'Sponsorship
forms are available at all
branches of The Bank ofFlncastle, Bank of Buchanan and
at the Valley VIew location of
Royal Diamond Jewelers.
Anyone unable to participate on the day of the walk-athon who would like to make a
contribution can contact The
Bank of Flncastle where the
Lorraine Smusz account has
been established.
For more Information on
the· walk-a-thon, call 9770426.
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PAGE 2·A·THEJI'JNCAS:n.z ~~y~~pg~ f,:·~88l·.:
e
~ e t.t ~s·:.,·::~:::·' ·~:: ,~,,;f~Y·~\~~;r~~;t··:~:::·:.
, ..:,. . _. sin:USz :Benefit'
anee. ratses·. ove.r:;.~. J. .~·s.2·o. ~. :,;·_~· :· · ....
.
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•,•· •.
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•';
Edttor: .
,
· •. and Myrtle silnm0n8~ ·· •
The Buchanan Jaycees' benefit ·: Thank you to ev~ne- :who
danceforLonalneSmuszwasheld ·~ · contitbuted.
. · .· ··
· •:
Saturday, Feb. 2. A total of .
. ...•· - ·
Pam .Austin
$1,927.15waara1sedforthefund·,.
·. ·. · _:..;. BUchananJoucees
for Lorraine's cancer treatment.. .
· . ·., .. · :.:·.• (.. ' .... , -.
·
We arc gratef..U for all of the ..
~-_.
community support that helped to '.
n·~'
.I II'
make the dance asucccss.1banks
.
to the following, whose donauona · . ·' ·• · · -~ ·. ~i: ' •:· : ·.: ·,. · :-'' · .:.
weregrcatlyapprectatcd:Automo·
Uve World, Del's Supennarket, ·
· .. ' ,
· J .. . ·
Happy Food Mart, HilltopCroccry, _ ,. ·
·.~ ,;.: : . .'·t~ . .:. . ·.: ~.../
North Star Restaurant, Pepsi-Cola · ·: EdUDr: ·: ... '('. ··.:·; · ·; · :· ··· ··· ., ··:
Distributors, Perfect Stranger, .... AsoneQ(the.OWPersofthclocal.
Stop-In Food Store, Waskcy's M111; . Western SIZZlln ·st~ak ~ouse ln ·
Crocery, EPllly Barley, Dennis~ Palevtlle, I would like to thank our·
Dudding, Luther Hartman, Tom' · customers ~d staff for. the' sup··
and Nancy ·Middlccamp, IJll!an: porttheyshowedln~fund-ra!ser
Peery, Mr. and Mrs • .J.B. Preston,·; for Lorraine Smusz.:. · :... • ·
'· .
VIrgie Rothwell, Linda Wcade and·;. · We .were very happy wtth the
Usa Wright.
. ' ~., raults. Due to .the response, we
.. Also, a special thank you to all' · · an: able to donate $1,000. to the
of the ladles who donated cakes: ~ fund, We feel very fortunate to be.
Margaret Campbell, Betty Dud·': able to· contnblltc ·anct to. have'
ding, Estelle Dudding, Paullne': . such aupporUy~_C1.4'&Amers•. ··-··
Duke, Jane Klng,.Jane McRae,·: ··:.·CG.s.$andraAWCse·:·:·_. ,,·.·,. ·
.UlllanPccrJ,EllaPullcn,ElvaReed · :: :: ... •.:·" ..·;.J~~~--~-·.:~.· .-.- 1
.•
•
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>:·:::.-~:~.
t'i ·.-'··.'' ::·;·. · ·
I
·. ·
·We''s't'e r· s zz' n.
ra1ses $.1 000 ·
1
•
· ,. : . · .: \·.
..
.··:'><\.
Apprecta1C? fu.n.d . _h~Jt~:~.::~. -·:;_.: :.·~·:·.-: ·. :· : : ;
.
:
' ..
. .• ·. . . ·:, :~·· : •, -~
• •I':· .. ,. '~.
· . Edllor. ·
· .·
..
,: . me sh¥c ~e. spof:Ug~t ·~m ~rums
We would Uke to· thank eve I)'·, wtth you.) ' : . :. •_: ,.... ·...:' . ..
one who has been Involved In our' · : ·· Also, thanks to Vernon Meador
campaign to. raise f~nds for and the Blue ~ge Booster Club:.'
Lorraine's cancer treatmcnL :. . : · for putUng tog~thcr the walk-a··
So many people, buslncS&CS,; thon at Valley View Mall January
· ' · organizations and churches have 26; ancUlnally to the ucopla of the.
given us an Incredible amount o{ ,Church. of the Trans1lguraUon for:
support and love. We have been · .organJzlng. the raffle .w~ch. con·
deeply moved by your praycra and. eluded onJaJluaty ·-~-~;) ·:;·! . :-..-·: :. . ~
generosity.
·
· , ·· i : · . · · :- ,, : . · ·.- .: ; ~· · ·.· · :. ·
..
A specJal thanks to Ann Duke'. ·
AU of the~ CVCD.1.twenho.weU·
and the Buchanan .Jaycees for: · ~ were a huge a~ceM. ·i- =·.: · ..·. ..
orgaptzJng the benefit dance at · .. ··.:.four. c;onUn"ed .support. and
EaglcRockElemcntarySchoollast : 'prayera-.gwe·-~ the stre~th to
Saturday, and to members of' the, move; forward and. c~ em.-··. ! . . ·
band Perfect Stranger who played . :: \·: · .. '· ~.:.. Frank'c!t. ·LOrraine amusz
so well. Ob~ks, guys, .for lctUng, .· . '.-.·:·. ·: :···:.·· ..::····_1'; •• ~~ :-: -·· •• •B~fuznan
.
.
..
·-----
-·-- ··--------.. -· ..
.· ··. ~ Longaberger Baakct opel\
house Frtday, Feb .. 8 W1ll ~ne·
. fit th~ Lorralpe smu~ Fund.:
'All profits !roll\ the open ~ouse.
:wtll go to .the funct ltla.t wtll' help pay for c:ancex: ~rea~eot.s
for Mnt. Smusz. . :· · · . .
;· .The open house W1ll be l)cld
!rom .5-e p.m. at Trinity Epta· _
· copal Church, M~ Street;
Buchanan.
. -, . · ~ .
···, •.''lbe 1991. Eaater'~tt.i
· and special edtuone .for:
Mother'• and Father's Days.
._ an4 ,JW Cpllector basketa wll~
. be·Qn dleplay along ~th the
. complete llnc of regular baa•
.
.
;
.
. ..... -.' .. - . ~. A signed medium key bas·
ket .wtll a1ao be ranled _with
-~"'· .
.. procc;cd~
t~
go to the .SmWiz
:fund.:,._ · ,,. : .... · \ · ::'·
:! ·· ·
For more lnfonnaUon, con·
tactClorlaCarterat254·1443.
Dot Canon at 254·1091'· or
-Marg~t Anne. ~mlth at 254~
).~~: .• ;. ::
!
: _. ;·..i: ~~,.~·.
.:~.,
,_.
'
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.. ,_·:.: .::'_i:!~:.
·.! !· r:· i•'· .. ·
·/·~·.:
f.
'
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aau,.-:' ·:; ·
•:
•.,..
,,
~·:'·_:·~- :.~ •. :- sJXLusz
,;: ·,ft. rally has been planned. to
aupPQrt Lorraine Sll)u~·s.and
.pther breast cancer vtctlma'
di'Qfta to have Blue C~s/ .
.Slue Shield ofVlrg~ pay for
.ABMT cancer treatments. . .
- The· rally wtll. be held Mqn~·
day, Feb. 11 from 11:45 a.m.
to 1:15 p.m. on the sidewalk 1n ·
front of the Blu~ C~s/.Bluc
... Shield buUdtng at the comer
of Jc1Tcrson Street and Fran~ ·
1 kiln Road tn d~wr;ttt;)~n
~~~6-~·~,a1~~ 'stitcid ~~
Vlrgtnla docs not cover ,f.BMT
. for breast cancer. ·· . : · '
-''' For ·more lnfonnaUon call
473-2542 or 992·0219. Rain
date ta February 13.
----· -·-· ---- ·--· ··---
. . (·; . ... ,.,·:\\:~·: \::::··; <:'·;'/~~-~: . ·-.:-..
WEDNESDAY
rhe :FinCastle. Herald
Botetourt County News ·
FEBRUARY 6, 1991
35 CENTS
(USPS 160-680) Fincastle, VA
· Volume 126 • Number 6
2 Sections •14 Pages
Plus Supplements
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�.... ~-· ... ·-··--- ·--·----- ..
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-·---.:
. ·!.~~iiestifle~, t~ Value. ~f B~~e-Marrow.Transplant
~
I
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..:
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llofraine Smusz's life is in jeopardy .and 6 years old).
· :.
· \' t>eeause· Blue Cross/Blue Shield of ~ ·... ·An ABMT is not an 11alternative" .:
.. Virginia has refused to cover a 11State ~ . :.method but a federally regulated .
i of me~ art" medical treatment for dis~·'· :. clinical trial that has been reviewed .:
:~ semU1ated breast cancer : that has·::·.· and implemented, based
success- ~
! beeir'documented to have a response ·: ful lab studies and lJtandard treat- :.
{ r~~~ver the l~st few. years of so.:·.·..ment. '
. .
. .
:.
. \ · petcent and is bemg implemente~ na-·.; · Yes, there are risks, but ones that .~
I tio'ff<Vide with t~e financial support of ; · are not foreign to any cancer victim. ,
·l inslirance· companies, including Blue ... .In retrospect, those rises are dim in- j
\. Cro~si Blue Shield outside Virginia. . . ishing due to the enhanced manage- ;
.:
:r.HtABMT (autologo~s bone ~ar~ · ment of these potential problems. · ·:
ro:wJ~ansplant) that I underwent this .·
~ cancer _victim does not ha~e the ·.
...; p~~s~mmer,. after a five-year battle option of bme. A woma~ dymg of .•
1
with 1:ireast cancer was advised· as. · cancer should have the cho1ce to take ,
·
m~:1iest chance f~r prolonged ,life~· the ultimate. risk for life:
;
... . anCI ·possible 11cu~e." .. .: . . · ·· .. . ,. ·. .
. PAT HORRELL, R.N •..
.J.. . ·. · .\am healthy today because of the· Chester. : .·
•'
optimal health care received and the . . <· Editor's note: The Associated .:.
j . fin'ancial suppor,t ~f my heal~.lnsu,r· ... Press news story c~cerning th~ case ·;
llj. . ance company.
·
.
. · · . . of Mrs. Smusz, whach appeared m the :;
N~·
If and when I metastasize agam I · earlv edition of the Times-Dispatch ::
. /. · .
will .be ext!emely thankful for .the·· Jan. · JO, quoted Blue Cross/Blue ·:·
/l. .. q~j\Uty .of time the ABMT gave me, .Shield as saying it denied coverage .1
· ....:~ ;-.--an<l1/·I·may die I will have a peace •.. for 'the· bone-marrow transplant .:
· ' :·. th,'\~,J, did everything availa~le to be·~: treat~ent because- the proce?ure ~ .)
(f':_. . ~ . V(Jf&.,!f.lY ~~~band _and two _ch1ld~en. (9 expenmental and needR te.dmn. · . I
on
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'l!$d-'l-/91
/lf.R- r4/...cJ
Booster clubs ,raise. 1,300
for: Lorraine :::srnu·sz· fuo9.
.
••
.
.·•
.
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• • •·•
j,
•
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•
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Ftveofthe·~~~s~utlts~~-·: wa8donated.bfHoldren's.Inc. tria:
booster· clubs ..·have raised over. drawingheldM!)ndayntght. Renee
' $1,300 for: the: Lorraine. Smusz Noch of Roanoke won .the $1_00 .
Fund to help pay for her autologous secC?pd.,.prlze ·and,.H.& , Haga of.·:
· bone marrow ~plant .(ABMn •.· D~~e;~n the $50 third.. prize. .
Mrs•.SmusztscurrentlyatDuke
·:Persons :~ho want to mak~;
University going through.· .the co~trtb.uttons to .the ·:Lorraine··
· transplant .. whtch·:.she: and,.her .. s~usz: Ft.m.d·can stUl . ~Q .. so by
famtly·hope~wlll ~st the breast:.· sen.~git!OLorralneSn.tuszli\tnd,
cancer.that has:threatened:.her:;. c/~.B~!~..of..~cas~~!;:rtD.~tle,,
life The Fincastle mother·.·oftwo 24990~,.·'::::'
::: :.:· · ·., . · ·:· ~.:,·:
and hero•husband;:·,Frank. .•have . · · · '• ;,·.
···
benefitted fi:om fund-raising efforts ·
that. are .helping.;pay· .for 'the '
treatment. which <'Is ··expected,. to: .
cost as much as,.$180;000;,;1be __:
•
faintly's health li:lsuranee has ilo.t ·
agreed to pay. for... the:;~a~~nt-1
· because it._consi~e~'!il:' ~rio::: .
mental.·.
\i:·--! .l .t ~~~ ~ ~ i... . -l
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ROanoke Ttmes &\\oi'ld·Ne\\:,
T
lliDEATI-iSB2 ·
.. SPORTSBS
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~IOAY MORNING, MAY 17, 1991
Coming home like a tonic
By MARK MORRISON
STAfF WRITER
FINCASTLE - Each day is
getting better for Lorraine Smusz.
She's home now, after spending
the past seven weeks at Duke Uni· ·
ve~ny Medical Center undergoing a
dra~nmg and controversial cancer
treatment.
.
And although her doctors won't
know Probably until August whether
the treatment was a sqccess, they say
her chances look good. So far, she
has responded well.
·
Smusz says it just feels good to
be hack home in Botetoun County
She arrived home on Mothrr's Day: .
It feels good to see her kids,
Brian, 5, and Kevin, 2, and it feels
good to get a good .night's sleep
again, she said.
It feels good, even ifshe doesn'L
Weak from the bone manow
transplant and intensive chemotherapy.treatment she endured, Smusz
said between naps at her home outside Fincastle that she didn't count
on being so tired.
"I thought I would need help,
but I didn't think I'd be completely
out of it," she said. "'I can't even
take care of my son at all."
Nor can she work in the garden
som~thing she had secretly
hopmg to do soon after coming
home. Instead, she has been sleeping
about half the day, while her mother
or a neighbor, Terri Vass,· watches
the kids.
.
"I'll ~ust have to put everything
ofT and JUSt recuperate· this summer," Smusz said.
Still, she said she is feeling a
little strongerwilh each day. She has
been forcing herself to get out of bed
twice a day and t~ke shan walks.
Monday, she made it around
the yard only once. By Thursday,
she sa1d she was up to two laps.
"That's the only way you can build
yourself up."
·
.
Mean,while, she has been enjoyIng her children. and sleeping in her
own bed again. '"We have a water
bed here," she said. "I kept looking
Cancer patient Lorraine Smusz came home from th~ Duke University
forward to that water bed." ·
Medical Center.on Mother's Day to a house full of balloons and signs put
PLEASE SEE HOME/84 up by sons Kevrn (prctured) and Brian.
been
~iaiiijiiiiiiji-===-------------.=SECTION &:
Home
FROM PAGE 81
Getting to see Brian and Kevin,
however, has been her favorite thing
about being back. Their homecom·
ing decorations are still hanging
throughout the house, even though
many of the balloons are beginning
to shrivel.
For :.ix weeks, when she was
confined to an isolation unit at
Duke, she didn't get to see them at
all. She only got to see her husband,
Fnmk, and a few other family mem·
bers, and they had to wear gloves,
masks and hospital gowns.
Smusz was kept in isolation to
protect her from infection - a potentially fatal risk that bone marrow
transplant patients face because
their immune systems become so
weak.
..Frank would come up to visit
me and we would watch movies all
day," she said. "We could be movie
critics now. we've seen so many
movies.''
She gave thumbs up to "Ghost"
and "'Driving Miss Daisy." And
thumbs down? "Those movies I
would sleep through," she said.
Although nervous when she
fim got to Duke, she said she always
remained confident. '"I never
thought I wasn't going to make it,
not even for a minute.
"I iust had faith that God sent
me theie and He was going to get me
out of there," she said.
What got to her more was the
air-filter system in her room. "It was
so loud, it would drive you crazy. I
think that was the worst part, that
fan."
From ilere, the 33-year-old
Smusz will have weekly blood tests
to monitor her progress. In the late
stages of breast cancer before the
procedure, she now has a 68 percent
chance of going into complete remi,..
sian.
She and her husband also will
continue to battle Blue Cross and
Blue Shield of Virginia over whether
the company should pay for the procedure.
The health insurance company
has denied coverage of the treat·
mcnt, which it calls experimental.
Citing many other insurance
carrien that cover the treatment,
Frank Smusz said he hopes Blue
Cross of Virginia will change its
mind. Previously, he said they might
sue Blue Cross. Now, he's not sure.
••J want to give them the oppor·
tunity to come around. Maybe
they'll rt..evaluatc their position and
at least start covcrina this on a caseby-case basis," he said.
Either way, he said, they will be
covered for the bulk of the treatment
costs, thanks to nearly SI 30,000 in
private contributions.
Most of that money was raised
aner Lorraine Smusz went publiC
with her plight shonly after le"';"ing
!.
that Blue Cross had denied her cov.
erage. She hoped that by telling her
story, she might be able to help other
women who also needed the treatment.
The story generated interest
across Virginia and elsewhere. The'
even received calls from "60 Min'utes," "48 Houn" and the Nationa:
Enquirer.
She said she has no regrets
about all the media attention, but
she is looking forward to life gettin~<:
back to normal.
~
The telephone rang about then.
It was her neighbor asking who was
going to pick up Brian at school.
He's in kindergarten at Buchanan
Elementary.
·
Lorraine Smusz liked getting
that call.
"Things like that, it makes you
feel nonnal again. It doesn't make
you feel so sickly."
�· .... '·
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.~.a.
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-~:·:: ··· ·THE-~EDITORIAL ':Health ins.urers 1
·:In black:_liats,'.' J_uly 15,.Is a pathetic at- 1
' temp(to lend credence to Blue Cross/Blue j
·}Shield:s/deriilil oU.:Oriaine Smusz's treat~ I
.-·~··:Jr:~!~~~~~~I~~i5~a~~i~ i- ·
, : of its·.costs· and the demands made on it. I
.
~~. O~e.reason. cpsts _have 'risen is the gread~--
.:.•,. stndes ·:~ad~~,by .._medical techno~ogy." \
1; ~~~~~ a,re, ~ing ·denied that have
})·~~e.n:.ll!~~lf.Jor.,years,: ,.., ....~.> .. ,,....,•;, ..
. .". :: . .. ~!= insurers are legion of Scrooges '
i: an~ (iends.l wanted to find a cheaper way 1
a
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to treat iny problem and found a form of i
. treatment that· could· be documented as
c· far back as 1953. New not by any medical ,
, ::':•:.standard. or-lay01an's stretch of the imagi-·:
1
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.-:,::J:(iiif'i' I think my benefit was denied primar- 1
-~,~'ily'because it.involved an inpatient ad-·:
::;:'.JlliS~iori and they thought I had ~o othe~r ',
. /·recourse. Well, guess wh.at: I did have
· ·,-,.another recourse .:..:.; several, much more
costly than; the one ~ey had initially :
agreed 'to pay· for and then backed out of. ·
:n~ nation does.not need a unified, .
coilipreliensive' system· to' provide a de. cent level of health' care to all Americans:
· it needs io_ have a toially revamped insur-
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cent.of those;who •get the treatinent,l
will~die :from its. effect5;',he said;\<
: ·;;•~The jury.'-is':still.oui. .-we~are';
not - being '' '. .
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they·have,.:to. be willing· to pay ithe·.:
higher''preD:Uunis'·.that.·would}'go}
along'\vith : it; MatheW&-~ added;i:;!;;~.i(
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who'. already."&re:· fi81iting:·a:·-life:'
threatening 'disease·fshowd not '-be ;
forced·to fight)n'eourt~for insur- ·
. ance coverage..·' · . "Time is not ·on the side. bf..
anybody but the insurance compa:·.
nies,,. said Frank ·cowan, a· Rich-·.
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·. Raising·awareness
· Loi'ralne Smu&Z (left) and her cousin, Therese.Sisaon, lead about so pickets. outside the
·A~oke headquarters. of Blue.Cross ind Blue·shleld of VIrginia on Monday.· Smusz rieeds
. to undergo an autologous bone marrow transplant as a treatment for breast cancer.
However, the Insurance company considers the medical procedure to be experimental and
won't cover the cost. Friends of Smusz have raised $119,000 to pay for the procedure at
Duke University Medical Center later this month.
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Richmond Times-Dispatch, Thul"'day, July II, 1991
Insurance sought for experimental cancer therapy·
By Jean McNair
Allodaled Press writer
Lorraine Smusz's cancer is gone for now, but she's
still lighting.
Her enemy is not the disease but the insurer that
rdused to pay for ber cancer treatment.
Mrs. Smusz, a mother of two from Buchanan, was
among a parade of cancer patients, physicians and
lawyers who spoke yesterday at a public hearing before the State Corporation Commission's Bureau of
Insurance.
The bureau is studying whether to set up an appeals
panel for cases In which patients were denied coverage
for treatments that insurers consider experimentaL
Mrs. Smusz, 33, was diagnosed with advanced breast
cancer last year. Her insurer, Blue Cross and Blue
Shield of'Virginia, would not pay for a treatment that
included high doses of chemotherapy and a bone marrow transplant So sbe and ber husband, Frank Smusz,
went public with their plight and raised $130,000 for the
treatment Last week, doctors told ber sbe is cancerfree.
Mrs. Smusz scolfed at the insurer's contention that
the bone marrow treatment has not been proven safe
and effective.
"When you have a terminal disease and you're told
maybe you have only a year to live I don't see how
safety comes Into it," she said.
Her story was echoed by other women wbo told,
sometimes tearfully, about learning they have breast
cancer and then finding that their insurer would not
pay· for the treatment they wanted.
Many of their comments were directed against Blue
Cross and Blue Shield, the largest insurer ln Virginia.
Patti Goodall. vice president of the Virginia Breast
Cancer Foundation, said sbe would like to ge_t the bone
marrow treatment if ber breast cancer spreads but ber
insurer is Blue Cross and Blue Shield.
"When I need my insurance company the most ...
they literally will be able to band me a death sentence,"
she said.
·
Roderick Mathews, a senior rice president for Blue
Cross and Blue Shield of Virginia, said the procedure which can cost $100,000 or more - is still experimental
when used for breast cancer.
"Last hope should not be confused with standard
medical procedure," he said.
As many as 20 percent of those wbo get the treatment
will die from its effects, be said.
''The jury is still out We are not being unreasonable,"
be said.
U patients want the coverage, they have to be willing
to pay the· higher insurance premiums that would go
along with it. Mathews added.
Mrs. Smusz said Blue Cross and Blue Shield companies in other states cover the treatment Patients wbo
have sued the insurer In Virginia for refusing to pay
have usually won, be said.
·
Other speakers said patients who are already fightIng a life-threatening disease should not be forced to
fight In court for insurance coverage. The patients'
health can be jeopardized by lengthy court batUes, said
Frank Cowan, a Richmond lawyer. ·
'Time is not on the side of anybody but the insurance
companies." be said.
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~ush ·superior
lresident, but
sunappr~i.ated
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years .. lfyou.need.mediCal care; you pinch
pennies to pay your own.or you don't go to
the doctor. I can . sympathize ·With .the
Vietnam veterans' plight. My brother
went to 'Nam twice; Now he is retired
military and can't afford to pay his own
telephone bill so I could call and wish him
. a. merry Christmas and. happy new year.
I think.it is time for the honest, upright, working, tax-paying lJ .S. citizens to
call on our leaders to make some changes
in this country. Enact new laws concern. ing govemment.programs and give back.
io the people what they have worked and
-paid for.
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I do feel very strongly that we.as people·~·:
and America as a nation have taken a··;-.:: '
wrong tum when $96,000 wins over a=~ l
person's life. It's good P.R. when the :;~ 1
United States is always there to help other ·:: •:
countries and their people in need. What . : ·
hurts is to find out what really takes prior- : ;
ity here at home. If our people die from : :
lack of medical help, what happens to .. : !
America?
~: 1
LARGE part of th~ Ameri~ pub:
, does: not appreciate what a· treasure
PANSY NEWCOMB . ..: :
by have in George Bush as their presiTROUTVILLE ··• i
nt..I would put him up in the top six of
. ~~ I
~,,. I
ir presidents. He is a real relief from the.
... :
t of paper tigers we have had in .the
··'"-4;
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esidency the last 40 years.
SARAH L FURROW
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; · In intellect, training, experience, edu.
ROANOKE
-- !
ition and savvy, he is head and shoulders
love any recent office-holder: Of course,
hen any man's ability raises his head
rn· s··· ·s··m;. ·re_.s·p-.onseto Ro~erCiark's ·
...
1 1
>ove the mob; you have the usual parade
WAITE
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f
letter Dec. ·12. There is nothing · wrong ·
. second-raters with their tar brushes and
Letters on public issues are welcome.
"th
t
b li
·
!B guns rushing to the attack. ..
They must be signed. Please include
WI
pro estmg a war a person e eves IS .
/ Now for a suggestion to really scare
full address and, for verification only, a
wrong. It is one of our constitutional·:
veryone: Let's say we tum the governing
telephone number at which you may
rights.
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f the country over to the vocal opposibe reached during the day. All letters.
..My fiance, his twin brother and my
-""•tt
of
l
.'on • ·Let's · ·appo"nt a co.......... ee, say. of · · are edited. Because of the volume ·
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. friend's fiance have all been dep.loyed to
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D
· ·· to ·
·letters at times, not all letters are' · ·' · ·
l'ilder, KennedY and ., e·concmt, · be
i'
the Mt"ddle East. I can say.fi·-t-hand the~
·
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h·
published. Writersarelimitedtooneb t guns. Th
military want to protect the ... ~
country, but
··e apbli t ey are otltstan mg eac 1m
'
W"ld ·
ail b"l"t
letter !n any t:U'\ .... period. Letters
uv-uay
11s pu . c s ance: 1 er m av a 1 Y..
should ·not exceed 200 words. :n·. '· . .
, morale is:·very low- because they have no .. ·
. rotation date to look forward to and be- ·
1te~n~dy for stupidity and DeConcini for
1up1d1ty. · . ·
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· Lettertotheeditar
.cause they are not really sure why they are
i . .-The country would pray for there.•. ,.. _., . P.O.Box2491
..___ _.,
there:,Tbey.wouldbefightingonbehalfof:~
!Urn of Bush in the wink·of an eyelash.
., , • Roanoke,Va.24010.:. , .·
acountrywhosewholewayoflifeistotal- ~~
Let's not nit-pick the mari. to:death and ·
... .
· ly opposit~Jr.olPo o~. TJley ~n't pro~on.d~~e~s him to our:sorro~. .· . ' .:.... --'-----------"-----'-_- .;..:;"""--' ;.· .. tecting our,.country, only: our ~nomic;; .
::.-·
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in.terests. · . .L, ..• ·., .
·
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GORDON T~ HILL · ·
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:.. ··'As for oil, enough is bemg produced·~
'·· ·
RoANoKE.· .
to make up for the oil we aren't' buying .
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from Kuwait and Iraq. Maybe we could be ·• ·
a stronger country if the military was actu- ....
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ally protecting America at home, and we -:
REGARDING the Lorraine Smusz . started using the oil we have in our own ~
story (Dec. 27): I cannot believe a large country and/or developed other energy_
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facility such as Duke University Medical resources· instead of dep~ding on other- .
A RECIPE for an easy and better life: Center would 9r could put a price tag on a nations.
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Don't .ev:en work and pay taxes or Social · human's life. What. good. do~s. medi~ ,
·~ :: USA LEVINE ':
expertise do mankind if. we cannot afford
Security.
.
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HOWNS
If you are single or married and you it?
1 have ·children, and their father doesn't
Excuse me, but I thought the idea of
, support them, take him to court. If you are having such a facility and the best physiworking, the judge will tell you to go to cians available was to help people, not to
Social Services. You probably would be sell a name or a product.
; better off if you did.
Yes, I know there are financial re·
Now if you don't want tlte taxpayers
I THOUGHT if there was to be a _
I· to support your.family, you gc;> on back to sponsibilities; you can't eat or spend char- \
work. When you work 35 or 40 years to itY ·or. human kindness. Medical. sc~ool Christmas miracle, it would be for Baby · .
I support your family and you are too old has to be paid for, and malpractice premi- Isaiah. to live. He _missed out on Santa ·~
I and sick to work any more, you can exist urns, and last but not least, the.ccist of all Claus, he missed out on life. It breaks my~,
J
on the Social Security you have earned -· the bureaucracy. It just seems to me we've heart that his parents had so many op, which is much less than if you let the lost sight of the point of health care when tions, but decided to throw him out like
taxpayers support you.
it becomes out of reach .for the people who trash. What if their parents had done that
·~
You also don't qualify for anything · .need it (regardless of their finan~al sta- to them?
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except your own Social Security, but they tus).
DONNA TATE"'"'
will help you find a job in your retirement
I don't claim to have any answers, but.
VINTON.,;
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Military's ·morale
in Mideast is· low·
1
Losing sight of.: · ·.·
Return what people ) health care's point
Ihave worked for
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Isaiah's parents
had many options
·a
Roanoke T1mes &World-News
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· , . . SECTION C
�---- How well do we
share peace in
our own circle?
-.::N .
·--....
YOUR EDITORIAL the moiuing af.
ter the outbreak of war stated: "Humanity
continues to kill to resolve conflicts. An
evil defect resides still in our nature,
thwarting human evolution toward a
peaceful world."
We appear to have an enormous ca·
pacity for creating and "handling" suffering, but a very small capacity for being
truly peaceful and joyous. Even when we
say that we can stand no more pain, ironically we not only handle it, we also spread
it to others.
We suffer because we cannot get what
we want, or cannot make it last, and because we are so disdainful of unpleasant
situations. We know, deep down, that we
cannot expect to satisfy our wanting, yet
· we seem controlled more by our wanting
than by our appreciation.
When we awaken in the morning, do
we have peace of mind? Are we happy to
be alive, do we look forward to the challenges of the day, do we feel that we have
something worthwhile to offer? Are we ·
grateful for our warm bed and house, our
loving mate beside us, our progeny
around us? In our words and actions, do
we say ..good morning" to ourselves, our
family and our neighbors?
Or do we share anxiety, frustration
and impatience - all aspects of our fear
to face our responsibility for our own
lives? Do we see that our happiness and
unhappiness are the fruits of seeds we've
sown in the past, and that we are sowing
our
tan
the seeds of
fut~re .suffering and got his statistics. Duke also
pinpoint·:
peace?
the cause of failure for each person who
. Perhaps tonight we can take a break does not survive. Duke has altered its ·
from TV coverage of the war and see bow . procedure, based on those who have not·
well we share our own· resources of peace- survived the program, and the currenr·:;
fulness and patience and caring with our- cancer-free rate is much closer to. lOQ~~
· ··
selves and with our family. We don't need percent.
to depe,nd on our technology, our troops,
We take exception to another po~r:
or our pre~dent to bring us real peace.
by Dr. Lougheed. Our mother recently. :
.JACKSON METCALF .JR. completed the program. The $160,000 ~
SALEM · cost is certainly well worth her life. Had:·.
she not gone through the program, she was
· almost guaranteed that cancer would recur; only the second time, it would be.
fatal.
·
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Dr. Lougheed would lead you to ~··i
lieve that the success rate with .l»reast-can-.:·:
IF NO PERMANENT solution to the cer patients is not as high as in other' I.
Israeli-Palestinian problem can be accom- cancer patients using this treatment. Ac~ ~:
plished, then a defeat of Saddam Hus- tually, it is used for many types of cancel'$~·::
.sein's troops will be just a military victory. Breast cancer actually has one of the high;;·7;
1 don't see that the Bush administra· est success ~tes for this treatmenL
·
tion has been or is interested in the
Finally, many insurance comparue~ ·.:
long-range goal of a permanent peace in have approved this procedure, including~:
the Gulf region. As long as Bush does not Blue Cross/Blue Shield of other states. rn··.~
overcome his obsession to beat upon addition, those insurance companies that"•"
Iraq's troops and to kick·Saddam's ass, as· have refused to pay have· often been·.~·
Bush put 1t, the ·effort of a half-million · threatened with a lawsuit and have subse- ..
young men and women to bring a lasting ·quently agreed to pay. ·
peace to the region will· be in vain, and
nothing will be accomplished but keeping ·
MARY·MARGRET KOBALL.;,
the price of oil down. .·
·
HEATHER KOBALL.4,
. . Only if we are able to bring a lasting
BLACKSBUR~.;,
peace can we also claim to have won the
·war. And only after we have dealt as effectively with our domest.ic wars, including
the crippling economic, f10ancial, social
and educational problems that beset this
nation, can we claim superpower status .in
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the new world· order. If this nation is
THE CLOSING sentence of a Jan. 26 ..:.
neither willing nor able· to tackle these
problems, the defeat of the Iraqis will be a editorial, "But safe sex is one thing; safe .. ,,.
shooting is something else,''· is. a vacuity •·,
Pyrrhic victory•. ·
parading as a profundity. There is no such--·
HENRY W. TIELEMAN thing as "safe sex" because there is np
· .
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RINER such thing as safe sin. ,
u.s. must seek
a lasting peace ··
Vacuity parading
as a profundity ·
.
WRITE
Letters on public issues are welcome. They must be signed. Plea& in· .
elude full address and, for verificat on
only, a telephone number at which ~ou
may be reached during the day. Fer
faxing letters. the number is
(703) 981·3391.
All letters are edited. Because o
the volume of letters, not all can be
published. Writers are limited to on~
letter in any 60-day period. Letters
should not exceed 200 words.
Latter to the editor
P.O. Box 2491
Roanoke, Va. 24010
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(Of course, the sex act used with fidel- . _.,
ity within a monogamous marriage is not .; :
only safe; it is also sinless and beautiful, :
pleasing, to God who created us and en-·:t
dowed us with procreative powers. But~·~
that is no~ what the phrase "safe sex" has·;;;
. · TWO PERCENT of the participants come to mean these days.)
of the cancer treatment program at Duke
Safe shooting is a
University survive, says Dr. Marvin activity, although beingdistinct!¥ possible ,
shot at 1s bnzard-:r,:
Lougheed Oetter, Jan. 14). That is acuri- ous to one's health whether on the streett: ~
ous statistic, considering Duke predicts an
80 percent success rate for all participants of Roanoke or the sands of Kuwait. Your~~·
comparison of safe sex to safe shooting···.:
in its program.
makes as much sense as comparing the.::
Compare this to a three-year cancer· mythical griffin to the camel, a real if · ·
free rate of only I 0 percent of patients somewhat preposterous creature~
with the same type of cancer who have not
GERALD L. &RUNNING.::.
had the benefit of Duke's program. This ..
THAXTON._..
makes me wonder where Dr. Lougheed
.Duke has high , .
·degree of success·
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Islam's glory is more than .material
By NABIL F. AL.AMI
R.E. KNODEL Jr.'s commentary Jan.
24 only adds to the misunderstandings and
stereotyping of Arabs and Moslems in this
country. The ~evc:rcnd from. Grace Onho-
Abraham is a cornerstone of Moslem be·
lief. The continuous existence of Moslems
and Arabs for the past 5,000 years in all
the land between the Nile and the Euphrates rivers is in fulfillment of God's promise to the descendams of Ishmael.
their belief in the one uod and his eternal ;:
laws as revealed in the Koran. Islam · ·
means to submit or to surrender to the ..
will of God. Its doctrine is only a continuation of the revelations and teachings of
~artier prophets of the Old and New tes·
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..·,:·.' ;.She'~. a little. tired· knd ·• a little .··weeks -~hether Lorraine is c~cer
;·:.: -
'}:pa!~.;lU}d n_eedstoput!)ackop. the
·>free: ~d her husband,!.Frank.,
· · 20 pounds she lost, but ·Lorraine who has become an expert ~m 'his
Smusz is ·alive ·arid home at last. ··wife's disease and. has, been her
~t: ., Jbe--33~year-·old mother of two .greatest ·champion.· "With bone
~ .... came h~me from Duke University :involvement;. it's har'd to tell: the
·,,,Hospital late· Mother's Day after- pictures (CAT .scan, X-ray). don't
1.'' noon'folloWinganautologous bone . always tell the whole story.·:
... · inarrow1 transplant (ABMT) that
Mrs. Smusz knows· she still has
: - kept her in' the medical center for a' long road of recovery ahead of
.· eight weeks.
.
. her. "Each day I'll feel a little
· ,..·.·~It·f.eels si:>·good to be'home/ ··.stronger, but.tl1e doctors. said it's
said M:rS. Smusz.'.~e kids are so· : going to take a while, some,times
· ; · happy. that I'm here ..~ .
· up to three· months, to get back to
· . , ~Th,e.youhg mother .underwent normal.· .
.· ·......-~ ·
· · . the ABMT" as .her. only hope of . For now, she Is basking in the
. ' combat~g~the·. Stage.IV metas-. · feeli~g ofbeing home-being .tpere_
tatlc breast cancer .which had when her children wake·up in the
· , Jnyaded her bones and liver.
morning and sleeping in· her own
· ·::--: ·she;ll.ha'VetoretumtoDukefor bed.·
·
.
· · .... ·
·
Check-~ps every six .weeks and · ..... Home looked'a little different to
will have blood tests at the Cancer herwhen she arrived there SunIIUI4e.-lt hcline from Duke UDiver.ltY bl·tlme to. Center in Roanoke each week for day. As a surprise, her two brothIM41)UleJ:.!S Day. With her is husband, Frank.
the foreseeable future.
· ·
ers had completely redone the
: ); '.;: · · ·
.
·Benld Photo/Kathleea Momao&loiiD
"Tlleywon'tknowforatleast 12
(Continued on ·Page 2-A)
. . .
.
.... [.
,.
'
.• 1,,-'
.
.
Smusz---
..
cconthtiU:ci· frOm Page l~Al
exterior of her house With an insu·tated ·siding;·_..._,·
· · · _,
'
· She Is beginning to think about
the future ·. agam ·and ts ·hoping
she'll feel 'Well enough. to take a
beach vacation later in the summer with her family. But for now
she Is content.
"I'm just glad I'm home," she
said.
·
•
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�The Fincastle H
Botetourt County News
Reviews mixed on middl
By Kathleen Morra-Sioan
&t&ft'Wrltcr
nltlal reaction to the county's
posal to put middle school
dents at James River High
aool (JRHS) has not been favore. according to the PTA preslats of two of the elementary
aools that would have sixth
.des a1Tected by the change.
The School Board and Board of
pervlsoni announced the pro;ed middle school plan In mldcember following their annual
joint retreat. The feasibility of the
plan will be studied over the next
six months and lhe proposal has
been characterized as an "Interim
measure."
The two boards have been trying
to find a way to Implement the
state-mandated middle school
concept, alleviate overcrowding In
the southern elementary schools,
utilize current school space and
buy time to see how residential
growth Is going to affect the schoolage population over the next dec-
ade.
At a PTA meeting the week after
the announcement, Eagle Rock
Elementary (ERE) PTA President
Cody Lowe said there were ·a
number of people who were not
happy about the proposal."
"There Is a perception among
many people that the James River
High School students are shortchanged In terms of course offerIngs and other opportunities,· he
said. "There Is the feeling that this
(proposal) would not alleviate those
Area gives
finaneial,~L ..
emotional
support
By Kathleen Morra-Sioan
· · ltal'\1rrttcr
Life has been "hectic" for Frank and Lor·alne Smusz of Fincastle and their two young
;ons since a story about their struggle to obaln a possibly life-saving medical treatment
br Lorraine appeared In the December 12
ssue of The Fincastle Herald.
Lorraine has ~tage IV metastatic breast
:ancer and has been told by her doctors that
)nly one current medical treatment oiTers any
hope of arresting the disease which has now
Invaded her bones and liver.
High dose chemotherapy and autologous
bone marrow transplant (HDCT-ABM1l Is a
procedure performed at leading rnedlcal centers across the country. Although the procedure has been accepted as the treatment of
choice for this disease bY much of the medical
eommunlty,-sorne lnsuran~e carrters classify ·
the treatment as "Investigative" and refuse to
cover lt.
Lorraine has been accepted Into Duke Unl:
verslty Medic~ Center's HDCT-ABMT program and her doctors feel she Is a good candidate for the trea_tment because of the early
stages of her bone and liver cancer.
·The treatment Is very expensive (Duke's
program averages $132,000, but can go as
high as $180,000), painful, and not without
risks, but It Is Lorraine's best and only hope.
She has begun the high dose chemotherapy
that Is prepartngherbody for the bone marrow
transplant she must receive In early February.
Things were proceedlr)g well until she learned
· In early December that her Insurance carrier.
E!lue Cross/Blue Shield of VIrginia (BC/BS of
Va.), would not cover theABMTon the grounds
that It Is sUI! experimental and Investigative.
The Smuszes also learned that without Insurance coverage, Duke requires a $96,000 down
payment before the bone marrow transplant
process can begin. ·
·
, Rumors that the communliy had already raised enough money for the Smusz famUy
to make a down payment on Lorraine's cancer treatment are unfounded. Tuesday
morning, the Lorraine Smusz Fund was still nearly $40,000 shy of the $96,000 the famlly
needs.
'
This year In the United States, approxi- public aiTalrs program on Sunday, and In an
mately 144,000 women wtll get breast cancer In-depth story broadcast MondaY. on Public
·
and an estimated 44,000 wlll die from lt. Radio WVTF-FM 89.
On Monday, Frank was contacted by the
ABMT Is a procedure that has shown remarkable success with advanced stage breast can~r ; . tlnlted Press International reporter In
HH·hmond.
patlents In recent years. "More than 30 p<"r·
BC/BS of Va. demanded equal time folcent of women with late-stage breast cancer
are alive and disease-free up to twoyeal'l! after lowing the Smuszes' appearance on the Gary
Minter show and the company's medical
ABMT, compared with only 5 percent on standard chemotherapy." reported a December director was Interviewed on that program
the following day.
10. 1990 Newsweek article on the current
status of breast cancer treatment In the counThe young couple thinks the response has
try.
Since the Smuszes decided to go public with
been overwhelming. "We've had lots of media
their sltuallon, whlcli they maintain could afattention.· said Frank, "It's given us a Jot of
fect any woman Insured byBC/BS ofVa.. they
hope. I never expected It to be this powerful.
have received a great deal of media attention.
We've received support from people all over
Both WSLS-1V 10 and WDBJ-1Y 7 did lllmed
the state and even out of state, but I firmly
reports on the family and their predicament.
believe that lflt wasn't for the good Lord all
The Channel 10 report was re-broadcast In
these doors wouldn't be opening and we
Richmond just before Christmas. 'The Roanoke wouldn't be getting all this help."
Times & World ·News also ran a front-page
story which has generated a number ofletters
The media attention has helped brtng In
to the editor and the story has appeared In
financial and emotional support from all
both a Covington and Richmond newspaper.
over the Roanoke Valley and the stale. The
Frank and Lorraine have also been the subBotetourt County community has been
ject of three local radio broadcasts In the past
seemingly galvanized In support ofthe young
two weeks. They were Interviewed on the Gary
(Continued on Page 2-AJ
Minter show on WFIR last week, on a K-92
1
�,
Smuszes
people that we've gotten. I want to
[Continued from Page 1-A)
couple. In churches of all denomi- thank all the people who have sent·
nations, and In schools and clubs cards and are praying for me and
throughout the county, donations who have sent donations - It's
large and small have been col- been very helpful."
Frank says the positive response
lected and deposited In the "Lorraine Smusz Fund" at The Bank of they've received has given him the
Fincastle. TheChurchoftheTrans- drive to continue what has almost
flguratlon, the small Fincastle become a full-lime occupation. He
.Roman Catholic congregation says he has become "focused" on
;where the Smuszes are members, changing this situation for other
has organized a raffie and a letter people. ·r really think we're mak;writing campaign to raise money Ing a difference,· he said. "We want
for Lorraine's treatment. There Is to help Lorraine, but we want to
word of a petition and letter from help other people, too, so that they
Blue Ridge to BC/BS ofVa. urging can get this treatment when they
a change In policy and a walk-a- need lt."
"1111s has snowballed Into such
then fund raiser for the Smuszes.
As of Tuesday morning, there a big thing.· said Lorraine. "I think
was $58,443.79 In The Bank of It will help other women because It
Fincastle account and donations has brought the Issue of breast
continue to arrive _dally. Included cancer to the public's attention.
In thatamountlsa$10,000anon- Maybe It will make women check
ymous donation received New their policies - I didn't know I
;year's Eve. as well as· countless wasn't covered. I guess a lot of
good Is going to come out of this.·
other Individual donations.
Frank agrees and ponders other
, The Smuszes did receive ~ord questions, one of which he's
!several weeks ago that a large brought to the attention of Del. Bo
:donation that might pay for Trumbo. A major contention for
•Lorraine's treatment was coming. .the Smuszes In their argument
As of this writing, no such dona- with BC/BS of Va. Is that other
tlon has been received and only Blue Cross/Blue Shield carriers
halfthe down payment of$96,000 In the country cover ABMT, ln(whlch Is a third or less of the total eluding BC/BS of North Carolina.
cost of treatment) has been re- Frank thinks that If there are re·
celved. The rumor that has clrcu- strictlons keeping the North Carolated In the Fincastle area that llna company from bidding In VIrLorraine's treatment has already -glnla they should be changed since
:been paid for Is, unfortunately, a the coverage Is not available to
:false one.
BC/BS ofVa. patrons._. ..... _ .
1;;;~au.t _the. Smuszes :1U'e optl.rntstlc ·-: _ He also wonder~ jf hot oo:verlng'
iand filled with hope that Lorraine's this treatment lsn t a dlscrimlna:treatment may be a reattty after. tory act against women, though he
1all. ~I believe It's going to happen admits the potential number of
!now,· •revealed Lorraine. "I had women who may need the treat:.
1hoped we'd get some response but ment Is a large one and would be
1never, never did I believe we would expensive for the Insurance carri:get the support and help from ers. He thinks that's why the In-
surance carriers don't want to
cover the procedure despite the
medical eVidence. "It's a money
thing,. he said.
For now, Frank continues rallyIng all the forces he can to gel the
treatment that may save his wife's
Walk-A-Thon
to benefit
Smusz fund
life and gathers Information for a
suit he hopes to wage agalnstHC/
BS of Va. He Is working with lhe ;
Alexandria attorney who success- !
fully argued a similar case In fed- .
era) court In April 1990.
· He laughs when he recalls an
Inspirational message scrawled on
a "post- a-note" that accompanied
a donation several weeks. ago.
"Hang tough" was the note's simple
message.
Lorraine and Frank Smllsz have
taken that adVice to heart.
A group of Blue Ridge area
citizens Is sponsoring a fund·
raising walk-a-thon to benefit
the Lorraine Smusz Fund.
Thewalk-a-thon will be held
Saturday, Jan. 26. The
Inclement weather date Is
February 2.
Pledge sponsorship forms
are available at The Bank of
Fincastle branches In· Blue
Ridge, Fincastle and DaleVille,
at the Bank of Buchanan
branches In Buchanan and
DaleVille and at Royal Jewelers
In Valley VIew Mall. Roanoke.
For more Information or to
help. call 977-0426.
Got The January Blahs?
TRY CERAMICS!
20°/o OFF ALL GREENWARE
. •· Try sw'eatshirt Painting &
Free Ceramic Classes. Too!
sprlngwood ·ceramics
Main Street·. Buchanan
254-9845
'TWo special business
.classes being ·offered
· .- The Botetourt Chamber of emphasis on financial records
Commerce and Economic Devel- needed for management control
opment Commission, In coopera- • and tax reporting purp9ses. The
tlon· with Dabney _S. Lancaster course will help participants betCommunity College and the ter organize financial records and
Botetourt County School System, proVide an awareness of records
will offer two special classes for needed for tax reporting of various
business and Industry personnel financial activities of a small busl.thls semester. These classes will ness or contracting serVice. Legal
be held In Fincastle.
requirements also will be dls"Tax Rtcords for Small Bust- cussed.
nesses• (ACC 195-91) Is an lntro- ·
The course will meet from 7ductory course In record-keeping . ~:p~p.m. on Wednesdays, Janu. for tax-return preparation with an , ; ar)t 0 6-February 13, at the ·
· · i.}~Botel~h1rt Technical Education
;' ·center on Rt. 681. The cost Is
~
,-"If"'\ r""" ~ ... $30.20. Anita Dingus,0 ar' '" l:"fn-•
partner In
I ... .......
1
r·u .... rf;,,.. R. Un1~1r'AH
r;..., n
NEED MONEY?
Anew and exciting product has been introduced
to the Roanoke Valley. Phone today for voice ·.
message. This is truly a product for the 90's. i.I
Everyone can . use it. Thousands of uses, I
n,,....,.,,.,..,n., nf -::2nnli"~tinnc: Ricrnrnfi__ ,.__,._._-'----'--'-''----'-'--'--'--'-L.._---"----'
�Two victims
Of an unfair
nealtn system
....._._ ___
···-----·---·~-
WITHOUT adequate sciciiir"suppon,
the homeless, the poor, and now even
. those usually denoted as privileged are
denied the health care and support needed
to continue life. Recently the Roanoke
Times & World-News carried stories on
both Baby Isaiah and Lorraine Smusz,
Americans who, because their financial
and/or social circumstances were not opti·
mum, Jose their right for healthy, happy
lives.
In an era of decreased public support
for the underprivileged, a young, desper·
ate mother committed an irrevocable, de·
spicable act: abandoning her newborn son
to die in a cold dumpster. People talk of
indicting the mother, if found, for mur·
der; however, this would not be a solution
- only funher tragedy. Perhaps if the
young woman had received reliable infor·
mation about binh control, perhaps if
so-called pro-lifers had provided a practi·
cal solution 'to her dilemma instead of
merely preaching from above, Isaiah
would have been spared all his suffering.
Without public suppon for such
women, ever more of them will face seem·
ingly bleak situations like that of Isaiah's
binb mother. Today, thousands of chit·
· dren like Isaiah languish in state institu·
lions, waiting for homes and loving rami·
lies, or at least the publicity to give them
an edge in their search.
The plight of Lorraine Smusz funber.
highlights the need for a public health care
system.
Normally
considered
middle-class, Mrs. Smusz and other wom·
en in her position are underprivileged in
that merely their financial status_, or lack
thereof, denies them access to lite-saving
medical techniques.
In a health-care system with exorbi·
tant prices, and with insurance companies
that may selectively distribute funds and
thus life, Americans without the proper
social standing are discriminated a"inst.
Policy holders of not the highest soctoeconomic situation are pawns of a health-care
system that becomes ever more focused
on profits, and Jess concerned with human
well-being.
It is too late for Baby Isaiah, but it is
not too late for Lorraine Smusz and others
in her situation. Until a system exists that
supplies every American, no matter what
their race or background, with equal ac. cess to medical care, all we can do ts fill in
the gaps and pray the American dream
will soon be realized.
toys which surrounded him, I could not
help but think of the thousands of babies
like Isaiah who are a boned each and every
day who have no one to mourn their loss,
and who have been aborted for reasons no
different or more compelling than Isaiah's
mother would offer for her actions. If she
had aborted him, would anyone have
cared? Or would we have turned our backs
and pronounced Isaiah's abortion his
mother's "right"?
ANNETTE Q. MARIANO
ROANOKE
WRITE
Letters on public Issues are welcome.
They must be signed. Please include
lull address end, lor verification only, a
telephone number at which you may
be reached during the day. All letters
are edited. Because of the volume of
letters at times, not all letters are
ublished. Writers are limited to one
etter in any. 60-day period. Letters
should not exceed 200 words.
r.
Latter to the eclllar
P.O.Iox2481
extraction who convened to Judaism in
the Dark Ages and migrated to Poland to
form the cradle of Western Jewry as discussed in the book "The Thineenth
Tribe" by Arthur Koestler. Jewishness by ...marriage, conversion or otherwise should .. '
never be used as a legal or moral claim to
colonize, inherit or usurp Palestinian
lands.
Finally, God's promise to Abraham
and his seed was fulfilled in his oldest son.....
Ishmael and his Arab descendants. Since .. ·:
the dawn of history the mass of Arab
Semites have lived and enjoyed the land
between the Nile and the Euphrates rivers
without interruption.
·
I applaud Thomas' concern and love
for Israel. Perhaps he should direct his
generosity toward settlin!l Soviet Jewry in
his own homeland and m his own back·
yard and not in the land of others.
Insurer should
approve treatment
Roanoke, Va. 24010
IT WAS certainly upsetting to hear
about the plight of the Smusz family
(news story, Dec. 27) and the reluctance of
Blue Cross/Blue Shield to pay for treat·
·
ments that mif)lt give Mrs. Smusz a
chance for survtval.
Surely there is one executive at
BC/BS who would come forward and apREGARDING your editorial of Dec. prove this request, which gives this wife
22, I agree that Virginia law should be and mother at least a one-in·tbree chance
changed to allow immediate seizure of a at survival. By approving the procedure,
drivers' license when a driver fails or re- BC/BS would gam the respect and confi·
fuses to take a sobriety test.
dence of the public it serves, which should
I also agree that the license should be fenerate revenues for the corporation far
automatically revoked for a period of time 10 excess of the payment for Mn. Smusz.
for the fint offense. There should be no Don't let the bean-counters stand in the
slap-on-the-wrist non-penalty for any way of a good humane decision. All
DUI offender. Fines and/or mandatory BC/BS card-carriers are watching.
safety classes are not effective in curbing
JOHN ADDINGTON
this reckless endangerment of the Jives of
SAL£M
innocent motorists.
I UI'Je all Virginians to contact our
state legtslators in Richmond and insist
that an administrative license revocation
law be passed. How much of the holiday
highway carnage would have been
-~--·-·~
avoided if we already bad such a law?
YOUR DEC. 27-Siory about the ,
young Botetourt County mother facinL~~
SHIRLEY S. CRAGHEAD
ROANOKE probable death from breast cancer be- · • '
cause her insurance carrier would not pey·-·
for an "experimental" bone-marrow :·
transplant touched my bean, as I am sure ·•
it did other readers.
. ;·
Certainly health insurers deserve 11·;." ·
measure of criticism, but the key issue·.·::,.
CAL Thomas' logic in his column here appears to be the enormous cost of "
Dec. 19 was as twisted as Saddam Hus- medical care, regardless of whether or not
sein's claim over Kuwait. If we were to it is covered by insurance. The $96,000
accept the premise that the U.N. Security "deposit," not to mention additional
J, ASHLEY SHEETS Council under the "new world order" of costs to be billed later by the hospital •.
ROANOKE President Bush is effective, impartial and performing the procedure, is so far be-'"';.
just in imposing sanctions on Iraq, tben yond comprehension that an insurance ";.
under the same premise the United Na- company would be forced to adopt cover·
tions can be as JUS! and as impanial to age restrictions for such claims. There is
convene an international conference to something terribly wrong with a health· "
enforce its resolutions on Israel. They call care delivery sy•tem that impOses such
ROANOKERS have united to mourn for grantin~ P~!cstinians their rights of costs, regardless of who pays them.
' the tragic death of Baby Isaiah, and we self-determmation and nationhood.
Profiteering in human misery is inde·
Mr. Thomas must also accept the fact fe',lsible !n a ~oc!ety that ~as laws against -·..
shudder in disbelief at a mother who
could discard her child as so much gar- that Israel was established as an alien pnce-fixmg, mstder tradmg, and setting' · •
bage. We cannot imagine any circum· colonial outpost in the Eastern Mediterra- back the odometer of a used car, but closes ;;
stance which would compel a woman to nean. In that aspect Israel is no different its eyes to unconscionable abuses of those
put her newborn baby tn a trash bin, from the European settlers in the far lands whose lives han' in the balance. If social·"·';
knowingly consigning him to ·certain, of South Africa, New Zealand and Austra· ism takes root m America, God forbid;-··
lia.
painful death.
this is the catalyst that will bring it aboutl";,
Evidence also indicates that many
Yet, as I looked at little Isaiah lying in
RANDOLPH GREGO
his casket and viewed all the flowers and modem-day Jews are of Eastern European
ROANOKE ·•
Who will mourn
their loss?
Roanokellmes &World-News
Walter Rugaber
President and publisher
Alan Sorensen
Editorial page editor
Geoff Seamans
Bob Willis
Margie Fisher
Editorial page staH
Seize licenses
of drunken drivers
Meqic.al_~re's
.f.l!9.h cost is the issue
Arabs have
claims, too
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~tlnue4J~.~~:~age 1-Af . · ., .. :· ~~th~t.tthf!ABMr,doc:tor'sgiVe ·this :famtly '~d·. (6~. :~fu~f~ Wtth · f)ti~ute. •to detenntne whether.an bone marrow transp,ants that are
lO to· 20. p:erc~nt. for: w~nieri. _.·Mrs; S~usz_l~s~ than tWo years' to·: .._can~er~ but'\~·~·-~ust. ~ake judg- ., expertmental treatment:-ABMT-19 . covered toclay; Only 50 percent of.
hvlng ~lie ti.eatirieht and ques~ · live." A. December .10 Newsweek .. · ments.:ancl do what's best for the ·· .. better. thai), equal to, or wor~ · th~ women in th~ study will have :
ls whether ihe treatment has artlc}e on the current state ofbreast . majority o( o4r policyholders.· • •
than pre~~nt treatments for breast ac~ess to_ABMT. and they won·t
.
:long-term benefit. .. · '· · : . .
. < ·· .· . ~ ,:· .·:·.-· :· . . ~ :-:· :· '.::•:. · .··. · . :
c~cer.· . <
. .
. _know.who they are.
Decem~er , jggo u.s. New_'s ·· ; cancer treatment states, ,·~More , A listing· obtained iii:>m, .Quke . , · ..These .clinical trlals wUl begin . "This tr~atme.nt has been going
3
' oriel, Report. st9ry states that'.· than30 percentofthe_wo~en with . Universtty_.Me~lcaqJe.nter names· ..)ater this year and approximately on at Duk~ and otherplaces like
risk ofdea~ from the therapy · late~.stage ~?rea~t cancer ar~ alive : 421nsu.~ce .compan_les ~that have : 30. t~ 60 Virginia women will par- Duke for sl'C or more years now
reach 6 per,cent.• An article In: .. anddls.eas~-free ~p to two years paid or. have. indicated that ~ey •. tlclpale~· Berry could not give any and this study will 'take a mini11th Week ~describing· the re~ ·: after~M~. compare~ W!th only 5 .. will pay fo~ J\I:lMTfor breast can- . e~tlmale o~ how long before the .. mum of five years to be completed.
rch some BC/Bss· are funding· perc~n.t on standard,.chemother- . cer:_(on: a·,_ case-l?y-case basi~).· data ob~alned might change cur- Durlngtpat time, too many women
are.golng to die from not gelling
·Eley~I:l of the~~ are BC./BS compa": re~t policy~
.
.
h the National Cancer Institute · apy.,:
:s the ·procedure itself Is fatal :.
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· · · · .. .'· .. '· ·- · ·· · · ·· · · Clinical trials take lime." he the p~per treatment.·
AS certain as Smusz and BC/
about .. IO-.'perc~ntof patients ·. BC/~S _o.f.v_a. rept:esentatlve
· · . . ·.,. ·: .... :. <·: ·,. • · · said. "'·•· . . ,
·. ,
!!.ted.· There' Is evidence .that . John .Berry, e.'<:ecullv~.:vlce-presl- . since 'u)87.''BC/BS ofvah1as. . Whenaskedlfotherexpenmen- . BS of Va. are of their respective
! mortality· rate Is Improving· ·as . dent m cJ:uuge of th~ -cor,npaf!y's covered ABMT for cerlatn forms of tal lrealnienls for breast cancer · positions, the demonstrators ex0 1
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hnlques Improve and -better,;·.Roanokeoperatlon·Mt"ch·ae'1Mc""- ·lymp.ho··m·a and · 1 u· k·. ·1a,:an·d· -a •·vere"b I t s i m 11 ar1 ·S l ucII ec; pressed an equal commitment to
· · . ·· .
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llentscreenlngisaccomplished.'. ney Sr,,· vlce_-presldent. for com- ·rare_c~ildhood cancer called neu~ . McHaney said, "No other treal- their. purpose.
Bill Amos of Roanoke said. "I'm
f<'rank Smu$z has strong opin- · · munl.callons,.and Jim Goss, dl,. roblastoma; .• . . ·-.~-·· :S/:.;.(-- .;. . .· menls,sofar have come along that
's on this ·particular Issue. "I , rector ,of public alTa irs~. were. all·
. ·.. -· · .. ·:- .. ·: ·.;··.· .:..: ,;"~·<:);;•.>:: ; :) warrant this kind ofexamlllallon." down here to demonstrate and get
~stion ho~ r.ecent thelr/infor- · ·. ava~lable to the m~dla on Monday_ • ~e ~.eatm~f1t1tselQ~.notbap. ·;;. ·_.Smusz fir:tds BC/BS of Va.'s BC/BS to pay for Lorraine's opitJon. is /on·· mortal icy rate: he · ,dunng :the rally.. All s~ated that . butfor br~st,cancer.It ~~s 110t yet:: .d~ctslon to participate In this study eration.· ·
Mrs. Aldhizer said It had a lot to
Cl. ·rve~ seen rates. that range ·. until ABM~. whlcl?-. the company been proven- safe and ::_effective; ·: Interesting. ·aC/.BS of Va. sudm 6 to iS j>ercent mortality. It' maintains Is e:cpertmental, is ~eny said. .
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, ... ,.· " · ,denly wants to help fund a study do with economics. ~e reality Is,
pends
tlie ·condition of the ·prove~ safe and! effective, BC/BS, ,
. · ·· .. · and get Involved in a randomized too many people have breast cantlent. arid. hovi intensive the·. of~a.wtll not ch~nge Its policy.. , ·. In a _fact s~eet 89/BS of Va. . trial. before they get lnvolvea In· cer and Ifyou don't have the money.
:rapy ls.~nle pOint.is, that with- . I. : We care. deeply· abouJ our ,provld~ tor reporters,· the' ·eo~- · ~overing this treatment,· pe salcl. you're doomed, • she said.
Phyllis Mardian of Botetourt
t this t~eatineiit. all· these' pa-· .· :,.subs~r.lb«;:~ •. -said Ber;ry.__"This I~ .pany says it has joined .~everai · ·. Now they're requiring this doublents are going to die anyway:
notBI?- easy: position to. take.·Thls o~er BC/BS plan~ In funding .a· blind, randomized study that has County had strong feelings on the
· · .·
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· . Is. a tough ca~. I feel sympathy for.. study by the National Cancer Iri-. . never been required for any other Issue. ·rm a friend and aBC /BS of
·---·--.-·---·--- ·Va. policyholder and I'm here
because I want to know that. If my
doctor decides I need this treatment. I ca~ get it, • she said. "I have
five friends In various stages of
breast cancer and I'd like to know
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Patient lorraine Smusz exercises with an elastic strap as part of her recovery at Duke's bone marrow unit
::Cancer treatment comes around
.;'Jjqn~ marrow transplant procedures improve, but refinements needed
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By RACHELE KANICEL
Staftwrllt:r
When William P. Peters came
to Duke University in 1984 to set
up a bone marrow transplant unit
Cor breast cancer patients, many
saw the treatment as a last-ditch
effort to save dying women.
Twenty-two percent - more
than one in five - or the patients
died of complications from the
treatment.
And many of those who survived
came perilously close to death
after receiving the extremely high
doses of the chemotherapy and
radiation therapy used to treat
their cancer.
But new advances in cancer
treatment have chanscd that.
Growth factors that stimulate
production · or · Infection-fighting ·
while blood. cells make patients in
· the.U-bcd unit stronger and less
vulnerable to disease. New drugs
help control the potentially debili·
tating nausea and vomiting that
go along with the treatment.
As a result, patients arc going
home sooner and the death rate
associated with· the treatment is
down to 11 percent to 15 percent,
depending on the stage of disease
at which treatment begins.
"There's been a real evolution
in the treatment over the past
decade," says Dr. Peters, dircc·
tor of the transplant unit.
To see that evolution, says
Peter J. Tutschka of Ohio State
University Hospitals in Columbus,
all one needs to do is to talk to
patients.
"Ten years
'The advances are
coming from many
directions. You couldn't
ask for a more exciting
time in cancer
medicine.'
-·William P. Peters,
director or Duke transplant unit
bone marrow.
Dr. Peters likens the treatment
to a farmer burning down the
barn to drive the rats out and then
extinguishing the flames.
"We're getting better at putting
out the fire," he says.
The theory, Or. Peters explains,
Is "the more drug you can give,
the better the chance of killing the
cancer."
The problem Is that anti:cancer
drugs kill healthy cells as well,
particularly In the bone marrow,
the factory for blood cells. There,
in the sort tissue inside the long
bones, the body manufactures red
cells, which carry oxygen; platelets, which make the blood clot;
·and white cells, which fight Infection. Without constant orcKiucticm
Throughout the intensive treatment, patients arc kept in specially designed germ-free rooms.
Each chamber Is equipped with
a sophisticated air filtration system. Doorways arc pressurized so
that when a door is opened, air is
pushed out but does not flow in
from the hallway. Health care
workers and guests must wear
masks, gloves, gowns and protective booties.
"It's like a little cocoon in
there," Ms. Cavanaugh sllys.
"When they have to come out,
some of the patients don't want to.
They're afraid."
Dr. Peters hopes that someday
patients will no longer need. the
protective chambers and will be
able to have portions of the
nrtwt>~ur·" on an
basis.
8 New drugs to control vomit·
ing and nausea, one of the most
dcbilit!lting side ercects of cancer
treatment.
8 The use of computers to monItor patients more accurately and
to enable medical workers to
quickly adjust drug dosages.
8 The production of growth C
actors that act like fertilizers to
transplanted bone marrow and
speed the growth of infectionfighting white blood cells.
8 Development of techniques to
purge the bone marrow of stray
cancer cells before the tran•plant.
"The advances arc coming
from many directions," Dr. Peters says. "You couldn"t ask for a
more exciting time in cancer
medicine."
As one of the pioneers in the use
of high-dose therapy in the treatment of advanced breast cancer,
Dr. Peters is now leading a
nationwide study comparing the
eC!cctivencss of the treatment
with standard-dose chemotherapy.
The study, which will include
about 350 women at 20 medical
centers around the country, will
focus on patients with breast
cancer that has spread to 10 or
more lymph'nodes.
With stan.!Jard therapy, about 70
percent or such women will have a
recurrence of their breast cancer
within five years. But studies at
Duke have shown that only 26
percent or patients treated with
high-dose therapy and .bone marrow transplantation have a recurrence within four years.
"God willing, our team and
others around the
focused
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· transplant experience without becoming extremely, emotional,
tearful, crying," he says. "It was
like they were reliving a nightmare. Almost all of them joined
support groups to help them get
over it.
"Now when I offer patients a
support group, most of them say,
'What for?'"
Despite such dramatic improvements, however, there still is
much that needs to be done to
refine the treatment.
"Now our job is to figure out
how to make it easy, simple and
cheap," Dr. Peters says.
For now, the treatment is laborintensive, complex and expensive,
costing as much as· $120,000 for
three to six weeks of therapy.
Health insurance often doesn't
cover the treatment, because
many companies see the treatment as experimental for breast
cancer patients. But as studies
come in showing the benefits of
the therapy, some firms are beginning to pay for it.
The regimen involves giving
deadly doses of chemotherapy
and radiation therapy to kill all
the cancer cells and then rescuing
the patient with an infusion or
ul Llu_,,., \'&Lal u&utul
n~u~.
lliC lJutly
is unable to survive.
After rour days or intensive
chemotherapy and radiation therapy - at three to five times the
standard treatment dose - bone .
marrow usually is decimated,
leaving the patients anemic and
vulnerable to disease.
Once the drugs have cleared the
body, about three days from the
last chemotherapy infusion, patients get their bone marrow
transplant. On that day they begin
the slow and sometimes erratic
journey to recovery.
Most patients in the Duke transplant unit arc given what is known
as an autologous transplant - a
reinfusion of their own bone marrow. The bone marrow is extracted before the high-dose therapy,
frozen and then given back to the
patient in a procedure si~ilar to a
blood transfusion.
"It's kind or anticlimactic,"
Colleen A. Cavanaugh, assistant
head nurse on the unit, says of the
actual transplant. "The whole
thing takes about 10 to 15 minutes."
But the transplant usually saves
the patient. Within days the marrow is engrarted and the patient
starts to produce new blood cells.
Jll'UI:Ctlurc uu an uulpaucul lJa::.&:-..
Aln·ady, he says, new tlcn·lup-
mcnts have made the whole process- from the high-dose therapy
to the transplant and through the
recovery period - safer and
easier for patients. Among them:
on ihis prohh•m will be abk lo
dispel a little or the hopelessness
often associated with breast cancer," Dr. Peters says. "I feel we
arc in the early morning of a
sunny day."
Nurses Debbie Kennedy, left, and Rhonda Abernethy check a
patient's chart at a work station in a room at the Duke unit
�n~ option rn,ay save mother's life~
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.. By Jtilthleen Morra~loaJi .·
. · .. ··· ... ·...... :-; BtaJfWdter, . ; :·.
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· When high sc4qol ~weethearts
Lorraine and Frank Smusz mar. . rted nine years_ ago, they never
Imagined that at thl$ stage o(thelr
lives they"d be fighting Lorraine's ·
death with all the strength they ·
can muster. The villain that threatens to rob this .beautiful 33.:yearold mother of her fUture and take
her away from her tWo young sons
Is breast. cancer,. which first. ap-.
peared In September 1988. ~ ·.
peared · after ..chemotherapy· and
radiation. and then,.rectirred with
a vengeance this. past September
. by ~'!8dlng Lorraine's bones and
.liver•. ·-_:-~~·-. ·o .. '·'.! ' .\>·.·:· ' · "· ··. ·· ··· .
But Frank and Lorraine, who
live near Ftneastte~. are fighter&•.
She wants to l1ve and wants her
five-and two-year-old
to know
their mother as a person. not just
as a vague memoty. J:)ut her treatment options. are. slim.. Doctors
told the young couple. that
Lorraine's only hope for her Stage
IV metastatic breast cancer was
high dose chemotherapy with
autologous, bone marrow transplant (HDCT-ABMO. The procedure Is performed at several lead-:
trig medical centers across the.
countJy including Duke: Untver.
(CoU:tlnuecl
Peg~ 3-A)
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and Lomdne Smuaz with their ftve- and two-year-old sons:··
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(Coatllluecl· from I'll&• l·AJ · ,, . "We've ~n on ~ roller CoaSter'".: Arozzl
lJi federal. court. He .
stty Medical Center In D\.ll'harn r since September,:
Frank." : saystheABMTprocedureha&been
N.C. After several21·day cycles oi· "''bere'e a lot of emotlonelnvolved... i considered non-tnvestig11 uve by ..
hlgh-doee chemotherapyde&Jgned when you're looking at your: Wlfl!.'.' :. cancer expe~ for tivo years, "The·
to shrink existing tumors, the . and ~e mother of your two chll· · .cure rate With standard dose che·
procedure removes from two to dren ..Jmoutragedand&ng~ythat :motherapylsrlghtaboutzeroand
four quarts. of the patient's bone 1 htheree treatment that could help.• doeenotlncrea&eswvtvalanymore ·
marrow and blood, treats tt With · er and the ln&urance company Js than no treatment at all," &aJd
high levels of chemotherapy to ktll . dlhactatlngth \Vhat .they'll cover and >Carter; "ABMT has a long-term,
anytumorlnthemarrowandlater w ~ eywon~~ey've-:eallygot .dl&ea&e-Cree fiU~ rate of 30
reinject& the marrow, gMng the you.
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body the opportunity to regenerFrank has already experienced ; Since the Pirozzi decision, Car·
atehealthybonemarrow.A8MTI8 ·the lo88 of a loved one- to cancer. ·iter says, ~ere have .been four or
an expensive (Duke's progr8m: HJsmo~er~ecl.ofl~gcanc~~t .Jlveotherc~sacrossthecountJy
averages $132,000, but can go as ~·,
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,and hJ8 finn ha& handled two or
high as $180,000), painful and
Its really cWilcult to tell your 'three. ''To my knowledge, all the
lengthy process which can Itself fihve-year-old that Mommy may rultngs have been In favor of the
be ltfe-threatenlnR;, but It was • ave to go to heav.:n,• he &ald.·' ,woman," &aid Carter.
Lorraine's best and only hope. ·
Flve-year-old Brian knows that'.' Lorraine Smusz does not want
ADecember.10 Newsweekar·· . Gran~ we~t to heaven and .l_le . herstorytoen~llkePamPirozzl's.
ticle on the current state of breast . says, Mommy, th~t ~eans ~ WO~'t •~ Even Ifthe couple takes the case to · .
cancer treatment In the counuy ~,!I ~re. Jt s c:JUllcult•. l~ ' court, there's no guarantee they'll
1
and the politics.lnvolved, stat~
'or'l' ,..· <''.'";''·•'.!I<::.)·, wan. That's why they're attemptthat thl8 procedure "has shown ... Js ' manespot 98J1cer on my liver.:;;, lng to ~se th~ necessary funds
remarkable success.•
,
- .. 8
and. was caught early,:·:!, themselves, but$96,00018alotof ···
•Morethan30percentofwomen . ~Lorralne:_~~doctorefeehny:;. monwforanyonetocomeupWlth. ·.
With late-stage breast cancer are · an~s ~ ........1 good Wlth''.the , ' The Smuszes urge anyone who
alive and disease-free up to two rne ~w ~splant. But lf.r.:,· feels strongly about this situation
on't get ~~ th~' nothing-: .~o . to Write to the omce of Public
years after ABMT, compared With
··
· : · t · · 1•.-:. · /• Affairs, BlueCro&sandBlueShleld.
only 5 percent on standard che- • treatment~
motherapy." rePQrts Newsweek. . . Lorraine was admitted. for. a ~ ofVJ.rglnla. 2015StaplesMliiRoad,
. Lorraine applied for and was .. concentrated dose of ch.emother- ·~Richmond, Va. 23279 as _well as.
accepted tnto the Duke program apy thJs past Sunday. She has . their elected state and federal omand Is now In her second stage of already loet all her hair and suf·. ·, clals; . -~
.
pre-ABMThlgh dosage chemother- fered the painful mouth sores that ; A fund has alsO·been l!et up to
apy. Things were proceeding well are an expected side effect of the i receive donations In Lorraine's
untll last Thursday when word chemotherapy. She had decorated ;-name at The Bank of FtncasUe. .
cameCromBlueCross/BlueShleld ..her house for Chnstmas durtng ;Anyone Interested 1n making a
of Vtrglnla (BC/BS of Va.), the. theweekbetweeqtreatment&whlle . donatio~ can address It to the
Smuszes• Insurance earner, that ·she felt weU enouib to. dolt.
:Lorraine Sm,usz Fund, The Bank
theABMTwouldnotbecoveredon · Frank. meanwhlle•. was doing .of Fincastle, P.O. Box 107, Fin···
the grounds that the procedure "18 hJs homework and trying. to ex- 'castle, Va. 24090.
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currently con~ldered lnvestlga- plore any avenue that might help
"I don't think there co~d be a
tional. •
· · htm make this possibly curative more supportive and sympathetic
"To elate. the literature has not treatment avallable to h18 wife. He 1 community than thJs one, • &aJd
provedABMT to be safe and etrec- has contacted the Alexandria law •,Frank. There was a spontaneous
;outpouring of generosity In the. , .
tlve ~ treating breast cancer and. finn that successfully argl.led
thats why It's not covered.". &aid slmtlarcaselnfederalcourtagalnst ,_community just after word ctrcu- ·
Jtm Goes, public aJfalrs director.. BC/BSofVa.lnApi111990.Pamela ·latedlnSeptemberthatLorraine's ·
for BC/BS ofVa. "Another Issue 18 Pirozzi also sutrered from s~e·IV ~ :cancer had returned.
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that so many women die from the metastatic breast cancer. Accord· :. Her fondest Wish was to take
treatment Itself.• BC/BS of'Va. lngtotheUS FederalSupplement ;her chlldren to Dl8ney·World be·
does cover the procedure In treat- which records cases heard 1n US .fore sbe died. Frank, who works as
ment ofleukemla,lymphoiJUl, and D18trlct Courts, she sued BC/BS .the maintenance supervl&or for
a rare chlldhood CIUlcer and there~· orva. on the grounds that her plan Botetourt County, saw the people
are other BC /BS companies In the covered HDCT·ABMT because It . be works With and many he didn't
countJy that do cover the proce~ was the "medlcally lndlcated, state- ~even know In the community put·
dure ln breast cancer cases. BC/ of-the-art, generally accepted treat- ·:together $1,000 In the space of a
BS of North Carolina Is one of ment for her dl&ease. • The Judge , few hours so.thc family could take
ruled that the treatment. was ·, thetr trip before Lorraine began
them.
TheSmuszessaytherlskasso- "medlcallynecesearyandetTcctlve, her b:eatment&. ~ey are hoping
elated with the treatment Is worth currently In use In maJor· medical for the generosity of the commu- ·
It since Lorraine Is definitely going centers, had sclentlfically proven nlty again and thetr support In a
to dte If she 18 denied the treat· value and was In accordance With : let~r-wnung campaign to help
ment.
. generally accepted ·standards of ·:· them accompl18h an even greater
. . ·· , ..~ miracle.
·
The Smuszes now find them· medical practice. • : .
~~elves In the ranks of a groWing
But for Pam Ptrazzl. lt.was toO
U by chance Lorraine's treat·
· number of breast cancer patients . late. By. the .Ume ~c coae came. to ' . ment 18 covered, any money that'•
who must battle Insurance com- trial, her tumors had grown back ... collectedWlllgolntoafundtohelp
. panles In court for coverage of and she was no lon&er ellglble for . other breast cancer VIctims who
_ABMT treatmen~. b~t they. doq:_t,:.trea~o.nt• . i' .• > •. :• •• • • .:. 1.' may find themselves In th18 dlre .
.. have time for a'cc:iurt'batue: " · ...• .,. .. _•Put yourselt'ln'th18'pgslUorl,• ~ sltuaUon."' ,. ·. · 1 ".' · ·,':: . •·
TheSmuazeshaveuntlltheend urges Smusz. "Here's something
·
ofJanuarytoraJse$96.000topay that would help thl8 woman and
. the hoepltal or Lorraine 18 out of · has been medically proven etrec·
the program. Sixty days 18 more ttve, and they, won't cover at.• :
than just a cutoff for the money, Appi'CQQmate!yl44,000womenwliL'
It's also the extent of the Window of get breast cancer thla year and an
opportunity on the treatment It· . , !=Otimated 44,000 Wlll dle from lt.
self. The ABMT must be done · "There 18 treatment· out there
Within days of finishing the last that Js shown to be etreciave ahd
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21-day cycle of preparatory che- curative In some cases and BC/
motherapy and, In th18 situation, BS of Va. Js denying that treat·
there's no such thing as a second ment whlle other BC/BS can1era
chance. The body has a llfetlme are covering It, • &aid Smusz.
saturation point on one of the
Rich Carter of the Alexandria
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chemotherapydrugsandLorraine law finn of Hudgln&, Carter and.
18 approaching hers.
·
Coleman successfully argued the
"''ct
l"Jb ,.
a
>.
·.·.·~ ··ao ,.TO .THE
.
FOR OUR SENIO
.CUSTOME~R'"-'"""-""'8....______
�Hillary Rotllram Clinton
·'· ..
lfn ~.._,LE
~O
Jill
till
I
'v
""'
OCT J 1 '92
I
Jill
7'LrLil~ _,:;})~
f2 Wj.L -2, & !GSit
.Ac(J~-uu1__ou1 VA :2 LJD'[(
i
�WRITE
letters on public issues are welcome.
They must be signed. Please include
full address and, lor verifiCation only a
telephone number at which you
be reached during the day. All letters
are edited. Because of the volume of
letters at times, not all letters are
published. Writers are limited to one
letter in any SO-day period. Letters
should not eJtceed 200 words.
may
Latter to the editor
P.O.Box2491
Roanoke, VL24010
OPINION
FRI[}AY, JAN. 18,
'
1~.1__,
. . I
n
Bone-marrow cancer therapy in· use 20 years, ·sole hope for sOllle ·:::~
;
.
..
By FRANK M. SMUSZ
I WISH to c:omment on a letter here
Jan. 12 by Michael P. McRaner of Blue
Cross and Blue Shield of Virgmia with
regard to the autologous bone-marrow
transplantation and high-dose chemotherapy issue.
· Blue Cross states, in pan, that its policy is not to provide coverage for experimentallinvestiptional treatments: in this
case, ABMT for breast cancer. (Many
bealth-care insurers do cover this treatment, including some BCIBS providen.)
Let me point out that bone-marrow
Lransplantation is not unique. It has been
in use for about 20 years. There are many
major medical centers in this country that
have established, well-run, successful
~BMT programs for breast cancer, some
for six or more years. Many, I suppose, do
not consider ABMT therapy experimental.
\\ "b~ are the be~s at ~esc facilities full and
-
.
. ..
.
.
the waiting lists long?
One important fact is that stage 4 metastatic breast cancer is a 'terminal illness.
Conventional chemotherapy can sometimes slow down the spread of the disease,
but rarely does it render a patient diseasefree, as can be accomplished with the
ABMT therapy.
Most patienu havina ABMT treatment are young, many with small ehildren.
It is their only chance at long-term, discase"free survival. Even if the disease returns in three, four or five years, there is
·the ~ibility that other treatments will be
available then.
'.
·.
Some reports su&&est that with ABMT
therapy, more than 30 percent of the women who have late-stage breast cancer are
alive and disease-free up to two years after
the ABMT, compared with only S percent
on standard chemotherapy. In another repon, up to 2S percel!t of patienu with
metastatic stage 4 cancer have remained
··-r·
.
•.
.
.
..
..
• .......!:
disease-free with foUow-up for as long as contracts to defme and identify services . many yean ww ll talce? Tbrei yean? Five:·:":.'·:
seven yean.
they will not provide coverage for. One of · years?
·
·
·.
.., · !
ABMT is not without risks. lbe mor- those is ABMT for breast cancer. (More . I do n<?t !lave all the ~swers on this •· ; ;
tality rate from this treatment has been than 44,000 women die from breast cancer ISsue. But 11 u my concluSion that when···~ ·
about S to IS percent in the past. But with
in this country each year.)
competent, expenenced _medical doctors
new techniques and drugs, i.e., &rowth raeprescn"be a _course of treatment or therapy• "r..,
tors, these numbers appear to have been
In 1990, the 73 BCIBS plans nation- in a matter of life or death, and when this.. ~:.:
reduced. Without the ABMT treatment, . wide had a collective net pin to reserves of treatment is concurred with by other com-·····~
these women will die anyway, so to many $2.2 billion, according to their own projec- petent and experienced medical .profes-· .: ...,
the risk is worth taking.
·
lions. This \\'85 despite the loss of SOO,OOO sional specialists in that field of study, the :;
Is this treatment medically neCessary members. Amazing!
.
worst thing that can happen to the patient:··;'
and effective? Absolutely! In a recent court
The BCIBS national association an- is to have the health<are insurer practice--=:!
case with Blue Cross and Blue Shield of nounced last Oct. 30 that it would partici- medicine from afar and deny you the medi·
Vi.rsioia, the coun found the treatment (I) pate in a nationwide study conducted by cal coverage you may need to' keep you··~·~
was medically necessary and effective; (2) the National Cancer Institute to determine alive.
·
.: .. :.'
was currently in use in major medical cen- whether ABMT with high-dose cbemotherI ponder the ~thical, moral, ·and Jcpf :"·:
ters; (3} bad scientifically proven value; apy for breast cancer is effective and safe aspects of this. Don't you? · .
::·:;)
and (4} \\"BS in accordance with generally therapy. Blue Cross and Blue Shield of
-·-·
accepted standards of medical practice. Virginia waited more than six weeks to
(Other health-care insurers have lost in announce it would do the same. (It apPears ·Frank M. Smusz fiVes in Rncastle. His :;-·::"'.
coun too!}
that only after much publicity and public wife, Lorraine, has been denied coverage :-• .-:'
In pan due t9 pending and concluded outcry did the company volunteer to par- by Blue Cross/Blue Shield for ABMT for ller::-::-~
litigation, Blue Cross bas amended many ticipate.) This study has yet to begin. How cancer.
····-
,.
.I
I
�BUSINESS
WANT TO BUY AMERICAN?
. GOOD LUCK FIGURING OUT
WHA"rS MADE IN THE U.S.A.
IY
:Sto.a.
1onA2.
Roanoke limes .&World~News
....
•'
'
Classified ce
Crossword 84
Deaths E2
Homes cs
Travel as
' '
~P·.
ttacks·
f!ltsin
::s 'economic
ocide' policy
Los Angeles Times
tSCOW -
Russian Vice
111 Alexander Rutskoi ac·
resident Boris Veluin'saov.
~rs.~===~~~ P~:!:1Je~
iu own people.
obowamed lhat itYeiiSin'o
\CDI did DOt declare 1D ~
:~e:Uidi:d~•c:uso::;
IOialllariaolom.
uaibuhod denlllldatloo .
ivered II lhe C...,... of•
td Patriotic Fcm:a. an a.
Jfmonlhan 30 puupotbat
• movemeot or
lot
: 10
IIIII)' ••
accuocdYdlllo'o:am of judll'yina tho lll<ri.opielnlhc nome ofrodue>uclaetdelldt.
:yare ready to acccp1 retir~
1 while they stand in line
.~'dnr;_;o,:i::r~
disqrce witb such apand reforms." Rutskoi
ily...Doesn't this remind
lC Bolshevik principle -
n at any call?" he asked
I, which roared qrcement.
kol repeatedly has attad<·
n's economic reforms. but
's speech, toacthcr with an
p~hb~i•~:tmr::~~:.d•~.,~;
cancerollricken wire, Lorraine, and their
IWO sons. maJntalai~ a full-time job as a
IN HIS FIRSI' day as a novice
lobbyist, FrankSmusz wenJ{rom
feeling liklan outsider with a noble
t~~~~~~!::;u.-:w.s r=~~oWt~
cads u an clearicel conlraCior, who would
bave time?
Still, the sugcstion naged ll Fnnk
Smuu's mind.
anue to an Insider with a more
reallsllcvlewofhow l'lf!rlnla's
legis/Jllive system. started nearly 37J
)Wlnagtl.-*.t
Why oat at lcut look into h?
Ia November, as Lorraine continued
..
:=:.;';l~:\'!':t~:~=it~~i~t~.:
By~~RISON
and ~ncrina as one or BSO state lobby·
istL Ia 10 doi._, he was takina their ~car·
lana battle ap1n11 Blue Cross and Blue
:r, were his llronant at-
Shlild ol Virainla 10 another level.
Blue"'&:~~L'Ti~':~cd:'!•:n~n':!:~
0
;jn launched his reforms
:C:'3c::n~.oil"'.:er:!P'~~:d wbatlntcrtSI
r:l!~"!~~;
says. Even better, when uked
• ~fc\~::3a~!·::
1
<b •• okymekct.
we have a way out," Rue.
poup he repmented, he listed his wire.
Fr1Dk had no idea doln• 10 would
dildnJuish him u the only rq.aslered lo~
=sts =
...Aa emcraen~ sltuatioa.
traduced Ia tbe ecoaomy.
bylst::: l:te affiliated with associations,
:".~~~~~~=·~
are
l'::eevc~~n.t:;:.':
0111~aod the people
ICI
COIJ)Ofttiou or sped&in~aat aroupa.
to power Ia 1911 wiU
AJ alobb)'.lst, however. Frank s1aycd
power apia."
laactlve uatil January.
~rci=~~u~::oi'r.~:o,•::
PLEAsE SEE CRUSADEIA2
tedarcd "ccononilc emer•
.aation,.. nor did he &lvc a
· economic success.
1ayle draws ·olyri1pic'mb~j}·lndia.;.&aby~killing reported
'•soctated Press
)~~-1.1~~-R>\IN~.
Ftant'f"
,.,...... :.... \i.·•······
.
LoaAnQeleaTimoa
... ~turAf!.~,.m. ~~..!~' ~. . :m~·i··i~i~:~~~~;.
72% Of girls' deathS
in
~rri0n defiher.l'':'l
�..
Publicity helped couple fight
cance~, ·insura~ce company
Youth sought
after slayings
i~ captured
I
e
r
'd
'
one
"I tell Y.oiJ;
p~
can do it. SomebOdy wilh
an Interest and
perseverance can get
get something done."
AIDS resec
skirts law il
~=-~
inlurancobl
Loa Angeles Oally News
apprO\'C'd
withOUII
and Dr1
avoidinp.
Search
whether
"Tho
on any I
=~·~:
Wh.
Kienlili.
lie and
somc1h1
10:35a.m.S.o. VIIJ!IOoodeor
Roctr Mount Isn't in, either.
time liter, occun to
called the reporter by the
Frank h1d heard Ooodc was ln. Frank:
thouJht he was
tcrcstcd in ensurlaa 11 least thai wrona name. ... admits, ref'errina
Richard Real." he
Stale employees are covered ror
oald.
4p.m.Onaro11itow.
'!·0:
David Brickley,thebilraHo~ ··,
FD
said thn
sponsor, doesn't keep Fran1C ...
waitina. His reason for backlna the
bill also is clear: his wife, Loii, b · •
or P:"r
bcmeoomarrow lraaJPtaaca. a benefit ;r~~c~':lo':\':.~:6~~ fiahtlna breUI Clnccr. "It's real~··:
lbat worl<e11ln Muyland and Nonb Clwlnd 7.
semen to me," he says.
.. :•
carolina bave.
.., .•
Noon. "Wha1 do you do. correct
In his own dlstriCC. Goode h1d him7"
Bric~e~rr.e'v~~we~:!~~:~~;e~f :. :
Frank:' llell you, one penon can do .. •
From tbe balcony above the
J:~ ~=.o.1~·~:~:.::
I~ Somebody with an interest and
• cer and the state's Insurer, Blue Senate Door, Frank bas sent 1 DOte perseverance Cln 8C1 Jet IOmctbin& • ,
down to Trumbo, utlnato be Intro- Clone.
Cross. over her tratmeaL
o ,•
duced. He Is quiet and rapmrul, u
Anotbcr aide. Brian Foster, tr In a museum.
"You don't need a whole army · ,
ruas intcrl'creace. TrPJcally vaaue
On Trumbo's tum to like the or hilh·paid lobbyilll." be 18)'1. ' :' .
. - most aida seem to have little
,-duo about where their lqlslaiOn are ftoor, bll Introduction Is 1 short.
4:30 p.m. Virall Goode doesD•l · '
upbeat 1y_nopoi1 or l.orraine'l llory
, •·
···:;.,~.-:=~t:.:;i.': and haw h resulted in Frank's com~ keep Frank waltlna eilher.
llsbelleriOukbim."
Ina to RichmoDd. Ho usa words and
phrun like ''cou~" "ordeal" stan~·f:s~Ptr~~Ce ~=e~:~~··:
:Fruklelvesblocanl.
idea," ~oodc tells him. "It brinp ,
and "one-man c:nalade."
more awareness if oothina else." .. ,
Only TNmbo ,ets it wrona.
He saya "bone cancer transo'!~rs.~~!~::::!orn=fs ~r~~
plants " instead ol bone-marrow trict who bad to battle: Blue Cro15a' ·
lriDSII'iants. AI I raul~ SO does Lt.
requirr•
iment!l
ensurP.'
effect to other plant," he says.
• ,.:~
was u1
4:50p.m. Bois sony,
· •
8<~
drupr,
tesunp.
But lh'
appro'
tonwh
to lflpl
C'r
too slu
-and
pic wh
St·
unwom
30 do:
meDII
.
~C::te~~ ~~nJ:nr :t: :::;~ r.· ~r·~~v~~u:= ::
Sha::
CUilomary pod luck.
Fraak ltlnds and waves any..
"My, "ltbouaht it wu nry nic:o,'' tie
...,..
He11 Cllk to
AIDS
ltOUftl
Tl
tlona1
Wilh I
ina h1
sion.
did ;rJ:~ d:'J.'f:!If':~t· :bat ..
h11 introduction. Frank wanted 10
thank Trumbo noneahelcss.
tic
~
an
~
~
l
••
---""';"=-~=
·=
..-...............,...
.....
~
study
apolopzina to Frank about ftubbrr:
~''
.·•tPil
:In the lO months since it was
rolmed, he oald, the Sean:h Alliance
hu arowa to include more than 40
docton In Los Anaeles, Son Fra•
dsco. New York and New M11ico
wlto bave condUCied trials on 12
difTcrent druas and uutmenu.
: , ·Rotbman n:odlly ooknowl··
cdaed that Searth membcn usc un-
.~.
Tho
tlonapi
was Unl\
with lhe
·ina hum
sian. Sto
"WI:
study th
...::a=.....~
:::.,~
w
Smuu tpid daat Is a ynr many women who need
breut c:aoccr treatment can't wait for.
~eanwbile,
continue hb ciTona
1~, ... ror lba he plaM to and will ... hi• ...,.in
lqi~atioo
..
nu.t oa the 14-member advisory panel.
And aoy doubt be evor had. he said, l)as raded.
!f!s eapcrience ~ len him inspired to do more.
I m"alread~ th1nklna of thinp 10 introduce ntxt ,
year o he uid.
Call on Res fur all of )'OUr Financial
PlarinlnR nreds.
�---- --
~K~
J;;' .
"..... •Ia• L
Cod« 1:
Cbecler.
Dale Ear17: - - - - - - Proofor.
ltceelvecf: Lector
I
Norccud
(circle oao)
_PRJOJUTY: VIP (Membu of Cooare.ss. OovelliOI', Mayor), FOB, FOH, FOA, etc., or lime teosirive.
_ _ YALE ORAD
_WELLESLEY ORAD
_ARJC.ANSAN
_PAIUC RJOOE RES
_CONGRATULATIONS/SUPPORT CARD: Utter cfoe.s aor address ISSUC$ or ofrer suggestions,
_IDEAS/ISSUES CARD: Ldlet of'fen &ood icfus (DO( ioco~reot, blaofecf or racist). General responst
J( lcfus ue particularly well lbouahr oul aocf expfaioecf io cfepdt. mast lSSUBS.
h appropriate.
'
..,SSUESffRANS: Ldru addresses specific ls.suet. Writer lt seddna 1 sp«Jnc response. Seocf rransirioa
Idler ro mosr people. lte.sJlOnse will iodicaro chat i~ un.oot k eMres5ed ~UrreodJ.
_OTHER ISSUES: For letrua liom loduW)t frofwlona1e, eoosrirueoey aroupa or JodlvidUAJa who aeacl
cfc.Wtcd flans woriLy of roo.sideralioa. Ldtu sbouJd be forwarded lo approprialo lssue3 sralf,
_CAMPAJGN/CAMPAIGNCARDa Writu lw ~cfped willa umpai,a.
_APPOINTMENT R.ECOMMENDATIONS/AfPOINT fORM
FOREIGN:
_
CONORA TS/FOREIGN
TRANS LEITER
_OTHER:
CouofiJLanp._ __
RESUME: (drcfe ooe) FOH/fOB
__THREAT: Oive fo
~pervisor
FOFOH
PS
VIP
HRCR.EC
IMMEDIATELY.
_JNVJTA TION: Jtour.e lo Scbedufia,.
_ _GIFT
___REQUEST: (circle ooe)
photo
avroarapb
_INAVGUJtAL: Lcner "iucm infoi'Tillrjon ot tichu.
_K.IDS
_lNTEAYltW Rf.QUESTSICLIJ>PINGS: Roulc lo prtaa.
_NO R.ESPONSE NECE.SSMY: No return t44rcu
Of
llell 1n18.
recipe
aucfioa irem
speecJa
olher.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
HRC - Health Care Correspondence [4]
Creator
An entity primarily responsible for making the resource
First Lady's Office
Maggie Williams
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 5
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
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42-t-2194630-20060223F-005-002-2015
2194630
-
https://clinton.presidentiallibraries.us/files/original/2b3cc46c17da7b480cc828833421b49f.pdf
9e8d710dcc350b2c12bcfe9684f86632
PDF Text
Text
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECTtriTLE
RESTRICTION
001 a. letter
Hillary Clinton to Barbara Mendel Mayden. [partial] ( 1 page)
03/31/1993
P6/b(6)
001 b. letter
Barbara Mendel Mayden to Hillary Clinton. [partial] (1 page)
02/03/1993
P6/b(6)
002. resume
Curriculum Vitae for Kelly Clark Pinkard. (Partial) (1 page)
n.d.
P6/b(6)
003.1etter
Ellen Roseman-Curtis to Hillary Clinton. [partial] (1 page)
02/23/1993
P6/b(6)
004a. letter
Hillary Clinton to George H. Bergdoll. [partial] (1 page)
03/3111993
P6/b(6)
004b. letter
George H. Bergdoll to Hillary Clinton. [partial] (1 page)
02/10/1993
P6/b(6)
005. resume
Paul W. Willihnganz [partial] (1 page)
[none]
P6/b(6)
006. resume
Vivian Riefberg [partial] (1 page)
[none]
P6/b(6)
007a. letter
Hillary Rodham Clinton to Bruce R. Brookens. [partial] (1 page)
03/29/1993
P6/b(6)
007b. letter
Bruce R. Brookens to Hillary Clinton. (Partial) (1 page)
03/10/1993
P6/b(6)
OOS.letter
Hillary Rodham Clinton to Sister Margaret Vincent Blandford.
[partial] (1 page)
03/29/1993
P6/b(6)
009a. letter
Hillary Rodham Clinton to June Kozak Kane, M.S., RD [partial] ( 1
page)
03/24/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Aet -(44 U.S.C. 1104(a))
Freedom of Information Aet -IS U.S.C. SS2(b))
Pl National Seeurity Classified Information ((a)(l) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(Z) Release would disclose internal personnel rules and practices of
an agency ((b)(l) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or fmaneial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning weDs ((b)(9) of the FOIA)
P2 Relating to the appointment to Federal office ((a)(Z) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfde defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
---- ----~-------'
�Withdrawal/Redaction Sheet
•
Clinton Library
DOCUMENT NO.
AND TYPE
009b. letter
DATE
SUBJECTffiTLE
June Kozak Kane, M.S., RD to Hillary Rodham Clinton [partial] (1
03/10/1993
RESTRICTION
P6/b(6)
page)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Ad -144 U.S.C. 1104(a))
Freedom of Information Ad- (S U.S.C. SSl(b))
Pl National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office ((a)(1) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
fmancial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6)ofthe PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(1) Release would disclose internal personnel rules and practices of
an agency ((b)(1) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or fmaneial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disdose information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disdose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
1101(3).
RR. Document will be reviewed upon request.
�---
----- - - - - - - - - - - - - - - - - - -
THE WHITE HOUSE
March 31, 1993
Mr. James Harold French, Jr.
3299 Woodburn Road
Annandale, Virginia 22003
Dear Jim:
Thank you for your thoughtfulness in writing to offer your
assistance as solutions are developed for the incredibly complex
health care issues. I appreciate your generosity and will certainly
keep you in mind.
The President is committed to reforming our nation's health
care system -- controlling runaway costs and providing security to
every American family. It won't be easy and it won't happen
overnight, but we can bring costs under control while maintaining
quality medical care and preserving the choice so important to us all.
We will be grateful for your ongoing support for the success
of our endeavors.
Sincerely yours,
~+Cllnron
�--~~~--
,
I
'S"Lct"=t
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"J
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JAMES HAROLD FRENCH, JR.
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/'"7
I
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
OOla. letter
SUBJECTffiTLE
DATE
Hillary Clinton to Barbara Mendel Mayden. [partial] (1 page)
03/31/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Ad - [44 U.S.C. 2204(a))
Freedom of Information Ad- [5 U.S.C. 552(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would diselose trade secrets or confidential commerdal or
· tinaneiallnformation [(a)(4) of the PRA)
PS Release would dlsdose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security elassified Information ((b)(l) of the FOIA)
b(2) Release would dlselose Internal personnel rules and pradices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would dlselose trade secrets or confidential or financial
Information [(b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted Invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disdose Information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would dlsdose information concerning the regulation of
finandallnstltutlons [(b)(8) of the FOIA)
b(9) Release would diselose geological or geophysieallnformatlon
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restridions contained in donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�---------------
THE WHITE HOUSE
March 31, 1993
Barbara Mendel Mayden
[oo\
o.1
Dear Barbara:
I appreciate your thoughtfulness in taking time to write and
provide the names of Drs. Claire M. Fagin, Linda Aiken and Mary
Naylor, nurses whom you deem well qualified to assist in the work
of the Task Force. I value your personal recommendation and will
pass the information along to the appropriate working group of the
Task Force.
/
./
/
/
/
/
/
The Inaugural week was an exciting and exhilarating time
indeed for our family, and it was so gratifying to us, knowing that
friends had come from near and far to experience the historic events
with us. I am pleased to learn of the most memorable highlights,
both for you and for your relatives from Georgia.
There have been all sorts of comments about my hat, but I
loved it, and I'm glad you did too!
Hope to see you soon.
Sincerely yours,
~ IJ__
(J"Vv
Jb~Clinwn ~fu._ ~
~ ~~ ~
~to
N----
lJ1v.,._
l ' " ( \ (.
w-e__
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001b. letter
SUBJECfffiTLE
DATE
Barbara Mendel Mayden to Hillary Clinton. [partial] (1 page)
02/03/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number:
10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
•
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Ad- (44 U.S.C. 2204(a)J
Freedom of Information Ad- (S U.S.C. SS2(b)J
Pl National Security Classified Information ((a)(l) ofthe PRAJ
Pl Relating to the appointment to Federal office ((a)(2) of the PRAJ
P3 Release would violate a Federal statute ((a)(3) of the PRAJ
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRAJ
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy ((a)(6) of the PRAJ
b(l) National security classified Information ((b)(l) of the FOIAJ
b(2) Release would dlsdose Internal personnel rules and practices of
an agency ((b)(2) of the FOIAJ
b(3) Release would violate a Federal statute ((b)(3) of the FOIAJ
b(4) Release would dlsdose trade secrets or confidential or financial
information ((b)(4) of the FOIAI
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy ((b)(6) of the FOIAJ
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) of the FOIAI
b(8) Release would disclose Information concerning the regulation of
financial Institutions ((b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�[oo\ ~1
February 3, 1993
Ms. Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue, N.W.
Washington, D.C. 20500
Dear Hillary:
My nieces and nephew (and sister) tell me that
they met you in washington. You should be pleased to
know that you rank an admirable third on their list of
best parts of their trip - (1) riding in an airplane (2)
ice skating (they are, after all, from Macon, Georgia)
and (3) meeting the President and First Lady. Thank you
for being so gracious to them.
I was very pleased to read that you will be
spearheading the President's health care task. force.
This gives me great reason for optimism. I assume that
you are in the process of assembling your focus groups,
and also that you will be including the largest group of
health care providers, those most directly involved with
patients 24 hours a day/7 days a week - the nurses.
I am taking the liberty of submitting a few
names for your considerat.ion. These are very qualified
nurses about whom I am familiar through a colleague in my
law firm:
Claire M. Fagin, RN, PhD, recently stepped down
as Dean of the University of Pennsylvania School of Nursing. Currently president of the National League for
Nursing, Dr. Fagin co-authored the position statement on
nursing for the transition team. Her
ne numbers are
(215) 898-9581 (O) and
I
�.- .·
Ms. Hillary Rodham Clinton
February 3, 1993
Page Two
Linda Aiken RN, PhD, is Trustee Professor of
Nursing and Professor of Sociology at the University of
Pennsylvania. A past vice president of the Robert Wood
Johnson Foundation, Dr. Aiken is considered the leading
nurse-spokesperson for health and social policy. Dr.
Aiken was the second co-author for the transition's position paper on nursing. Her office phone number is (215)
898-9759.
Mary Naylor, RN, PhD, is Associate Dean and
Director of Undergraduate Studies at the University of a
Pennsylvania School of Nursing. Currently, Dr. Naylor is
a part-time legislative fellow with Senator Wofford in
Washington, D.C. Her Penn office phone number is (215)
898-8285.
These women are also in a good position to make
recommendations of other nurses from other parts of the
country.
I had a wonderful time during inauguration
week. I think the highlight of a week full of highlights
was the "ABA Friends of Hillary Dinner" where we all
looked "mahvelous" in our fancy dresses, and got a little
misty eyed toasting you (and, of course, Bill). I miss
you and wish you the best.
J
Very truly yours,
r-·b(,U"LbGL\C'-
~. \ Yl (1~_£/)
Barbara Mendel Mayden
P.S. I liked the hat.
(
IP
�----- ----------------------\
THE: WHITE: HOUSE:
WASHINGTON
March 31, 1993
Mrs. Elliott Roosevelt
7307 East Valley Vista Drive
Scottsdale, Arizona 85250
Dear Mrs. Roosevelt:
Betsey Wright has forwarded to me your letter recommending Dr. Kay Pinckard for
participation in the work of the Health Care Task Force. The Task Force includes the
Secretaries of the Treasury, Defense, Commerce, Labor, Health and Human Services, and
Veterans Affairs; the Director of the Office of Management and Budget; the Assistant to the
President for Domestic Policy; the Assistant to the President for Economic Policy; the Chair
of the Council of Economic Advisors; and the Senior Advisor to the President for Policy
Development.
In addition, the Senior Advisor to the President for Policy Development will lead
interdepartmental working groups which will gather information for, and provide information
to, the Task Force. The working groups, which are working closely with Members of
Congress and their staffs, are comprised of government employees.
While the working groups have begun the process of preparing policy options for
reforming our health care system, their work is an ongoing process. The members of the
Task Force are anxious to consult with knowledgeable and concerned people. I am directing
a copy of your letter with Dr. Pinckard's curriculum vitae to the appropriate working group.
The President and I will appreciate your support for the success of our endeavor. He
is committed l9 reforming our nation's health care system-- controlling runaway costs and
providing security to every American family. It won't be easy and it won't happen
overnight, but we can bring costs under control while maintaining quality medical care and
preserving the choice so important to us all.
Sincerely yours,
�dl1.u..
7307
Ea~t
ELliott d?oo~euelt
rvaLLey
rvl~ta
March 17, 1993
1
!Duue
~A
Ms. Elizabeth Wright
1317 7th St. N.W., Suite 600
Washington, D.C. 20004
Dear Betsy:
It was such fun talking to you yesterday and I hasten
to write this letter so that me may resolve and
confirm our telephone conversations.
I am enclosing the Curriculum Vitae of Dr. Kay
Pinckard who is so highly respected in the southwest
as well as nationally for her studies and work in
pediatrics.
The health care and the treatment of
young people is of paramount importance to Kay and she
has worked long and diligently in this field since
graduating with Honors from Baylor Medical School in
1973.
I feel that her dedication and expertise in
these fields will certainly add to the President's
Task Force on National Health Care Reform chaired by
Mrs. Clinton.
It is really super that we have made our acquaintance
via the telephone and I look forward to a visit by you
in Scottsdale in the near future.
Lady, you did a great job for our President and some
day soon I expect fully to see you as Ambassadress to
the Court of St. James, at least.
Seriously, I urge you to give Kay Pinckard's CV to
Hillary Clinton at the earliest opportunity, as she
has just ended a three year term as Chairwoman of the
American Academy of Pediatrics Committee on Careers
and Opportunities. She has also, in this busy life,
found time to volunteer her time to provide medical
exams and care to children of the Navajo Nation in
Northeastern Arizona and has accompanied the American
Voluntary Medical Team on two medical missions to
Micronesia and on numerous health care screenings in
low income communities throughout Arizona.
In each
case, she utilized vacation time from her position on
i
\
I
\
�Ms. Elizabeth Wright, March 17, 1993
Page 2
staff at Phoenix Children's Hospital to pursue these
worthwhile endeavors.
As Associate Director of the Phoenix Children's
Hospital Outpatient Clinic, a primarily non-profit
facility that focuses on treating the working poor -those whose income is too much to qualify for health
care under Arizona's Health Care Cost Containment
System, but too little to be able to afford private
medical insurance
she knows all too well the
defects in the current health care delivery system.
Kay is Hillary Clinton's kind of person and I just
know they would get along marvelously.
Regarding the painting of Eleanor Roosevelt, I must
get Polaroid film and will send a photo under separate
cover.
Betsy, again, it was such fun talking to you. After
hearing Jesse George extol your virtues, I really feel
that we will be good friends. Thanks again, and I am
looking forward to hearing from you very soon. Please
come and visit me in ~ beautiful house.
With warm regards,
Tel:
Fax:
( 602) 443-3370
(602) 596-1091
P.S. Thank you for finding out.about the books I sent
to the Clinton's before Thanksgiving.
I am really
anxious to hear how they liked them, as I thought they
would be logical introductions to the White House
before they took possession on the 20th of January.
P.P.S. Remember, ~ dear, when you do sleep over at
the White House to ask for the Lincoln bedroom. As I
told you, Elliott and Rose Kennedy both slept there
but not together.
Affectionately,
~~
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. resume
SUBJECI'ffiTLE
DATE
Curriculum Vitae for Kelly Clark Pinkard. (Partial) (1 page)
RESTRICTION
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 1104(a))
Freedom of Information Act -IS U.S.C. SS1(b))
Pl National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office ((a)(1) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(1) Release would disclose internal personnel rules and practices of
an agency ((b)(1) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or f"maneial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf"de defined in accordance with 44 U.S.C.
1101(3).
RR. Document will be reviewed upon request.
-----
----------
-------
�CURRICULUM VITAE
NAME:
(Linda) Kay Clark Pinckard, M.D., F.A.A.P.
OFFICE ADDRESS:
Phoenix Children's Hospital
909 East Brill Street, Phoenix, AZ 85006
Phone: (602) 2.39-4822
DATE OF BIRTH:
November 24, 1947
PLACE OF BIRTH
Auburn, New York
MARITAL STATUS
Married: Kenneth R.
CHILDREN:
Justin Todd Pinckard,
Meghan Ashley
EDUCATION:
Undergraduate:
State University of New York at Binghamton,
Harpur College, B.A. Degree In Biology,
1965. 1969
Graduate:
The (Woman's) Medical College of Pennsylvania,
Philadelphia, Pennsylvania, 1969 • 1971
Baylor College of Medicine, Houston, Texas,
M.D. with Honors, 1971-1973
Internship:
Baylor College of Medicine Affiliated Hospitals,
Department of Pediatrics, Houston, Texas,
1973. 1974
Residency:
Baylor College of Medicine Affiliated Hospitals,
Department of Pediatrics, Houston, Texas,
1974. 1976
Fellowship:
Baylor College of Medicine, Department
of Pediatrics, Pediatric Development •
Awarded but not taken 1976 • 1977
Yoo<d-J
�'
.
CURRICULUM VITAE
Kay C. Pinckard, M.D., F.A.A.P.
Page 2
STATE
LICENSURE:
Texas: August 18, 1973 - 1989 (E 1229)
Arizona: November 27, 1987 (17256)
BOARD
CERTIFICATION
Diplomate, American Board of Pediatrics,
February 2, 1979
HONORS:
Alpha Omega Alpha, an honor medical society,
elected 1973
Graduated with Honors, Baylor College of Medicine,
1973
Outstanding Woman Graduate, elected by American
Medical Women's Association, Houston
Chapter, 1973
H.J. Ehlers Award in Surgery, Baylor College of
Medicine, 1973
AOA Award for Research: Use of the Direct
Fluorescent Antibody Test for Identification
of Bacterial Cultures, 1970
Physician's Recognition Award, American Medical
Association, 1980, 1983, 1986, 1988, 1992
J\1 EMBERS HIP IN
PI~OFESSIONAL
SOCIETIES:
Alpha Omega Alpha (honor medical society)
Fellow, American Academy of Pediatrics
Arizona Chapter of American Academy Pediatrics
Phoenix Pediatric Society
Treasurer, 1991-1992
Ambulatory Pediatric Association
Baylor College of Medicine Pediatric Alumni Assn
American Medical Association
American Medical Women's Association
Texas Pediatric Society (through 1988)
Houston Pediatric Society (through 1988)
Texas Medical Association (through 1988)
Harris County Medical Society (through 1988)
�CURRICULUM VITAE
Kay C. Pinckard, M.D., F.A.A.P.
Page 3
ACADEMIC
APPOINTMENT:
Associate Director Ambulatory Clinic, and full-time teaching
faculty, Phoenix Children's Hospital, 1987 • present
Clinical Teaching Staff, University of Arizona Medical College
-pending
Clinical Associate Professor, Department of
Pediatrics, Baylor College of Medicine
1985 • 1988
Clinical Assistant Professor, Department
of Pediatrics, Baylor College of Medicine,
1981 • 1985
Clinical Instructor, Department of Pediatrics,
Baylor College of Medicine, 1976 - 1981
OTHER MEMBERSHIPS
AND SERVICES: Pediatric News, Editorial Advisory Board, 1993-1996
American Academy of Pediatrics Committee on Careers
& Opportunities, 1986-1992; Chairperson 1989- 1992
AAP Council on Pediatric Practice, 1989 - 1992
AAP/AZ Chapter Day Care Committee, 1990- present
Phoenix Children's Hospital, PHAPP faculty and attending teaching
staff, 1987 - present
Ambulatory Operations Committee, 1988
Curriculum Committee, 1988 - 1990
Outpatient Care Committee, 1988 - 1991
Patient Services Task Force, 1988
Professional Advisory Committee, 1989 • present
Children's Miracle Network Telethon, 1989, 1990, 1991, 1992
Public Relations Advisory Committee, 1990 - present
Social Calendar Committee, 1991-present
Special Tracks Committee, 1991-present
Pediatric Update Conference Committee, 1991-present
Sick Child Day Care Committee, 1991
Emily Anderson Family Learning Center Operational
Advisory Committee, 1990 - present
Governor's Office for Children/School Age
Child Care Coalition, 1990 - Present
Conference Subcommittee, 1991
�CURRICULUM VITAE
Kay C. Pinckard, M.D., F.A.A.P.
Page 4
Good Samaritan Regional Medical Center Pediatric Committee,
1988- 1991
"Current Decisions in Infant & Children", Consultant to
Editorial Board, Health Learning Systems, Inc., 1989-1991
"Practice Management" - Reviewer
"Pediatrics" - Reviewer
Arizona Volunteer Medical Team- medical missions to
Micronesia, Arizona communities, etc; Officer and
First Vice President, 1989 - present
Primary care physician for children brought from Bangladesh and El
Salvador with cleft lip/palate and congenital heart disease
American Cancer Society Jail-a-thon, 1989
Baylor College of Medicine, Department of Pediatrics
attending teaching staff and preceptor, 1977 - 1987
Texas Pediatric Society
Accidents and Environmental Hazards Committee,
1984- 1986
The Woman in Pediatrics ad hoc Committee,
1986- 1987
Kelsey-Seybold Clinic, P.A., Houston, Texas
Executive Board, 1983 - 1985
Marketing and Practice Development, Chairperson,
1983- 1985
International Patient Relations Committee, 1978 - 1979;
Chairperson, 1979 - 1983
Professional Committee, 1978 - 1982
Finance Committee, 1980 - 1985
Pr·actice Development ad hoc Committee, 1979 - 1980
Pre-term Labor Study Committee, 1987
Texas Children's Hospital - Houston, TX
Joint Emergency Services Committee, 1983
Nursing Service Committee, 1979 - 1983
Medical Audit/Tissue Committee, 1986 - 1987
Infectious Disease Committee, 1987
St. Luke's Episcopal Hospital - Houston, TX
Newborn and Premature Records Screening
Committee 1981 - 1982
Perinatal Advisory Committee, 1982 - 1987
The Woman's Hospital of Texas - Houston, TX
Pediatric Service Record Review Committee, 1981 - 1983
Quality Assurance Control Committee, 1978-79
�CURRICULUM VITAE
Kay C. Pinckard, M.D., F.A.A.P.
Page 5
St. Martin's Lutheran Church, Houston, Texas
Fellowship Committee, Secretary, 1978-1980
Sunday Church School Teacher, 1978-1980, 1986
Vacation Church School Teacher, 1981, 1982, 1986
Church Council, 1985-1986
Crippled Children's Services Program, participating physician,
1983 -present, Texas and Arizona
HOSPITAL PRIVILEGES:
Phoenix Children's Hospital • Associate Staff Membership,
1987 - present
Good Samaritan Regional Medical Center - Active Staff Member
in Pediatrics, 1988 - present
Maricopa County Medical Center - Provisional Visiting Medical Staff,
1988 - present
St. Joseph's Hospital - Courtesy/Provisional, 1988 • present
Arizona Children's Rehabilitative Services • Provisional Status
and Membership on the Pediatric Staff, 1988 -present
Texas Children's Hospital - Active Staff (through 1988)
St. Luke's Episcopal Hospital - Attending Staff (through 1988)
The Woman's Hospital of Texas - Courtesy Staff (through 1988)
The Methodist Hospital - Courtesy Staff (through 1988)
Hermann Hospital - Courtesy Staff (through 1988)
PUBLICATIONS,
PRESENTATIONS AND
LECTURES:
Research Paper: "Use of the Direct Fluorescent
Antibody Test for Identification of
Bacterial Cultures", 1970
"Pragmatics of Pediatrics", October 1977
"Genetic Counseling in Pediatrics", October 1978
"The Woman in Pediatrics" Workshop at Baylor
College of Medicine Intern Retreat, September 1980, 1981, and 1982
The Tabletop Grandmother, May 1981
"Comprehensive Ambulatory Management of the High Risk Infant", Texas
~edical Assoc. Annual Meeting, May 1982; 7th Annual West Texas Perinatal
Conference, Odessa, Texas, February 1983
Conference for Women Chapter Representatives by
�CURRICULUM VITAE
Kay C. Pinckard, M.D., F.A.A.P.
Page 6
American Academy of Pediatrics' Provisional
Committee on Careers and Opportunities • Workshops:
"Balancing Career and Family", San Francisco, California,
May 8-9, 1987
"Immunization and Back to School" Brown Bag Lunch,
Enron Corporation, Houston, Texas, August 12, 1987
"AAP Recommendations on Pediatric Manpower" revision,
American Academy of Pediatrics' Provisional Committee on Careers
and Opportunities, May 1987; under revision, 1991
Women in Pediatrics Conference, participant and speaker,
65th Annual Meeting Texas Pediatrics Society, Houston, Texas,
September 12, 1987 ·
American Academy of Pediatrics Executive Director's Designee
to Specialty Society Luncheon of American Medical Women's
Association, 72nd Annual Meeting, Orlando, Florida, October 28, 1987
Second Conference for Women Chapter Representatives by
American Academy of Pediatrics' Provisional Committee on Careers
& Opportunities- Workshops: "Building a Support System", Chicago,
Illinois, June 25-26, 1988
"Prevalence of Cytomegalovirus Antibody in Subjects Between the
Ages of Six and Twenty-two Years", Journal of Infectious Diseases, Vol.
159, No. 6, pp. 1013-1017, June 1989
Phoenix Children's Hospital Love Magazine articles on
Pediatric Clinic, and Outreach, 1989, contributor
"Breastfeeding" combined seminar, Phoenix Children's
Hospital PHAPP core teaching lectures, 1988, 1989, 1991
"Phoenix Children's Hospital General Pediatric Clinic",
presentation to Cinquentas, 1988; Dairy Queen Conference, 1989
"Estimation of Gestational Age", Well Baby Lecture series,
Maricopa Medical Center, 1988-90, and Phoenix Children's Hospital,
1990-present
Television and radio interviews: "Immunizations", 1988;
"Back to School", 1989; "Flu", 1990; "Outreach", 1990; "Babies of Drug
Abuse", 1990; "Parents call-in to Pediatrician", 1990; "Outreach", 1990;
"Immunizations in Arizona and Pertussis Epidemic", 1990; "Arizona's
Dismal Statistics", 1991; "Kids Count Data Book", 1991; TV and radio
interviews on Pertussis Epidemic, Legislation for Health Care, Cardiac
Surgery on AVMT patient from El Salvador
�CURRICULUM VITAE
Kay C. Pinckard, M.D., F.A.A.P.
Page 7
AAP Annual Fall and Spring Meetings, chaired "Breakfast Forum
for Women Pediatricians", 1989- 1992
Grand Rounds PCH ''Whose Watching the Children? The
Arizona Day Care Crisis", February 20, 1990
Third Leadership Conference for Chapter Women Representatives
by AAP/COCO, presided as chairperson, April 6-8, 1990
"Delivery of Medical Care to the Third World", Phoenix Children's
Hospital Pediatric Review, Vol. 3, No. 1, pp. 12-16, Spring, 1990
AAP Spring Meeting Roundtable, "Balancing Career and Family",
May 1, 1990
AAP brochure for medical students, Pediatrics as a Career, written with
AAP/COCO, 1990
"When To Call The Doctor", Parent Pages, May, 1990, contributor
"Fluoride Supplementation", Phoenix Children's Hospital
Pharmacy and Therapeutics News, pp. 2-3, September, 1990
"Outreach Program to Isolated Towns and Navajo Reservation",
NACHRI Newsletter, Sept, 1990, contributor
"Holiday Safety", Mesa Tribune, November, 1990, contributor
AAP Annual Fall Meeting Residents' Section Roundtable "Women in
Medicine/Balancing Career and Family", October 6, 1990
AAP Annual Fall Meeting Starting In Practice Workshop
"Part-time/Interrupted Practice" and "Part-time Employment/Shared
Positions", October, 1990
Series of monthly articles on "Development in the First Year of Life",
Phoenix Gazette, February, 1990- January 1, 1991
Testified before the Arizona House of Representatives' Committee
on Health on "Children's Health Initiatives", January 1991
American Medical News article on shared practices, 1990, contributor
"Balancing Career and Family" University of Arizona
Medical School Pediatric PL 3 Resident Retreat, November 1990;
PHAPP Core Lecture Series, January 1991
"Increase in Female Medical School Applicants Good for
Pediatrics", Pediatric News, January 1991, contributor
"Hospital Works to Reverse State's Dismal Statistics", Phoenix
Children's Hospital press release, February 1991, contributor
American Academy of Pediatrics Task Force "Report on the Future
Role of the Pediatrician in the Delivery of Health Care", Pediatrics, Vol 87,
No 3, March 1991
AAP District VIII Leadership Workshop, March 1991
AAP Membership Recruitment Brochure, June 1991 ·
�CURRICULUM VITAE
Kay C. Pinckard, M.D., F.A.A.P.
Page 8
PR Videos for Phoenix Children's Hospital "Outreach to Page,
AZ", "Outreach to Indian Health Services"; "A Special
Place for Children"
AAP packet for Women in Medicine Month, contributor, September 1991
"Career Opportunities", AAP/AZ Chapter Breakfast for Women
Pediatricians, guest speaker, September 1991
Ross Roundtable "Children and Violence", participant, September 1991
"Primary Care Perspectives ·in Pediatrics", Physician Services,
The Samaritan Foundation, Medical Update V for the Primary Care
Physician, October 1991
AAP Manual on Pediatric Practice II. contributor, October, 1991
AAP/COCO Leadership Conference, AAP Annual Fall Meeting,
chaired, October 1991
AAP Starting In Practice Workshop/Career Day for Residents,
AAP Annual Fall Meeting, chaired, October 1991
AAP/COCO Booklet on Employment Issues for Medical Students
Entering Pediatric Residency, in progress
"Children and Violence" presentation of 15th Annual Pediatric Update, Phoenix
Children's Hospital/Maricopa Medical Center/AAP AZ Chapter, March 7,
1992; core lecture series, GSRMC Family Practice Residency Program,
May 19, 1992.
"Children and Violence", Audio-Digest Pediatrics, Vol 38, No 8, April 28, 1992.
"Family Violence" presentation to PCH Child Protection Committee, June 1992.
"Healthy Mothers-Healthy Babies 1992 CARE Fair", AAP/AZ Chapter participant,
July 14, 1992
AAP/AZ Chapter, Committee on Child Abuse, 1992-present
Maricopa County Coalition of Healthy Mothers, Healthy Babies C.A.R.E. Fair,
August 14-15, 1992.
Maricopa Medical Center Resident Lecture, Children and Violence, September 4,
1992
Phoenix Children's Hospital Resident Lecture, "Children and Violence",
September 18, 1992
Re\i sed 01/9.1
�THE WHITE HOUSE
March 31, 1993
Ms. Ellen Roseman-Curtis
Cooperative Adoption Consulting
54 Wellington Avenue
San Anselmo, California 94960
Dear Ellen:
I appreciated receiving your letter expressing concern that
health insurance coverage be expanded to include family building and
infertility treatment. A copy of your letter is being directed to the
Task Force.
President Clinton is committed to reforming our nation's
health care system -- controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
Thank you for sharing your suggestions and for your support
for the success of this tremendous undertaking.
Sincerely yours,
�Withdrawal/Redaction Marker
Clinton Library
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AND TYPE
003.letter
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DATE
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02/23/1993
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COLLECTION:
Clinton Presidential Records
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finaneial information ((a)(4) of the PRA)
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and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
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Information ((b)(4) ofthe FOIA)
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purposes ((b)(7) of the FOIA)
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PRM. Personal record misfile defined In accordance with 44 U.S.C.
ll01(3).
RR. Document will be reviewed upon request.
�ELLEN A. CURTIS
54 WELLINGTON AVENUE. SAN ANSELMO. CA 94960
(415) 453-0902
February 23, 1993
Hillary Rodham Clinton, Chairperson
Task Force on National Health Care Reform
The White House
Washington, D.C. 20510
Dear Ms. Clinton:
Growing & Learning
go hand In hand
On January 20, 1991 you and I met and talked when you and your
friend,Mary Steenburgen 1 attended the Sausalito First Presbyterian
Church near San Francisco. You had come with Mary and another
friend for a weekend stay, each with a daughter, I think I remember you mentioning that the girls were not with any of you because they opted to "sleep in."
I will always remember our conversation which covered adoption in
this country (open and closed) as well as the Children's Defense
Fund and its focus. Although I did not know you would one day be
First Lady, I will always remember the conversation as being personal, focused, and genuine. It delighted me when your husband
was elected and I knew you would be carrying on your work for families an~ children.
I believe that having a family is a fundamental right for all
Americans, regardless of class, ethnicity, medical history or any
other factor. I hope myself and others can count on your support
for expanding health care coverage so that we may realize our dreams.
Sincerely,
Ellen Roseman-Curtis
COOPERATIVE ADOPTION - A LOVING OPTION
�(
•
..•
.' ..
CODER:_ _
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:_ _
GENERAL SORT:
_Personal stories
POSTCARD 1:
_Letter Campaign
_Other Health Providers
POSTCARD 2:
_Offers to help/Employment
FORM LETI'ER:
_Letterhead
_Policy
REROUTE:
_Casework
_Scheduling _President
_Jihy&icilm&
_Other
POLICY AND PERSONAL STORIES:
_ORGANIZATION (I)
_insurance premiums
_insurance reform
_insurance pools
_boards and oversight
_COVERAGE (ll)
_working families
_unemployed/low income
_benefits
__providers
_INFRASTRUCTURE/WORKFORCE (ill)
_quality assurance (guidelines)
_administration, reimbursement
& information systems
_malpractice & tort reform
_manpower issues (training)
_unnecessary procedures
_GOVERNMENT PROGRAMS (IV)
_medicare
_medicaid
_veterans
_ DoD
_Indian health
_COST ISSUES (VI)
_drug prices
__physician fees
_hospital fees
. _medical equipment
_fraud & abuse
_FINANCING
(VII)
_MENTAL HEALTH (IX)
_LONG-TERM CARE (X)
_PUBLIC HEALTII/
SPECIAL POPULATIONS (XII)
__prevention
_AIDS
_women's health
_immunizations/children
_rural
_urban
_OTHER._________________________
�THE WHITE HOUSE
March 31, 1993
Thomas W. I..angfitt, M.D.
President
The Pew Charitable Trusts
One Commerce Square
200S Market Street, Suite 1700
Philadelphia, Pennsylvania 19103-7017
Dear Dr. l..angfitt:
I appreciate your offer to send me a copy of The Pew Trusts'
recommendations for health care reform when they have been
finalized. This will be helpful both to me and to the Task Force as
we consider various options in finding solutions to the incredibly
complex health care issue.
President Clinton is committed to reforming our nation's
health care system -- controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
We will appreciate your continuing support for the success of
this enormous undertaking.
Sincerely yours,
�- -
THE PEW CHARITABLE TRUSTS
One Commerce Sq11are
2005 Market Street. S11ite 1700
Philadelphia, Penmylvania 19103-7017
Thomas W. Langfitt. M.D.
President
Direct Telephone: 215.575.4710
Telephone: 215.575.9050
Facsimile: 215.575.4939
February 24, 1993
Mrs. Hillary Rodham Clinton
The White House
Washington, D.C. 20500
Dear Mrs. Clinton:
I appreciated the opportunity to speak to you at Senator
Wofford's health reform meeting in Harrisburg last week.
For several years The Pew Trusts have supported a Health
Professions Commission which has recommended profound changes in
the way physicians and other health professionals are educated and
trained so that they will be more responsive to the health needs of
the public. Toward that end, we are in the process of preparing a
number of specific recommendations for federal action for health
care reform. They link the development of a system of universally
accessible primary care to a shift in the current level of
resources away from educating and training specialty-based health
care practitioners to producing a greatly increased pool of primary
care givers.
The result should be real cost containment in a
system with improved quality. As you requested, I will send you
these recommendations in the near future.
Again, my best wishes for the success of the crucial and
difficult work you are undertaking.
Please call upon me or the
staff of the Trusts at any time if you believe we can be helpful in
your endeavors.
/v:'v,
!
Th~:s
I
J~
w.iLangfitt, M.D.
TWL:dm
cc:
Melanne Verveer
The Peu' Memorial Tmst
The]. Howard Pew Freedom Tmst
The Mabel Pew Myrin Tmst
The]. N. Pew Jr. Charitable Tmst
The Medical Trust
The Mary Anderson Trust
The Knoi/Brook Trust
�-·
THE. WHITE. HOUSE.
WASHINGTON
March 31, 1993
Daniel B. Kopans, M.D.
Department of Radiology
Massachusetts General Hospital
Boston, Massachusetts 02114
Dear Dan:
I greatly appreciated receiving your letter with the copy of your letter regarding breast
cancer screening to Dr. Bernadine Healy enclosed.
Thank you for your offer of assistance to the Health Care Task Force. The Task
Force includes the Secretaries of the Treasury, Defense, Commerce, Labor, Health and
Human Services, and Veterans Affairs; the Director of the Office of Management and
Budget; the Assistant to the President for Domestic Policy; the Assistant to the President for
Economic Policy; the Chair of the Council of Economic Advisors; and the Senior Advisor to
the President for Policy Development.
In addition, the Senior Advisor to the President for Policy Development will lead
interdepartmental working groups which will gather information for, and provide information
to, the Task Force. The working groups, which are working closely with Members of
Congress and their staffs, are comprised of government employees.
While the working groups have begun the process of preparing policy options for
reforming our health care system, their work is an ongoing process. The members of the
Task Force are anxious to hear from knowledgeable and concerned people like you - people
with firsthand experience or particular expertise in the health care field. I am sending your
letters along to the appropriate working group. Again, thank you for your offer of assistance
and your contipued support for the success of our endeavor.
Your positive comments about the President and me are uplifting indeed. Both of us
are committed and more than willing to make whatever sacrifices are necessary as the new
Administration implements its agenda to get our country moving in the right direction again
and make a significant difference for Americans.
Sincerely yours,
�MASSACHUSETTS GENERAL HOSPITAL
DANIEL B. KOPANS, M. 0., F.A.C.R.
Associate Professor of Radiology
Assistant Director of Ambulatory Care Radiology
Director of Breast Imaging
HARVARD MEDICAL SCHOOL
•
Massachusetts General Hospital
Department of Radiology
Boston, Massachusetts 02114
Tel. (617) 726-3093
January 27, 1993
Ms. Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue, NW.
Washington, D.C. 20500
Dear Hillary:
Please forgive my informality. I dated Kit Schneider (Tower Court and Bates) through
most of college. Kit was a good friend of Eldie Acheson and, given the amount of time I
spent at Wellesley, I'm sure we met. Al Gore was a classmate in Dunster House, and
Roger Altman was the goalie on my lacrosse team in high school. Government certainly
seems less abstract as I think back to those days and now see faces from the past at the
pinnacle of responsibility.
I am writing to wish you well in your effort to reform the health care system. As you know,
breast cancer is a major health problem as the leading cause of non-preventable cancer
death among American women. Screening, and access to it, for all women is likely to be
one of the issues that you will consider in your planning. As a leading expert in breast
cancer detection and diagnosis in this country I would be happy and honored to assist you
in any way with questions you may have concerning this important health challenge. The
National Cancer Institute is hosting a meeting next month to review the data on screening.
The issues are complex, and I am enclosing a copy of a letter I wrote to Dr. Bernadine
Healy that addresses a few of the problems.
I admire youP strength and determination. I cannot imagine the pressures that you and the
President are under, but I am impressed by the grace and confidence with which you both
have handled the problems you have faced.
Once again, best wishes. I hope that you will feel free to call on me.
srryours,
'/
'
'i
J
{/\;;;./--~
Daniel B. Kopans, M.D.
�MASSACHUSETTS GENERAL HOSPITAL
HARVARD MEDICAL SCHOOL
DANIEL B. KOPANS, M. D., F.A.C.R.
Associate Professor of Radiology
Assistant Director of Ambulatory Care Radiology
Director of Breast Imaging
I
T
'
•
v.
Massachusetts General Hospital
Department of Radiology
Boston, Massachusetts 02114
Tel. (617) 726-3093
December 2, 1992
Bernadine Healy, M.D.
Director
The National Institutes of Health
Bldg. 1 Room 126
9000 Rockville Pike
Bethesda, Maryland 20892
Dear Dr. Healy:
I am writing in follow-up to a letter that I sent last spring concerning breast cancer
screening. At that time there was a great deal of discussion concerning the anticipated
results of the National Breast Screening Study of Canada (NBSS). As I am sure you are
aware, the results have just been published (1,2) and I understand that the National Cancer
Institute will be convenmg a meeting to review the data to decide whether screening
guidelines should be altered. Since I am not sure that I will be invited, or if invited will be
able to attend, I wanted to express my concerns about this study as well as the 9uestion of
screening guidelines. In case you have not had a chance to reVIew the publications, the
investigators concluded that there was no benefit from screening women 40-49 with either
mammography or physical examination, and that mammography did not add to ehysical
examination screening for women 50-59. This was a large study, and as such is likely to
have significant im.Pact. Unfortunately, there are major problems with the design and
execution of the tnal that raise serious questions about the validity of its results.
MAMMOGRAPHIC QUALITY IN THE NBSS
I have had direct involvement with the NBSS having spent considerable time over the years
with the principal investigators as well as having been asked by them to review the quality
of the mammography with two other radiologists. Our review confirmed that, for much of
the trial, the mammography was of poor quality. The NBSS published the results of our
review (3,4) and this clearly showed that through the fourth year of the trial more than 50%
of the mammographic studies were graded as poor or unacceptable. Since this was a study
purportedly designed to evaluate mammograpby, it is surprismg that the performance of
the test itself had not b.een given priority.
The quality of the mammography had certainly been a concern to outside advisors since the
planning phases of the trial in the late 1970's. Laszlo Tabar, the principle investigator of
the Swedtsh Two County Trial and a leading expert in mammography, had urged that the
NBSS require quality mammograms from the participating centers. He offered to train the
technologists and radiologists (5), but his concerns were ignored and his offer rejected.
Despite the fact that the nurses who performed the clinical breast examinations for the
NBSS underwent special, intensive training (6), there was no training for the technolo~ists
performing the mammograms, and no training for the radiologists who were interpretmg
the images. Furthermore, the sites were permitted to utilize whatever mammo~aphic
equipment they had available, and the quality control monitoring by the NBSS mvolved
primarily the maintenance of low doses. This latter concern meant that scatter reduction
�grids were not employed for much of the trial with the attendant loss of image quality (see
enclosure). Dr. Wende Logan Young (Rochester N.Y) was enlisted as an advisor to the
NBSS. She was concerned about image quality, but was repeatedly denied access to the
images. As a consequence she resigned. Dr. Stephen Fei~ (Philadelphia, PA) was then
brought in as an advtsor. He was permitted to review the Images and expressed his concern
over the poor image quality. When his concerns were ignored he, too, resigned.
Poor image quality reduces the ability to fmd small cancers. Problems found with the
NBSS images included poor exposures, unsharp images, and areas of the breast that were
not even included on the mammogram due to poor positioning. The NBSS's own
"reference" radiologist found that the untrained "Center" radiologists overlooked numerous
cancers. In fact, he reported that 25% of the cancers that were ultimately diagnosed in the
screened group should have been detected on mammograms 1 - 5 years earlier (7). These
were cancers that were visible on the mammograms, but had been missed. There has been
no estimate of how many additional cancers could have been detected earlier if more
breast tissue had been included on the mammograms with better positioning by trained
technologists.
ADVANCED CANCERS AND PROBABLE RANDOMIZATION ERRORS IN TilE
NBSS
There are significant other problems that are apparent in a review of the published data.
What many oo not realize is that the NBSS did not use a blind randomization. In order to
increase the statistical power of the study, symptomatic women were permitted to
participate and allocations occurred after a physical examination. The investigators cannot
explain how, but significantly more advanced cancers (women with positive nodes) were
"randomly" assigned to the screened groups. This disproportionate "loading" of the study
group with women with poor prognoses amounted to a 30% difference in the prevalence
year (at the time of randomization). This difference actually increased over the incidence
years so that for women 40-49 there were, overall, 102 women in the screened group with
positive nodes at the time of diasnosis as compared to 66 women in the control group. This
not only indicates faulty randoiillZation, but tlie fact that the number of excess advanced
cancers increased over the course of the trial rather than converging suggests that the poor
quality of the screen actually resulted in a delay in diagnosis for many of the screened
women. Delayed diagnosis occurs among screened women when they are falsely reassured
by a negative screen. This phenomenon has been documented in a screening program in
Finland (8). When a breast problem occurs between screens they may delay seeking
attention assuming that, since they had had a negative screen, they could not have breast
cancer or they delay seeking evaluation awaiting the next screen. Counterparts in the
control group, without such false reassurance, seek help earlier and are diagnosed sooner
when a problem develops.
The problem of false reassurance would be amplified by poor quality mammography.
Coupling the failure to detect a cancer at a smaller size and earlier stage with false
reassurance and delayed diagnosis could convert a curable cancer into an advanced stage
and incurable process. If the assignment in the NBSS had been random, then there should
ultimately have been the same total number of advanced cancers in each group (assuming
no benefit from screening). Not only were there more in the prevalence year among the
screened women, but rather than decreasing over time, the disparity increased. These
results suggest faulty randomization in addition to poor mammography failing to detect
cancers earlier.
A further suggestion of faulty randomization lies in the observation that, among women 5059, if the women who died from cancers detected in the prevalence year- when faulty
�randomization would have the greatest impact - are eliminated, the mammography group
actually had a 30% reduction in mortality compared to the physical-examination-only
control group over the "incidence" years.
The investi~ators insist that there was no problem with the randomization since there is a
balanced distribution of other demographic factors. What they have ignored is the fact that
a shift of women with advanced cancers to the screened group would not have any impact
on the demo~aphic distribution of the other thousands of women in the study. The fact
that the surv1val for control women 40-49 at five years is 90% when the background survival
for women in Canada is 70-80% at five years suggests that some of the advanced cancers
may have been shifted to the screened group proaucing an abnormally high survival rate
among the controls.
WHY WAS CANCER SIZE DISTRIBUTION IN THE NBSS NOT REPORTED ?
The excess of advanced stage cancers in the screened women was even ~eater than
reported by the investigators. It is extremely unusual that the authors d1d not include the
size distribution of the cancers in this trial. Based on their previous presentations at
meetings, the number of advanced cancers in the screened group was much greater than
the papers would indicate. Instead of the 49% stage ll implied by nodal status alone
among women 40-49, 65-75% of the cancers eventually "detected" by their poor quality
screen were stage ll or worse if size is included. Such a high percentage ofadvanced
cancers would confirm the poor quality of the screen.
ASCERTAINMENT OF MORTALITY AMONG CONTROL WOMEN
Another possible reason for the apparent high survival rate among the controls may lie in
ascertaimng cancer deaths among these women. The investi~ators have no direct follow-up
of the control women, but must rely on linkages to other national databases to try and
determine who has died, and what were the causes of death. Either their control group has
an exceptional and inexplicable survival record, or there has been a transfer of advanced
cancers from the screened group to the controls, or they have under-ascertained deaths
among the controls.
WHY VAUDITY FOR 40-49 AND NOT 50-59?
The poor quality of the mammo~aphy in this trial is reflected in the fact that it did not
even show the benefit for scree~ women 50-59 with mammography that other programs
have clearly demonstrated. I find 1t surprising that Prof. Miller stated on Canadian
television that he would, nevertheless, recommend women 50-59 be screened because other
studies have shown this to be efficacious. H the quality of the mammography was so poor
that it is not valid for "older women", where mammography is more sensitive and specific,
how can we expect it to have any validity for younger women?
"BUT IT'S A LARGE STUDY"
Those who insist that the size of the study eliminates the major problems with its design
and execution fail to understand the importance of the technical issues involved in
mammography screening. The enclosed example demonstrates the difficulty in perceiving
a large cancer with poor mammography. Perceiving small cancers would, obviously, be
even more difficult. A large number of poor quality mammograms is no better than a small
number of poor quality mammograms. It merely means that more cancers will not be
detected at an earlier stage. Enormous time, effort, and resources were spent on the NBSS
and it is truly unfortunate that the results have little validity given the basic and critical
�---
-------~
flaws in this study, but these flaws were pointed out repeatedly since the outset and were
ignored by the investigators. It would mlly compound these errors if the results are used to
withdraw support for screening women 40-49.
IS THERE A BENEFIT FROM SCREENING WOMEN 40-49 ?
Those who oppose screening women 40-49 cite the lack of data to demonstrate an absolute
benefit for these women. This is a specious and disingenuous argument. What they neglect
to acknowledge is that no studies have been properly designed (with the appropriate
statistical power) or executed (appropriate image quality, screening interval, and
interpretive expertise) to answer this question. With the exception of the NBSS, all the
other studies have been retrospectively stratified by age, and fiave lacked the statistical
power and study design to even address the _question. Even the NBSS was designed with a
statistical power that could only detect a 40% or greater benefit and this is larger than
should have been expected. Furthermore, 25% of the "control" women 40-49 underwent
mammograph}' further illluting the power of the study. Their analysis actually comes too
soon with insufficient follow-up.
In fact there are data that show that there is benefit from screening younger women. This
was seen in the Health Insurance Plan of New York study (9) where there were 25% fewer
deaths in the screened women age 40-49. A recent analysis of all the Swedish screening
programs is now showing a 13% mortality reduction for women 40-49 even thouJdt the
screens were not optimized for these women. The curves appear to parallel the lnP results
(10). The benefit for younger women does not appear as qwckly as for older women. This
is likely due to the fact that breast cancer is not as rapidly fatal among younger women
(11). It takes 7-8 years before deaths among the unscreened women begin to exceed the
controls. This "delayed" benefit is no less important merely because it does not occur
immediately. It is a reflection of the fact that mammographic screening and earlier
detection can down-stage cancers among women at all ages, and this translates into
deferred mortality.
SCREENING INTERVAL
Screening guidelines for women 40-49 should be modified. The option of mammography
every 1-2 years should be changed to annual screening. The present guidelines are the
result of a "political" decision made in the early 1980's. As a response to the varied, and
sometimes conflicting guidelines that were promulgated by various medical organizations
that were confusing women and their physicians, a consensus meeting was held. A few
organizations, including the NCI, did not want to support any mammographic screening for
women 40-49. In order to produce a consensus, and despite concerns raised by many of us
who had studied the questton, the compromise of every 1-2 years was reached. The
available data suggest that mammography can detect breast cancer, on average, 2 years
before a woman m her forties will feel the tumor (12,13). A two year interval between
screens means that screening will detect the cancer at about the time the woman will feel it.
Thus, a two year screening interval will only slightly advance the time of detection. If we
are going to expend the effort and resources to screen women in their forties, they should
be screened every year.
I know that there are those at NCI who have been waiting for the results of the NBSS to be
made public so that those data can be used to withdraw support for screening women 4049. There may be legitimate economic arguments to do so, but opponents of screening
�-~---
- - - -- - - - - - -
-
---
---~----
should not invoke ..science.. as having not shown benefit. Until biostatisticians can devise
faster, more valid methods, the randomized controlled trial is the only method we have for
assessing the question of efficacy. However, simply because a study is randomized with
controls does not guarantee its validity. One cannot merely put women into the front end
of a trial and expect that, since it is ..scientific.., what comes out the end is ..truth... The
parameters of the performance of the trial are critical to the validity of the results.
There are legitimate concerns over the cost of screening, but before we decide not to
screen because it is too expensive, we should develop more efficient and cost effective
approaches as long as they do not compromise earlier detection.
Thank you for taking the time to read these comments. If you have any questions please
don't hesitate to call me.
Wif.
~el
B. Kopans, M.D.
cc.
Peter Greenwald, M.D.
Vivian W. Pinn, M.D.
Samuel Broder, M.D.
Senator Albert Gore
References
1. Miller AB, Baines CJ, To T, Wall C. Canadian National Breast Screening Study: 1.
Breast Cancer Detection and Death Rates Among Women Aged 40-49. Can Med Assoc J
1992;147;1459-1476.
2. Miller AB, Baines CJ, ToT, Wall C.Canadian National Breast Screening Study:2.
Breast Cancer Detection and Death Rates Among Women Aged 50-59. Can Med Assoc J
1992;147;1477-1594.
3. Baines CJ, Miller AB, Kopans DB, Moskowitz M, Sanders DE, Sickles EA, ToT, Wall
C. Canadian National Breast Screening Study: Time-related changes in Mammographic
Technical Quality- An External Review. AJR 155:743-747, October 1990.
4. Kopans DB. The Canadian Screening Program: A Different Perspective. AJR 155:748749, October 1990.
5. Personal communication from Laszlo Tabar, M.D.
6. Miller AB, Baines CJ, Turnbull C. The Role of the Nurse-Examiner in the National
Breast Screening Study. Can J Public Health 1991;82:162-167.
7. Baines CJ, McFarlane DV, Miller AB. The Role of the Reference Radiologist.
Estimate of Inter-Observer Agreement and Potential Delay in Cancer Detection in the
National Breast Screening Study. Invest. Radiology Vol. 25. 1990:971-976.
8. Joensu H, Klemi PJ, Tuominen J, Rasanen 0, Parvinen I. Breast Cancer Found at
Screening and Previous Detection by Women Themselves. Letter to the Editor Lancet
1992;339:315.
9. Shapiro S, Venet W, Strax P, Venet L Periodic Screenin\{ir Breast Cancer: The
Health Insurance Plan Project and its SeQ.Uelae. 1963-1986.e Johns Hopkins University
Press, 1988.
10. Tabar et al in Press. Data presented at the Swedish Medical Society Meetings Nov. 26,
1992.
11. Adami H, Malker B, Holmberg L, Persson I, Stone B. The Relation Between Survival
and Age at Diagnosis in Breast Cancer. New Engl. J. Med. 1986; 315:559-563.
--
�12. Moskowitz M. Breast Cancer: Age-Specific Growth Rates and Screening Strategies.
Rad. (1986) 161:37-41
13. Tabar I., Faberberg G, Day NE, Holmberg L. What is the Optimum Interval Between
Mammographic Screening Examinations? - An Analysis Based on the Latest Results of the
Swedish Two-county Breast Screening Trial. Br. J. Cancer 1989,55:547-551
�------------
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THE WHITE HOUSE
March 31, 1993
Jack B. McConnell, M.D.
Volunteers in Medicine Clinic
P. 0. Box 23287
Hilton Head Island, South Carolina 29925
Dear Jack:
Thank you for your letter to follow up on our conversation at
Renaissance Weekend. The President and I really appreciated your
sharing the concept and practice of the Volunteers in Medicine
Clinic. I am pleased to receive the additional infonnation provided
in your letter and have passed a copy of it along to the Task Force.
The President is committed to reforming our nation's health
care system -- controlling runaway costs and providing security to
every American family. It won't be easy and it won't happen
overnight, but we can bring costs under control while maintaining
quality medical care and preserving the choice so important to us all.
Again, thank you for your suggestions and for your continuing
support as we develop solutions to this incredibly complex issue.
Sincerely yours,
�VOLUNTEERS IN MEDICINE CLINIC
P. O.Box 23287
Hilton Head Island, South Carolina 29925
Telephone 803 681-6612 Fax 803 681-66J.I
February 5, 1993
Ms. Hillary Rodham Clinton
The White House
Pennsylvania Avenue
Washington, DC
Dear Hillary,
Pursuant to your new assignment in the health care field, I wish to update you on an idea
we discussed at the Renaissance Weekend over New Years, in which you seemed to be
interested.
You may recall that I visited briefly with Bill, and then with you (inexplicably calling you
Valerie) at the recent Renaissance Weekend on Hilton Head. I was introducing the two of
you to the Volunteers in Medicine Free Clinic which a group of retired professionals on
Hilton Head are developing.
Our Mission is to understand and serve the health and wellness needs of the medically
underserved population segments who live or work on Hilton Head Island using the
retired health care professional community to staff the clinic.
Our scope of services includes the following: primary health care, physical examinations,
inoculations, special disease diagnostics and treatment clinics, target-community medicine,
pre-natal and well baby clinics, and consultation on the wellness issues of the target
population. Screening and referrals to the more comprehensive medical and social
resources of the island and county, when necessary, are primary functions of the Clinic.
.
In the course of this we will be addressing three questions:
•
Do the retired physicians, nurses and dentists represent a new and untapped
resource for the delivery of no-cost/high-quality medical care?
•
What must a community or State do to facilitate the development of a clinic using the
retired professionals?
•
What difference in health and wellness can we demonstrate in the target population by
our efforts?
A Not-For-Profit Clinic No"' Being Established for the MedicaUy Undersened on Hillon llead Island
�--------- .--------
As I mentioned to you and Bill, essentially as many physicians retire as enter medical
school each year. If we can provide the proper environment for them to donate their
services free of charge in a not-for-profit clinic, we could, in four yours, have as many
physicians providing free care as are now training in the medical schools.
Since the inception of the idea a year ago we have:
•
Incorporated
•
Obtained a 501(c)(3) designation (in six weeks)
•
Obtained malpractice coverage for the health care professionals donating their time
•
Obtained a grant of $50,000 from the Robert Wood Johnson Foundation for the
development of the project
•
Encouraged the 1992 South Carolina General Assembly to pass an amendment
directing the Board of Medical Examiners to promulgate regulations leading to the
creation of a "Special Volunteer License" (which I believe to be the first in the United
States) for physicians wishing to donate their services free of charge in a not-for-profit
clinic.
o
Structured an Honorary Board and Operating Board of outstanding citizens from the
Town ofHilton Head and across the state.
During this same time we have recruited 44 Physicians, 55 Nurses, 8 Dentists, 2
Chiropractors, and 2 Nutritionists all of whom are residents ofHilton Head Island.
While we have a large number of retired medical personnel on Hilton Head Island, we are
developing the program so that a free clinic can be developed anywhere using only one
physician and one nurse providing malpractice coverage, a special volunteer license, a
facility, and funding (by local community) are made available.
The Town ·council of Hilton Head has just voted to provide a 1.1 acre piece of land for
the siting of our free clinic. Design plans are now underway and we hope to be open by
early fall.
Not a dime of Federal, State, County, or Local Government funds has been involved,
with the exception of the grant of land. It is an idea that started from a need and
developed by ordinary citizens in response to that need.
�Hillary, I hope you have forgotten my calling you "Valerie", but I hope you have not
forgotten the idea I presented. I feel strongly that we must ask more of all sectors of
society, especially the recently retired. We are able, experienced, mature and, for the most
part, willing to give back to society some of that which has been given to us.
I have provided you only a brief description of the Volunteers in Medicine clinic. If you
would like to know more, please let me know and we will provide whatever you want or
need.
Our best wishes to you in your attempt to reorganize our health care system.
Sincerely yours,
~B~MD.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004a. letter
DATE
SUBJECTfi'ITLE
Hillary Clinton to George H. Bergdoll. [partial] (1 page)
03/3111993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence (3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act- (S U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commereial or
financial Information ((a)(4) of the PRA)
PS Release would diselose confidential advice between the President
and his advisors. or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) ofthe FOIA)
b(2) Release would disclose Internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disclose Information concerning the regulation of
finaneial institutions ((b)(8) of the FOIA)
b(9) Release would diselose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
I
I
I
I
I
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THE WHITE HOUSE
March 31, 1993
George H. Bergdoll
,
Director of Development
and Public Relations
United Methodist Family Services
3900 West Broad Street
Richmond, Virginia 23230
Dear
George:
I am grateful for your affirmation of my role in tackling the
health care issue. The President is committed to reforming our
nation's health care system- controlling runaway costs and
providing security to every American family. It won't be easy and it
won't happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
We will appreciate your continuing support as the new
Administration develops solutions to the incredibly complex issues
before us.
Sincerely yours,
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004b. letter
SUBJECTffiTLE
DATE
George H. Bergdoll to Hillary Clinton. [partial] (1 page)
02/10/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Reeords Act - (44 U.S.C. ll04(a))
Freedom of Information Act- (5 U.S.C. 552(b))
PI National Seeurity Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(l) of the PRA]
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade seerets or confidential commercial or
fmancial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA]
b(l) National security classified information ((b)(l) of the FOIA]
b(l) Release would disclose internal personnel rules and practices of
an agency ((h)(l) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or fmancial
Information ((h)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((h)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal reeord misfile defined in accordance with 44 U.S.C.
ll01(3).
RR. Document will be reviewed upon request.
�.._..
,.
.....
..... ,.
/~-;.,
United Methodist Family Services
3900 West Brood Street. Richmond. VA 23230
FAX (804) 355-2334
(804) 353-4461
SINCE 1900
February 10, 1993
Mrs. Hi 11 ary Rcdham Clinton
The White Hause
1600 Permsylvania Avenue
washinqtcn, IX: 20500
It is great to kna.i' that you are dimcting the efforts of the new
National Health Pl:OCJLam. The country is very fortunate to have you in such an
iDpartant position. One of the areas that is of gmat concem is health em
far yamg people just out of high school, or college, who can not afford
health benefits.
1/
i
I
I
I am DDSt illpressed with the way Bill has handled
issues sillce heccmi ng Pl:esident.
SCDe
very difficult
I will keep you advised on the elderly project which includes the day ·
care center. You kna.i' of nw willingness to serve on airJ carmi.ttees that would
be of benefit to you, or Bill, dealing with children or elderlyissues.
The country is very fortunate to have the Cl.intons in the White Bouse at
this time.
GBB/tjp
UMFS Tidewater Reglonol Center
715 Boker Road, Suite 201. Virginia Beach, VA 23«l2
(804) 490-9791
UMFS Northern Vlrglnla Regional Center
6335 Uttfe River Turnpike, Alexandria, VA 22312
(703) 941-9008
�----- - - -
THE WHITE HOUSE
WASHINGTON
March 31, 1993
Ark Monroe, ill, Esquire
Mitchell, Williams, Selig,
Gates & Woodyard
320 West Capitol Avenue, Suite 1000
Little Rock, Arkansas 72201-3525
Dear Ark:
Thank you for forwarding to me the resume of Paul W. Willihnganz for participation
in the Health Care Task Force. The Task Force includes the Secretaries of the Treasury,
Defense, Commerce, Labor, Health and Human Services, and Veterans Affairs; the Director
of the Office of Management and Budget; the Assistant to the President for Domestic Policy;
the Assistant to the President for Economic Policy; the Chair of the Council of Economic
Advisors; and the Senior Advisor to the President for Policy Development.
In addition, the Senior Advisor to the President for Policy Development will lead
interdepartmental working groups which will gather information for, and provide information
to, the Task Force. The working groups, which are working closely with Members of
Congress and their staffs, are comprised of government employees.
While the working groups have begun the process of preparing policy options for
reforming our health care system, their work is an ongoing process. The members of the
Task Force are anxious to consult with knowledgeable and concerned people. I am directing
a copy of your letter with the attached letters and resume to the appropriate working group.
The President and I will appreciate your support for the success of our endeavor. He
is committed to reforming our nation's health care system-- controlling runaway costs and
providing secqrity to every American family. It won't be easy and it won't happen
overnight, but we can bring costs under control while maintaining quality medical care and
preserving the choice so important to us all.
Perhaps our paths will cross at sometime while you are working in Washington.
Sincerely yours,
I
I
I
I
�-,----
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--------~
--
- - -----
----
LAW OFFICES
MITCHELL, WILLIAMS, SELIO, GATES
& WOODYARD
320 WEST CAPITOL AVENUE, SUITE 1000
l.rrri.E Roox, .ARKANsAS 72201·3525
TELEPHONE 501-688-8BOO
TELEPAX 501-688-8807
1420 NBW YoBX AVEN1J'1!, N.W, StnTB 7t10
WASHINGTON, D.C. 2000tl-2122
T~HONE202~7~00
TELBFAX 202~7-7tl00
ARK MONROE, Ill
OIRECT
CIA~
501·688·8833
100 WJ!Hr CENTRAL AVENUE
POST OPPlCE Box 6tl8
BENTONVILLE. ABx.ufBAS 72712-oBt\8
T~HONE tl01·273-9t161
TELBFAX ti01·27IJ.Ot127
February 1, 1993
IBI~I&:::::::I::::::::a&IIBUI
Mrs. Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue, NW
Washington, D.C. 20500
Dear Hillary:
Congratulations on agreeing to head the task force on
health care reform for the administration. I remember quite well
our discussion on this subject back in August of 1991 at the
National Governors• Association conference. It seems like that
was the last time we had a chance to visit at any length before
the campaign began. Nancy and I had a wonderful time at the
inauguration and appreciate all that you did for us during that
week.
I am enclosing a resume that was forwarded to me by
Donna Mundy, a close friend from Portland, Maine, regarding Paul
w. Willihnganz who has an interest in working with Judy Feder on
the health care reform. I am also enclosing information
regarding his background. If I can supply additional
information, please let me know. Thank you for your
consideration of this recommendation.
I look forward to seeing you soon. I am spending a
great deal'of time in Washington because I am currently
representing the District of Columbia Insurance Superintendent
regarding his supervision of the Blue Cross and Blue Shield plan
in the District of Columbia. If you ever need to get in touch
with me, you can reach me at my office in washington.
Sincerely,
Ark Monroe, III
TAM:la
Enclosures
cc: Donna T. Mundy
---.
�--,
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••
,/
1.
Paul W. Willihnganz
Attorney at Law
5214-F Diamond Heights Blvd., Suite 601
San .Francisco, California 94131
Telephone (415) 206-9229
Facsimile (415) 206-0414
December 9, 1992
PERSONAL
Ms. Donna Mundy
Vice President, External Affairs
UNUM Life Insurance Company of America
2211 Congress Street
Portland, Maine 04122
Dear Donna:
It was good talking with you, and.! really do miss
Sugarloaf.
I sincerely appreciate your willingness to serve as a
reference in my quest, and your offer to contact the Mitchell law
firm in Little Rock on my behalf.
Along with the resumes you requested, I am enclosing a copy
of my letter to Senator Mitchell that summarizes my goals, his
reply letter and his letter to Judy Feder recommending me.
Together with your recommendation, I would appreciate any
information you can provide regarding UNUM's position and
industry positions on the new Administration's health care reform
agenda.
Again, many thanks.
You are a true F.O.P.
Very truly yours,
Paul
w.
Willihnganz
�I. ..
I
·------------
. ,.
I
Paul W. Willihnganz
I
55 Ora Way, Apt. B-108
San Francisco, California 94131
Home: (415) 282-7143
Office: (415) 206-9229
November s, 1992
PERSONAL
The Honorable George J. Mitchell
Majority Leader's Office
United States Senate
Washington, DC 20510
Dear Senator Mitchell:
I once told you I wanted to serve in government someday-after Joseph and Heather finished college (now done) and
when there is a real need I could fill.
With the election of Bill Clinton, the need is there and
"someday" is now. I would like to join the Clinton team.
I know the health insurance industry from the inside, and
I share Governor Clinton's conviction that our health
care system needs fundamental change. I could help shape
that change and enlist the support of the key players--or
take them on if need be. With my business and legal
background, I could work effectively with the insurance
industry, the health care industry and the trial lawyers.
And I would enjoy working with you, your staff, and my
Georgetown Law classmate Mickey Kantor.
If you would recommend me to President-elect Clinton or
put me in touch with the appropriate people on his
transition team, I would be most grateful.
Hope to see you in Washington.
Sincerely,
Paul
w.
Willihnganz
�.. . ..
Gr:ORGE J. MITCHEll
'·
• MAINE
1lnittb jltattl jtrnatt
$fhtt of tbt .fl\aioritp lrabu
•••b•n~ton,
Ja( 205\o-7010
November 25, 1992
Mr. Paul Willihnganz
55 Ora Way, Apt. B-108
San Francisco, CA 94131
Dear Paul:
Thank you for informing me of your interest in serving with
the Clinton-Gore administration. My colleagues in Congress and I
are looking forward to working with the new Administration to
produce real and positive change.
I have personally forwarded your resume and expressed your
interest in serving with the new Administration to Judith Feder,
Director of Health Policy for the transition team. Enclosed
please find a copy of my letter to Ms. Feder for your
information.
Again, thank you for your letter and for your interest in
serving with the new Administration. I hope that my efforts on
your behalf prove helpful in the weeks ahead.
Si~
George J. Mitchell
•
�' •'GEOA'Ge J. MITCHELL
MAIN I
11niteb litatel lienate
emcc of tbc jlajaritp lcabcr
•••bia;aon,
•~
205\o-7010
November 24, 1992
Ms. Judith Feder
Director for Health Policy
Presidential Transition Office
P.O. Box 8086
Little Rock, AR 72203
Dear Judy•
Congratulations on your appointment to the Clinton-Gore
transition team. As you know, you and your colleagues have an
extremely important task before you in seeking individuals who
possess the talents, abilities and dedication necessary to
effectively serve with the new Administration and to work for
real change in America.
As you continue moving into the transition period, I would
like to recommend to you such an individual, Mr. Paul
Willihnganz. Paul has expressed to me his interest in serving
with the Clinton administration, and I believe he could provide
valuable insight and expertise on the health care and health
insurance industries .
.I have known Paul for many years and not only have the
highest regard for his integrity, but I also know he is firmly
committed to President-Elect Clinton's vision of a fundamentally
reformed health care system. I have enclosed Paul's resume for
your information, and would welcome the opportunity to provide
additional thoughts on his qualifications. Please don't hesitate
to call me should you feel this necessary.
·-- --·
•
~Y·~c£/
George J. Mitchell
�'
•
I
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•
•
PAUL W. WILLIHNGANZ
55 Ora Way, Apt. B-108
San Francisco, California 94131
Home: (415) 282-7143
Office: (415) 206-9229
Fax: (415) 206-0414
April 1992-Present
LAW OFFICES OF PAUL W. WILLIHNGANZ
San Francisco, California
Counsel life insurance companies (including my former employers, American General and UNUM) regarding
legislative, regulatory and risk management matters related to life and health insurance. Represent clients in
_litigation. Serve on the California Insurance Commissioner's Advisory Task Force on Unfair Claims Practices.
Although I am extremely busy with profitable legal work, it was never my intention to have a limited private
practice-something I left behind years ago. I would now like to use my background as a senior executive in the
life insurance industry to help the Clinton administration attack and resolve America's health care crisis.
April1991-April1992
KORNBLUM, FERRY & FRYE, P.L.C.
San Francisco, California
Shareholder
While serving as General Counsel of American General Life Insurance Company, I was invited to become a senior
shareholder of this San Francisco based, 33 lawyer insurance litigation firm. I accepted because the position offered
an attractive challenge, a substantial increase in compensation, and an opportunity for equity participation in a
growing, prosperous firm representing some of the country's leading insurers. Although I accepted this offer in
December 1990, we agreed that I would delay joining the firm until April1991 in order to give Bob Devlin, my
CEO at American General, time to conduct a search for my successor.
When I arrived in April, things bad changed. A serious rift bad developed between principals Kornblum and Frye.
Mr. Frye left in August, taking lawyers and clients with him. This produced financial problems which caused more
lawyers to leave; this in turn created client service problems. I did what I could to help, bringing in new clients and
working the litigation I bad been hired to manage. By year end, however, the firm had shrunk to 15 lawyers-with
fixed overhead for 40-and it was clear that my own efforts could not solve the firm's problems. Concerned about
my clients, especially my fonner employers whom I had brought to the firm, I concluded that it was not in their
best interests or mine to stay with the finn. I left, and so did they. Because Bob Devlin had hired my successor at
American General and I bad a personal client following, I decided to establish my own practice.
1988-1991
AMERICAN GENERAL LIFE INSURANCE COMPANY
Houston, Texas
Senior Vice President, General Counsel & Secretary
Recruited as chief legal officer for the $5 billion Houston-based life insurance subsidiaries of American General
Corporation, one of the nation's largest financial services holding companies. As one of six members of the Senior
Management Team reporting to President and CEO Robert M. Devlin, I actively participated in planning and dayto-day management of the company. As General Counsel, I directed the full range of legal and government
relations services needed by the company, managed a 17 person Law Department with a budget of $1.6 million,
and managed all outside counsel~th directly and through staff. Some highlights:
�. •'
. ..
Cost4ectiveness: Improved the quality and effectiveness of a downsized Law Department through
restructuring, staff changes, work elimination, computer technology and a strong emphasis on projects directly
supporting business objectives. Despite a bigger law department role in company operations and a more aggressive
litigation stance, better expense management held total legal costs per million dollars of revenue to
$2,623-approximately 62% of the industry average per Cantor & Co. Survey of Corporate Law Departments.
Litigation: Achieved excellent results in high risk litigation, including defense verdicts in multi-million
dollar punitive damage trials in Texas and California. In my first full year, we closed 20 cases with claims totaling
$95 million, plus a Texas discrimination suit claiming $1 billion, for total loss payments of only $19 thousand.
Regulation: Obtained a reversion of $1.6 million in plan assets for the company upon terminating a
defined-contribution retirement plan for General Agents and Managers. We persuaded the IRS, on a question of
first impression, that the company was entitled to a reversion of the present value of an erroneous contribution
made to this plan by the company ten years previously.
Competition: Personally renegotiated American General's contract with the State Bar of California to
retain our position as underwriter of the State Bar Approved Life Insurance Program (20,000 participants, $12
million annual premium, and $2 billion insurance in force) after a competitor cballenged our position.
Conservation: Reorganized the faltering Separate Accounts of Cal-West Life (a subsidiary) into a unit
investment trust. obtaining SEC and insurance department approvals and a favorable proxy vote of over 1,500
participants. This allowed us to retain major clients such as the California State Employees Association and save
over $100,000 annually in administrative costs.
Litigation avoidance: After a corporate decision to tenDinate the company's managerial distribution
system, worked with Marketing to design and implement a successful transition without triggering any litigation.
Strategic support: Successfully implemented the strategic divestiture of marginal individual health and
disability business through assumption reinsurance, thus reducing claims staft: sharpening the company's strategic
focus on interest-sensitive life and annuity products, and increasing our competitiveness in our chosen market
Government relations: Served on the Executive Committee of the American General Corporation
Political Action Committee, the Board of Directors of the Association of California Life Insurance Companies, and
the Legislative Action Committee of the Texas Life Insurance Association. Chaired a working group of the
American Council of Life Insurance task force developing recommendations on assumption reinsurance for the
National Association of Insurance Commissioners; guest lecturer on this subject at an NAIC Annual Meeting.
1977-1988
UNUM LIFE INSURANCE COMPANY
Portland, Maine
Second Vice President and Counsel
UNUM, the nation's 17th largest life insurer (assets $9 billion), is the successor to Union Mutual Life Insurance
Company, the first major mutual company in the United States to demutualize and convert to public ownership
(NYSE 1986). UNUM is the largest provider of group long-term disability insurance in the U.S. and the U.K.
'87
Second Vice President & Counsel: Claims & Litigation
Created and headed UNUM's first centralized litigation management team (7 lawyers and
support staft) which directed all UNUM litigation. Developed and implemented a new litigation strategy which
brought more litigation functions in-house, reduced aggregate company exposure by $20 million in one year, and
established favorable legal precedent on the application of ERISA to employee group insurance. Achieved excellent
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. resume
DATE
SVBJECffi'ITLE
Paul W. Willihnganz [partial] (1 page)
[none]
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a))
Freedom of Information Act -IS U.S.C. SSl(b))
PI National Security Classified Information )(a)(l) of the PRA)
P1 Relating to the appointment to Federal office ((a)(l) of the PRAJ
P3 Release would violate a Federal statute )(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information )(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRAJ
b(l) National security classified Information [(b)(l) ofthe FOIAJ
b(l) Release would disclose Internal personnel rules and practices of
an agency l(b)(l) of the FOIA)
b(3) Release would violate a Federal statute l(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or fmancial
Information )(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions l(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells l(b)(9) of the FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record minde defined In accordance with 44 U.S.C.
1101(3).
RR. Document will be reviewed upon request.
�. ,.
.,
-·
results in litigated cases. Developed a computerized management information system for litigation.. Member of the
management team of the Legal and External AJfairs Division (59 people, budget $7 million), in charge of
recruiting. budgeting, and computer systems for the Division.
'84
Second Vice President & Counsel: Employee Benefits & Reinsurance Division
Chief counsel, with a staff of 6 lawyers. for UNUM's largest operating division. Planned and
directed a tax issue management program which enabled UNUM to establish a leadership position in the flexible
benefits market Key member of a risk management task force which significantly improved benefit loss ratios
without materially increasing legal risk. My staff and I managed all group insurance and reinsurance litigation
with excellent results. Through legal judgments on a crucial "prohibited transactions" question, I helped UNUM
accomplish its landmark demutualization. Member of the Legal and External A1fairs Division management team.
'80
Second Vi6:e President & Counsel: Personal Financial Servkes Division
As chief counsel for this newly formed profit center, I recognized the strategic need for an
amendment of the Internal Revenue Code to permit tax-free exchanges of Union Mutual whole life policies for new
universal life policies being issued by our stoCk subsidiaries, and I initiated the action by Senator George Mitchell
which brought this about I planned the legal as~ of the termination of UNUM's general agency system and
managed the resulting litigation; the result was a net 10-year saving in distribution costs of over $50 million.
'77
Assistant Counsel, Insurance Operations
Primary legal adviser to the Marketing, Product R&D. Corporate Communications, Underwriting
and Administrative areas of the Company before its restructuring into divisional profit centers.
1969-1977
'74
TRIAL LAWYER
San Diego, California
Wll.LmNGANZ, MANNING & SUDMAN
Partner: Insurance law and litigation
'71
BRUNDAGE, WU..LIAMS & ZELLMANN
Partner: Insurance, product /lability and personal injury litigation
'69
moos. FLETCHER & MACK
Associate: Insurance defense and coverage litigation
1967-1968
1959-1967
BYDROTRONICS DIVISION, DATA-DESIGN LABORATORIES
Falls Church. Virginia
Program Manager & Contracts Administrator
UNITED STATES NAVY
Destroyer and submarine officer; Program Manager, Submarine and Nuclear Power Training, Washington, D.C.
Secretary of the Navy Commendation for Achievement in submarine training program management
EDUCATION:
PERSONAL:
Georgetown University Law Center, JD 1968
University ofNotre Dame, B.S.M.E. 1959
�-- - - - - - - --- - - - - - , -
• ·
-.
-~
~·-. ..
' ' HEALTH CARE TASK FORCE SORTING SHEET
'IYPE OF MATERIAL:
_o.meral mail
_P81'801U11 stories
_Letterhead
_Offers to help
_Letter Campaip
_PoUcy
_C888WOI'k
~oyment
_Advocacy
ExpbmaUmM.__________________________________
_Requesta
-sPeech
-meeting
·_Other
~-r------------
v.r· p. '
ADVISORY PANEL?
_r.u.
_other h8alth provider
·~
_..,._emplo~
small busines&
~
other OOD81Diler&
fee~
f,-.m L.~ /(.
pmMARY INTEREST:
COST ISSUES
_Drag Prices
_PUBUC BEALTBJSPECUL POPULATIONS
Prevention
-~cbm.Fees
AIDS
Women's Health
_Hospital Fees
_
UDDecB8881'7 Procedures
_Medical Equipment
Fraud and Ab1188
Immunizations
Rural
U:rban
COVERAGE
_
Wo~ Families
_Unemployed/Low Income
Benefits
Providers
ORGANIZATION
hun:arance Premiums
hun:arance Reform
hun:arancePools
_Boards and Ovendpt
GOVERNMENT PROGRAMS
Medicare
Medicaid
Veterans
DoD
_INFRASTRUCTURE/WORKFORCE
_
Quality A&surance (Guidelines)
_Administration, RelmbU1'11811lent
& Patient Information 8)ratems
_Malpractice & Tort Reform
_
Manpower Issues
LONG-TERM CARE
MENTAL HEALTH
FINANCING
<'l'nlnina>
OTHER
ExpbmaUom.____________________________________________________
PLAN PREFERENCE: (Support=+; Oppose=-)
CP
SP
OP
CUnton Plan
Single Payer
Other Plan
MC
PP
CV
Managed Competition
Pay or Play
Credits, Vouchen,
Medical Savinp Aoots.
CA
BR
GE
Canadian
British
German
�----\·
----
..
' '
THE WHITE HOUSE
WASHINGTON
March 31, 1993
Sam Boyce, Esquire
Boyce Law Firm
Post Office Box 38
Newport, Arkansas 72112-0038
Dear Sam:
Thank you for recommending your friend, Vivian Riefberg, for work with the Health
Care Task Force. The Task Force includes the Secretaries of the Treasury, Defense,
Commerce, Labor, Health and Human Services, and Veterans Affairs; the Director of the
Office of Management and Budget; the Assistant to the President for Domestic Policy; the
Assistant to the President for Economic Policy; the Chair of the Council of Economic
Advisors; and the Senior Advisor to the President for Policy Development.
In addition, the Senior Advisor to the President for Policy Development will lead
interdepartmental working groups which will gather information for, and provide information
to, the Task Force. The working groups, which are working closely with Members of
Congress and their staffs, are comprised of government employees.
While the working groups have begun the process of preparing policy options for
reforming our health care system, their work is an ongoing process. The members of the
Task Force are anxious to consult with knowledgeable and concerned people. I am directing
a copy of your letter and her resume to the appropriate working group.
Again, thank you for your recommendation and especially for your continued personal
support for the success of our endeavor.
Sincerely yours,
lcAll~
Hillary
Rodhajn Clinton
�'
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BOYCE LAW FIRM
307 MAIN STREET
SAM H. BoYCE
HENRY H. BOYCE
PosT OF'F'ICE Box 38
NEWPORT. ARKANSAS 72112-0038
NEWPORT OFFICE
(501) 523-3626
FAX (SOl) 523-4839
BETTY BUTLER
JONESBORO OFFICE
PARALEGAL
(501) 932-7189
TOLL-FREE 1-800-794-2850
February 4, 1993
Ms. Hillary Rodham Clinton
White House
Washington, D. C. 20500
Dear Hillary:
I am enclosing a resume for a dear friend of mine, Vivian
Riefberg, who has enormous abilities plus a desire to work in
the health care field for the Clinton Administration. I am
sure that you can tell from her resume that she has extensive
abilities in public relations as well as health care.
Vivian and her husband, John Ashford, have been close friends
of mine for several years; and I sincerely believe she would
be of great assistance to you in carrying out the health care
initiative.
Our thoughts and prayers are with you and the President
during the harsh weeks of a new administration, and you know
any assistance that I can offer is yours for the asking.
With warmest personal regards, I am
Sin~ yours
....... ~
-·~Boyce
SB/sc
�r
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006. reswne
DATE
SUBJECTfi"ITLE
Vivian Riefberg [partial] (1 page)
[none]
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Aet -144 U.S.C. ll04(a))
Freedom of Information Aet -IS U.S.C. SSl(b))
Pl National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office ((a)(l) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(l) Release would disclose Internal personnel rules and practices of
an agency ((b)(l) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted Invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misflle defined in accordance with 44 U.S.C.
ll01(3).
RR. Document will be reviewed upon request.
- - - - --------~----------~
�. - ·--
(ooc, 1
~es~onalExperten~
McKINSEY&. COMPANY, Management Consulting. Washington, DC
Member, Healthcare Practice
1991-present
Engagement Manager Direct all aspects of analysis and manage client and consulting finn
resource allocation for major client studies. Complete written reports and present findings to senior
client executives. Counsel senior executives on a full range of management issues. Studies focus on
strategy and operations management for leading health care participants:
.
• Developed 3-5 year strategy for major player in healthcare information technology including
developing an overview of future structure of US health care system.
• Designed entry strategy in less-inv~ve surgery for leading hospital supply company.
• Created and initiated turnaround strategy for non-profit insurance plan including divestiture of
subsidiaries.
• Designed change management and strategy development program for major national insurance
earner. Program developed to assure immediate profit impotvement and to develop long term
managed care strategy.
t9S9 ·1990
Senior Asspeiate. Lead analyst for major client studies:
• Analyzed market opportunities for development of products 1services leading to major reform of
healthcare billing, collecting, and claims proces~ng systems.
• Designed program to effect major change in management approach among senior management at
leading home center retailer.
• Completed market analysis and designed implementation plan for client participation in
hazardous waste field.
t9S7 - 1988
AssoCiate. Team member and lead researcher on major client studies:
• Developed new model for healthcare delivery systems on medical and surgical wards for
leading hospital system.
• Analyzed HMO market for finn healthcare practice.
THE SIGAL-ZUCKERMAN COMPANY, Real Estate Development, Washington, DC
Project Manager De~gned and implemented creation of $150 million planned unit development
(Franklin Plaza) in downtown Washington. Franklin Plaza project included land assembly and
major rezoning efforts as well as negotiations for amenities with D.C. Board of Education (historic
presetvation of Franklin School) and DC Department of Public Housing (Rehabilitation of
multiple public housing units).
'1988 -1989
Lead Staff DC Mayor's Commission on Downtown Hou~ng. Setved as research and editorial staff
to this majCilr public-private initiative on downtown housing.
AMERICAN MEDICAL INTERNATIONAL. Healthcare Marketing Communications, Atlanta, GA
t9S4 -1985
Manager. Marketing Communications and Community Relations, Southern Region Planned and
directed $4 million marketing communications and public affairs program for 18 hospitals in five
southern states resulting in a 15% increase in hospital emergency room use and a 22"/o increase in
hospital awareness levels. Supervised a marketing field staff of 20 and created a network
marketing approach in two target markets. Analyzed and developed a hospital service cost
accounting program to improve pricing strategies. Developed community relations and government
affairs programs.
·-~
-:;---
-.
�• OGIINY & MATHER, Public Relations, NewYorl<, NY
: ~~;1 -1984
Account Syperyjsor/At}anta. Served as interim manager of the public relations division.
Developed over S300K in communication consulting bt11ings. Trained and supervised three
professionals in the analysis, development and implementation of marketing communications
programs including programs for regional participant in emergency health care clinics.
Senior Accoynt Exerntiye I Washington. Designed and executed comprehensive communications
programs to reach key government personnel and community decision makers.
Account Executive I New York. Completed marl<.et analysis and designed national consumer
promotions for Dove Beauty Bar and Silhouette Book. Won David Ogilvy Award for
implementing promotion that increased Silhouette Book sales by 35%.
I
THE MAC GROUP, Management Consulting, Cambridge, MA
AsSOCiate. Team member on major client studies:
• Arranged and conducted on-site customer interviews, analyzed industty data and devised
market segmentation approaches for a major manufacturer of diagnostic imaging equipment.
• Developed industty background materials for a firm training program on the psychiatric
healthcare market.
summer1986
]. WALTER THOMPSON CO. Public Relations, NewYorl<, NY
Account Coordjnator. Wrote press releases and developed media training program
summer1980
ABC-TV "GOOD MORNING AMERICA•, New Yorl<, NY
Research Assistant. Created background papers on guests for use by program writers.
summer 1979
Education:
MASTER IN BUSINESS ADMINISTRATION, WITH DISTINCTION, JUNE, 1987
Harvard University Graduate School of Business Administration . Focus on heahhcare management.
Admission Counselor- HBS Admission's Office. Chaitperson- Women's Student Association Career Day.
Member of the Health Care, Venture Capital and Real Estate Industry Oubs. Completed field study on
congregate care living for the elderly.
BACHELOR OF ARTS DEGREE, MAGNA CUM LAUD4 IN HISTORY, JUNE, 1981
Harvard-Radcliffe College. Elizabeth Agassiz Certificate of Merit for academic excellence. ChairmanAdams House Harvard-Radcliffe Fund; Events page editor- Harvard Independent; Coordinated Harvard
Institute of Politics I WGBH-TV programming project resulting in joint production of two television series.
Publications:
"Healthcare Industty Overview: Is It Time for Cost Effective Bold Initiatives" co• authored with Fred Eppinger in The Healthcare Payor Annual, McKinsey & Company,
1992.
Articles on the press and politics co-authored with Edwin Diamond have appeared in
Adweek Magazine, American Film Magazine and the Washington journalism Review.
Community Service:
"Mentor" for DC public high school student- Mentors, Inc.
Memberships:
Harvard- Radcliffe Oub - Interviewing Committee; Old Town Civic Association; City
Oub of Washington; Harvard Oub at the National Press Club.
·
REFERENCES AVAILABLE UPON REQUEST
�•
....• ':.!
POSITIONS IN THE CLINTON ADMINISTRATION --VIVIAN RIEFBERG
Office of Management and Budget
- Associate Director, Human Resources, Veterans, and Labor
- Deputy Director for Management
Council of Economic Advisers
- No particular position identified -- health care interest
Department of Health and Human Services
Immediate Office of the Secretary
- Executive Secretary to the Department
-Executive Assistant to the Secretary and White House Personnel
Liaison
Office of the Deputy Secretary
- Director of Intergovernmental Affairs
Office of the Assistant Secretary for Legislation
- Principal Deputy Assistant Secretary
- Deputy Assistant Secretary for Legislation (Health)
Office of the Assistant Secretary for Management and Budget
-Deputy Assistant Secretary
Health Care Financing Administration
- Deputy Administrator
Office· of the Associate Administrator for Legislation and Policy
-Director
Food and Drug Administration
- Deputy Administrator for Policy
�..
!.. • ~ • ~ ...•
CODER:_ _
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:_ _
GENERAJ, SORT:
_General mail
_Personal stories
_Other Health Providen
POSTCARD 1:
_Letter Campaign
POSTCARD 2:
_Offei'B to help/Employment
FORM LETTER:
_Letterhead
REROUTE:
-
_Polley
-~cilms
Casework
1 -Sched.uliner -President ·
v) ~ - ('tJOI... ¥-· d.1J~:
~AAA k{)vJ
u
~
Other
I<JVV-·
POLICY AND PERSONAL STORIES:
_ORGANIZATION <D
_insurance premiums
_insurance reform
_insurance pools
_boards and oversight
_COVERAGE (ID
_working families
_unemployed/low income
_benefits
__providers
_INFRASTRUCTUREJWORKFORCE (liD
_quality assurance (guidelines)
_administration, reimbursement
& information systems
_malpractice & tort reform
_manpower issues (training)
_unnecessary procedures
_GOVERNMENT PROGRAMS (IV)
_medicare
_medicaid
_veterans
_ DoD
_Indian health
_COST ISSUES (VI)
-~prices
__physician fees
_hospital fees
_medical equipment
_fraud & abuse
_FINANCING
(VII)
_MENTAL HEALTH
(IX)
_LONG-TERM CARE (X)
_PUBUC HEALTH/
SPECIAL POPULATIONS (XII)
__prevention
_AIDS
_women's health
_immunizations/children
_rural·
_urban
_OTHER.________________________
•
�-
THE WHITE HOUSE
March 31, 1993
Ms. Victoria Bigelow
President
Suburban Primary Health Care Council
2235 Enterprise Drive #3501
Westchester, Dlinois 60154
Dear Ms. Bigelow:
Thank you for writing and sending a copy of the Summary of
your ACCESS TO CARE PROGRAM. I appreciated receiving it and
will pass it along to the Task Force for further review.
President Clinton is committed to reforming our nation's
health care system -- controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
Again, thank you for sharing information about your unique
program and for your support for the success of this tremendous
undertaking.
Sincerely yours,
�- - - - - - - - -------- --- ------·
- - - -- - - - -
--~-
February 20, 1993
Hillary Rodham Clinton
The White House
Washington, D.C.
Dear Mrs. Clinton,
On behalf of the Suburban Primary Health Care Council I submit the enclosed information concerning our Access to Care Program. This program is a unique public-private partnership making
primary health care, and the ancillary pharmacy, laboratory, and
radiology services, available to medically indigent, uninsured
residents of suburban Cook County at a yearly cost of only
$226.41 per person.
Because you are now considering health care delivery alternatives as national models, we wished to bring the Access to Care
program to your attention.
This model seems particularly applicable to suburban areas.
I would be happy to answer any questions you may have about
this program. You may reach me at (708) 531-0680.
Sincerely,
i I,
(-'-· <
~/t:~
;;;:;'.
"' · ·:'
.<_z__ ~--/~ c11(/
'-·-
Victoria Bigelow
President
Suburban Primary Health Care Council
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Suburban Primary Health Care Council
ACCESS TO CARE PROGRAM
Summary
The
problem of the medically indigent and the uninsured
compromises good community health status, drives up the cost
of
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medical care, and generates significant hardships for
individuals.
The Suburban Primary Health Care Council was created with
and remains dedicated to a single purpose: to facilitate access
to primary health care for suburban Cook County residents who are
medically indigent.
The Council is a private not for profit
confederation of four health and social service organizations:
the Community and Economic Development Association of Cook
County, Inc.
(CEDA), Cook County Department of Public Health,
Northwest Suburban Cook County Health Care Task Force, and Park
Forest Health Department.
Access to Care, the program developed by the
Council,
enables low-income, uninsured residents of suburban Cook County
to receive basic health care services including physician office
visits, prescription drugs, lab and radiology services £or no
more than a five dollar payment.
Services are delivered through
a unique decentralized system utilizing private physicians
throughout a 735 square mile area.
Most of our patients live in
the far south or northwest areas.
In 1993 we also began serving
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northeast suburban Cook County.
The Problem
According to a report of the American Hospital Association,
only 58% of persons in Illinois with incomes below the poverty
level receive Medicaid benefits (the federal-state medical care
program for the poor).
With the spiraling costs of health care
and health insurance, there is an increasing gap between persons
covered by public medical programs and the privately insured.
Individuals and the families of low-income workers, contract and
part-time workers, as well as the unemployed fall into this gap.
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The poor and uninsured face great difficulty in obtaining
and paying for health care. Many are forced to go without care,
to delay seeking care until a crisis exists, or to use costly and
inappropriate resources such as hospital emergency rooms for nonemergencies.
More than half of persons currently enrolled in Access to
care have family incomes below the poverty level ($13,900 for a
family of four) but make too much money to qualify for Medicaid.
Women and children under the age of eighteen are overrepresented
in the program (57.1% and 42.7% respectively), bearing out
national statistics that they are more likely to live in poverty.
Minorities, too, are overrepresented in relation to the general
population. In 1992, 37.2% of Access To Care participants were
Hispanic, 22.% were African-American, 3.6% were Asian, and 37%
were white.
Seventy-two percent of the heads of household in
the program work, but have no insurance.
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The Access to Care Program
This innovative program was developed tailored to the needs
of the suburban poor, who are dispersed over a large geographic
area with poor transportation resources.
The program is open to persons with incomes less than twice
the federal poverty level who are uninsured by public or private
programs for primary health care.
The Council estimates that
there are 99,000 persons in suburban Cook County in this
situation.
The Council contracts with local providers throughout the
area and pays them a discounted rate to provide services to
persons enrolled in the program.
Covered services include office
visits to a primary care physician, routine lab and x-ray
services and prescription drugs.
Patients pay only a nominal fee
($5.00) for each visit, and pay no more than $5.00 for other
services.
There is no charge to enroll in the program.
Screening for eligibility and enrollment occur at local township
offices, health departments and community agencies, where
patients are also linked to other needed services not provided
through the program.
Coordination agreements are maintained with
the providers of these services.
It is the intent of the Council
to utilize existing resources to the fullest extent possible and
to fill in the gaps.
The services provided through Access to
Care are scarce to non-existent in suburban Cook County for the
uninsured.
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Physicians volunteer to participate in Access To Care, and
choose the number of patients they will add to their practices.
Currently, one-hundred eighty-seven physicians participate in the
program, providing the capacity to serve 10,079 patients. They
are paid a nominal $52 per patient per year, yet their response
to participation has been enthusiastic:
11
I am working in the
program because I want to do something for my community" says
Yahya Ahmadian,M.D., a Homewood pediatrician.
Many feel that the
program addresses a major cause of serious afflictions, lack of
treatment in the early stages: "I saw a patient ••• who needed his
medication. 11 says Vasantha Kumaraiah, M.D.
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He knows he has
diabetes. He knows he has hypertension, but he quit taking his
medication months ago because he couldn't afford it."
The Benefit
Access to Care removes the financial barrier to primary
care and provides an entry point to the health care system.
Early detection and treatment of illness should reduce and, in
most cases, obviate the need for more costly secondary care.
Thus, although the program covers only "sick care" office visits,
it is preventive in that it helps keep people out of the hospital
and, particularly, out of the emergency room.
The types of prescriptions and services utilized by patients
as well as the most common diagnoses show that patients are being
treated for acute and chronic conditions which could become
serious or require hospitalization if left untreated. For adults,
the most frequent diagnoses are hypertension and diabetes, and
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for children, ear infections. These diagnoses affirm the need for
primary care to prevent more serious sequelae.
The Access To Care program offers more than diagnosis and
on-going treatment. Patients choose a personal physician, with
whom they form a relationship. Access To Care participants have
the security of knowing that they can get care if they need it,
without a serious financial sacrifice. This saftey net creates
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peace of mind even before the medical need arises.
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costs. Patients are referred to local hospitals or Cook County
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The Access To Care program does not cover hospitalization
Hospital for inpatient admission. Council staff facilitates
referrals to county-operated specialty clinics to help provide
continuity of care. The small number of these referrals, under 4%
of the patient population, validates the program's concentration
on primary care.
Everyone pays indirectly for uncompensated care for the
uninsured through higher charges for medical care, higher
insurance premiums, and higher taxes to support Medicaid and
Medicare.
Access to Care provides compensation to providers for
patients who cannot afford to pay. Because Access To Care is not
facility-based, it can operate more economically than other
primary care delivery systems.
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Access To care's costs are surprisingly low, especially when
compared to the cost of an emergency room visit or inpatient
admission. Total costs per person for one year's participation in
Access To care are estimated at $226.41 for 1993.
5
�Endorsement
In 1991 the Access To Care program received the endorsements
of the Illinois Chapter of the American Academy of Pediatrics,
the Illinois Academy of Family Physicians, and the Institute of
Medicine of Chicago. In 1992 the program received the full
support of the Chicago Medical Society. Each of these organized
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medical societies is concerned about the problem of the uninsured
and encourages its members in suburban Cook County to participate
in the Access To Care program.
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In 1992 the Council conducted its annual physician satisfaction
survey.
93% of participating physicians reported being either
satisfied or very satisfied with the program. The Council also
conducted a patient survey which contrasted patient experience
before and after joining Access To Care. 29% reported that in the
year prior to joining the program,· a family member skipped taking
prescription medication because of the cost, and 58% had
postponed medical care when they needed it. Use of the emergency
room decreased by 18.4% after joining the program. Most
importantly, patients reported an improvement in health status
since joining the program. Only 39.6% of adults reported good or
excellent health before Access To care compared to 80.4% after
being in the program for a year.
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The Organization
The Council was formed in 1986 in response to The Chicago
Community Trust's "Health Care in Cook County Initiative". The
Council received a planning grant in 1987 to design a delivery
system of primary care for the medically indigent in suburban
Cook County. The Council was incorporated as an Illinois notfor-profit corporation in April, 1988, and received tax-exempt
status in April,1989.
The four organizations which make up the Council bring many
years of experience in health and social services to the program.
The Board of Directors is composed of four representatives from
each of the four member organizations and four at-large members.
Three community advisory boards advise the Council and serve as a
liason with the community.
Funding
The program was originally supported by a grant from The
Chicago Community Trust. Additional support has been provided by
the Baxter Foundation, Square D Corporation, Robert R. McCormick
Charitable Trust, Washington Square Health Foundation, Inc.,
Blowitz-Ridgeway Foundation, Children's Care Foundation, Special
People in Need, the Ford Motor Company, the Searle Charitable
Trust, and the W.P.& H.B. White Foundation. Five municipalities
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and eight townships have also supported the program. Funding by
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expanded the program and institutionalized it as a primary care
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delivery system to the medically indigent in the suburban area.
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At current funding levels, Access to Care can serve only 5.2%
of those eligible for care in suburban Cook County.
There is
currently a waiting list for the program in the entire service
area.
II
Although the program's physician capacity is 10,079
patients, present funding will cover just 5,497 patients.
Of
99,000 estimated eligible, most uninsured children and adults
I
•
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continue without adequate care.
I
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Conclusion
While providing health care to low-income, uninsured persons
is a major topic today, the Access to Care program actually provides a mechanism to do something about the problem.
In addi-
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tion to the human suffering caused by lack of access to health
l
care, society bears a cost in terms of low productivity resulting
from the postponement of needed medical care, reduced school
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attendance, and higher insurance premiums and health care costs
due to subsidization of uncompensated care.
Locally based pri-
mary care can fill in the gaps in large areas with dispersed
indigent populations, without involving capital funds, costly
facilities, or equipment.
This model gives physicians a partner-
i
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ship with private and public funders working to solve a growing
national problem in a cost-effective manner.
Access to Care is a local solution to a local problem. How-
I
ever, we believe that our efforts may serve as a prototype for
I
addressing a serious problem which exists not only in suburban
I
Cook County but in many communities throughout the nation.
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8
�Clinton Presidential Records
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visit the Clinton Presidential Library's Research Room.
�Annu-al Report
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9
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
007a.letter
DATE
SUBJECTffiTLE
Hillary Rodham Clinton to Bruce R Brookens. [partial] (1 page)
03/29/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Act -(44 U.S.C.ll04(a))
Freedom of Information Act- (5 U.S.C. SSl(b))
PI National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office ((a)(l) of the PRA)
P3 Release would violate a Federal statute ((a)(J) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of tbe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would c:onstitute a c:learly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) ofthe FOIA)
b(l) Release would disclose internal personnel rules and practlc:es of
an agency ((b)(l) oftbe FOIA)
b(3) Release would violate a Federal statute ((b)(J) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf"de defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�r
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THE WHITE HOUSE
March 29, 1993
Dear Bruce:
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Thank you for sending the photographs from that memorable
evening together. Although I have received some others, these are
among the best, and I especially appreciate having them to add to my
treasured collection. That was a grand opportunity for us to be
together, celebrate and catch up after all these years.
I am grateful for your writing and sharing your views on
health care reform. I readily understand that physicians who rely on
news accounts may be frustrated by descriptions of our process, but
most of them are not aware that the Task Force and working groups
have been meeting with every group of physicians which has
requested meetings and been giving careful consideration to the
letters, proposals and suggestions received from many concerned
health care professionals. In fact, many of the groups which claim to
be "locked out" have been part of these meetings on a regular basis.
We want to have doctors part of the process for the very reason you
suggest- to be "invested" -and, even more important, to help design
the system they will be part of implementing.
I
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I appreciate the invitation to speak at the Annual Legislative
Conference of the American Society of Anesthesiologists on April 26
or 27. You indicated .we have already received this request, but I
will direct a copy of your ·letter to my scheduler as well.
�,.
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Bruce R. Brookens, M.D.
March 29, 1993
Page Two
Thank you again for sharing your views and those of your
colleagues, and for your support as we endeavor to find workable
solutions to the incredibly complex health care issue.
I haven't had much time to practice that pitch lately, but
perhaps I'd better get started! The season is upon us, and I can
hardly wait.
Sincerely yours,
cc: Scheduling
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
DATE
SUBJECTifiTLE
RESTRICTION
AND TYPE
007b. letter
Bruce R. Brookens to Hillary Clinton. (Partial) (1 page)
03/10/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Act -(44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
rmancial information [(a)(4) ofthe PRA)
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b){8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misnle defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�-----·-
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(g)(q)J9d
'{·
•
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c.
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��..
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
008.letter
DATE
SUBJECfffiTLE
Hillary Rodham Clinton to Sister Margaret Vincent Blandford.
[partial] (1 page)
03/29/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Ad- [44 U.S.C. 2204(a))
Freedom of Information Ad- [S U.S.C. SS2(b))
PI National Seeurity Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would diselose trade secrets or confidential commereial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advison [a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National seeurity elassified information [(b)(l) of the FOIA)
b(2) Release would diselose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would diselose trade secrets or confidential or f'maneial
Information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
f'maneial Institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfde defined in accordance with 44 U.S.C.
2201(3).
RR. Document wiD be reviewed upon request.
�- - - - - - - - - - ...........-.. .----·->~- _-;;..,.-;;:::;:;;;;::,::.;.,;;--_;:,-;:::::::;:;..-. __,._,.~~···-
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THE WHITE HOUSE
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March 29' 1993
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Dear Sister Margaret Vincent:
Thank you for sending me a copy of the Executive Summary
prepared for the hospitals operated by the Sisters of Charity. It will
be helpful both to me and to the Task Force as we consider various
options in finding solutions to the incredibly complex health care
issue.
President Clinton is committed to reforming our nation's
health care system - controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
On a personal note, I want you to know of my genuine,
heartfelt gratitude for the excellent care and attention St. Vincent
Infirmary Medical Center has provided during my father's illness.
The ongoing support for our family during a difficult time has been
extraordinary and extremely helpful.
Do continue to remember our family - and our nation - in
your prayers in the challenging decisions before us.
Sincerely yours,
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J[ovvQ~.ff ~vv-
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�..
January 26, 1993
EXECUTIVE
SUMMARY
The design presented here is the product of a broadly based team representing
healthy people, patients, providers, employers, healthcare administrators, people
who work in in-patient and out-patient care facilities and healthcare related
foundations and organizations, consultants, academics, students and others with
an interest in changing healthcare in the United States. A common belief of the
participants is that healthcare must be redisgned, not reformed.
As a
consequence, the group•s design contrasts from most of the published efforts at
reform in that it approaches healthcare systemically; that is, it recognizes that
healthcare as a system is a product of the interaction of its parts, not the sum of the
actions of each of its parts considered separately or independently. This means
that if the system as a whole is to be changed effectively, all of the significant parts
and the ways they interact must be changed (redesigned).
Current reform efforts are unlikely to succeed because they focus only on
reimbursement and neglect other aspects of the healthcare system. This design
presented here includes changes not only in how the system is paid for, but also in
how care is accessed, how consumers and providers behave, where responsibility
for and control of the system is located, and its focus on disease and disability as
.
opposed to wellness. The design brings about these changes because it does the
following:
1.
Provides Universal Access to Essential Healthcare
Each resident of the United States would receive a voucher that entitles him or
her to essential healthcare for one year.
The voucher would be issued
annually by the IRS and its value would reflect the age, health status, and
�'
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January 26, 1993
2
characteristics of the residential environment of the recipient.
(Wellness
stamps, discussed below, would also be issued at the same time.)
2.
Relieves Employers and Government•s Current Burden of Paying
for Care
Care would be paid for by a combination of taxpayer and employer. The
taxpayer would be taxed according to his/her ability to pay, number of
dependents, lifestyle (for example, a smoker would pay more than a
non-smoker, a race car driver would pay more than an accountant)
residential environment. The
employers~\
and
contribution would be in the form of
a healthcare tax proportional to the health hazards, stresses, etc. associated
with the particular industry or employment circumstances.
However,
employers could cover part or all of the healthcare costs of their employees as
a benefit, if they so chose.
All U.S. residents who are required to file income tax returns would file a
healthcare tax forms at the same time and pay any taxes that are due
regardless of whether the filers 1 incomes are large enough to require payment
of a tax.
3.
Reduces Total Costs as Compared to the Current System by (a)
Reducing Administrative Costs, (b) Inducing Competition and
Utilizing Free-Market Controls, and (c) Providing Incentives for
Cost-Effective Provider and Consumer Behavior
Placing responsibility for administrative costs with the community and
substantially reducing third-party involvement would reduce administrative
costs to a fraction of those in the current system.
�. ..
January 26, 1993
The role of insurance companies would be to provide catastrophic coverage
to healthcare providers whose patient mix results in costs that do not allow the
primary care provider to earn a suitable income. They would also continue to
provide malpractice insurance but the threat and cost of malpractice suits
would be significantly reduced as described in Section 6 below.
Competitive behavior is induced through a mechanism that (a) gives bonuses
to healthcare providers for each patient that renews his or her registration with
them each year, (b) allows patients to transfer to other providers for justified
dissatisfaction, and (c) use of both internal and external markets. Providers
and administrators within each system would be able to purchase healthcare
services_ and products from within that unit, or from units external to the system
if they charge less and their quality is considered to be at least as good as that
obtained from internal suppliers.
Incentives for cost-effective provider behavior would come principally from the
providers' control of their patients' vouchers, but also from a mechanism that
allows physicians to discontinue service to patients who seek inappropriate
and/or excessive use of healthcare services or products.
lncenti~s
for cost-effective patient behavior (healthy life style) would come
through reduction of their healthcare tax rates or enlargement of the list of
services to which they are entitled.
4.
Places Responsibility for and Control of the Health care System in
the Combined Hands of the Users and Providers of Care and
Provides Choices for Both
- - - - - - - - - - - - - · - - · - -
3
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January 26, 1993
Recipients of the vouchers would register them with primary care providers of
their choice.
These providers would then pay all essential healthcare costs
incurred by those registered with them including the costs of hospital stays,
specialist visits, tests and pharmaceuticals. These costs could not be incurred
without approval of the primary care provider except in an emergency. The
value of the vouchers would provide the primary care providers with a suitable
income after paying all their patient's bills.
Primary care providers could practice in either the public (National Health
Plan) or private system, but not both.
Primary care providers who participate in the National Health Plan could
practice individually, in groups or be employed in an integrated healthcare
system.
Patients could choose providers who practice outside the system but have to
pay for the services they receive. However, this would not relieve them of the
obligation to pay the healthcare tax.
5.
Establishes a System as Close to the Users as Possible for
Determining What Care is Covered and What Is Not.
This System
is Con"trolled and Varies by Communities According to Their
Needs.
Each community would assure access to essential primary, secondary,
tertiary, quaternary, and extended-stay healthcare services either within that
or another community. Essential healthcare services would be determined by
a Community Healthcare Board established within each community. These
services would reflect the environmental and healthcare characteristics of that
�'\
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January 26, 1993
community. Non-essential (elective) services would be available at a fee.
These Healthcare Boards would certify wellness services for which the
wellness stamps issued by the IRS could be used. The Community
Healthcarre Information Systems managed by these boards would provide
each resident with an annual healthcare printout that would be filed with their
healthcare tax form. These healthcare board activities would be funded by the
IRS.
6.
Reduces the Potential for Malpractice Suits
Each community's healthcare board would receive funds from the IRS to
conduct quality audits of the healthcare services provided and establish a
healthcare court that address appeals concerning services and costs.
7.
Simplifies and Significantly Reduces the Inconsistencies and
Redundancies Associated with Healthcare Information Systems.
The Healthcare Information System established by each Community
Healthcare Board will maintain a complete healthcare record of each resident
of that community. Access to the record could only be obtained with the
individual's permission, except in an emergency. All records would adhere to
nationally specified standards and be accessible through a national network.
8.
Places Emphasis on Well ness
Rather Than Illness
Each recipient of a healthcare voucher would also receive wellness stamps
that could be used to purchase membership in certified programs of wellness
education, nutrition, exercise, immunization and so on. Participants in these
�January 26, 1993
programs would become part of the individual•s healthcare record and affect
the individual•s healthcare tax rate or healthcare service.
9.
Makes Physical Access to Providers Easier
Primary healthcare services would be within walking distrance of most people
living in population centers (in Healthcare Malls where feasible). Those who
are not ambulatory would receive care either at home. from mobile units, or be
transported to care-providing units. In-home healthcare services would be
provided wherever possible and economically feasible.
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�HEALTH CARE TASK FORCE SORTING SHEET
nPE OF MATERIAL:
_O.eral mall
_P81'801U11 stories
_Letterhead
_Offers to help
_LetterC8Dlpaip.
_Policy
_CII8eWOI'k
_ . _ . . empl.,_.
_r.n.
_&eDioN
_small busineas
_other h8alth provider
Expbmatiom~--------------------------------------~------pRIMARY INTEREST:
COST ISSUES
_ Dra8 Prices
_ PhJ&lciaD Fees
_Hospital Fees
_
UDDece•ary Procedures
_Medical Equipment
Fraud and Abuse
_PUBUC HEALTH/SPECIAL POPULATIONS
Pievention
AIDS
Women's Health
Immunization&
Rural
urban
COVERAGE
_
GOVERNMENT lPROGRAMS
Work:iDg Families
Medicare
Medicaid
Veterans
DoD
_Unemployed/Low Income
Benefits
Providers
ORGANIZATION
Insurance Premiums
Insurance Reform
Insurance Pools
_Douds and Oversilht
_
INFRASTRUCTUB.FJWORKFORCE
_
Quality AIBurance (Guidelines)
_
Administration, Relmb1li'88Dlent
& Patient Information s,atema
_Malpractice & Tort Reform
_
Manpower l&&ues ('l'rainlna)
LONG-TERM CARE
MENTAL HEALTH
FINANCING
OTHER
Explanatiom~------------------------------------------------
PLAN PREFERENCE: (Support=+; Oppose=-)
CP
SP
OP
Cllnton Plan
Sinpe Payer
Other Plan
MC
PP
CV
Manaaed Competition
Pay or Play
Credits, Voucher&,
Medical Savina& Aceta.
CA
BR
GE
Canadian
British
German
�THE WHITE HOUSE
March 29, 1993
Mr. Joseph A. Califano, Jr.
Chairman and President
Center on Addiction and Substance Abuse
Columbia University
152 West 57th Street
New York, New York 10019
Dear Joe:
It was indeed a pleasure to meet with you and Mrs. Ford on
an issue of mutual concern to all of us. I appreciate your sending for
my review a copy of the Bush and Clinton responses to the CASA
questionnaire during the campaign.
Thank you for your offer of assistance and especially for your
affirmation and expectation of •great things. • I will work hard to
measure up to that.
Sincerely yours,
�Center on Addiction
and Substance Abuse
at Columbia University
March 2, 1993
15!2 West 57th Street
New York, NY 10019
phone !21!2 841 5!200
fax !21!2 956 80!20
Board of Directors
Joseph A. Califano, Jr.
Mrs. Hillary Rodham Clinton
Office of the First Lady
The White House
1600 Pennsylvania Avenue, N.W.
Room 100-0EOB
Washington, D.C. 20500
Dear Hillary:
Chairman and President
James E. Burke
Betty Ford
Douglas A. Fraser
Barbara C. Jordan
Donald R. Keough
LaSalle D. Leffall, Jr., M.D.
Manuel T. Pacheco, Ph.D.
Linda Johnson Rice
E. John Rosenwald, Jr.
Michael I. Sovem
Frank G. Wells
Thank you for meeting with Betty Ford and me. It was a
stimulating and productive meeting. We greatly appreciate the
opportunity to discuss the importance of addressing the problem of
substance abuse and addiction in the context of health care
reform.
Although I did not mention it at the meeting, I am sure you are
aware of the President's response to the questionnaire CASA sent
to him and President Bush during the campaign. In his reply,
President Clinton stated ... "we will require that every insurance
plan includes a core package of benefits to be defined by a
National Health Board. Treatment of drug addiction for those who
need it will be incorporated in this core package .... " He also
committed to increasing the resources devoted to prevention and
treatment. (I have enclosed a copy of the President's full
response.)
We applaud these policy directions and look forward to assisting
you in any way we can.
Enclosure
�Center on Addiction
and Substance Abuse
at Columbia University
CASA Questionnaire and Candidates' Complete Responses
Question 1 : The National Cancer Institute and the National Heart, Lung and
Blood Institute each spend $7 billion a year on basic science research. The
federal government spends no more than $300 million a year on basic science
research involving substance abuse and addiction. Do you support increasing
federal expenditures for basic science research on substance abuse and
addiction to an amount comparable to that spent for basic research on cancer
and cardiovascular disease?
Bush Response: I have strongly supported research increases in the drug budget each of the
last four years. This year total spending on research involving substance abuse and addiction
will be $360 million. Unfortunately, the Congress has not been willing to appropriate all the
funds for substance abuse addiction research and services that I have requested. Federal efforts
in basic scientific research on substance abuse and addiction have increased by 64% between
1989 and 1992, and the Administration is requesting an additional increase of $17.5 million for
Fiscal Year 1993. I also strongly support increases in funds for applied research to help develop
more effective and targeted treatment and prevention programs.
We can and must do more in both the basic and applied research areas. I have fully
outlined my research goals in the National Drug Control Strategy, and I am encouraged that we
will see a real contribution from the additional research effort we are undertaking.
Clinton Response: I believe our nation has to find ways of treating more addicts more
effectively. Too little is known about addiction, and too little has been done to explore different
cures. Further research into substance abuse and addiction-both into the causes of addiction and
into possible cures-is essential to improving treatment. I strongly support the comprehensive
approach and substantial, long-term commitment made by CASA in this field.
Federal funding of basic science research is obviously constrained by budgetary
considerations, and I would be unwilling to cut other vital medical research projects.
However, substance abuse costs our country $300 billion a year. Our nation cannot afford to
delay serious investment in solving this problem.
Question· 2: The Congress has appropriated nearly $12 billion for this year's
budget for the •war on drugs. • More than two-thirds of that amount will go to
law-enforcement efforts and less than one-third to treatment and prevention.
Do you agree with this allocation of resources? If not, what do you consider the
appropriate
allocation?
Bush Response: Treatment and prevention are essential parts of our comprehensive
National Drug Control Strategy. With my 1993 budget request, Federal funds supporting the
drug strategy would almost double to $1 2. 7 billion since I took office. This includes a 121 %
increase for prevention and a 94% increase for treatment.
The primary goal of the strategy is to reduce illegal drug use and I am encouraged to see
(more)
�-··-
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-2that we are making significant progress, particularly with America's youth. For example,
overall drug use declined by 13% from 1988 to 1991. Adolescent drug us declined by 27% and
adolescent cocaine use declined by 63% over the same period.
Our comprehensive strategy is working. I believe that in the second term we should
continue to expand and improve our programs on reducing the demand for drugs-on treatment,
education and prevention. We also need to improve our interdiction, law enforcement and
international efforts in order to help make prevention and treatment more effective.
Clinton Response: The present administration has concentrated on badly coordinated
policies to cut the supply of drugs at the expense of more cost-effective measures to decrease
demand. Yet what successes we have had so far in cutting casual use of illicit drugs and cigarettes
have been primarily through education and prevention, not through making drugs or tobacco any
less accessible.
Any sensible policy on drug abuse must tackle both cutting the demand for drugs and
reducing supply. And I will increase the resources that are devoted to prevention and treatment.
But I do not believe this is simply a matter of counting the dollars allocated in the ONDCP budget.
I propose expanding and improving treatment, education and prevention. The first thing
we have to do is make sure existing resources .are· being spent in the most cost-effective way, by
for example, improving aftercare facilities so that fewer people relapse after they leave
treatment, and ensuring school drug education programs include training for teachers to make
them work. Then we will expand treatment-targeting first pregnant women-and implement
new prevention programs aimed at kids in high-risk situations. Policies such as a Youth
Opportunity Corps, urban investment, fully funding Head Start-described by one expert as the
best drug-prevention program we have-will be funded through other budgets, not from the
ONDCP budget.
I do not favor shifting resources away from local law enforcement-unlike George Bush,
who proposed this several times. Police in our neighborhoods are in the front line against drugs,
keeping people safe frpm drug-related violence, keeping dealers off the streets where children
play. I support community policing which gives law enforcement a preventive role. Cops on the
beat working with local residents is as much a preventive strategy-stopping crack houses and
dealing networks growing in the neighborhood-as it is retrospective law enforcement. And as we
improve treatment in prison and explore court-mandated treatment options along the lines of
the Miami Drug Court, law enforcement will become a key way to direct more people into
treatment.
Other supply reduction strategies have been a failure under the present administration.
Billions have been poured into high-tech surveillance and interdiction equipment, whilst the
quantity of drugs entering the country has only increased. We have to fundamentally reexamine
our interdic~ion policies, to ensure that resources are being used in the most efficient and costeffective way to stop drugs entering the United States.
Question 3: In your proposal to reform the health care insurance system, what
kind of coverage for the treatment of substance abuse and addiction do you
provide?
Bush Response: My health reform program allows states to define a basic benefit package.
Any mandated benefits within the package require approval from the Secretary of Health and
Human Services. States would base the composition of the basic benefit package on the needs of
their citizens, therefore basic health benefit plans are expected to vary by state. Insurers could
(more)
�-3offer more extensive packages with greater coverage of benefits; however, coverage for
particular services or procedures could not be mandated. Individuals would be able to select
from a variety of health plans that best meet their health care needs. To the degree that
substance abuse and addiction treatment are cost-effective and are needed by the citizens of a
particular state, the state may include such treatments as part of a mandated set of benefits.
Clinton Response: I am proposing fundamental and far-reaching reform of America's
health care system, and treatment of drug addiction will become a part of that. I have a plan to
control costs through reforming the insurance market to make it competitive and efficient,
and global budget targets to provide added discipline. Then as costs are controlled we will phase
in universal coverage building on the current employer based system of coverage. Businesses
will have to do their fair share and cover all their employees, whilst financial assistance from
government will help small businesses and nonworkers, so that every American is covered.
As part of our reforms of the insurance system, we will require that every insurance
.. plan includes a core package of benefits to be defined by a National Health Board. Treatment for
drug addiction for those who need it will be incorporated in this core package along with
ambulatory physician care, inpatient hospital care, prescription drugs, and basic mental health
services, expanded preventive. treatments. .
Question 4: Canada is experimenting with a significant tobacco tax increase to
discourage people from smoking. The United Kingdom uses liquor taxes to reduce
consumption. Do you favor increasing the taxes on liquor? Wine? Beer?
Tobacco? If so, by what amount?
Bush Response: In the United States, most excise taxes on alcohol and tobacco are levied at
the state and local level and are an important source of state revenue. States have been active in
this sphere. Cigarette taxes, for example, rose in 11 states from 1990 to 1991, and the median
state tax rose from so:21 to $0.24 per pack. Excise taxes should best remain an issue whose
focus is at the state level.
Clinton Response: In Arkansas we have raised the tax on tobacco products on more than one
occasion, but an increase on .alcohol and tobacco-related products is not included in my national
economic strategy. Despite raising taxes on tobacco products in Arkansas, we have maintained
one of the lowest state tax burdens in the nation. The federal tax code already penalizes middleclass families and low-income families whilst benefitting the rich. Substantially raising
consumption taxes will make the system even more regressive. I want a more progressive tax
code that will ask the top 2% of income earners to pay their fair share and give low- and
middle-income families a tax break.
There are other steps we can take, however, and as Governor of Arkansas I have played
an active role in tobacco-related issues. I have signed legislation making it illegal to place
tobacco vending machines in public places that are accessible to people under 1 8 years of age and
prohibiting the free distribution of tobacco products in public areas around schools and
playgrounds or to any person under 1 8 years of age.
I have signed a law requiring all state agencies to implement a smoking policy for their
general office space. I vetoed a bill that would have prohibited employers from hiring only
nonsmokers and potentially given smokers rights in the workplace itself, which I believe is
inappropriate. While Americans plainly may smoke in many circumstances, smoking is an
acquired behavior and given the overwhelming evidence of the toll it takes every year in disease
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�-4and death, it should not be accorded legal protection like freedom of speech, nor should smokers
be a protected class like those who have been wrongly discriminated against because of race,
sex, age or physical handicaps.
Question 5: Do you favor a ban or further restrictions on the advertising of
tobacco? What kinds of restrictions, if any, do you favor on the advertising of
alcohol? For example, should beer advertising be allowed on television?
Bush Response: I believe the present restrictions on tobacco advertising are appropriate;
but that does not relieve either the tobacco or the advertising industries from exercising
responsible self-restraint in promoting tobacco products. I also favor the current health
warnings and the efforts of the Department of Health and Human Services to educate the public
on the serious health consequences from their use.
I do not want to see our youth gain access to cigarettes or other tobacco products. I
strongly favor the actions many states have taken to restrict where these products are
displayed, and how they are sold through vending machines.
With respect to restrictions on advertising alcoholic beverages, I believe the broadcast
and media industries must balance the promotion of these products with legitimate concerns for
public health. As I mentioned with respect to tobacco, there is more that can be done by the
alcoholic beverage industry and the advertising industry.
For example, I am gratified that members of the Outdoor Advertising Association of
America have agreed that they do not want to display such advertising in places where children
are likely to view it frequently. I am also encouraged that the alcoholic beverage industry has
indicated to the Administration its willingness to review its practices, particularly with regard
to promoting products in a manner that has little to do with the quality of the product, but
associates it with a certain kind of lifestyle.
In summary, the answer to this problem is not another rule or Jaw from Washington,
but a cooperative partnership with health and prevention organizations, the industry, and the
Administration to work with communities across our nation to reduce the misuse and abuse of
alcohol, and to exercise good judgment in the promotion of these products. We must also ensure
that existing laws are strictly enforced.
Clinton Response: I support the current advertising restrictions and warning
requirements for alcohol and tobacco products, and my administration will be dedicated to fully
enforcing these laws. My administration will move quickly to stop any efforts to relax the
current restrictions. We will consider any new and appropriate scientific data that suggest that
the current restrictions or labeling requirements should be updated.
As a· former professor of constitutional law, however, I believe that we must also make
sure that we consider the possible First Amendment implications of broader restrictions. Any
new restrictions or requirements must meet constitutional standards.
Question 6: In 1990, more than half the inmates in federal prisons were there
for drug-related crimes. An even larger percentage of state prison inmates
were under the influence of drugs and/or alcohol at the time of their offense.
Should the federal government condition financial support for state prison
systems on states' providing substance abuse treatment to all inmates who need
it?
(more)
�-5Bush Response: We spent $10.7 million in 1991 and will spend $22 million in 1992 for
drug treatment programs in Federal prisons. Our FY 1993 budget request is for nearly $28
million. In addition, to provide substance abuse services to persons awaiting Federal trials, we
have requested another $44 million for FY 1993.
Today, Federal assistance is being provided for drug-related pilot programs in a number
of States. Most States also fully recognize the benefits of providing substance abuse services to
inmates.
While the Federal government has encouraged, directly and by example, new substance
abuse treatment programs for State inmates, the Administration has not conditioned Federal
assistance on substance abuse treatment and has no plans to do so at this time.
Clinton Response: I am committed to expanding treatment for substance abuse in prison.
We have to treat inmates while they are in prison to stop the revolving door of recidivism. It is
wholly irresponsible of both state and fede-ral governments to release inmates back onto the
streets after lengthy sentences-but having had no treatment for substance abuse. Reducing
recidivism is essential both to protect American citizens from crime, and to make space in
prisons for violent offenders.
But first the federal government has to get its own house in order. In 1991, the GAO
reported that although an estimated 44% of federal inmates needed substance abuse treatment,
only 1% were receiving any. We will also expect states to increase treatment in state prisons
and we will encourage them to explore court mandated treatment options along the lines of the
Miami Drug Court.
Question 7: Do you favor removing criminal penalties for possession of
marijuana for personal use? Do you favor removing criminal penalties for
possession of any other drugs for personal use? Do you favor legalization of
marijuana or of any other drugs that are now illegal?
Bush Response: No. I strongly oppose legalizing or decriminalizing marijuana or any illegal
drug.
Clinton Response: No. I do not favor removing criminal penalties for the possession of
marijuana or other drugs, nor do I support the legalization of these drugs. I believe we should
expand drug and alcohol treatment and education. The current administration has not made
improving drug treatment and education the priority it needs to be, and my administration will.
But we cannot move to reduce or remove criminal penalties before we have made a serious effort
to reduce demand. Otherwise, we risk encouraging personal drug use in the short term.
Question
8: Do you favor increasing criminal penalties for drug users or drug
dealers? Do you favor the death penalty for drug dealers of for drug dealers who
sell to minors? Do you favor mandatoty life imprisonment for drug dealers of
for drug dealers who sell to minors?
Bush Response: My Administration has vigorously pursued the War on Drugs, obtaining
more than 46,000 convictions between 1989 and 1991. We have worked hard to establish
appropriate penalties for drug offenses, and current laws are generally adequate. There are,
however, some areas that need improvement.
(more)
�-6My "Comprehensive Violent Crime Control Act of 1991 ," which Congress still has not
enacted, proposes the death penalty for drug-related felony violations which result in the death
of another person.
Whether a drug dealer deserves the death penalty depends on a variety of factors, and
these sanctions should be reserved for the most serious cases. I also strongly support stiff,
mandatory minimum sentences contained in current law for drug trafficking and for involving
minors in any aspect of the drug trade.
Clinton Response: In Arkansas, I have increased penalties for drug traffickers. I will
continue to support lengthy and severe sentences for drug traffickers, including the death
penalty for drug kingpins.
Despite the efforts of Congress and the President to severely punish drug
traffickers, our anti-drug laws have filled our prisons with first-time and low-level drug
offenders while many of the drug kingpins continue to evade the system. In fact, despite the
administration's efforts to create a federal death penalty offense for drug
kingpins, this statute remains virtually unused. We need to make sure that the worst offenders
are receiving appropriately tough sentences.
Question 9: Do you favor pre-employment testing for drugs and alcohol for all
federal employees? For law-enforcement personnel?
Military personnel? Others?
Transportation
workers?
Bush Response: I strongly support drug-free workplace programs, not only for the Federal
government, but also for the private sector. The Federal government has done an exemplary job
in creating a model program which emphasizes, above all, the well being of our employees,
public confidence in our Government, and reducing any health or safety threats to the members
of the public.
Drug testing is only one component of the Federal program, which also includes training
for managers and supervisors on illegal drug use, intensive drug awareness programs, and
employee assistance programs.
Only those employees in national security, safety-sensitive, health, transportation, or
similar occupational areas are subject to random drug screening. Applicants for these positions
are subject to drug screening as well. Generally, this includes personnel who carry firearms,
such as law enforcement personnel, and some-but not all-transportation workers. Our drug
testing program in the military, which has been in operation for over ten years, has done an
excellent job in reducing drug problems in the Armed Forces. It includes pre-induction
screening for drug use.
•
Clinton Response: I support the idea of pre-employment drug testing for safety-sensitive
and security-related positions, such as certain law enforcement and military personnel. I
continue to believe, however, that drug tests are no substitute for expanded drug treatment and
education.
Question 10: When is random drug testing of Federal employees an appropriate
tool?
Bush Response: Federal Drug Free Workplace Programs are composed of several elements,
(more)
�.
•
-7of which drug testing, including random testing, is a necessary and effective component.
Randomdrug testing for Federal employees is appropriate for employees who carry firearms,
for motor vehicle operators who carry passengers, for pilots and flight crew members, for air
traffic controllers, for those having access to national security information, and for others who
hold similar positions. These are just a few examples of the types of positions where employees
are in sensitive posts. The Federal program has been carefully designed and tailored to be as
minimally intrusive as possible, and to protect the privacy of Federal employees.
Clinton Response: While I am concerned that random drug testing, without a reasonable
suspicion of an employee having engaged in illegal drug use, can be administered in an unfair and
arbitrary manner, I do believe drug and alcohol testing is justified for employees in safetysensitive positions. Any such testing mechanism, however, should include strict standards to
insure accurate results and equitable implementation.
Question 11 : Do you favor legislation that would hold tobacco companies liable
for diseases caused by the use of tobacco?
Bush Response: According to a recent United States Supreme Court decision, tobacco users
who claim to have become ill from using tobacco products already have the right to sue the
tobacco companies.
._
In Cipollone v. Liggett Groups. Inc.; the Court held that, while claims by tobacco users
against tobacco companies for failure to warn of the risks of tobacco are preempted by the
Federal Cigarette Labeling and Advertising Act of 1965, tobacco users who have become ill may
sue the tobacco company on other grounds-breach of express warranties, intentional fraud, or
conspiracy to misrepresent or conceal material facts concerning the health hazards of smoking.
Clinton ·Response: I have not had the opportunity to study this particular legislation and the
extensive related case law and, therefore, cannot comment on it.
Question 1 2: Should the.· U.S. government promote the sale of U.S. cigarettes
abroad as a means of reducing our trade deficit?
Bush Response: The United States Trade Representative's (USTR) policy is to challenge
discriminatory barriers to U.S. exports that violate international law. Nevertheless, it is also
USTR's policy not to challenge nondiscriminatory measures that have been legitimately adopted
by foreign governments to protect public health and safety. The GATT recognizes that
governments have a legal right to implement such measures, so long as they do not operate as
disguised barriers to trade. The U.S. supports efforts by all governments to protect their
populations from drug, alcohol, or tobacco abuse, but also strongly opposes misuse of this
rationale for protectionist reasons.
Clinton Response: The only way for the U.S. to reduce its trade deficit is to win in the global
economy. We need to fundamentally change our trade policy, and that means we need a trade
policy that puts people first by investing in ourselves. My national economic strategy will
invest in the ongoing education of American people, in the productive equipment that gives our
workers the tools to compete, and in the economic infrastructure that binds our markets and our
businesses together. And instead of focusing on tobacco exports to help reduce the trade deficit,
(more)
�..
-8my trade policy will recognize that we need companies that invest in the future-and that profit
from change.
Question
1 3: Do you favor requiring that all cigarettes exported by U.S.
tobacco companies be required to carry warning labels in the language of the
country to which they are exported?
Bush Response: The GATI recognizes that governments have a right to protect the health of
their populations through legitimate public health and safety measures, such as warning labels
and nondiscriminatory restrictions on tobacco advertising. Uke all U.S. firms, tobacco
producers have a legal obligation to comply with the public health and safety requirements of
the nations in which their products are sold.
·
Clinton Response: I certainly believe all governments should encourage their businesses to
·translate warning labels that· are affixed to their exports, particularly where health concerns
exist.
Question ·1 4: Do you favor tougher warning labels on alcohol?
Bush Response: Warning labels on the risk of alcohol use for pregnant women and the
danger of drinking and driving are already on many alcoholic beverages. A Federal Interagency
Task Force is currently working to determine how best to represent the alcohol content of
beverages for consumers. Recommendations from the Task Force are expected soon.
Clinton Response: I support the current warning label requirements and will consider any
appropriate changes that need to be made. I believe warning label messages should be based on
the most current medical and scientific information, so that consumers can be fully aware of the
possible effects of alcohol use.
###
�THE WHITE HOUSE
March 29, 1993
Sarah F. Hays, M.D.
Batesville Neuropsychiatry
1695 Harrison Street
Batesville, Arkansas 72501
Dear Dr. Hays:
Thank you for your letter of concern about the disparity of
insurance coverage for those with physical illness and those with
mental illness. I will direct your views and suggestions to the Task
Force.
President Clinton is committed to reforming our nation's
health care system -- controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
Again thank you for sharing your thoughts and for your
support in this tremendous undertaking.
Sincerely yours,
�---..
Batesville Neuropsychiatry
Sarah F. Hays, M.D.
1695 Harri soo Street
Batesville, Ark. 72501
(501 ) 793-0017
March 16, 1993
Hi 11 i ary Cl i ntoo
The W'lite 1-buse
Washington, DC 20500
Dear Ms. Clintoo,
I am writing yoo this 1etter in regard to yoor hea1th care reform p1anni ng. I am a 40 year o1d white
femle physician, W1o graduated fran the University of Arkansas ~ical Scie"'Ces Carrpus in 1900. I
did an internship in internal ITEdicine, which was then folla-.ed by a neurology residency. I becarre a
OOard certified neurologist in 1985. That sarre year I \'h1t into privBte· practice of neurology in
Batesville, Arkansas. I ranained in practice here in Batesville until May of 1990. At that tine I
returned to little Rock to do a oo year residency training program. in psychiatry, which I subsequently
CXlJ1)leted in June of 1992. Since that tine, I have returned to Batesville tO the private practice of
neuropsychiatry.
I:U'ing ·rrrf .psychiatry residency, I was eJqX>Sed to the Arkansas Divisioo of r-BTtal 1-ealth and spent
several rrmths of training at the Arkansas State ~spital, as well as· \\Orking in the Greater Little
~ Ccmrunity t-ealth Center. I witnessed, first hand, the plight of the chronically nentally i 11.
b that. i have returned to private practice, I am roti ng the disparity between insurance reirrtxJrserent
for "jjlysical 'illness" as CQ'Il)ared to that of ''nmtal ill~ss~" I· think with the advaramrt of ITEdical
science, it· has becare increasingly clear that the necharnsms underlying rmntal illness invariably involve
pathophysiologic processes involving the brain.· Therefore, there i's no differt:n:e between physical and
nenta1 ill ness.
In additiorl'; ·there are a nl.ll'ber of people 'IA'lO are 11 solid citizens" that \'0'1< hard in our society and
care for their families. Yet rmny of these people suffer .frtm rrental illnesses, such as depression,
\rttlich ·ill1)airs their capacity for a full and enriched life. It seens ·an unreasonable discrirninatioo ·
oo the part of insurance CQ'Il)anies, to reirrDllrse less for these peoples• illnesses than for sareone
\b) has hypertensioo or diabetes, for exarrple. These "walking \OJI'lded" rreke up a large portioo of oor
society •s \\OI"k force and taxpayers.
·
It is rrrf plea that you will stroogly coosider the issues to 'fklich I have ·alluded in this letter, as you
make plans for health care reform. Furthernore, I \\Ollld be happy to talk· with you about· these issUes ·
at anytineorcamunicate in any fashion, in regard to these matters.
.. .. ~:;
. :
•'.·i-·
p~q-;
Sarah F. Hays, M.D.
D-03-16-93
T-Q3-18-93
...
-~.'
-~ .
;-~~.
t.·
..·,
�THE WHITE HOUSE
March 29, 1993
Ms. Eleanor Butler
President, Board of Directors
Hospice of Burke County
P. 0. Box 1579
Morganton, North Carolina 28655
Dear Ms. Butler:
Thank you for writing and sharing your views regarding the
_,...
/
/
./
benefits of hospice programs. Certainly, caring for terminally ill
patients at home has definite advantages when it is at all feasible.
/
President Clinton is committed to reforming our nation's
health care system -- controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
Thank you again for your ideas and for your support in this
tremendou.s undertaking.
Sincerely yours,
�. ....
HCSPICE
0
F
B U R K E
C 0 U N T Y
Post Office Box 1579
Morganton, North Carolina 28680
004) 879-1601
Hillary Rodham Clinton
100 Pennsylvania Ave.
Washington, D.C.
March 19, 1993
Dear Mrs. Clinton:
I am writing on behalf ofthe Board ofDirectors ofHospice ofBurke County. We are very interested in and
concerned with national health care reform and the impact that the various proposals currently being
discussed might have on the families being served by hospice programs throughout the country..
It has been shown in the past that home care is frequently a less costly and equally effective alternative to
hospital- or clinic-based care. For more than twenty years hospices in the U.S. have provided a readily
available alternative to often non-effective treatment for the terminally ill.
It is our hope that any basic benefit package proposed by the Health Care Reform Task Force will include
a hospice benefit. This will encourage patients to take advantage of palliative care when appropriate and
allow for the support services necessary to care for terminally ill persons at home, or in other palliative care
settings when indicated.
We would appreciate your continued awareness ofhospice services as progress is made in health care reform
and also would appreciate being kept informed of legislative action regarding this issue.
Sincerely,
£~4~
Eleanor Butler, President
Hospice of Burke County Board of Directors
�THE WHITE HOUSE
March 29, 1993
Ms. Betty Ervin
104 Woodside Place
Morganton, North Carolina 28655
Dear Betty:
Thank you for writing and sharing your views regarding the
benefits of hospice programs. Certainly, caring for terminally ill
patients at home has definite advantages when it is at all feasible.
President Clinton is committed to reforming our nation's
health care system - controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
Thank you again for your ideas and for your support in this
tremendous undertaking.
Sincerely yours,
�-~~--
-
-------
104 Woodside Place
Morganton, NC 28655
March 19, 1993
Mrs. Hillary Rodham Clinton
The White House
Washington, DC 20500-2000
Dear Hillary:
I am writing t? ask that you and your Health
Care Task Force g~ve in depth and (hopefully)
favorable attention to the Hospice concept.
currently I am vice-chair of our local Hospice
board, and I have been an interested observer and
volunteer for a number of years.
To me, Hospice
exemplifies the innovative and cost effective
approaches to health care that our country needs.
It is certainly less costly and more humane than
the extreme pointless measures often taken to keep
terminally ill patients technically alive in
hospitals.
The most important factor to me is the human
element.
Patients can remain in their own homes,
be surrounded and cared for by their family members
and
loved
ones,
receive
medical
and
other
supportive help, be kept relatively pain free, and
have a quality of life that is hard if not
impossible to achieve in a hospital.
It is my hope that Hospice will be an
important facet of our new health system and will
· have the resources it needs to keep up the high
quality of care.
Anything you and your group can
do will be deeply appreciated.
Sam and I are so very proud of you and the
President. We are always ready to help you in any
way possible. Please call on us when you need us.
Affectionately yours,
r&dlj
Betty Ervin
: jcc
~.(0
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�-- - - - - - - ·
-
·:--::.:o."'::."',-.-...:::e- .-::-:... ....~~=:--..><:-~=~--~--•
{'
I
THE WHITE HOUSE
March 24, 1993
Dear Ms. Kane:
Thank you for writing and sharing your views on health care
refonn and other human services which relate so closely to it.
Certainly, wellness programs, good nutrition and prevention of
diseases enter clearly into the total picture.
-----·- -
President Clinton is committed to refonning our nation's
health care system - controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
Thank you again for your views and for your support.
Sincerely yours,
---
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
009b. letter
DATE
SUBJECTffiTLE
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page)
03/10/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number:
l 0813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Aet - (44 U.S.C. 2204(a))
Freedom of Information Aet -(5 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) of the PRA)
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P3 Release would violate a Federal statute ((a)(3) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA)
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a elearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning weDs ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf"de defined in aeeordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�-- r
,.
March 10, 1993
Ms. Hillary Rodham Clinton
CLINTON HEALTH CARE TEAM
THE WHITE HOUSE
1600 Pennsylvania Avenue
Washington, DC 20006
RE: HUMAN SERVICES REFORMS AND COORDINATED COMMUNITY MODELS ("HEALTH AND
HUMAN SERVICES CENTERS") IN RE HEALTH CARE REFORMS.
Dear Mrs. Clinton:
-··----· ··-:c-
< .......~-
""
rs--~Thomases'-motheJ_stiggested that I forward my enclosed views. to you. I hope these comments may be of
~the administration's disease prevention and health care/human services refonns.
From 1978 to 1981, as developer of an immensely successful nutrition segment for a Robert Wood Johnson-funded
wellness program in Milwaukee, and later as Chief Nutritionist for that city's health department, I was directly
involved in community based wellness programs and· community health centers that included WIC facilities. We
routinely coordinated nutrition education and wellness programs with clinical and food assistance systems. And
eventually, we were asked by the County to take over several WIC sites and bring them into our comprehensive
wellness and community health care system.
During those years, I testified before state and federal committees on food assistance programs, giving oral and
written suggestions for their improvement and reform. I am sure I do not need to tell you how little reform
occorred in these areas during the last 12 years. despite passionate pleas. Therefore, I'd like to reiterate some of
my suggestions now, in case they might be of assistance to new policies being developed by the Clinton
administration. These suggestions may also have bearing upon healthcare reforms now under construction.
After observing several food-and nutrition assistance programs, and speaking to people who lived through the
"dole" of the 30's depression, I feel strongly that we need a new format for food assistance, based on the WIC
specific voucher model, coordinated with clinical and learning segments - but streamlined, with needed
modifications (a modular 'credit card' or punch card system?) and attention to current sensibiijties.
Few in the U.S. begrudge giving necessary food to those in need. Most anti food-stamp feelings arise only when
taxpayers observe food stamp shoppers purchasing either perceived "luxury" items or "junky" non-nutritious (and
therefore "non-necessary") foods which the taxpayers feel they themselves cannot afford on a budget already asked
to subsidize the food stamp purchase in question. As a nutritionist, I have concerns about food stamp choices that
will not help build optimal health in an already at-risk population. And too often, I have witnessed homes which
simply do not have enough food at the end of the month for family members. either through poor planning or
inadequate scrip. But current food assistance programs can be altered to alleviate concerns such as these.
•
Rather than providing food stamp scrip in too limited amounts usable for a wide variety of discretionaiY purchases.
I believe the program would be more successful if it were administered much like the successful WIC model:
Hungry people could be provided vouchers good for ample amounts of healthful products such as milks,cheeses,
yogurt and eggs; dried/canned beans and peas; oatmeal and other nutritious cereals; brown and enriched rice and
other whole grains and enriched breads and flours; healthful fat sources; juices, apples. oranges and bananas;
green.yellow and orange vegetables; and minimally processed fish, poultry and other healthful protein sources such
as natural (non-hydrogenated ) peanut butter. Other vouchers could be used for generic or house brand paper
products such as diapers, toilet tissue. and personaVsanitary products. If the country can afford it, there could also
be a minimal amount of unspecified scrip or special vouchers issued monthly to cover "extras" such as generic
chocolate syrup, coffee, tea, etc., which most people might agree to be actual necessities; but the clinician
approving the packet might specify "decaffeinated" types only, for example, depending upon health conditions.
The use orspedfic vouchers would automatically tend to provide consumers with more healthful food
products while eliminating most empty calorie (or especially expensive) food items. Such specific vouchers
would also eUminate many resentments voiced in the plllt by taxpayers., and conld close gaps of inadequate
WIC funding until a seamless melding of the two systems might be effected.
�KOZAK KANE I HEALTH & HUMAN SERVICE REFORMS
MARCH lO, 1993
Pagel
Food assistance programs could also be broadened to include a participant-run meals-on-wheels option for new
mothers or others who might temporarily be unable to shop and/or cook. H able-bodied food stamp program
participants can be given the opportunity to staff such programs. peer pressure may help deter abuses,
while new and valuable job skills may be learned. These programs could be broadened, as well, to include food
kitchens which could exchange cooked meals for special food stamp vouchers issued to those who are unable to
cook their own meals. Such communal kitchens would be ideal placements for high school students exercising
their community service requirement. Food service management trainees could provide additional staffing, with
professional supervision provided by those with professional training (perhaps training financed by the proposed
government grant/work payoff system). Hospitals or community schools with cafeterias could be considered for
sites offering social services, classes, meals,day care,extended day, and auxilliary clinic services. If such
comprehensive community health and human services centers were coordinated with HUD, available buildings
. could be found and renovated, and new jobs could be created in the renovation and upkeep of such programs.
This important broadening of the food stamp prognuh to include community food kitchens or available site meal
service (which could be contracted for) should ideally be coupled with a complete array of health. day care.
social senice and counseling or training senices. In urban/suburban community facilities, eligible participants
could take part in available (mandatory or incentive) classes to learn nutrition and wellness tips, healthy food
preparation techniques, and other skills. Providing meals, day care, homework assistance and other incentives to
learning, centers might prove popular and gain necessary community support. If such programs were held in
association with community medical centers, it would enable these programs to be further coordinated with
medical attention, WIC exams, classes in parenting, breast feeding, wellness and stress management, home safety,
Headstart, HIPPY,etc. Rural models, of course, would need to be planned with travel modifications.
Existing urban models around the country currently provide several facets of the above. Several large city health
centers provide a wide variety of health facilities that incorporate wellness classes along with medical/dental clinic
opportunities. And, of course, most WIC centers provide, as well, nutrition classes on various topics, including
breast feeding, maternal and infant nutrition, etc., which are an integral part of that program. Coordinated centers
could provide all of these options. A different example of such programs is The Floating Hospital model
(operating out of NYC). The Floating Hospital is a non-profit ship that sails around Manhattan during the summer
months and provides a free day-long outing plus lunch to eligible participants who then utilize on-board medical
and dental screening services, and attend nutrition, parenting and wellness lectures, films, etc. Each model offers
workable aspects which can be incorporated into comprehensive health and human services centers.
Obviously, I concur with the Clinton administration's belief that it is critical to address the total health and welfare
issues of the economically disadvantaged -which I believe can best be done dealing concurrently with food
assistance. While a totally reformed medical system with universal access will eventually provide medical
attention for all, it will better serve taxpayers and beneficiaries if we can also improve the quality of foods and quality of life - for those on financial assistance. Rather than providing only crisis -oriented food and
medical assistance, a community-based comprehensive wellness model could provide access to a totally
healthier lifestyle.
Additionally, since medical costs of the indigent are- and will be- borne by tax- payers, attention to
prevention of diseases and to social needs in a comprehensive health and human senices model should be
expected to provide cost benefits similar to that which the exemplary WIC program has so consistently
shown throughout its existence.
Please feel free to contact me if I may be of additional assistance in your endeavors.
Very truly yours.
,J~Mc-~~
June Kozak Kane M.s•• R.D.
cc. Ms. Shalala, Health and Human Senices
Mrs. Tbomases, Englewood, NJ.
�(
-·
CODER:_·_-_ -" -.,.
•.
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:_ _
GENERAL SORT:
_General mall
__Personal stories
__Other Health Providers
POSTCARD 1:
__Letter Campaign
POSTCARD 2:
_Offers to help/Employment
FORM LETrER:
_Letterhead
_Policy
REROUTE:
__Casework
_Scheduling _President
_J»hy&ici.ans
__Other
POLICY AND PERSONAL STORIES:
_ORGANIZATION (I)
_insurance premiums
_insurance reform
_insurance pools
_boards and oversight
_COVERAGE CID
_working families
_unemployed/low income
_benefits
__providers
_INFRASTRUCTURE/WORKFORCE (W)
_quality assurance (guidelines)
_administration, reimbursement
& information systems
_malpractice & tort reform
_manpower issues (training)
_unnecessary procedures
_GOVERNMENT PROGRAMS (IV)
_medicare
_medicaid
_veterans
_DoD
_Indian health
_COST ISSUES (VI)
_drug prices
__physician fees
_hospital fees
_medical equipment
_fraud & abuse
_FINANCING (VII)
_MENTAL HEALTH (IX)
_LONG-TERM CARE (X)
_PUBLIC HEALTH/
SPECIAL POPULATIONS (XII)
__prevention
_AIDS
_women's health
_immunizations/children
_rural
_urban
_OTHER~--------------------
··~
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
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Paper
Dublin Core
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Title
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HRC - Health Care Correspondence [3]
Creator
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First Lady's Office
Maggie Williams
Identifier
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2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 5
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Reproduction-Reference
Date Created
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1/8/2015
Source
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42-t-2194630-20060223F-005-001-2015
2194630
-
https://clinton.presidentiallibraries.us/files/original/4c7df42f0ed6c44cac1ff54a875f60c1.pdf
d94a7dd527eb4f2b4916497bf8d866d6
PDF Text
Text
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECTfi'ITLE
DATE
RESTRICTION
001. card
Business card from Studio Giovanna with note on reverse. ( 1 page)
[none]
P6/b(6)
002a. letter
Hillary Rodham Clinton to Danielle Y. DeLorme. [partial] (1 page)
04/22/1993
P6/b(6)
002b. letter
Hillary Rodham Clinton to Jane Haynes. [partial] ( 1 page)
04/22/1993
P6/b(6)
003a. letter
Hillary Rodham Clinton to Dr. RichardS. Buker, Jr. [partial] (1 page)
04/22/1993
P6/b(6)
003b. letter
Hillary Rodham Clinton to K.C. "Casey" Johnson. [partial] (1 page)
03/24/1993
P6/b(6)
004.letter
Hillary Rodham Clinton to Joyce Watson Nutta. [partial] (1 page)
03/22/1993
P6/b(6)
005. letter
Hillary Rodham Clinton to Silvia Ibanez, Esq. [partial] (1 page)
03/22/1993
P6/b(6)
006_.letter
Hillary Rodham Clinton to Bill Mann. [partial] (1 page)
03/22/1993
P6/b(6)
007. letter
Hillary Rodham Clinton to Francis Daranza. [partial] ( 1 page)
03/22/1993
P6/b(6)
008. letter
Hillary Rodham Clinton to Martina Oellette. [partial] (1 page)
03/22/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie W illiarns
OA/Box Number: 10813
FOLDER TITLE:
HRC Health Care Correspondence [2]
2006-0223-F
ab617
RESTRICTION CODES
Presidential Records Ad -(44 U.S.C. 2204(a)(
Freedom of Information Ad -15 U.S.C. 552(b)]
Pl
P2
P3
P4
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
Information [(b)(4) of the FOIA]
b(6) Release would constitute a dearly unwarranted Invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
·
purposes [(b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
National Security Classified Information ((a)(l) of the PRA]
Relating to the appointment to Federal office ](a)(2) of the PRA]
Release would violate a Federal statute ((a)(3) of the PRA]
Jtelease would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a dearly unwarranted Invasion of
personal privacy ((a)(6) of the PRA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. card
SUBJECTffiTLE
DATE
Business card from Studio Giovanna with note on reverse. ( 1 page)
[none]
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Health Care Correspondence [2]
2006-0223-F
ab617
RESTRICTION CODES
Presidential Records Act • [44 U.S.C. 2204(a))
Freedom of Information Act • [5 U.S.C. SS2(b)(
Pl National Security Classified Information [(a)(l) of the PRA(
P2 Relating to the appointment to Federal office [(a)(2) of the PRA[
P3 Release would violate a Federal statute [(a)(3) of the PRA(
P4 Release would disc!ose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA(
P6 Release would constitute a dearly unwarranted Invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified Information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA(
b(3) Release would violate a Federal statute [(b)(3) of the FOIA(
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted Invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA(
b(8) Release would disclose Information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical Information
concerning wells ((b)(9) of the FOIA(
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�[
\
.f
\
2/2/93 letter from susan Davis, Associate General counsel,
International Brotherhood of Teamsters, apologizing for her
intrusion on NY to DC shuttle evening of January 26 after your
busy day in NY. General President Ron carey appointed a committee
to study problem of health care as it affects Teamster members and
their families. If tbey can be of assistance in your endeavors,
please do not hesit~e to call •
DISPOSIT
'fj .
f
~~~~
~\}}~·
~
\ t-.1\1
\J'
•
\
/.
'
t"~\_
i'li j}•j\.;
j~·
I
/See
File; NRN
\ /'\)
.>.:
HRCklgMCA
062193
�INTERNATIONAL
BROTHERHOOD OF TEAMSTERS
AFL·CIO
OFFICE: (202) 624·6945
FAX: (202) 624·6884
---======~
:1
. /
GENERAL COUNSEL
'J)GAL DEPARTMENT
COHEN, WEISS AND SIMON
Richard N. Gilberg
Director
[I Gary S. Willen
Associate General Counsel
Susan Davis
/
February 2, 1993
Hillary Rodham Clinton
The White House
Washington, D.C. 20500
/
Associate Director
James A. McCall
Kurt C. Kabel!
Mary T. Connelly
David L. Neigus
Paula J. Cairo
Carolyn D. Kaminski
Counsel
Earl V. Brown, Jr.
Dear Ms. Rodham Clinton:
Please forgive my intrusion on the 8:30 p.m. New York to
Washington, D.C. shuttle on Tuesday, January 26. It was not until
after I arrived in Washington that I learned of the many activities
that brought you to New York that day. I hope that your ability to
take a brief rest on the plane, free from well-intended wellwishers, was not irreparably disturbed.
Once again, on behalf of Teamsters General President Ron carey
and the New Teamsters Union, I would like to express our heartfelt
congratulations on your much-deserved victory. Although on a much
smaller scale, the recent triumph of democracy in the New Teamsters
Union also portends a future of hope and prosperity for millions of
Americans and their families.
Like President Clinton, General
President Ron Carey, a client with whom I have worked for more than
ten years, was initially given only a slim chance of defeating an
entrenched, conservative leadership.
Like President Clinton,
additionally, by shaking hundreds of thousands of hands and
campaigning tirelessly for more than two years, a candidate
dedicated to progressive political action, honesty and reform
prevailed.
As you may know, Ron Carey was elected in the first rank-andfile election in the Teamsters' history. As I mentioned on the
plane, shortly after taking office in February, 1992, General
President Carey established a committee to study the problem of'
health care as it affects the more than 1. 2 million Teamster
members and their families.
The committee has been meeting and
gathering data on this critically important issue. If we can be of
any assistance in your endeavors, please do not hesitate to call.
25 LOUISIANA AVENUE, N.W. • WASHINGTON, D.C. 20001 • {202) 624-6800
�- 2 -
Once again, it was a great pleasure meeting you on Tuesday
night. The role you will play in the future -- and the role you
have played to date -- is indeed formidable and inspirational. I
hope that our paths will cross again.
Very truly yours,
susan Davis
Associate General Counsel
International Brotherhood
of Teamsters
SD/lmb
�THE WHITE HOUSE
June 23, 1993
Ms. Jessica Mitford
6411 Regent street
Oakland, California 94618
Dear Decca:
......
,)
.
Thank you for your letter and the
enclosed copy of your letter to the editor
of Harper's Magazine. I appreciate your
eloquent defense of my views on family
matters.
Congratulations on the success of
your new book. I'll be anxious to read
it.
Warm, best wishes.
Sincerely yours,
!~((
Hilla~odham Clinton
PHC~TfJCOPY
HRC HANDWRITING
�THE WHITE HOUSE
WASHINGTON
I
Ms. Jessica Mitford
6411 Regent Street
Oakland, California 94618
I
�Phone: (510)655-1836
FAX:
(510)655-2954
o#//~~bed
e;~
~~rP#o/tf
3 March, 1993
Hillary .Rodham Clinton
The White House
Washington, DC
Dear Hillary,
I enclose a letter to the ed. of Harper's -- never made
it into their letters column; I was in England when the Lasch
article appeared so didn't see it ~until much later, hence
I suppose too late for my response.
(Incidentally the case on
page 2, 9-#p-old black kid in Juvy, was one of Bob's,many
years ago) •
Since my book (American Way of Birth) came out I've
been rather swamped with speaking engagements. The 38& latest
is I'm to address the Commonwealth Club of
California, March 12.
It's got to be written out, so I'll send you a copy when I've
done it. It's a two-fold pitch, as in my book: 1) legalization
of lay-- or direct-entry-- midwives in Calif., 2) singlepayer universal health program like the one in Canada.
Best regards,
Jessica Mitford
ps The last time we met was in Gov's Mansion, Little Rock,
Chelsea a aabe in high chair. Must have been circa 1980?
pps Also enclosed, a couple of items that might amuse you
from (British)~uardian & SF Chronicle, last October.
I must say I was a bit appalled at that ghastly EXHXH
creature Murdoch doing Bush's dirty-tricks work from
afar!
�Jessica Mitford
6411 Regent Street
Oakland, CA 94618
Harper's Magazine
666 Broadway
New York, N.Y. 10012
Letter to Editor
During the late unlamented election campaign we
y
were exposed night and day to the Bush/Quale version
of Hillary Clinton's views on family matters -- "She
equates marriage with slavery!"
"She would encourage
children to sue their parents!"
A lot of campaign claptrap, hardly worth bothering
with.
Of more substance is Christopher Lasch's piece
"Hillary Clinton, Child Saver" in the October Harper's,
in which he draws on articles and speeches by Hillary
Clinton to prove that, as he puts it, "what she values
will not help the family."
In a convoluted and sometimes confusing passage
about the reforms of early twentieth-century do-gooders,
in which the control of delinguent children was transferred from parents to the juvenile courts, Mr. Lasch
seems to favor restoring "some of the parental respon-
�page 2
sibility expropriated by the state."
(His emphasis)
But, says he, "Clinton proposes a very different solution.
She wants to abolish minority status, to give
children and adolescents the same rights as adults,
and to integrate them into our adversarial system of
justice."
And why not? say I.
Anyone with first-hand ex-
perience of the juvenile court system, in which the
young suspect is denied the basic civil rights accorded under the Constitution to adults accused of crime
viz. right to counsel, right to remain silent, right
to bail, right to confront their accusers, right to
call witnesses, right to jury trial, the presumption
of innocence -- will attest to the failure of the system.
Lawyers may rail against its injustice, but it is above
all the parents of kids who must feel the frustration
of standing by while children are being railroaded.
Has Mr. Lasch ever talked with the mother of a
black nine-year-old accused of stealing a dollar from
a white playmate?
Who was whisked off to Juvy and there
incarcerated for six weeks pending a hearing?
Whose
�page 3
frantic mother would gladly have bailed him out, engaged counsel, sought witnesses, all to no avail?
And what of custody cases?
Shouldn't the child
have the right to decide which parent he prefers to live
with?
Most enlightened judges routinely consult the
child in such disputes.
The centerpiece of Mr. Lasch's article is the case
of Wisconsin v. Yoder in which the Supreme Court ruled
in favor of three Amish families, allowing them to keep
their children out of high school in defiance of a state
law compelling attendance.
Justice William 0. Douglas
dissented -- nobody had asked the children if they
shared their parents' views.
He said that the children
should have been consulted and that their judgment should
count more than that of their parents.
If children were
"harnessed to the Amish way of life," their lives were
likely to be "stunted and deformed."
Mr. Lasch observes that "According to Clinton, this
'groundbreaking view of the case' lays down principles
that ought to guide family policy.
Instead of assuming
that parents know best, she argues, we should let child-
�page 4
ren speak for themselves.
We should recognize their
competence to make their own decisions.
We should
treat them as rights-bearing individuals ••• "
Lasch disagrees:
Mr.
"A careful reading of Clinton's
argument shows that she objects to the family much
more than she objects to the state ••• her writings
leave the unmistakable impression that it is the
family that holds children back, the state that sets
them free."
But I couldn't agree more with Hillary
Clinton's stand on Justice Douglas's dissent.
In fact this passage of Mr. Lasch's article
recalled an ancient resentment against my own parents,
who were not of the Amish faith -- far from it;
they
were ultraconservative members of the Church of England.
Home was a large, well staffed country house in the
Cotswolds, a far cry from
Amish.
th~
austere dwellings of the
It was the dream of my childhood to go to school
-- I should have liked to go to a university when I grew
up, but in order to qualify one had to have a proper
education.
My mother was adamant; she didn't approve
of girls going to school (our only brother went to Eton)
so the six of us were kept at home under the iurisdiction
�page 5
I
!"J.
of a series of inept governesses, from whom we learned
next to nothing.
Not wishing to be 'harnessed to the Cotswold way
of life" as Justice Douglas might have put it had he
been asked to rule on the matter, at age 12 I started
a Running Away Account in our family bank, and so
eventually escaped.
We are not told what became of the
hapless Amish children.
Mr. Lasch endorses the idea of healthy neighborhoods where people look out for each other, where the
corner grocer scolds a child for running out into the
street -- implying that Ms. Clinton frowns on such
neighborly intervention, would oppose the grocer's right
to rescue a child from the onrushing traffic; she would
"transfer control of children from the local community
to state-devised institutions designed specifically for
the purpose."
That's a truly wild leap of the Laschian
imagination, supported nowhere in the articles and
speeches of Hillary Clinton on which his essay is based;
nor does it reflect the thinking of the Children's
Defense Fund of which she was national chairman for
�page 6
many years.
In sum, "Hillary Clinton, Child Saver" appears
to be essentially a
longe~
rendition of the Bush campaign
television sound bites, replete with their distortions
of Clinton's stated position on children's rights.
********
�~~ c~~
s.r. ~ ~OV\ \.z.
\C.
adi-.
:t ~, tCl '1 ~
a: En~l~:d:-~h
·THERE'LL :way: be
·
Kaspar of Sail Jose, visiting London, found this
delicious sign in a narrow parking area next to
an old building: ''Park With Rear Outward So
Exhaust Doesn't Besmirch Building." I have yet
to find a single "besmirch" in any signs around
here ... For a cuuute firm name, Bill Lorenzen .
nominates the bookstore called · Journe 's
iend at Gatwlck Airport, nr. London .• •. Ail
Oakland's Jessica (Decca) Mitford, in London to
plug her new book, "The American Way of
Birth," got a phone call Tues. from a reporter for
the Sunday Times who asked if she'd been at an .
anti-Vietnam War demonstration · outside the
U.S. Embassy there on October 16, 1969. "Quite
possibly," replied Decca, "but in answer to your
next qu~tion, no, I have no idea if Bill Clinton
was there" ... Minor spinoff: Little Rock, Ark., s
famous for more than Bill Clinton. Maire Far. rington, visiting there, discovered a pizza parlor
called Pizza D'Action.
·
··1
�Diary
Andrew Moncur
.•............................
.-&E famous Hindsight
I team at the Sunday
Times, Britain's bigest tabloid, ls really scratc:hinR to
ftnd something ~ anything
- to tl.lng at Governor Bill
Clinton. Well, time ls runnlnl out, lsn't,U (for Georp
Bush, malnly). This may explain the sudden Interest In
the Vietnam W•r period
beinl displayed by the paper,
owned by that anat bornagain Amerlean, Rupert
Murdoch. Pirst, Hindsight
c:omes on the blower to CND. ·
Wanted: arc:hlve material
relatlnl to the war, protests,
and so on. In partleular, any-.
thinR about Group '88, whlch
broupt together US and
Britlsll aaU-war students.
Bmm. Next tb1ng - snUf,
sniff - a Sunday Times
aewshound arrives in person
and .OD a s1m1Jar track. By
DOW the peaoy has flropped.
It's not so much a ease of
redlsc:overiJlB · 1988 And All
That more a matter of fin..
gerlug Mr CUnton. Go away,
_. am.
A SMALL question. Am I
Malone in thinking that
John MIQor has only one
more U-turn to make?
Namely, that he should Join
Sunday's big TUC rally, opposing pit elosuns.
ested In this sort of dirty
work. Then the Sunday
Tilll88 calls Jessica Mitford.
the (usually) Californiabased author. The chat ps
something like this. ST:
Remember the Grosvenor
Square demo In London? JM:
Yes, most e!Qoyable .•• You
want to ftnd out IfI knew BW
Cliaton (Miss Mitford Is not
slow). S7': You've ROt it. JM:
Terribly sorry. Never saw
him. Footnote: Wbo else has
been bot)lered by these
N
•anu.
people?
.-&ANK you, the Dally
I Star, for that fighting
headline aimed at the hapless PM: "Get rid of your ero-.
Dies, JohnJ" But was it really
taetful to run lt over a picture of Lord Stevens, chair·
man of Express NeW8JQ81'8
and boss of the Star?
NIMAGINABLE, Jsn't it,
that editon to the Baymarket magazines group
(prop: Mlehael Beseltine)
milbt be asked to cheek
whether any staff were Joinlog the miners' protest
mareli. Over to Mlilrtin
Hover, Haymarket's pel'SOD~
nel director, for a clear
answer on this one. "I would
Wew. DOt ...._, ~pe &bat our ecUtors were
U
(r t{
CVLl:ct n
)
the weekend, the system
came up, as we technology
buffs say, on Monday mornIng. It came down, as we describe it, by lunchtime. On
Tuesday, it came up and
stayed up - except in 34 of.
flees~ "All up and runnlnR
ow. our competition: again by 11 this morning," a
thumbnail sketches of spokespel'SOD said yesterda)';
Mr MJQor. Such as: "Be has not very c:onftdeatly.
to be heard to be dlsbeneved" (BiD Power); "Eyes of
the chalrman of
a dentist, mouth of a letter- WW the exciting London
box" (Andy ·vallls); "The Forum was duly named, to
man who ehose Lamont" scenes ofjoy bordering on de(John Maclean, again):
Urium. And, yes, it's Sir
Allen Sheppard - as forecast.
I ABOUR attaches from the In yesterday's diary. Many
~.former eastern bloc have miners later vls1ted London,
a Whitehall briet'iag today: probably to join to eelebrathow to reform their soeialse- tog this happy event. .
curlty systems along the
Unes of our own. If that were
IG NEWS from the
not punishment enough,
Gazette, Claeton: "If you
there are drinks afterwards were planning to see Domiwith Ann Widdec:ombe, the ole O'Brien, the amazing
small but perfeetly terrifying Memory Man, at Claeton's
Junior social security mlnls- West CWJ Theatre, forget. it.
ter. I wonder. Old any of Due to other c:omml~ts.
them pop toto our world-· he has had to cancel the show
beatlnl benefit oft'lces this on November 4." You don't
week? If so, they might wish Imagine, do you, that It
to ask Miss W about a prob- sUpped his JQIHmow-wbatf
lem with the Income support
computer system, running II!!!IINALLY, not a word,
basic needs payments for rplease, about the·· Lord
four million claimants. Bav- Mayor of London's head
iq been rePJ'OII'8IDIIUlC over ~ur, Mr Wheels. ·
aware of where their staff
were at every time. I don't
see today is anything
special." Thank you. I don't
think that c:ould posslhly be
any clearer.
EANWHILE, President
Beseltine will not, after
Mbe giving the peoples
all,
of
China (some of the world's
great c:oal.bumen) the benefit of his wisdom this weekend. Plans for visit to Bong
Koog and China deferred. .
Why? Pressure of parllamentary business. Is there some
crlsls soinB on?
B
Soundbites
,,
• THE ·last piece of advice I
would give to the Prime Minister is that it ls not a good idea to
surround yourself with cronies
and buddies in the Cabinet and
elsewhere. You must surround
yourself with good people, as
far as you c:an, and if at the end
of the day the people are not
good enough, you must get rid
of them- otherwise it will end
up being you.
Lord Stevens of LudBt*. Chair·
num
qf Exprat~ New/KIIJIITS,
·
'
·DaU,v Express
• IF this government ever
wishes to be rHlected, it must
ask itself why a poHcy of reduc- ,
ing the arms industry in the
name of emetency has led normally loyal Tory voters Hke
myselftotaketothestreets.
Lonl Ne/dptltJI, ~
• ONE OF the things that I will
always resent about Saddam
Hussein ls that he robbed me of
time with my famUJ.
Nornum St:huxlrzAfJJII, lleliD!
• WHO's going to fall in love
with someone with 11 children,
soon to be 12? Somebody crazy.
MIG Farrow. ditto
·
�THE WHITE HOUSE
WASHINGTON
April 23, 1993
Mr. Earl Old Person
Chairman
Blackfeet Tribal Business Council
Browning, MT 59417
Dear Friend:
It was a wonderful pleasure to meet you on my trip to
Montana. Thank you for your letter and Tribal Health memo about
the health care needs of the Blackfeet Nation that I received
from you when I was in Billings. It was a most thoughtful letter
that will inform the work of the health care task force. I am
also forwarding it to key Federal officials.
The President is committed to improving the nation's health
care system. The needs of the Indian community will receive
special attention as we develop a national health care proposal.
I am grateful for all the information that was provided to
me on my.trip to Montana and for the public statements that were
made describing the health needs of Native Americans.
Thank you for your assistance.
best wishes.
You have our prayers and
Sincerely,
L~~ 0.JJ-..,.~t-.
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Dr. Bruce Chessen
Transwestern I I
490 No. 31st St., Suite 304
Billings, MT 59101
Dear Dr. Chessen:
Thank you for the interesting materials which you gave me
when I was in Montana for the health care discussions.
The information is very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
LJ,'I~ 0.tlk-.. . c;.;...fl.,-.
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Ms. Jean R. Barbo
Home Care Coordinator
Career Development Associates
2022 Central Avenue
Great Falls, MT 59401
Dear Ms. Barbo:
Thank you for the thoughtful comments you gave me when I was
in Montana for the health care discussions.
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Mr. Donald R. Judge
Executive Secretary
Montana State AFL-CIO
110 West 13th Street
P.O. Box 1176
Helena, MT 59624
Dear Mr. Judge:
Thank you for the thoughtful comments you gave me when I was
in Montana for the health care discussions.
Your views are very helpful as we work to formulate the
reform of our national health care system.
do.
Thank you for caring.
Best wishes in the important work you
Sincerely,
(J,'I~ (t.flk- ..... ~~
Hillary Rodham Clinton
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002a. letter
SVBJECTffiTLE
DATE
Hillary Rodham Clinton to Danielle Y. DeLonne. [partial] (1 page)
04/22/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential RecordsFirst Lady's Office
Maggie Williams
·oA/Box Number: 10813
FOLDER TITLE:
HRC Health Care Correspondence [2]
2006-0223-F
ab617
RESTRICTION CODES
Presidential Records Act- [44 V.S.C. 2204(a)J
Freedom of Information Act- [S V.S.C. SS2(b)J
Pl National Security Classified Information [(a)(l) of the PRAJ
P2 Relating to the appointment to Federal office [(a)(2) of the PRAI
P3 Release would violate a Federal statute [(a)(3) of the PRAI
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRAJ
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRAJ
b(l) National security classified Information [(b)(l) of the FOIAJ
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIAJ
b(3) Release would violate a Federal statute [(b)(3) of the FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
Information [(b)(4) of the FOIAI
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy [(b)(6) of the FOIAJ
b(7) Release would disclose Information compiled for law enforcement
purposes [(b)(7) of the FOIAJ
b(8) Release would disclose Information concerning the regulation of
financial Institutions ((b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIAI
C. Closed In accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 V.S.C.
2201(3).
RR. Document will be reviewed upon request.
�I ...
I
THE WHITE HOUSE
WASHINGTON
April 22, 1993
·,
i
I
'
i
Dear Ms. DeLorme:
Thank you for the thoughtful comments you gave me when I was
in Montana for the health care discussions.
Your views are very helpful as we work to formulate the
reform of our national health care system.
Jennifer's story is a tragic one and I wish you strength in
coping with the loss of your daughter. Thank you for caring and
sharing her story with me. Best wishes.
Sincerely,
L~~~ 0.t~J-..,..u;.._t-.
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Dr. George F. Sheckleton
1810 Mulberry Drive
Billings, MT 59102
Dear Dr. Sheckleton:
Thank you for the thoughtful comments you gave me when I was
in Montana for the health care discussions.
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
sincerely,
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Ms. Linda Olsen
Ms. Jennifer Smith
ASK-A-NURSE MONTANA
St. Vincent Hospital
1233 North 30th
Billings, MT 59101
Dear Ms. Olsen and Ms. Smith:
Thank you for the thoughtful comments you gave me when I was
in Montana for the health care discussions.
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
lch~ (t.t~J,.... .,.a;_.,_,..
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Mr. Melvin P. Espy
Pacific Northwest Youth Development Inc.
3871 Ox Yoke Drive
Billings, MT 59105
Dear Mr. Espy:
Thank you for the thoughtful comments you gave me when I was
in Montana for the health care discussions.
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
tch"~ O..tll-.-.,. c._p;_.,.,.,..
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Mr. Doug campbell
President
Montana Senior Citizens Assn., Inc.
P.O. Box 423
Helena, MT 59624
Dear Mr. campbell:
Thank you for the thoughtful comments you gave me when I was
in Montana for the health care discussions.
Your views are very helpful as we work to formulate the
reform of our national health care system.
do.
Thank you for caring.
Best wishes in the important work you
Sincerely,
Hillary Rodham Clinton
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002b. letter
SUBJECTffiTLE
DATE
Hillary Rodham Clinton to Jane Haynes. [partial] (1 page)
04/22/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Health Care Correspondence [2]
2006-0223-F
ab617
RESTRICTION CODES
Presidential Records Act -144 U.S.C. ll04(a))
Freedom of Information Ad- (S U.S.C. SS:Z(b))
PI National Security Classified Information ((a)(l) of the PRA)
P:Z Relating to the appointment to Federal office ((a)(:Z) of the PRAJ
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy ((a)(6) of the PRAJ
b(l) National security classified Information ((b)(l) of the FOIA)
b(:Z) Release would disclose internal personnel rules and practices of
an agency ((b)(:Z) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
:Z:Z01(3).
RR. Document will be reviewed upon request.
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Dear Ms. Haynes:
Thank you for the thoughtful comments you gave me when
in Montana for the health care discussions.
I
was
Your views are very helpful as we work to formulate the
reform of our national health care .system.
do.
Thank you for caring.
Best wishes in the important work you
Sincerely,
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Mr. John T. Borgreen
Easter Seal/Goodwill
Corporate Headquarters
4400 Central Avenue
Great Falls, MT 59405-1695
Dear Mr. Borgreen:
Thank you for the information on the AgrAbility Project
which you gave me when I was in Montana for the health care
discussions.
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Mr. Dan J. Richman
Executive Director
Blaine County Activity Center, Inc.
P.O. Box 457
Harlem, MT 59526
Dear Mr. Richman:
Thank you for the information on the Blaine County Health
Care Task Force which you gave me when I was in Montana for the
health care discussions.
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
t~~ O.tJJ-._(Jl;..."'*'
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Dr. Fred J. Cowie
Disaster & Emerqency Services
P.O. Box 4789
1100 N. Last Chance Gulch
Helena, MT 59604
Dear Dr. Cowie:
Thank you for the interestinq materials you qave me when I
was in Montana for the health care discussions.
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for carinq.
Best wishes in the important work you
do.
Sincerely,
t~~ (l.,p._.,.
u;_.,._
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Chairman L. J. Killham
McCone County MAF & Nursing Home Assoc.
Box 48
Circle, MT 59215
Dear Chairman Killham:
when
Thank you for the thoughtful comments and report you gave me
I was in Montana for the health care discussions.
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
tJ.;~ 0.tlk-- u;.._.,._
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Ms. Rachel McCloy
Coordinator
McCone Countycouncil on Aging
Circle, MT 59215
Dear Ms. McCloy:
when
Thank you for the thoughtful comments and report you gave me
I was in Montana for the health care discussions.
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
Hillary Rodham Clinton
�THE WHIT£ HOUSE
WASHINGTON
April 22, 1993
Ms. Connie Eissinger
Chairman
McCone County Commissioners
Box 199
Circle, MT 59215
Dear Ms. Eissinger:
when
Thank you for the thoughtful comments and report you gave me
I was in Montana for the health care discussions.
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
(J.;~ O.tJA-.,.c£..-f-r.
Hillary Rodham Clinton
................____________________________
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Ms. Suzy Holt
Director, Information and Library Services
Shodair Hospital
840 Helena Avenue
P.O. Box 5539
Helena, MT 59604
Dear Ms. Holt:
Thank you for the thoughtful comments and Report to the
Governor you gave me when I was in Montana for the health care
discussions.
Your views are very helpful as we work to formulate the
reform of our national health care system.
do.
Thank you for caring.
Best wishes in the important work you
Sincerely,
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Ms. Nancy Aagenes
The Natural Medicine Clinic
1820 Harrison Ave.
Butte, MT 59701
Dear Ms. Aagenes:
Thank you for the information on Naturopathic medicine which
you submitted when I was in Montana for the health care
discussions.
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
(ch~ O.r~J- ,_a;._~
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Ms. Lee Gasnick
1219 Steffanich Drive
Billings, MT 59105
Dear Ms. Gasnick:
Thank you for the thoughtful comments you gave me when I was
in Montana for the health care discussions.
Your views are very helpful as we work to formulate the
reform of our national health care system.
I wish you strength in coping with your family's health
needs. Thank you for caring and sharing your story.
Sincerely,
LJ.;t~ (t.c~J,.....,.o;;_~
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Mr. Jerome Connolly, PT
First Physical Therapy
1027 North 27th Street
Billings, MT 59101
Dear Mr. Connolly:
Thank you for the thoughtful comments you gave me when
in Montana for the health care discussions.
I
was
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
Lch~ O.JL..,.~~
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Ms. Karen J. Gransbery, R.N.
Deaconess Health Center
1020 North 27th Street
Billings, MT 59101
Dear Ms. Gransbery:
Thank you for the thoughtful comments you gave me when I was
in Montana for the health care discussions.
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
LJ;~ O.JA-.... ~~
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 1, 1993
Dr. Steven Schroeder
President
Robert Wood Johnson Foundation
P.O. Box 2316
Princeton, NJ 08543-2316
Dear Steve:
It has been a wonderful experience to participate in the
Foundation's "Conversations on Health." I know that these public
discussions will have an impact on continuing the health care
discussion across America and in informing our public policy
debate.
My special thanks to you, Steve Somers, Nancy Kaufman, and
the others at the Foundation, including the many Board members I
had the pleasure to meet. The Foundation has demonstrated
significant leadership in contributing both to the delivery of
more effective health care in our nation and in providing vital
public education on the need for health care reform.
Again, my thanks.
I hope you will stay in touch.
Sincerely,
t~~t~odham
Clinton
�. I
�·... ·
'
.
'
THE WHITE HOUSE
WASHINGTON
April 22, 1993
Ms. Virginia Wallace
St. Johns Nursing Home
3940 Rim Rock Road
Billings, MT 59102
Dear
Virginia:
I heard about the call you made while I was in Billings. I
know how difficult it must be not having a health care facility
on the reservation. As we work on the health care proposal, and
as we work to make our government more responsive to the needs of
the people, know that we will be working to insure the
improvement of Indian health care. You are in our prayers.
With best wishes,
--------------------
Sincerely,
LJ.;t~ O.JJ-- c.£-tHillary Rodham Clinton
------
----------
�·.. ··
'
...
THE WHITE HOUSE
WASHINGTON
April 22, 1993
Chippewa Cree Tribe of
Rocky Boy's Indian Reservation
Box Elder, Montana
Dear Friends:
I appreciate the statement about the health
Native Americans that I received from you when I
It was a most thoughtful letter that will inform
health care task force. I am also forwarding it
officials.
care needs of
was in Billings.
the work of the
to key Federal
The President is committed to improving the nation's health
care system. The needs of the Indian community will receive
special attention as we develop a national health care proposal.
I am grateful for a·ll the information that was provided to
me on my trip to Montana and for the public statements that were
made describing the health needs of Native Americans.
Thank you for your assistance.
best wishes.
You have our prayers and
Sincerely,
l~~ o.~~c£-~
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Mr. Randy L. Spear, PA-C
Huntley Project Medical Center
Box 246
Worden, MT 59088
Dear Mr. spear:
Thank you for the thoughtful remarks you made when I was in
Montana for the health care discussions. Your views are very
helpful as we work to formulate the reform of our national health
care system. The White House Health Care Task Force is reviewing
health care reform recommendations, and I am forwarding to them
your statement on the importance of utilizing Physician
Assistants.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
(chi~ R.~-~~
Hillary Rodham Clinton
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003a. letter
DATE
SUBJECTffiTLE
Hillary Rodham Clinton to Dr. RichardS. Buker, Jr. [partial] (1 page)
04/22/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number:
10813
FOLDER TITLE:
HRC Health Care Correspondence [2]
2006-0223-F
ab617
RESTRICTION CODES
Presidential Records Ad- 144 U.S.C. 2204(a)J
Freedom of Information Ad- JS U.S.C. SS2(b)J
PI National Security Classified Information J(a)(l) of the PRAJ
P2 Relating to the appointment to Federal office [(a)(2) of the PRAJ
P3 Release would violate a Federal statute [(a)(3) of the PRAJ
P4 Release would disdose trade secrets or confidential commercial or
financial information J(a)(4) of the PRAJ
PS Release would disdose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRAJ
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRAJ
b(l) National security dasslfied Information J(b)(l) of the FOIAJ
b(2) Release would disdose internal personnel rules and practices of
an agency J(b)(2) of the FOIAJ
b(3) Release would violate a Federal statute [(b)(3) of the FOIAJ
b(4) Release would disdose trade secrets or confidential or financial
information [(b)(4) of the FOIAJ
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy J(b)(6) of the FOIAJ
b(7) Release would dlsdose information compiled for law enforcement
purposes l(b)(7) of the FOIAJ
b(8) Release would disdose information concerning the regulation of
financial institutions J(b)(8) of the FOIAJ
b(9) Release would disdose geological or geophysical information
concerning wells J(b)(9) of the FOIAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�1-~~---
--~--------·-····-··········-
..
. - . . -..
I
THE WHITE HOUSE
WASHINGTON
April 22, 1993
Dear Dr. Buker:
When I was
received a copy
Tbe Sentinel on
the citizens of
accomplished in
practitioners.
in Montana for the health care discussions, I
of the wonderful article on you that appeared in
April 14. Your achievements and contributions to
Liberty county are a fine example of what can be
the area of rural health care by dedicated family
You deserve our thanks and congratulations.
As the Administration works on the health care proposal, and
as we work to make our government more responsive to the needs of
the people, we will be working to insure the improvement of rural
health care as well.
do.
Thank you for caring.
Best wishes in the important work you
Sincerely,
Hillary Rodham Clinton
�~
·'
·
...
THE WHITE HOUSE
WASHINGTON
April 22, 1993
Chairman Caleb Shields
Fort Peck Tribes
P.O. Box 1027
Poplar, MT 59255
Dear Chairman Shields:
I am grateful for the statement you presented to me with
regard to the health care needs of the Fort Peck Tribes when I
was in Billings. It was a most thoughtful statement that will
inform the work of the health care task force. I am also
forwarding it to key Federal officials.
The President is committed to improving the nation's health
care system. The needs of the Indian community will receive
special attention as we develop a national health care proposal.
I am grateful for all the information that was provided to
me on my trip to Montana and for the public statements that were
made describing the health needs of Native Americans.
Thank you for your assistance.
best wishes.
You have our prayers and
Sincerely,
Lch·~ O.JJ- ~ c_p;_ftv..
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Fort Belknap Community Council
P.O. Box 249
Fort Belknap Agency
Harlem, MT 59526
Dear Friends:
I appreciate the memo about the health care needs at Fort
Belknap that I received from you when I was in Billings. It was
a most thoughtful memo that will inform the work of the health
care task force. I am also forwarding it to key Federal
officials.
The President is committed to improving the nation's health
care system. The needs of the Indian community will receive
special attention as we develop a national health care proposal.
I am grateful for all the information that was provided to
me on my trip to Montana and for the public statements that were
made describing the health needs of Native Americans.
Thank you for your assistance.
best wishes.
You have our prayers and
sincerely,
~J.;r~ a.~
. . c.;;_+w--
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Madame Chairman Clara Nomee
Crow Tribe
P.O. Box 159
Crow Agency, MT 59022
Dear Madame Chairman Nomee:
Thank you for the statement you made to me when I was in
Billings. Thank you for the wonderful gifts you bestowed on me
and thank you for your confidence in the President, your prayers,
and your good wishes. The copy of your thoughtful remarks will
inform the work of the health care task force. I am also
forwarding it to key Federal officials.
The President is committed to improving the nation's health
care system. The needs of the Indian community will receive
special attention as we develop a national health care proposal.
I am grateful for all the information that was provided to
me on my trip to Montana and for the public statements that were
made describing the health needs of Native Americans.
Thank you for your assistance.
best wishes.
You have our prayers and
Sincerely,
tJ,'~ R.t~J-.,..u;_f,.,..
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
President Llevando Fisher
Northern Cheyenne Tribe
P.O. Box 128
Lame Deer, MT 59043
Dear President Fisher:
It was wonderful to meet you and receive your important
statement on my recent trip to Billings. It was a most
thoughtful statement that will inform the work of the health care
task force. I am also forwarding it to key Federal officials.
The President is committed to improving the nation's health
care system. The needs of the Indian community will receive
special attention as we develop a national health care proposal.
I am grateful for all the information that was provided to
me on my trip to Montana and for the public statements that were
made describing the health needs of Native Americans.
Thank you for your assistance.
best wishes.
You have our prayers and
Sincerely,
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 22, 1993
Ms. Maria Stephens
Ms. Mary Ellen Doty
Ms. Claudia Stephens
Montana Migrant and seasonal
Farmworker Council, Inc.
1148 First Avenue North
Billings, Montana 59101
Dear
Ms. Stephens, Ms. Doty, and Ms. Stephens:
Thank you so much for the information I received when I was
in Billings on the work of the Montana Migrant Council. I too am
sorry I could not visit your clinic but perhaps there will be
another opportunity. Your views are very helpful as we work to
formulate the reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
~J,·,~ (2.~
,_a;...f.,.,.,
Hillary Rodham Clinton
�.'
)
.,
.
1
1
�•'
.
March 24, 1993
Thomas A. Krause, Esq.
Legal Services Corporation of Iowa
312 Eighth Street, Suite 300
Des Moines, Iowa 50309-3828
Dear Mr. Krause:
Thank you for the thoughtful comments you gave me when I was
in Iowa for "Conversations on Health.".
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
Hillary Rodham Clinton
�•'
.
March 24, 1993
Iowa Pharmacists Association
8515 Douglas Avenue
Suite 16
Des Moines, IA 50322
Gentlemen:
Thank you for the thoughtful comments you gave me when I was
in Iowa for "Conversations on Health."
Your policy positions are very helpful as we work to
formulate the reform of our national health care system.
do.
Thank you for caring.
Best wishes in the important work you
Sincerely,
Hillary Rodham Clinton
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003b. letter
SUBJECTffiTLE
DATE
Hillary Rodham Clinton to K.C. "Casey" Johnson. [partial] (1 page)
03/24/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number:
10813
FOLDER TITLE:
HRC Health Care Correspondence [2]
2006-0223-F
ab617
RESTRICTION CODES
Presidential Records Ad- (44 U.S.C. 2204(a)J
Freedom of Information Act- (S U.S.C. SS2(b)J
PI
P2
P3
P4
b(l) National security dasslfied Information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIAJ
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) of the FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) of the FOIAJ
b(8) Release would disclose Information concerning the regulation of
flnandallnstltutions ((b)(8) of the FOIAJ
b(9) Release would disdose geological or geophysical information
concerning wells [(b)(9) of the FOIAI
National Security Classified Information ((a)(l) of the PRA)
Relating to the appointment to Federal office [(a)(2) of the PRA)
Release would violate a Federal statute ((a)(3) of the PRAJ
Release would disclose trade secrets or confidential commercial or
finandallnformatlon [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRAI
P6 Release would constitute a dearly unwarranted Invasion of
personal privacy [(a)(6) of the PRA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�March 24, 1993
Mr. K.
c. "Casey" Johnson
Dear Mr. Johnson:
I'm sorry you were unable to attend our meeting in Iowa for
"Conversations on Health," but I do want you to know how much I
appreciate your good wishes.
Thank you for caring •.
With best wishes,
Sincerely,
Hillary Rodham Clinton
CLINTON LIBRARY PHOTOCOPY
�•'
.
March 24, 1993
Karen L. Forrest, R.N.
Regional Manager
HCR
725 Greenleaf st.
Galesburg, IL 61401
Dear Mr. Forest:
Thank you for the thoughtful comments you gave me when I was
in Iowa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
Hillary Rodham Clinton
�March 24, 1993
Ms. Luanne Linn
Director of Nursinq
HCR
2081 N. Main Street
Canton, IL 61520
Dear Ms. Linn:
Thank you for the thouqhtful comments you qave me when I was
in Iowa for "Conversations on Health.",
Your views are very helpful as we work to formulate the
reform of our national health care system.
do.
Thank you for carinq.
Best wishes in the important work you
Sincerely,
Hillary Rodham Clinton
�March 24, 1993
Ms. Heather Darling
School of Nursing
Des Moines Area Community College
Boone Campus
Boone, IA 50036
Dear Darling:
Thank you for the thoughtful comments you gave me when I was
in Iowa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
Hillary Rodham Clinton
�.
.
.
~·
March 24, 1993
Ms. Tonda L. Thompson
Admissions/Marketing Director
HCR
2081 N. Main Street
P.O. Box 40
Canton, IL 61520
Dear Ms. Thompson:
Thank you for the thoughtful comments you gave me when I was
in Iowa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
Hillary Rodham Clinton
�1S
21
�•.
March 22, 1993
Dr. Steven J. Kraus
503 N. Main
Carroll, Iowa 51401
Dear Dr. Kraus:
Thank you for sending your information on chiropractic care.
It has been forwarded to the appropriate person.
We appreciate
your interest and willingness to share your ideas.
With best wishes,
Sincerely,
Hillary Rodham Clinton
�March 22, 1993
Dr. steven J. Kraus
503 N. Main
Carroll, Iowa 51401
Dear Dr. Kraus:
Thank you for sending your information on chiropractic care.
It has been forwarded to the appropriate person.
We appreciate
your interest and willingness to share your ideas.
With best wishes,
Sincerely,
Hillary Rodham Clinton
��March 22, 1993
Ms. Melba E. Dix
2521 Old Polk City Road
Lakeland, FL 33809
Dear Ms. Dix:
Thank you for the thoughtful comments you gave me when
in Tampa for "Conversations on Health."
I
was
Your views are very helpful as we work to formulate the
reform of our national health care system •
•(
Thank you for caring.
i
Best wishes in the important work you
do.
Sincerely,
Hillary Rodham Clinton
�March 22, 1993
Ms. Phyllis Hockl
Village Mobile Home owners Association, Inc.
P.O. Box 20594
2001 - 83rd Ave. No. Lot 1243
St. Petersburg, FL 33742
Dear Ms. Hockl:
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
do.
Best wishe,s in the important work you
Sincerely,
Hillary Rodham Clinton
�March 22, 1993
Ms. Connie Kinder
Occupational Therapist
1303 North 20th Avenue
Pensacola, FL 32503
Dear Ms. Kinder:
Thank you for the thoughtful comments you gave me when
in Tampa for "Conversations on Health."
I
was
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
I
Hillary Rodham Clinton
P.S. I regret that I am not able to come back to your area but I
thank you for your kind invitation.
�March 22, 1993
Mr. William H. Mauk Jr.
10040 s.w. 141 Street
Miami, FL 33176
Dear Mr. Mauk:
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
Hillary Rodham Clinton
�March 22, 1993
Mr. Kevin McDonough, R.T.
P.O. Box 151412
Altamonte Springs, FL 32715-1412
Dear Mr. McDonough:
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
I also appreciate the information:' you sent to the Health
Care Reform Task Force. I am sorry that Ira won't be able to
meet with you when you are in Washington, D.C.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
Hillary Rodham Clinton
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. letter
SUBJECTffiTLE
DATE
Hillary Rodham Clinton to Joyce Watson Nutta. [partial] ( 1 page)
03/22/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number:· I 0813
FOLDER TITLE:
HRC Health Care Correspondence [2]
2006-0223-F
ab617
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a)(
Freedom of Information Act - (S U.S.C. SS2(b)(
PI National Security Classified Information ((a)(l) of the PRA(
P2 Relating to the appointment to Federal office ((a)(2) of the PRA(
PJ Release would violate a Federal statute ((a)(3) of the PRA(
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRAJ
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) of the PRAJ
b(l) National security classified information ((b)(l) of the FOIAJ
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIAJ
b(J) Release would violate a Federal statute ((b)(J) of the FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIAJ
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy ((b)(6) of the FOIAJ
b(7) Release would d·isdose information compiled for law enforcement
purposes ((b)(7) of the FOIAI
b(8) Release would disclose Information concerning the regulation of
financial institutions ((b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIAJ
C. Closed In accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�March 22, 1993
Dear Ms. Nutta:
I
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health."
I
I.
Your views are very helpful as we work to formulate the
reform of our national health care 'System.
do.
Thank you for caring.
Best wishes in the important work you
Sincerely,
Hillary Rodham Clinton
P.S. Thank you also for the copy of Jessica Mitford's book
American Way of Birth.
It was most thoughtful of you.
I
'i
I i
.I
I'
~
�March 22, 1993
Ms. Gladys R. Hernando
Marketing & Development Coordinator
Southpoint Manor
42 Collins Avenue
Miami Beach, FL 33139
Dear Ms. Hernando:
Thank you for the thoughtful comments you gave me when
in Tampa for "Conversations on Health."
I
was
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wi'shes in the important work you
do.
sincerely,
Hillary Rodham Clinton
I
I
I
l
'·
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. letter
SUBJECTtriTLE
DATE
Hillary Rodham Clinton to Silvia Ibanez, Esq. [partial] (1 page)
03/22/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Health Care Correspondence [2]
2006-0223-F
ab617
RESTRICTION CODES
Presidential Retords Ad· (44 U.S.C. 2204(a)(
Freedom of Information Att -IS U.S.C. SS2(b)(
PI National Seturity Classlned Information [(a)(l) of the PRA(
P2 Relating to the appointment to Federal offlte [(a)(2) of the PRA(
P3 Release would violate a Federal statute [(a)(3) of the PRA(
P4 Release would disclose trade setrets or tonfidential commercial or
financial information [(a)(4) of the PRAJ
PS Release WOI!Id disclose tonfidential advlte between the President
and his advisors, or between suth advisors [a)(S) of the PRAI
P6 Release would tonstitute a dearly unwarranted invasion of
personal privaty [(a)(6) of the PRAJ
b(l) National seturity classified information [(b)(l) of the FOIAJ
b(2) Release would disclose internal personnel rules and pradites of
an agenty ((b)(2) of the FOIAJ
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIAI
b(6) Release would tonstitute a tlearly unwarranted Invasion of
personal privaty [(b)(6) of the FOIAJ
b(7) Release would disclose Information tompiled for law enfortement
purposes [(b)(7) of the FOIAJ
b(S) Release would disclose information tonterning the regulation of
financial institutions [(b)(S) of the FOIAI
b(9) Release would distlose geologital or geophysical information
tonterning wells [(b)(9) of the FOIAJ
C. Closed In attordante with restrittions tontained in donor's deed
of gift.
PRM. Personal retord misfile defined in attordante with 44 U.S.C.
2201(3).
.
RR. Dotument will be reviewed upon request.
�March 22, 1993
Dear Ms. Ibanez:
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
do.
Thank you for caring.
Best wishes in the important work you
Sincerely,
Hillary Rodham Clinton
�March 22, 1993
Ms. M. N. Whaley
10707 Roundview Lane
Tampa, FL 33624
Dear Ms. Whaley:
Thank you for the thoughtful comments you gave me when
in Tampa for "Conversations on Health."
I
was
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
Hillary Rodham Clinton
�March 22, 1993
Dr. Karen Liller
Assistant Professor
University of South Florida
College of Public Health
13201 Bruce B. Downs Blvd.
Tampa, FL 33612
Dear Dr. Liller:
Thank you for the thoughtful comments you gave me when
in Tampa for "Conversations on Health."
,.,
I
was
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
Hillary Rodham Clinton
�March 22, 1993
Ms. Joan Knight, MSW
Administrative Director
Psychosocial Services
Orlando Regional Medical center
1414 South Orange Avenue
Orlando, FL 32806
Dear Ms. Knight:
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
Hillary Rodham Clinton
�March 22, 1993
Mr. Benjamin P. Wisotzky, PNEC
430 Bay Street N.E. #1506
St. Petersburg, FL 33701
Dear Mr. Wisotzky:
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
With best wishes,
Sincerely,
Hillary Rodham Clinton
�March 22, 1993
Mr. Benjamin P. Wisotzky, PNEC
430 Bay Street N.E. #1506
St. Petersburg, FL 33701
Dear Mr. Wisotzky:
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
With best wishes,
Sincerely,
,•
Hillary Rodham Clinton
I'
�March 22, 1993
Ms. Jerry Brunton, RN
3663 58th Avenue North Lot 354
St. Petersburg, FL 33714
Dear Ms. Brunton:
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
With best wishes ,
Sincerely,
'
Hillary Rodham Clinton
�March 22, 1993
Mr. Kevin McDonough, R.T.
P.O. Box 151412
Altamonte Springs, FL 32715-1412
Dear Mr. McDonough:
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
I also appreciate the information you sent to the Health
care Reform Task Force. I am sorry that Ira won't be able to
meet with you when you are in Washington, D.C.
Thank you for caring.
Best wishes in the important work you
do.
Sincerely,
Hillary Rodham Clinton
�March 22, 1993
Mr. and Mrs. Martin c. Hand
1515 E. Diana Street
Tampa, FL 33610
Dear Mr. and Mrs. Hand:
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
With best wishes,
Sincerely,
Hillary Rodham Clinton
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006.letter
SUBJECTffiTLE
DATE
Hillary Rodham Clinton to Bill Mann. [partial] (1 page)
03/22/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Health Care Correspondence [2]
2006-0223-F
ab617
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)J
Freedom of Information Act- [5 U.S.C. 552(b)J
Pl National Security Classified Information ((a)(l) of the PRAJ
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
PJ Release would violate a Federal statute [(a)(J) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRAJ
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(J) Release.would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIAJ
b(8) Release would disclose Information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
· b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIAJ
C. Closed in accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misflle defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�March 22, 1993
Mr. Bill Mann
Dear Mr. Mann:
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
With best wishes,
Sincerely,
Hillary Rodham Clinton
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
007.letter
SUBJECTffiTLE
DATE
Hillary Rodham Clinton to Francis Daranza. [partial] (I page)
03/22/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number:
10813
FOLDER TITLE:
HRC Health Care Correspondence [2]
2006-0223-F
ab6l7
RESTRICTION CODES
Presidential Records Ad- (44 U.S.C. 2204(a)(
Freedom of Information Act -(5 U.S.C. SS:Z(b))
PI National Security Classified Information ((a)(l) of the PRA)
P:Z Relating to the appointment to Federal office ((a)(:Z) of the PRA(
P3 Release would violate a Federal statute ((a)(3) of the PRA(
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(:Z) Release would disclose internal personnel rules and practices of
an agency ((b)(:Z) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial Institutions ((b)(8) of the FOIA)
b{9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA(
C. Closed in accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
:Z:Z01(3).
RR. Document will be reviewed upon request.
�,,'
I
I
March 22, 1993
'!
i
!·
Mr. Francis Daranza
Dear Mr. Daranza:
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
With best wishes,
Sincerely,
Hillary Rodham Clinton
�March 22, 1993
Ms. Marjorie Thompson
719 s. Delaware
Tampa, FL 33606
Dear Ms. Thompson:
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
With best wishes,
Sincerely,
.Hillary Rodham Clinton
�March 22, 1993
Ms. Fran Geedy
8706 s. Meacowview Circle
Tampa, FL 33615
Dear Ms. Geedy:
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
With best wishes,
Sincerely,
Hillary Rodham Clinton
�March 22, 1993
Mr. and Mrs. William Meredith
6421 Murray Hill Drive
Tampa, FL 33615
Dear Mr. and Mrs. Meredith:
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
With best wishes,
Sincerely,
Hillary Rodham Clinton
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
008. letter
SUBJECTffiTLE
DATE
Hillary Rodham Clinton to Martina Oellette. [partial] (1 page)
03/22/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number:
10813
FOLDER TITLE:
HRC Health Care Correspondence [2]
2006-0223-F
ab6l7
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)J
Freedom of Information Act- [S U.S.C. SS2(b)J
Pl National Security Classified Information [(a)(l) of the PRAJ
P2 Relating to the appointment to Federal office [(a)(2) of the PRAJ
P3 Release would violate a Federal statute [(a)(3) of the PRAJ
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRAJ
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRAJ
b(l) National security classified Information [(b)(l) of the FOIAJ
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIAJ
b(3) Release would violate a Federal statute [(b)(3) of the FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIAJ
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release, would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIAJ
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�March 22, 1993
Ms. Martina Ouellette
Dear Ms. Ouellette:
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
With best wishes,
Sincerely,
Hillary Rodham Clinton
�March 22, 1993
Ms. Pauline McKee
1513 E. Diana Street
Tampa, FL 33610
Dear Ms. McKee:
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
With best wishes,
Sincerely,
Hillary Rodham Clinton
--------
-----------------------'
�March 22, 1993
Mr. William Athanson
7800 113th Street North Suite 203
Seminole, FL 34642-4097
Dear Mr. Athanson:
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health. 11
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
With best wishes,
Sincerely,
Hillary Rodham Clinton
�March 22, 1993
Mr. James Geoghagen
6416 Murray Hill Drive
Tampa, FL 33615
Dear Mr. Geoghagen:
Thank you for the thoughtful comments you gave me when I was
in Tampa for "Conversations on Health."
Your views are very helpful as we work to formulate the
reform of our national health care system.
Thank you for caring.
With best wishes,
Sincerely,
Hillary Rodham Clinton
�March 25, 1993
Catherine Pinkerton CSJ
Network
806 Rhode Island Avenue, N.E.
Washington, DC 20018
Dear Sister Catherine:
I greatly appreciate your candid views about why you think
the single payer approach to health care reform is the best
approach. As we continue to work to help the President decide on
the contours of his health care reform initiative, know that we
share your commitment to ensuring access to health care for all
Americans.
We greatly appreciate your hard work on this and so many
other important issues and we look forward to having you work
with us to achieve health care reform this year.
Thank you again for your heatfelt letter.
prayers.
Keep us in your
Sincerely,
•
Hillary Rodham Clinton
�THE WHITE HOUSE
WASHINGTON
April 1, 1993
Governor John Engler
P.O. Box 30013
Lansing, MI 48909
Dear Governor Engler:
I greatly appreciate having your recommendations for
reforming our nation's health care system. The Robert Wood
Johnson Foundation's recent forum in Michigan demonstrated that
Michigan is a real example of the health care challenges we face
across the country.
As you know, the Task Force is in the throes of preparing
options for the President to consider. Your letter and the
recommendations that you put forward will be considered as that
process goes forward. The President has indicated that the need
for State flexibility will not be ignored in the national plan.
The Governors have a very important role in this process and
this administration welcomes the important advice that you and
your fellow governors are in a position to provide.
Again, thank you for your kind letter.
Sincerely,
Clinton
�STATE OF MICHH;AN
OFFICE OF THE GOVERNOR
LANSING
JOHN ENGLER
GOVERNOR
March 19, 1993
Mrs. Hillary Rodham Clinton
First Lady
The White House
Washington, D.C. 20500
Dear Mrs. Clinton:
By way of this letter, I welcome you to the great State of Michigan and offer
my best wishes for success as you seek insight into the problems and possibilities
for reform of our nation's health-care system. I believe you will find that
Michigan is a microcosm of the health-care challenges we confront across the
country. I regret that I am unable to attend your hearing, and I thank you for
this opportunity to convey my personal observations and recommendations for
reform.
The problems confronting health care are obvious: Costs are too high, access
is too limited, and performance is poor. The cost of health care is now the number
one budget concern of families, businesses, and government at all levels.
Michigan's largest employer, the automobile industry, spends over $1,000 per car
on employee health care -- more than it does for steel. One quarter of our state
general revenues is spent on health care, and double-digit inflation has been the
norm for nearly 30 years.
Coverage for Michigan's citizens compares favorably with the nation as a
.
whole. Only 9% of our citizens are uninsured, while up to 18% of all . Aunericans
are without coverage. Michigan's Medicaid program is also the most generous
among the United States, offering coverage for virtually every optional service
permitted by the federal government. Just recently, I proposed to further expand
coverage for over 80,000 poor and near-poor children through my "Healthy Kids"
initiative. Unfortunately, Michigan still has hundreds of thousands of citizens
who lack even the most basic coverage.
Perhaps the greatest challenge we face is to improve performance.
Michigan's infant mortality rate, while improving, is still unacceptably high,
with rates in the inner city of Detroit exceeding those of many third world
countries. Even though we have provided free, Michigan-made DTP vaccines to
all of our children for nearly 40 years, immunization rates for young children,
ages 0-2 years, in some areas are still only 30%. Worst of all, Michigan ranks
"dead last" among states in excess deaths due to chronic disease.
At"Cl'C~EO
PAP£R
�Mrs. Clinton
March 19, 1993
Page2
For these reasons and more, I believe it is time for refomi. I further believe
that providing universal access for all citizens is not only a moral imperative, but
a necessary pre-condition to controlling costs.
The Michigan Leaders' Health Care Group, which I co-chair with Harold
Poling, CEO of Ford Motor Corporation, and which consists of a partnership of
business, labor, government, and health-care providers, has adopted a series of
principles for national reform that I recommend to you as the policy compass for
your deliberations. These principles have been provided to the Task Force under
separate cover. In addition, I have endorsed the December 15, 1992, statement
produced by the National Governors' Association, as well as several other
business and governmental organizations, that defines the respective roles of
states and the federal government.
I recommend support for the reform framework known as "managed
competition" as it has been articulated by Alain Enthoven and the so-called
Jackson Hole Group. This plan calls for universal coverage with a federally
established standard benefit package that is community rated and provided
primarily through employers. Health care would be provided by vertically
integrated provider organizations, similar to the most advanced HMOs, that are
accountable for delivering all of the benefits defined by the standard package
under one roof. Payments for services would be "bundled" or capitated, and
providers would share risk. The purchasing power of multiple employers would
be consolidated into "purchasing cooperatives," thereby leveling the playing field
between provider and payer, and eliminating the third-party middle man. A
unique and cost-saving feature of the plan is its potential to merge health coverage
currently provided through multiple insurance sources, including auto, health,
and workers' compensation, into one plan.
I understand that the Task Force is advocating "managed competition";
however, reports indicate that a greater omphaais is being placed on
"management" than on "competition." Managed competition must nQt be reduced
to a buzzword. True managed competition does nQt entail global budgets, limits
on capital investments in technology, or price controls because it restructures the
fundamental relationship between payers and providers of health care to
eliminate the need for such heavy-handed governmental regulation.
Paying a single price for a defined set of benefits on a per-person basis and
putting providers at risk for excess costs removes incentives to overuse services by
transforming profit centers into cost centers. Amassing the purchasing power of
multiple small employers and individuals will equalize the relationship between
historically powerful providers and weak purchasers. One result of this new
relationship will likely be a consolidation of the health-care insurance industry
and a reduction in administrative overhead costs that currently approach 25%.
Community rating will prevent the "cream skimming" and risk avoidance that
currently plagues the health-insurance industry.
-
..........
�Mrs. Clinton
March 19, 1993
Page3
I am especially concerned that the Task Force may be considering price
controls in its desire for short-term cost containment. As you know, total healthcare costs are the product of price and volume. Price controls will not contain
costs unless concurrent controls over service volume, i.e., rationing, is instituted.
I would strongly recommend against any efforts to ration care because it will
result in pitting one part of society against another. Neither price fixing nor
service rationing are necessary if the Task Force sticks to the basic tenets of
managed competition.
There are two key federal law changes that are necessary to make managed
competition work: First, it is necessary to permit waivers of the federal ERISA
pre-emption law for state plans so that all employers may be brought into a
purchasing cooperative, and, second, it will be necessary to amend federal antitrust laws to permit the vertical integration of physician- and hospital-based
services into accountable health plans. I strongly recommend these essential
changes in federal law.
Finally, as a governor, I am concerned that all states be granted the tools
and flexibility to serve as true "laboratories of democracy" in the reform effort.
Specifically, I encourage you to remain modest in setting a standard benefit
package so that states may supplement according to their needs; I discourage any
recommendation to cap entitlement programs like Medicaid because such action
would result in unacceptable cost shifts to the private sector; and I support
providing states with the flexibility to incorporate Medicare into comprehensive
health plans.
I wish to draw your particular attention to the impact that Medicaid reform
may have on state mental health systems like Michigan's, which utilize
community-based waivers to provide personal care services to thousands of
mentally ill and developmentally disabled persons. Over $400 million worth of
care is provided to mentally ill and developmentally disabled persons under the
current Medicaid program in .Michigan, and I urge that this care n2t be
disrupted by changes in Medicaid.
·
Thank you for this opportunity to express my views to you and the Task Force
on this most important matter. I look forward to your May 4 recommendations
and the ensuing debate over national health care reform.
JE/DLS/jlf
�THE WHITE HOUSE
March 31, 1993
Ms. lane Warwick Yoder
The capitol Hill Center
for Individual and Family Therapy
530 Seventh Street, S.E.
Washington, D C 20003
Dear Jane:
Thank you for writing ·and sharing your insight and views on
psychotherapy for our consideration in health care refonn. The
members of the Task Force are anxious to hear from knowledgeable
and concerned people like you -- people with firsthand experience or
particular expertise in the health care field. I am sending a copy of
your letter along to the appropriate working group.
The President is committed to reforming our nation's health
care system -- controlling runaway costs and providing security to
every American family. It won't be easy and it won't happen
overnight, but we can bring costs under control while maintaining
quality medical care and preserving the choice so important to us all.
Thank you again for your suggestions and especially for your
continuing personal support. Best regards to Ed.
Sincerely yours,
j
~~amm
~ d,v--6Llu>f
.
[ov~ k_u., 1 ~ ~
l/l M ~ (0__ (XJOY\ -
v-r-
:
�. ..
,
jane Warwick Yoder, L.I.C.S.W.
LICENSE# LC0030187
(202) 543-4645
THE CAPITOL HILL CENTER
FOR INDIVIDUAL AND FAMILY THERAPY
530 SEVENTH STREET, S.E.
WASHINGTON, D.C. 20003
I"larch 23, 1993
Hillary rtodham Clinton
The 14hi te House
Washington, D.C. 20500-2000
Dear Hillary:
I was delighted to read, the other day, that you had put in a
good word for mental health in the health dispensation. ~f I may
say so, you made exactly the points that need making.
I don't think it is fully realized how often good psychotherapy,
at relatively small cost, heads·off far greater costs of hospitalization, drug dependency, illegitimacy, incarceration, medical expenses,
and emotional dysfunction. I have one patient, for instance, who gets
along well enough when she and I stay in close touch but who often has
to go into hospital if I am out of town. She is not unusual.
\ve had a shock recently when our clinic's l'v1edicaid funding was
abruptly terminated due to its not being a "free-standing" mental
health clinic. This is penney~wise and pound foolish, as such clinics
are top-heavy with administrative staff and paperwork. This means
only a small portion of the fee goes to the therapist, reducing the
staff of therapists, primarily, to students and beginning therapists
with high turn-over rate. I can testify on the basis of practical
experience that a clinic like ours -- a group of private practitioners
can offer higher quality service for considerably less cost than
bureaucratic clinics which are overwhelmed by administrative costs
and busy-work. 'rhe ;vredicaid regulations need modifying.
I read, the other day, a statement by Ira Magaziner to the effect
that the number of therapy sessions may be limited. I know savings
must be sought. But this idea ought to be examined carefully, lest
it prove to be a false economy. Many of my patients suffer from severe
emotional and psychic disabilities, and progress with them is usually
slow. But I do often see dysfunctional people becoming functional.
This process takes time and it is essential that the therapeutic space
be protected. Interruptions due to arbitrary ceilings on the number
of therapy ~essions can be experienced as a trauma that repeats the
earlier trauma that originally led to the emotional illness.
If you would like to visit our clinic on Capitol Hill, we would truly
welcome the opportunity to talk to you and elaborate on these issues.
?d and I follow the brilliant opening act of the ~linton years with
interest and pride. 1e hope to see you all one of these days.
Affectionately,
~Arms
:I?S -- ;<;d appreciated your recent note abg_
(-.vhom both of us
are very fond of) and the enclosed photo~~ph from Renaissance.
~s -- ~~!
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�\
THE WHITE HOUSE
March 29, 1993
Ms. Bernadette I. Mandel
906 South Western Avenue
Park Ridge, Dlinois 60068
Dear Bernadette:
I was deeply touched by your letter about Lauren and the
struggles, difficulties and challenges you continue to face in your
day-to-day living, in addition to the necessary surgical procedures
and treatment for her. She must be a wonderful, courageous little
girl and is fortunate indeed to have such a loving, caring family to
nurture and support her. I certainly commend you for your foresight
and diligent efforts in educating the other children at her kindergarten
before Lauren's enrollment. This, obviously, made a tremendous
difference in their understanding and acceptance of her condition and
helped them know her as another child with the same feelings, needs,
hurts, joys that they experience.
I have forwarded a copy of your letter and the enclosures to
the Task Force to include your experiences with Lauren and your
suggestions regarding health insurance coverage.
I appreciate your invitation for Chelsea and me to attend the
Juniors' annual fashion show on November 13, 1993. This request is
being directed to my scheduler for consideration as we determine my
agenda for the fall.
Sincerely yours,
cc:
Scheduling
John M. Ebeling Jr.
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�BERNADETTE J. MANDEL
906 S. WESTERN AVE
PARK RIDGE, IL 60068
(708) 698-6193
~ar~h
12, 1993
Hillary Rodham Clinton
White House
1600 Pennsylvania Ave.
Washington D.C. 20500
Dear Hillary:
Our daughter Lauren was born 5/31/87 with a hemangioma (vascular
lesion) which has grown since birth to deform her face, please
see enclosed articles.
I am writing to you as a mom, who has struggled for the past 5
years to keep my daughter alive (her hemangioma has bled a lot,
requiring many directed donor blood transfusions).
My husband
and I have dealt with stranger's stares and rude comments as well
as the medical issues, and the difficulties with insurance
coverage.
Please be aware, as you are reviewing national insurance issues,
that comprehensive care health insurance coverage for children
born with a congenital birth defect, such as a craniofacial
anomaly,
is very crucial to families who must deal with these
issues for years.
Health insurance coverage should not only
include major medical; but comprehensive
care required by
children with craniofacial anomalies such as:
orthodontal,
dental, opthomology, speech,
physical therapy, occupational
therapy,
psychologic/developmental
therapy,
prescriptions
including unlabeled uses (i.e. Interferon alfa-2a for serious and
life threatening hemangiomas), and respite care (which we were
denied because of technicalities).
We also need to eliminate all pre-existing condition exclusions
of congenital and acquired facial disfigurements. We are not all
wrapped in pretty packages, yet society judges all of us on
appearance.
It is sad that a child with a facial disfigurement feel pain and
isolation for what they look like on the outside and not for what
they are on the inside. My daughter is still young, but I see the
stares and hear the comments and it really hurts. As a mother I
keep it in, so she continues to have a high self-esteem.
It is
easier for her to accept, since she has not known any othe~ way
of life; but as a parent you want to protect your child.
�Education is the key to understanding and thus acceptance.
We
have learned to understand and accept the handicapped, why not
the facially disfigured?
Ca~ you help Lauren and
all the other children like her?
you please also help me educate society?
Would
Because of Lauren, Twentieth Century Juniors Foundation of Park
Ridge has chosen AboutFace (a support and information network for
those who are facially disfigured), as their major recipient this
year.
Juniors' annual fashion show is November 13, 1993.
If
your schedule permits I would like to personally invite you and
Chelsea, so that Lauren and I would have an opportunity to meet
both of you.
Encl.
�'
!
I
;
-\.-.-
�Eric
Zom
Kids learn lesson
· before class starts
Those who thought they were being kind
quietly advised Bernadette Mandel that, you
know, it is possible to educate a child like
Lauren at home, behind closed doors, hidden
away, where no one has to see her, where
she does not have to be seen by anyone.
ihe girl, now 5, has a pronounced facial
disfigurement-a large, discolored growth on
her upper lip accompanied by smaller
growths on her left cheek and eyelid.
Strangers tend to stare at her in disbelief and
dread. Adults have ~ped and fled at the
sight, her mother satd. Children have taunted
·
and avoided her.
But it is only a birthmark, a surface.
condition. Underneath it, Lauren Mandel is
just a regular kid of
,...--..,....-------, normal intelligence
who loves to swim,
color and draw, go
down the slide at the
park, eat macaroni and
cheese and watch
"DuckTales" on TV.
"I wasn't going to
hide hedn a closet,"
said Bernadette .
Mandel. "For her sake
and everyone else's."
Late last winter when
Mandel went to regiLauren Mandel
ster Lauren for fall
"
kindergarten at Washington School in Park Ridge, she took her
concerns to Principal Larry Csajaghy. "I
knew l couldn't bring her mto the classroom
on the first day without saying anything,"
Mandel said. "Everyone's mouth would fall
open."
Lauren calls her birthmark-a
hemangioma that doctors say will be gone by
the time she is an adult-"my lip." Her
mother said she has become extremely aware
of how others react to it. "When people
smile at her and say, 'Howya doin'?' she
smiles at me and says, 'Mommy, they like
my lip!'" said Mandel. "When they tum
away and won't talk to h~r, s~e's hl_lrt.~'
...
1.'
r
.~
.
�YOUR LOCAL SOURCE
May28,1992 • $1.00
LOCAL
PATRIOT
[-·THIS WEEK -]
·Carpenter
parents
protest
Robert Lyng, a
member of
Veterans of Foreign
Wars Post 3579,
salutes the colors
during Monday's
Memorial Day
parade.
Anotherphoto on
Lead by Principal
Phyllis Long,
Carpenter parents
demand attention
from school board.
PAGE9
IN THIS ISSUE.
I
PLAY THE
PAGE3
-!
PIONEER
PRESS
SOCIAL
SECURITY
NUMBER
CONTEST
School omclals and
parents are JlreJ!I¢nB
students at Washington
School to welcome a'-; ..:
special classmate.
~
Four MaJne South
runners combliled to
form a state
meet-bound
.
3,200-meter relay.squad
at the Glenbrook South
Sectional track meet. ·
PAGE125
,,
'I
�NEWS
PIONEER PRESS
ThiJISdav, Mav28.1992
s
First contact
Getting to know the real Lauren Mandel
By DORIS FOLKL
ITAFFWRITER
'
Lauren is
just a little
girl who
·likes to
play and
loves hugs.
'
Five-year-old Lauren Mandel, who
lives on South Western Street, has a
problem meeting people for the first
time.
Her mother explains it in
straightforward, simple words.
uWhen Lauren meets someone Cor
the first time, if they smile at her,
she whispers to me, 'Mom, I think
they like my lip,' " said Bernie
Mandel In a quiet, knowing mother's
voice.
·
"But If they stare at her and back
away suddenly, or gasp and avert
their eyes, abe moves closer to me
and says, 'Oh Mom, they don't like
myllp.'u
Life has never been simple for
Lauren and her family. Born with .a
significant birthmark, a hemangioma
that affecta her lips, her len eye and
a portion of her len skull, Lauren
knows that meeting a strange child
on her front sidewalk can be a
devastating emotional experience.
Meeting an unthlnklng adult on a
shopping trip with her mother can
be a nightmare.
On Aug. 24, when she begins
kindergarten classes at Washington
'
School, Lauren will meet 438
children and a faculty of teachers for
the first time, and, thanks to her
parents, preparations to make her
first day a success have already
begun.
"Mr. and Mrs. Mandel have had
some wonderful ideas,'' said
Washington Principal L.arry
CsaJaghy. "Mrs. Mandel provlde4 us
with a lot of Information about
hemangioma, and explained how
important It is for Lauren that a first
reaction to her be positive. She has
given us pictures of Lauren, so the
children will know ahead of time
what she looka like. If they have a
tendency to stare, it can be at the
picture, not Lauren."
CsaJaghy has formed a small
committee, made up of himself, the
district superintendent, the school
nurse and the school social worker.
This week, special teams will vlsii
classrooms at Washington, sharing
Lauran and her
mother Bemla
Mandel, above,
information about Lauren, and a
letter will be sent home to parents.
share a laugh In
thelrWestem
Avenue home.
Bernie Mandel
has worked with
Washington
School Principal
Lany Csajaghy
and teachers to
prepare Lauran's
schoolmates to
welcome her
when school
begins In Auiust-.
The letter has been timed to reach
parents at the same time this article
and pictures of Lauren appear In the
Advocate.
Similarities
"We'll be telling children how
everybody Is the same on the
Inside,'' CsaJaghy sald. ''We'll be
talking about how Lauren Is the
same as you and me, and how they
should try to react positively to her
outside appearance and to the
hemangioma."
Homeroom teachers at
Washington will follow up on the
!nltlal effort, Csl\laghy said, In case
children need to talk about more
about Lauren and their reactions to
her.
"We're going to talk about
Lauren's favorite color, her favorite
book and the dog she plays with at
home,''CsaJaghy said. "We're going
to do whatever it takes to make her
feel welcome."
Bernie Mandel remembers vividly
the day Lauren was born. At home,
seated at a picnic table on her
screened-in back porch, while
Lauren and her brother, two-year-old
Joe, blow bubbles, she offers the
standard 8x!O colored photograph
that all mothers brlr.g ho~e from
(continued on page 8)
Caught Ina··>
..
pensive moment,
far left, Lauren
Mandella looking
forward to
attending
Washington
School next year.
Riding her bike, above, Is a favorite
actMty for Lauren. Brother Joe
(behind her) often accompanies her.
II
••
�• Lauren
the hospital along with their
first-born.
''To me, It just looked like
the red splotches you see on
many new babies," she said,
and Lauren did Indeed look
like every other newborn,
with a small redness around
her lips and lefi eye. "But·
Lauren had six specialists
examine her when she was a
day old, and she had a CAT
scan," Mandel said. Her lip
and then her eye began to
swell when she was ten days
old."
*'
&~,...
·. f!4¥d& ;e_,
11
IIIIa,.
~JI~
'We're going to do
whatever it takes
to make her feel
welcome.,
I
1st IN THE STATE ... 6 YEARS TO DATE!
I
THE "GOOD" LIFE...
•.. starh with this all brick Split
with new, hardwood fiDDfsl lighting fixtures1 kitchen; appliances;
skylights, & lower level family
room plus .4th bedroom or study.
The central-air, polio and 2.5 cor
garage make it even beHerl
Larry Csajaghy
Principal
Washington School
$229,000
'"1991 Over $91 Ml11ionln Soles ondlhe 6th year ElM REALTORS sold
morolloal Eslale than any of the 370 Century 2t Officosln IUinols.
,...-At. ...,
Elm Realtors
~IIIU.,,2J
.:......:::::::
741 Devon, Park Ridge. IL
®
(708) 692·5522
continued from pages
lit
In reality, Lauren's birth·
date, May 31, 1987, marked
the beginning or a difficult
five-year journey that has
included four mll!or surger·
les; o serious bout with anemia; numerous trips to
Children's Memorial Hospital
and to specialists both lnond out-of-state; speech ther·
opy and soclolizotlon closses
ot Melzer School in Morton
Grove; long, broken nights
for parents listening to the
difficult breathing of o tod·
dlcr ond jumping up to help
her when she had problems;
copped teeth thot will give
way to surgery and braces
when she is a teen-ager; a
speciol tube inserted in her
lefi eor to keep the notural
Eustachian tube open; and
most Important and difficult,
introducing Lauren to a
world that ofien looked only
at her hemangioma and
failed to see the little girl
behind it.
.
Mother's goal·
(OR FREE HONEYWELL
ELECTRONIC AIR
CLEANER)
ON PURCHASE OF ANY SPACE·PAK · SYSTEM
• Call now for more information
• Mention this ad when you call
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I
I
I
1
--- -·
1
"I decided right afier she
was born that I would ·do
everything I could so that
she would have a normal life
and go to school Uke other
children," said Mandel.
She related stories of long
months spent looking for a
preschool and the disappoint·
ment of being r~ected by a
local private school aner two
months or sitting with Lsu·
ren during classtime.
"She's been at Triton Col·
lege's Child Development
Center for the past couple
years, and it's be,n very successful," said Mandel.
She described how a preschool teacher handed out
M&Ms to Lauren's classmates on the first day and
explained how things may
look different on the outside
but are the same underneath.
"One boy asked If Lauren
could talk, and there were
Only a slight redness on her Up and aye ware apparent at Lauren
Mandel's birth.
some other questions,n Mandel said. ''Then the children
got up and played, and I was
sent away.
"A hemangioma Is really a
vascular birthmark," Mandel
explained. "Gorbachev has
one on his head, and I see a
lot or children In Park Ridge·
who have them on their arms
and legs."
"Usually, It's a self·
limiting lesion that goes
away naturally by the age or
three to five," Mandel said.
"But In Lauren's case, the
birthmark Is slgntflcant. The
small Veins In her· face have
bubbled and then bubbled
agaln, and surgerj has been
Indicated.
"The ·worst part Is the
welting," said Mandel, focus·
lng her glan.ce on Lauren's
stitches from the latest sur·
gery, that run In a vertical
line down across her Ups.
"The surgery Involves her
lipllne, so the plastic surgeon
can't remove too much tissue
at one Ume. She'll be perfect
by the Ume she's 20."
Family life
In the meanUme, the Man·
dels struggle to keep family
life on an even course. A
swing set In the backyard Is a
popular pasUme for the chll·
dren, and Lauren and Joe
like riding their bikes on the
sidewalk. An Intelligent, curl·
ous child, Lauren Is begin·
,,
..
nlng to work with letters and ·.
numbers. She enJoys her eo!·
lecUon of children's books, ··
painting with water
and crayon work.
In a special letter to
lngton School, Lauren's
tie surgeon described her :
recently as "an extremely ·
bright child, who wiU benefit
from maximum Intellectual
sUmulation In her school and '
who does not need to be shel·
tered from other chll· ·;
dren .... She
does
not '
represent any medical risk to ~
the children In her class."
·;
"Lauren Is just a little girl \
who likes to play and loves .;
hugs," said her mother. "I ;
guesa staring at her Is human ,
nature, but if· people could
learn to emi·.tt with a smile, .,
It would gii much easier, fpr '
her."
.:
·
As If to underscore. her ,
mother's
words,
La1lren
jumped up when two little ·
boys next ·door walked ·
through their yard toward the
family garage with their
mother.
"Hi Matt, and baby Mark,"
Lauren sald loudly, and the
two boys turned and smiled
and waved back.
''Their parents are wontlerfill people who have talked to
them about Lauren," said·
Bernie Mandel. "Most or the
kids used to stare and run
by. Just having the two of
them talk to her makes It
much better and much easier
· for her and for all or us."
�To support ABOUTFACE or
receive further information
_ _ Yes ... I want to support AboutFace.
My one year contribution of $20 or more entities me to bimonthly newsletters, access to
resource and video libraries, and the knowledge that I am helping AboutFace grow.
(Please make check payable to AboutFace
U.S.A)
_ _ In addition to the $20.00 per year
donation, I am enclosing a gift to AboutFace
and would appreciate a receipt for income tax
purposes.
I am not interested in or unable to contribute just now, but am enclosing a note
detailing my interests and request. Please add
me to the mailing list.
"'
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facial disfigurement?
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What is the name of the condition?
Do you wish to be in contact with other families with the same condition? DYes D No
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program? U Yes D No
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�• pamphlets and booklets about most
facially disfiguring conditions.
• resource and video libraries.
• advocacy support and information on legislation which impacts on the treatment
of those with facial disfigurement.
• referral information to appropriate support and information resources.
Aboutface U.S.A.
Our mission is to provide support to people
with facial disfigurement. Families and caregivers are included in this program. Emotional
support is provided for all types of facial disfigurement whether congenital (birth defects}
or acquired through accidents or disease.
Those we serve range in age from birth to
senior citizens. An extensive database links
them for networking opportunities and support.
Various chapters and support groups across
the nation provide opportunities for personal
contact and meetings. By sharing information
and mutual support, AboutFace helps individuals and families to be well-informed,
assertive, and confident in their ability to contribute to society.
Although the treatment of facial disfigurement is often long and extensive, support is
available on a continuing basis. Through
AboutFace, we learn, grow, and adapt successfully to society.
Causes and frequency of
facial disfigurement
Over 6000 infants are born in the U.S. each
year with a birth defect affecting the face.
One of the most common is cleft lip and
palate. Clefts occur in about one in every 700
births. Other rare syndromes may involve the
skull, eyes, and face. Even with these complex
conditions, people can look forward to leading successful and fulfilling lives.
Parents who have an infant with a facial disfigurement are often overwhelmed with feelings of shock, guilt, sadness, and anger.
Dealing with other family members can sometimes present a challenge at a time when support is needed. AboutFace provides volunteers
offering hope and encouragement through
these early difficult days.
Where we came from and
where we're going:
Birth
Facial disfigurement can happen to anyone
at any time as a result of trauma, burns, and a
variety of diseases. Disfigurement affects
about 350,000 Americans each year. In these
cases, individuals need to learn to adjust to an
appearance much different from the one to
which they are accustomed. AboutFace can
put you in touch with someone who truly
understands and can make a difference in a
time of despair and isolation.
AboutFace began in 1985 in Toronto,
Canada. Already, this organization has helped
thousands of individuals and families all over
the world. AboutFace U.S.A. began in 1991
and is a division of AboutFace International.
AboutFace is recognized by the Cleft Palate
Foundation of the American Cleft PalateCraniofacial Association as the leading support
organization for parents and patients affected
by facial disfigurement.
The Aboutface
Program provides:
• a toll-free number directly to our office
• chapters and support groups in many
areas of the country.
• school programs to teach children how to
be more accepting
of those who look
different.
• leadership training
for new and established chapters.
• training programs,
conferences, and
workshops for families, professionals,
and the general
public.
• a bimonthly
newsletter.
Two Months
One Year
AboutFace is not organized with the intention of providing medical information, advice, or referrals.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
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Paper
Dublin Core
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Title
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HRC - Health Care Correspondence [2]
Creator
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First Lady's Office
Maggie Williams
Identifier
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2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 4
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Reproduction-Reference
Date Created
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1/8/2015
Source
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42-t-2194630-20060223F-004-008-2015
2194630
-
https://clinton.presidentiallibraries.us/files/original/53f2fdb03523b308711bde97da46becc.pdf
ec1042beb2386fa8d1a65572608433bd
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
First Lady's Office
Series/Staff Member:
Maggie Williams
Subseries:
Misc. Subject Files
OA/ID Number:
10813
FolderiD:
Folder Title:
HRC Health Care Correspondence
Stack:
Row:
Section:
Shelf:
Position:
s
59
4
2
3
�March 16, 1995
MEMORANDUM FOR
HILL!~Y
RODHAM CLINTON
FROM:
CHRIS JENNING~
Re:
Congressional Health Care Meetings
cc:
Melamie Verveer
Patti Solis
In response to some recent inquiries about our Congressional outreach, we called up the latest
tabulation of all of your meetings with Members of Congress. ·we wanted to make sure that
you had the opportunity to see this. As you will note, through August 1994 you conducted
nearly 250 meetings with Members of Congress.
�MASTER LIST OF CONGRESSIONAL MEETINGS
HRC MEETINGS: 246 of 8/11/94
TOTAL MEETINGS: 421 as of 8/11/94
DATE
MEMBER
MET WITH
213
Gephardt
HRC
2/4
Stark
IM/HP
2/4
MITCHELL
HRC/IM/JF
GENERAL
2/4
SENATE DEMOCRATS
HRC/IM/JF
GENERAL
HRC, ICM, JF
process, general
discussion
SUBJECT
MITCHELL
BAUCUS
BINGAMEN
BOXER
BREAUX
CONRAD
DASCHLE
FEINGOLD
BUMPERS
HARKIN
KENNEDY
KERREY
LEAHY
LIEBERMAN
METZENBAUM
MIKULSKI
MOSELEY-BRAUN
MOYNIHAN
PELL
PRYOR
RIEGLE
ROCKEFELLER
ROBS
WELLSTONE
WOFFORD
2/4
DOLEICHAFEE
2/10
ROCKEFELLER
2/11
HEALTH REFORM CONFERENCE
· HRC
GENERAL
HRC
Event in
Pennsylvania
IM
GENERAL
WOFFORD
2/11
MITCHELL's Office
�2/11
MITCHELL's Office
1M
2/15
McD~rmott
IM
2/16
House Democratic Leadership
Foley
Gephardt
HRC/IM/JF
2/16
House Democrats
Andrews
Bonior
Cardin
C. Collins
Cooper
Conyers
de Ia Graza
Derrick
Fazio
Ford
Hoyer
E.B. Johnson
Johnston
Levin
Lewis
Matsui
McDermott
Meek
Obey
Richardson
Rose
Rostenkowski
Slattery
Slaughter
Stark
Stenholm
Strickland
Synar
Waxman
Williams
Wyden
HRCIIM/JF
2/16
House Republican Leadership
HRCIIM/JF
Michel
Gingrich
Hastert
GENERAL
GENERAL
�2116
House Republicans
HRC/IM/JF
Bilirakis
Bliley
Goodling
Goss
Grandy
Gunderson
Hoke
N. Johnson
Kasich
McCrery
Moorhead
McMillan
Roberts
Roukema
Thomas
Walker
2/18
Rostenkowski
HRC
2/18
Ford
HRC
2118
Dingell
HRC
2/23
Congressionial Women's Caucus
HRC
DEMOCRATS
Schroeder
Furse
Kaptur
Lambert
Lowey
Maloney
Mink
Slaughter
Waters
REPUBLICANS
Snowe
Morella
2/23
Stark
HRC
2/23
Waxman
HRC
2/23
Williams
HRC
2/23
DURENBERGER
HRC, ICM
GENERAL
�2/24
House Democratic Leadership and
Committee Chairs
HRCIIM/JF
Gepbardt
Lewis
Richardson
Rostenkowski
Stark:
Dingell.
Waxman
Ford
Williams
2/24
WELLSTONE
LQ
2/25
REIGLE
(and Mrs. Reigle)
HRC
Pregnant women
and children
-UAW retirees
2/25
SASSER
HRC
GENERAL
1,/26
Stark:
RV
GENERAL
2127
Torres
RV
GENERAL
HRC
Affordable Health
Care
3/2
3/2
.WELLSTONE
Congressional Black: Caucus
DEMOCRATS
·MOSELEY-BRAUN
Clayton
Collins
Conyers
Flake
McKinney
Meek
Mfume
Norton
Rangel
Stokes
Waters
Watt
REPUBLICANS
Franks
HRC
�3/2
Congressional Hispanic Caucus
HRCIRV
DEMOCRATS
Serrano
Roybal-Allard
Pastor
de Ia Garza
de Lugo
Ortiz
Richardson
Torres
Becerra
Guttierrez
Mendez
Romero-Barcelo
Tejeda
Velazquez
Underwood
REPUBLICANS
Ros-Lehtinen
Bonilla
Diaz-Balart
3/4
BREAUX and JOHNSTON
Jefferson
HRC·
LOUISANA TRIP
.
�3/4
DEMOCRATIC POLICY
COMMriTEE
IM/JF
MITCHELL
DASCHLE
AKAKA
BAUCUS·
BINGAMAN
BOXER
BRYAN
CAMPBELL
CONRAD
DODD
EXON
FEINGOLD
FEINSTEIN
GRAHAM
HOLLINGS
KENNEDY
KERREY
KERRY
LAUTENBERG
LEAHY
LIEBERMAN
LEVIN
MATI11EWS
METZENBAUM
MIKULSKI
'MOYNTIIAN
PELL
PRYOR
REIGLE
ROCKEFELLER
SARBANES
SASSER
'
SIMON
WELLSTONE
WOFFORD
3/6
FEINSTEIN
IM'
3/9
Conyers
McDermott
HRC
�3/9
Energy and Commerce Committee
HRC
Dingell, Chairman
S. Brown
Hall
Kreidler
Lambert
Lehman
Margolies-Mevzinski
Markey
Pallone
Richardson
Schenk
Slattery
Studds
Tauzin
Towns
Waxman
3110
ROCKEFELLER
MEG, BA
�3/10
SENATE REPUBLICAN MEMBERS
general discussions
about process and
about directions
for/components of
reform
HRC
DOLE
CHAFEE
BENNE'IT
BOND
BURNS
COATS
COCHRAN
COHEN
COVERDELL
CRAIG
DANFORTH
DOMENICI
DURENBERGER
FAIRCLOTH
GREGG
HATCH
HELMS
JEFFORDS
KASSEBAUM
KEMPTHORNE
LUGAR
MACK
MCCAIN
MCCONNELL
MURKOWSKI
NICKLES
PACKWOOD
ROTH
SIMPSON
SPECTER
STEVENS
-
3110
JEFFORDS
ICM
3/11
Wyden
HRC
3/11
KENNEDY
IM
�3/11
SENATE WOMEN'S CAUCUS
HRC
Women's Health
Issues
Overall Reform
Veteran's Issues
DEMOCRATS
BOXER
FEINSTEIN
MIKULSKI
MOSELEY-BRAUN
MURRAY
REPUBLICANS
KASSEBAUM
3/11
ROCKEFELLER
Montgomery
Rowland
HRC
3/11
Gephardt
Rostenkowski
Stark
Dingell
Waxman
Ford
Williams
IM/JF
3/11
MOYNIHAN
HRC
3/11
House Republicans
1M
Bliley
Gingrich
Goss
Hastert
Johnson
Thomas
3/12
RWJ Forum
HRC
GRAHAM
Gibbons
3/15
RWJ Forum
HARKIN
Neal Smith
HRC
GENERAL
�3/17
Democratic Ways and Means Committee
Members
HRC
Rosten.kowski
Andrews
Cardin
Gibbons
Hoagland
Jefferson
Kennelly
Kopetski
Levin
Lewis
Matsui
McDermott·
McNulty
Neal
Payne
Reynolds
<
3/17
Waxman
RV
3/17
Brooks
HRC
3/17
Indian Health Meeting
HRC
INOUYE
3/18
House Republicans
Bliley
Goss
Grandy
Hasten
N. Johnson
McMillan
Thomas
IM
'
3/18
Andrews
Cooper
Stenholm
_L. Payne
HRC
3/18
KERREY
HRC
. 3/18
Reynolds
HRC
MALPRACTICE
�3/22
RWJ Forum
MEG/CRID
s
Michigan Health
Event
RIEGLE (and Mrs. Riegle)
LEVIN
Dingell (and Mrs. Dingell)
Conyers
3/24
Pastor
RV
3/24
DEMOCRATIC POLICY
COMMI'ITEE
IM/JF
MITCHELL
AKAKA
BAUCUS
BINGAMAN
BOXER
BRYAN
CONRAD
DASCHLE
DECONCINI
DODD
FEINGOLD
GLENN
GRAHAM
HOLLINGS
JOHNSTON
KENNEDY
KERRY
LEAHY
LEVIN
MATIHEWS
MOSELEY-BRAUN
REID
WELLSTONE
WOFFORD·
3/25
Torres
RV
3/25
De La Garza
RV
3/25
House Republicans
1M
Bliley
Goss
Grandy
Hastert
N. Johnson
McMillan
Thomas
GLOBAL
BUDGETS
�3/25
Democratic Committee Members of:
IM
Education and Labor
Ways and Means
Energy and Commerce
Andrews
Cooper
Engel
Cardin
Lambert
Levin
McDermott
Synar
Tauzin
Pallone
Woolsey
Slattery
Rostenkowsk.i
Dingell
Waxman
Richardson
Markey
Hall
Studds
Margolies-Mezvinski
Kennelly
Hoyer
Fazio
Kreidler
Bryant
Klink
Sawyer
3/29
WELLSTONE
LQ
3/30
Ortiz
RV
3/30
Roybal-Allard
RV
�3/30
Mainstream Forum
McCurdy
Bacchus
Browder
Carr
Danner
Glickman
Geren
Green
Moran
Payne
Penny
Peterson
Price
Orton
Rowland
Slattery
Spratt
Tanner
1M
�3/31
House Democratic Caucus
Barlow
Cooper
DeLauro
Derrick
Ding ell
Durbin
Filner
Gephardt .
Geren
Gordon
Hamilton
Hochbrueckner
Hoyer
Hughes
lnslee
D. Johnson
E.B. Johnson
Kaptur
Kennelly
Lancaster
Levin
Lewis
Lloyd
Lowey
McDermott
Moran·
Obey
Olver
Pomeroy
Richardson
Romero-Barcelo
Sawyer
Shepard
Sisisky
Skaggs
Smith
Stark
Stupak
Synar
Thurman
Velazquez
Volkmer
Wise
Woolsey
IM/JF
�3/31
Ways and Means Subcommittee on
Health
IM/JF
Stark
Levin
Cardin
McDermott
Andrews
Klezka
4/1
House Republicans
LQ
RURALHEALm
CARE
Bliley
Goss
Grandy
Gunderson
Hastert
N. Johnson
McMillan
Roberts
Thomas
4/1
Serrano
RV
4/2
Romero-Barcelo
RV
4/2
Obey
RS
General
4/8
House Leadership
,IM.
General
4/13
s. Levin
LQ
Michigan Hearing
4114
Ways and Means Subcommittee on
Health
HRCIIM
General
Stark
Cardin
Levin
Andrews
McDermott
4114
Oberstar
LQ
4/lS
VA Meeting
HRC/
ROCKEFELLER
Montgomery
SECRETAR
Y JESSE
BROWN
4/16
KERREY
Hoagland
HRC
NEBRASKA
EVENT
�4/17
BAUCUS
Williams
HRC
MONTANA
EVENT
HRC
GENERAL
Overall Reform
BURNS
4/20
SENATE FINANCE COMMTITEE
(Bipartisan)
DEMOCRATS
BAUCUS
BOREN
BRADLEY
MITCHELL
PRYOR
RIEGLE
ROCKEFELLER
DASCHLE
BREAUX.
CONRAD
REPUBLICANS
CHAFEE
PACKWOOD
DANFORTH
ROTH
GRASSLEY
HATCH
WALLOP
4/20
DURENBERGER
ICM
4/20
Moakley
HRC
4/20
Valentine
CJ
4/20
L. Payne
LQ
4120
Kennedy
RV
4/20
McDermott
RV
4/21
Hispanic Caucus
RV
4/21
Gonzalez
RV
Testimony on the
Health Care
Reform Plan
�4/21
ROCKEFELLER
HRC
GENERAL
4/21
House Republicans
IM/JF/Roby
n Stone
OVERALL
REFORM LONG
TERM CARE
4/22
SIMON
RS
4/22
DURENBERGER
LQ
GENERAL
4/22·
PRYOR
CJ
GENERAL
4/22
Roybal-Allard
RV
GENERAL
4/22
McDermott
RV
GENERAL
4/22
Gutierrez
RV
GENERAL
4/22
Richardson
RV
GENERAt
4/23
Coleman
RV
GENERAL
4/23
Becerra
RV
GENERAL
4/23
Torres
RV
GENERAL
4/23
Hastings
RS
.GENERAL
�4/23
SENATE CONFERENCE
JAMESTOWN
AKAKA
BAUCUS
BINGAMAN
BOXER
BRADLEY
BREAUX
BUMPERS
CONRAD
DASCHLE
DECONCINI
DODD
DORGAN
EXON
FEINGOLD
FORD
GLENN
GRAHAM
HARKIN
HEFUN
HOLLINGS
JOHNSTON
KENNEDY
KERREY
KERRY
LAUTENBERG
LEAHY
LEVIN
LIEBERMAN
MATHEWS
METZENBAUM
MIKULSKI
MITCHELL
MOSELEY-BRAUN
MOYNIHAN
MURRAY
NUNN
PELL
PRYOR
REID
RIEGLE
ROBB
ROCKEFELLER
SARBANES
SIMON
WELLSTONE
WOFFORD
HRCIIM/JF
GENERAL
�4/26
Congressional Democratic Leadership
HRC/BC
GENERAL
MITCHELL
Foley
Gephardt
4/26
Roybal-Allard
RV
4/27
Hisp~c
IM/RV
4/27
Dingell
HRC
GENERAL
4/27
Bonoir
HRC
GENERAL
4/27
House Democratic Leadership ·
HRC/BC
Caucus
Foley
Gephardt
Rostenkowski
Stark
Dingell
Waxman
Ford
Williams
Bonior
Kennelly
4/27
Congressional Hispanic Caucus
(Bipartisan)
_)
1M
DEMOCRATS
)
Serrano
Roybal-Allard
Pastor
de Ia Garza
de Lugo
Ortiz
Richardson
Becerra
Gutierrez
Menendez
Ronnero-Barcelo
Tejeda
Velazquez
REPUBLICANS
Ros-Lehtinen
4/28
Richardson
RV
�4/28
Martinez
RV
4/28
Congressional BOrder Caucus
JF/Richard
Veloz
DEMOCRATS
Coleman
REPUBLICANS
Kolbe
4/28
WELLSTONE
LQ
4/29
Town Meeting
HRC
Valentine
4/29
House Working Group on Mental Health
Health Care
Reform
Teleconference
BA
Strickland
DeLauro
Kopetzsk:y
Markey
Kaptur
4/29
McDermott
HRC
Single Payer
Concerns
4/29
House Republicans
1M
OVERALL
REFORM
FINACING
�4/30
SENATE
(Bipartisan meeting)
HRCIIM/JF
GENERAL
DEMOCRATS
AKAKA
BAUCUS
BINGAMAN
BRYAN
CONRAD
DASCHLE
DORGAN
FEINGOLD
FEINSTEIN
GRAHAM (FL)
HEFLIN
KENNEDY
KERREY
KERRY
LEAHY
LEVIN
LIEBERMAN
METZENBAUM
MITCHELL
NUNN
PELL
PRYOR
RIEGLE
ROBB
ROCKEFELLER
SIMON
WELLSTONE
WOFFORD
-.
REPUBLICANS
BENNETT
BOND
BURNS
CHAFEE
COATS
COCHRAN
COHEN
COVERDELL
DANFORTH
DOLE
DOMENICI
DURENBERGER
GORTON
.'
�4/30
SENATE
(Bipanisan Meeting)
HRCIIM/JF
GENERAL
REPUBLICANS (Cont.)
GRAMM
GRASS LEY
GREGG
HATCH
HATFIELD
JEFFORDS
KEMPTHORNE
MURKOWSKI
PRESSLER
SIMPSON
SMITH
SPECTER
STEVENS
THURMOND
-
.
4/30
Mental Health Briefing
MEG
DEMOCRATS
WELLSTONE
Lowey
Kopetsk.i
Markey
Mazzoli
Romero-Barcelo
Strickland
Wise
..
REPUBLICANS
DOMENICI
-
�5/4
SENATE LABOR AND HUMAN
RESOURCES COMMITTEE
(Bipartisan Meeting) .
HRC
DEMOCRATS
KENNEDY
METZENBAUM
DODD
SIMON
HARKIN
MIKULSKI
BINGAMAN
WELLSTONE
WOFFORD
REPUBLICANS
KASSEBAUM
THURMOND
GREGG
DURENBERGER
JEFFORDS
COATS
HATCH
5/4
5/4
515
CHAFEE
. House Rural Health Care Caucus
SENATE DEMOCRATIC
LEADERSHIP
.MITCHELL
FORD
PRYOR
DASCHLE
MOYNlliAN
KENNEDY
ROCKEFELLER
RIEGLE
BREAUX
MIKULSKI
515
House Democratic Caucus
1M
DSILQ
HRCIBC
Status of reform Consultation
..
Ken Thorpe
Current Status of
Employer/
Employee Health
Insurance
�515
KENNEDY
EG
Combined I ewish
Philanthropies of
Massachusettes
516
SINGLE PAYER ADVOCATES
HRC
Single Payer
Concerns
WELLSTONE
INOUYE
SIMON
516
1 5/6
516
I
Underwood
RV
I
Diaz-Balart
RV
HRC
SENATE AGING COMMITEE
Individual
Responsibility and
Prevention Issues
HRC, IM
BasiCare
provisions
DEMOCRATS
PRYOR
GLENN
BREAUX
REID
GRAHAM
FEINGOLD
KRUEGER
KOHL
I
I
REPUBLICANS
COHEN
PRESSLER
SIMPSON
DURENBERGER
CRAIG
BURNS
GRASSLEY
516
McCurdy
-·
I
�516
CONGRESSIONAL REPUBLICAN
LEADERSHIP
HRC,BC
Status of Reform - Consultarion
Insurance Reform
SENATE
DOLE
CHAFEE
KASSEBAUM
DURENBERGER
DANFORTH
PACKWOOD
JEFFORDS
COHEN.
HATCH
HOUSE
Michel
Gingrich
N. Johnson
B. Thomas
Bliley
Moorhead
Roukema
516
House Republicans
Gary
Claxton
516
WOFFORD
LQ
516
Lambert
LQ
5/10
Norton
BA
S/11
Velzasquez
RV
5/11
Grandy.Hastert
5/11
wEsT VIRGINIA TOWN MEETING
-
LQ
Conference
Steak Dinner
HRC
ROCKEFELLER
S/11
KENNEDY
EG
5/12
House Democratic Caucus
Gary
Claxton, CJ
5/12
Dickey
CJ
5/12
BIDEN
JF, CJ
Congressional
· Senior Citizen
Intern Program
Insurance Reform
�f'·
5/12
De Lugo
RV
5/13
Ros-Lehtinen
RV
5/13
Senate Labor & Human Resources
BA,MEG
WELLSTONE
KENNEDY
HATCH
5/13
JEFFORDS
Ken Thorpe
5/13
Derrick
CJ
5/13
House Republicans
Gary
Claxton, CJ
5/14
Fingerhut
5/16
Waxman
IM, CJ
5/17
Maloney
JL
Health Care Town
Hall Meeting
5/18
Asian Pacific American Caucus
HRC/MV
Issues related to
Asian and Pacific
Islands
Public Official's
Spouses
-
AKAKA
Matusi
Mink
Mineta
Faleomavaega
Underwood
5118
Martinez
5/19
Coleman
5119
RV
..
WOFFORD
5119
KASSEBAUM
BURNS
DANFORTH
Glickman
Mc.Curdy
5/20
RV
.
LB
HRC
re: Basicare
co-sponsers
GRASS LEY
LQ
Cable TV Show
5/20
Hilliard, Bachus
SE
5/20
Andrews
CJ
5/21
Waxman
RV
5/21
Lewis
JH
Georgia
Roundtable
�5/22
Mfume
MIKULSKI
HRC
Baltimore Health
C:u-e Event
5/22
Hamburg
JS
Health Care Town
Hall Meeting
5/24
Tejeda
RV
5/24
Maloney
JL
Health Care Town
Hall Meeting
5/25
BIDEN
CJ,
Malpractice
Berenson
5/26
Becerra
RV
5/26
McDermott
BA
5/27
Lafalce
IM
5/27
KOHL
JF
5/28
KERREY
HRC
5/28
FORD
HRC
6/1
BURNS
DD
Health Care Town
Hall Meeting
6/1
Kennedy
JW
Health Care Town
Hall Meeting
6/1
WELLSTONE
LQ
·Health Care Town
Hall Meeting
6/3
Kreidler
SR
Health Care Town
Hall Meeting
6/3
BINGAMAN
BS, CM
Health Care Town
Hall Meeting
6/3
COHEN
LQ
Health Care Town
Hall Meeting
6/4
ROCKEFELLER,DASCHLE
HRC
Message
6/4
Radio Broadcast in Detroit
HRC
I
I
'
Dingell and Mrs. Dingell
6/4
DOMENICI
617
Dickey (and physicians)
.
BS, CM
HRC
Health Care Town
Hall Meeting
�6/8
Reception for Congress
HRC, MV,
CJ, SR
619
SENATE DEMOCRATIC FOCUS
GROUP
IM, JF, CJ
BOXER
BINGAMAN
FIENGOLD
WELLSTONE
6/9
Tribute to Senator
MOSELEY-BRAUN
HRC
6110
House Republicans
IM
6/10
EXON
HRC
6/11
DODD
HRC
6/13
Reynolds
Rush \
Sangmeister
HRC/CJ/SR
Kasich Dinner
HRC/CJ/M
Health Reform,
Abortion
Return flight from
Chicago
-
6/14
v
Kasich
Allard
Hastert
Hobson
Johnson
Kolbe
McMillan
Miller
Pryce.
Shays
Snowe
6114
Meehan
6/15
Cooper
6/15
PRYOR
LEAHY
HRC/CJ/M
6/17
Carville Roast
HRC
HARKIN
MD
. CJIMV.
v
Health care Town
Hall Meeting
�6/17
KENNEDY·
PRYOR
REID
DASCHLE
MITCHELL
WOFFORD
ROCKEFELLER
BOXER
RIEGLE
KERRY
HRC/MV
6/17
Senate Focus Group
IM/JF/CJ/K.
PIMV
BOXER
DASCHLE
METZENBAUM
REID
..
ROBB
DORGAN
6/18
Woodstock Event in VT
HRC
LEAHY
JEFFORDS
-
6/22
Andrews (fX)
HR.CIIM/CJ
IMV
6/22
DODD
HARKIN
KENNEDY
METZENBAUM
ROCKEFELLER
WELLSTONE
WOFFORD
HRC/CJ/SR
IMV
6/22
Congressional Message Meeting
HR.CIIM/CJ
/JE
MITCHELL
DASCHLE
Gephardt
Bonior
�6/23
McDermott Co-Sponsors
HRC/MV
McDermott
Nader
Sanders
Kennedy
LaFalce
Gejdenson
Becerra
Romero-Barcelo
Furse
Pelosi
Reynolds
Miller
6/23
CSIS Health Care Event
HRC/CJ/M
v
NUNN
DOMENICI
6/23
Blackwell
KM
6/24
Rose
HRC/CJ/M
V/Miles
Goggans
6/24
DASCHLE
KERREY
CONRAD
LEffiERMAN
DODD
SARBANES
IM/JF/CJ/K
P/MV
6/28
Serrano
RV
6/29
JEFFORDS
6/29
6/30
HRC/CJ/M
v
LaFalce
HRC/CJ/M
Ways and Means Democrats
HRCnM/JF
I CJIJKJSRI
Stark
Levin
Cardin
Andrews
McDermott
Kleczka
MV
v
-
Health Care Town
Hall Meeting
�6/30
BOXER
KENNEDY
KERREY.
ROCKEFELLER
Gephardt
Bonior
Richardson
Lewis
HRCIIM/JF
I
Shalala/CJI
JK
6/30
DASCHLE COMMUNICATIONS
MEETING
HRC/JF/M
V/JEIBB/JK
-
DASCHLE
MITCHELL
KENNEDY
RIEGLE
PRYOR
REID
ROCKEFELLER
6/30
Gephardt
MITCHELL
HRCIIM/JF
/CJ/MV/
POLLITZ
SHALALA
RICHEITI
6/30
KENNEDY
RV
7/1
McDermott
RV
7/1
Cooper
Stenholm
Andrews, Mike
Glickman
McCurdy
IMIPE/CJ/
RSILM
7/1
CHAFFEE
HRCIIMIM
V/CJIRICH
EITI
7/1
BUMPERS
HRCIIMIM
V/CJIRICH
EITI
7/1
Kasich
HRC/MV
711
BOXER
DASCHLE
METZENBAUM
REID
ROBB
DORGAN
IMIJF/
POLLITZ
�7/8
Upton
7/9
GC
Health Care Town
Hall Meeting
Fazio
LP
Health Care Town
Hall Meeting
7/13
Pomeroy
Robin
Stone/ CJ
LTC
7/14
Congressional Message Meeting
MG/ SG/
PB/ Arnold
Bennett/ IM
I JF
7/15
PRYOR
COHEN
MEG
7/15
House Message Group
Stan
Greenberg/
CJ
'.
Bonoir
Derrick
DeLauro
Levin
Obey
Hoagland
Pomeroy
Hoyer
Cardin
Johnston
Wyden
Strickland
Matsui
Shepherd
7/15
I
''
Health Care Focus Group
Brown
Coleman
Defazio
Deutsch
Hamberg
Hinchey
Margolies-MezvinSk:y
Menendez
Obey
Pelosi
Slaughter
de Ia Garza
McKinney
JF/CJ/SE
Aging and Mental
Health
�7/15
DURENBURGER
IM/JF
7/19
LIEBERMAN
PL
7/20
Cooper
Andrews
Slattery
Glickman
Stenholm
IM/CJ/Lynn
Marghario
7/21
Congressional Message Group
David
Wilhelm/1M
/JF/JE/CJ
DASCHLE
BOXER
KERREY
REID
W;OFFORD
Gephardt
Bonior
Fazio
Kennelly
Richardson
7/21
House Focus Group
Hoyer
Deal
Geren
Gordon
Holden
Kennedy
McHale
Moran
JF/ SE
Health Care Town
Hall Meeting
�7/22
House Focus Group
JF/ SE
Barlow
Collins
Coopersmith
Danner
Frank
Hughes
Hutto
Johnson, E.B.
Kaptur
Long
Mann
Meehan
Maloney
Mazzoli
Neal
Shepherd
7/23
House Focus Group
JF, SE
Bishop
de Lugo
Eshoo
Klein
Murphy
Payne, Don
Peterson
Swett
Valentine
Woolsey
7/27
Daschle
Gephardt
MV,JE
BB,CJ,SE
7/27
House Focus Group
IM, CJ, SE
Ackerman
Dooley
Engel
Lancaster
Romero-Barcelo
Unsoeld
Becerra
Hoyer
�7/28
Committee on Small Business
HRC, CJ,
CH
LaFalce
Smith, Neal
Skelton
Sisisk:y
Bilbray
Mfume
Sarpalius
Poshard
Clayton
Meehan
Danner
Strickland
Velazquez
Tucker
Klink
Roybal-Allard
Hilliard
Lancaster
Andrews
Meyers
Combest
Machtley
Ramstad
Johnson
Zeliff
Collins
Mcinnis
Huftington
Talent
Dickey
Kim
Torklldsen
Portman
-
�7/28
Joint Message Group
"Criticisms and Responses"
HRCIIM/JF
/CJ/MV/JE
SENATE
REID
ROCKEFELLER
WOFFORD
KERREY
BOXER
RIEGLE
DASCHLE
KENNEDY
PRYOR
HOUSE
Gephardt
Fazio
Bonior
Kennelly
Richardson
Hoyer
. 7/29
Senate Focus Group
HRC
BREAUX
DASCHLE
FEINGOLD
HEFLIN
KENNEDY
LIEBERMAN
METZENBAUM
MITCHELL
REID
7/29
Clay
HRC/CJ/M
v
Malpractice
�2/4
WOFFORD
SPECTOR
Blackwell
Mezvinsky
Foglietta
2/4
WOFFORD
Greenwood
HRC
2/7
MITCHELL
COHEN
Andrews
HRC, LC,
MV,
Alswang
2/7
Snowe
HRC
2/8
Simon
HRC, LC,
MV,
. Marshall,
Alswang
-
HRC, MV,
CJ
2/8
Slattery
HRC, MV,
JL
2/9
Rangel
HRC, MV,
JL
2116
BRADLEY
Pallone
Klein
Payne
Menendez
BC,HRC
2/8
DASCHLE
CONRAD
PRESSLER
KERREY
WELLSTONE
Minge
Grams
HRC, MV,
LC, Espy,
Rogers,
Craighead,
Alswang,
Kinsella,
Brogioli,
Weiland
2/18
Obey
Feingold
Kohl
HRC, MV,
LC, Rogers,
Craighead,
Alswang
2119
Feingold
Kohl
Obey
Barrett
Kleczka
HRC
2120
Lambert
HRC, MV,
JL
�2/20
Brewster
HRC, MV,
IL
2/25
WELLSTONE
HRC, MV,
CJ
2/25
CONRAD
HRC, MV,
CJ
2/28
MOYNIHAN
FEINSTEIN
MIKULSKI
HRC, MV,
CJ, LC,
KT,
Craighead,
Marshall,
Jordan,
Fanner,
O'Donnell,
Drummond,
Chandler,
Foster
.
-
..
2/28
Owens
Towns
HRC
2/28
MIKULSKI
BOXER
FEINSTEIN
MURRAY
FEINSTEIN
MOSELEY-BRAUN
liRC
3/1
Pomeroy
HRC~ MV,
JL
3/1
Schenk
HRC, ·CJ,
IM, MV
3/2
BINGAMAN
HRC, CJ,
IM, MV
3/2
BOREN.
HRC, CJ,
IM, MV
3/2
LIEBERMAN
HRC, CJ,
IM, MV
3/4
BRADLEY
HRC, CJ,
IM, MV
3/9
Sharp
HRC, MV,
CJ
3/9
MOSELEY-BRAUN
HRC, MV,
CJ
�3/9
DURENBERGER
HRC, MV,
CJ
3/10
DORGAN
HRC, CJ,
MV, IM
3/10
KOHL
HRC, CJ,
IM, MV
3/14
Skaggs
HRC
3/14
Schroeder
HRC
3/15
Volkmer
HRC
3/15
Gephardt
HRC
3/21
Johnston
Deutsh
Hastings
HRC
3/21
GRAHAM
HRC
3/22
Slattery
HRC
3/23
Foley
Gepbardt
Bonior
Wyden
HRC
3/24
Senate Democratic Policy Committee
Mtg
MITCHELL
HRC, BC,
AG
3/26
Frost
E.B. Johnson
Bryant
HRC
3/31
Schenk
Filner
HRC
4/4
Rostenkowski
MOSLEY-BRAUN
HRC
4/5
MOYNIHAN
Slaughter
HRC
417
ROCKEFELLER
HRC, Ickes
4/8
Snyar
McCurdy
HRC
4/14
Rangel
HRC,
Eugene·
·McCabe
-
�4/16.
MITCHELL
BC,HRC
4118
MIKULSKI
Cardin
Mfume
HRC,
Shalala
4/20
Hoagland
HRC, JL,
MV
4/26
MOSLEY-BRAUN
HRC
4/27
McKeon
Berman
HRC
5/4
KENNEDY
MITCHELL
DODD
KASSEBAUM
JEFFORDS
HRC
5/18
RIEGLE
HRC
6/14
Hefner
Valentine
Neal
Lancaster
Rose
HRC
-
6/22
Daschle
HRC
6/23
Gephardt
Bonior
DeLauro
MITCHELL
DASCHLE
GLENN
HRC
�6/24
Congressional Dinner Naval Observatory
Brooks
Abercrombie
Bilbrary
Brown, George
·Dicks
Frank
Gejdenson
· Johnson, E.B.
Johnston
Lantos
Murtha
Sabo
Skaggs
Smith, Neal
Underwood
Wise
Meek
Slaughter
Long
AG, MEG,
JL, KT, JG,
SE,BA
.
. ,...
.
6/29
Darden
Johnson, Harry
Kreidler
Harman
Bevill
Levin
Slaughter
LaFalace
DeLauro
Skaggs
Fingerhut
Browder
Shepard
Bernice-Johnson
Barca
HRC, JL,
MV
6/29
Gejdenson
Gephardt
DASCHLE
HRC
�-
,
6/30
SMALL BUSINESS EVENT
Andrews
Bacchus
Blackwell
Bonior
Borski
Brown
Bryant
Clyburn
Coleman
Collins, Barbara-Rose
de tugo
DeLauro
,Derrick
Deutsch
Durbin
Engel
Eshoo
Fazio
Fields
Filner
Flake
Norton
Schroeder
Scott
Shepherd
Slaughter
Stokes
Strickland
Synar
Thornton
Thurmond
Watt
Wise
BC, HRC,
EB, CJ, SE
�6/30
..
SMALL BUSINESS (cont'd)
Synr
Frank
Gibbons
Hilliard
Hinchey
Johnson, E.B.
Kennedy
Klein
LaRocco
Meek
McKinney
Menendez
Moran
Pastor
Payne
Price
Reed
Romero-Barcelo
Sabo
711
MITCHELL
HRC,BC
7/2
Jefferson
HRC.
7/20
KENNEDY
WOFFORD
ROCKEFELLER
REID
DASCffi.E
HRC
7/20
Bonior
Gephardt
Hoyer
HRC
7/20
EXON
HRC, MV,
.
CJ
7/21
20 Members
HRC
7/21
MITCHELL
Gephardt
Foley
HRC,BC
7/22
Wyden
DeFezio
Wyden.
HRC
7/23
Murray
McDermott
Cantwell
Kreidler
HRC
Health Securty
Express
�HRC
7/28
DASCHLE
7/30
Wheat
7/30
METEZENBAUM
Fingerhut
Sawyer
Brown, S.
BC,HRC
7/31
KENNEDY
HRC
HRC, VP,
. MEG, BC
Meehen
Moakley
7/31
KENNEDY
KERRY
HRC
Meehan
Moakley
......
�POTUS MEETINGS: JULY 14 -AUGUST ll
July 14th:
Senator
Senator
Senator
Senator
July 15th:
Senator Conrad
July 17th:
Senator Heflin
Senator DeConcini
July 20th:
Senator Lautenberg
Senator Ford
Senator Breaux
July 21st.:
Richard Bryan
J. Bennett Johnston
Joseph Lieberman
Dorgan
J
Majority Leader Mitchell
Speaker Foley
Majority Leader Gephardt
. Senator Hollings
Senator Exon
Senator Kohl
July 22nd:
Senator Lautenberg
Senator Feinstein
July 27th:
Majority Leader Mitchell
Senator Campbell
July 28th:
Senator Bradley
August 1st:
Senator Graham
Senator Robb
August 2nd:
Senator Reid
Senator· Lieberman
August 4th:
Senator Baucus
August 5th:
Senator Breaux
·
�August 8th:
Rep. Peter Barca
Rep. Ben Cardin
Rep. Jim Chapman
Rep. Bob Clement
Rep. Don Johnson ·
Rep. David Mann
Rep. Paul McHale
Rep. David Minge
Rep.· Earl Pomeroy
Rep. Tim Roemer
Rep. Mike Synar
August 9th:
Senator Nunn
Senator Sasser
August lOth: .
Senator Feinstein
August 11th:
Rep.
Rep.
Rep.
Rep.
~ep.
Rep.
·Rep.
Rep.
Rep.
Rep.
Rep.
Rep.
Rep.
Rep.
Rep.
Rep.
Rep.
Glen Browder
Sam Coppersmith
Pat Danner
Buddy Darden
Chet Edwards
Eric Fingerhut
Jane Harman
Tim Holden
Blanche Lambert
Earl Pomeroy
Glenn Poshard (tentative)
Bart Stupak
·
Dick Swett
Tim Valentine
John Lewis
Tom Sawyer (tentative)
Phil Sharp
'\
\
(
\
)
...
'.
\..
'
.
.
(~ '·~
�7/29
House Focus Group
JF/SE
Andrews (ME)
Bacchus
Chapman
Kanjorski
LaFalce
Meek
Peterson
Price
Reed
Roemer
Sangmeister
Scott
Serrano
Skaggs
Tanner
Green
7/29
House Message Group
Bonior
Cardin
Sheperd
Synar
Hoagland
Johnston
DeLauro
Levin
Matsui
MG/SE
�7/29
House Education and Labor
HRC/CJ/M
v
Ford
Murphy
Williams
Owen
Payne
Unsoeld
Andrews, Rob
Roemenr
Becerra
Green
English
De Lugo
Underwood
Woolsey
Engel
Reed
Sawyer
Kildee
Martinez
7/30
House Focus Group
JF/CJ/SE
Beilenson
Chapman
DeLauro
Laughlin
Oberstar
Sarpalius
Sawyer
Strickland
Stupak
Volkmer
Glickman
Farr
8/3
Senate and House Leadership
'
HRC
�8/3
House Focus Group
JF/SE
Cantwell
Conyers
Edwards
Filner
Frost
Hilliard
Ins lee
Johnston
LaRocco
Lowey
Manton
Mfume
Parker
Wise
Smith
Foglietta
8/3
WELLSTONE
HRC
8/3
LaFalce
HRC
8/4
Joint Message Group
HRC/Shalal
a/JF
SENATE
ROCKEFELLER
WOFFORD
DASCHLE
RIEGLE
MITCHELL
KENNEDY
KERREY
BOXER
HOUSE
Hoyer
Richardson
Derrick
Kennelly
Fazio
8/4
Democratic Policy Committee
HRC
8/4
House Progressives (Tuesday Group)
HRC
Machtley
Small Business
�8/4
House Wednesday Group
Doug Bereuter
Bill Clinger
Michael Crapo
Jennifer Dunn
Hamilton Fish
Wayne Gilchrest
Porter Goss
Fred Grandy
Steve Gunderson
David Hobson
Peter Hoekstra
Steve Hom
Amo Houghton
Nancy Johnson
Jack Kingston
Jim Kolbe
Rick Lazio
Jim Leach
Bob Livingston
Jim McCrery
Dan Miller.
Connie Morella
Rob Portman
Tim Petri
Jim Ramstad
Ralph Regula
Marge Roukema
Clay Shaw
Olympia Snowe
·Bill Thomas
Craig Thomas
HRC
�8/4
House Focus Group
Eva Clayon
Glenn English
Jane Harman
George Hochbrueckner
Don Johnson
David Minge
Alan Mollohan
Eleanor Holmes Norton
John Olver
David Price
Charlie Stenholm
Karen Thurman
Maxine Waters
Scotty Baesler
John Spratt
Owen Pickett
Mel Watt
Peter Barca
8/5
NASW and APA
JF/SE
..
HRC
INOUYE
8/5
House Republicans
IM,CH
8/5
Single Payer Working Group
IM, JF, CJ
.
McDermott
Frank
Miller
Clayton
Pelosi
Stokes
8/5
Senate Small Business Committee
(Bipartisan)
BUMPERS
HRC
8/5
Romero-Barcelo
IM, RV, SE
8/6
Kennelly
Matsui
Levin
Cardin
Hoagland
Neal
HRC
Puerto Rico Task .
Force
�8/10
ROCKEFELLER
HRC, IM,
CJ
8/10
Dingell
HRC, MV,
CJ
8/10
Rostenkowski
HRC, MV,
CJ
8/11
Waxman
HRC, IM,
CJ
8/11
KENNEDY
HRC, IM,
CJ
919
Congressional Leadership Mtg
MITCHELL
Foley
Gephardt
HRC
9/28
House Ways & Means Committee
38 Members
HRC
9/28
House Energy & Commerce Committee
44 Members
HRC
9/29
Senate Labor &. Human Resources
HRC
9/29
Education and Labor
HRC
9/30
Senate Finance Committee
MOYNIHAN
PACKWOOD
HRC
9/20
Health Care University
320 Members
HRC.
9/21
Ways and Means Committee
38 Members
HRC
9/23
BREAUX
HRC, CJ,
AR, MV
Coope~
10/5
Mezyinsky
.
HRC,LC
v:·-
--
~ ~X/"' ~
/
10/8
CHAFFEE
PELL
Reed
Matchtley
HRC
10/20
Waxman
HRC, MV,
CJ,JF,JL
.•+
..
./~
I'Y~/
/
�10/20
KERREY
DASCHLE
HRC, MV,
IM, CJ
10/21
Collins, Cardis
HRC
10/21
Rush
HRC
10/21
Rostenkowski
HRC
10/23
LaFalace
HRC
10/25
Hayes
HRC
.10/25
Dingell
HRC,
Shalala
10/26
MOYNIHAN
HRC,
Rivlin,
Bentsen,
IM, CJ,
MV,
Altman,
Binder
10/26
MIKULSKI
HRC, CJ,
AR, IM,
MV
10/27
Senate Cosponsors
Bipartisan House/Senate Leadership
Foley
Gephardt
Michel
DOLE
MITCHELL
BC,HRC
10127
Bipartisan Members of Congress
BC, HRC,
Riley,
Tyson
10/27
MITCHELL
BC,HRC
10/28
Cardin
BC,HRC
10/28
Pickle
HRC
10/29
Danner
Wheat
HRC, MV
Craighead,
Lattimere.
Kinney,
Meyers
�10/29
Congressional Delegation
DOLE
McCAIN
BOND
DANFORTH
KASSENBAUM
Wheat
Danner
Meyers
HRC,MV
Craighead,
Lattimere,
Kinney,
Meyers
11/3
SPECfER
WOFFORD
Klink
Murphy
HRC
11/4
ROCKEFELLER
Wise·
HRC
1115
MOYNIHAN
LaFalace
Boehl en
Hinchey
HRC
11/6
GRAHAM
BOXER
MITCHELL
HRC
11110
House Leadership Meeting
HRC
11110
Message Group Mtg.
12 Members
HRC
11/12
GLENN
Stokes
HRC
11/12
Strickland
HRC
11/14
Dinner w/ Congressional Members
HRC
11115
Slaughter
HRC
11116
Shays
Houghton
HRC
11118
Bacchus
HRC
11119
Freshman Democratic Members
SS Members
HRC
11/29
Gephardt
HRC
11129
ROCKEFELLER
HRC
I
-
-L
�12/2
Sanders
Swett
HRC,MV
Craighead,
Caputo,
Alswang,
Margherio,
Rabner
12n
COHEN
MITCHELL
KENNEDY
BOND
Moakley
Studds
Andrews
17 other unlisted Members
HRC, MV,
Craighead,
Caputo,
Epstein,
Fanner,
Nemko
~EN
I~ ~~:
/
//"'-.
12/8
HRC,
,1
/ ' "''·. . / ' f'..Cr · ea ,
'·
uto, ."
Epst · -,
r,
F
Ne 0
~-yx
HSA Cosponsors
12/8
-
10 Members
BC,HRC
HRC,
Panetta
12/9
Bonior
HRC, MV,
IM, CJ, JL
12/16
HARKIN
HRC, MV,
CJ
12/20
ROCKEFELLER .
HRC, MV,
CJ
12/21
Matsui
HRC, MV,
JL
1/6
Richardson
HRC
1/26
Congressional Meeting
HRC,BC
1/26
Cardin
HRC, MV,
JL
1/27
Dixon
HRC
1/28
Bilbray
Reid
HRC
2/3
Hall
HRC, MW,
MV, AB
/
..
..
·'
'
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
HRC - Health Care Correspondence [1]
Creator
An entity primarily responsible for making the resource
First Lady's Office
Maggie Williams
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 4
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-2194630-20060223F-004-007-2015
2194630
-
https://clinton.presidentiallibraries.us/files/original/34a5e3ad300f2045952bc64d897e8f8f.pdf
347f6e9845cd5320762c744b3bde5ec5
PDF Text
Text
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. fax
DATE
SUBJECTffiTLE
Fax cover sheet. Jeff Gutman to MaJjorie Tanney. [partial] (1 page)
08/06/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
FACADocuments [5]
2006-0223-F
ab861
RESTRICTION CODES
Presidential Records Ad -144 U.S.C. 2204(a))
Freedom of Information Ad -IS U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRAJ
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIAJ
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or fmaneial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. fax
SUBJECTffiTLE
DATE
Fax cover sheet. Jeff Gutman to Marjorie Tanney. [partial] (1 page)
08/06/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
FACADocuments [5]
2006-0223-F
ab861
RESTRICTION CODES
Presidential Records Act - 144 U.S.C. 2204(a))
Freedom of Information Act- IS U.S.C. SS2(b))
PI National Security Classified Information l(aXI) of the PRA)
P2 Relating to the appointment to Federal office l(aX2) of the PRA)
P3 Release would violate a Federal statute l(aX3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information l(aX4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors laXS) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy l(aX6) of the PRA)
b(l) National security classified information l(bXI) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency l(bX2) of the FOIA)
b(3) Release would violate a Federal statute l(bX3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information l(bX4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy l(bX6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes l(bX7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions l(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weUs l(bX9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf'lle defmed in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
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FtAJAt_
UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC,
AMERICAN COUNCIL FOR HEALTH
CARE REFORM AND NATIONAL
LEGAL & POLICY CENTER,
)
)
)
)
)
)
Plaintiffs,
8/~
Civil Action
No. 93-399
)
)
v.
DRAFT i..f
(Judge Lamberth)
)
HILLARY RODHAM CLINTON,
DONNA E. SHALALA, Secretary of
Health and Human Services,
LLOYD E. BENTSEN, Secretary of
the Treasury, LES ASPIN,
Secretary of Defense, JESSE
BROWN, Secretary of Veterans
Affairs, RONALD H. BROWN,
Secretary of Commerce, ROBERT
B. REICH, secretary of Labor,
LEON E. PANETTA, Director of
the Office of Management and
Budget, ALICE RIVLIN, Deputy
Director of the Office of
Management and Budget, CAROL
RASCO, IRA MAGAZINER and
JUDITH FEDER, White House
Advisors and THE PRESIDENT'S
TASK FORCE ON NATIONAL
HEALTH CARE REFORM,
Defendants.
}
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
•)
__________________________________
}
)
)
)
)
)
)
DEFENDANTS' RESPONSES AND OBJECTIONS TO
PLAINTIFFS' FIRST SET OF INTERROGATORIES AND
SECOND SET OF REQUESTS FOR PROQUCTION OF DOCUMENTS
Pursuant to Fed. R. Civ. P. 33 and 34, defendants respond
and object to plaintiffs' first set of interrogatories and second
set of requests for production of documents as follows.
GENERAL OBJECTIONS
1.
The question remaining in this action is whether the
interdepartmental working group, or its cluster groups or
�r.u.J
subgroups, were "advisory committees" subject to the Federal
Advisory Committee Act ( 11 FACA").
The D.C. Circuit instructed
that the relevant factors for resolving this question are the
groups' structure, personnel and purpose.
AAPS
v. Clinton, No.
93-5086, slip op. at 29-33 (D.C. Cir. Jun. 22, 1993).
The
factual issues relevant to this question include how formally the
groups were structured and operated, the extent to which the
groups rendered advice as a group or as a collection of
individuals, how large and anonymous the groups were, the nature
of the groups' membership, the roles of the special government
employees and ''consultants 11 in the groups' activities, and the
extent to which the groups' members interacted with each other.
See JJL_
These requests seek information beyond that which the D.C.
Circuit held to be relevant for resolving the remaining issue in
this case.
Defendants therefore object to this discovery to the
extent that it seeks information that is irrelevant to the issues
listed supra and is not reasonably calculated to discover
relevant and admissible evidence relating to them.
Moreover, defendants object to these requests to the extent
they seek documents and information that would reveal the groups'
substantive work product.
Assuming arguendo that such materials
are not exempt from disclosure under the FACA, the Freedom of
Information Act or constitutional principles, plaintiffs would be
entitled to receive them only by first prevailing on the merits
2
�r,u't
of their FACA claim.
Plaintiffs are not entitled to receive in
discovery materials sought on the merits.
Finally, defendants object to discovery about the
President's Task Force on National Health Care Reform and the
"audit" and other groups, identified infra, that acted in
connection with the Task Force or interdepartmental working
group.
The D.C. Circuit held that the Task Force was not an
advisory committee subject to the FACA, rendering discovery
related to it irrelevant to whether the inter-departmental
working group was such a committee and not reasonably calculated
to the discovery of relevant evidence.
In their complaint, plaintiffs did not claim that the
interdepartmental working group or its subgroups were subject to
the FACA or that the "audit" or other groups were.
Although the
D.C. Circuit remanded to this Court the issue of whether the
interdepartmental working group was an advisory committee subject
to the FACA, it did not remand for resolution the status of any
other groups.
Discovery about these latter groups is,
accordingly, inappropriate.
2.
Defendants object to plaintiffs' use of the term "Task
Force groups" as inaccurate and misleading.
Many of the groups
identified herein were not established by the Task Force and many
had no relationship to it.
In these responses, defendants will
employ terms used during the process at issue and defined as
follows.
3
.-
�r.uo
The "Task Force" was the President's Task Force on National
Health care Reform.
It was chaired by the First Lady and was
composed of six cabinet secretaries, the Director of OMB, the
Chair of the Council of Economic Advisors and three senior White
House advisors.
The purpose of the Task Force was to review
information and options provided by the interdepartmental working
group and to furnish the President with advice and recommendations on a health care reform proposal.
The Task Force did
not create any subcommittees or subgroups.
The "interdepartmental
\~orking
group" was a group of
individuals, ultimately numbering over 500, employed as regular
or special government employees and subject to federal ethics
rules, who together served an essentially staff function,
gathering information about the current health care system and
developing options for its reform.
The "interdepartmental working group" was divided into
twelve "cluster groups," each of which examined a different
aspect of health care reform.
for reference as
indicat~d
Each was assigned a roman numeral
in Tab 19.
some of the "cluster groups" were further divided into
11
subgroups. 11
Undivided "cluster groups" and the "subgroups 11 were
each assigned a number and defendants will refer to them herein
as "working groups."
several "audit" groups, "outreach" groups, and consumer
panels were also created, but were not part of the interdepartmental working group.
Unlike the working groups, these
4
�r.uo
''"',..
v
uv a-n.&
au•c..,
other groups and panels were entirely-composed of individuals
from outside the government and were tasked with reviewing
portions of the options papers prepared by the working groups.
REQUEST NO. 1;
Identify all members of the President's Task Force on Health
Care Reform ("the Task Force") ,
RESPONSE TO REQUEST NO, 1:
Notwithstanding General Objection 1, the former members of
the President's Task Force on National Health care Reform were:
Chairperson Hillary Rodham Clinton;
Secre~ary
of the Treasury
Lloyd Bentsen; Secretary of Defense Les Aspin; Secretary of
Commerce Ron Brown; Secretary of Labor Robert Reich; Secretary of
Health and Human Services Donna Shalala; Secretary of Veterans
Affairs Jesse Brown; Office of Management and Budget Director
Leon Panetta; Assistant to the President for Domestic Policy
carol Rasco; Assistant to the President for Economic Policy
Robert Rubin; Council of Economic Advisors Chair Laura Tyson and
Senior Advisor to the President for Policy Development Ira
Magaziner.
REQUEST NO
I
l.;
Identify all persons who served as members of, participated
in meetings of, attended meetings of, and/or were invited to
attend meetings of the Task Force, the Task Force interdepartmental working qroup 1 all cluster groups, the Health
Professional Review Board, the qroup{s) looking at legal issues,
and the group{s) looking at administrative simplification and
5
�P.07
quality issues, and any other groups or subgroups that were
created, formed, established, held meetings, reported to,
rendered advice or information to, or otherwise assisted,
supported, or acted in connection with the Task Force and the
groups specified above, (hereinafter, all of the foregoing
groups, including the Task Force, shall be referred to
collectively as "Task Force groups") and any and all advisors or
consultants to any of the Task Force groups.
In identifying all
such persons, indicate all Task Force groups with which they were
associated.
RESPONSE TO REQUEST 2:
Subject to the general objections stated above, defendants
respond as follows:
The Task Force
The .identities of persons who served as members of the Task
Force are provided in defendants' Response to Request No. 1.
Defendants specifically ob_ject to the request for identification
.
of persons who attended
me~tings
of, or were invited to attend
meetings of, the Task Force on the ground that such request is
irrelevant to the remaining issue in this case and not reasonably
calculated to lead to the discovery of admissible evidence.
Moreover, to the extent that lists of individuals invited to and
attending such meetings can be created, the names of individuals
attending closed, deliberative meetings of the Task Force are
subject to the privilege protecting Presidential
com~unications.
See AAPS v. Clinton, No. 93-5086 (D.C. Cir. Jun. 22, 1993); AAPS
6
�r.utl
v. Clinton, 813 F. Supp. 82, 92-93
(D.o.c. 1993). A list of
speakers who made a presentation to the Task Force at the March
29, 1993 public hearing is provided at Tab 1.
The Interdepartmental Working
The document at Tab
2
Grou~
is an alphabetized list of individuals
who participated in the interdepartmental working group.
Included in this·list are regular (ederal employees employed by
the Executive or Legislative Branches, special government
employees, "consultants, 11 and individuals employed by state or
local governments or associations 1 who were retained or
dispatched by their employer to participate on the
interdepartmental working group.
The employment affiliations of regular federal employees are
indicated by the name of their department, agency, congression,al
committee or office or other federal entity.
Some are denoted by
the name of a department followed by a slash and name of
departmental unit, such as "HHS/HCFA."
For the remaining
individuals, the names of the federal entity that obtained or
received their services, paid or unpaid, is followed by a hyphen
and the names of their permanent employers, if any, such as "WHOBoston University. 111
As indicated below, there were a few
These categories of participants are not mutually
exclusive.
1
z The initials "WH0 11 denote the White House Office.
Because the·White House Office of Intergovernmental Affairs
played a role in coordinating the participation of
representatives from state and local governments and
associations, these individuals' affiliations are also preceded
by the initials "WHO."
7
�r.u~
additional individuals listed who may have maintained expert or
consultancy agreements prior to the advent of the working group
or for purposes of participating on the working group with an
entity within the Department of Health and Human Services.
They
have been designated as being retained by HHS pending a search
and review of pertinent documentation, if any.
Defendants will
attempt to confirm this designation and will supplement this
response if additional information becomes available.
addresses of government offices and the
organi~ations
The
listed are
matters of public record,l
The document at Tab 3 is a list of individuals who
participated with each working group. 4
This list reflects the
fact that many people served on more than one working group.
In
addition, some individuals who appear on the list at Tab 2 do not
appear among those who participated on particular working groups
according to the list at Tab 3.
Many of these individuals served
Mr. Magaziner's first declaration, dated March 3, 1993,
indicated that several agencies, including the Department of
Defense and the Office of Management and Budget, retained special
government employees and consultants. The Department of Commerce
retained three individuals who participated in administrative .
capacities on the working group. The Department of Defense did
task an individual (William Hix) who was engaged in executing a
pre-existing contract to participate in the interdepartmental
working group. The Office of Personnel Management retained an
independent consultant (Stanley Jones) to assist a working group.
William Welch of the Urban Institute participated in the working
group on an unpaid basis through OMB. Ultimately, however, it
was decided that federal entities other than the White House
Office and HHS would not retain additional special government
employees (SGEs) and "consultants."
3
No list for Working Group lA exists.
8
�t'. 1U
the interdepartmental working group in largely administrative
roles. 5
A number served on Ira Magaziner's staff and are
denominated as "policy analysts,"
assistants."
11
special assistants 11 or "policy
Others were employees of HHS.
The "policy
.analysts," "special assistants" and HHS employees generally had
broad administrative responsibilities and were not identified
with a particular working group or groups.
"Policy assistants 11
were generally assigned to perform administrative functions for
particular cluster groups as follows:
Name
GroupCsl
Gail oaumit
Karen Paul
Marjorie Ross
Michelle Manowitz
Jim Jorling
Margery Gehan
Theresa Picillo
Lauren Kelley
Deborah Levine
Anne Stoline
Susan Otrin
Helen Levy
I
I
I
II
III
IV, V, VII
IV, V, XI
VI
VIII
IX
X
XII
Maria Bueno also served as a policy assistant for a short
period of time.
The lists do. not include the names of large numbers of
volunteers who served in the Intake Center by opening and
responding to mail and assisting with scheduling.
Tabs 2 and 3 should not be considered "membership" rosters.
A number of individuals listed served as part-time or intermit tent "consultants" who were regarded not as ''members" of the
$
Working group affiliations for the remaining individuals
could not be determined.
9
�r.
11
interdepartmental working group, but as advisors on particular
issues to specific working groups.
Given the fluid and dynamic
process by which the interdepartmental working group was formed
and operated, "membership 11 was not a significant or operative
concept.
Instead, Tabs 2 and 3 are simply lists of individuals,
most of whom were chosen by their
cJf~~
employer~ to~a
meeting or
meetings of a working group or groups.
Nor should Tabs 2 and 3 be understood as fully exhaustive or
completely accurate lists of individuals who participated on the
interdepartmental working group or of the participants on
individual working groups.
Mr. Magaziner and his staff did not
select or appoint the substantial majority of the participants of
the interdepartmental working group.
Federal departments,
agencies or Congressional offices designated most of the
participants.
Nor did Mr. Magaziner and his staff assign most of
the working group participants to serve on particular working
groups.
·Individuals, often with their employing agency or
office, typically selected the working groups they wished to
participate on depending on their interest and background.
The
lists provided at Tabs 2 and 3 were therefore not derived from
central rosters of individuals Mr. Magaziner and his staff
selected to participate on the interdepartmental working group.
Rather, the relevant departments, agencies, White House
Offices and Congressional offices and state and local governments
supplied Mr. Magaziner and his staff with many of the
na~es
of
individuals they designated to serve on the interdepartmental
10
�r.
working group at the beginning of the process..
1~
Some of these
individuals did not ultimately participate in meetings.
Moreover, many individuals were subsequently added to the working
groups later in the process.
Some policy assistants also prepared lists of individuals
who attended certain cluster or subgroup meetings or who were
selected by Congress and federal departments and agencies to
serve on the interdepartmental working group.
Nonetheless, some
individuals attended meetings of cluster or subgroups without
being listed by a policy assistant.
The policy assistants also
noted some names of individuals who needed to be
c~eared
through
building security to attend meetings at the Old Executive Office
Building.
However, those who already worked in the Old Executive
Office Building, attended meetings outside the building or had
alternative means of obtaining clearance into the building, may
not have been noted.
several weeks after the interdepartmental working group
..
began its work, Mr. Magaziner's staff developed and circulated a
standardized form to obtain basic information from the working
group participants.
Nonetheless, not all participants completed
the form, and some individuals ended their participation in
meetings prior to the circulation of the form.
Moreover, Mr. Magaziner and his staff did not impose a
requirement that sign-in sheets be circulated at meetings.
Nor
were formal invitations issued to individuals to attend working
group meetings.
All participants on the interdepartmental
11
�t' 1.~
I
working group were welcome to attend any working group meeting
and they often did.
Individual participants frequently met to
discuss ideas and assignments outside the working group meetings.
Mr. Magaziner and his staff did not organize such meetings,
require that they approve the meetings, issue formal invitations
or maintain any central record of such meetings or who attended
them.
Thus, Tabs 2 and 3 are derived from several different
sources and by different means.
As a result, they contain the
names of some individuals who did not attend any meetings or
attended only one or two.
Similarly, some individuals who did
attend some working group meetings are not listed.
Defendants specifically object to identifying any further
groups or individuals that acted in connection with the Task
.
Force or interdepartmental working group to the extent that such
-
information is not relevant to the remaining issue in this case
and is not reasonably calculated to lead to the discovery of
admissible evidence.
See General Objection l.
Notwithstanding
this objection, and because this information is already in the
public domain, defendants provide the following information on
these additional groups and individuals:
The Audit Groups;
Five "audit groups" were established.
Tab 4 is a list of
the members of the group examining cost issues.
Tab 5 is a list
of the members of the group examining administrative issues.
Tab
6 is a list of the members of the group examining legal issues.
12
·--
~
�r.
14
Tab 7 is a list of the members of the qroup examining issues
pertaining to minorities.
Tab 8 is a list of the members of the
qroup examining issues pertaininq to health care providers.
The Drafting Group:
A separate group focused exclusively on drafting proposed
leqislation to implement health care reform initiatives.
The
group differs from the working groups because it was not tasked
with reviewing information and developing health care reform
policy options.
[The following list has NOT been m•de public before to
One approach we can, take is simply to
identify that the group exists, as the first Maqaziner
declaration-did and refuse to provide the names as
irrelevant. Ira will have to make the call on this.]
my knowledge.
Participants in this group include Sarah Rosenbaum, Peter
I~
~etti,
Gawande.
Diane Roland, Greg Lawler, Jennifer Klein, and Atul
Other individuals may have participated on an
intermittent basis.
Othe~
Groups:
The interdepartmental \-Jerking group also rec.eived input from
a large number of health-care consumers organized into groups
focusing on discrete issues (a list of these groups and their
members is attached at Tab 9) and twelve
11
outreach groups 11
composed of health-care professionals (a list of these groups and
their members is attached at Tab 10).
[Concern has been raised about i4enti!yinq the
political group. Legally, it seems possible to justify
not identifying it as both nonresponsive and
irrelevant. Ira did not express concern about
including it and the names of its members. verify that
he wishes to include it. Its Ira's call.)
13
�r. 1:>
An additional group addressed the political aspects of
health care reform, meeting to discuss the legislative prospects
of possible proposals and the public's views on health care
reform issues.
This group was not part of the interdepartmental
working group and included Stan Greenberg, Mandy Grunwald, Paul
Begala, Mr. Magaziner and staff members of the White House
Offices of congressional Affairs, Intergovernmental Affairs,
Political Affairs, and Communications. Did I forget anyone???
Outside Groups
~
An enormous number of groups, organizations and individuals
~ =~ the public and private sectors also had input in this process.
The White House Offices of Public Liaison, Intergovernmental
Affairs, Political Affairs and congressional Affairs were
frequently involved in setting up meetings with such groups,
organizations and individuals or were informed of such meetings
convened by working groups or participants thereof.
Tab 11 is a list of groups, organizations and private
individuals who met with the President~ Task Force members or
working 9roup participants during the
and working group and
~xistence
of the Task Force
thereaf~er.
Tab 12 is a list of representatives of state and local
9overnrnents who met with the President, Task Force members or
working group
p~rticipants
through mid-May [????].
Tab 13 is a list of Members of Congress and Congressional
staff who met with Task Force members or working group
participants through mid-May.
14
�r.
10
Because of the number of participants on the interdepartmental working group, the group's strict timetable, the
encouragement given to them to contact outside individuals to
obtain data and information as needed and the substantial effort
undertaken to hear the views of outside parties, Tabs 11-13 do
not record every such contact.
Working group participants
frequently met or communicated with outside groups or individuals
or public and private sector colleagues in their efforts to
obtain information on the existing health care policies and
alternatives to them without listing or noting those contacts.
As a result, the lists.at Tab ll-13 are not exhaustive lists of
groups, organizations and individuals who may have given advice
or information to the interdepartmental working group or its
EST NO. 3:
State the identity of all documents and communications
relating to the persons identified in response to Interrogatories
1 and 2, including all docu~ents relating to any meetings held by
the Task Force groups or by· members of the Task Force groups with
other persons and the dates and locations of the meetings,
including but not limited to meeting agendas, meeting minutes, a
list which stated the identity of all meeting attendees for each
meeting, including their names, addressees, and occupations, and
any and all documents and communications which identify the roles
of the meetings' participants and the purpose of the meetings.
RESPONSE. TO REQUEST NO.
3~
15
�r.
11
Defendants object to this request on the ground that it is
overbroad, seeks information that is irrelevant to the issues
determined to be pertinent on remand by the D.C. Circuit and is
not reasonably calculated to lead to the discovery of admissible
evidence.
The request asks defendants to identify not only
virtually all working group-related documents and communications,
whether or not related to the structure, personnel and purpose of
the working group, but also seeks the identity of documents that
merely "relate to" the individuals listed in Tabs 2 and 3.
The
request thus would require defendants to identify in discovery
thousands of documents to which plaintiffs could only obtain
access, if at all, by prevailing on the merits.
See General
Objection 1.
Moreover, de.fendants object to the request on the ground
that it is vague.
The request asks defendants to identify
documents "relating to" meetings held by "Task Force groups" or
their members with
11
other persons."
The tern "other persons" is
undefined and may refer to other participants on the
interdepartmental working group, persons with whom working group
participants met in connection with their work on the working
group or persons with whom \olorking group participants met
unrelated to their working group efforts.
Notwithstanding these objections, information apparently
responsive to this request has been provided in response to
Request No. 2.
Notwithstanding these objections and those set
forth in General Objection 1, and without conceding that such
16
�I I
IV
information is relevant, defendants state that neither Mr.
Magaziner nor his staff directed that aqendas, minutes or
attendance lists be prepared for cluster and subgroup meetings or
for meetings between working group participants and outside
parties.
steve expressed oonoern about including reference to
agendas for fear of conceding relevance. Since
plaintiffs specifically raised agendas, I feel as
though we should mention them. X hope that the
additional language should resolve steve's ooncern. We
also need to be sure that the statement is fully
accurate.
REQUEST NO. 4:
As to each person who served as member of, participated in
meetings of, or attended meetings of a Task Force group, if the
person was not a full-time officer or employee of the Federal
Government state:
(a) whether the person was a special government
employee while
pe~forming
services for a Task Force group;
(b) whether the person was deemed to be, or denominated
as, a·consultant to a Task Force Group;
(c) The name of the person's regular employer and the
person's job title with than employer (If
a~y
such person was
self-employed, identify any partnership, group practice, firm or
other entity with which the person was affiliated in offering the
person's services for remuneration);
(d) the length of time that the person performed
services for any Task Force group and, if the person received any
remuneration while performing services for a Task Force group,
17
�the amount of remuneration received (including payment or
reimbursement for out-of-pocket and travel expenses) and the
identify of the entity providing the remuneration.
RESPONSE TO REQUEST NO. 4:
Defendants object to this request because it incorrectly
assumes that the SGEs who performed services
f~r
the inter-
departmental working group were riot full-time officers or
employees of the federal government.
Notwithstanding this objection, defendants state that the
term "special government employee•• is defined in 18 U.S. C.
202(a).
§
The term denotes a category of federal officers or
employees who are retained, designated, appointed or employed to
perform temporary duties, with or without compensation, for a
period not to exceed 130 days during any 365-day period on a
ful.l-time or intermittent basis.
SGEs are subject to federal
ethics rules that are·more limited than those to which regular
federal employees must adhere.
The terms
11
special government employee 11 and "consultant," as
employed in this litigation, are not necessarily mutually
exclusive. 6
11
Consultants 11 may be SGEs if they satisfy the
definition of SGE set forth in
consultant has an
§
202(a).
employ~rjemployee
As a result, if the
relationship with the
government, and the consultant satisfies the remaining
6
Nor, it should be noted, are the terms necessarily used
by federal departments and agencies to denote an employment
status. Federal personnel materials commonly use the terms
"expert" and "consultant."
18
�1 • ~u
requirements of§ 202{a), the consultant is an SGE for purposes
of determining the ethics restrictions to which the consultant is
subject.
In contrast, some consultants may be ,independent
contractors, not government employees, and thus not subject to
the ethics restrictions imposed on SGEs unless those restrictions
are incorporated in any contract that retains the services of the
consultant.
Because the legal definitions of SGEs and "consultants" are
not mutually exclusive, the distinction drawn between them is
essentially a practical one, based on degree of participation.
Those who participated on a regular, full-time basis have been
placed in the SGE category, and were permitted to supervise
others.
Those who participated intermittently, not attending
meetings regularly and providing periodic advice upon request .on
particular subjects have been placed in the "consultant"
category.
They did not supervise others and were regarded as
consultants to a working group and not as a
11
member 11 of one.
Given this explanation, the individuals listed in Tab 14 are
special government employees, subject to a limited set of ethics
restrictions, who participated in the interdepartmental working
group on a full-time or regular basis.
Incluc~d
in this list are
a small number of individuals whose services may have been
obtained by HHS prior to the advent of the working group or who
were retained to participate in the interdepartmental working
group, but whose documentation has not yet been accessed.
Because of the nature of their participation in the working
19
�r.
c.1
group, they were regarded as special government employees subject
to the relevant ethics rules.
These individuals include: Richard
Frank, Deborah Lewis-Idema, Joanne Lukomnik, Sheila Pires,
and Ann zuvekas. 7
"Consultants," as defined above, are listed in Tab 15.
This
list also includes individuals who may have had pre-existing
Consultancy agreements with HHS or agreements made for the
specific purpose of using their services in the interdepartmental
working group, but whose documentation has not yet been accessed.
These individuals include: Thomas Chapman, cathi Callahan, James
Mays and Gordon Trapnell.
Individuals employed by state and local governments or
organizations are listed separately in Tab 16.
The list includes
persons who participated either regularly or intermittently.
Moreover, the individuals who served on the "audit" groups,
Tabs 4-8, were provided an ethics briefing and advised that they
are subject to the ethics restrictions applicable to SGEs.
HHS maintained time records for the paid SGEs and
"consultants" brought on specifically to perform services for the
interdepartmental working group.
at Tab 17.
Those time records are provided
Defendants have not located similar time records for
7
HHS has confirmed that Sybil Goldman and Beth Stroul
maintained pre-existing professional services agreement with HHS.
The remaining individuals listed may have encered similar
agreements with HHS or a component thereof prior to or at the
time the working group began its efforts. If this information
becomes available, defendants will supplement this response.
20
�r , c.c.
,,_._
..,
vv
1
,,.
&v· vv
the remaining individuals listed in Tabs 14-16 and do not believe
that such records exist,
The SGEs and consultants listed as having been obtained by
the White House Office, including the employees of state and
local governments or associations, or OMB were not paid for their
work on the interdepartmental working group.
The individuals
listed as have been hired through the Department of Commerce and
the Office of Personnel Management were paid for their work by
those agencies.
The following persons hired by HHS to
participate in the interdepartmental working group were also paid
for their work by HHS:
Thomas Pyle
Lois Quam
Sally Richardson
David Satcher
Jane Schadle
Aaron shirley
Shoshana Sofaer
Paul Starr
Robyn stone
Robert Valdez
Robert Veloz
Joshua \viener
Walter Zelman
Linda Aiken
Robert Berenson
Linda Berqthold
Richard Brown
Gary Claxton
Shelley Crow
Richard Curtis
Denise Denton
David Eddy
carolyn Handy
Richard Kronick
Alan Krueger
Roz: Lasker
Larry Levitt
Simi Litvak
Katherine Lohr
Carol Miller
The following
~ersons
obtained by HHS to participate in the
interdepartmental working group were not. paid for their work by
HHS:
Judith Eddy, Arnold Epstein, Alan Hillman, Mark Smith, Ciro
Sumaya and Farah Walters.
Hix
maintain~d
Sybil Goldman, Beth stroul and William
pre-existing paid consultancy agreements with the
federal government.
The financial arrangements for those
21
�l
··-- - --
......
--
• '-V'
-·
remaining individuals designated as being brought on the
interdepartmental working group by HHS is not known; this
response will be supplemented should additional information
become available.
Defendants object to providing any information regarding the
amounts that these employees were paid or reimbursed for
expenses.
This information is irrelevant to the remaining issue
in this case
and,~}reasonably
admissible evidence.
calculated to the discovery of
Moreover, release of this information would
result in an unwarranted invasion of personal privacy.
Notwithstanding this objection, the full-time HHS SGEs were
permitted to submit a voucher for reimbursement of one round trip
plane ticket to Washington, o.c.
Part-time experts were allowed
reimbursement for each round trip to Washington, D.c., plus pe,r
diem, when they were requested to come to Washington.
HHS SGEs were reimbursed for travel expenses.
was provided for
~ther
expenses.
Seventeen
No reimbursement
The White House SGEs and
individuals from state and local governments or organ.izations
were not paid for their services.
Final determinatio.ns for
reimbursement for travel expenses have not be€n made, but the
total reimbursement for such expenses is expected to be limited.
REQUEST NO. 5:
Identify all documents reflecting the information provided
in response to Interrogatory 4, including but not limited to
conflict of interest or ethics forms supplied to or signed by the
22
�persons performing services for the Task Force qroups, payroll
records, expense accounts, expense records, and travel records.
BESPONSE TO REQUEST NO. 5:
See Response to Request No. 4.
Both the White House and HHS
collected the financial and other information needed to determine
whether prospective participants in the interdepartmental working
group from outside the [federal?] government presented a possible
conflict of interest.
SGEs and consultants retained by
HHS
specifically to participate on the workinq qroup (listed in
response to Request No.
7)
completed either an SF 278 (Public
Financial Disclosure Report) or an SF 450 (Confidential Financial
Disclosure Report).
These forms are provided at Tab 18.
In addition, White House and HHS personnel conducted several
ethics briefings to which individuals not permanently employed, by
the federal
gover~ment
audit groups.
were invited, including members of the
They were advised of the ethical restrictions to
which they were subject and provided copies of the Standards of
Ethical Conduct for Emplcyees of the Executive Branch (prepared
by the United States Office of Government ~thics) and a summary
of the Standards.
Additional materials were provided at or
following these briefings.
REQUEST NO. 6:
Describe the operations, activities, purposes, structure,
and organization of each Task Force group.
RESPONSE TO REQUEST NO. 6:
23
�r.~o
In addition to the general objections stated above,
defendants object to this request to the extent it seeks
infonnation regarding the "operations" and "activities" of the
interdepartmental working group and the other groups identified
herein.
Such information is irrelevant to the structure, purpose
and personnel of these groups, and not reasonably calculated to
lead to the discovery of admissible evidence relevant to the
remaining issue in this case.
Notwithstanding these objections,
defendants respond as follows:
The purposes, structure and organization of the
l
interdepartmental working group, its cluster groups and subgroups
are not easily described or sumruari2ed.
The working group
process was an evolving one, intended to adapt to needs as they
arose, and a flexible one, designed to provide the professionals
on the working group the latitude necessary to accomplish a
considerable task in a short period of time.
Thus, different
cluster and subgroups worked differently, depending on the issues
they were studying, the personaiities and needs of their leaders
and the efforts of their parti6ipants.
The following discussion
is not intended and should not be interpreted as an
e~haustive
and detailed description, but instead is.a general overview of a
process that involved more than thirty groups, more than 500
people and thousands of meetings.
The interdepartmental working group generally gathered
information concerning existing health care
services and developed
pos~ible
alternatives
24
p~licies
~c
and delivery
the current
�health care system.
The interdepartmental working group was not
charged with making, and did not make, recommendations directly
to the President.
Instead, its components presented options to
Mr. Magaziner.
The interdepartmental working group did not gather
information or develop options for change as a group.
Indeed,
Mr. Magaziner called the entire interdepartmental working group
together for a meeting only twice, both neat the end of its
process.
(Ann Hall at HHS advises that there was a large ethics
briefing on March 2.
was this a meeting of the
Ch~rlotte
whole working group convened at that time?]
The purposes of
these meetings were primarily administrative, but also afforded
Mr. Magaziner an ·opportunity to thank the participants for their
efforts, to update them on the status of their work and to answer
questions.
These meetings were not intended for the group as a
whole to deliberate or decide on health care reform options to
present to the Task Force or to present information or options to
the Task Force.
The interdepartmental working group was aivided into cluster
groups.
Some of the cluster groups were, in turn, divided into
subgroups.
The names and
nurr~ers
of each of the cluster groups
and subgroups are indicated in Tab 19,
cluster and subgroups
~ere
Mr. Magaziner's direction.
infr~.
Not all of the
created at the same time or created at
Flexibility was required to respond
to needs to study new issues as the need arose and to do so
effectively.
25
. ·-.
..
�I I '- I
The purpose of each cluster and subgroup was different as
each studied different aspects of the health care system.
purposes of these groups are suggested in their names.
The
Shortly
after the interdepartmental working group was established,
departments and agencies \vere asked to provide employees to serve
on the working group.
These employees were generally allowed to
select which working group they wished to partic"ipate in; many
agency employees had particular areas of expertise that lent
themselves to service on particular working groups.
Shortly
after the working groups began their work, Congressional staff
members were also assigned to the working group by House and
Senate offices and committees.
As the process continued,
additional personnel with substantive knowledge and expertise
required by the working groups to complete their tasks were
added, typically by the working groups themselves.
For each cluster and working group, the process generally
consisted of three phases -- identifying and exploring issues for
study, developing a wide range of policy opticns and narrowing
those options.
Mr. Magaziner, his staff. and others conducted
five "tollgate 11
meetin~s,
designed to challenge, explore, test
and exchange views and ideas.
The meetings
t~·pically
lasted two
or three days, during which each working group would, in turn,
make a presentation summarizing its efforts and answer questions
posed by Mr. Magaziner and others.
a paper prior to each tollgate.
26
Most working groups presented
�-
-- .... .---Between these "tollgate" meetinqs, the working groups
continually met in a very fluid and informal fashion.
All
working group participants 'rlere able to attend any workinq group
meeting and there was extensive "cross-qroup" participation.
Small groups of people within each working group met very
frequently to discuss issues, debate options and prepare papers.
Because
~any
working groups were examining common issues,
participants on different working groups often met together, in
ad hoc groups or otherwise, to discuss and analyze these "crosscutting" issues.
Many, but not all, working groups, and
individual participants in working groups, frequently met and
spoke with outside individuals, groups and organizations to
obtain needed information and to listen to their ideas and
concerns.
At the conclusion of the working group process, many of the
working groups prepared a paper that contained background
information and policy options for its area of study.
Certain
·individuals and groups prepared memoranda for Mr. Magaziner, Or .
.Judy Feder or their staffs other than papers for the "tollgate"
meetings either by request or unsolicited.
These papers were not
directly forwarded to the Task Force, but, instead, were
presented to Mr. Magaziner and his staff.
Mr. Magaziner and his
staff, in turn, prepared consolidated materials based on the
working groups' efforts for the Task Force's review.
Defendants object to describing the purposes, structure and
organization of any further groups or individuals that acted in
27
�l • C.\Ml
connection with the Task Force or interdepartmental working group
because such information is not relevant to the remaining issue
in this case and is not reasonably calculated to lead to the
discovery of admissible evidence.
~
General Objection 1.
Notwithstanding this objection, the "audit groups" were panels
formed to share their members' expertise and judgments with the
working groups.
Their members served as "devil's advocates" and
gave feedback to working group members on the possible impacts of
various health care reform options that the working group was
considering.
There were five audit groups, which addressed
administrative issues, legal issues, issues pertaining to health
care providers, issues pertaining to minorities, and cost issues.
Some of the audit groups presented written material to Mr.
Magaziner or his staff.
The working group also received input from a large number of
health-care consumers organized into groups focusing on discrete
issues and twelve "outreach groups" composed of health-care
professionals.
the
11
The consumer groups exposed the working group to
real world 11 concerns and perspectives of individual health-
care consumers.
The outreach groups played a similar role but
presented the perspectives of individual health care providers.
REQUEST NO.
7:
Identify each written contract, agreement or letter of
invitation to participate with the Task Force groups involving
any federal employee, special government employee, advisor,
consultant or other person, who was a member of or an advisor or
28
�.·-·
--- .... .-- - .
I 1 VU
consultant or participant on a Task Force group, including, for
each such agreement:
(a)
the date of the contract, agreement or letter of
invitation;
(b)
the subject matter of the contract, agreement or
letter of invitation;
(c)
any person with knowledge of the contract,
agreement or letter of invitation;
(d)
all documents and communications concerning the
contract, agreement or letter of invitation, including but not
..
limited to payroll records, expense accounts, expense records,
and travel records.
RESPONSE TO REQUEST NO. 7:
The defendants did not enter into contracts or
agreement~
with regular federal employees to serve on or participate with
the interdepartmental working group.
Nor did the defendants
issue "letters of invitation" for such individuals.
HHS's agreements to obtain the services of the following
paid and unpaid individuals are manifested in variously dated
(none prior to February, 1993) government documents reflecting a
personnel action, Forms SF-52, HHS-410 and SF-50:
Linda Aiken
Robert Berenson
Linda Bergthold
E. Richard Brown
Gary Claxton
Shelley Crow
Richard Curtis
Denise Denton
Judith Eddy
David Eddy
Katherine Lohr
Carol Miller
Thomas Pyle
Lois Quam
Sally Richardson
David Satcher
Jane Schadle
Aaron Shirley
Hark Smith
Shoshana Sofaer
29
�I
Arnold Epstein
Howard Goldman
Carolyn Handy
Alan Hillman
Richard Kronick
Alan Krueger
Roz Lasker
Larry Levitt
Simi Litvak
1
;;J
1
Paul Starr
Robyn stone
Ciro Sumaya
Robert Valdez
Richard Veloz
Farah Walters
Joshua Wiener
Walter Zelman
HHS also tasked the following individuals whose services HHS
had previously obtained through Purchase Order to participate on
the interdepartmental working group:
Sybil Goldman (Purchase Order dated 2/18/93)
Beth Stroul (Purchase Order dated 8/11/.92)
Defendants will supplement this
informa~ion
as to similarly
situated individuals if it becomes available.
The Commerce Department completed Supply, Equipment or
Service Orders, CD-404, all dated March 26, 1993, for the
individuals it hired.
The Department of Defense maintained a pre-existing contract
for advisory services with the Rand National Defense Research
Institute in support of a Congressionally mandated "Comprehensive
Study of the Military Medical Care
S~stem."
Michael Hix, a Rand
employee who was working on that study, was tasked to participate
on Working Group 14.
The Office of Personnel Management issued an Order for
·Supplies or Services, Purchase Order 93-P045648, dated March 3,
1993, to obtain the services of Stanley Jones.
The White House did not prepare contracts, agreements or
letters of invitation for the individuals whoss services it
30
�r.
''"""'
v
vv
1
n a
Jt:.
'u • ...,.,
obtained for the interdepartmental working group, audit groups,
outreach groups or consumer groups.
REQUEST NO. 8:
Identify each oral contract or agreement involvinq the Task
Force groups and any federal employee, special government
employee, advisor, consultant or other person who was a member of
or an advisor or consultant or participant on a Task Force group,
•
including, for each such contract or agreement:
a.
the date of the oral contract or agreement;
b.
the subject matter of the oral contract or agreement;
c.
any person with knowledge of the oral contract or
agreement;
d.
all documents and communications concerning the oral
contract or agreement, including but not limited to payroll
records, expense accounts, expense records, and travel records.
~ESPONSE
TO REQUEST NO. 8
Defendants are
awar~
of no such oral concracts or
agreements.
REQUEST NO. 9:
Identify any organizational charts or similar documents that
reflect the structure and/or interrelationship among and between
the Task Force groups and their members and participants.
RESPONSE TO REQUEST NO. 9:
Mr. Magazinei drafted a document on or about January 25,
1993 entitled ''Preliminary Work Plan for the Interagency Health
Care Task Force."
This document, in part, outlined his initial
31
�IIU'U
U
U''!J
&v• _,_,
I Ul
conception of the structure, organization and staffing needs of
the interdepartmental working group.
The structure, organization
and personnel of the working group were modified substantially
over time and Mr. Magaziner did not revise or update that
document to reflect these changing realities.
REQUEST NO. 10:
Identify those persons \iho were responsible for directing
the activities of each Task Force group.
RESPONSE TO REQUEST NO. 10:
Defendants object to this request on the grounds that it is
vague.
The term "directing" is undefined and unclear.
Notwithstanding this objection, Tab 19 is a list of the cluster
group leaders and the subgroup leaders as of che end of the
working group process.
The audit group examining issues pertaining to health care
providers was chaired by Steve Gleason.
Irwin Redlener and Pat Ford-Roegnor.
cost issues was chair by Rich Ostuw.
REQUEST NO.
The vice-chairs were Dr.
The
audi~
group examining
(any more chairs?]
11:
Identify those persons who were responsible for directing
communications to, from, among, between and within each Task
Force group and to, from, among, and between the members and/or
participants in each Task Force group.
RESPONSE TO REQUESI NO. 11:
Defendants object to this request on the grounds that it is
vague.
The term
11
responsible for directing communications .. is
32
�undefined and susceptible to several alternative interpretations.
Notwithstanding this objection, defendants state that in order to
foster a free flow of ideas, Mr. Magaziner and his staff imposed
no procedures or methods by which participants on the interdepartmental working group were required to communicate with each
other.
Participants on cluster or subgroups could -- and
constantly did -- freely meet with participants on their own or
other cluster and subgroups in person and by telephone to
exchange ideas, information and written materials.
Communication
among and between cluster and subgroups and their participants
was primarily the product of informal, fluid, often spontaneous,
contacts both inside and outside of called meetings.
The Task Force and interdepartmental working group did
receive an enormous amount of information from outside
source~.
The Task Force Intake Center's correspondence unit, headed by
Mary Schuneman and staffed by a large number of volunteers,
routed material received by the Task Force to cluster and
subgroups working on issues related·to the material received.
33
�r. Jo
~s
to Interrogatories l-3, 6-11 or portions thereof:
I
declare under penalty of perjury that the foregoing is
true and correct.
iRA MAGAZINER
Senior Advisor to the President
for Policy Development
Dated:
August ___ , 1993
As to Interrogatories 2-6, 10-11 or portions thereof and Tabs 110. 14-16, 19:
I
declare under penalty of perjury that the foregoing is
true and correct.
MARJORIE TARMEY
Special Assistant to Ira
Magaziner
Dated:
August
1
1993
Interrogatories 2, 4-5 or portions thereof and Tabs 2-3,
~to
14-16:
I declare under penalty of perjury that the foregoing is
true and correct.
CHARLOTTE HAYES
Special Assistant to the
Vice President
Dated:
August
~,
1993
As to Tab__ll.;_
34
�r • .Ju
Based upon information provided to me by my staff and other
White House staff, I declare under penalty of perjury that the
foregoing is true and correct.
MICHAEL LUX
[Title]
\~hite House Office of Public Liaison
Date:
August
As to Tab
1
1993
12:
Based upon information provided to me by my staff and other
White House staff, I declare under penalty of perjury that the
foregoing is true and correct.
JOHN HART
(Title]
White House Office of Intergovernmental
Affairs
Date:
August
As to Tab 13:
' 1993
~
Based upon information provided to me by my staff and other
White House staff, I
decla~e
under penalty of perjury that the
foregoing is true and correct.
CHRIS JENNINGS
('l'itle]
White House Office of Congressional
Affairs
35
�r. J r
Date:
August ___ , 1993
As to Portions of Interrogatories 4, 5 and 7-8 Relating to HHS
and Tabs 12-13, 15-16;
I declare under penalty of perjury that the foregoing is
true and correct.
KEVIN THURM
Chief of Staff to Secretary
Donna Shalala
Date:
August
1993
1
As to the objections stated herein:
Respectfully submitted,
FRANK W. HUNGER
Assistant Attorney General
3. RAMSEY JOHNSON
United States Attorney
.. .
DAVID J. ANDERSON
ELIZABETH A. PUGH
JEFFRE'i S. GUTMAN
ROBERT S. WHITMAN
Department of Justice
Civil Division - Room 952
90l ESt., N.W.
Washington, D.c. 20530
T~lephone:
(202) 514-4775
Attorneys ·for Defendants
Dated:
August
1
1993
36
~
�Cost Issues
Howard Atkinson, Jr.
Atkinson & Co., Inc.
Silver Spring, MD
John Bertko
Coopers & Lybrand
San Francisco, CA
Phyllis Doran
Millman & Robertson, Inc.
Washington, DC
Brent Greenwood
Tllinghast/Towers Perrin
Minneapolis, MN
Dick Helms
The Principal Financial Group
Des Moines, IA
Rich Ostuw
Towers Perrin
Cleveland, OH
Ken Porter
The Dupont Co.
Wilmington, DE
Jack Rodgers
Price Waterhouse
Washington, DC
�Administrative Simplification
Leonard Abramson
Health Care
Blue Bell, PA
u.s.
Paul Batalden, M.D.
Hospital Corporation of America
Nashville, TN
Ellen Gaucher
University of Michigan Hospitals
Ann Arbor, MI
Ileana Herrell
Public Health Service
u.s.
Hank Cauley
Telesis
Providence, RI
Christine Kovner
New York University
New York, NY
Gordon Mosser, M.D.
Minnesota
Phil Nudelman
Group Health Cooperative of Puget Sound
Seattle, WA
Norene Rickson
Telesis
Providence, RI
Kathy Schroeder, M.D.
William Beaumont Hospital
Royal Oak, MI
Jack Stephens
Lakeland Regional Medical Center
Lakeland, FL
G. Rodney Wolford
Alliant Health System
Louisville, KY
�Legal Issues
Barbara Anthony
Office of the Massachusetts Attorney General
Boston, MA
Mark Barnes
New York City Dept. of Health
New York, NY
Richard Briffault
Columbia Law School
New York, NY
Ed Goldman
University of Michigan Hospitals
Ann Arbor, MI
Michael Graetz
Yale Law School
New Haven, CT
Angela Holder
Yale University School of Medicine
New Haven, CT
Barbara McGarey
National Institutes of Health
Bethesda, MD
Kathryn Meyer
Beth Israel Medical Center
New York, NY
Peter Millock
New York State Dept. of Health
Albany, NY
Betsy Ryan
New Jersey Dept. of Health
Trenton, NJ
Marjorie Shultz
Boalt Hall School of Law
Berkeley, CA
Rick Slowes
Office of the Attorney General of Minnesota
st. Paul, MN
�~~
Minority Issues
James Acevedo
Assistant Director
American Healthcare Management
Huntington Park, CA
Jesse Barber
National Medical Association
Chair of Council Medical Legislation
Washington, DC
Phillip Brooks
National Black Hospital Association
President, Norfolk Community Hospital
Norfolk, VA
Richard Butcher
President
National Medical Association
El Cajun, CA
Michael Byrd
Research Fellow
Department of Health Policy and Management
Harvard School of Public Health
Boston, MA
Pamela Cashew
Assistant Administrator
Riverside General Hospital
Houston, TX
Linda Clayton
Research Fellow
Department of Health Policy and Management
Harvard School of Public Health
Boston, MA
Rosemary Davis
National Medical Association
Washington, DC
susan Drake
Senior Attorney
National Immigration Law Center
Los Angeles, CA
Adolph Falcon
Nation Coalition of Hispanic Health and
Human Services Organizations
Washington, DC
7
�Maria Elena Flood
Program Director
Health Sciences Center
Texas Tech
El Paso, TX
Hector Flores
Co-Director
Family Practice Residency Program
White Memorial Medical Center
Los Angeles, CA
Joyce Essien
Director
Office of Public Health Practice
School of Public Health - Emory University
Atlanta, GA
Luis Estevez
Medical Director
Segundo Ruiz Belvis
Neighborhood Family Care Center
Bronx, NY
Thurman Evans
President and CEO
WholeLife Associates
Elkins Park, PA
Ernest Gibson, III
Administrator - CEO
Riverside General Hospital
Houston, TX
Tessie Guillermo
Executive Director
Asian American Health Forum
San Francisco, CA
Hazel Harper
National Dental Association
Washington, DC
Joseph Henry
Associate Dean
Harvard School of Dental Medicine
Boston, MA
Anne Hill
National Urban League
New York, NY
�Sadako Holmes
Executive Director
National Black Nurses' Association, Inc.
Washington, DC
Charles I<amasaki
National Council of La Raza
Washington, DC
Elizabeth I<ing
Medical Director
Queens Village Community for Mental Health
Chair of Health Policy and Resolutions Committee
St. Albans, NY
Daphne John
Riverside General Hospital
Houston, TX
B. Waine I<ong
Executive Director
The Association of Black cardiologists
Miami, FL
Osvaldo Lopez
Chairman
Department of Opthomology
Chicago, IL
Randall Maxey
President, CEO
HealthQuest
Hawthorne, CA
Ramona McCarthy
President
National Pharmaceutical Association
Silver Spring, MD
Laurin Mayeno
Association of Asian Pacific Community Health Organizations
Oakland, CA
Terri Smith Moore
Nationa Pharmaceutical Association
Washington, DC
Vernellia Randall
Assistant Professor of Law
School of Law - University of Dayton
Dayton, OH
�.
.
Elena Rios
President
The Chicano/Latino Medical Association of California
Huntington Park, CA
Rene Rodriguez
President
Interamerican College of Physicians and surgeons
Washington, DC
Diane Sanchez
Women's Medical Arts
Milpitas, CA
Frank Sessoms
Pittsburgh, PA
Wes Sholes
National Association of Black County Officials
Rancho Palos Verdes, CA
Samuel Simmons
Caucus and Center on Black Aged
Washington, D.C.
Paul Simms
Department of Health Services
San Diego, CA
Sara Torres
National Association of Hispanic Nurses
College of Nursing - USF
Tampa, FL
David Valdez
Family Practice Center
Memorial Medical Center
Corpus Christi, TX
Herbert Weldon
Administrator and CEO
Southwest Hospital and Medical Center
Atlanta, GA
�Health Professions Review Group
Stephen c. Gleason, DO
Chair, Health Professions Review Group
Chief Medical Officer, Mercy Clinic system
Family Practice
Des Moines, Iowa
Irwin Redlener, MD
Vice Chair, Health Professions Review Group
Chief, Community Pediatrics, Montefiore Medical Center
Pediatrician
Bronx, New York
Pat Ford-Roegner, RN, MSW
Vice Chair, Health Professions Review Group
Health Consultant
Atlanta, Georgia
Susan Hershberg Adelman, MD
Pediatric Surgeon
Detroit, Michigan
Maria del Rosario Aguirre, MD
Pediatrician
San Antonio, Texas
Betty Ahlgren, RN
Staff Nurse
Bellevue, Washington
Richard Barr, MHA
President, Presbytrian Health Care Services
Albuquerque, New Mexico
David Blementhal, MD
Chief, Health Policy Research & Development,
Massachusetts General Hospital, Internist
Boston, Massachusetts
Rick Boxer, MD
Urologist
Milwaukee, Wisconsin
Gwendolyn Braxton, RN, MSN
Assistant Academic Vice President, Delaware State College
Dover, Delaware
Benjamin Chu, MD, MPH
Senior Vice President for Medical & Professional Affairs,
New York City Health & Hospitals Corporation
New York, New York
�Jerome Connolly, PT
Physical Therapist
Billings, Montana
LC Dorsey, DSW, LCSW
Director, Delta Health Center
Mt. Bayou, Mississippi
Barbara Fassbinder, RN, BSN
Nurse Consultant
Monona, Iowa
Kevin Fickenscher, MD
Associate Dean, Michigan State University Medical School
Family Practice
Kalamazoo, Michigan
Janet Freedman, MD
New York University Medical Center
Rehabilitation Medicine
Mt. Kisco, New York
Stephen H. Gorin, PhD
Assistant Professor of Social Work
University of New Hampshire
Canterbury, New Hampshire
Pedro Jose Greer, MD
Asst. Dean of Homeless and Poverty Medicine
University of Miami
Internist
Miami, Florida
John Hatch, PhD
Professor, School of Public Health, University of North Carolina
Chapel Hill, North Carolina
Lester Hosto, PhD
Community Pharmacist, Arkansas Board of Pharmacy
Little Rock, Arkansas
Marshall Jackson, EMT
Trauma Technician
Upper Marlborough, Maryland
Gloria Johnson-Powell, MD
Professor of Clinical Psychiatry, Harvard Medical School
Boston, Massachusetts
Florence July, RN, BSN, CRRN
Creek Nation Community Hospital
Okemah, Oklahoma
�Mary Mundinger, RN, DrPH
Dean, Columbia University School of Nursing
Family Nurse Practitioner
New York, New York
Arnold Relman, MD
Editor in Chief, Emeritus, New England Journal of Medicine
Professor of Medicine, Harvard Medical School
Boston, Massachusetts
Susan Reynolds, MD
Emergency Medicine
Malibu, California
Marily Rhudy, RPh
Pharmacist
Lawrence, Kansas
Elena Rios, MD, MSPH
State of California, Office of Health Planning & Development
California
Lawrence Scherr, MD, MACP
Associate Dean, Cornell Medical College
Manhasset, New York
Julia R. Scott, RN
National Black Women's Health Project
Washington, D.C.
Kenneth Shine, MD
President, Institute of Medicine
Cardiologist
Washington, D.C.
Pat Starck, RN, DSN
Dean, School of Nursing, University of Texas-Houston Health
Science Center
Advanced Practice, Psychiatric/Mental Health
Houston, Texas
Reed V. Tuckson, MD
President, Drew University of Medicine and Science
Los Angeles, California
Stanley Yarnell, MD
Psychiatrist
San Francisco, California
Kneeland Youngblood, MD
Emergency Medicine
Dallas, Texas
�CONSUMER PANEL #1
Mr. Ken McEldowney
Consumer Action
San Francisco, California
Ms. Cheryl Gurlik
Concerned Consumers League
Milwaukee, Wisconsin
Ms. Ellen Dewind
Mr. Steve Meili
Center for Public Representation
Madison, Wisconsin
Mr. Joel Ario
OS PRIG
Portland, Oregon
Ms. Irene Leech
Virginia Citizens Consumer Council
Ms. Regene L. Mitchell
Consumer Federation of California
Ms. Jackie Thomas
Parksley, Virginia
Mr. Tom Simonton
Falls Church, Virginia
Mr. Bill Luckhard
Manakin, Virginia
Mr. Robert Byrne
Mr. Allen Blackford
Ms. Carol Franco
Ms. Brenda Robinson
Ms. Virginia Robinson
�CONSUMER PANEL #2
Mr. Hugh Wyatt
Mr. Guadelupe Pacheco
Ms. Wann McNabb
Ms. Shirley Smith
Ms. Lynne Starkweather
Ms. Saun Mateer
Ms. Theresa McKenna
Ms. Anne Mcleod
Harry and Shirley Kranz
Mr. John Lawhiczak
Ms. Anne Parke
Ms. Concha Johnson
Mr. Franklin Wallach
Mr. William Woody
Ms. Bonnie Cicler
Ms. Kathleen Newell
Mr. Tony Gallo
Ms. suzanne Mast
Mr. David Mast
Ms. Hope Marlan
Ms. Rosalee Wayman
�CONSUMER PANEL #3
Ms. Betty Newell
Mr. John Harlan
Ms. Sarah Jane Stewart
Ms. Sheryl Esbheach
Ms. Janice Walker
Mr. Charlie Gearhart
Ms. Karin Allen
Ms. Elizabeth Allen
Ms. Lisbet Searle-White
Mr. George Moehrle
Katina Economou
Ms. Mary L. Geuarter
Ms. Susan Jaeger
�CONSUMER PANEL #4
Martha Mawer
Mary Halfhill
Carol Dorsey
Eason Cross
Mrs. Pamela Mundell
Mr. Mundell
Terry Moore
Carol Cavanaugh
Cornelia Biddle
Neil Biddle
�CONSUMER PANEL #5
Joseph Rourke
Yancey Bobo
Mrs. Carmi T. Blaisdell
Mary segu
Sylvia Jackson
Chuck Gengrech
Marie Wheynnery
Dr. Lacey
Charles Culbertson
�CONSUMER PANEL #6
Anne Glendening
Earlane Johnson
Dr. David Nelson
Helen Dudding
Andy Garza
Sylvester Wedge
Diane Burkholder
David Roads
Kathy Mays
Dr. Lacey
�CONSUMER PANEL #7
Rachel Brubaker
Daniel Fisher
Randy Thurman
Carol Obrachta
John Allen
Barbara Huff
Marrisa Brown
Mary Jo Quinlan
Edith Hawkins
Robert Summers
Francene Williams
�CONSQMER PANEL #8
Ms. Janis Light
Ms. Mary Halfhill
Ms. Elizabeth Cain
Ms. Jennifer Arnold
Mrs. Lois Roberts
Mr. Roberts
Patricia A. DeRatto
Ms. Melinda Schuler
�CONSQMER PANEL #9
Mrs. Carole Weinstein
Mr. Tom Brewer
Richard and Mindy Benn
Ms. Linda Miller
Mr. Jim Currie
Ms. Susan Rogan
Mr. Julian Olinick
Mr. Olinick
Mrs. Olinick
�CONSUMER PANEL #10
cynthia Veidt
Hartford School Health Services
Olga Wright
William Ramsey Elementary School Nurse
Teri Holbrook
Baltimoe County Middle School
Lorraine Nault
Rhode Island School Nurse
Barbara Longo
Rhode Island School Nurse
Anne Marie Kachanis
Carlyn Jehle
Harvey Press
Elizabeth Miola
Kathleen Feroli
Laurie Callaghan
Judy Ressallot
Winson Hudson
Melinda Schuler
�CONSUMER PANEL #11
Dorothy Montgomery
Karen Christich
Eunice Cox
Sister Carol Taylor
Miles Appleton and wife
Diane Onwuchukewa
Ron Braden
�CONSUMER PANEL #13
Penny Fall
stacy Ewell
Richard Jones
Sheryle Powers
DOD
Thomas Stafford
DOD
Meg Butterworth
DOD
�CONSQMER PANEL #14
Jeffrey Winans
Marie Brookter
Beverley Rees
Kathy Caplins
Olyanda De'Allesandero
Melinda Schuler
�OUTREACH GROUP # l
FINANCE AND BUDGET
Robert Reyna, MD
San Antonio, TX
Irving Loh, MD
Thousand Oaks, CA
Richard Corlin, MD
Santa Monica, CA
Susana Morales, MD
New York, NY
John Bowen, MD
Ochnsner Clinic
New Orleans, LA
Richard Hachten
Bergen Mercy Medical Center
Omaha, NE
Clyde Oden, OD, MPH
United Health Plan
Watts Health Foundation
Ingelwood, CA
John McDonald
Mulliken Medical Center
Artesia, CA
Stephan Hegarty
President, Massachusetts Hospital Association
Burlington, MA
Robert Heyssel
Johns Hopkins Hospital
Baltimore, MD
Robert Margolis, MD
CEO, California Primary Care/
Huntington Medical Group
Los Angeles, CA
Sue Hopkins
Mercy Hospital
Des Moines, IA
Eric Tangalos, MD
Mayo Clinic
Rochester, MN
�Robert Elkins, MD
Integrated Health Services
Hunt Valley, MD
Adela De La Torre, PhD
California State University, Long Beach
Long Beach, CA
Lois Copeland, MD
Hillsdage, NJ
Raul Burciaga
Albuquerque, NM
Jerome Blum, MD
Los Altos, CA
Robert Butler, MD
Mount Sinai Medical Center
New York, NY
Peggy connerton
SEIU
Washington, D.C.
Pamela Gallin, MD
Harkness Eye Institue
Columbia-Presbyterian Medical Center
New York, NY
Richard Levy
Meg Norton
Mike Stringer
�OURTREACH GROUP #2
FRAUD, ANTITURST, TORT
James E. Acevedo
Executive Director
Community & Mission Hospitals of
Huntington Park
Huntington Park, California
Marlene Hartmann
Barnes Hospital
St. Louis, Missouri
Steve R. Eckstat, D.O.
Altoona, Iowa
John Howley
SEIU
Washington, D.C.
Larry P. Elliott, M.D.
Georgetown University Hospital
Washington, D.C.
Kent Westbrook
Little Rock, Arkansas
Neil Schlackerman, M.D.
u.s. Healthcare
Blue Bell, Pennsylvania
Karen s. Ehrat, Ph.D
Chief Operating Officer
St. Joseph's Mercy Hospital
Clinton Township, Missouri
Terry Lierman
President
Capitol Associates Inc.
Washington, D.C.
Robert Waters, Esq.
Arent Fox Kintner Plotkin & Kahn
Washington, D.C.
Douglas Maynard, M.D.
Chairman
Department of Radiology
Bowman Gray School of Medicine
Wake Forest University
Winsont-Salem, North Carolina
�Steve Volla
Chairman and Chief Executive Officer
American Healthcare Management
King of Prussia, Pennsylvania
Debra Cohn. Esq.
Attorney's Office
Philadephia, Pennsylvania
u.s.
George L. Spaeth, MD
Wills Eye Hospital
Jefferson Medical College
Philadephia, Penn.
Antonio Falcon, M.D.
Rio Grande City, Texas
Michael s. Levin
Newton, Mass.
Paul Freedman
Oral Pathology Laboratory, Inc.
Flushing, New York
Osvaldo I. Lopez
Ilinis Masonic Medical Center
Chicago, Illinois
Hugh F. Hill, M.D.
Bethesda, Maryland
�OUTREACH GROUP #3
BUREAUCRACY REDUCTION
Regina Kyle, MD
Joel Lanstein
Susan Hockstetter
Joe Diaz, MD
Julia Henion
Jim Hanson, MD
Stephen Fastwolf, RPt
Don Schneiter
Lawrence Hill, DDS
Warren Paroly
Steve Uranga McKane, DOS
Alan Solomont
Alan Bennett
Terry Gaffney, RN
Jane Delgado
Nilsa Gutierrez, MD
Barry Scheur, JD
Pete Savino, MD
Kenneth Offit, MD
Jan Spencely
Paul Grief, MD
Karen Guice, MD
v. Suzanne J<limberg
Arthur Kohrman
�OUTREACH GROUP #4
SPECIAL LIST OF SPONSORED PHYSICIANS
Dozoretz, Ronald MD
Norfolk, VA
Bendixen, Henrik
Columbia University
New York, NY
Edwards, z. Colette MD
Columbia Medical Plan
Columbia, MD
Schattman, Mary Ellen
Tarrant County Hospital District
John Peter Smith Hospital
Fort Worth, TX
Greely, Henry JD
Stanford Law School
Stanford, CA
Slaven, John MD
Pathology Labs of Arkansas
Little Rock, AK
Houpt, Jeffrey MD
Dean, School of Medicine
Ward, Janet RN, MS
Hospice Bereavement Volunteer Coordinator
Sinai Hospital of Baltimore
Owings Mills, MD
Alcorn, Merritt, MD
Chairman of the Board
Anatrol
Pathology Computer Systems, Inc.
Madison, IN
Hatem Bonsack, Rosemary MD
Delegate
Legislative District 34
Aberdeen, MD
Blim, R. Don MD
Corporate Director, Medical Staff Division
Saint Luke's Health System
Kansas City, MO
�Cleghorn, G. Dean EdD
Executive Director
South Carolina Area Health Education Center
Medical University of sc
Charleston, sc
Dickey, Nancy MD, FAAFP
Medical Director
Fort Bend Family Health Center, Inc.
Richmond, TX
Chucker, Francis, MD, PC
Internal Medicine
Washington, D.C.
Crist, Takey MD FACOG FACS
Surgical Ambulatory Care Center
Jacksonville, NC
Coyle, Joseph, MD
Harvard Medical School
Belmont, MA
Benson, John Jr. MD
Oregon Health Sciences University
Portland, OR
Edwards, Adrian MD, PC
cardiology and Internal Medicine
New York, NY
Pierce, Phillip, PhD
Chief Psychologist
Department of Veterans Affairs
Togus, ME
Levine, Howard
Miller & Martin
Chattanooga, TN
Copeland, Robert MD
La Grange, GA
carey, William MD
swarthmore, PA
�OUTREACH GROUP #5
CHOICE OF PROVIDER
Hoskins, H. Dunbar
San Francisco, CA
Weber, James
Jacksonville, AK
Meyer, Ileen
Emporia, KS
Weinstein, Irwin
Los Angeles, CA
Levine, Seymour MD
Los Angeles, CA
Mellion, Morris MD
Omaha, NE
Connally, N. Thomas MD
Washington, D.C.
Walkow, Warren MD
South Orange, NJ
Tudor, John MD
Salt Lake City, Utah
Colner, Gary MD
Vista, CA
Tasman, William
Philadelphia, PA
Robinson, Laurence MD
Lancaster, CA
Golding, Martin
Wheaton, MD
Lange, Robert MD, MBA
Eagle Rock, CA
Loh, Irv MD
Thousand Oaks, CA
Arce, Gabriel
Chula Vista, CA
Linares, Antonio
Chula Vista, CA
MD
�Hochweiss, Sharon
New York, NY
Petrovich, Janice MD
Washington, DC
Lichtenfeld, J. Leonard MD
Pikesville, MD
Baskin, Alan MD
Montvale, NJ
Rodriguez, Rene MD
Chevy Chase, MD
Estevez, Luis, MD, MPH
Yorktown Heights, NY
Rebhun, Donald MD, MSPH
Northridge, CA 91325
Weiss, Don MD
Debbs Ferry, NY
Warren, Russell MD
New York, NY
MacRae, Scott MD
Portland, OR
Mills, Paul MD
San Diego, CA
Hay, James T. MD
Encinitas, CA
Brunst, Robert MD
Encinitas, CA
�OUTREACH GROUP #6
ACCESS TO UNDERSERVED/URBAN
Pelberq, Arthur
Arizona Physician IPA
Phoenix, AZ
Butcher, Richard MD
San Dieqo, CA
Shukal, Stephen
San Dieqo, CA
Hutchinson, Thomas
Boston, MA
Schulhoff, Joan PA-C
Chicaqo, IL
Lurie, Nicole MD
Maples, MN
Raphael Carol
UNSNY
New York, NY
Sanchez, Diane MD
Milpitas, CA
Worth, PUrdentia
Detroit, MI
Geiqer, Jack MD
Brooklyn, NY
Gleason, Herbert
Boston, MA
Asward, Charles, N. MD
Binqhamton, NY
Ramirez, Ed MD
Lonq Beach, CA
Levine, David MD
Baltimore, MD
Shapiro, Martin MD
UCLA School of Medicine
Los Anqeles, CA
Sherman Joseph
�OUTREACH GROUP #7
ACCESS TO UNDERSERVED/RURAL
Blossom, H. John MD
Fresno, CA
Christopher, Neil MD
Guntersville, AL
Jones, Clark
Fresno, CA
Shattls, Stephen
Huntington, WV
Langston, Edward MD
Houston, TX
Massa, Lawrence J.
Webster City, Iowa
Primus-Cotton, Bobbie
Univeristy of Central Florida
Daytona Beach, FL
Kelly, Patricia
ona, wv
DeNeal, Larry PhD, MPH
Washington, DC
Platt, James
Mercy Hospital Medical Center
Des Moines, Iowa
Cooper, Rebecca MHA
Audubon County Memorial Hospital
Audubon, Iowa
Brown, Carmela
Mercy Hospital Medical Center
Des Moines, Iowa
Salow, William DO
Des Moines, Iowa
Kline, Thomas, DO
Indianola, Iowa
Walsh, Richard
West Des Moines, Iowa
�Harward, Tom
Belington, West Virginia
Toney Carl PA
Atlanta, GA
Moffitt, David
Creston, Iowa
Angagala, Mario
Mission, TX
Caballero, Ramiro MD
McAllen, Texas
O'Neill, George
Shawnee Health Service
Carterville, Illinois
Brasher, Stanley
Plan de Salud el Valles
Fort Lupton, co
Johnson, Douglas MD
Rochester, MN
Freed, Howard MD
Emergency Medicine-Albany Medical College
Slingerlands, NY
Coleman, William PhD, MD
Scottsboro, AL
Post, Bonnie
Maine Ambulatory Care Coalition
Manchester, Maine
Ulmer, Evonne
Ionia Co. Hospital
Ionia, Michigan
Harr, Parick MD
Maryville, MO
Gaskin, Ira May
Summertown, TN
Anderson, Larry MD
Wellington, Kansas
Milner, Darrell
Northern Michigan Health Services
Houghton Lake, Michigan
�OUTREACH GROUP #8
OUTCOME/QUALITY MEASUREMENT
Hoffman, Dan
Sommer, Alfred
Williams, Sankee
Kaplan, Sherrie
Greenfield, Sheldon
Spencely, Jan
Brook, Robert
Deyo, Richard
Fryback, Dennis
Dresing, Robert
Bodenhorn, Karen
Donoghue, Marguerite
Lierman, Terry
Ferris, Frederick
Galbraith, Geoffrey
Shaffer, Allen
Cunningham, Kevin
McBean, Marshall
Lohr, Kathleen
Jeffrey, Brian
James, Brent
McKay, Francis
Schlackman, Neil
Freed, Howard
Tudor, John
�OUTREACH GROUP #9
NURSES
De Leon Siantz, Mary PhD, RN
National Assoc. of Hispanic Nurses
Indiana University School of Nursing
Indianapolis, IN
Link, Victoria
Unit Manager, Lithotripsy Unit
West Allis, WI
Igoe-Diaz, Maureen RN, MS
Nursing coordinator
New York Children's Health Project
New York NY
Chulay, Marianne RN DNSC
Clinical Nurse Specialist
.National Institutes of Health
Spindel, Peggy
Vice-Chair, North American Registry of Midwives
Newton, MA
Morris, Phyllis
Encinitas, CA
Mendias, Nonie MS
UTMB SON
Galveston, TX
Schadle, Jane
HCTF Humphrey Building
Eckel, Jennifer
Toledo, OH
Marren, Joan
VP for Clinical Services
Visiting Nurse Service of NY
New York, NY
Lumpkin, Barbara
Assoc. Exec. Dire.
Florida Nurses Assoc.
Orlanda, FL
Summers, Lisa CNM
Dept. OB-GYN
Johns Hopkins School of Medicine
Baltimore, MD
�Roberts, Gail, RNC OGNP
Portsmouth, Ohio
Garcia Walters, Esperanza
San Jose Medical Center
San Jose, CA
Masson, Veneta RN, FNP
Community Medical care
Washington, DC
Hamrick, Renee c.
Fairmont, WV
Dominguez, Linda NP
OB\GYN
Albuqueque, NM
Littrell, Peggy RN CCRN
Burlington, NC
Healey, Thomas CRNA
Long Lake, MN
Allen Homes, Linda RNCS
Ho·uston, EX
Georges, c. Alicia RN, MA, FAAN
Lehman College
Bronx, NY
Wiliams, Wayne RN, MSN, NP
San Jose, CA
Owley, Candice RN
Milwaukee, WI
Salsich, Jan
Westerly, RI
Larly, Bernardine
Harvard Univ. College of Nursing
WK Kellog Homeless Project
Backer, Terry RN, MSN
Alphacetta, GA
O'Brien, Sally RN, MSN, CNAA, COHN
Kimberly-Clark Corp.
Neenah, WI
Holmes, Sadako RN, MPH
Exec. Dir., National Black Nurses Assoc., Inc.
Washington, DC
�Goode, Rhonda
SEIU Local 535
Pasadena, CA
O'Connor, Karen
Fairfax, VA
Henrick, Ann RN, MS
Clinical Nurse Specialist Cardiac Research
Northlake, IL
Gawkaski, Anna RN, DNSC
Clinical Nurse Specialist
UCLA Medical Center
Los Angeles, CA
Ritter, Ted
Duvall Family Health Clinic
Duvall, WA
�OUTREACH GROUP #10
MEDICAL STUDENTS/RESIDENTS
Alvarez, Kathy
Anthony, Paul
Beech, Derrick
Blanchard, Janice
Boyd, Barbara
Canis, Thomas
Castro, Maria
Chataman, David
comerci, John
crater, Glenn
Crowder, Valda
Dill, Barbara
Dwinnell, Mark
Flores, John
Frazier, Charles
Goldberg, Lee
Gonzales, Casimiro
Guerra, Juan
Hobson, Charles
Ingraldi, Peter
Johnstone, William
Lawlor, Daniel
Moore, Robert
Morrison, Elizabeth
Morrow, Mary Helen
Mura Ling, Shari
Obbard, Laura
Pelias, Marilyn
Peoples, Guy
Pogue, Doug
Rinderle, Theresa
Rucker, Cheryl
Rudd, Miles
Ruiz, Gonzalo
San Miguel, Virginia
Senqir, Andrea
Shaw, Carolyn
Sinstrunk, Sheryl
Slayton, Jim
Spingam, Roger
stone, Lee
Strand, Chris
Suck, Michael
Thronquist, Steven
Tong, Wendy
Trazerra, Salvatore
Whitaker, Eric
Wong, Kenneth
�OUTREACH GROUP #11
MATERNAL AND CHILD HEALTH
Marty McGeein
National Council of Community Hospitals
Washington, DC
Mary Carpenter
National Commission to Prevent Infant Mortality
Washington, DC
Diane Acevedo
GEMHPMP Community Foundations
Huntington Park, CA
Cahrles M. Ginzberg
UT Southestern Medical School
Dallas, TX
Owen Rennert
Georgetown University Children's Medical Center
Washington, DC
R. Rodney Howell
University of Miami School of Medicine
Russell w. Cherney
Le Bonheur Childrens Medical Center
University of Tennessee College of Medicine
Memphis, TN
Marion Rud MD
Mississippi Childrens Health Project
Lurica MS
Mary Bourdette and Ester Koblenz
Child Welfare League of America
Washington, DC
Kay Johnson
March of Dimes
Washington, DC
Patricia Hinton Walker
Assoc. Dean for Community Practice
University of Rochester School of Nursing
Rochester, NY
Michael Doyle
NWK Childrens Health Project
Newark, NJ
�William Sciarillo
Associate Care of Children's Health
Bethesda, MD
Karen Burke
New York, NY
Mary Chryssiadis
Los Angeles, CA
Kathy Vincent
Montgomery, AL
Catherine Hess
AMC HP
Washington, DC
Pat Thompkins
National Black Nurses Assoc.
Commission of Public Health
Washington, DC
Antoinette Parisi Eaten MD
Director of Government Affairs
Childrens Hospital
Columbus, Ohio
Louis z. Cooper MD
American Academy of Pediatrics
Roosevelt Hosp. Ch
St. Lukes, NY
Jackie Noyes
Amer. Acad of Pediatrics
Steven Shelov
Vice Chairman, Pediatrics
Albert Einstein College of Meidcine
Montefiore Medical Center
Bronx, NY
Josie Morales
Director, Women's Health
NYC Health and Hospital Corp
New York, NY
Frances Dunston MD, MPH
Assoc, Dean for Special Prog.
UMDNJ New Jersey Med. School
Newark, NJ
Patricia Kelly
Dept. of Pediatrics-Ado!.
Huntington, WV
�Joe Werthammer
Chairman, Dept. of Pediatrics
Marshall University of School of Medicine
Huntington, WV
Woodie l<essel
Maternal and Child Health Bureau/HRSA/PHS
Josie Sochalski
Senator Bill Bradley
Penny Bellamy
Planned Parenthood of Connecticut
Sharon Schnare
Director, Harbor UCLA NP Prog.
Torrance, CA
Joe Sherman
Georgetown Childrens Med Ctr
Washington, DC
Jacqueline Green, RN
Philadelphia, PA
Mary Middleton
Univ. of CA San Diego
San Diego, CA
Marjorie Barnett, MD
Silver Spring, MD
Carol Degan
Children's Defense Fund
Washington, DC
�OUTREACH GROUP #12
MENTAL HEALTH
McNair, Lorren LCISW
Health Management Strategies International, Inc
Alexandria VA
Javitt, Daniel MD, PhD
Albert Einstein College of Medicine
Bronx, New York
Cohn, Cliff
SEIU Local 509
Cambridge, MA
Forman, Robert PhD
Rehab After Work
Media, PA
Redlener, Neil MD
Boston Univeristy Medical Center
Boston, MA
Kinn, Mark MS
Primary Care, Internal Medicine
New York, NY
Achtenbert, Hannah
The League Treatment Center
Brooklyn, NY
Pruss, Richard
Samaritan Village
Rego Park, NY
Schut, Arthur
Mid-Eastern Council on Chemical Abuse
Iowa City, Iowa
Choukin, Wendy MD MPH
Beth Israel Medical Center
New York, NY
Morehouse, Ellen ACSW, CAC
Student Assistance Services
Ardsley, NY
Irby, Edward
First Hospital Corporation
Norfolk, VA
Klykylo, William MS
Dayton, OH
�Thomas-Knight, Robbie PhD
Clinical Psychologist
Independent Practice
Little Rock, Arkansas
McCall-Perez, Fred PhD
Group Practice Consultants, Inc.
Miami, Florida
Sheehan, Kathlee
National Association of Sate Alcohol & Drug Abuse Directory
Washington, DC
Volz, Deborah RN, CD
Vanguard Services
Arlington, VA
Taylor, Clishia RN
New Haven, CT
Flugsrud-Brekenridge, Marchia MD, PhD
Des Moines, Iowa
Jue, Jeff, LCSW
Deputy Director of Public Health for
Mental Health and Substance Abuse
Stark, Walter MD
Professor of Ophathalmology
Johns Hopkins University School of Medicine
Baltimore, MD
Inglesi, Ellie
SEIU Health care and Social Services Union
Columbus, Ohio
Gabbard, Glen MD
Vice President for Adult Services
The Menninger Clinic
Topeka, Kansas
Goldbaum, Carol PhD
Director of Social Work
Michael Reese Hospital and Medical Center
Chicago, IL
Edinburg, Olda ACSW, LICSW
Director Social Work Department
McLean Hospital
Belmont, MA
�Trevino, Fernando PhD, MPH
School of Health Professions
Southwest Texas States University
San Marcos, Texas
Giachello, Aida PhD
Jane Adams College of Social Work
Director, Hispanic Latino Health Research Center
Chicago, IL
Gumbiner, Robert MD
FHP Inc.
Long Beach, CA
Woffard, Chester III RN, MSN
Institute of Living, Chief Nurse
Hartford, CT
�f
-
Tab 17
PLEASE CHECK AND VERIFY ACCURACY. NOTE THAT MARK SMITH WAS
A LEADER, BUT THAT WE HAVE HIK DOWN AS A CONSULTANT. HE APPEARS
TO HAVE BEEN MORE ACTIVE.
GROUP NUMBER
TITLE
LEADER
l.
New System Organization
Walter Zelman
1
Principles and Operation
of Purchasing Cooperatives
Richard Kronick
lA
H~alth
Plan, Providers and
Patients in the New System
Robert Berenson
2
Special Issues in Purchasing
Cooperatives
Lois Quam
Claudia Baquet
3
Governance Issues
Rick Curtis
Parashar Patel
4
A Global Budget
Sherry Glied
Larry Levitt
5
Insurance Reform
Gary Claxton
il
New System Coverage
Atul Gawande
6
Benefits Package
Linda Bergthold
7
coverage for Working
Families
Steve Finan
Randy Hardock
J. Mark Iwry
8
Coverage for Low-Income
Families
Shoshanna Sofaer
Rick Bro,m
New System Infrastructure
9
I!
Quality Measurement
Arnold Epstein
Risa LavizzoMourey
10
~f"'!
Bill Sage
(replacing
Tom Pyle)
Information Systems
John Silva
Shanna Koss
�ll
Malpractice and Tort
Reform
12
Health Care Workforce
Development
FitzHugh Mullan
Ciro Sumaya
Integration of Health
Programs Into the New
system
Josh Wiener
Nancy-Ann Min
(replacing Steve
Bandeian)
Robert Berenson
Kathleen Hastings
13
Hedicare
Barbara Cooper
14
Department of Defense
Joel Slackman
15
Veterans Affairs
Karen Walters
16
federal Employees Health
Benefits
Curt Smith
16A
Indian Health Service
Mike Lincoln
Ethical Foundation of the
system
y
Nancy Dubler
Secundy
17
.N~w
~~arian
Yl.
Transition to the New System
Short-Term Cost c~~!
Paul starr
18
Accelerating New System
Development
Lois Quam
19
Short-Term Steps Toward
Tim Hill
Administrative Simplification
20
Interim Cost Controls
David cutler
Kathy Buto
Yll/21
fina~ing
Marina Weiss
VIII/22
Underserved Populations
and Preventive Health
Bonnie Lefkowitz
Mark Smith
Aaron Shirley
22A
Public and Preventive
Health
Joanne Lukomnik
22B
Infrastructure
22C
Services
Deborah LewisIdema
Aaron Shirley
220
HIV/AIDS
Mark Smith
Ann Zuvekas
nc • 1"1 T Ti1 J
C'~
_Q _:'l'1f.J
�Hental Health
Bernie Arons
23
Benefit Package: Basic
and/or Supplemental
Mike English
Mary Harper
24
Substance Abuse
Peter Brock
Lisa Sheckel
25
Children's Services
Shiela Pires
Sybil Goldman
26
Public System Impact
Grayson Norquist
Long Term Care
27
Josh Weiner
Private
Peter Kemper
29
Background/Populati~r.s
Mary Harahan
30
Cost and Financing
Mark Wasserman
Xl./31
Economic Impact,
David Cutler
XII/32
I!
Public
28
L,f",
Robyn Stone
Josh Weiner
Quantitative Analysis
l<en Thorpe
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
FACA Documents [5]
Creator
An entity primarily responsible for making the resource
First Lady's Office
Maggie Williams
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 4
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-2194630-20060223F-004-006-2015
2194630
-
https://clinton.presidentiallibraries.us/files/original/bfe6a52cb62aa454f4e8c4cfb6ee5e56.pdf
78529ad2fbd2bde3671f4aeff9d62557
PDF Text
Text
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECTffiTLE
DATE
RESTRICTION
OOI.letter
Bernard Nussbaum to John Conyers and William F. Clinger. Status of
FACA Litigation. (7 pages)
10/2511993
P5
002.memo
Vince Foster to Maggie Williams. Re: Attached Memo. (5 pages)
03/23/1993
.P5
003. fax
Jeff Gutman to Marjorie Tarney. File FACA. (15 pages)
11110/1993
P5
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
FACA Documents [4]
2006-0223-F
ab860
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [S U.S.C. SS2(b))
Pl National Security Classified Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(J) of tbe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and bls advisors. or between such advisors [a)(S) of tbe PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of tbe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misme defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
OOl.letter
SUBJECTfi'ITLE
DATE
Bernard Nussbaum to John Conyers and William F. Clinger. Status of
FACA Litigation. (7 pages)
10/25/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
FACA Documents [4]
2006-0223-F
ab860
RESTRICTION CODES
Presidential Records Ad - (44 U.S.C. 2204(a))
Freedom of Information Ad -IS U.S.C. 552(b))
PI National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disdose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) ofthe FOIA)
b(2) Release would disdose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or fmancial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf'Jie defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. memo
DATE
SUBJECfffiTLE
Vince Foster to Maggie Williams. Re: Attached Memo. (5 pages)
03/23/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
FACADocuments [4]
2006-0223-F
ab860
RESTRICTION CODES
Presidential Records Act - (44 U.S.C. 2204(a))
Freedom of Information Act -IS U.S.C. SS2(b))
Pl National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRAJ
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or fmancial
information ((b)(4) of the FOIA)
h(6) Release would constitute a dearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
h(7) Release would diselose information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
h(S) Release would diselose information concerning the regulation of
financial institutions ((b)(S) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record. misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�* WEDNESDAY, NOVEMBER 10, 1993
.~~dge demands health panel's
papers from Whi(e House
~
By Pa;..· Beoa·o
THE
l
i
~A$P1 '~':'0"-
TIMES
A federal judge yesterday re·
buked the V.'hite House for wnhhold·
ing key records of Hillary Rodham
Clinton's health care task force and
threatened to hold the administra·
tion in contempt if the papers aren't
produced in 20 days.
ln language that re,oealed his rrus·
tration. t.:.S. District Judge Royce
Lamherth accused White House and
Jusuce Department lawyers of offer·
ing "preposterous" excuses. ·
The \\'hne House is "improperly
withholdmg germane information"
sought by pubhc tnterest and health
care groups. he satd. adding that the
PAPERS
FrompageAJ
Judge Lamberth allows such a move.
which court observers said was
highly unlikely.
An administration spokeswoman
said the White House would comply
with the court order.
~This is the biggest victory we've
had in this case:• said Kent Master·
son Brown, attorney for the three
groups suing the White House- the
Association of American Physicians
and Surgeons Inc., the American
Council for Health Care, and the Na·
tiona! Legal and Policy Center.
It was the second time Judge
Lamberth had ruled against Mrs.
Clinton's efforts to keep the activ·
ities or the health care task force and
its Wt>rking group a ,;ecret.
Judge Lamberth's order stems
from a June ·ruling by the U.S. ·cir·
cuit Court of Appeals that the activ·
ities or the working group helping
Mrs. Clinton ·Write the administra·
lion's health care plan may be sub·
ject to disclosure.
Judge Lamberth must determine
whether the working group is sub·
ject 10 the 1972 Federal Advisory
Committee Act that prohibits gov·
emment task forces with consult·
:<~nts and other outsiders as mem·
bers from meeting in secret.
The task force and working group
were established by Mr. Clinton on
Jan. 25 and disbanded May 30. None
of the working group's meetings was
open to the public.
Judge Lamberth's seven-page or·
der was a stem· rebuke to Mr. Nuss·
baum. who said in a letter to Con·
gress that the White House was
being "responsive" to the three
groups.
"Obviously, Judge Lamberth
didn't agree," Mr. Brown said.
Mr. Brown is seeking member·
ship rolls, tra\-ei vouchers. ethtcs
forms. and workmg group agendas
and minutes to determine whether
any nongovernment employees
worked on the health care task force.
administration has "submitted
mentless relevancy objections in al·
most all instances and incomplete
and inadequate responses in most in·
stances."
Judge Lamberth said the White
House has produced ".dribbles and
drabs or information at its conve·
nience .... The court condemns this
litigauon tactic and will not tolerate
it in future resP<»nses in this case."
Le11al experts said that not since
Watergate could they recall a time
when a federal ju4ge had been so
critical or the V.'hite House.
Judge Lamberth gave the V.'hite
House until ~O\', 29 to comply with
his order to tum over documents.
payroll records. travel vouchers.
I
ineeting agendas and notes or the
uisk force and the Sll·member
:·~·orking group" that produced
Pi'esident Clinton's health plan.
1b demonstrate his anger, Judge
Lamberth ordered Mrs. Clinton and
six Cabinet members named in the
suit to pay the legal fees of the three
.groups that filed suit In February
challenging the secrecy in which the
task force was operating.
i Presidential Press Secretary Dee
, Dee Myers said While House Coun·
.sel Bernard Nussbaum was review·
· irig the court order to determine
: whether it would be appealed. But
the order cannot be appealed unless
• see PAPERS, page AJ6
The White House hired dozens: of
special interest representatives ~~d
consultants but called them "spec;tal
government employees." But it i.s oot
clear whether they met the strict
ethics guidelines covering outsiders
given that special title.
·
Judge Lamberth said In his order
that a trial may be required to deter·
mine whether the consultants. were
''ol,ltsiders" and whether the wall or
secrecy around the task force work·
ing group should be removed. ·~ra.
released one to Mr. Brown.
Clinton would probably be among
"Even more egregiou·s." said
the first to toe called to testify if a Judge Lamberth, was that the .White
trial is required, according to a .law· House did not prepare a list of task
yer involved in the suit.
force members for Mr. Brown. He
Describing ·the degree of White said White House lawyers had made
House stonewalling, Judge Lam· little effort to draw up a complete
berth said the administratlqn·:has
"even refused to provide to plail)tiffs list.
White House lawyers have proforms that are already publicly
duced incomplete lists of the task
available."
·
·
force's working group committee
At an October court hearing,
members while admitting they
White House lawyers argue,d. that didn't know whether other outside
the information sought by. Mr.
special interests played a role. in
Brown wasn't relevant to the suit.
writing the Clinton plan.
The lawyers also said that, although
"Defendants cannot simply check
they were unsure whether all. task
the records that happen to be in ltask
force documents were available,
force director Ira) Magaziner's of·
they had turned enough over t() Mr.
flee, a •sampling' of other records
Brown to satisfy his request. ·
and then claim to have proper))• re·
Judge Lamberth rejected.' that
sponded:' Judge Lamberth said.
view.
:1
"Defendan ,;; h~·,·e ;·.;ai;·. improp·
The White House at first, said It
erly thwart~~ plaintifl"s legitimate
didn't have a list of individual's on the
... requests.
task force's working group ~ut then
'1
'h
�*WEDNESDAY, NOVEMBER 10, 1993
~~dge deman4s health panel's
·•.
papers front White House
:•
I
Justice lawyer to probe Clintons' business partner
By Jerry Seper ·
THE WASHII'fOTOfrf TIMES
LITTLE ROCK, Ark.- The Jus·
tice Department late yesterday
sent a senior staff lawyer here to
take charge of the fraud investiga·
uon of the former owner of a failed
savings and loan, a longtime busi·
ness partner of President Clinton's
and f.irst lad)' Hillary Rodham
Chnton·s.
The decision came after U.S. At·
tome)· Paula J. Casey here asked
that siie' and her staff be taken off
the ca5e.
Actini! Assistant Attorney Gen·
era! Jcihil C. Keeney said yesterday
that tile: department's crimil)al di·
vision: has taken charge or the
probe: .
·
The investigation is focusing on
charges that James B. McDougal,
former president of the defunct
Madiso'! Guaranty Savings and
Loan and a longtime Clinton busi·
ness associate, approved fraudu·
lent lOans of 5250,000 and diverted
money to the campaigns of several
powerful Arkansas politicians, in·
eluding Mr. Clinton.
'The Resolution 'n'ust Corp.
<RTCJ, the federal agency in
charge of S&L liquidations, had
asked Mrs. Casey to investigate
questions of irregularities in the
case, including ties to the Clintons.
In a statement, the Justice De·
partment said Mrs. Casey told her
s~periors in Washington last week
see PROBE, page A16
j'
PROBE
FrompogeAJ
that she and her aides wanted to
recuse themselves from the case
"because or their familiarity with
some or the· parties and the need to
ensure that there be no mispercep·
lions about the impartiality or the
investigation."
Recenth· appointed b)' the pres·
id~nt. Mrs. Casey was a campaign
volunteer in several Clinton guber·
natorial races and a student of Mr.
Clinton's when he taught at the Uni·
versit)' of Arkansas Law School.
Moreover, Mrs. Case)··s husban!l. Gil
Glover. once .was appointed to a state
job b)' !\1r. Clinton when he was go\'·
ernor of Arkansas.
It was uncertain yesterda)' wh)'
Mrs. Case)'. decided to ask the Jus·
tice Department to step Into the
case. Earlier this week. she told re·
porters here that she believed she
could conduct an impartial probe.
The Associated Press reported
late yesterda)' that the Justice De·
partment's No.3 official. Webster L.
Hubbell. former manaRing partner
of Uttle Rock's powerful Rose Law
Firm, also has recused himself from
the matter. along with his staff.
Donald B. Mackay, a senior trial
low;·c,- m .lus,;~e's fraud section.
will head the investigation, Mr.
Keene)' said.
Mr. Mack&)', 55. a former U.S. at·
tome)' for the Southern District of
Illinois. IA'ill be assisted br two crim·
inal di\'ISIOn lawyers. both fraud ex·
perts. He arrived here yesterda)'.
Federal investigators also are
looking mto a controversial Small
Business Administration-approved
5300.000 loan by Capital·
Management Sen•ices Inc. to Mr.
McDou~al's wife, Susan H.
McDougal. and the role of the Rose
Law Firm. where Mrs. Chnton was a
senior partner. m pre\'enung the Ar·
kansas Securities Departmeni frt•m
closing Madison.
As Arkansas governor, Mr. Clinton
had oversight of the state regulator)'
agency. ·
At that time, the Clintons and the
McDougals were full partners in
Whitewater Development Corp.. a
5203,000 :real estate development on
the White .River, deep in the Ozarks
of northern Arkansas.
The White House said that neither
Mr. Clinton nor his wife is a subjects
or a targei in the federal investiga·
tion.
. ,
"We di~ nothing improper, and I
have nothing to sar about it," Mr.
Clinton :tcild reporters In a terse
statement: last week.
Mr. McDougal, who was indicted
in 1989 bn fraud charges in connec·
til)n wit!t Madison and was acquitted
in 1990;·.also has denied an)' wrong·
doing. He' has called the allegations
"ridiculous."
.
Da\'id L. Hale, a former Uttle
Rock municipal judge who was in·
dieted in September. for defrauding
the SBA in other loans, has told The
Washington Times that he, Mr. Clin·
ton and' Mr. McDougal structured
the loan to Mrs. McDougal although
they knew she did not qualif)' under
the law.
Mr. Hale has said Mr. Clinton and
Mr. McDougal told him the)' needed
to "clean up" financial problems at
Madison 'and that the Joan to !\Irs.
McDougal would help them do·that.
He said he was never told how the
5300.000 would be used.lt was ne\-er
repaid and. according to the can·
celed c.heck, was posted to a Madr·
son account.
Some of the documents se1zed br
the FBI· from Mr. Hale's off1ce in a
Jul~· raid included those outhning
the 5300,000 loan.
Wluin .reports about Whitewater
surfac·~d· in the 1992 campa1gn. the
Chntons described themsel\-eS as
"passr\'e shareholders." But The
Times has obtained a Jetter from
Mrs. Clinton to Mr. McDougal asking
for power of attome)' to assume ag·
gressive management of White·
water.
•
In a related development yester·
da)', Republicans called for a House
Banking Committee investigation in
the failed Arkansas S&L linked to the
president, citing the panel's similar
probe of a thrift with ties to former
President Bush's son, Neil.
"Given the record of this commit·
tee. in addressing thrift issues that
touched the former president. it is
incumbent that this committee not
refuse to address issues that ma)'
embarrass the current administra·
tions in Washington and Uttle Rock."
Rep. Jim Leach. Iowa Republican.
said in a letter to Rep. Henn· B. Con·
zalez. TeXBS Democrat and Bankin(l
Committee chairinan.
In a repl)'. Mr. Gon~les said the
committee has ·a "legitimate inter·
est" in examining Madison. but
added that "the committee must
tread carefull)' around ongoing
criminal referrals and professional
Jiabilit)' cases."
He said he would direct commit·
tee staffers to begin collectmg infor·
mation about Madison.
Mr. Leach's call for an im-esti(la·
lion into the case follows similar
pleas last IA-eek from Democratic:
and Republican lawmakers.
Rep. John J. LaFalce. !'\ew '\'ork
Democrat and chairman of the
House Small Business Committee:
Rep 1bb)' Roth. Wisconsin Repub·
lican and a member of a House sub·
c:ommutec that O\'ersees RTC: and
Rep. Jan ~lerers. Kansas Republi·
can. outlined their concerns in sep·
arate letters on Friday.
Rand)' Coleman. an attorney for
Mr. Hale. offered on Monda\' to make
his chent a\·ailable for am.'heanni!S
on Capnol H1ll
• Carlercm R. Br;>anr 1n 1\'ashmg·
ton comnbuled to this repor:
I
I
�: .-;'
Abc-Task-Farce-suit
REPEAT
TO CITY EDITOR:
.
CLINTON TASK FORCE IS SUED TO REVEAL INTERNAL DOCUMENTS:
MENTAL HEALTH CONSUMERS JOIN LAWSUIT
PHILADELPHIA, Nov. 9 /PRNewswire/ -:-:A coalition of people with
mental illness is joining a lawsuit to demand that the national Task Force on
Health care Reform, chaired by Hillary Rodha~ Clinton, release its internal
documents •
:;
A press conference will be held concerning the event on Thursday,
Nov. 11, at 3 p.m. in room 1001, 311 s. Juniper st., Philadelphia.
The Coalition for Mental Health Car~ That's Always There, which
includes consumers of mental health services' from across the country, is
demanding to see the documents, includ-ing the Mental Health Working Groups'
Cluster research studies that led to the proposal to 11 cap 11 mental health
benefits. The Coalition is joining the suit filed by the Association of
American Physicians and Surgeons, Inc., et ill., v. Hillary Rodham Clinton,
and other Task Force members in the Federal. ·:District Court for the District
of Columbia. The coalition is represented ~y the Disability Law center of
New York Lawyers For the Public Interest. : ,·
"These documents will help prove oul': case in Congress against
such limits," said Joseph A. Rogers, a spokesperson for the Coalition, whose
name puts an ironic spin on the Task Force s'logan, "Health Care That's Always
There."
!
"As consumers of mental health services, we strongly endorse the
goal of providing universal health coverage for all the health care needs of
all Americans. However, we have serious concerns about how the proposal
treats mental health care," Rogers said.
·
He noted that the proposal covers mental illnesses differently
than any other illness. It limits, or "caps," benefits for mental health
services by covering onty 60 days of inpati~nt services per year, and only 30
days per year per occurrence. Outpatient visits are limited to 30 visits per
year, with a 50 percent co-payment required;'from the consumer. "That means
we must pay half of what these services cos1;i every time we use·them," he
said. "This can be a devastating hardship ~or people who, as a group, have
historically been among the poorest of cit~zens.
.
"Although the proposal includes no· \.lifetime' limit for mental
health services denying us vital services because we have exceeded their
yearly limit may truly threaten our survival," Rogers continued.
Another concern is that the President's propo~al does not mention
consumer-operated services and other altern~tive "non-medical model"
services.
,
.
"The proposal does promise that by the year .2001, coverage for
mental health services will achieve parity·with the unlimited benefits for
other illnesses. But this means that, until 2001 -- another century, another
President -- mental health consumers will r~main second-class citizens,"
Rogers concluded.
· ·:
/del val/
-oll/9/93R
.
/CONTACT: Joseph A. Rogers of the Mental H~alth Association of
southeastern Pennsylvania, 215-735-6082, .ext. 312/ ·CO: Mental Health
Association of southeastern Pennsylvania sT: Pennsylvania'IN: HEA su:
JM-MJ
PH048 -- 9817 11-09-93 17:42 EST !;
e
, t
'''f
�'·
·;
';
"AM-Mrs Clinton-Task Force, 510 .; ,
"Judge Chastises White House For :root Dragging
"By JAMES H. RUBIN= "Associated Press Writer=
WASHINGTON (AP) A f'ederal judge told the Clinton administration
Tuesday to quit stalling and prqvide information that ultimately may shed
more light on deliberations leading to the president's health care plan.
The task force headed by Hillary Rodham Clinton is ''improperly
withholding germane information~:' sought by public interest and health care
groups, said u.s. District Judge.Royce Lamberth in a sharply worded opinion.
The White House said it·intends to comply with the judge's
decision.
.
,
The task force must make:a legitimate effort within 20 days to
disclose whether some participants in the health care discussions were
government employees or privatefcitizens, Lamberth said.
If they are not federal:employees, their work product presumably
must be made available to the gtoups that sued the task force.
Instead of cooperating, :·Lamberth said, the administration prefers
''to produce dribbles and drabs:. of information at its convenience.''
''The court condemns this litigation tactic and will not tolerate
it in future responses in this case,'' the judge said, hinting at a possible
contempt citation.
",
He called ''preposterous'' the administration's explanation that
it lacked the names of particip11nts in some of the deliberations.
White House spokeswoman;Marla Romash said, ''Our intention is to
comply fully'' with Lamberth's order after administration lawyers decide what
information must be provided. ·. i
''These kinds of disagreements are not unusual in civil
litigation,'' she said. ''We have worked in good faith and will continue to
act in good faith.''
Frank Northan, a lawyer· ·for the groups seeking the information,
said Lamberth ''has made it clear he won't allow them to dilly-dally.''
Tuesday's order stems from a June ruling by a federal appeals
court here that could force the 511-member working group that aided the task
force to disclose its activities.
The appeals court said :t;he 1972 Federal Advisory Committee Act
exempts from public disclosure meetings of full-time government employees.
But if outside consultants regularly participate·in working group
meetings as if they were meinbe:t::s, the appeals court said, the public is
entitled to see their deliberations.
Lamberth previously had ruled that because the 13-member task
force was chaired by a ''privat$ citizen,'' namely Mrs. Clinton, it came
under the 1972 federal act anditherefore had to meet in public, except when
providing confidential advice to the president.
The appeals court reversed Lamberth's decision on that point,
ruling that Mrs. Clinton was a;''de facto'' government officer as head of the
task force.
:
The task force and working group were established by President
Clinton Jan. 25 and disbanded May 30.
At issue now are documents describing their deliberations.
Lamberth gave the administration un~~l Nov. 29 to supply
information sought by the health care and public int¢rest groups pertaining
to the status of individual working group members.
After he studies that information, Lamberth would determine what
documents, if any, must be made.public.
~ '
·''
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. fax
SUBJECTffiTLE
DATE
Jeff Gutman to Marjorie Tarney. File FACA. (15 pages)
11110/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number: 10813
FOLDER TITLE':
FACADocuments [4]
2006-0223-F
ab860
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
Pl National Security Classified Information [(a)(l) of the PRA)
Pl Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
fmancial information [(a)(4) ofthe PRA)
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
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Original Format
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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FACA Documents [4]
Creator
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First Lady's Office
Maggie Williams
Identifier
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2006-0223-F
Is Part Of
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Box 4
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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William J. Clinton Presidential Library & Museum
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Adobe Acrobat Document
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Reproduction-Reference
Date Created
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1/8/2015
Source
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42-t-2194630-20060223F-004-005-2015
2194630
-
https://clinton.presidentiallibraries.us/files/original/277348be4b7e9a15d30dc6f559f8d414.pdf
63a9d02a30848a7a0564ad7467a171ac
PDF Text
Text
THE WHITE HOUSE
WASHINGTON
2j2Aj93
'IO:
Maggie Williams v
Assistant to the President and
Chief-of-Staff, Mrs. Clinton
Lisa Caputo
Deputy Assistant to the President
and Press Secretary
FROM: Stephen Neuwirth
Associate Counsel
�'•·.'
'WEDNESDAY, FEBRUARY 17,1993 .A171"
THE WASHINGTON PosT
· :: ·
..·...-.:.......;... ..
.. · .. •·
EDERALPAGE
M
IEORGE STEPHANOPOULOS:
,."'*,.,.,,.,..,,.,.
.,.......
'le Mill Ht111J1 IIOflliuiiiD mtiftJ tMiilulltnt •••
.
.
..., hllflt
~~---------
..................._
EXHIBIT A
�UNITED STATES DISTRICf COURT
DISTRICT OF COLUMBIA
)
)
)
)
)
)
)
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.,
an Indiana not-for-profit corporation,
1601 North Tucson Boulevard, Suite 9
Tucson, Arizona 85716;
AMERICAN COUNCIL FOR HEALTH CARE )
REFORM, a Virginia not-for-profit corporation,)
5155 North 37th Street
)
)
Arlington, Virginia 22207;
)
)
and
)
NATIONAL LEGAL & POLICY CENTER, a )
District or Columbia not-for-profit corporation, )
)
1156 15th Street, Suite 550
)
Washington, D.C. 20005,
)
Plaintiffs
)
)
vs.
)
)
HILLARY RODBAM CLINTON, wife of
)
the President of the United States,
)
1600 Pennsylvania Avenue
)
Washington, D.C.20500;
)
)
DONNA E. SBALALA, Secretary of the
)
Department of Health & Human Senices,
)
615F Hubert B. Humphrey BuDding
)
200 Independence Avenue, S.W.
)
Washington, D.C. 20410;
)
)
LLOYD E. BENTSEN, Secretary of the
)
Treasury,
)
3330 Main Treasury Building
)
1500 Pennsylvania Avenue, N.W.
)
Washington, D.C.20220;
)
1
CIVIL ACTION N O . - - - IUDGE ___________
VERIFIED COMPLAINT FOR
DECLARATORY JUDGMENT.
BESTRAINING ORDER. AND
TEMPORARY AND PERMANENT
INJUNCTIVE RELIEF
�LES ASPIN, Secretary of Defens~
3880 The Pentagon ·
Washington, D.C.20301;
)
)
)
)
JESSE BROWN, Secretary of Veterans AtTain, )
810 Vermont Avenu~ N.W.
)
Washington, D.C.20420;
)
)
RONALD H. BROWN, Secretary of Commerc~
5858 Herbert Oark Hoover BuDding
14th Street and Constitution Avenu~ N.W.
Washington, D.C.20230;
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
ROBERT B. REICH, Secretary or Labor,
S2018 Frances Perkins Building
200 Constitution Avenue, N.W.
Washington, D.C. 20210;
LEON E. PANETIA, Director or the
Omce or Management and Budget,
17th Street and Pennsylvania Avenue, N.W.
252 Old Executive Omce Building
Washington, D.C.20503;
ALICE RIVLIN, Deputy Director or the
Omce of Management and Budget,
Executive Omce of the President
Washington, D.C. 20503;
CAROL RASCO, IRA MAGAZINER, and
JUDITH FEDER, White House Advison,
Executive Omce of the President
Washington, D.C. 20500,
)
)
)
)
)
)
)
)
)
)
)
)
individuaUy, and in their omcial
capacities as memben or the·
PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE
REFORM;
and
2
___........_____________________________ _
�The PRESIDENT'S TASK FORCE ON
NATIONALHEALmCAREREFORM,
Executive Office of the President
Washington, D.C. 20500,
Defendants
)
)
)
)
)
VERIFIED COMPLAINT FOR DECLARATORY JUDGMENT. RESTRAINING ORDE&
AND TEMPORARY AND PERMANENT INJUNCTIVE RELIEF
1.
NOW COME the Plaintiffs, ASSOCIATION OF AMERICAN PHYSICIANS &
SURGEONS, INC., an Indiana not-for-profit corporation, by and through its Executive Director,
Jane M. Orient, M.D., the AMERICAN COUNCU.. FOR HEALTil CARE REFORM, a V1rginia
corporation, by and through its Executive Director, William Shaker, and the NATIONAL
LEGAL & POUCY CENTER, a District of Columbia not-for-profit corporation, by and through
its President, Peter T. Flaherty, and for their Verified Complaint for Declaratory Judgment,
Restraining Order, and Temporary and Permanent Injunctive Relief against the Defendants,
HILLARY RODHAM CLINTON, wife of the President of the United States; DONNA E.
SHALALA, Secretary of Health & Human Services; LLOYD E. BENTSEN, Secretary of the ·
Treasury; LES ASPIN, Secretary of Defense; JESSE BROWN, Secretary of Veterans Affairs;
RONALD H. BROWN, Secretary of Commerce; ROBERT B. REICH, Secretary of Labor;
LEON E. PANETTA, Director of the Office of Management and Budget; ALICE RIVLIN,
Deputy Director of the Office of Management and Budget; CAROL RASCO, IRA
MAGAZINER, and JUDim FEDER, White House advisors, individually, and in their official
capacities as members of the PRESIDENT'S TASK FORCE ON NATIONAL HEALTil CARE
REFORM, and the PRESIDENT'S TASK FORCE ON NATIONAL HEALTII CARE
REFORM, after being duly sworn, allege and state:
JURISDICTION
2.
That this is a civil action arising under the laws of the United States, specifically
the Federal Advisory Committee Act ("FACA"), TitleS U.S. C. App., Sections 1 through 14, and
•
the Government in the Sunshine Act, Title S U.S.C. Section SS2b, and is brought pursuant to
3
�Title 28 U.S.C. Sections 1331, 1361, 1651 and TitleS U.S.C. Sections SS2b and 702. Plaintiffs
seek a Declaratory Judgment that the individual Defendants, as members of the PRESIDENTS
TASK FORCE ON NATIONAL HEALTH CARE REFORM, and the Defendant,
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, comply with the
FACA, TitleS U.S.C. App., Sections 1 through 14, and specifically Sections 9 and 10 of said Act,
which require the filing of an advisory committee charter for all federal advisory committees and
further requires that all the meetings of all advisory committees, not wholly composed of federal
officials or employees, to be open to the public after advance notice of the date, time and location
of the meetings are published in the Federal Register. Plaintiffs seek a Temporary Restraining
Order and a Temporary and Permanent Injunction against the individual Defendants, barring them
from holding any meetings as members of the PRESIDENT'S TASK FORCE ON NATIONAL
HEALTH CARE REFORM, and barring any meetings of the Defendant, PRESIDENT'S TASK
FORCE ON NATIONAL HEALTH CARE REFORM, until an advisory committee charter is
filed and said meetings are opened to public participation after advance notice thereof in the
Federal Register, pursuant to FACA, TitleS U.S.C. App., Sections 9 and 10, and the Defendants
conform to the requirements of the FACA, S U.S.C. App., Sections 1 through 14, and TitleS
U.S.C. Section SS2b, in the conduct of all future meetings ofthe aforesaid task force. This Court
may grant such relief in this action under authority of Title 28 U.S.C. Sections 1361 and 2201 and
Rules 57 and 65 of the Federal Rules of Civil Procedure.
3.
That this action involves the legality and course of conduct of a federal advisory
committee and the interpretation and meaning of the Federal Advisory Committee Act (FACA),
TitleS U.S.C. App., Sections 1 through 14, and the Government in the Sunshine Act, Trtle S
U.S.C. Section SS2b, enacted by the Congress of the United States of America, and, therefore,
the Attorney General of the United States (or the interim Attorney General of the United States if
no person bas been confirmed for the position) shall be served with a copy of the Verified
.
Complaint for Declaratory Judgment, Restraining Order, and Temporary and Permanent
----------~-----~--~-~~-~
4
-------------------------
�Injunctive Relief: and shall be entitled to be heard as required by Rule 4 of the Federal Rules of
Civil Procedure.
VENUE
4.
That venue is laid in this judicial district pursuant to Title 28 U.S.C. Section
1391(e) in that the individual Defendant members of the Defendant, PRESIDENTS TASK
FORCE ON NATIONAL HEALTH CARE REFORM, with the exception of HILLARY
RODHAM CLINTON, are officers and agents ot: and employed by, the Government of the
United States, and all of the individual Defendants are acting in an official capacity for the
Government of the United States as members of the Defendant, PRESIDENTS TASK FORCE
ON NATIONAL HEALTH CARE REFORM; all the individual Defendants have their offices-in
the case of the Defendant, HILLARY RODHAM CLINTON, her residence-within this judicial
district; the Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTii CARE
REFORM, has its offices located within this judicial district; the cause of action arose within this
judicial district; and, no real property is involved herein.
PUJNTIFFS
S.
That the Plaintifl: ASSOCIATION OF AMERICAN PHYSICIANS & .
SURGEONS, INC. (" AAPS"), is a national physician and osteopath membership corporation,
organized and existing under and by virtue of the not-for-profit corporation laws of the State of
Indiana, with its principal offices located at 1601 North Tucson Boulevard, Suite 9, Tucson,
Arizona 85716.. AAPS consists of member physicians and osteopaths from every state and
· tenitory in the Union and the District of Columbia. The purpose of the association is to preserve
and protect the practice of private medicine and osteopathy. The members of AAPS have a deep
concern over the fonnation of national health care policy and any health care reform measures
which may be devised, and, accordingly, desire to attend and participate in the meetings and
deliberations of the individual Defendants, as members of the PRESIDENT'S TASK FORCE ON
NATIONAL HEALTII CARE REFORM, and the Defendant, PRESIDENT'S TASK FORCE
ON NATIONAL HEALTII CARE REFORM, in order to advance and protect the interests of
s
�physicians and osteopaths. The Plaintifl: AAPS, and its members are "interested persons" within
the meaning of the FACA
6.
That the Plaintiff, AMERICAN COUNCU.. FOR HEALTH CARE REFORM,
("ACHCR") is a national public interest, membership corporation, organized and existing under
and by virtue of the not-for-profit corporation laws of the Commonwealth of V~rginia, with its
offices located at 5155 North 37th Street, Arlington,
V~rginia
22207.
The purpose of the
ACHCR is to represent consumers of health care services in an effort ensure that the health care
market remains free ofunneceswy and costly government regulations and for the implementation
of reforms within the insurance industry to protect the consumers of health care services. Like
the members of AAPS, the members of ACHCR desire to attend and participate in the meetings
of the individual Defendants, as members of the PRESIDENT'S TASK FORCE ON NATIONAL
HEALTH CARE REFORM, and the Defendant, PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM, in order to ,advance and protect the interests of
consumers of health care services. The Plaintiff, ACHCR, and its members are "interested
persons" within the meaning of the FACA.
7.
That the Plaintiff, NATIONAL LEGAL &. POLICY CENTER ("NLPC") is a
private foundation, organized and existing under and by virtue of the not-for-profit corporation
laws of the District of Columbia, with its offices located at 1156 15th Street, Suite 500,
Washington, D.C. 20005. The Plaintiff, NLPC, was established to promote ethics in government
by publicizing and distributing a "Code of Ethics for Government" which it believes is essential to
the health of the nation's democratic institutions. The NLPC has a deep concern over the fact that
the PRESIDENT'S TASK FORCE ON NATIONAL HEALTil CARE REFORM is not operating
under an advisory committee charter and is not conducting its meetings in public with advance
notice thereof in the Federal Register, and it regards such conduct as violative of federal law.
Like the members AAPS and ACHCR, the members ofNLPC desire to attend and participate in
.
the meetings of the individual Defendants, as members of the PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM, and the Defendant, PRESIDENT'S TASK FORCE
6 .
�ON NATIONAL HEALTH CARE REFORM, not only due to Plaintiffs' and its officers' its
interest in health care reform, but their interest in the proper operation of government and the task
force itself. The Plaintiff, NLPC, and its members are "interested persons" within the meaning of
theFACA
DEFENDANTS
8.
That the Defendant, HILLARY RODHAM CLINTON, is the wife of the President
of the United States, William Jefferson Clinton, and resides at 1600 Pennsylvania Avenue,
Washington, D.C. 20500. The Defendant, HILLARY RODHAM CLINTON, is not now an
employee or official of the Government of the United States and receives no remuneration from
the Government of the United States. The Defendant, HILLARY RODHAM CLINTON, was
named Chairperson ofthe Defendant, PRESIDENT'S TASK FORCE ON NATIO~AL HEALTH
•
CARE REFORM, on January 25, 1993 by President Clinton.
9.
That the Defendant, DONNA E. SHALALA, is now, and at all times mentioned
herein has been, the Secretary of the United States Department of Health & Human Services, an
official of the federal government, with her offices located at 615 F Hubert H. Humphrey
Building, 200 Independence Avenue, S.W., Washington, D.C. 20410. On January 25, 1993 the
Defendant, DONNA E. SHALALA, was named a member of the Defendant, PRESIDENT'S.
TASK FORCE ON NATIONAL HEALTH CARE REFORM, by President Clinton.
10.
That the Defendant, LLOYD E. BENTSEN, is now, and at all times mentioned
herein has been, the Secretary of the United States Department of the Treasury, an official of the
federal government, with his offices located at 3330 Main Treasury Building, 1500 Pennsylvania
Avenue, N.W., Washington, D.C. 20220. On January 25, 1993 the Defendant, LLOYD E.
BENTSEN, was named a member of the Defendant, PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM, by President Clinton.
11.
That the Defendant, LES ASPIN, is now, and at all times mentioned herein has
been, the Secretary of the United States Department of Defense, an official of the federal government, with his offices located at 3880 the Pentagon, Washington, D.C. 20301. On January
7
�25, 1993 the Defendant, LES ASPIN, was named a member of the Defendant, PRESIDENTS
TASK FORCE ON NATIONAL HEALTH CARE REFORM, by President Clinton.
12.
That the Defendant, JESSE BROWN, is now, and at all times mentioned herein
has been, the Secretary of the United States Department of Veterans Affairs, an official of the
federal government, with his offices located at 114 Tech World Plaza, 801 Eye Street, N.W. (the
mailing address is 810 Vermont Avenue, N.W., Washington, D.C. 20420) Washington, D.C.
20001. On January 25, 1993, the Defendant, JESSE BROWN, was named a member of the
Defendant, PRESIDENTS TASK FORCE ON NATIONAL HEALTH CARE REFORM, by
.
President Clinton.
13.
That the Defendant, RONALD H. BROWN, is now, and at all times mentioned
herein has been, the Secretary of the United States Department of Commerce, an official of the
federal government, with his offices located at 5858 Herbert Clark Hoover Building, 14th Street
and Constitution Avenue, N.W., Washington, D.C. 20230. On January 25, 1993, the Defendant,
RONALD H. BROWN, was named a member of the Defendant, PRESIDENTS TASK FORCE
ON NATIONAL HEALTH CARE REFORM, by President Clinton.
14.
The Defendant, ROBERT B. REICH, is now, and at all times mentioned herein
has been, the Secretary of the United States Department of Labor, an official of the federal
government, with his offices located at 52018 Frances Perkins Building, 200 Constitution
Avenue, N.W., Washington, D.C. 20210. On January 25, 1993 the Defendant, ROBERT B.
REICH, was named a member of the Defendant, PRESIDENTS TASK FORCE ON
NATIONAL HEALTH CARE REFORM, by President Clinton.
15.
The Defendant, LEON E. PANETTA, is now, and
at
all times mentioned herein
has been, the Director of the Office of Management and Budget of the United States, an official of
the federal government, with his offices located at 52018 Frances Perkins Building, 200
Constitution Avenue, N.W., Washington, D.C. 20210. On January 25,. 1993 the Defendant,
LEON E. PANETTA, was named a member of the Defendant, PRESIDENT'S TASK FORCE
•
ON NATIONAL HEALTH CARE REFORM, by President Clinton.
8
__________________________________________......
�16.
The Defendant, ALICE RIVLIN, is now, and at all times mentioned herein has
been, the Deputy Director of the Office of Management and Budget of the United States, an
official of the federal government, with her offices located at Executive Office of the President,
Washington, D.C. 20503. On January 25, 1993 the Defendant, ALICE RIVLIN, was named a
member of the Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTII CARE
REFORM, by President Clinton.
17.
The Defendants, CAROL RASCO, IRA MAGAZINER, and JUDITII FEDER, are
now and at all times mentioned herein have been, domestic advisors to President Clinton, and are
officials of the federal government, with their offices located in the Executive Office of the .
President, Washington, D.C. 20500. On January 25, 1993, the Defendants, CAROL RASCO,
IRA MAGAZINER and JUDITii FEDER were named as members of the Defendant,
PRESIDENT'S TASK FORCE ON NATIONAL HEALTii CARE REFORM, by President
Clinton.
18.
The Defendant, PRESIDENTS TASK FORCE ON NATIONAL HEALTII
CARE REFORM, is an "Advisory Committee" or "Task Force", composed of the Defendants,
HILLARY RODHAM CLINTON, wife ofPresident Clinton; DONNA E. SHALALA, Secretary
of the Department of Health & Human Services; LLOYD E. BENTSEN, Secretary of the
Treasury; LES ASPIN, Secretary of Defense; JESSE BROWN, Secretary of Veterans Affairs;
RONALD H. BROWN, Secretary of Commerce; ROBERT B. REICH, Secretary of Labor;
LEON E. PANETTA, Director of the Office of Management and Budget; ALICE RIVLIN,
Deputy Director of the Office of Management and Budget, CAROL RASCO, IRA MAGAZINER
and JUDITii FEDER, White House advisors, formed by the President of the United States on
January 25, 1993, for the purpose of listening to all parties and preparing health care reform
legislation which could be submitted to Congress. The offices of the Defendant, PRESIDENT'S
TASK FORCE ON NATIONAL HEALTii CARE REFORM, are located at the Executive Office
of the President, Washington, D.C. 20500. The Defendant, PRESIDENT'S TASK FORCE ON
NATIONAL HEALTii CARE REFORM, is named as a party herein for all purposes of Rule
9
�17(b) of the Federal Rules of Civil Procedure. Service of Process sball be made upon the
Chairperson, the Defendant, HILLARY RODHAM CLINTON, at her address, the White House,
1600 Pennsylvania Avenue, Washington, D.C. 20500.
STATEMENT OF THE CASE
The Formation of the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH
CARE REFORM as an Athrisory Committee
19.
That on or about January 25, 1993 President William Jefferson Clinton announced
the formation of the Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH
CARE REFORM, at the White House, the announced purpose of which was, according to the
press release from the White House, "[to] build on the work of the campaign and the transition.
.
Listen to all parties and prepare health care reform legislation to be submitted to Congress within
one-hundred (100) days of our taking office [on January 20, 1993]". A true and correct copy of
the President's Remarks on Health Care Reform of January 25, 1993, is attached hereto and made
a part hereof as though
set
out at length herein and marked, for purposes of identification, as
Exhibit "A".
20.
That the Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH
CARE REFORM, was formed by the President for the purpose of furnishing him with "expert
advice, ideas and diverse opinions," and is a "task force" established by the President in the
interest of obtaining advice and recommendations on national health reform and consists of at
least one member who is not a full-time officer or employee of the federal government.
B.
The PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM is an
Advisory Committee Within the Meaning of the Federtll Advisory Committee Act
21.
That, pursuant to Title 5 U.S.C. App., Section 3, an "advisory committee" is any
"task force" which is "established or utilized by the President ... in the interest of obtaining advice
or recommendations for the President or one or more agencies of the federal government, except
that such term excludes ... any committee which is composed wholly of full-time officers qr
employees of the Federal Government."
10
�22.
That the Defendant, HILLARY RODHAM CLINTON, Chairperson of the
Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and
wife of the President of the United States, is not now, nor at any time relevant hereto has beeu, a
full-time officer or employee of the Government of the United States.
23.
That the Defendant, HILLARY· RODHAM CLINTON, the Chairperson of the
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and wife of the
President of the United States, is barred from being a full-time officer or employee of the
Government of the United States under the Kennedy Act, Title S U.S.C. Section 3110.
24.
That the Defendant, PRESIDENTS TASK FORCE ON HEALTH CARE
REFORM, is an "advisory committee" within the meaning ofthe.Federal Advisory Committee
Act, S U.S.C. App., Sections 1 through 14.
C
The PRESIDENT'S TASK FORCE ON NATJONAL·HEALTH CARE REFORM Has
Failed to File an Advisory Committee Charter•.
25.
That, according to TitleS U.S.C. App., Section 9(a), "no advisory committee shall
meet or take any action until an advisory committee charier has been filed with the Director [of
the Office of Management and Budget][Administrator of the General Services Administration]."
Such charter sbali contain, according to Title S U.S.C. App., Section 9(c), the following
information: "(A) the committee's official designation; (B) the committee's objectives and the
scope of its activity; (C) the period of time necessary for the committee to carry out its purposes;
(D) the agency or official to whom the committee reports; (E) the agency responsible for
providing the necessary support for the committee; (F) a description of the duties for which the
committee is responsible, and, if such duties are not solely advisory, a specification of the
authority for such functions; (G) the estimated annual operating costs in dollars and man-years for
such committee; (H) the estimated number and frequency of committee meetings; (I) the
committee's termination date, if less than two years from the date of the committee's
11
�establishment; and (J) the date the charter is filed." The advisory committee charter shall be filed
as well with the Library of Congress.
26.
That as of the date of the filing of this Verified Complaint for Declaratory
Judgment, Restraining Order, and Temporary and Permanent Injunctive Reliet: no advisory
committee charter establishing the Defendant, PRESIDENT'S TASK FORCE ON NATIONAL .
HEALTH CARE REFORM, has been filed pursuant to FACA, TitleS U.S.C. App., Section 9(c).
D.
The Meetings ofthe PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CAREP
REFORM Must Be Ooen to the Public With Advance Notice Published in the Federal
Register.
27.
That, pursuant to Title S U.S.C. App., Section 10, (a)(l), "Each advisory
committee meeting shall be open to the public." Further, under said section 10(a)(2) of said Title,
"Except when the President determines otherwise for reasons of nation security, timely notice of
each such meeting shall be published in the Federal Register, and the Director [of the Office of
Management and Budget] [Administrator of the General Services Administration] shall prescribe
regulations to provide for other types of public notice to ensure that all interested persons are
notified of such meeting prior thereto." According to subsection (3) of Section IO(a) of said
Title, "Interested persons shall be permitted to attend, appear before, or file statements with any
advisory committee, subject to reasonable rules or regulations as the Director [Administrator]
may prescn"be."
28.
That according to the FACA, Title S U.S.C. App., Section lO(d), and the
Government in the Sunshine Act, Title S U.S.C. Section SS2b(b), "every portion of every meeting
of an agency shall be open to public participation" except where the agency finds that its meeting
or meetings should be closed because not closing the meeting or meetings would involve the
disclosure of matters outlined in TitleS U.S. C. Section SS2b(c) and it takes the requisite steps set
forth in Trtle S U.S.C. App., Section lO(d), and TitleS U.S.C. Section SS2b(d). An "agency",
.
according to Title S U.S.C. Section SS2b, shall include all those entitles set forth in Title S U.S.C .
Section SS2(d), including any "establishment in the executive branch ofthe Government."
12
�29.
That the Defendants have not applied for or sought to invoke any of the
exemptions from holding the meetings of the individual Defendants, as members of the
PRESIDENTS TASK FORCE ON NATIONAL HEALTH CARE REFORM, and the
Defendant, PRESIDENTS TASK FORCE ON NATIONAL HEALTH CARE REFORM, open
to the public and giving adequate notice in the Federal Register and otherwise providing for
public participation set forth in the Government in the Sunshine Act, Title S U.S.C. Section SS2b.
F.
No Meetings of the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH Cd.BE.
REFORM Have Been Conducted To Date.
30.
That the individual Defendants, as members of the Defendant, PRESIDENTS
TASK FORCE ON NATIONAL HEALTH CARE REFORM, .and the Defendant,
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, have not
conducted any meetings, as of the date of filing the within Verified Complaint for Declaratory
Judgment, Restraining Order, and Temporary and Permanent Injunctive Relief: but a meeting of
said individual Defendants and said Defendant task force is imminent.
Subgroups and
subcommitteess thereof: however, are now meeting and conducting business.
G.
Plaintiffs Have Requested to Participate In A.H the Meetings of the PBESIDENT'S
TASK FORCE ON NATIONAL HEALTH CARE REFORM.
31.
That on February 10, 1993 the Pllintift: AAPS, by and through its Executive
Director, Jane M. Orient, M.D., forwarded a letter, overnight mail, to 'the Defendant, HILLARY
.
R.ODHAM. CLINTON, Chairperson of the .Defendant, PRESIDENTS TASK FORCE ON .
NATIONAL HEALTH CARE REFORM, with a copy to Hon. Bernard W. Nussbaum, counsel to
the President of the United States, demanding that she and members of the PlaintUJ: AAPS, be
permitted to attend the meetings of the individual Defendants, as members of the PRESIDENTS
TASK FORCE ON NATIONAL HEALTH CARE REFORM, and the Defendant,
PRESIDENTS TASK FORCE ON NATIONAL HEALTH CARE REFORM, and that she and it
receive advance notice.of all subsequent meetings, pursuant to TitleS U.S.C. App., Section 10.
13
_ _ _____J__ _ _ _ _ _ _ _ _ _ _ _
-
-----~---
-----~------
- - -
�A true and correct copy of the aforementioned letter is attached hereto and made a part hereof as
though set out at length herein and marked, for purposes of identification, as Exhibit "B"
32.
That on February 10, 1993 the Plaintiff:. ACHCR, by and through its executive
director, William Sharker, forwarded a letter, overnight mail, to the Defendant, HILLARY
RODHAM CLINTON, Chairperson of the PRESIDENTS TASK FORCE ON NATIONAL
HEALTH CARE REFORM, with a copy to Hon. Bernard W. Nussbaum, counsel to the Presidellt
of the United States, demanding that he and members of the Plaintiff: ACHCR, be pennitted to
attend the meetings of the individual Defendants, as members of the PRESIDENTS TASK
.
FORCE ON NATIONAL HEALTH CARE REFORM, and the Defendant, PRESIDENTS
TASK FORCE ON NATIONAL HEALTH CARE REFORM, and that he and it receive advance
notice of all subsequent meetings, pursuant to Title S U.S.C. App., Section 10. A true and
correct of the aforementioned letter is attached hereto and made a part hereof as though set out at
length herein and marked, for purposes of identification, as Exhibit "C".
33.
That on February 11, 1993, the Plaintifl: NLPC, by and through its President,
Peter T. Flaherty, forwarded a letter to the Defendant, IDLLARY RODHAM CLINTON,
Chairperson of the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM,
with a copy to Hon. Bernard W. Nussbaum, counsel to the President of the United States,
demanding that he and members of the Plaintiff: NLPC, be permitted to attend the meetings of the
individual Defendants, as members of the PRESIDENTS TASK FORCE ON NATIONAL
HEALTH CARE REFORM, and the Defendant, PRESIDENTS TASK FORCE ON
NATIONAL HEALTH CARE REFORM, and that he and it receive advance notice of all
subsequent meetings, pursuant to TitleS U.S.C. App., Section 10. A true and correct copy of the
aforementioned letter is attached hereto and made a part hereof as though set out at length herein
and marked, for purposes of identification, as Exhibit "D".
H.
Tie Defendants Assert T/Jat the Federal Advisory Committee Act Does Not Applp to
Tiem and Thus Have Refused to Allow Plaintiffs to Attend All of the Meetings of the
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM.
14
�34.·
That the Defendants, by and through Bernard W. Nussbaum, counsel to the
President, notified the Plaintiffs, AAPS, ACHCR and NLPC, by letters dated February 12 and 16,
1993, that no meetings of the individual Defendants, as members of the PRESIDENTS TASK
FORCE ON NATIONAL HEALTH CARE REFORM, and the Defendant, PRESIDENTS
TASK FORCE ON NATIONAL HEALTH CARE REFORM, had been held and, further,
responded to the demands of the Plaintiffs, AAPS, ACHCR and NLPC, regarding their
attendance and participation in the meetings and providing advance notice thereof in the Fed6ral
Register, and otherwise following the Federal Advisory Committee Act, S U.S. C. App. Sections 1
through 14, and the Government in the Sunshine Act, TitleS U.S.C. Section SS2b, by stating the
following:
It is our opinion that the Federal Advisory Committee Act does not, and was not
intended by Congress to, apply to the health task force-composed solely of
Cabinet secretaries, senior White House officials and the First Lady. The
participation of the First Lady on the task force does not trigger application of the
Act.
True and correct copies of the aforesaid letters from Bernard W. Nussbaum, counsel to
the President, to the Plaintiffs, AAPS, ACHCR and NLPC, dated February 12 and 16, 1993, are
attached hereto and made a part hereof as though set out at length herein and marked, for
purposes of identification, as Exhibits "E", "F" and "G".
'
L
The Defendants Are In Vrolation of the Federal Advisory Committee Act and the
Government in the Sunshine Act.
35.
That the Defendants, HILLARY RODHAM CLINTON, DONNA E. SHALALA,
LLOYD E. BENTSEN, LES ASPIN, JESSE BROWN, ROBERT B.· REICH, LEON
PANETTA, ALICE RIVLIN, CAROL RASCO, IRA MAGAZINER, JUDITH FEDER, as
members of the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM,
and the PRESIDENTS TASK FORCE ON NATIONAL HEALTH CARE REFORM, by not
.
filing an advisory committee charter and by not opening aU of the meetings of the individual Defendants, as members of the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH
15
�CARE REFORM, and the Defendant, PRESIDENTS TASK FORCE ON NATIONAL
HEALTH CARE REFORM, and their and its subgroups and subcommittees, to attendance and
participation by the Plaintiffs, and by not providing advance notice of said meetings in the Federal
Register, are in violation of the FACA, S U.S.C. Sections 1 through 14, and specifically Sections
9 and 10, and the Government in the Sunshine Act, TitleS U.S.C. Section SS2b.
J.
The PlaintiffS Are Being Denied Their Rights to Participate in the Meetings of the
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM. and to be
InfOrmed oflts Limits o(Authoritv Under an Advisory Committee Charter.
36.
That as a direct and proximate result of the acts of the Defendants, the PlaintifFs,
AAPS, ACHCR and NLPC, are being, and will be, denied their right, under FACA and the
Government in the Sunshine Act, to attend and participate in all of the meetings and deliberations
of the individual Defendants, as members of the PRESIDENTS TASK FORCE ON NATIONAL
HEALTH CARE REFORM, and the Defendant, PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM, and the subgroups and subcommittees thereof, and are
being denied their right to be infonned of the limits of authority of the Defendants, as members of
the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and the
Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, by said
Defendants failing and refusing to file an advisory conunittee charter.
37.
That by reason of the Defendants' conduct, the Plaintiffs have suffered, and will
continue to suffer, immediate, actual and irreparable harm in that the Defendants will conduct
their meetings without an advisory conunittee charter being filed, and the Plaintiffs will be denied
their right to participate in the meetings and deliberations of the Defendants unless this Honorable
Court grants the relief sought herein. The first meeting of the individual Defendants, as members
of the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and the·
16
�Defendant. PRESIDENTS TASK FORCE ON NATIONAL HEALTH CARE REFORM, is
imminent. but, subgroups and subcommittees thereof are now meeting and conducting business.
38.
That the Plaintiffs have no adequate or speedy remedy at law for the above-
mentioned conduct of the Defendants, and this action for injunctive relief is the PlaintifFs' only
means of securing relief.
PRAYER
WHEREFORE, Plaintiffs pray that this Honorable Court enter judgment against theDefendants, HnJ..ARY RODHAM CLINTON, DONNA E. SHALALA, LLOYD E. BENTSEN,
LES ASPIN, JESSE BROWN, RONALD BROWN, ROBERT B. REICH, LEON PANETTA,
ALICE RIVLIN, CAROL RASCO, IRA MAGAZINER, JUDITH FEDER, individually, and as
members of the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM,
and the Defendant. PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE
REFORM, as follows:
(A)
declare that the said Defendants are in violation of the Federal Advisory
Committee Act, TitleS U.S.C. App., Sections 1 through 14, and the Government in the Sunshine
Act, Title S U.S.C. Section 552b, because the Defendants have failed to file an advisory
committee charter for the Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTil
CARE REFORM, and the Defendants are refusing to open all of the meetings of the
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM to the Plaintiffs and
refusing to permit their participation therein and are refusing to notify the Plaintiffs of the
meetings of the Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE.
REFORM, by fonnally announcing said meetings in the Federal Register.
(B)
enter a Temporary Restraining Order and a Temporary Injunction, pursuant to
Rule 65 of the Federal Rules of Civil Procedure, enjoining the individual Defendants, as members
of the PRESIDENTS TASK FORCE ON NATIONAL HEALTII CARE REFORM, and the
Defendant, PRESIDENTS TASK FORCE ON NATIONAL HEALTH CARE REFO~ and all
.
those in active concert' or participation therewith, from holding or conducting any meetings of the
17
�individual Defendants, as members of the PRESIDENT'S TASK FORCE ON NATIONAL
HEALTII CARE REFORM, and the Defendant, PRESIDENT'S TASK FORCE ON
NATIONAL HEALTII CARE REFORM, pending a final hearing and detennination of this
action; and enter a Permanent Injunction, pursuant to Rule 65 of the Federal Rules of Civil
Procedure, perpetually enjoining the individual Defendants, as members of the PRESIDENTS·
TASK FORCE ON NATIONAL HEALTII CARE REFORM, and the Defendant,
PRESIDENT'S TASK FORCE ON NATIONAL HEALTII CARE REFORM, and all those in
active concert and participation therewith, from holding or conducting any meetings until an
advisory committee charter is filed in accordance with the Federal Advisory Committee Act, Tide
S U.S.C. App., Section 9, and mandatorily enjoining the individual Defendants, as members of the
PRESIDENTS TASK FORCE ON NATIONAL HEALTII CARE REFORM, and the
Defendant, PRESIDENT'S TASK FORCE ON NATIONAL. HEALTil CARE REFORM, and all
those in active concert and participation therewith, from holding or conducting any meetings until
they are all open to the Plaintiffs' (and the public's) attendance and participation, and said
meetings are announced in advance in the Federal Register, in accordance with the Federal
Advisory Committee Act, TitleS U.S.C. App., Section 10, and the Government in the Sunshine
Act, Title S U.S.C. Section SS2b.
(C)
award Plaintiffs such other and further relic( including attorneys' fees, to which
this Honorable Court may deem Plaintiffs entitled.
I, Jane M. Orient, M.D., declare under penalty of perjury that the foregoing is true and
correct.
Executed on ;~.J• r I , 1
JANE M. ORIENT, M.D.
STATEOFNE~~
COUNTY OF ~
t:7 e.
18
�,
Sworn and subscribed to before me by Jane M. Orient, M.D., all on this the
rdrU4v:y
. 1993.
/?td day of
.
My commission expires: 7lJtJtf.
111 9?.5
>
I, William Shaker, declare under penalty of peljury that the foregoing is true and correct.
Executed on ;. - ;J. 3-
Y-3...
Wll.LIAM SHAKE
DISTRICT OF COLUMBIA
WASHINGTON, D.C.
~bed
to
__
E:....._~-=~~-----r-..J' 1993.
My commission expires:
before me by William Shaker, all on this the..231l.lday of
1"----/
.
~~(P
NOT~~ ;t, ~7
I, Peter T. Flaherty, declare under penalty ofpeljury that the foregoing is true and correct.
Executed on .l-
/2 3. / tf.3
I
DISTRICT OF COLUMBIA
WASHINGTON, D.C.
j~wo
and subscribed to before me by Peter T. Flaherty, all on this the,;JS"J,!/.day of
._
--~~-.....::;...-:;;::;o..._.~c..__.. 1993.
19
�20
�KENT MASTERSON BROWN, ESQ.
CHRISTOPHER J. SHAUGHNESSY, ESQ.
BROWN & BROWN, P.S.C.
1114 First National Building
167 West Main Street
Lexington, Kentucky 40507
(606) 233-7879
Fac~e(606)252-6791
~~ Ml'ltril1ltia~
f
P. DYE, ESQ.
Bar No. 215379
FRANK M. NORTHAM, ESQ.
BarNo. 206110
WEBSTER, CHAMBERLAIN
&BEAN
1747 Pennsylvania Avenue, N.W.
Suite 1000
Washington, D.C. 20006
(202) 785-9500
COUNSEL FOR PLAINTIFFS, ASSOCIATION
OF
AMERICAN
PHYSICIANS
AND
SURGEONS, INC., AMERICAN COUNSU. FOR
HEALTH CARE REFORM, and NATIONAL
LEGAL & POLICY CENTER
21
- ---------------------------------------l
�..
Weekly Compilation of
Presidential
Documents
. Monday, February 1, 1993
Volume 29-Number 4
· Pages 93-114
EXHIBIT A
�96
Jan. !.5
the Couneil as the Council may request, to
the extent permitted by law.
WlUiam J. Cllntoa
The 'White House,
Janwuy 25,1993.
[Flied with the Office of the Federal Register,
1:01 p.m., January 25, 1993)
Ncm:: '1111s Eucuti~ order was published In the
Federal Register on January 27.
I Admlni.rtration of William]. Clinton,l993
once again they said, If you want to do some·
thing to help rebuild the auto industry do
something to control health care costs. And
as Mr. Panetta just said agaiD. In a rather
plaintive way before you came in, there 11
no way we will ever get control of the Federal
budget defldt unless we do something about
health care.
The message Is pretty simple. It's time to
make sense of America's health care system.
It's time to bring costs under· control and to
make our families and businesses secure. It's
time to make good on the American
that too m~:y people have talkec:l
t for
too long, while we have continued to spend
more than 30 percent more of our income
on health care than any other nation in the
world, get less for it, and see 100,000 Americans a month losing their health insurance.
As a flrst step in responding to the demmds of literally millions of Americans,
today I am announcing the formation of the
President's Task Force on National Health
Reform. Although the Issue Is complex, the
task force's mission Is simple: Build on the
work of the campaign and the transition, lfs.
ten to all parties, and prepare health care
reform legislation to be submitted to Congress witl:iin 100 days of our taldng office.
This task force will· be chaired by the First
Lady, Hillary Rodham Clinton, aDd will in·
elude the Secretaries of Health and Human
Semces, Treasury, Defense, Veterans Affairs, Commerce, Labor, as well as the Director of the Office of Management and Budget
and senior White House staff members.
J am grateful that Hillary has agreed to
chair thiS task force and not onlr because
it means she'D be sharing some of the heat
I expect to generate. As many of you Jcnow.
whife I was Governor of my State, Hillary
chaired the Arkansas Education Standards
Committee, which created public acbool accreditation standards that have since become
a model for national reform. She lelved as .
my designee on the Southem
Taik
Force on Infant Mortality, was
chair of
our State's rural health committee in 1979
and 1980, a time in which we Initiated anumber of health care reforms that beneflt the·
people of my State to the present day. And
on the board of the ArkansaS Children's Hos-
Admlnlftrat
pital, she he
neonatal UDi
I thinJc t
American p .
our State di !
manr talent: '
people toget
Issues to h.
things done.
. ·· · Here in
work .with ar
Rasco: my
Jouromlse
Remarks on Health Care Reform and
. an Exchange With Reporten
JanutJry !5,1993
I want to say good aftemoon to members
of the press. We have just fmished a very
lively discussion about the massive task before us in health care. Vice President Gore
and I made a strong commitment to the
American people during the last election that
we would present to the United States Congress, within 100 days, a plan that would take
strong action to control health care costs in
America and to begin to provide for the
health care needs of all Americans.
As I traveled across the country last year,
no stories moved me more than the health
care stories. As I think all of you lcnow, IDIIl)'
of the ~le in our Faces of Hope luncheon
last we.Jc ouring the Inaugural were people
who were struggling to overcome inciedible
adversity occasionea by their health care
problems. We've met elderly people choos·
ing every week between meDicine and food·
we've met ~pie forced to leave their job~
to get on public assistance to deal with Children with terriflc problems; we've met countleu ~le who can't change their jobs be· ·
cause tliey or someone in their family have
had health care problems.
You will all remember, at the economic
conference that we ~nsored in Uttle Rock,·
perhaps the overwhelming concem of the
business ~pie there, of all sizes, was doing
aometbing a6out the cost and the availability
of health care. When the Vice President and
I met with the big three auto makers and
the president of tlie United Auto Workers,
Magaziner; :
transition te
of them to:
uapartoft
publlc to wr
with their ac
seat to the
Care Refom
in\:~ DC~
e will r
for undertalc
tious. But as
we're going
choices In or
to bring thei
provide heal
serve the vitt
tor, in order
budget here
totally banla
malce some t
and special i
efforts, and v.
But we are c
best possible
at leaSt. ther1
IenlUS that sc
We have a
Aaociatlon,
..
1
Physicians, f1
Family Pract
:·•
industry ltsel:
nea and lab
lcnowledge tl:
now. We are
ae.e,onal
our l)'ltem. '
meet the bur.
country.
There are:
.. ID lie dealt v
·: ·. · cuaed yet ac
:
!"
..
�-linCa~,m·af
18Dt to do
Jto
mdustzy,
care costs. ADd
aiD, In a ntber
illle m, there II
;,I of the Federal
;omething about
.pie. It's time to
dth care system.
r control and to
:sses secure. It's
Derican promise
tallced about for
tlnued to spend
' of our income
er nation in the
100,000 Ameri-
ealth insurance.
ding to the de~
af Americans,
formation of the
National Health
is complex. the
le: Build on the
1e transition, lis.,. health care
'mitted to Conllr taking ofl'ace.
.Ired by the Fint
ton, and will inalth and Human
e, Vetenns AfveU as the Direc-
nent md Budget
rmemben.
y has agreed to
.ot onlr because
ome of the heat
my of )'OU bow,
"' State, Hillary
.cation StandardS
public school ac-
~ IIDce. become".
aened u
~ll'ei--Tulc
~·=--or.
WillimnJ. Clltalma,l993 I }tm. 25
jii ... '
she' helped to establish our State's first rural areas. covenge for little children. dealing with the AIDS crisis adequate!)', ltll1
Ul ilf:MIOnallal UDft.
: I tbinJc that In the coming months the unmet needs in the area of women's health
!~~rnel'lican people willleam. u the people of care, the problem of the vetenns ID this
State Clid.- that we have a Fint L8dy of counay wlio don't have access to care, evea
manr talents, that who most of all can bring as their own network goes broke. All these
: people together around complex and difficult issues will be dealt with in this task force.
.' Issues to hammer out consensus md get Tbls is going to be m unprecedented effort.
·: things done.
ADd let me just say. in general, we're going
::: Here In the White House, HUWy will to set up a workroom, Jdnd of liJce the war
' "work with my domestic ~licy adviser, Carol room we had in the campaign, over In the
Rasco; my senior ~licy adviser, In Executive Office Building. And all of the deMagaziner; and the head of our health care partments you see here represented and
transition team, Judy Feder. I've asked all leaden you see represented around this table
of them to be u inclusive u possible. And will be represented in that room. ADd we
as a part of that, we are inviting the American are going to work constant!)'. day and night,
public to write w here at the White Howe, until we have a health care plan ready to subwith their suggestions. All of them should be mit to the Congress that we believe we can.
.
sent to the Task Force on National Health pass.
Finally, let me say I ~ committed to
Care Reform at the White House in Wash·
ington. DC 20500.
doing this in a partnenhip with the Congress.
We will no doubt be ~ticized by some I will ask the leadenhip of the CoD~ to
for undertaking something very, very ambi· work with me on a bi~sm buis and to
· tiow. But as I said in my Inaugural Address, do whatever we can to make sure that u we
we're going to have to make some tough present the plan, we have also muimlzed Ia
choices in order to control health care costs, Chances of early passage in the Congress.
to bring them down within inflation, and to
I tlWilc all these people for their willingprovide health care for all. In order to pre- ness to serve and to work together. I hope
serve the vitality of the American private sec- the Americm people will see just how pastor, in order to keep the American people's sionately I penonally am committed to dOing
budget here at this national level from going something about health care reform. We've
totally bankrupt, we are going to have to talked abOut it long enough. The time has
make some tough choices. Powerful lobbies come to act. and I have chosen the coune
and ~ interests may seek to denil our that I think is most likely to lead to action ·
efforts, and we may malce some people angry. that will improve the lives of millions of
But we are determined to come up with the Americans.
best possible solution. And in my lifetime,
Q. Mr. President. em you provide univerat least. there has never been so much con- sal covenge without driving up the deftclt?
sensw that something has to be done.
rM PrAiclenc. J think you can do It If
We have a plm from the American Nunes you control the cost of health care. You haw
Association. from the American Academy of to really-let me just-1 don't want to get
Physicians, from the American Academy of into ODe of these thin~ that provolce a lot
Family Pnctlce. from the health insunnce of cartoons about my policy woolc weabess,.
industry itself. We have a plan uniting busi· but we're at 14 percent of our income on
Dess md labor. There is an overwhelming health care now. The next most ~
knowledge that we have to move and move health care system in the world is CAnada's.
now. We are going to do our best to reform It's at about 9.2 percent of income. n.t Is
our system. We are going to do our best to a huge difference, massive. And yet. IMIIY
meet the human needs of the people of this other major country with which we compete
country.
p~des some basic health care to every·
There are all 1cinds of problems that have · body. something we don't do. So the answer
to be dealt with that we haven't even dis- to your question is. in my judgment, If we
cussed yet: access to care in inner cities and do this right over the next 8 yean. you're
�98
]tm. !ZS I Adminutrotlon of WiUIGm ]. Clinton,l993
going to see huge savings in tax dollars and
even bigger savings. more than twice the savings, in frivate dollars that will free up hundreds o billions of dollars literally between
now and the end of the decade to reinvest
in economic growth and opportunity.
In the short run, our tough c8ll will be
bow do you take the savings and phue in
univenal coverage. Or shoulCl there be some
other way to ~pay for that? We've got some
short-term calls to make. But there's no question that In the median term, 5 to 8 yean.
you're loolcing at massive savings witb univerSal coverage in both tax dollan and private
sector dol18n if we do it right.
Q. Mr. President, do you intend to pay
· the Fint Lady for her efforts?
The PreaicMrae. No. No. I never have paid
her for her public service efforts. I don't want
to start now.
Q. Is 100 days hard and fast, or are you
wilfing to be flexible on that if it's not quite
ready?
7'lae Prnid.rat. If it were 101 days I
wouldn't have a heart attack. but I don't want
to-1 want lt done now. I think we know
what the major alternatives are. What we
have to do now is something nobody's done,
and that is to meld them into the best possible legislation, talcing account of some of
the prolilems that exist with every coune.
And let me make one acknowledgment on
the front end about this. Legitimate objections can be raised to any course of action
in this area. That is, there .is no such thing
as a perfect solution. So whatever coune we
choose to take, somebody can say, 'Well, It's
not perfect for these reasons." To that, I have
two answen, and rm going to say this until
rm blue in the face Cor thii entire year until
we get action. Number one, the wont thing
we can do is keep on doing what we're doing•
now, because more and more people are Calling out of the system and the cost is becoming more and more burdensome to those who
are stlll bearing it. So whatever coune we
talce, we will preserve what is best about
American health care, some consumer choice
and the quality of care. So whatever problems we have, they won't be as bad as the
ones we've ~ now. Number two, this is not
going to be the end of the line. Whatever
. problems are there can be fixed later. But
we wi11 never, never get anywhere lfwe stand
paralyzed. because there's no such thing u
a perfect alternative.
Q. What facton did you consider in glving
this high-prome position to Mn. Chnton?
The Preaident. Of all the people I'w ever
worked with in my life, she's better at orpnizing and leading people from a complex
beginning to a certain end than anybody I'w
ever worked with in my life. And tl.at'i what
I want done here.
NOTE: 11ae President ~Ire at !:02 p.m. In the
Roosevelt Room at the White House at a meeting
of the Health Care Working Croup.
Statement by the Director of
Communications on the President's
Meeting With the Joint Chiefs of
Staff
January ~5. 1993
The President and the Joint Chiefs of StafF
had a cordial, honest. and respectful meeting.
They covered a range of issues but focused
primarily on gays in the military.
The President reiterated his commitment
to ending discrimination against bomosemals
in the military solely on the basis oC status
and to maintaining morale and cohesion in
the military.
The Joint Chiefs of Staff upreued their
concerns and difBculties with tlie President's
commitment but also expressed their respect
for his decisionmaking power u Co~der
in Chief.
Appointment of John D. Bart as
Deduty A.uistant to the President
an Deputy Director of the omce of
Intergovernmental Afl'aln
Jcnwry ~5. 1993
The President today appointed John D.
Hart to the position of Deputy Assistant to
the Presiden
Bceoflnler£
Forthela:
a senior trar
Assistant tD
~her
foDowing hi;
Hart bacllx
· ·tDniCore T
the pre-tra
formed dur
palgn. Duri:
Hart played
operations. ~
neyinWul
for the Hor
U.S. Claims
~polntm
LOrraiDe··
BousePn
}4fltiD"J~5
The Pres
ennpresss
raine Voles,
Press Secret
Voles ser.
retuyforth
been press:
o( Iowa iin{
project dire
Defense C
press secret
paign. She
House on~·
Jones lw
Mayor Ray
he served I!
Musachuse
andwuarc
begins work
i
�1601 N. Tucson Blvd. Suite 9
Association of American Physicians and Surgeons. Inc.
Tucson, AZ. 85716
(800) 635-1196
(602) 327-4885 in AZ
February 9, 1993
01-W.;ERS
Nir11.1 '1.1. C1'2mC'=St. MO.
Fr~
NO!'~ 01~
~'WI·. Jf. M~.
~'reSICICftl·klect
C:t\ori!H W.
1\'chc~a!l~.
GA
L)(:f,uld Qu.~IQI"•• ~.to
Hillary Rodham Clinton
Chairperson
President's Task Force on National Health care Reform
The White House
Washington, DC 20500
5e':le1CII'i
Ncllhf.-,,11
P..
t~aco~.Mn.
lrOQ$UIVr
CtT.Jic:ano. TX
John M
ilcvlOl. Jr., '.4 0.
II"M"l'CIUial'llm" Cresleor.,
t:QnteM;tP., Ot 1
DIRECTORS
Cl(l;,(( A bd. Jf. M.O.
A.lQuW,G/,
Curti~ W
Ccltllf. s~. MD.
..ICC:~$01\
t.'IS
left. J. ~0. \'I.IJ.
Hilisdn-t ~JJ
Ja~~ I.
C.."\'. ~.1C.
r>o~""~· H.
JeM J Owltlf. M.;)
011t.~n.•
V L (;o~r,, M.\).
Dear Ms. Clinton:
on behalf of the Association of American Physicians
and Surgeons, Inc., a national association of private,
practicing physicians, please be advised that I and its
members desire to attend the next and all subsequent
meetings of the President's Task Force on National Health
Care Reform.
This request is made pursuant to Section 10 of the
Federal Advisory Committee Act, which mandates that all
such advisory committees be open to the public. Advance
notice of the next meeting and any and all subsequent
meetings would be appreciated so that I and other members
may make plans to travel to Washington to be in
attendance.
BciMt,ID
Giots.A:". Sl. ~Ai>.
Son 1\nlc."''IICI, f)(
flnt111.
w. IJ;x'lllt' ..lo!ac'\ r.• ::>
I
date.
will appreciate a reply at the earliest possible
~llantn. Gil
Andrftloo 1.. t.'.C:K:8.
~.11':.
sincerely,
OOIIIOIYJ. MD
~m~
Uen w """''· \W
tuck~·. Gl'
..,..,.., Sc"~!.:vr. ~.1.0
ScOlii'-'Qie. 1.1
M~h01tt ~tr.t,
Jane M. Orient, MD
Executive Director
M 1.::
~"'~Oti.WA
ex~CU11vt t~RFCTOR
.U~tt
r.t Ortent. ~.,IJ
C"..FNE:t~AL
K(lnt
COUI'.ISFL
M'lSI~ R~,.
l<MB/jmo
cc:
Bernard w. Nussbaum
Counsel to the President
The White House
..
y
y
EXHIBIT B
I
p
�American Council for Health Care Reform
5155 North 37th Street
Arlington, Virginiu22207
February 9, 199:\
Hillary Rt,dham Clinton
Chaifl'C1'SM
President's Task Force on National.Healthcare Rcfarm
The White House
Washin~rtan, D.C. 20006
Dear Ms. ('linton:
I am writing on behalf of the American Council f•lr Health Care llc:form. We were
cstahlilih'-~d in 1983 as a non-profit organiation to protect consumer rights and help lower tht
cast uf health care delivery.
r•tcase accept my request to attend the next and all subsequent meetings of the Pres; dent'~
Task Force an National Healthcare Reform. The Amcritan Council for Health Care Ilcfonn is
making this request pursuant to Section 10 of the Federal Advisory Committee Act. As you
must know. this Act mandates that all such advisory committee mectinss be open to the public.
We are asked daily if we support the President's health care reform initiatives. Our "nly
answer can be that we have no idea of what is being prorascd because all deliberations are bein~
condu"1~d
in secret. We would be supportive of a numbnr of changes in health care policy.
Howe\'CT' these changes must be thoroughly examined; srcret deliberations can produce nothing
but bad public policy.
Please reply to our request at your earliest possible convenience.
Slncm.ly, ·
'L.,
~H. sir~
E"~ utive
cc:
Director
R~mard W. Nussbaum
(',,unset ta the President
The White House
Please provide us with advanced notice of the ne>:t and any and all subsequent meeting~
so that we may plan accordingly.
.,
'I'
EXHIBIT C
•
p
·.
�,
•
NATIONAL LEGAL & POLICY CENTER
1156 15th Street, Suite 550, Washingtoll, DC 20005 202·331-Q541
February 11, 1993
Mrs. Hillary Rodha.rn Clinton
Chairm~n
President's Task Force
on National Health care Reform
The ~nite House
·
Washington, DC 20006
Dear Mrs. Clinton:
Please be advised that members of the staff of the National
Legal and Policy Center wish to attend the next and all s~sequent
meetings of tr.e President's Task Force on Health ca=e Reform.
This request is made pursuant to Section 10 of the Advisory
Committee Act, which requires that all such advisory committee
meetings be open to the public. Advance notice of the next and all
subsequent meetings would be appreciated so that ou~
representatives may attend.
The Natio!"!al Legal and Policy Center promotes ethics in
government. We do r.ot believe that the secrecy of Task Force
deliberations, including the closed nature of its ~eetings, serves
this ena.
I have enclosed a copy of the •code of Ethics for Goverr~er.t
service.• Your attention is directed to item #2 which states, •Any
person in Government service should uphold the Constitution~ laws,
regu!ations of the United States and all governments therein and
never be a party to their evasion.• I encourage you to circulate a
copy of the Code to all me~ers and staff of the Task Force.
I look forward to your reply.
Peter T. Flaherty
President
cc: Bernard
w.
Nussbaum, Counsel to the President
•.
EXHIBIT D
--------------------------------------------------------------------------·------
�THE WHITE HOUSE
WASHINGTON
February 12, 1993
Jane M. Orient, M.D.
Executive Director
Association of American Physicians
and Surgeons, Inc.
1601 N. Tucson Blvd., suite 9
Tucson, Arizona 85716
Dear Dr. Orient:
The First Lady baa asked •• to respond to your letter,
dated February 9, 1993, concernin9 the President'• health care
task force.
The President bas selected the First Lady, Hillary
Rodham Clinton, to chair the health care task force. In addition
to the First Lady, the task force currently includes the
Secretaries of the Treasury, Defense, commerce, Labor, Health and
Human Services, and Veterans Affairs' the Director of the Office
of Management and Budget; the Assistant to the President for
Domestic Policy; the Assistant to the President for Economic
Policy; the Chair of the Council of Economic Advisors, and the
Senior Advisor to the President for Policy Development.
The task force haa not yet held a meeting, althou9h
members of the task force were present on January 25 when the
President announced the formation of the task force and defined
ita mission. The task force is planning to hold aome public
meetings in the future. Those maetin9s have not yet been
schedulecS.
.
As the President announced on January 25~ the senio~· ·
Advisor to the President for Policy Development will leacS an
interdepartmental working ;roup that will gather information for,
ancS provide information to, the task force. The working qroup
will consist of ;overnment employees, and will consult with a
wide ran;e of citizens in the public and private sectors. Tba
task force, in turn, will review information providecS by the
working group and make recommendations to the President.
It is our opinion that tha Federal Advisory Committee
Act doea not, and was not intended by Congress to, apply to the
health care task force -- compoae4 solely of Cabinet secretaries,
senior White House officials and the First Lady. The participation of the First Lady on tbe task force does not trigger
·
application of tbe Act.
FROM COY
GRAPH I>
EXHIBIT E
�--·-----.--. --- --
Jane M. orient, M.D.
February 12, 1993
Page 2
As noted above, the task force will be holding soma
public meetinqs at which citizens, organizations and institutions
will have an opportunity to present their views. Those meetinga
have not yet been scheduled, but will be announced in advance.
If you and other representatives of the Association of American
Physicians and Surgeons, Inc., are interested in attenting such
public meetings, please contact Mike Lux at 202-456-2930.
Please feel free to contact me, my deputy Vincent
Foster or Associate counsel Stephen Neuwirth should you require
further information in response to your request.
Bernard W. Nussbaum
Counsel to the President
•.
�THE 'WHITE HOUSE
WASHINGTClN
February 12, 1913
William H. Shaker, P.l.
Executive Director
American Council tor Health Care Reform
5155 North 37th Street
Arlington, Virginia 22207
Dear
Mr. Shakers
._,,_
... -··
The First Lady bas asked me to respond to your letter,
dated February 9, 1993, concerning the President's health care
task force.
The President has selected the Firat Lady, Hillary
Rodham Clinton, to chair the health care task force. In addition
to the First Lady, the task force currently includes the
secretaries of the Treasury, Defense, commerce, Labor, Health and
Human Services, and Veterans Affairs; the Director of the Office
of Manaqement and Budget; the Assistant to the President for
Domestic Policy; the Assistant to the President for Economic
Policy; the Chair of the council of Economic Advisors; and the
Senior Advisor to the President for Policy Development.
The task force has not yet held a aeetinq, althou9h
members of the tas~ force were present on January 25 when the
President announced the formation of the task force and defined
its mission. The task force is planning to hold some public
meetings in the future. Those meetings have not yet bean
scheduled.
·As the Pre•i4ent anno\mced on t1an~~~·.:·:l.!$.,,.... ~,.~s~ni.w;
Advisor to the President fer Policy Development will leaa an
interdepartmental working ;roup that will ;ather information tor,
and provide information to, the task force. The working ;roup
will consist of 9overnment employees, and will consult with a
wide ranqe of citizens in the public and private sectors. The
task force, in turn, will review information provided by the
working ;roup and make recommendations to the President.
It is our opinion that the Federal Advisory Committee
Act does not, and was not intended by Congress to, apply to the
health care task force ·-- composed solely of Cabinet secretaries,··
senior White House officials and the First Lady. The participation of the First Lady on tbe task force does not trigger
application of the Act.
~
�--·-···------.
William H. Shaker, P.E.
February 12, 1993
Page 2
As noted above, the task force will be holdinq some
public meetings at which citizens, orqanizations and institutions
will have an opportunity to present their views. Those meeting•
have not yet been scheduled, but will be announced in advance.
If you and other representatives of the American council for
Health care Reform are interested in at~endinq such pu~lic
meetin;s, please contact Mike Lux at 202-456•2930.
Please feel free to contact me, ay deputy Vincent
Foster or Associate counsel Stephen Neuwirth shoul4 you require
further information in response to your request.
------------__·:_=:.:.=-----------------------.;,. ___ -----------.---------------- -~ -----.
�•
~
•
I
THE WHIT£ HOUSE
WASHINGTON
Fe~ruary
16, 1993
Peter T. Flaherty
President
National Legal and Policy Center
1156 15th Street, Suite 550
Washington, D.C. 20005
Dear Mr. Flaherty:
The First Lady has asked me to respond to your letter,
dated February 11, 1993, concerning the President's health care
task force.
Tbe President has selected the First Lady, Hillary
Rodham Clinton, to chair the health care task force. In addition.
to the First Lady, the task force currently includes the
Secretaries of the Treasury, Defense, Commerce, La~or, Health and
Human services, and Veterans Affairs' the Director of the Office
of Management and Budget1 the Assistant to the President for
Domestic Policy; the Assistant to the President for Economic
Policy; the Chair of the council of Economic Advisors; and the
Senior Advisor to the President for Policy Development.
The task force has not yet held a meetinq, although
members of the task force were present on January 2' when the
President announced the formation of the task force and defined
its mission. The task force is planning to hold soae pUblic
meetings in the future. Those meetings have not yet ~aen
scheduled.
.
.
.
President announced on January 25, the senior
Advisor to the President for Policy Development will lead an
interdepartmental working group that will gather information ror,
and provide information to, the task force. The workinq group
will consist of government employees, and will consult with a
wide range of citizens in the public and private sectors. The
task force, in turn, will review information provided by the
working group and make recommendations to the President.
As the
It is our opinion thKt u,. Fe4eral A4vicory Committ~A
Act does not, and was not intended by Congress to, apply to the
health care task force -- composed solely of Cabinet sacretar1ea,
senior White House officials and the First Lady. The partici~
pation of the. First Lady on the task force does not tri;qer
application of the Act.
Jane M. orient, M.D.
"
•
EXHIBIT G
IP
�•
February 16, 1993
Page 2
As noted above, the task force will be holding some
public meetings at which citizens, organizations and institutions
will have an opportunity to present their views. Those meetings
have not yet been scheduled, but will be announced in advance.
If you and other representatives of the Association of American
Physicians and surgeons, Inc., are interested in attending such
public meetings, please contact Mike Lux at 202-456-2130.
Please fee~ free to co~tact •• my deputy Vincent
Foster or Associate Counsel Stephen Neuwirth should you require
further information in response to your requeat.
Very truly yours,
•
----------------------------------------------------------------------- --------.
�UNITED STATES DISTRICT COURT
DISTRICT OF COLUMBIA
)
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.,
etc., et aL,
)
)
)
)
VL
IIJLLARY RODHAM CLINTON, etc., et al.,
CIVIlL ACTION NO.---~
)
)
)
Plaintiffs
JUDGE ___________
)
)
Defendants
DISCLOSURE OF CORPORATE AFFlLIATIONS
AND FINANCIAL INTERESTS
We, the undersigned counsel of record for the ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC., an Indiana not-for-profit corporation, the AMERICAN
COUNCll.. FOR HEALTH CARE REFORM, a Vaginia not-for-profit corporation, and the
NATIONAL LEGAL & POLICY
C~
a District of Columbia not-for-profit corporation,
certify to the best of our knowledge and belief, the Plaintiffs are not parent companies,
subsidiaries or affiliates of any companies which have outstanding securities in the hands of the
public.
These representatives are made in order that judges of this Court may determine the need
for recusal.
KENT MASTERSON BROWN
CHRISTOPHER J. SHAUGHNESSY
BROWN & BROWN, P.S.C.
1114 First National Building
167 West Main Street
Lexington, Kentucky 40507
(606) 233-7879
Facsu.nile(606)252-6791
1
�ALAN P. DYE, ESQ.
Bar No. 215379
~"'"ne M ';{erWfA·..M. NORTHAM, ES .
BarNo. 206110
WEBSTE~
CHAMBERLAIN
&BEAN
1747 Pennsylvania Avenue, N.W.
Suite 1000
Washington, D.C. 20006
(202) 785-9500
COUNSEL FOR PLAINTIFFS, ASSOCIATION
OF
AMERICAN
PHYSICIANS
AND
SURGEONS, INC., AMERICAN COUNSEL FOR
HEALTH CARE REFORM, and NATIONAL
LEGAL & POLICY CENTER
•.
2
�.
UNITED STATES DISTRICT COURT
DISTRICT OF COLUMBIA
)
)
)
)
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.,
etc., et aL,
Plaintiffs
)
CIVIL ACTION N O . - - - -
VL
)
)
)
IUDGE ___________
HILLARY ROD BAM CLINTON, etc., et aL,
Defendants
)
)
MOTION FOR PERMISSION FOR
THE HONORABLE KENT MASTERSON BROff'N
TO APPEAR AND PARTICIPATE
PRO HAC VICE
NOW COME the Movants, Honorable Frank M. Northam and Honorable Alan P. Dye,
licensed, practicing attorneys-at-law in the District of Columbia and members of the bar in good
standing of the United States District Court for the District of Columbia, and hereby move this
Honorable Court, pursuant to Rule 104 of the General Rules of the United States District Court
for the District of Columbia, for permission for Honorable Kent Masterson Brown of Lexington,
Kentucky, to appear and participate in the above-entitled cause, pro hac vice.
In support of the foregoing Motion, Movants state that the Honorable Kent Masterson
Brown is a member in good standing of the bar of the Supreme of Kentucky and of the bars of
numerous other federal courts.
In further support of this Motion, Movants have appended the Affidavit of the Honorable
Kent Masterson Brown to which is attached his curriculum vitae.
WHEREFORE, Movants pray that the Honorable Kent Masterson Brown be permitted to
appear and participate in the above-entitled cause, pro hac vice.
1
�ALAN P. DYE, ESQ.
Bar No. 215379
~--_/.) M .. 1~---
~TiiAM, Esfif
BarNo. 206110
WEBSTER, CHAMBERLAIN
&BEAN
1747 Pennsylvania Avenue, N.W.
Suite 1000
Washington, D.C. 20006
(202) 785-9500
2
·
�UNITED STATES DISTRICT COURT
DISTRICT OF COLUMBIA
)
)
)
)
)
)
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.,
etc., et aL,
Plaintiffs
,..
)
CIVIL ACTION N O . - - - JUDGE ____________
)
)
)
IOLLARY RODHAM CLINTON, etc., et aL,
Defendants
AFFIDAVIT OF KENT MASTERSON BROWN
NOW COMES the Affiant, Kent Masterson Brown, and, after being duly sworn, deposes
and says:
1.
That this Affiant is a resident and citizen of Lexington, Fayette County, Kentucky
and is forty-three (43) years of age.
2.
That this Affiant is a graduate of the Centre College of Kentucky, Danville,
Kentucky (B.A., 1971) and the School of Law, Washington & Lee University, Lexington,
Vaginia (J.D., 1974).
3.
That this Affiant was admitted to the bar of the Supreme Court of Kentucky in
1974, and is a licensed, practicing attorney-at-law in the Commonwealth of Kentucky in good
standing. Affiant is neither under suspension or disbarment. This Affiant is not licensed to
practice law in the District of Columbia, and is not a member of the bar of the United States
District Court for the District of Columbia.
4.
That this Affiant is a member of the bars of the Supreme Court of the United
States (1978), the United States Courts of Appeals for the Fifth (1989), Sixth (1975) and
Eleventh (1985) Circuits and the United States District Courts for the Eastern District "of
Kentucky (1977) and the Central District ofDlinois (1985) in good standing.
1
�S.
That, in addition, this Affiant has been admitted to practice, pro hac vice, before
the Supreme Courts of Florida, Dlinois and Indiana and the United States District Courts for the
Eastern District of North Carolina, Northern District of Georgia, Southern District of Mississippi,
Westeni District of Louisiana, Western District of Kentucky, Northern and Southern Di~ricts of
Ohio, and the District ofNew Jersey.
6.
That this Affiant is familiar with the Rules of the United States District Court for
the District of Columbia and all the obligations of counsel arising thereunder.
7.
That a true and correct copy of the curriculum vitae of the Affiant is attached
hereto and made a part hereof as though set out at length herein and marked, for purposes of
identification, as Annex "A".
Further the Affiant sayeth naught.
The foregoing is true as I verily believe.
/
;Ld_.A_..t -1\
KENT MASTERSON BROWN
COUNTY OF FAYETTE
STATE OF KENTUCKY
Sworn and subscribed to before me by Kent Masterson Brown, all on this the
ofFebruary, 1993.
My commission expires: 'r /t~r.5
'
2
aOt( day
�CURRICULUM VITAE
KENT MASTERSON BROWN
Bom:
February 5, 1949
Home Address:
1629 Fincastle Road
Lexington, Kentucky 40502
(606) 269-9724
Office Address:
1114 First National Building
167 West Main Street
Lexington, Kentucky 40507
(606) 233-7879
Married to:
Vickie A. Yates
Acotkmic Background:
B.A. (History), Centre College of Kentucky, Danville, Kentucky, 1971
J.D., School ofLaw, Washington & Lee University, Lexington, VD'ginia, 1974
Acotkmic Honors:
Phi Alpha 'rheta Honorary History Fraternity
Profession:
Lawyer (private practice of law, in Lexington, Kentucky, practicing in the fields of
Constitutional law and Health law) 1974 to the present.
Bar Affiliations:
Supreme Court of the United States (1978); Supreme Court of Kentucky (1974);
United States Courts of Appeals for the Sixth (1975), Fifth (1989), and Eleventh
(1985) Circuits; United States District Courts for the Eastern District of Kentucky
(1977) and Central District ofDiinois (1985).
Professional Associations:
National Health Lawyers Association and American Society of Law and Medicine
Scholarly Writing and Lecturing in Health Law Field:
y
•
ANNEX A
I
P
•
�"PPOs An Antitrust Analysis", 1984
Preventive Law Reporter
"Hospital Liability for Premature Discharge,"
3 Prospective Payment Survival, January, 1985
"Preventive Law in Health Care," 1984
Preventive Law Reporter
"The Law of Peer Review"
Lecture, National Health Lawyers Association, Spring, 1980, Toronto, Canada
"PROs And the Law," Seminar lectures, Dallas, Texas, January, 1988; Chicago,
Dlinois, May, 1988; San Francisco, California, October, 1988
"The Physician and Medicare," Seminar lectures, Atlanta, Georgia, Fall, 1988,
Columbus, Ohio, May 1989, Orlando, Florida, September, 1989, Decatur,
Georgia, December, 1988 and 1989, Toledo, Ohio, April, 1990, Lexington,
Kentucky, September, 1991; Burgen County, New Jersey, January, 1992
"Medical Staff Bylaws," Scottsdale, Arizona, September, 1990
Medical Law Writer, Private Practice Magazine
Editorial Board and Writer, 1987-present, Medical Office Management Magazine
I have given lectures on national health policy before various state medical
societies and hospital medical staffs in virtually every State in the Union.
Government Positions Held:
Trial Commissioner, Fayette Circuit Court, Kentucky, 1985-1988
Commissioner, Kentucky Registry of Election Finance (3 terms) 1981 to present;
Interim Chairman, 1987
Character ofLaw Practice:
Throughout my career in the practice of law, I have been a trial and appellate
lawyer. Principally, my cases have involved the adjudication of constitutional issues
arising out of the regulation of the health care industry and the administration of the
Medicare and Medicaid programs as well as antitrust issues within the health care
industry.
Exemplary of the type of litigation in which I have been involved as both trial and
appellate counsel and representing amici are the following reported cases:
2
�McGuffey. etc., eta/. v. Hall, eta/., Ky. 557 S.W.2d 401 (1977). Constitutional challenge
to Kentucky Medical Malpractice Act of 1976.
&nforth v. Fayette Memorial Hospital, Ind. App., 383 N.E.2d 368 (1978).
Constitutional challenge to hospital requirement that medical staff members
purchase minimum amounts of medical liability insurance.
Frederick v. University of Kentucky Medical Center, Ky. App., 596 S.W.2d 30 (1979).
First impression challenge to state hospital invoking the doctrine of sovereign
immunity after the enactment of the Kentucky Medical Malpractice Act and the
University of Kentucky Medical Center Malpractice Act.
Adkins, etc. v. Sarah Bush Lincoln Health Center, 129 m.2d 497, 136m. Dec. 47, 544
N.E.2d 733 (Dl., 1989). First impression case involving whether the minois
antitrust laws apply to medical staff credentialling decisions; whether the minois
Peer Review Act creates a cause of action for willful violation of hospital bylaws;
and, whether hospital bylaws were breached thereby necessitating injunctive relief
under the exception to the rule of non-review in minois.
Whitney, et al. v. Heckler, 603 F.Supp. 821 (N.D. Ga., 1985) and Whitney v. Heckler, 780
F.2d 963 (11th Cir., 1986), cert. den. 107 S.Ct. 64 (1986). Constitutional
challenge to the physician fee freeze in the Medicare Amendments to the Deficit
Reduction Act of 1984.
AAPS, eta/. v. Bowen, et al., 909 F.2d 161 (6th Cir., 1990). Challenge to the requirement
of the U.S. Department of Health and Human Services and its Medicare
intermediaries that all clinical diagnostic laboratory services performed for
Medicare beneficiaries be billed only on an assigned basis.
Coy v. Florida Birth-Related Neurological Injury Compensation Association, 595 So.2d
943 (1992). Challenge. to the constitutionality of the Florida Birth-Related
Neurological Injury Compensation Act of 1988.
Caine v. Hardy, 943 F.2d 1406 (5th Cir., en bane, 1991), cert. den., 112 S.Ct. 1474
(1992). First impression civil rights case challenging whether the State of
Mississippi, by enacting a statute allowing an aggrieved physician to proceed to a
state chancery court after his or her hospital medical staff privileges have been
revoked, may, constitutionally, deny a physician the right to file a civil rights action
in a federal forum against a public hospital within the recognized one-year period
of limitations.
Union Labor Life Ins. Co. v. Pireno, 458 U.S. 119, 72 L.Ed.2d 647, 102 S.Ct. 3002
(1982). Whether claims peer review in the chiropractic field is the "business of •.
insurance" for purposes of the McCarran-Ferguson Exemption to the Sherman
Antitrust Act. (amicus curiae, Supreme Court ofUnited States)
3
�Jefferson Parish Hospital Dist. No.2 v. Hyde, 466 U.S. 2, 80 L.Ed.2d 2, 104 S.Ct. 1551
(1984). Whether an exclusive contract for anesthesiology in a hospital is a per se
violation of the Shennan Antitrust Act. (amicus curiae, Supreme Court of United
States
Patric/c v. Burgett,_ U.S.____,_ L.Ed.2d ____, 108 S.Ct. 1658 (1988). Whether
peer review in a hospital is exempt from the Shennan Antitrust Act under the
"State Action" doctrine established in Parker v. Brown (amicus curiae, Supreme
Court of United States)
People of the State of New York v. Roth, et a/, 419 N. Y.S.2d 851 (Nassau County Court,
1979) (amicus curiae). Defense of criminal antitrust case which involved the first
impression legal question ofwhether the New York State antitrust laws (Donnelley
Act) apply to the medical profession.
Cruzan v. Director, Missouri Dept. of Health,_ U.S.____, L.Ed.2d ____, 110 S.Ct.
2841 (1990). (amicus curiae for a number of physician organizations and for
Surgeon General C. Everett Koop). Whether the state, upon application of the
guardians, may constitutionally withdraw nourishment from a patient in a
"persistent vegetative state".
Stewart v. Sullivan, (D.C.N.J., 1993) (unreported) case in the District of New Jersey
(Newark) challenging whether the U.S. Department of Health & Human Services
and the Health Care Financing Administration can prevent Medicare beneficiaries
and their physicians from privately contracting for health care services and not file
any claims for payment with Medicare.
In addition, I have practiced before State Medical Licensure Boards; Judicial
Councils and Claims Committees of State Medical Associations; Utilization and Quality
Control Peer Review Organizations (PROs) and Certificate of Need and Licensure Boards
in such states as Kentucky, Indiana, Dlinois, Tennessee, Florida, New York, Texas, and
Georgia. I have also appeared before the Office of the Inspector General, Medicare, and
the Secretary of Health & Human Services, Baltimore, Maryland.
In a related field, I have testified before the Judiciary Committee of the United
States House of Representatives on the Health Care Quality Improvement Act of 1986
and the Act to Repeal the McCman-Ferguson Exemption from the Federal Shennan
Antitrust Act. In addition, I have testified before the Ways & Means Committee of the
United States House of Representatives on the Federal Alternative Medical Malpractice
Insurance Act, and, I have prepared testimony before the Judiciary Committee, United
States Senate, and the Health Subcommittee, United States Senate.
•.
4
�UNITED STATES DISTRICT COURT
DISTRICT OF COLUMBIA
)
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.,
etc., et aL,
Plaintiff's
)
)
)
)
)
)
)
)
VL
HILLARY RODHAM CLINTON, etc., et aL,
Defendants
CIVD.. ACTION N O . - - - SUDGE ___________
)
PLAINTIFFS' MEMORANDUM OF POINTS AND AUTHORITIES IN SUPPORT OF
MOTION FOR A TEMPORARY RESTRAINING ORDER AND TEMPORARY
INJUNCTION
MAY IT PLEASE THE COURT:
NOW COME the Plaintiffs, ASSOCIATION OF AMERICAN PHYSICIANS AND
SURGEONS, INC. ("AAPS"), AMERICAN COUNCn.. FOR HEALTH CARE REFORM
("ACHCR"), and NATIONAL LEGAL &. POLICY CENTER ("NLPC"), pursuant to Rule 65(b)
of the Federal Rules of Civil Procedure, and for their Memorandum of Points and Authorities in
Support of their Motion. for a Temporary Restraining Order, and Temporary Injunction, state as
follows:
INTRODUCTION
This case involves the construction of the Federal Advisory Committee Act ("FACA"), 5
U.S.C. App., Sections 1 through 14, and the Government in the Sunshine Act, S U.S.C. Section
552b, and their application to the formation and activities of HILLARY RODHAM CLINTON,
DONNA E. SHALALA, LLOYD E. BENTSEN, LES ASPIN, JESSE BROWN, RONALD H.
BROWN, ROBERT B. REICH, LEON E. PANETTA, ALICE RIVLIN, CAROL RASCO, IRA
MAGAZINER and ruDITH FEDER, individually, and as members of the PRESIDENT'S TASK
FORCE ON NATIONAL HEALTH CARE REFORM, and the PRESIDENT'S TASK FORCE
1
�ON NATIONAL HEALTH CARE REFORM (collectively referred to as "the TASK FORCE").
The nation's health care system is probably the single most important domestic issue facing the
United States today. Every American citizen will be profoundly affected by any health care
reform policy or legislation which emerges from the Capital in the future. In order to facilitate the
formation and implementation of a national policy of health care reform, the President of the
United States recently established the PRESIDENTS TASK FORCE ON NATIONAL HEALTH
CARE REFORM. The Plaintiffs maintain that the controlling provisions of the Federal Advisory
Committee Act, S U.S. C. App., Sections 1 through 14, and the Government in the Sunshine Act,
S U.S.C. Section 552b, as applied to the composition of the TASK FORCE and its activities;
together with the overarching public import of any contemplated reform of the nation's health care
system, and the need for open and vigorous public debate of the issue, require that the TASK
FORCE be chartered and that the meetings of the TASK FORCE and its subgroups and
subcommittees be open to the public and be subject to public scrutiny after adequate notice is
published in the Federal Register.
STATEMENT OF FACTS
The Plaintiffs
The Plaintiff, AAPS, is a national physician and osteopath not-for-profit membership
corporation, organized and existing under the not-for-profit corporation laws of the State of
Indiana. AAPS consists of member physicians and osteopaths from every state and territory in the
United States and the District of Columbia. AAPS was established in 1943, and its purpose is to
preserve and protect the private practice of medicine. Its members have a serious interest in the
formation of national health care policy and any national health care reform measures which may
be proposed or implemented in the future. Specifically, AAPS is deeply committed to limiting
government intrusion into the practice of medicine and the physician-patient relationship, and
preserving and protecting freedom of choice for consumers ofhealth care services.
The Plaintifl: ACHCR, is a national public interest not-for-profit membership corporatiOn
organized and eXisting under the not-for-profit corporation laws of the Commonwealth of
2
�Virginia. The purpose of ACHCR is to represent consumers of health care services in order to
ensure that the nation's health care system remains free from uMecessary and costly government
regulations, and to promote the implementation of reforms within the insurance industry to
protect consumers of health care services. ACHCR, like AAPS, possesses a serious interest in the
formation of national health care policy and any national health care reform measures which may
be proposed or implemented in the future.
The PlaintHI: NLPC, is a private foundation, organized and existing under and by virtue of
the ncn-for-profit corporation laws ofthe District of Columbia. The primary purpose ofNLPC is
to promote ethics in government by publicizing and distributing a "Code of Ethics for
Government" which it believes is essential to the health, vitality, and legitimacy of the nation's
democratic institutions. NLPC is also seriously interested in national health care reform as well as
the proper and legal operation of the TASK FORCE itself. AU of the Plaintiffs strongly object to
the TASK FORCE and its individual members not conducting its or their meetings in public with
advance notice and consider such conduct to be violative of federal law.
B.
The Defendants
On January 25, 1993, President Clinton established the Defendant, PRESIDENT'S TASK
FORCE ON NATIONAL HEALTH CARE REFORM, which currently consists of at least twelve
(12) members, who are also individual Defendants in this action:
First Lady Hn..LARY
RODHAM CLINTON; DONNA E. SHALALA, Secretary of the United States Department of
Health &. Human Services; LLOYD E. BENTSEN, Secretary of the Treasury; LES ASPIN,
Secretary of Defense; JESSE BROWN, Secretary of Veterans Affairs; RONALD H. BROWN,
Secretary of Commerce; ROBERT B. REICH, Secretary of Labor; LEON E. PANETTA,
Director of the Office of Management and Budget; ALICE RIVLIN; Deputy Director of the
Office of Management and Budget; and CAROL RASCO, IRA MAGAZINER, and JUDITH
FEDER, who are White House Advisors.
According to the January 25, 1993 "Remarks on Health Care Reform and an Exchange
With Reporters", contained in the
Week~
Compilation of Presidential Documents (Exhibit "A:"
3
�to Verified Complaint) (hereinafter "January 25 Remarks"), the avowed purpose of the TASK
FORCE is to "[b]uild on the work of the campaign and the transition, listen to all parties, and
prepare health care refonn legislation to be submitted to Congress within 100 days of our taking
office." Week.{y Compilation of Presidential Documents, Vol. 29, No. 4, p. 96 (Febiuary 1,
1993). In his January 25 Remarks, President Clinton expressly stated as follows: "We have a
plan from the American Nurses Association, from the American Academy of Physicians, from the
American Academy of Family Practice, from the health insurance industry itself. We have a plan
uniting business and labor." ld, at p. 97.
According to recent press accounts, the Defendant, IRA MAGAZINER, will lead "'an.
interdepartmental working group' which is to coordinate policy development for the Task Force."
4 Medicare Report 138-39 (Bureau of National Affairs, January 29, 1993). As to this group, in
his January 25 Remarks, President Clinton stated as follows: "And let me just say, in general,
we're going to set up a workroom, kind of like the war room we had in the campaign, over in the
Executive Office Building. And all of the departments you see here represented and leaders you
see represented around this table will be represented in that room." Week{)' Compilation of
Presidential Documents, Vol. 29, No.4, p. 97 (February 1, 1993). According to a recent account
in the Washington Post, the "interdepartmental working group" headed by the Defendant, IRA
MAGAZINER, who is himself a fonnally-named member of the TASK FORCE, "is organizing
and working with the 20 groups of consultants as well as political strategists who are developing
a way to sell the health care plan to the public." Anonymity is Buzzword for Health 'Worker
Bees', Washington Post, Feb. 17, 1993, at A17, col. 4. The Washington Post reported the
following on the TASK FORCE's and the "interdepartmental working group's" use of outside
consultants:
The outside consultants, who technically are not members of the President's
Task Force on National Health Care Reform, toil behind the curtain of a White
House-imposed news blackout on their work and on their identities.
4
•.
�.....
The administration describes them as "worker bees" who will fill out the
technical details of policy that will be decided by the formal task force, headed by
Hillary Rodham Clinton.
ld. A true and correct copy of the aforementioned Washington Post article is attached hereto as
Exhibit IIAII.
The Defendant, HILLARY RODHAM CLINTON, the wife of the President, is the
Chairperson of the TASK FORCE. As to the appointment of the First Lady to chair the TASK
FORCE, President Clinton, in his January 25 Remarks, stated as follows:
I think that in the coming months the American people will learn, as the
people of our State did, that we have a First Lady of many talents, that who most
of all can bring people together around complex and difficult issues to hammer
out consensus and get things done.
Here in the White House, Hillary will work with my domestic policy
adviser, Carol Rasco; my senior policy adviser, Ira Magaziner; and the head of our
health care transition team, Judy Feder. I've asked all of them to be as inclusive as
possible. And as a part of that, we are inviting the American public to write us
here at the White House with their suggestions. All of them should be sent to the
Task Force on National Health Care Reform at the White House in Washington,
D.C. 20500.
Weekly Compilation of Presidential Documents, Vol. 29, No. 4, p. 97 (February 1, 1993)
(Emphasis added.).
Importantly, the Defendant, HILLARY RODHAM CLINTON, the Chairperson of the
TASK FORCE, is not a full-time officer or employee of the federal government. In his January
25 Remarks, President Clinton was asked, and he answered, the following question:
Q. Mr. President, do you intend to pay the First Lady for her efforts?
MR. PRESIDENT: No. No. I never have paid her for her public service efforts.
I don't want to start now.
ld, at p. 98.
Indeed, the Honorable William F. Clinger, Jr. (R-PA), Chainnan of the House Committee on
Government Operations, which possesses sole jurisdiction over the Federal Advisory
Act, stated in part as follows in a February 1, 1993letter to President Clinton:
5
Committ~
�..
~;.,
FACA defines "advisory committee" to include, inter alia, any group (1)
established by the President, (2) in the interest of obtaining advice or
recommendations, and (3) not composed wholly of full-time federal officers or
employees. It appears that the Task Force on Health Care meets this definition, as
it was established for the purpose of obtaining a consensus on recommendations
for health care reform legislation and is chaired by an individual who is not a fulltime federal officer or employee.
Affidavit of Genevieve M. Young, Attachment 1.
In a letter to Representative Clinger from Hon. Bernard W. Nussbaum, counsel to the
President, dated February 5, 1993, in response to Representative Clinger's letter, dated February
1, 1993, Mr. Nussbaum stated as follows:
It is our opinion that the Federal Advisory Committee Act ("FACA") does
not, and was not intended by Congress to, apply to the health care task force. The
participation of the First Lady on the task force does not trigger application of the
Act.
Affidavit of Genevieve M. Young, Attachment 3.
Additionally, the February 5, 1993, letter from Mr. Nussbaum to Representative Clinger states as
follows regarding the role of the "interdepartmental working group" led by Defendant, IRA
MAGAZINER:
As the President announced on January 25, the Senior Advisor to the President for
Policy Development will lead an interdepartniental working group which will
gather information for, and provide information to, the task force. The working
group will consist of government employees, and will consult with a wide range of
citizens in the public and private sectors. The task force, in turn, will review
information provided by the working group and make recommendations to the
President.
Affidavit of Genevieve M. Young, Attachment 3.
B
Facts Giving Rise to This Litigation
On February 10, 1993, the Plaintiff, AAPS, through its Executive Director, Jane Orient,
M.D., forwarded a letter to the Defendant, HILLARY RODHAM CLINTON, Chairperson oftJte
6
i'
. :
�...
TASK FORCE, with a copy to Hon. Bernard W. Nussbaum, counsel to the President of the
United States, which reads, in relevant part, as follows:
On behalf of the Association of American Physicians and Surgeons, Inc., a
national association of private, practicing physicians, please be advised that I and
its members desire to attend the next and all subsequent meetings of the President's
Task Force on National Health Care Refonn.
This request is made pursuant to Section 10 of the Federal Advisory
Committee Act, which mandates that all such advisory committees be open to the
public. Advance notice of the next meeting and any and all subsequent meetings
would be appreciated so that I and other members may make plans to travel to
Washington to be in attendance.
I will appreciate a reply at the earliest possible date.
Exhibit "B" to Verified Complaint for Declaration of Rights. Restraining Order. and Temporm
and Permanent Iniunctive Relief(hereinafter, "Verified Complaint").
l
On February 10, 1993, the Plaintiff, ACHCR, through its Executive Director, William
Shaker, forwarded a virtually identical letter to HILLARY RODHAM CLINTON, Chairperson of
the TASK FORCE, with a copy to Hon. Bernard W. Nussbaum, counsel to the President,
requesting that he and other members of ACHCR be given advance notice o( and be permitted to
attend, all future meetings of the TASK FORCE. See, Exhibit "C" to Verified Complaint. On
February 11, 1993, the Plaintiff, NLPC, through its President, Peter T. Flaherty, likewise
forwarded a letter to HILLARY RODHAM CLINTON, Chairperson of the TASK FORCE, with
a copy to Hon. Bernard W. Nussbaum, counsel to the President, requesting that he and other
members of 'NLPC be given advance notice o( and be permitted to attend, all future meetings of
the TASK FORCE. See, Exhibit "D" to Verified Complaint.
On or about February 12 and 16, 1993, the Defendants, by and through Bernard W.
Nussbaum, counsel to the President, forwarded letters to the Plaintiffs in response to their
requests regarding the TASK FORCE complying with the Federal Advisory Committee Act, S
U.S.C. App., Sections 1 through 14, and the Government in the Sunshine Act, 5 U.S.C. Sectiem
7
�....
-'
·'
SS2b. These letters, which are virtually identical to the February S, 1993 letter from Bernard
Nussbaum to Representative Clinger, state, in relevant part, as follows:
It is our opinion that the Federal Advisory Committee Act does no~ and was not
intended by Congress to, apply to the health task force-composed solely of
Cabinet secretaries, senior White House officials and the First Lady. The
participation of the First Lady on the task force does not trigger application of the
Act.
See, Exhibits "E", "F", and "G" to Verified Complaint.
Upon investigation, the Plaintiffs have determined that no advisory committee charter for
the TASK FORCE has ever been filed with the Administrator of the General Services
Administration, and no copy of an advisory committee charter for the TASK FORCE has been
furnished to the Library of Congress, pursuant to Section 10 ofthe Federal Advisory Committee
Act. See, Affidavit of J. Chad Jackson. While the TASK FORCE itself has apparently not held
any meetings to date, press releases. and various press accounts illustrate that such meetings are
imminent, as the January 25, 1993 "Remarks on Health Care Reform and an Exchange with
Reporters" explicitly states that one goal of the TASK FORCE is to prepare and develop health
care legislation within the first one-hundred (100) days of President Clinton's administration.
Furthermore, the letters from Hon. Bernard Nussbaum, counsel to the President, illustrate that the
Defendants firmly take the position that they do not intend to comply with the Federal Advisory
Committee Act, S U.S.C. App., Sections 1 through 14, and the Government in the Sunshine Act,
S U.S.C. Section SS2b.
Most importantly, the recent press accounts discussed herein reveal that the shroud of
secrecy, which is apparently contemplated for the TASK FORCE as a whole, has been enlarged to
the "interdepartmental working group" led by Defendant, IRA MAGAZINER, who is apparently
meeting with a plethora of private and public consultants, many of whose identities are, as yet,
unknown to the public. It is precisely this type of secrecy and stealth in the federal government's
decisional processes that the Federal Advisory Committee Act and the Government in the
Sunshine Act were designed to eliminate.
8
�..·"
!
Unless this Honorable Court mandatorily enjoins the Defendants to comply with these
statutes, the Plaintiffs and their members will be forever foreclosed from attending and
participating in the meetings and other activities of the Defendants concerning health care issues
that will deeply affect them and other members of the American electorate. Because no entity,
including this Court, can re-create past meetings and activities of the TASK FORCE, and· its
subcommittees and subgroups, the Plaintiffs will suffer irreparable harm unless a Temporary
Restraining Order and Temporary Injunction issues requiring full compliance with the
.
aforementioned controlling federal statutes.
ARGUMENT
L
THE PLAINTIFFS HAVE STANDING TO MAINTAIN THE INSTANT SUU
BECAUSE THEY ARE "INTERESTED PERSONS" WITHIN THE MEANING OF
THE FEDERAL ADVISORY COMMITTEE ACZ:
The Plaintiffs Are "Interested Persons" Within the Meaning of Section 10 of the
Federal Advisory Committee Act. 5 U.S.C App.. SectionlO.
The Federal Advisory Committee Act, 5 U.S.C. App., Section 10, provides, in relevant
part, as follows:
(aXl) Each advisory committee meeting shall be open to the public.
(2)
Except when the President determines otherwise for reasons of national
security, timely notice of each such meeting shall be published in the
Federal Register, and the Administrator [of the General Services
Administration] shall prescribe regulations to provide for other types of
public notice to insure that all interested penons are notified of such
meeting prior thereto.
Interested penons shall be permitted to attend, appear before, or file
(3)
statements with any advisory committee, subject to such reasonable rules
or regulations as the Administrator [of the General Services
Administration] may prescribe.
(b)
Subject to section 552 of title 5, United States Code, the records, reports,
transcripts, minutes, appendixes, working papers, drafts, studies, · agenda,
or other documents which were made available to or prepared for or by
each advisory committee shall be available for public inspection and
copying at a single location in the offices of the advisory committee or the
9
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.'
agency to which the advisory committee reports until the advisory
committee ceases to exist.
(Emphasis added.)
As the Verified Complaint and correspondence to the Defendant, HILLARY RODHAM
CLINTON, and the counsel to the President make clear, the Plaintiffs and their members are
seriously interested in the issue of national health care reform, and thus wish to have notice of and
to attend and participite in the meetings of the TASK FORCE and otherwise obtain the benefits
to which they are statutorily entitled under the Federal Advisory Committee Act, S U.S.C. App.,
Sections 1 through 14, and the Government in the Sunshine Act, S U.S.C. Section SS2b. The
Plaintiffs are, therefore, "interested persons" within the meaning of the Federal Advisory
Committee Act, S U.S.C. App., Section 10.
B.
The Plaintiffs Have Suffered a Distinct and Palpable lnjurv-in-Fact Which Will Be
Remedied By the Relief Requested Because the Plaintiffs Have Requested But Have
Not Received Notice of. and Have Not Been Afforded Access to and Participation in
the Meetings ofthe TASK FORCE and Its Subgroups and Subcommittees.
The Plaintiffs have specifically alleged that they have requested notice of, and access to,
meetings of the TASK FORCE, pursuant to Section 10 of the Federal Advisory Committee Act,
and have been specifically and consistently advised that the Defendants take the position that the
Federal Advisory Committee Act is not applicable to them or their activities. Although no.
meetings of the TASK FORCE as a whole have been held to date, the avowed purpose and
mission of the TASK FORCE, as stated in public documents, indicate that such meetings are
imminent. See, Verified Complaint, Paragraphs 31 through 37; Exhibit "A". Moreover, the
Plaintiffs have plead, and recent press accounts illustrate, that individual members of the TASK
FORCE have secretly met, and are secretly meeting, ·with groups of public and private
"consultants", thereby conducting meetings of subgroups and subcommittees without in any way
complying with the controlling provisions of the Federal Advisory Committee Act. See, Verified
Complaint. Paragraphs 30, 35. The United States Supreme Court has flatly held that such
.
allegations suffice to establish injury-in-fact for standing purposes, and has also held that the fact
10
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;
that other non-plaintiff members of the public have also been denied and are being denied their
rights under the Federal Advisory Committee Act is totally irrelevant to the standing inquiry.
In Public Citizen v. U.S. Dept. ofJustice,_ U.S.~ 109 S.Ct. 2558, __ L.Ed.2d
_
( 1989), two public interest groups filed suit against the United States Department of Justice
and the American Bar Association's Standing Committee on the Federal Judiciary after the
defendants refused their requests for the names of potential federal judicial nominees they were
considering and for copies of their reports and minutes of their meetings. The action sought
declaratory and injunctive relief under the Federal Advisory Committee Act which, inter alia,
defines an "advisory committee" as any group "established or utilized" by the President or an
agency to give advice on public questions, and requires a covered group to file a charter, afford
notice of its meetings, open those meetings to the public, and make its minutes, records, and
reports available to the public. As a threshold matter, the defendants contended that neither
Public Citizen nor its co-plaintiff, the Washington Legal Foundation, had standing to maintain the
suit under FACA The defendants argued that the plaintiffs were advancing a general grievance
shared in substantially equal measure by all or a large class of citizens, or alternatively, that a
decision in favor of the plaintiffs would not redress their alleged injury because the meetings they
sought to attend and the records they wished to review would probably be closed to them under
Section lO(d) ofFACA, which cross-references 5 U.S.C. Section 552b(c), the exceptions to the
open meetings requirement of the Government in the Sunshine Act. The United States Supreme
Court soundly rejected these arguments. The Court first concluded that the plaintiffs suffered a
distinct injury-in-fact:
Appellant [Washington Legal Foundation] has specifically requested, and been
refused, the names of candidates under consideration by the ABA Committee,
reports and minutes of the Committee's meetings, and advance notice of future
meetings. WLF Complaint, App. 8. As when an agency denies requests for
information under the Freedom of Information Act, refusal to permit appellants to
scrutinize the ABA Committee's activities to the extent FACA allows constitutes a
sufficiently discrete injury to provide standing to sue. Our decisions interpreting
the Freedom of Information Act have never suggested that those requesting
11
�infonnation under it need show more than that they sought and were denied
specific agency records. [Citations omitted.] There is no reason for a different rule
here.
Public Citizen v. U.S. Dept. ofJustice, 109 S.Ct. at 2563-64.
The Court then proceeded to conclude that the defendants' claim that the plaintiffs Jacked standing
because a ruling in their favor would not provide relief because of FACA's exceptions to
disclosure was "untenable".
Public Citizen v. U.S. Dept. of Justice, 109 S.Ct. at 2564.
Numerous cases from the lower federal courts, and specificaiJy this Honorable Court and the
United States Court of Appeals for the District of Columbia, are in accord with Public Citizen v.
U.S. Dept. of Justice on the threshold issue of standing under the Federal Advisory Committee ·
Act. See, e.g., National Anti-Hunger Coalition v. Executive Committee, SS1 F.Supp. 524, 527
(D.D.C. 1983), ajj'd711 F.2d 1071 (D.C. Cir. 1983);Naderv. Baroody, 396 F.Supp. 1231, 1232
(D.D.C. 1975); Center for Auto Safety v. Cox, 580 F.2d 689 (D.C. Cir. 1978).
The Plaintiffs clearly have met the threshold requirements for standing under the Federal
Advisory Committee Act. The Verified Complaint and the exhibits thereto illustrate that the
Plaintiffs have directly requested the Defendants to comply fully with all provisions of the Federal
Advisory Committee Act, and have been directly advised that the ·TASK FORCE will do nothing
of the sort. The Plaintiffs have thus suffered and will continue to su~er a discrete "injury-in-fact"
under the Federal Advisory Committee Act and the interest they seek to advance in procedural
regularity and public scrutiny and oversight of the Defendants under the Federal Advisory
Committee Act will manifestly be advanced by a judgment in their favor and injunctive relief,
requiring the Defendants to comply with the Federal Advisory Committee Act.
ll
THE PLAINTIFFS HA. J'E DEMONSTRATED THE REQUISITE ELEMENTS FOR
THE ISSUANCE OF A TEMPORARY RESTRAINING ORDER AND TEMPORARY
INJUNCTION.
A Temporary Restraining Order and Temporary Injunction may be granted only when the
plaintiff demonstrates (1) a substantial likelihood of success on the merits; (2) that irreparable
injury will result in the absence of the requested relief; (3) that no other parties will be banned if
12
�temporary relief is granted; and (4) that the public interest favors entry of a Temporary
Restraining Order and a Temporary Injunction.
Washington Metropolitan Area Transit
Commission v. Holiday Tours, Inc. 559 F.2d 841, 843 (D.C. Cir. 1977); Public Citizen v.
National Economic Com'n, 703 F.Supp. 113, 124 (D.D.C. 1989).
A.
The Plaintiffs are Likely to Succeed on the Merits Because the President's Ttuk Force
on National Health Care Reform is an "Advisory Committee" Within the Meaning of
the Federal Advisory Committee Act
It is well-established that, as a condition of obtaining a Temporary Restraining Order, a
plaintiff is required to demonstrate a substantial likelihood of success on the merits. Public
Citizen v. National Economic Com'n, 703 F.Supp. 113, 124 (D.D.C. 1989). At bottom, the issue
in this litigation is whether the TASK FORCE is an "advisory committee" within the meaning of
Section 3 of the Federal Advisory Committee Act, 5 U.S.C. App., Section 3. When the facts
surrounding the establishment and function of the TASK FORCE are analyzed against the plain
language and remedial purpose of the Federal Advisory Committee Act and Federal Advisory
Committee Management Regulations, it is patent that the TASK FORCE is an "advisory
committee" within the meaning of5 U.S.C. App., Section 3, and that the Defendants are required
to comply with all of the relevant proviSions of the statute, but have refused, and will continue to
refuse, to do so. Thus, as discussed more specifically below, the Plaintiff's have a substantial
likelihood of prevailing on the merits of their claims on an application for a Temporary and
Permanent Injunction, pursuant to Rule 65(a)(2) of the Federal Rules of Civil Procedure.
i.
The TASK FORCE is a tllskforce established and utilized by the
President tu a preferred source of advice from which to obtain
advice or recommendations on the specific issue of health care.
In Public Citizen v. U.S. Dept. of Justice, _
__L.Ed.2d _
U.S.
---J
109 S.Ct. 2558, 2562,
(1989), the United States Supreme Court, citing Section 2(b) of the statute,
recognized that the purpose of the Federal Advisory Committee Act was "to ensure that new
.
advisory committees be established only when essential and that their number be minimized; that
13
�they be tenninated when they have outlived their usefulness; that their creation, operation, and
duration be subject to uniform standards and procedures; that Congress and the public remain
apprised of their existence, activities, and cost; and that their work be exclusively advisory in
nature." Furthermore, in one of the first reported decisions construing the Federal Advisory
Committee Act and the exceptions to its open meetings requirement, this Honorable Court
recognized the overarching salutary purpose and rationale for the legislation by observing:
The importance of the Federal Advisory Committee Act is epitomized by Senator
Metcalfwho handled. the legislation in the Senate:
What we are dealing with here goes to the bedrock of government
decision making. Information is an important commodity in this capital.
Those who get information to policy-makers, or information for them,
can benefit their causes whatever it [sic] may be. Outsiders can be
adversely and unknowingly affected. And decisionmakers who get
information from special interest groups who are not subject to rebuttal
because opposing interests do not know about the meetings-and could not
get in the door if they did--may not make tempered judgments. 118 Cong.
Rec. S15285-86 (daily ed. September 19, 1972)
This court will not allow the door to close on these meetings when Congress has
expressly ordered the door be open except on the rarest occasion.
Na&kr v. Dunlop, 310 F.Supp. 177, 179 (D.D.C. 1973).1
1
Senator Metcalfs observation about the salutary purpose of the Federal Advisory
Committee Act is especially applicable to this case. At the outset of the TASK FORCE's
appointment, President Clinton explicitly stated in his January 25 Remarks:
We have a plan from the American Nurses Association, from the American
Academy ofPhysicians, from the American Academy of Family Practice, from the
health insurance industry itself. We have a plan uniting business and labor.
Weekly Compilation ofPresidental Documents, Vol. 29, No. 4, p. 97 (February 1, 1993)
Additionally, at least one recent press account in the Washington Post has stated that an
"interdepartmental working group" headed by the Defendant, IRA MAGAZINER, is working
with a number of groups of consultants, many from certain segments of the private sector and
many of whose identities are still unknown. This is precisely the type of governmental activity
which led to the enactment of the Federal Advisory Committee Act and the Government in the
Sunshine Act.
14
�The plain language of Section 3 of the Federal Advisory Committee Act reveals that the
TASK FORCE is within the statute's perview. Section 3 of the statute provides as follows:
Section 3.
Definitions
For the purpose of this Act( 1) The term "Director" ["Administrator"] means the Director of the Office of
Management and Budget [Administrator of General Services].
(2) The term "advisory committee" means any committee, board, commission,
council, conference, panel, task force, or other similar group, or any
subcommittee or other subgroup thereof (hereafter in this paragraph
referred to as "committee"), which is(A) established by statute or reorganization plan, or
(B)
established or utilized by the President, or
(C)
established or utilized by one or more agencies,
in the interest of obtaining advice or recommendations for the President
or one or more agencies or omcen of the Federal Government except that
such term excludes (i) the Advisory Commission on Intergovernmental
Relations, (ii) the Commission on Government Procurement, and (iii) any
committee which is composed wholly of full-time officers or employees of the
Federal Government.
(3) The term "agency" has the same meaning as in section SS1(1) of title S
United States Code [S USCS Section SS1(1)].
(4) The term "Presidential advisory committee" means an advisory committee
which advises the President.
(Emphasis added.)
Additionally, the Federal Advisory Committee Management Regulations issued by the
General Services Administration, 41 C.F.R. Sections 101-6.1001 to 101-6.1035 (1990), illustrate
that the TASK FORCE is subject to the strictures of the Federal Advisory Committee Act. 41
C.F.R. Section 101-6.1003 contains the following definitions, among others:
Act means the Federal Advisory Committee Act, as amended, S U.S.C.,
App.
Administrator means the Administrator of General Services.
Advisory committee subject to the Act means any committee, board,
commission, council, conference, panel, task force, or other similar group, or any
subcommittee or other subgroup thereof, which is established by statute, or
established or utilized by the President or any agency official for the purpose of
obtaining advice or recommendations on issues or policies which are within the
scope of his or her responsibilities.
IS
..
�Committee member means an individual who serves by appointment on an
advisory committee and has the full right and obligation to participate in the
activities of the commi~tee, including voting on committee recommendations.
Presidential advisory committee means any advisory committee which
advises the President. It may be established by the President or l,ly the Congress,
or used by the President in the interest of obtaining advice or recommendations for
the President. "Independent Presidential advisory committee" means any
Presidential advisory committee not assigned by the President, or the President's
delegate, or by the Congress in law, to an agency for administrative and other
support and for which the Administrator of General Services may provide
administrative and other support on a reimbursable basis.
Utilized (or used), as referenced in the definition of "Advisory committee"
in this section, means a committee or other group composed in whole or in part of
other than full-time officers or employees of the Federal Government with an
established existence outside the agency seeking its advice which. the President or
agency official(s) adopts, such as through institutional arrangements, as a preferred
source from which to obtain advice or recommendations on a specific issue or
policy within the scope of his or her responsibilities in the same manner as that
individual would obtain advice or recommendations from an established advisory
committee.
Fmally, at least one commentator, in discussing the coverage of the Federal Advisory
Committee Act, has concluded that a "committee or similar group" should have all or most of the
following characteristics:
(1)
(2)
(3)
(4)
fixed membership (including at least one penon who is not a full-time Cedent
officer or employee),
a defined purpose of providing advice to a federal official or agency regarding a
particular subject or particular subjects,
regular or periodic meetings,
an organizational structure (e.g., officers) and a staff.
D. Marblestone, "The Coverage of the Federal Advisory Committee Act", 35 Fed B.J. 119, 12728 (1976) (Emphasis added.)
Under the plain language of the Federal Advisory Committee Act and relevant regulations,
as well as the characteristics set forth above, the TASK FORCE is an "advisory committee"
within the meaning of the Federal Advisory Committee Act. On January 25, 1993, President
Clinton established the TASK FORCE and appointed its members, and contemplates utilizing the ·
TASK FORCE as a preferred source of advice and recommendations on the particular issue,
16
�subject, or policy of national health care reform. The TASK FORCE, at least at the present time,
has a fixed membership of twelve (12) persons specifically chosen by the President. Furthermore,
the President has openly stated that the TASK FORCE will have at least periodic meetings to
discuss the subject of health care reform, with an eye toward making "recommendations" on this
discrete policy issue to the President. Finally, the TASK FORCE has at least one formally-named
"officer", FU'St Lady HILLARY RODHAM CLINTON. In sum, the TASK FORCE, in every
substantive aspect and characteristic, is an "advisory committee" within the meaning of the
Federal Advisory Committee Act.
B.
The TASK FORCE is not composed wholly off•ll-time fedeml
officers or employees becllllse the First Ltuly, who chairs the
TASK FORCE, is not and cannot be a filii-time officer or
employee ofthe federal government.
It is aucial to note that the TASK FORCE cannot be deemed to fall within any of the
exceptions to the definition of"advisory committee" set forth in Section 3 of the Federal Advisory
Committee Act, specifically the exception of Section 3(2XC)(iii) for "any committee which is
composed wholly of full-time officers or employees of the Federal Government."
The
Chairperson of the TASK FORCE, HILLARY RODHAM CLINTON, is simply not a full-time
officer or employee of the federal government. The TASK FORCE is thus not composed wboUy
of full-time officers or employees of the federal government under the plain meaning of that
language, and, under the "characteristics" analysis of Federal Advisory Committee Act coverage·
discussed, supra, there is at least one person sitting on the TASK FORCE (indeed, sitting as
Chairperson of the TASK FORCE) who is not a full-time federal officer or employee.2
2
Plaintiffs also maintain that the federal anti-nepotism statute, also known as the Kennedy
Act, S U.S.C. Section 3110, precludes the Defendant, HILLARY RODHAM CLINTON, from
being considered a full-time officer or employee of the federal government for the purposes of the
Federal Advisory Committee Act. TitleS U.S.C. Section 3110 provides as follows:
Section 3110. Employment of relatives; restrictions.
(a)
For the purpose of this section17
�(1)
"agency" means(A) an Executive agency;
(B)
an office, agency, or other establishment in the legislative
branch;
(C)
an office, agency, or other establishment in the judicial
branch, and
(D)
the government of the District of Columbia;
(2)
"public official" means an officer (including the President and a
Member of Congress), a member of the unifonned service, an employee
and any other individual, in whom is vested the authority by law, rule, or
regulation, or to whom the authority has been delegated, to appoint,
employ, promote, or advance individuals, or to recommend individuals for
appointment employment, promotion, or advancement, in connection with
employment in an agency; and
(3)
"relative" means, with respect to a public official, an individual who
is related to the public official as father, mother, son, daughter, brother,
sister, uncle, aunt, first cousin, nephew, niece, husband, wife, father-in-law,
mother-in-law, son-in-law, daughter-in-law, brother-in-law, sister-in-law,
stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half
brother, or half sister.
(b)
A public official may not appoint, employee, promote, advance, or
advocate for appointment, employment, promotion, or advancement, in or to a
civilian position in the agency in which he is serving or over which he exercises
jurisdiction or control any individual who is a relative of the public official. An
individual may not be appointed, employed, promoted, or advanced in or to a
civilian position in an agency if such appointment, employment, promotion, or
advancement has been advocated by a public official, serving in or exercising
jurisdiction or control over the agency, who is a relative of the individual.
(c)
An individual appointed, employed, promoted, or advanced in violation of
this section is not entitled to pay, and money may not be paid from the Treasury as
pay to an individual so appointed, employed, promoted, or advanced.
(d)
The Office of Personnel Management may prescribe regulations authorizing
the temporary employment, in the event of emergencies resulting from natural
disasters or similar unforeseen events or circumstances, of individuals whose
employment would otherwise be prohibited by this section.
(e)
This section shall not be construed to prohibit the appointment of an
individual who is a preference eligible in any case in which the passing over of that
individual on a certificate of eligibles furnished under section 3317(a) of this title
will result in the selection for appointment of an individual who is not a preference
eligible.
·
18
�--
-'
...
_
~
..
It is well-established that the plain language of a statute must be deemed as the final
expression oflegislative intent. Caminetti v. United States, 242 U.S. 470,490, 37 S.Ct. 192, 196,
61 L.Ed. 442, 455 (1916). Thus, statutory language must be interpreted according to common
usage and ordinary meaning, in the absence of persuasive reasons to the contrary. N.LR.B. v.
Coca-Cola Bottling Co. of Louisville, 350 U.S. 264, 76 S.Ct. 383, 100 L.Ed. 285 (1956). The
plain language of Section 3 of the Federal Advisory Committee Act, and specifically the term
"wholly", simply does not lend itself to any construction which would create an ad hoc exception
to the rule for this particular TASK FORCE.
To craft such an ad hoc exception to the
unambiguous statutory language would "press statutory construction to the point of disingenuous
evasion." United States v. Locke, 471 U.S. 84, 96, 105 S.Ct. 1785, 1793, 85 L.Ed.2d 64 (1985).
Even if one were to conclude that the language of Section 3 of the Federal Advisory Committee
Act is somehow ambiguous under some tortured reading of the language, one will find absolutely
'
nothing in the legislative history of the statute which would countenance exempting the TASK
FORCE from its reach simply because the non-federal employee or official chairing the TASK
FORCE happens to be the First Lady.
In Center for Auto Safety v. Cor, 580 F.2d 689 (D.C. Cir. 1978), the United States Court
of Appeals for the District of Colubmia. held that the American Association of State Highway and
Transportation Officials was an advisory committee to the Federal Highway Administration. The
defendants argued that Section 4(c) of the Federal Advisory Committee Act, which exempts state
or local committees established to advise or make recommendations to state or local agencies
from the coverage of the statute, should somehow be construed to apply to the defendant
American Association, even though it was advising federal officiils. The court applied the plain
meaning of the statute and rejected the defendants' argument. The court concluded:
The plain meaning of section 4(c) is clear. Moreover, as a proviso, it should be
construed narrowly. A plausible interpretation, and one that does not do
violence to the plain meaning rule, is that Congress intended to include state and
local committees under the Act only when they functioned at the federal level. It
would be unreasonable to hold that Congress cannot expressly disavow an intent ·
19
..
-
�....
.. .
to regulate activity that may lie beyond its enumerated powers and to use this
holding to read out of the Act activity that Congress clearly may regulate. We
note finally that the legislative history in no way contradicts our conclusion
that the plain meaning of section 4(c) should prevaiL We therefore decline to
insert the words "or federal" into the otherwise clear section 4(c) to rescue it from
the lack of meaning envisioned by the Administrator and AASHTO.
Center for Auto Safety, 580 F.2d at 693. (Emphasis added.)
As in Center for Auto Safety, the Defendants here would like to craft out of thin air an
exception to the clear, unambiguous language of the Federal Advisory Committee Act in order to
evade the close public scrutiny and public participation on important national issues which are
envisioned by the FACA. As in Cox, the proviso of Section 3 of the Federal Advisory Committee
Act for committees composed wholly of full-time officers or employees of the federal government
should be construed narrowly3 and according to its plain meaning. It is for Congress alone, not
this Honorable Court, to craft an exception for the TASK FORCE if it so desires. Congress
manifestly did not do so when it debated and enacted the Federal Advisory Committee Act, and it
has not done so to date. Accordingly, the TASK FORCE is an "advisory committee" within the
meaning of the Federal Advisory Committee Act, and is thus bound by all of the controlling
provisions of that statute, as well as the Government in the Sunshine Act, S U.S.C. Section SS2b.
B.
This Honorable Court Should Issue a Tei!!Dorary Restraining Order and Tei!!Dorgry
Injunction. Enjoining the Defendants From Conducting Any Meetings Until an
Advisory Committee Charter is Filed Pursuant to Section 9 of the Federal Advisory
Committee Act and Until the Meetings are ODen to the Plaintiffs' Attendance and
Participation and Announced in Advance in the Federal Rerister Pursuant to Section
10 of the Federal Advisory Committee Act and the Government in the Sunslalne Act. 5
U£ C Section 552b.
Likewise, other. federal decisions construing the exemptions from the public meeting
requirements of the Government in the Sunshine Act set forth inS U.S.C. Section SS2b(c), which
exemptions the Federal Advisory Committee Act incorporates inS U.S.C. App., Section lO(d),
have held that the exceptions to the open meetings rule of the Government in the Sunshine Act
must be narrowly construed, and the burden is placed upon the defendants to illustrate that an
exemption is applicable. See, Public Citizen v. National Economic Com'n, 703 F.Supp. 113, 119
(D.D.C. 1989); Common Cause v. Nuclear Regulatory Commission, 614 F.2d 921, 939, 932
(D.C. Cir. 1982).
3
...................________________________
20
�..
In Public Citizen v. National Economic Com'n, 703 F.Supp. 113 (D.D.C. 1989) a
newspaper, business magazine editor, the Bureau of National Affairs, and a citizens' group
brought suit against the National Economic Commission and the Administrator of the General
Services Administration, seeking an injunction to prevent the defendants from closing
Commission meetings in which economic assumptions, budget options, and fiscal policy were to
be discussed. In this Court, the plaintift" moved for a Temporary Restraining Order, and this
Court granted the motion. This Court first relied on the "presumption of openness" discussed in
.
Common Cause v. Nuclear Regulatory Commission, 614 F.2d 921 (D.C. Cir. 1982) to conclude
that the plaintift"s had demonstrated a substantial likelihood of prevailing on the merits. Public
Citizen v. National Economic Com'n, 703 F.Supp. at 124-129. The Court next Concluded that
the plaintiffs would suffer irreparable harm if the restraining order were not entered because if an
upcoming meeting of the Commission were allowed to "proceed behind closed doors, plaintiffs
will be denied, perhaps for all time, but at a minimum during the on-going course, that which
Congress expressly protected through FACA" Public Citizen v. National Economic Com'n, 703
F.Supp. at 129. Finally, this Court balanced the potential harm to the defendants and the public
interest and held that the equities were decidedly in favor of the plaintift"s, concluding that opening
Commission meetings to the public constituted, at most, minimal harm to the defendants, and
would "highlight vividly the essence of our democratic society, providing the public its right to
know how its government is conducting the public's business." Public Citizen v. Natio11Dl
Economic Com'n, 703 F.Supp. at 129.
In the present case, the Plaintift"s have clearly established their entitlement to a Temporary
Restraining Order and Temporary Injunction enjoining the Defendants from holding meetings
unless and until all relevant provisions of the Federal Advisory Committee Act are followed. The
Defendants can point to nothing in the Federal Advisory Committee Act, the relevant regulations
of the General Services Administration, or the legislative history ofFACA to fashion an exception
21
�..
for the TASK FORCE for political expediency. 4 The TASK FORCE is an "advisory committee"
under any reading of the Federal Advisory Committee Act.
Additionally, the holding in Public Citizen v. National Economic Com'n clearly illustrates
that the Plaintiffs will suffer irreparable hann if a Temporary Restraining Order is not issued. The
Defendants' closure of their future meetings will forever prevent the Plaintiffs from attending and
participating in those meetings. Public Citizen v. National Economic Com'n stands for the
proposition that public scrutiny and analysis of advisory committee activities, which is the goal of
the Federal Advisory Committee Act, must be contemporaneous with the advisory committee's
activities, not after-the-fact. If a Temporary Restraining Order and Temporary Injunction are not
issued and the TASK FORCE's meetings are permitted to proceed behind closed doors, this Court
will not be able to "tum back the clock" to remedy the violation of the Federal Advisory
Committee Act. Injunctive relief is the only meaningful relief available to the Plaintiffs.
ii.
The public interest strongly favors the entry of a Temporary
Restraining Order and a Temporary Injunction.
Finally, as in Public Citizen v. National Economic Com'n, the balance of the potential
harm to the Defendants and the public interest militates strongly in favor of the issuance of a
Temporary Restraining Order and Temporary Injunction.
As the letters of Hon. Bernard
The Defendants also cannot claim that the application of the Federal Advisory Committee
Act to the TASK FORCE is violative of separation of powers principles under the United States
Constitution. The United States Court of Appeals for the District of Columbia has expressly
examined the application of the FACA to the Executive Branch of the federal government and bas
concluded that a broad and general separation of powers attack on the statute is without merit.
See, Common Cause v. Nuclear Regulatory Commission, 674 F.2d 921, 935 (D.C. Cir. 1982)
(Court of Appeals was "not persuaded by the Commission's contention that the separation of
powers principle imposes a constitutional requirement that budget meetings be exempt from the
Sunshine Act"). Furthermore, the Defendants cannot claim that their overt failure to follow the
preliminary requirements of the Federal Advisory Committee Act (e.g., filing an advisory
committee charter) justifies the holding of meetings behind closed doors. This Honorable Court
has expressly rejected that contention. Food Chemical News, Inc. v. Davis, 378 F.Supp. 1048,
1051 (D.D.C. 1974) (holding that agency's failure to charter an advisory committee "cannot &e
employed as a subterfuge for avoiding the Act's public access requirements").
4
22
�....
Nussbaum, counsel to the President, illustrate, see Exhibits "E", "F", and "G" to Verified
Complaint. the TASK FORCE apparently intends only to open some selected meetings to the
public. According to recent press accounts, various groups of public and private consultants have
already been meeting behind closed doors with the individual Defendant, IRA MAGAZINER, and
perhaps other individual members of the TASK FORCE, for extended periods of time. The
Plaintiffs simply request that the Defendants comply fully with the Federal Advisory Committee
Act and not consider the statute to be merely precatory, and to hold all meetings, including any
meetings of subgroups and subcommittees of the TASK FORCE, open to the public after the
required charter has been filed and proper notice given in the Federal Register.
As recent press accounts illustrate, especially the Washington Post article discussed
previously, the "interdepartmental working group" led by Defendant, IRA MAGAZINER (who is
himself a member of the TASK FORCE), has apparently been meeting in secret with a large
number of "health care consultants", many of whom are from selected interests from the private
sector. The identities of many of these persons are still unknown, and these "working groups" of
consultants are meeting with IRA MAGAZINER and perhaps other members of the TASK
FORCE (many ofwhom are heads of administrative agencies), for extended periods of time in the
Old Executive Office Building. The Plaintiffs maintain that these meetings, when attended by one
or more individual members of the TASK FORCE, are themselves subject to the requirements of
the Federal Advisory Committee Act, S U.S.C. App. , Sections 1 through 14, and the Government
in the Sunshine Act, S U.S.C. Section SS2b, because they are meetings of a "subcommittee or
other subgroup" of the TASK FORCE within the meaning of Section 3 of the Federal Advisory
Committee Act, S U.S.C. App., Section 3.
Section 101-6.1004 of the Federal Advisory Committee Management Regulations,
provides, in relevant part, as follows:
The following are examples of advisory meetings or groups not covered by the Act
of this subpart; ...
23
··
�.
'.
.
.
:
(i)
Any meeting initiated by a Federal official(s) with more than one individual
for the purpose of obtaining the advice of individual attendees and not for
the purpose of utilizing the group to obtain consensus advice or
recommendations. However, agencies should be aware that such a
group would be covered by the Act when an agency accepts the
groups deliberations as a source of consensus advice or
recommendations; ..•
(Emphasis added.)
While the Defendants may rely on Nat. Anti-Hunger Coalition v. Exec. Comm Etc., 711
F.2d 1071 (D.C.Cir. 1983) to argue that any meetings ofthe various groups of private and public
sector "consultants" with Defendant, IRA MAGAZINER, or other individual members of the
TASK FORCE, are not within the ambit of the Federal Advisory Committee Act, Nat. Anti-
Hunger Coalition is clearly distinguishable from the present case. First, as the findings of the
District Court illustrated, the "task forces" at issue in that case reported to a subcommittee subject
to the FACA, which subcommittee, in tum, reported to the Executive Committee subject to the
FACA See, Nat. Anti-Hunger Coalition v. Executive Comminee, 551 F.Supp., at 527 (D.D.C.
1983). Thus, the "task forces" at issue in Nat. Anti-Hunger Coalition were at least two steps
removed from the Executive Committee which was subject to the FACA. Second, and more
importantly, the District Court seized on the language of the statute and determined that the
members of the "task forces" were "advisory committee staff" rather than "advisory committee
members" within the meaning of the FACA. See, Nat. Anti-Hunger Coalition v. Executive
Committee, 551 F.Supp. at 529.
In the present case, however, press accounts reveal that the various groups of private and
public sector "consultants" are only one step removed from the TASK FORCE, and also reveal
that Defendant, IRA MAGAZINER, and perhaps other individual memben of the TASK
FORCE (the majority of whom head federal administrative agencies), are meeting with these
groups of "consultants" as "a source of consensus advice or recommendations" within the
meaning of 41 C.F.R. Section 101-6.1004(i). See, January 25, 1993 "Remarks on Health C~
..
Refonn and an Exchange with Reporters", Weekly Compilation of Presidential Documents, Vol.
24
�•' f
•
29, No.4, at p. 97 (February 1, 1993) (where President Clinton stated that "the American people
will learn... that we have a First Lady... who can bring people together around complex and
difficult issues to hammer out consensus and get things done.") (Emphasis added.)
Accordingly, the Plaintiffs also seek a Temporary Restraining Order and Temporary
Injunction enjoining the Defendants, HILLARY RODHAM CLINTON, DONNA E. SHALALA,
LLOYD E. BENTSEN, LES ASPIN, JESSE BROWN, RONALD H. BROWN, ROBERT B.
REICH, LEON E. PANETTA, ALICE RIVLIN, CAROL RASCO, IRA MAGAZINER,
JUDim FEDER, individually, and in their official capacities as members of the PRESIDENTS
TASK FORCE ON NATIONAL HEALTH CARE REFORM, and the PRESIDENT'S TASK
FORCE ON NATIONAL HEALTH CARE REFORM, their and its members, officers, and
successors, including any subgroups or subcommittees thereof meeting with one or more
individual Defendant members of the TASK FORCE, from' holding or conducting any meetings
until such time as the merits of the within case can be heard and determined.
iii.
Tlae Defendllnts will not suffer any cogni:llble harm if a
Temportuy Restraining Order and Temporlli'Y Injunction
is issued.
Finally, any harm to the Defendants due to requiring full compliance with the Federal
Advisory Committee Act is negligible, at best, whereas the public interest in the TASK FORCE's
full compliance with the Federal Advisory Committee Act is vast. The nation's health care
system, and any potential or contemplated reform of the system, significantly affects and will
significantly affect the lives of every citizen in the United States. Issues of access, cost, and the
distribution of the burdens and benefits of contemplated reform are of overarching concern to
every American, and especially the Plaintiffs herein. The public has an unequivocal statutory right
to scrutinize and participate in the business of its government under the Federal Advisory
Committee Act and the Government in the Sunshine Act. Accordingly, a Temporary Restraining
Order and Temporary Injunction requiring the Defendants' full compliance with the Federal
Advisory Committee Act and the Government in the Sunshine Act should issue.
2S
�.
••
IlL
THE PLAINTIFFS SHOULD NOT BE REQUIRED TO POST SECURITY OR, IN
THE ALTERNATIVE. IF SECURITY IS REQUIRED. SHOULD ONLY BE
REQUIRED TO POST NOMINAL SECURITY FOR THE ISSUANCE OF THE
REQUESTED TEMPORARY RESTRAINING ORDER AND TEMPORARY
INJUNCTION.
Rule 65(c) of the Federal Rules of Civil Procedure provides, in relevant part, as follows:
No restraining order or preliminary injunction shall issue except upon the
giving of security by the applicant, in such sum as the court deems proper, for
the payment of such costs and damages as may be incurred or suffered by any
party who is found to have been wrongfully enjoined or restrained. No such
security shall be required of the United States or an officer or agency thereof.
(Emphasis added.)
There is considerable authority for the proposition that a court may elect not to require
security pursuant to Rule 65(c) of the Federal Rules of Civil Procedure in "public interest"
litigation such as the present case where the potential harm to the Defendants is nonexistent or
insignificant and the public interest is strong. See, e.g., Highland Cooperative v. City of Lansing,
492 F.Supp. 1372, 1383 (W.O. Mich. 1980) (holding that no injunction bond is required for
injunction delaying construction project until an Environmental Impact Statement is filed); City of
Atlanta v. Metropolitan Atlanta Rap. Trans., 636 F.2d 1084, 1094 (5th Cir. Cir. 1981) (in action
to enjoin fare increase, "plaintiffs were engaged in public-interest litigation. an area in which
courts have recognized an exception to the Rule 65 security requirement"); Co"igan Dispatch
Co. v. Casaguzman, F.A., 569 F.2d 300, 303 (5th Cir. 1978) (under Rule 6S(c), trial court "may
elect to require no security at all"). In the present case, the Plaintiffs are clearly engaged in
"public interest" litigation and seek not only to vindicate their own statutory rights to be informed
of and participate in the activities of the TASK FORCE and its subgroups and subcommittees, but
also seek to vindicate the statutory rights of all American citizens to do so as well. To require
security in the case at bar would serve to deter the public from seeking to advance procedural
regularity and openness in the conduct of our government's decisional processes. Accordingly,
the Plaintiffs herein should not be required to post security for the issuance of the requested
Temporary Restraining Order and Temporary Injunction. Alternatively, the Plaintiffs herein_
26
�--
~-
..
-
.
.
w
'I
should be required to post only nominal security for the issuance of the requested Temporuy
Restraining Order and Temporary Injunction if any security is required. See, Public Citizen v.
Nationtll Economic Com'n, 703 F.Supp. 113, 130 (D.D.C. 1989) (where this Court ordered
Plaintiffs to post one-hundred dollars ($100.00) as security in a case brought under the Federal
Advisory Committee Act and the Government in the Sunshine Act).
CONCLUSION
For all the foregoing reasons, a Temporuy Restraining Order and Temporuy Injunction
should issue, enjoining the Defendants from conducting any meetings of the TASK FORCE,
including any meetings of any subgroups or subcommittees thereof: which meet with one or more
individual Defendant members of the TASK FORCE, until an advisory committee charter is filed
pursuant to Section 9 of the Federal Advisory Committee Act and until all such meetings are open
to the Plaintiffs' attendance and participation and are announced in advance in the Federal
Register, pursuant to Section 10 of the Federal Advisory Committee Act and the Government in
the Sunshine Act, S U.S.C. Section SS2b.
Respectfully submitted,
KENT MASTERSON BROWN, ESQ.
CHRISTOPHER J. SHAUGHNESSY, ESQ.
BROWN & BROWN, P.S.C.
1114 First National Building
167 West Main Street
Lexington, Kentucky 40507
(606) 233-7879
Facsimile (606) 252-6791
27
�.--,:.
'
If
r
•
I
~~
~DYi,ESQ.
M ~'-1~,.......__
BarNo. 215379
FRANK M. NORTHAM, ESQ.
BarNo. 206110
WEBSTER, CHAMBERLAIN
&BEAN
1747 Pennsylvania Avenue, N.W.
Suite 1000
Washington, D.C. 20006
(202) 785-9500
COUNSEL FOR PLAINTIFFS, ASSOCIATION
OF
AMERICAN
PHYSICIANS
AND
SURGEONS, INC., AMERICAN COUNSEL FOR
HEALTII CARE REFORM, and NATIONAL
LEGAL & POLICY CENTER
28
�UNITED STATES DISTRICf COURT
DISTRICT OF COLUMBIA
)
)
)
)
)
)
)
)
)
)
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.,
etc.,etaL,
Plaintiffs
.
HILLARY RODRAM CLINTON, etc., et aL,
Defendants
CIVIL AcriON N O . - - - -
IUDGE ___________
ORDER
On Motion of the Honorable Frank M. Northam and the Honorable Alan P. Dye, members
of the bar of this Court in good standing, for the Honorable Kent Masterson Brown, a member of
the bar of the Supreme Court ofKentucky, to be pennitted to appear and participate in the aboveentitled cause, pro hac vice, and it appearing that said Honorable Kent Masterson Brown meets
all the requirements of Rule 104 of the General Rules of this Court, and it further appearing that
the Defendants will interpose no objection thereto, and the Court being otherwise sufficiently
advised;
IT IS HEREBY ORDERED AND ADJUDGED that the said Motion be and the same is
hereby GRANTED, and the Honorable Kent Masterson Brown be and he is hereby permitted to
appear and participate in the above-entitled cause pro hac vice.
Dated:__________
JUDGE, UNITED STATES DISTRICT COURT
DISTRICT OF COLUMBIA
.
/
1
�UNITED STATES DISTRICT COURT
DISTRICT OF· COLUMBIA
)
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.,
etc., et aL,
Plaintiffs
)
)
)
)
)
)
~
CIVn. ACTION N O . - - - JUDGE ___________
)
BII...LARY RODBAM CLINTON, etc., et aL,
Defendants
)
)
MOTION FOR TEMPORARY RESTRAINING ORDER
NOW COME the Plaintiffs, ASSOCIATION OF AMERICAN PHYSICIANS AND
SURGEONS, INC., AMERICAN COUNCU.. FOR' HEALTil CARE REFORM, and
NATIONAL LEGAL & POLICY CENTER, by and through the undersigned counsel, and hereby
move this Honorable Court for a Temporary Restraining Order, pursuant to Rule 6S(b) of the
Federal Rules of Civil Procedure; restraining and enjoining the Defendants, HILLARY RODHAM
CLINTON, DONNA E. SHALALA, U.OYD E. BENTSEN, LES ASPIN, JESSE BROWN,
RONALD H. BROWN, ROBERT B. REICH, LEON E. PANETTA, ALICE RIVLIN, CAROL
RASCO, IRA MAGAZINER, and JUDITH FEDER, individually, and in their official capacities
as members of the PRESIDENTS TASK FORCE ON NATIONAL HEALTil CARE REFORM,
and the Defendant, PRESIDENTS TASK FORCE ON NATIONAL HEALTII CARE
REFORM, their and its officers, members, and successors, and any subgroups or subcommittees
thereof meeting with one or more individual Defendant members of the TASK FORCE, from
conducting any meetings pending a hearing and detennination of Plaintiffs' Motion for a
Temporary Injunction filed with this Court on February 19, 1993.
.
Unless this Motion is granted, Plaintiffs will suffer immediate and irreparable injury, loss
and harm in that the Defendants will be free to meet and conduct the meetings of the in!fividual
1
�Defendants, as members of the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH
CARE REFORM, and of the Defendant, PRESIDENT'S TASK FORCE ON NATIONAL
HEALTH CARE REFORM, and meet and conduct meetings of subgroups and subcommittees
thereo( without Defendants filing an advisory committee charter, and, at the same time, refuse to
pennit the Plaintiffs to attend and participate therein, and further refuse to provide adequate
notice of said meetings in the Federal Register, until a hearing can be had on Plaintiffs' Motion for
a Preliminary Injunction, as more fully set forth in Plaintiffs' Verified Complaint for Declaration of
Rights, Restraining Order, and Temporary and Permanent Injunctive Relief and the Affidavits of
Genevieve Young and J. Chad Jackson attached hereto.
Pursuant to Local Rule. 108, Plaintiffs hereby request an oral hearing on the within
Motion.
KENT MASTERSON BROWN, ESQ.
CEmaSTOP~J.S~UG~SSY,ESQ.
BROWN&. BROWN, P.S.C.
1114 First National Building
167 West Main Street
Lexington, Kentucky 40507
(606) 233-7879
I
M~ M~cbAifA~
F~)2S2-6791
P.DYE,ESQ.
BarNo. 215379
FRANK M. NORTHAM, ESQ.
Bar No. 206110
WEBSTER, CHAMBERLAIN
&BEAN
1747 Pennsylvania Avenue, N.W.
Suite 1000
Washington, D.C. 20006
(202) 785-9500
2
�t
COUNSEL FOR PLAINTIFFS, ASSOCIATION
OF
AMERICAN
PHYSICIANS
AND
SURGEONS, INC., AMERICAN COUNCIL FOR.
HEALTH CARE REFORM, and NATIONAL
LEGAL & POLICY CENTER.·
3
�UNITED STATES DISTRICI COURT
DISTRICT OF COLUMBIA
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.,
)
)
)
etc., et aL,
)
Plaintiffs
)
)
vs.
)
CIVIL ACTION N O . - - - JUDGE ___________
)
HILLARY RODHAM CLINTON, etc., et aL,
Defendants
)
)
ORDER SET11NG HEARING ON
MOTION FOR TEMPORARY RESTRAINING ORDER
On Motion of the Plaintiffs for a Temporary Restraining Order, with a request for an oral
hearing of the Motion, and the Court being otherwise sufficiently advised;
IT IS HEREBY ORDERED that
Plaintiffs Motion for a Temporary Restraining Order shall be heard in Room
----..J
at
_.m., on February ---J 1993, in the United States Court House, Washington, D.C.
Dated: ______
JUDGE, UNITED STATES DISTRICT COURT
DISTRICT OF COLUMBIA
•
I
1
�UNITED STATES DISTRICT COURT
DISTRICT OF COLUMBIA
)
)
)
)
)
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.,
etc.,etal.,
Plaintiffs
)
vs.
)
)
)
)
.
HILLARY RODHAM CLINTON, etc., et aL,
Defendants
CIVIL ACTION N O . - - - -
JUDGE ___________
TEMPORARY RESTRAINING ORDER
The Court has considered the Plaintiffs' Motion for a Temporary Restraining Order,
pending the hearing and determination of Plaintiffs' Motion for a Temporary Injunction herein; the
Verified Complaint for Declaration of Rights, Restraining Order, and Temporary and Permanent
Injunctive Relief, and the Affidavit of Genevieve Young in which it appears that the Defendants
will be free to conduct meetings of the individual Defendants, as members of the PRESIDENT'S
TASK FORCE ON NATIONAL HEALTH CARE REFORM, and the
Defendan~
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, without a charter
therefor having been filed and without permitting the Plaintiffs to attend and participate in all
meetings of the individual Defendants, as members of the PRESIDENT'S TASK FORCE ON
NATONAL HEALTH CARE REFORM, and the Defendant, PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM, and without providing sufficient advance notice in the
Federal Register prior to a hearing on Plaintiffs' Motion for Temporary Injunction.
On the basis of these pleadings and papers, it appears to the Court that Plaintiffs will suffer
immediate and irreparable injury, loss and harm in that the Defendants will be free to hold and
.
conduct meetings of the individual Defendants, as members of the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and the Defendant, PRESIDENT'S TASK
1
�FORCE ON NATIONAL HEALTH CARE REFORM, and meet and conduct meetings of
· subgroups and subcommittees thereo( without an advisory committee charter having been filed
and without the Plaintiffs being allowed to attend and participate therein and without adequate
notice having been given in the Federal Register of said meetings before a hearing can be had on
Plaintiffs' Motion for a Temporary Injunction, and the Court is of the opinion that a Temporary
Restraining Order should be issued.
Therefore, IT IS ORDERED that:
1.
The Defendants, HILLARY RODHAM CLINTON, DONNA E. SHALALA,
LLOYD E. BENTSEN, LES ASPIN, JESSE BROWN, RONALD H. BROWN, ROBERT B.
REICH, LEON E. PANETTA, ALICE RIVLIN, CAROL RASCO, IRA MAGAZINER,
JUDITII FEDER, individually, and in their official capacities as members of the PRESIDENT'S
TASK FORCE ON NATIONAL HEALTH CARE REFORM, and the Defendant,
PRESIDENTS TASK FORCE ON NATIONAL .HEALTH CARE REFORM, their and its
officers, members, and successors, and any subgroups or subcommittees thereof meeting with one
or more individual Defendant members of the TASK FORCE, be and they and it are hereby
enjoined and restrained, pursuant to Rule 65 of the Federal Rules of Civil Procedure, from holding
or conducting any meetings until such time as Plaintiffs' Motion for a Temporary Injunction can
be heard and determined. This Temporary Restraining Order does not extend to enjoin or restrain
any outside consultants to the TASK FORCE from meeting amongst themselves.
2.
_ .m. on
3.
Plaintiffs' Motion for a Temporary Injunction will be heard by this Court at _._ _
1993.
Plaintiffs are not required to post bond or other security as a condition of obtaining
this Order.
4.
This Temporary Restraining Order will expire
on----~
1993, unless
within such time, the Order is extended for good cause shown or unless the Defendants consent to
an extension.
2
�5.
A copy of this Order shall be immediately served by the United States Marshal on
all Defendants herein.
Dated:_ _ _ __
JUDGE, UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
..
3
�UNITED STATES DISTRICT COURT
DISTRICT OF COLUMBIA
)
)
)
)
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.,
etc., et aL,
Plaintiffs
)
)
vs.
)
CIVIL ACTION N O . - - - JUDGE ____________
)
BU.LARY RODBAM CLINTON, etc., et al.,
)
)
Defendants
MOTION FOR A TEMPORARY INJUNC7'ION
NOW COME the Plaintiffs, ASSOCIATION OF AMERICAN PHYSICIANS AND
SURGEONS, INC., AMERICAN COUNCIL FOR' HEALTH CARE REFORM, and
NATIONAL LEGAL & POLICY CENTER, by the undersigned counsel, and hereby move this
Honorable Court for a Temporary Injunction, under the authority of Rule 6S(a) of the Federal
Rules of Civil Procedure, enjoining the Defendants, HILLARY RODHAM CLINTON, DONNA
E. SHALALA, LLOYD E. BENTSEN, LES ASPIN, JESSE BROWN, RONALD H. BROWN,
ROBERT B. REICH, LEON E. PANETTA, ALICE RIVLIN, CAROL RASCO, IRA
MAGAZINER and RJDITH FEDER, individually, and in their official capacities as members of
the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and the
Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, their
and its officers, members, and successors, and any subgroups or subcommittees thereof meeting
with one or more individual Defendant members of the TASK FORCE, from conducting any
meetings pending a final hearing and determination of the merits in the above-entitled cause.
Unless the Defendants are restrained and enjoined by order of this Honorable Court,
Plaintiffs will suffer immediate and irreparable injury, loss and harm in that the Defendants will ~
free to meet and conduct the meetings of the individual Defendants, as members of the
1
�-----'-
PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and the
Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and
meet and conduct meetings of subgroups and subcommittees thereof, without Defendants filing an
advisory committee charter and, at the same time, refuse to permit Plaintiffs' to attend and
participate therein, and, further, refuse to provide adequate notice of the meetings in the Federal
Register, all as more fully described in the Verified Complaint for Declaration of Rights,
Restraining Order, and Temporary and Permanent Injunctive Relief and the Affidavits of
Genevieve Young and 1. Chad Jackson. The Motion is made on the additional ground that
Plaintiffs have no adequate remedy at law.
Pursuant to Local Rule 108, Plaintiffs hereby request an oral hearing on the within
Motion.
.!I
ALANi.DYE, ESQ:
. BarNo. 215379
FRANK M. NORTHAM, ESQ.
Bar No. 206110
WEBSTER, CHAMBERLAIN
&BEAN
1747 Pennsylvania Avenue, N.W.
Suite 1000
Washington, D.C. 20006
(202) 785-9500
2
•,
�---~-;-
--
COUNSEL FOR PLAINTIFFS, ASSOCIATION
OF
AMERICAN
PHYSICIANS
AND
SURGEONS, INC., AMERICAN COUNCIL FOR.
HEALTH CARE REFORM,· and NATIONAL
LEGAL & POLICY CENTER
..
3
�UNITED STATES DISTRICT COURT
DISTRICT OF COLUMBIA
)
)
)
)
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.,
etc., et aL,
Plaintiffs
VL
HILLARY RODHAM CLINTON, etc., et aL,
Defendants
)
)
)
)
)
)
CIVn. ACTION NO. _ _
JUDGE _ _ _ __
TEMPORARY INJUNCI'ION
This matter came on to be heard on Plaintiffs' Motion for a Temporary Injunction pursuant
to Rule 65 of the Federal Rules of Civil Procedure, to enjoin and restrain the Defendants from
conducting meetings of the individual Defendants, as members of the PRESIDENT'S TASK
FORCE ON NATIONAL HEALTH CARE REFORM, and the Defendant, PRESIDENT'S
TASK FORCE ON NATIONAL HEALTH CARE REFORM, their and its officers, members,
and successors, and any subgroups and subcommittees thereof, without a charter therefor having
been filed and without them permitting Plaintiffs to attend and participate in all meetings of the
Defendant, as members of the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE
REFORM, and the Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH
CARE REFORM, and the subgroups and subcommittees thereof, and without them providing
sufficient advance notice in the Federal Register, prior to a hearing on the merits of the within
action.
Now having considered ·Plaintiffs' Verified Complaint for Declaratory Judgment,
Restraining Order, and Temporary and Permanent Injunctive Relief, the Affidavits filed therewith
and such other evidence in the record and the arguments of counsel, this Court hereby finds anU
concludes as follows:
1
�FINDINGS OF FACT
It appears from the evidence that the PRESIDENT'S TASK FORCE ON NATIONAL
HEALTil CARE REFORM is established for the purpose of the President of the United States
obtaining advice and recommendations on national health reform and preparing legislation on
health care reform to be submitted to Congress. The TASK FORCE consists of at least twelve
members, including the SecretaJy of Health & Human Services, the Secret&l)' of the Treasury, the
SecretaJy of Defense, the SecretaJy of Veterans Affairs, the Secret&l)' of Commerce, the
Secretary of Labor, the Director and Deputy Director of the Office of Management and Budget,
three White House advisors and the First Lady.
The First Lady is not a federal employee or a federal officer under the meaning of Title S
U.S.C. App., Section 10, or TitleS U.S.C. Section SS2b. She cannot be a federal employee or
federal official under Title S U.S.C. Section 3110. The PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM is thus not "composed wholly of full-time officers and
employees of the Federal Government," within the meaning of TitleS U.S.C. App., Section 3.
Although the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE
REFORM itself has not held a meeting to date, a meeting is imminent. Various subgroups and
subcommittees thereof, however, have been, and are now, meeting, and said meetings are being
conducted by at least one or more members of the TASK FORCE with various persons and
interests outside of the federal government. The meetings to date have not been noticed in the
Federal Register, and have not been opened to the public.
The Plaintiffs have formally requested that they be permitted to attend and participate in
the meetings and deliberations of the PRESIDENT'S TASK FORCE ON NATIONAL HEALTil
CARE REFORM, including the subgroups and subcommittees thereof, but they have been denied
their request by the Defendants, who claim that the Federal Advisory Committee Act, Title S
U.S. C. App., Sections 1 through 14, and the Government in the Sunshine Act, S U.S.C. Section
SS2b, do not apply to the TASK FORCE. Consequently, the TASK FORCE has not filed
2
.
an
�advisory committee charter, and has published no notice of meetings in the Federal Register, and
has not opened, and does not intend opening, all of its meetings to the Plaintiffs and the public.
CONCLUSIONS OF UW
In view of the foregoing, the Court concludes that the Plaintiffs are entitled to a
Temporary Injunction, pending a final hearing on the merits or until further orders of the Court.
It appears as though there is a substantial likelihood Plaintiffs will succeed on the merits of the
case, irreparable injury will result in the absence of the relief requested; the Defendants will not be
harmed by the entry of a Temporary Injunction; and the public interest is served by the entry of a
Temporary Injunction.
Therefore,
IT IS ORDERED that the Plaintiffs' Motion for a Temporary Injunction be and the same is
hereby GRANTED,
IT IS FURTHER ORDERED that the Defendants, HILLARY RODHAM CLINTON,
DONNA E. SHALALA, LLOYD E. BENTSEN, LES ASPIN, JESSE BROWN, RONALD H.
BROWN, ROBERT B. REICH, LEON E. PANETTA, ALICE RIVLIN, CAROL ROSCO, IRA
MAGAZINER, and JUDITH FEDER, individually, and, in their official capacities as members of
the PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, and the
Defendant, PRESIDENT'S TASK FORCE ON NATIONAL HEALTH CARE REFORM, their
and its officers, members, and successors, and any subgroups or subcommittees thereof meeting
with one or more individual Defendant members of the TASK FORCE, be and they and it are
hereby enjoined and restrained, pursuant to Rule 65 of the Federal Rules of Civil Procedure, from
holding or conducting any meetings until such time as the Court considers the merits of the within
cause or until further orders of the Court. This Temporary Injunction does not extend to enjoin
or restrain any outside consultants to the TASK FORCE from meeting amongst themselves.
Dated:_ _ __
3
i
�- -,--
------------------
JUDGE, UNITED STATES DISTRICT COURT
DISTRICT OF COLUMBIA
4
----
�UNITED STATES DISTRICT COURT
DISTRICT OF COLUMBIA
)
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.,
etc., et aL,
Plaintiffs
)
)
)
)
)
VL
)
CIVIL ACTION N O . - - - -
JUDGE ___________
)
HILLARY RODHAM CLINTON, etc., et al.,
Defendants
)
)
AFFIDAVITOFGL~
KENT MASTERSON BROWN
.
d
=t
CErnUSTOP~J.S~UG~SSY
BROWN&. BROWN, P.S.C.
1114 First National Building
167 West Main Street
Lexington, Kentucky 40507
(606) 233-7879
Fac · · (606) 252-6791
AL
P. DYE, ESQ.
BarNo. 215379
FRANK M. NOR1HAM, ESQ.
BarNo. 206110
WEBSTER, CHAMBERLAIN
&BEAN
1747 Pennsylvania Avenue, N.W.
Suite 1000
Washington, D.C. 20006
(202) 785-9500
•
I
1
�COUNSEL FOR PLAINTIFFS, ASSOCIATION
OF
AMERICAN
PHYSICIANS
AND
SURGEONS, INC., AMERICAN COUNSEL FOR
HEALTH CARE REFO~ and NATIONAL
LEGAL & POLICY CENTER
2
�I, Genevieve M. Younq, owner of Health Law Hotline•, a leqal
information service, 5500 MacArthur Boulevard, NW, Washinqton, DC
20016, personally appeared in offices of Representative William P.
Clinqer, Republican Chairman of the commit~ee on Government
Operations, and received the followinq documents from Betsy
Linaburqer:
1. Letter dated February 1, 1993, from William F. Clinqer to
The Honorable William J. Clinton, President of the United StatesJ
2.
Letter dated February 5, 1993, siqned "Bill Clinton"
to William F. Clinqer:
3.
Letter dated February 5, 1993, from Bernard W. Nussbaum,
Counsel to the President, to William F. Clinqer.
I, Genevieve M. Younq, do hereby solemnly swear that the
attached copies of the above-named documents are true and correct.
s!<f'~.~r
~~.u.I'L )b i-~trict of Columbia. me on this .&.._
appeared before
i!iiiay
of February, 1993
the
~c~~
Not
Public
Vroinia A. Turner
.
Notary Public, Oistrid of Columbia
Uy Commission Expire& May 14. 1996
�r
f.
ON£ HUaED TIGRD COIIGREII
I
Q:ongras of tht Bnittd g;mts
tlwE of 'RqmarmiDo
·.
COMMrn'EE ON GOVERNMENT OPERATIONS
215 7 R.lYIUaN
HOUSI
WAIMINGTON.
O•JICI IV..._ .
DC 2D51W1•3
February 1, 1993
The Honorable William J. Clinton
President of the United·States
The Wbite Bouse
Wasbinqton, D.C. 20500
Dear Mr. President:
It is with concern that I have reviewed recent news accounts
suggesting the violation of the Federal Advisory Committee Act, 5
u.s.c. App (1988), by your Task Force on. Health care. 'l'he purpose
of this latter is to seek illllediate action to ensure no further
violation of f&aaral law until such time that the task force is
exeapted froa the Act or that it is restncturad to render the Act
nonapplicable.
'l'he Federal Advisory Co11111ittee Act (FACA) raqulates the
forJDation and operation of advisory collllittees by federal agenciu
in the Executive Branch. It is deliberative bodies such as this
taak force, which include aellbership froa both within and outside
government, which the congress sought to bring into the sunshine
throu;h the enactment of FACA.
FACA defines •advisory co11111ittee• to include, inter alia, any
group (1) established by the President, (2) in the interut of
obtaining advice or recollllendations, ancl (3) not coaposad vbolly of
full-time federal officers or eaployaes. It appears that the Task
Force on Health care aeets this definition, as it vas established
for the purpose of obtaining a consensus on recommendations for
health care reform leqislation and is chaired by an individual who
is not a full-time federal officer or aaployee.
once an organization satisfies the statutory definition of ·:
advisory co11111i ttee, all aeetinqs aust be advertised in advance
•
throuqb the Federal Register and held open to public observation.
Furthermore, all records, transcripts ancl drafts prepared by the
co. .ittee aust be aada available to the public.
'l'o -r understandinq, the Task Force on Health care held ita
first meetinq during the week of January 25, 1993. In violation of
the statute, the task force had neither filed a charter with ~
General Services Administration nor allowed the public to attend·
�Paqe 2
The Honorable William J. Clinton
February 1, 1993
its first formal meeting. Furthermore, White House press secretary
Dee Dee Myers has indicated that such meetings "will continua to be
closed throughout the development of the policy.•
·
As the Republican Chairman of the House Committee on
Government Operations, with sole jurisdiction over PACA, I must ask
that you taka immediate steps to ensure that no·further violatioft8
of this Act occur. Compliance can be achieved by chartering the
task force with the General Services Ad.ministration and making each
of its meetings open to the public following sufficient notice in
the Federal Register. You may otherwise wish to submit legislation
to congress seeking an exemption for this task force from the PACl
provisions.
I have also asked the minority staff on the House Governmant
Operations committee to conduct a further inquiry to ensure that no
further violation of FACA occurs and that no other federal statute.
has been violated through the conduct of these meetings. 'l'o aaaiat
us in this investigation, please make availa))le to my cOJialittae
staff a list of past and future meeting dates of the task force
along with the names of the participants at each meeting.
Let me say in closing that while I am concernact that no
further violation of federal law occur, I am quite supportive of
your efforts to formulate a policy to solve the nation's current
health care crises. In fact, I am introducing legislation this
week which will include the spouses of the President ancl Vice
President under the definition of full-time federal officer for the
purposes of FACA.
It is within my support of your efforts,
however, that I urge you to take steps to ensure that health care
reform policies are developed in full compliance with all federal
laws and regulations.
Please contact myself or ask your staff to contact Kevin Sabo,
my committee counsel, at 202-225-2738, if you require further
information regarding this request.
..
..
..
�..
•·.
THE WHITE HOUSE
WASHINGTON
February S, 1993
Dear conqressman Clinqer:
Thank you for your letter of February 1
concerning my health care task force. I appreciate
your support of my efforts to formulate a national
health care policy. It is my intention to develop a
plan for high quality, affordable health care for all
Americhs, ancl I have askecl the health care taaJt
force to help me develop leqislation for
comprehensive health care reform.
I have referred your questions concerninq tba
Federal Advisory committee Act to Bernard Husaba\Jil,
the Wbita Bouse Counsel. Mr. Huaaba\DI haa preparecl a
letter addressing your concerns, which he will
deliver to you under separate cav.r. I have also
askecl Mr. Nussbaum ancl his staff to be available to
answer any.further questions you may have on legal
issues relating to the health care task force.
With best wishes,
Sincerely,
The Honorable William F. Clinger, Jr.
Bouse of Representatives
Washinqton, D.C. 20515
�.
I
'
..
THE WHITE HOUSE
WASHINGTON
February s, 1993
The Hon. William F. Clinqer, Jr.
Committee on Government Operations
Conqress of the United States
House of Representa~ives
2157 Rayburn House Office Building
Washington, D.C. 20S1S-6143
Dear Representative Clinger:
The President has asked me to respond to your letter,·
dated February 1, 1993, concerning the President's health care
task force.
The President has selected tha First Lady, Hillary
Rodham Clinton, ,to chair the health care task force. In additicm
to the First LadY, the task force currently includu the
Secretaries of the Treasury, Defense, commerce, Labor, Health and
HWDan Services, and Veterans AffairsJ the Director of the Office
of Management and Budget: the Assistant to the President for
Domestic Policy 7 the Assistant to the P~esidant for Econaai.c
Policy 7 the Chair of the council of Economic Advisors: and the
senior Advisor to the President for Policy Development.
The task force bas not yet held a meeting, althouqh
melllbers of the task force were present on January 25 wben the
President aMounced the formation of the task force and defined
its mission. The task force is plaMing to bold same public
meetings in the future. Those meetings have not yet been
scheduled.
As the President announced on January 25, the Senior
Advisor to the President for Policy Development will lead an
interdepartmental workinq group which will gather information
for, and provide information to, the task force. The working
qroup will consist of qovernment employees, and will consult with
a wide range of citizens in the public and privata sectors. The
task force, in turn, will review information provided by the
working qroup and make recommendations to the President.
It is our opinion that the Federal Advisory Camaittaa
Act ("FACA") does not, and was not intended by Congress to, apply
to the health care task force. The participation of the First
Lady on the task force does not triqqer application of the Act.
•
I
•
�----..--
..
...
The Hon. William F. Clinqer, Jr.
February 5, 1993
Page 2
Finally, we appreciate your intention to introduce
leqislation to amend FACA to provide that the Act is not
triggered by the participation of the spouse of the President or
the spouse of the Vice President on a committee or task force
malting recommendations to the President. We believe, hawev.r,
that the existing statute already provides for sucb a result.
Please feel free to contact me, my deputy Vincent
Foster or Stephen Neuwirth. of this office, should you require
further information in response to your inqairy.
~m,_
w.
Barnard
Nussbaum
counsel to the President
•
.
•
�UNITED STATES DISTRICT COURT
DISTRICT OF COLUMBIA
)
)
)
)
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.,
etc., et aL,
Plaintiffs
)
)
VL
)
HILLARY RODHAM CLINTON, etc., et aL,
CIVIL ACTION N O . - - - IUDGE ___________
)
)
Defendants
)
AFFIDA. V1T OF J. CHAD JACK$0N
l~t.
A
•
KENT MASTERSON BROWN
-
C~STOP~J.S~UG~SSY
BROWN & BROWN, P.S.C.
1114 First National Building
167 West Main Street
Lexington, Kentucky 40507
(606) 233-7879
Facsimile (606) 252-6791
J
~Mh d1k ....ALAN P. DYE, ESQ. '
BarNo. 215379
FRANK M. NORTHAM, ESQ.
Bar No. 206110
WEBSTER, CHAMBERLAIN
&BEAN
1747 Pennsylvania Avenue, N.W.
Suite 1000
Washington, D.C. 20006
(202) 785-9500
1
.•
�-------
COUNSEL FOR PLAINTIFFS, ASSOCIATION
OF
AMERICAN
PHYSICIANS
AND
SURGEONS, INC., AMERICAN COUNSEL FOR
HEALTH CARE REFORM, and NATIONAL
LEGAL&. POUCY CENTER
2
�AFFIDAVIT
On February 16, 1993, at the request of Kent Masterson
Brown, Esq. of Lexington, KY, I, Chad Jackson, resident of
Fairfax, VA, and under the employ of Association of American
Physicians and Surgeons, in Washington, D.C., attempted to locate
a charter for the President's Task Force on National Health
Reform.
According to GSA Management Regulations a copy of charters
for Presidential Advisory committees should be filed at the
Library of Congress, Exchange and Gift division, Federal
Documents section. I located the appropriate section in the
Library of Congress and spoke with Mrs Alma Mather. Mrs Mather
informed me that she had no recollection of any charter being
filed for this task force and escorted me to the basement where
she sifted through the current mail searching for the charter.
When she could not locate the charter in any of the areas under
her jurisdiction, Mrs Mather directed me to the Serials Division
to speak specifically with Mr. Mark Sweeney. Apparently Mr
sweeney handles the charters after the Exchange and Gift Division
sorts and records them.
Mr sweeney also had no recollection of the charter in
question and could not locate one. I called Mr. sweeney today
and he stated that the charter for the President's Task Force on
National Health Reform has not been filed in the Libra
of
Congress as of the date of this Affidavit.
J.
c
SS:
Subscribed and sworn to before me, this
February, 1993.
My Commission expires:
/D)
~~ of
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
FACA Documents [3]
Creator
An entity primarily responsible for making the resource
First Lady's Office
Maggie Williams
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 4
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-2194630-20060223F-004-004-2015
2194630
-
https://clinton.presidentiallibraries.us/files/original/dba125e78af6b00dac39cc1e9effd283.pdf
ae71316ee5941f359529ec3d52dc71d7
PDF Text
Text
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. fax
DATE
SUBJECTffiTLE
04/20/1993
Declaration of Mary Schuneman. (4 pages)
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
FACA Documents [2]
2006-0223-F
ab859
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act- (5 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((aX3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRAJ
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6)ofthe PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(bX3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.·
PRM. Personal record misf'de defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
DATE
SUBJECTffiTLE
RESTRICTION
AND TYPE
001. fax
04/20/1993
Declaration of Mary Schuneman. (4 pages)
PS
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number: 10813
FOLDER TITLE:
FACA Documents [2]
2006-0223-F
ab859
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. l104(a))
Freedom of Information Act- [S U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(l) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
fmancial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(l) Release would disclose internal personnel rules and practices of
an agency [(b)(l) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�•.·
"'t
~G.-2nd
SESS.
T /1St:.
aet.:.
·.t·
1
. l_?~c(c.--
PUBLIC LAW 101-393 [B.R. 5488); October 6, 1992
of th
_#Ult and Seasonal
(29 tJ.o.C. 1864) il amended
1riDf new eubeeetion:
~.
er provision of thil Act, where
il appUcable aod coverage il
picultiiral worker, the worken'
, udusive remedy for 1011 ot
case or bodily iniwy or death.
ibed by paragraph (1) precludes
r actuial damqea for 1011 ftoJD
:lude recovery under subsection
ction.•.
·
TREASURY, POSTAL SERVICE, AND GENERAL
GOVERNMENT APPROPRIATIONS. Acr, 1993
A1t N.t ....... .,...,....... fw the Trecnury Oep..._...., the United llatee ,_...,..,.._,the
laecullve Ofllce ef the ............. acl _..... hldependent ~ fw the "-1 , _
....... ..,•••••, . . 1991, _, . . ....., ..........
1H it truxt«l by tAl StMII arwl Hou. of S.p,.,,.,.,dtiu11 of
tlal U11illcl S14111 of America i11 Co,..,.,, a•mbl«<, 'nlat the
rollowina tWill are appropriated, out or ey money in the Treuury
not otherwile appro~riat.d, ror the Treuury Department, the
United Statal Poetal Service, the Executive Office ol the Preeident,
and certain lnder.ndent Annciu, lor the fteca1 year endinr
September 30, 199 , and lor other purpo111, IWDely:
·
:~dment
made by subsection (a)
lmenced after the date or the
' 1 not apply after the expiration
.
1
ding any appUcable stat~te or
. d=es brought by a augrant
m
· y injury or death under
i Seasonal Ajricultural Worker
be brought during the 9-montb
1 ( 1) may be commenced, either
,r as an action by itaell, after
A statute ol limitations which
~entence shall be extended lor
• or expiration or such statu~ .
egislative Branch Appropriatio~
TITLE I
DEPARTMENT OF THE ~URY.
.
DEPARTMENTAL Omca
.IALAIUU AHD IXPIH8II
..
For neceuary expeneee ol the Depaltmental omce. lncludlnr
O{Mir&tion Uld maintell&JlCI ol the TriuUI'J Ju1J~ and ~~Xi
hire or ,.....r motor vehlclll; DO& to aCMcl tU,OOO tor OIDCW
reception ud repreeentation apeDIII; no& to aceed h3S\qoo lor
unlol'lllln tllllr(lncill ol a ooftftcltntlal u&un, to be auocated
and ,.ndtd uder the dlrectton ot the Stcrt~ of &be Tn~
=~ot& ~'in~~~.~
:..r::·".a:.~:-;
Forelp Aultl Coatrol; no& to._. tl,fti,OOO to ~'~maiD available
until ~cW, tor IJI&eiDI ~&loa ~tl; DR to
UCMd MIO,OOO, to nawa available uW ~d... tor repa1n
ad S.praYtiUiitl to the Mala Trluury IUiJIIIDI ud ADa;
171,201,000.
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Por UOIIIII')' ~..!'MI ot the IDtaru&toul al'aln ·fuutloa
ot the ~atal om... 1ae1~ ~tloa uu1 ma~ae....
ot the ~ IWldlq lad AuG; bin fll ~ motor
vehlcltl: malataance, ~. ud IID~tl" ...r ~
or OOIDIDerdalluvulcl poUdtllor, nil~ leutd or owuc1
oveneu, whta 11101uary lor the ~ ot olldal
DO& to tBMd t2 000,000 lor offtcll1 trl¥11
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IDOdtrnllatloa nquimllta:tt; 138,408,000.
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108 STAT. 1729
· ··
..
�4. CONG•.!..Znd SESS.
Oet. 6
• flRY other provision _of.law, a Fede~al
Lhe deposit from eX1st1ng appropna·
yees Compensation. AcCOllnt or ~he
.. rea··. ·-t by sectiOn 8509 or title
!r th.
ty days aner the De~art·
•eney
.e amount to be depos1ted.
'the pro~sions of the Act of Septem·
, -258, 31 U.S.C. 1345), any agency,
of the United States which provides
:are services for Federal employees
mr.loyee or any person employed to
ve transportation, and subsistence
:la~ses, coruerences or othe~ meetings
ion or such services: Prov&ded, That
, pursuant to this s-.ction shall not
regulations prescribed pursuant to
:tates Code.
e specifically provided, the maximum
:urrent fiscal year in accordance with
~st 2, 1946 (60 Stat. 810), for the
:otor vehicle (excl\llive of b\llls and
at $7,100 except station wasons for
$8 100: Providlld, That these limits
cce~d $3,700 for police·type vehicles,
special heavy-duty vehicles: Provided
' th in this section may not be exceeded
electric or hybrid vehicles purchased
~rovisions of the Electric and Hybrid
nt and Demonstration Act of 1976:
i~ts aet forth in this section may
ntal coat of clean alternative fu~ls
, Public Law 101-349 over the cost
ueled vehicles.
..f
1 of the executive departments and
for the current fiscal year available
~ he expenses of the activity concerned,
for Q'' · "'rl allowances and coat-of·
:e wi
.S.C. 5922-24.
.::·
.ae IJ.
..d durins the current ftecal
iation contained in this or any other
,m~naation of any officer or employee
Jmted States (includins any apncy
which is owned bf the Government
• post of duty is 1n the continental
Jeraon (1> is a citizen of the United
:he service of the United Statea 01
Act who, beins elisible for citizenship,
ntention to become a citizen of tile
date and il actually reaidins in the
tD who owes allesiance to the United
Cuba, Poland, SOuth Vietnam. or the
utted to the United States for _penu·
Vietnamese, Cambodian, and LaotiiD
ted States after January 1, 1975, :.r.
Repub~ic of China pro~ted bi_
tf A~nl 11, 1990: Pro11ided, That 111 amdavit siped by any auch penot
1
I
1
Exef:
Oct.
o
:·:. · ... ~ .. POSTAL, ETC., APPROP.
shall. be ~nsid~red prima fac:~e evidfnce that the requirements
o~ th1s sect~on w1th res~ct to h1s or her status have been complied
w1th: Proc:rded further, That any person makins a false affidavit
shall be JUilty Of a felo~y, &~d, Upon C~!\vic:tion, shall be fined
no more than_ $4,000 or 1m_p_nsoned tor nut more than one year,
~r bot~:. Proc:uud furtlae~. That the abo\·e ~enal clause ahall be
an a4d1~1on to, and !lOt an substitution for any other provisions
of ex1stmg law: Prov1tied furth.r, That any payment made to an
officer or empl~yee c~ntrary to the provisions of this section shafi
be recoverable 1n ac~1~n by the Federal Government. This seetion
sh~l~ n~t apply to Citizens of Ireland, Israel, the Republic: or the
Ph1hpp~nes or to nationals of those countries allied with the United
States 1n the current defense effort, or to temporary employment
of translators, . or to temporary em~loyment in the field service
(not to exceed s1xty days) as a result of emergencies
.SEc. 608. Appropriations available to any department or agency
duryns the current fi~al year tor necessary expenses, including
ma1ntenance or operat1ng expenses, shall also be available for pay·
ment to ~he General Services Administration tor c:harses for apace
an~ ~ervtc:es and, ~~ose ex.penses or renovation and alteration or
bu1ldans~ and faaht1ea whtc:h constttute public: improvements per·
formed 1n accordance with the Public Buildinss Act of 1959 <73
Stat. 749), the Public Buildinp Amendments of 1972 (87 Stat
216), or other a~plicable law. ·
·
·
~~c. 60.9. Funds ma~e available by this or any other Act for
a.dmtn1atrat1ve ~xpenae.s 1n the current fiscal year of the CO!PQra·
t1ona and agenaes ~ubgect ~ chap~r 91 of title 31, United States
Code, shall be avada le, 1n additson to objects for which such
fund.a a~ otherwise av~lable, for rent in the District of Columbia·
serv1cea I!' accordance wath 5l!.~.C. 3109: and the objects specifi;d
under thu he~d. all the ~rovtstons of which shall be apP,licable
to the expenditure of such funds unleu otherwile ~c1fied in
the Act by which they are made available: Pro11Ukd That in the
event any functions budgeted u administrative expe~ea are subae·
quently. t.ransf~rred to or paid from other funda, the limitations
on adm1n1strat1ve expenses shall be correspondinslr reduced.
SEc. ~10. No p~rt of any appropriation for the current fiscal
year conta1ned in thu or any otller Act ahall be paid to any ~non
for the fillins of any position for which he or she hU been nom~nated
after the senate liai voted not to approve the nomination of said
penon.
· .
.
SEc. 811. PursWUlt to section 1415 of the Act. of July 15
1952 (86 Stat. 66VJ foreign credits (includins currencies) owed
to or owned by the united States may be used l)y Federal apncies
for any pw:poae for which appropriations are made for the current
~seal year (Including the carryins out of Acta ~uiriq or authoriz·
!"I tlie use of such credits), only when reimtiursement therefor
11 made to the Treuury from applicable appropriatiou of the
agency concemed: Provided, T!Ult aw:h Ciedita received u
exchanged allowances or proeeeda of aalu of personal froperty
!"'Y b8 used in whole or ~ payment lor acquisition o limilar
1tema, to the extent and m the manner authorized by law, without
the Treuury.
..
.......,..:.u
ot anr. a~tioa contained 1ft thil or ~
availab tor iD~ ftnancina
~~lli01111, oouncill. COIDIDi~ or liliaiiU PNPI (Whether or
mt.~n.~Mftii!V at.itiee) which do not have a prior ancl
or-.
-----~1::-v<_.( . ..)
STAT. 1766
P.L. 10Z-393
106 STAT. 1767
�P.L. lOZ-393
LAWS OF 102nd CONG.-2nd SESS.
~ive
Oet. 6
specific statutory a.pproval to
financial support from more
than one agency_ or anstntmentahty.
SEC. 613. Funds made available by this or any other Act to
the "Postal Service Fund" l39 U.S.C. 2003) shall be available for
employment of tuards for all buildings and areaa owned or occupied
':ly the Postal Service and under the charge and control of the
?ostal Service, and such guarda shall have, with respect to such
special policemen provided by the first
property, the powers
section of the Act of.June l, 1948, aa amended (62 Stat. 281;
~0 U.S.C. 318), and, as to property owned or occupied by the
?ostal Service, the Postmaster General may take the same actions
u the Administrator of General Services may take under the pr0\'1·
:;ions of sections 2 and 3 of the Act of June 1, 1948, al amended
· 62 Stat. 281; 40 U.S.C. 318a, 318b), attaching thereto penal con·
;equencel under the authority and within the limita provided in
:ection 4 of the Act of June l, 1948, as amended <62 Stat. 281;
;O tJ.S.C. 318c).
SEC. 614. None of the funda made available pursuant to the
~rovisiona of thia Act shall be uaed to implement, administer, or
mforce any rei'Ulation which hu been d1aapproved punuant to
1 resolution
diaapproval duly adopted in accordance with the
applicable law of the United Statea.
SEC. 615. No pan of any appropriation contained in, or fUnds
made available by, this or any other Act, ahall be available for
any acency to pay to the Adminiatrator of the General Services
Administration a hicher rate per aquare Coot for rental of space
and service• (established pursuant to aection 210(j) of the Federal
Property and Administrative Services Act of 1949, u amended)
than the rate ~r square foot established for the apace and services
by the General Services Adminiatration for the fiacal year for which
appropriations were granted.
SEC. 616. (a) Notwithstandinc any other provi1ion of law, and
except u otherwise provided in this section, no part of any of
the funds approP-riated for the fiscal yean endinc September 30,
1993, or September 30, 1994, by this or any odler Act, may be
uaed to pay any prevailin1 rate employee deacribed in section
5342CaX2XA) of title 5, UniteCI States COde, or any employee covered
by section 5348 of that title(1) durinc the period from the date of expiration of the
limitation impoaed tiy section 616 of the Treuury, Postal Service, and Genlral Government Appropriationa Act, 1992, until
the ftnt day of the ftrst applicable pay period that bepna
not leu thaD ninety dar. after that date, 1n an amount that
exceedl the rate payati e Cor the applicable P.de and step
of the applicable wap schedule in accordance Wlth such section
616;ancl
(2) duriq tile period consisting of the remainder, it any,
of ftacal year 1993, and that portion of ftacal year 1994, that
precedtt the normal eft'ective date of the applicable wap survey
adjustment that is to be eft'ective in fisCal year 1994, in an
amount that exceecla, u a result of a w~ survey acijuatmant.
the rate payable under paragraph (1) of thi1 aubaectioft .,
more than fhe overall averap percentar. actiuatment in the
General Schedule duriq ftac:il year 199 , under section 5303
of title 5, United Statea Code.
(b) Notwithatandinc any other provision of law, no prevailinc
rate employee deac:ribid in aubparqraph (8) or (C) of section
or
or
106 STAT. 1768
Q
~
�.
~~
,.n(
'vl'A '1P~,
\I '"\f~
: ~., O
~
\?~\
J- 'It
Q and A's on Health care Task Force Appeal
Q:
Last week you told us that the President was happy with the
district court's decision. Why are you now appeallinq the
decision?
A:
As we told you last week, the President was pleased with the
district court's decision because the court held that
everythinq that has happened to date is leqal, and that
everythinq planned to take place in the cominq weeks -includinq the lonq-planned public meetinq of the task force
that is scheduled for next Monday in Washinqton -- is also
leqal.
For this reason, we believe that the Task Force and the
workinq qroup should be able to continue their work
unaffected by the court's decision. However, our lawyers at
the Justice Department felt stronqly that the court had made
substantial errors both in interpretinq the Advisory
Committee Act and in applyinq principles of constitutional
law. This case has implications beyond the health care task
force for the President's ability to seek advice and we were
advised by the Justice Department that an appeal was
important to ensure that these issues be properly resolved.
Q:
But you are not just appeallinq. You are askinq for an
expedited appeal. Doesn't that mean that you are really
concerned about the impact of the district court's decision
on the Task Force?
A:
Aqain, ~e are seekinq an expedited appeal based on the
advice of our attorneys at the Justice Department. The
Justice Department advised us that because of the short time
frame within which the Task Force will complete its work, it
is important to proceed with an expedited appeal if the
issues raised in the case are to receive the full attention
of the appellate court.
Q:
Don't your papers make reference to the "impractability" of
the judqe's decision -- that he has made the FACA
unworkable?
A:
I am not a lawyer, and I suqqest.that you read the papers
that the Justice Department has filed with the Court today.
I can tell you, however, that our Justice Department
attorneys, as well as our attorneys in the White House,
concluded that the district court had created a framework
that was unworkable from a constitutional perspective, and
that made it difficult in the lonq run to know exactly what
�it is that the Advisory Committee Act will now be construed
to require.
Q:
Aren't you just using this appeal as a means to maintain the
secrecy of the Task Force's work?
A:
Not at all. We had been planning all along to hold a public
meeting, and we would do that even if the district court's
decision were withdrawn today. This has been an open
process in which thousands of individuals and groups have
had an opportunity to give their input, both in person and
in writing.
Q:
What exactly was wrong with the district court's decision?
A:
As our brief filed with the Court of Appeals sets forth, the
district court failed to follow Supreme Court precedent when
it held that the Advisory Committee Act could be interpreted
to apply to a task force made up of cabinet secretaries,
senior White House officials and the First Lady. The
Court's decision raised significant constitutional
questions, and held FACA could not apply at all under
certain circumstances and that only part of FACA could apply
under other circumstances. Again, our Justice Department
lawyers have told us that this application of FACA does not
work as a legal matter.
Q:
Are you going to continue to maintain the position that the
Advisory Committee Act is unconstitutional?
A:
Again, I am not a lawyer, but I do know that our position in
this case was not to attack the constitutionality of FACA.
Rather, our position has been, and remains, that under
Supreme court precedent, FACA must be interpreted consistent
with Congressional intent, and in a manner that does not
create constitutional problems. The district court itself
found that FACA is unconstitutional if applied to adyice
qiyen to the President by a Task Force composed of Cabinet
secretaries, senior White House officials, and the First
Lady.
Q:
FACA requires 15-days advance notice of public meetings of
the Task Force. Why did you wait until this past Friday to
publish notice of next Monday's meeting, and doesn't this
mean that you have violated FACA?
A:
In this instance, we delivered notice of the public meeting
to the Federal Register as soon as the Task Force had
determined a date and location for its public meeting. OUr
lawyers advised us that although FACA normally requires 15days prior notice of a public meeting, the statute also
..................._________________________
�~
.
.
...
allows shorter notice to be qiven if there are
"extraordinary circumstances." In this case the short time
frame within which the President has asked the Task Force to
complete its work is an "extraordinary circumstance"
justifyinq a shorter notice period -- in this case, 10 days.
In addition, this is a situation where it has been widely
reported for many weeks that the task force would hold a
public meetinq, and the date of this meeting has already
been widely reported. This is far more publicity than mere
publication in the Federal Register normally provides. And
each of the plaintiffs in the lawsuit will be invited to
attend the public hearings.
�Q and A's on Health Care Task Force Appeal
Q:
Last week you told us that the President was happy with the
district court's decision. Why are you now appealling the
decision?
A:
As we told you last week, the President was pleased with the
district court's decision because the court held that
everything that has happened to date is legal, and that
everything planned to take place in the coming weeks -including the long-planned public meeting of the task force
that is scheduled for next Monday in Washington -- is also
legal.
·
For this reason, we believe that the Task Force and the
working group should be able to continue their work
unaffected by the court's decision. However, our lawyers at
the Justice Department felt strongly that the court had made
substantial errors both in interpreting the Advisory
Committee Act and in applying principles of constitutional
law. This case has implications beyond the health care task
force for the President's ability to seek advice and we were
advised by the Justice Department that an appeal was
important to ensure that these issues be properly resolved.
Q:
But you are not just appealling. You are asking for an
expedited appeal. Doesn't that mean that you are really
concerned about the impact of the district court's decision
on the Task Force?
A:
Again, we are seeking an expedited appeal based on the
advice of our attorneys at the Justice Department. The
Justice Department advised us that because of the short time
frame within which the Task Force will complete its work, it
is important to proceed with an expedited appeal if the
issues raised in the case are to receive the full attention
of the appellate court.
Q:
Don't your papers make reference to the "impractability" of
the judge's decision -- that he has made the FACA
unworkable?
A:
I am not a lawyer, and I suggest that you read the papers
that the Justice Department has filed with the Court today.
I can tell you, however, that our Justice Department
attorneys, as well as our attorneys in the White House,
concluded that the district court had created a framework
that was unworkable from a constitutional perspective, and
that made it difficult in the long run to know exactly what
�it is that the Advisory Committee Act will now be construed
to require.
Q:
Aren't you just using this appeal as a means to maintain the
secrecy of the Task Force's work?
A:
Not at all. We had been planning all along to hold a public
meeting, and we would do that even if the district court's
decision were withdrawn today. This has been an open
process in which thousands of individuals and groups have
had an opportunity to give their input, both in person and
in writing.
·
Q:
What exactly was wrong with the district court's decision?
A:
As our brief filed with the Court of Appeals sets forth, the
district court failed to follow Supreme Court precedent when
it held that the Advisory Committee Act could be interpreted
to apply to a task force made up of cabinet secretaries,
senior White House officials and the First Lady. The
Court's decision raised significant constitutional
questions, and held FACA could not apply at all under
certain circumstances and that only part of FACA could apply
under other circumstances. Again, our Justice Department
lawyers have told us that this application of FACA does not
work as a legal matter.
Q:
Are you going to continue to maintain the position that the
Advisory Committee Act is unconstitutional?
A:
Again, I am not a lawyer, but I do know that our position in
this case was not to attack the constitutionality of FACA.
Rather, our position has been, and remains, that under
supreme court precedent, FACA must be interpreted consistent
with Congressional intent, and in a manner that does not
create constitutional problems. The district court itself
found that FACA is unconstitutional if applied to advice
giyen to the President by a Task Force composed of Cabinet
secretaries, senior White House officials, and the First
Lady.
Q:
FACA requires 15-days advance notice of public meetings of
the Task Force. Why did you wait until this past Friday to
publish notice of next Monday's meeting, and doesn't this
mean that you have violated FACA?
A:
In this instance, we delivered notice of the public meeting
to the Federal Register as soon as the Task Force had
determined a date and location for its public meeting. Our
lawyers advised us that although FACA normally requires 15days prior notice of a public meeting, the statute also
�allows shorter notice to be given if there are
"extraordinary circumstances." In this case the short time
frame within which the President has asked the Task Force to
complete its work is an "extraordinary circumstance"
justifying a shorter notice period -- in this case, 10 days.
In addition, this is a situation where it has been widely
reported for many weeks that the task force would hold a
public meeting, and the date of this meeting has already
been widely reported. This is far more publicity than mere
publication in the Federal Register normally provides. And
each of the plaintiffs in the lawsuit will be invited to
attend the public hearings.
�MM-11·1993 14147
...
TO
FROM GAO GENER~ COUNSEL
94561647
P.e2
..
GAO
Udld State~
Gelml
Aceo- Olce
Wllht.qiol, D.C. 20MI
March 11, 1993
Mr. Bernard W. Nussbaum
Counsel to the President
Dear Mr. Nusabaum:
As you know, Representative William F. Clinqer, Ranking
Minority Member of the House Committee on Government
Operations, has requested our revie~ of certain issues
relatin; to the President's Task Force on National Health
Care Reform and the interdepartmental working group that has
been established to a3sist the task fo;ce, Incident to tbie
review, we have requested certain information about the
composition of the interdepartmental working group and its
outside consultants,
In telephone conversations with Mr. Stephen
Neuwi~th
of your
staff, Mr. Neijwirth questioned whethet the information we
are seeking is within the scope of Representative Clin9er's
request to us. Representative Clinqer, in a meetinq with us
yesterday, conti:med that he expects GAO to obtain this
'
I
•
•
'
•
'
•
~
'
•
,.
,,
4 '
o
..
-~
�4
.. •
--· -- - --
.
-
-
. -- - --
information ana that it is within the scope of his
re~est.
The information we are seeking relates to the interdepartmental working group's membership and use of outside consultants, as deaeribed in an affidavit attaehed to the Juatiee
Department's brief in Amtri;an!lsociation,Rf fhysicians,JAd
Surgeons v. Hillary RoQham Clinton, No. 93-0399 (D.D.C.
filed Feb. 24, 1993). Accordin~ to the affidavit, the
working group's membership eona11t1 of two categories of
federil employees: (l) 300 full-time, permartent employees
provided to the ~orking 9roup by the White House, Members ot
con~ress, and eeveral federal agencies; and (2) approximately 40 other individuals appointed as special 9overnment
employees by the White House and several aqencies. The
affidavit also indicates that outsiae consultants have been
retained to assist the 340-member working group, which has
been divided into lS issue-oriented "eluster groups."
·
~equest that you prcvide us with a list of the
emplo~ees in each of the two categories described
We
federal
above,
indicating the agency or other source of eaeh in4tvidual's
employment and the cluster group to
whi~h
the indLv1dual hae
�-
~
.
-- - --
~
.
~-
SENT.BY!Xerox Telecopier
.
7-o2o_:_a-2a-sa;
.
16!32
y·-~-r.
MAR-11-1993 14147 FROM GAO GENERAL
COUNS:~
TO
94561647
'"•
pI 03
..
been assiqned. In addition, we would like to know each
special 90vernment employee's appointment date. rinally,
would like a list of tne names of the outside consultants
oeing used by the working qroup, ident1fyinq each coneul-
w@
tant's organizational affiliation, rate of compensation,
ana, it a~plieable, the consultant's cluster qroup
assi~nment.
In order that we may proceed with our review, we requeat
your response no later than March 24, 1993. It you have any
questions concerning this req~est, please call me on
512-5156 or Ms. Lynn Gibson of my staff on 512-5422.
S1ncerely yours,
Henry R. Wray
Senior Associate General Counsel
-
�B•25237S
2
TOTI=L p,e3
�THE WHITE HOUSE
Office of the Press Secretary
January 28, 1993
For Immediate Release
PRESS BRIEFING BY
GEORGE STEPHANOPOULOS
The Briefing Room
3:48 P.M. EST
SUBJECT
ANNOUNCEMENTS
Meeting with Private Citizens • • • • • • • • • • • • • • • l
DOMESTIC
Economic Issues • • • • • • • • •
• • • • • • 175-6713-14
COLA Issue
•
•
•
•
•
•
•
•
•
•
•
Gays in the Military Issue
National Security Staff Meeting
"Gag Rule"
. . . . . . . . . .
•
•
•
•
•
• • • • • •
• • • • • • • •
•
• 1-2
l-9;11
• 2-3
. . . . . • . . • . . 3
Deficit Reduction • • • • • • • •
• • • • • • • • • • • 4
Oil Import Fee • • • • • • • • •
• • • •
5710
Healt~ care Meeting Coverage
• • • • • • • • • • • •
10
White House Phone Calls/Gays in Military • • • • • • • • • 8
President's PhysicianjDr. Lee/Allergy Shot
• • • 12-15
Attorney General Selection
• • • • • • • • • 9715
Patty·Presock at the White House • • • • • • • • • • • • 12
Wealthy Tax Proposal? • • • • • • • • • • • • • • • • • • 13
FOREIGN
Bosnia • • • • • • • • • • • • • • • • • •. • • • • • • • • 2
• • • • • • • • • • 57 ll
Israeli/Deportees Issue/Rabin
. . • . . . . • • . . 5-6
Date of MUlroney Visit? •
Iraq
• . . . . . • . . . .
Japanese Meeting/Summit?
. • • • • • • • .
• • • • •
END
14
• • • • • • •
13
4:17 P.M. EST
#9-0l/28
�THE WHITE HOUSE
Office of the Press Secretary
January 28, 1993
For Immediate Release
PRESS BRIEFING
BY GEORGE STEPHANOPOULOS
The Briefing Room
3:48 P.M. EST
Q
Where•s the President.
MR. STEPHANOPOULOS: It's nice to be welcomed. He's
still in his office. I apologize for being late. As you know, he'll
be meeting with some private citizens this afternoon -- Richard
English, a 17 year-old, who's suffering from bone marrow cancer, but
he's with the Make a Wish Foundation: Kevin Roche, who received a
gold medal in architecture this year: and Janie Ruth Hill Hatton, the
1993 Principal of the Year.
Any questions?
Q
George, Secretary Bentsen said that a 50 basis
point cut in interest rates would provide about $50 billion in
stimulus to the economy. was there any request for an interest rate
cut like that at the Bentsen, Greenspan, Clinton meeting this
morning?
MR. STEPHANOPOULOS: No, they had a good general
discussion about economic conditions we face right now and the goals
for the future. The President was very gratified by Chairman
Greenspan's testimony before the Congress: and I think they share the
same goals of getting growth in this economy, holding inflation down,
and really bringing up job growth.
Q
George, what's the status of the ban on military
Q
Wait, could I follow on that?
gays?
MR. STEPHANOPOULOS:
then I'll come back.
sure, why don't you follow, and
Q
Did they make -- was there any specific request not
to raise interest rates, or why not ask the Fed to lower interest
rates if Bentsen says that will provide --
MR. STEPHANOPOULOS: Well, the President believes that
the Fed should maintain its independence. He respects the right to
be independent. But they had a good discussion on the general goals
for the economy.
Q
May I follow on the economy? Are you considering
cost of living -- capping the cost of living increases under Social
security or other changes in Social Security system as part, as one
of the options, or two of the options?
MR. STEPHANOPOULOS: I won't rule it out. I mean, it's
one of the issues that's being discussed. But the President's made
MORE
01/28-#9
�- 2 -
-- are we considering COLA delays or caps as part of the budget,
economic agreement. And we have not made any final decisions yet.
Q
What is the advantage to a COLA capping --
MR. STEPHANOPOULOS: Well, I don't think I should go
into characterizing any proposals right now until the President's
made a decision.
Q
What about the likelihood of an uproar on the Hill
and from the public with any kind of change in the social Security?
MR. STEPHANOPOULOS: Well, I think that's conceivable,
and we'll make sure that any plan that we have is both fair and
solves the goals of both putting growth in the economy and achieving
deficit reduction. But I really don't want to comment on any
specific proposals until the President's made up his mind.
Q
George, what is the status of the military gay ban?
Is that -- are we near an announcement, or --
MR. STEPHANOPOULOS: I hope so. I mean, we're working
in consultations with the Hill and the military. Those consultations
are continuing·. And when we have an announcement, we' 11 let you
know.
Q
Today?
MR. STEPHANOPOULOS: I'm not sure, I hope it will.be
today, but if not we'll get it out soon.
Q
Are you dealing with legal issues? I mean, are
lawyers involved here? What is it that's taking so long about this?
MR. STEPHANOPOULOS: As Secretary Aspin said last night,
we're trying to figure out exactly how to deal with the interim
situation during the six months while we're waiting for the executive
order -- the six-month review period. And there are a lot of issues
right now that we're going over with the military and people on the
Hill. And we're just going through the details. We should have
something, we hope, relatively soon.
Q
George, are you going to suspend both dismissals
and prosecutions in the interim period on --
MR. STEPHANOPOULOS: I don't want to comment on exactly
what is going to happen in the interim period. That's under
discussion right now. We hope to have something soon.
Q
Has the President had a meeting with his senior
foreign policy and military advisers on this issue of Bosnia or any
other --
MR. STEPHANOPOULOS:
has not had any special meeting.
He's had his daily briefings.
He
Q
In other words, so beyond the daily briefing, there
have been no foreign policy sessions?
Q
George, we saw Secretary Aspin and Secretary
Christopher and Joint Chiefs Chairman Colin Powell, CIA Director
James Woolsey -- all of them coming over here for a 2:00 p.m.
meeting. Did President Clinton participate in that meeting?
MR. STEPHANOPOULOS:
Q
No.
Was is that meeting all about?
MORE
01/28-#9
�- 3 -
MR. STEPHANOPOULOS: I believe it's a meeting of the
principals of the national security staff and they're going over a
range of issues.
Q
To follow on the Bosnia question, is the situation
over there creating any sense of urgency that the United States has
to take some action in the near term, either passively or actively,
but to do something different other than just watch things go on?
MR. STEPHANOPOULOS: I don't want to characterize the
action or the timing, but it's obviously a very serious situation
that we're watching very closely, and we're reviewing our options
now.
Q
do something?
process?.
But should we expect the President to speak out or
or are you waiting to see what happens with the Vance
MR. STEPHANOPOULOS: Well, as you know, we supported the
Vance process.to bring the parties together. But, as I said, this is
very serious. Obviously if you read the newspapers and look at
what's happening over there, it's something that's of deep concern to
all of us. And we're working on it now.
Q
Do you think there's anything you can or should
contribute right now?
right now.
MR. STEPHANOPOULOS:
We're reviewing all of our options
Q
George, senior members of the Marine Corps
senior officers in the Marine .Corps apparently, including the
Commandant, have been copying and circulating on the Hill and
elsewhere a fairly inflammatory anti-gay videotape that they've been
circulating as part of their lobbying campaign. Does the President
believe that that sort of behavior is appropriate, or does it cross
some line that he believes that a military officer should not be
doing?
MR. STEPHANOPOULOS: Well, I haven't seen the
videotapes. I don't think the President has either. And I don't
know if he's had any of that activity confirmed. But obviously we
want to work with the military to come up with the best policy. And
that's why we sat down with them, that's why the President met with
the Joint Chiefs of Staff. That's why Secretary Aspin continues to
consult with them. And we think that's the appropriate way to· move
this process along.
Q
Have you barred them from lobbying?
Q
Does the President believe that there's a line of
conduct -- I mean, obviously the military have a right to make their
case to the Congress, but is there some line of conduct beyond which
he does not think his senior officers should go in this regard?
MR. STEPHANOPOULOS:
sit down and work this out.
The President thinks that we should
Q
senator Gramm has urged that the Joint Chiefs be
released from what he calls a 11 gag rule" that would prohibit them
from testifying against this -- the eventual ban. Would Mr. Clinton
support that?
MR. STEPHANOPOULOS: I believe the way the rules stand
is that if -- the Joint Chiefs can testify before the congress. And
if they're asked their personal opinion, they can give it.
MORE
01/28-#9
�- 4 -
Q
The President promised during the campaiqn that
he'd issue executive orders to prohibit discrimination against gays
and lesbians in federal employment, federal contracts and government
services. What's the status of those executive orders?
MR. STEPHANOPOULOS:
I don't know.
I'll have to check.
Q
Does the President plan to change his -- any other
policies in the federal government that may exist in such agencies as
the Secret Service regarding gays?
MR. STEPHANOPOULOS:
Q
Not that I know of, no.
Why not?
Q
George, is the President's commitment to reaching
at least $145 billion in deficit reduction -- is that a commitment?
Is that a goal? How would you characterize that? Is that slipping?
MR. STEPHANOPOULOS: Well, I don't know that it's
slipping. The President is looking at that right now. He has said
he would like to achieve $145 in deficit reduction. He believes
that's the commitment that he made, and that's what he's shooting
for.
Q
Is he shooting for it, but that he thinks it may
not be possible to reach it?
MR. STEPHANOPOULOS: No, he's shooting for it right now,
and he's trying to come up with a plan that would achieve that. But
the important thing on this package, and let's always remember, it's
not simply deficit reduction. We need an economic plan that's going
to promote growth in the economy, that's going to create jobs. We're
all very pleased with the growth numbers that came out today, but
even if you look at those growth numbers, we are still lagging far
beyond in job growth. And the first purpose of this economic plan is
to create jobs.
reduction.
Q
So that's the primary purpose, not deficit
MR. STEPHANOPOULOS: Hopefully they go hand-in-hand:
You bring the deficit down in order to create jobs, in order to get
growth in the economy.
Q
Is he being advised by some of his advisers that if
you move too quickly on deficit reduction, it might hurt the economy
rather than helping the economy?
MR. STEPHANOPOULOS: The President has said that in the
past, that we have to make sure we don't just shut the economy down.
And I don't think he's going to do that. He's going to come up with
a plan that achieves both goals.
Q
Is there disagreement now among his advisers on how
to balance that?
MR. STEPHANOPOULOS: There's a lot of discussion, but I
don't think there's any significant disagreement.
Q
George, last night senator Nunn said that part of
the loose agreement of last night was that Congress would not
legislate either way on the ban on gays as long as the President did
not issue an executive order during the six-month period. so what is
holding up this announcement? Are you still negotiating on the Hill
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to make sure that there is not an amendment to attached to a piece of
legislation?
MR. STEPHANOPOULOS: Well, I think we just want to make
sure we all understand what should happen in this interim six-month
period. That's where the focus of the discussion right now.
Q
George, today the Chairman of the Senate Energy
committee introduced legislation to propose legislation for an oil
import fee that would set a floor of $25 a barrel on crude oil. Does
the President support that kind of legislation.
MR. STEPHANOPOULOS: I haven't seen it, and I don't know
that he has, but we'll take a look at it.
Q
George, do you have any reaction to the Israeli
High Court of Justice decision on the deportees? And is the
administration ready to use the veto if necessary to block U.N.imposed sanctions on Israel?
MR. STEPHANOPOULOS: I don't think I should comment on
the decision itself, but as you know, Ambassador Harrop met with
Prime Minister Rabin this morning, and we are intensifying our
discussions right now with all sides. The question of a veto is
hypothetical, which I just can't address at this time •. Right now we
want to make sure we do everything we can to bring the parties
together.
Q
How are you doing that -- through diplomatic
channels, or what the --
MR. STEPHANOPOULOS: Yes, as I said, Ambassador Harrop
met with Prime Minister Rabin, and we have discussions going on now.
Q
George, do you believe that the U.N. -- now the
Israeli Supreme court has ruled, and you asked for a delay until that
time -- the U.N. is obligated to hold Israel to the same standard as
other countries in terms of obeying U.N. resolutions?
MR. STEPHANOPOULOS: Right now, we're in contact with
Israeli we're in contact with other parties1 and we're in contact
with the U.N. And it's most appropriate for us right now to see what
we can do to get a diplomatic solution. That's what we 1 re focusing
on.
Q
Should they comply?
MR. STEPHANOPOULOS: The important thing right now -- we
think that we should get a solution among all the parties in the.
region. We are trying everything we can do diplomatically to achieve
that.
Q
You say that the economy is getting better, but the
unemployment is going higher and higher. Do you have any estimate as
to how many jobs are needed? And is this also a surprise to you as
the deficit was a surprise to everybody? Now, when are the job -when is it going to stop the unemployment? Do you have any --
MR. STEPHANOPOULOS: When President Clinton's economic
package is passed by the congress
Q
Yes, but do you know how many numbers.
MR. STEPHANOPOULOS: No, we don't have the numbers.
obviously, the slow job growth has been a real concern. And that's
why we're focusing our economic package on creating good jobs.
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Q
George, can you confirm Prime Minister Brian
Mulroney's visit here next week? And if so, is there an agenda, or
is President Clinton going up to canada?
MR. STEPHANOPOULOS:
have it real soon.
Q
I don't have that yet.
We hope to
As in when can you give us --
MR. STEPHANOPOULOS:
Q
You said
but are you -- if you need
Fed has done as much as it
saying they've done enough
it now falls --
I don't have the time.
you respect the independence of the Fed,
this jobs growth, do you believe that the
can do to promote growth? I mean, are you
and there is nothing else they can do and
MR. STEPHANOPOULOS: No, I haven't said that at all. I
said that we are working on our economic plan; and we've had good
discussions with the Fed; and that I think we're all coming to the
goals.
Q
So they can do something else, they could go
further to promote growth than what they've done.
MR. STEPHANOPOULOS: I didn't say that, I said that
we're -- I said that we are going to come forward with an economic
package. We're going to come forward with an economic package that
we think will get a good response from the markets.
Q
And the Fed's on board.
MR. STEPHANOPOULOS: I didn't say that either.
had good discussions with the Fed.
Q
We've
Why won't you say it, because they're not on board?
MR. STEPHANOPOULOS: No, because we recognize the
independence of the Fed, and they will make their decisions as they
must.
Q
George, if the announcement is made on the gays in
the military, can we count on it being made directly by the
President?
MR. STEPHANOPOULOS:
President, yes.
I believe it.will be made by the
Q
Is there a chance he's going to make some kind of
address or statement to the nation explaining his reasoning in all
this?
statement.
MR. STEPHANOPOULOS:
Q
When?
MR. STEPHANOPOULOS:
Q
I don't know.
It won't be an oval Office speech, or will it?
MR. STEPHANOPOULOS:
Q
I'm certain he'll make a public
I don't think so.
-- say that it will be done by the President?
MR. STEPHANOPOULOS: I expect that it will.
not positive, but I expect that it will.
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Q
--
format?
MR. STEPHANOPOULOS:
Q
I'm not sure.
Could you give us a clue if it might be today,
just, I mean -Q
We might see the President in the Briefing Room
today, is that what you're saying?
MR. STEPHANOPOULOS: I don't know when it will be.
he's got an announcement to make, we'll make that announcement.
Q
What stage is this?
his policy all day?
When
I mean, has he been working on
MR. STEPHANOPOULOS: No, no. As you know, he was at
Thurgood Marshall's funeral for much of the afternoon. He's done
some other work. He met with Chairman Greenspan this morning.
Q
Who's working on the statement -- Pentagon lawyers
or -MR. STEPHANOPOULOS: Secretary Aspin is working quite
hard on it. We've had some consultations on the Hill. The President
has also made a phone call or two.
Q
Nunn.
George, did he make any calls today on this?.
MR. STEPHANOPOULOS:
I think he's spoken with Senator
Q
George, why has the President not spoken publicly
on this to some extent in recent days already, given the mounting
public protest over the intent to lift the ban?
MR. STEPHANOPOULOS: The President is working on his
announcement, and when he has the announcement ready he'll present
it.
Q
Do you agree with the analysts who say that this
issue of gays in the military represents a kind of test case for the
President's ability to lead Congress, including members of his own
party?
MR. STEPHANOPOULOS: I don't know about that. This. is
something that -- let me remind you, there was a lot of opposition to
this policy. And we were facing a vote -- we were facing a vote from
day one in trying to codify current policy. The President believes
this is the right thing to do. He is doing what he can to stand up
for that principle.
Q
What do you think the political impact has been
so far of this controversy?
MR. STEPHANOPOULOS: Well, I think it's eaten up an
awful lot of your attention. There's no question about that. And
that to the extent that it takes all of our time and attention away
from the economy, even though it's not affecting the President's time
to the extent it takes up all of your attention, I think that's
probably not too good.
Q
George, you have said that and the President has
indicated --
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Q
How about the public attention?
the public is interested?
You don't think
MR. STEPHANOPOULOS: I think the public cares about
making sure we have an economy that works, making sure we have a
health care system that works, and really getting to work on that.
Q
And not on this issue?
Q
By every indication, George, it has been the
other way around. By every indication, the public -- most of the
people in America live outside of Washington,o.c., and everybody out
there is talking about this issue and registering their protests or
their support for the President's position. Yesterday I believe you
said that it's your impression that the American public generally
supports the principle that Mr. Clinton is proposing here. But what
are your phone calls really like that you're getting through the West
Wing?
MR. STEPHANOPOULOS: I don't know that those phone
calls are necessarily a gauge of public opinion.
Q
What are they?
MR. STEPHANOPOULOS: I don't have the exact figures,
but they're more against the President's policy than for. That is
clear. But let's look at what's happening with these -- I don't have
the numbers.
Q
Are they organized?
Q
Is it 10-to-1?
Is it 5-to-1?
MR. STEPHANOPOULOS: I think that these are organized
phone calls. I mean, I think that anybody who read The Wall street
Journal this morning understands that there is an organized effort by
people like Randall Terry and other right-wing groups to focus
attention on this issue. It is organized. It isn't necessarily a
gauge of where people are. And, again, I would repeat: The
President simply believes that people who want to serve their country
should not be prohibited from serving their country simply on the
basis of their status. And that•_s the principle he's fighting for.
Q
George, how long are you going to give senator
Nunn the veto over figuring out what happens in a six-month period?
Has the President set for himself a deadline by which time he finally
will put an end to this agony?
MR. STEPHANOPOULOS: We're working very closely with
Senator Nunn. He's been very cooperative with this and we have no
complaints. And we expect to have an announcement I hope very soon.
Q
And how long is the President willing to stretch
this out?
MR. STEPHANOPOULOS: The important thing is to get
this policy right, and that's what the President's trying to do.
Q
Could it go into next week?
MR. STEPHANOPOULOS:
Q
George, I know this is a little hypothetical
MR. STEPHANOPOULOS:
Q
I don't think so.
Sorry, Wolf.
I just called on Adam.
(Laughter.)
Q
George -- do you believe that there's more
interest in this issue in sort of -- in the Beltway than there is in
�- 9 -
the "real world"? In other words, are you guys polling?
any independent --
Do you have
MR. STEPHANOPOULOS: Well, I don't know about polling,
but I think there's clearly more interest in this room on this issue
than anywhere else in the world. (Laughter.)
Q
George, is it conceivable in your mind that on
President Clinton's watch someone could be discharged from the
military simply for being a homosexual and having nothing else wrong
in his or her record?
MR. STEPHANOPOULOS: Again, I really can't comment on
that until the policy is announced. I believe that is something that
we're working towards -- to prevent that.
Q
George, would the President veto any piece
legislation that came to his desk with an amendment overturning this
once he's done it?
MR. STEPHANOPOULOS:
Let's wait and see.
I can't say that at this time.
Q
George, on the attorney general, is the President
shooting to try to get an attorney general named before the -- before
he leaves for the Cabinet retreat?
MR. STEPHANOPOULOS: I don't know if we can make that
I think that would be good. The sooner the better. But, again,
he wants to make sure he does this in a proper way and gets the right
choice.
Q
If he were to make the announcement before the
Cabinet retreat, would the new attorney general designee go along on
the retreat with the other Cabinet members?
MR. STEPHANOPOULOS: Usually once you make this
announcement they have an awful lot to do preparing for the
background check. So I would think probably not. But I wouldn't
rule it in or out.
Q
George, in his first week in office, the
President has had two big battles now with Congress on Zoe Baird and
the gays in the military issue. And there's been a lot of public
outcry on this, too. Why does the President think this is happening?
Does he think that people are just trying to challenge him, test his
authority? or does he think that he needs to change his approach --
MR. STEPHANOPOULOS: Well, I think in some -- it's
just a matter of circumstance. I mean, this issue has been forced on
the agenda by our opponents at this point. And they -- knowing that
they were going to have a vote to codify current policy, we felt it's
best to move ahead and stand up for the principle the President has
said he's moving forward on. But I would also remind you, that's not
all that's happened in the last week. The President,has also had
good consultation with the Congress on health care. He's had good
consultation with bipartisan leadership on the economy -- with the
Democratic leaders on the economy. And he's had meetings with
federal -- Chairman Greenspan, too. We've had good consultation with
Congress throughout this week on the big issues that matter to the
President. We expect that to continue.
Q
Has he learned anything on how to approach things
better to get things done without these big battles? Has he learned
a lesson?
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MR. STEPHANOPOULOS: Well, I think that -- you can't
avoid every legislative battle. There are issues of deep
disagreement. This is one of the issues where there is deep
disagreement. You try and work through that as best you can and come
up with the smartest and the wisest solution. That's the course the
President is following right now.
He is also in constant consultation and spending the
overwhelming majority of his time putting together his legislative
package on the economy, on health care, on national service, on
political reform. And that's what he's focusing on.
Q
If he's spending so much time and that's all so
important, could we have some coverage of the 5:00 p.m. health care
task force meeting?
MR. STEPHANOPOULOS:
Why not?
Q
with the staff.
MR. STEPHANOPOULOS:
Q
I don't think so.
the beginning of it?
It's just as a private meeting
But why not have at least a photo opportunity at
It's such an important meeting.
MR. STEPHANOPOULOS: We have meetings every day and we
open some of them up. We don't have to open up every single staff
meeting for the press, but we will certainly keep opening as many as
we can.
Q
But you're not going to let us take a picture of
the first meeting of the Health Care Task Force?
MR. STEPHANOPOULOS:
Not this one today, no.
I don't think at this one, no.
Q
George, on the question of political reform which
you just mentioned does the President intend to offer his own
legislative proposal on cafe finance reform
MR. STEPHANOPOULOS:
I think that's likely, yes,
Q
Has he made any decisions at this point about
what elements will be in that package?
MR. STEPHANOPOULOS: I think it will follow the basic
outlines of what he said out in the campaign. But we're also in
consultation now with a lot of experts, with people on the Hill and
we expect to have one relatively soon.
Address?
Q
Will it be ready for the state of the Union
MR. STEPHANOPOULOS: I'm not sure about that.
as we can, but I'm not sure exactly when it will be ready.
financing?
Q
As soon
Would you expect that it would include public
MR. STEPHANOPOULOS: Again, I don't know about every
element of it, but we should have it relatively soon.
Q
With regard to the oil import fee question I
asked you earlier, what is the President's attitude toward the idea
of an oil import fee?
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MR. STEPHANOPOULOS: I haven't spoken with the
President about the oil import fee, but we're reviewing all of the
various options for revenue-raising and spending cuts as we prepare
this package.
Q
Is that one of the options?
MR. STEPHANOPOULOS: Again, I can't comment on which
specific options are under consideration, but we're looking at
everything right now.
Q
In this intensified effort on the deportees, does
the United States have a plan or a compromise in mind that it's
trying to push?
MR. STEPHANOPOULOS: We're working on that right now.
We're working to bring the parties together7 we've intensified our
diplomatic efforts with all the parties, but I don't want to comment
on it any further than that.
they can't see?
Q
Is there a common ground that you can see that
MR. STEPHANOPOULOS: Again, I don't want to comment on
the substance of those discussions while they 1 re going on.•
Q
One other question on the same point. Prime
Minister Rabin said he can't imagine that the United states would
not veto a sanctions resolution against Israel. You said it's
hypothetical, but can you imagine it?
that.
MR. STEPHANOPOULOS:
Well, I'm not going to answer
Q
George, a couple -- last week we were told that
this particular -- this gay ban in the military was one promise that
wouldn't be changed because the circumstances hadn't been changed,
like the deficit projections. And you've affirmed several times,
most recently I think yesterday or the day before that decision would
be taken within the week. And doesn't this postponement change all
that? What's happened --
MR. STEPHANOPOULOS:
The week's not over yet.
Q
But a decision, not the postponement for six
months, not an interregnum or an interim action; an actual decision
that would implement the campaign promise since the circumstances
hadn't changed it was --
MR. STEPHANOPOULOS: 'Again, the week is not out and
the President is still looking forward to making an announcement
soon.
Q
Are you suggesting it might not be an interim
promise, there might be the permanent decision, then?
MR. STEPHANOPOULOS: No, I'm suggesting the President
will have an announcement on this this week, I hope.
Q
If the six months is to figure out the details of
how this ultimate executive order will be applied, what's holding up
this announcement of the President? What is still being worked out?
MR. STEPHANOPOULOS: There are questions on what you
do in the interim, on how you handle pending cases, on how you handle
investigations, on how you handle whether or not to ask people the
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question of whether or not they're homosexual.
have to be worked out for the interim period.
All of these things
Q
Has this administration attempted to confirm
whether or not military officers are, in fact, circulating those
videos?
MR. STEPHANOPOULOS:
Not that I know of, but I can
check on it.
Q
There is an easy question for you.
MR. STEPHANOPOULOS:
Good.
(Laughter.)
Q
Dee Dee addressed it this morning, but Burton
Lee, the former physician has been telling the world that he was
fired. would you straighten it out? And has the President gotten
his allergy shot?
allergy shot.
fired?
MR. STEPHANOPOULOS: The President has gotten his
I believe he got it yesterday.
Q
What would make Burton Lee feel that he was
I mean, he was, after all, Bush's physician.
MR. STEPHANOPOULOS: Right. I mean, I think that's
the case. I mean, the President, as you know, always has the
priority of picking his own personal physician. President Clinton
intends to do that. Burton Lee served President Bush well, but
President Clinton will be making his own choice.
Q
you.
Will you tell us who it might be?
MR. STEPHANOPOULOS:
When it's decided, we will tell
Q
Can I follow on that, George? I talked with the
allergist, Dr. caplinger in Little Rock today. He informed me that
he, in fact, was contacted by the military office last Friday about
this and asked for this information -- and he delayed five days in
getting it up here -- that he didn't respond, dictate the answer
until three days later and then put in the mail and it arrived. He
seems to think there might have been some basis for the delay. Can
you comment on that?
MR. STEPHANOPOULOS: None that I know of. I mean, I
just know that the records, to my knowledge, have arrived. The
President has received his allergy shot.
Q
Who gave it to him?
MR. STEPHANOPOULOS: One of the military doctors
assigned to the White House. What's a semi -- that's the first time
ever.
Q
And is Patti Presock working for you?
And if so,
what's she doing?
MR. STEPHANOPOULOS: I believe she is working for us
right now. I think she works with Nancy Hernwright. But I don't
know her exact, precise duties.
Q
Why are you holding over someone who was so close
to the previous occupant of the oval Office?
MR. STEPHANOPOULOS: Well, as far as I know, she's
worked in the federal government and the White House for close to 30
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- 13 -
years and she's served admirably and well, and we feel happy to have
her.
Dr. Lee?
Q
George, can you just clarify for us the status of
Was he fired? Was he dismissed? When did this occur?
MR. STEPHANOPOULOS: I don't know when the exact
communication happened, but President Clinton will be making another
selection for his doctor.
Q
Who canned him?
Q
What was the communication?
MR. STEPHANOPOULOS:
Q
(Laughter.)
(Laughter.)
I don't know.
But he got canned, right?
MR. STEPHANOPOULOS: I'll have to find out.
He will not be serving as President Clinton's doctor.
Q
Has a decision been made on the top income tax
bracket -- like 36 percent taxation of wealthy Americans? Has that
decision been made?
MR. STEPHANOPOULOS: The President said throughout his
campaign that he expected the wealthy to pay their fair share. Again
-- and we don't have final decisions on any specific proposal in the
economic plan, but this is something the President talked about in
the campaign and is committed to.
Q
Bentsen was putting out this warning that a 36
percent taxation rate looked like it would be ahead. So, I mean, is
it a done deal?
MR. STEPHANOPOULOS:
nothing is done yet.
I think that's not unlikely, but
Q
George, did Ambassador Armacost, in effect, tell
Japanese officials in Tokyo that they shouldn't try to seek a summit
meeting between Mr. Clinton and Mr. Miyazawa until the Japanese were
ready to make some trade concessions?
MR. STEPHANOPOULOS: I don't think we're going to set
any preconditions for any meeting with Japan. We're obviously
concerned by th.e bilateral trade imbalance, but we have no
preconditions for such a meeting.
Q
So the story in The Los Angeles Times this
morning, do you have a direct comment relating to that story?
MR. STEPHANOPOULOS: I don't know if I'll characterize
the story, but we have no preconditions for a meeting.
Q
Has the President made any decision as to how
many billions of doilars have to be injected into the economy?
MR. STEPHANOPOULOS:
Q
Not a firm decision, no.
Twenty billion, thirty billion?
MR. STEPHANOPOULOS:
about the right range.
I think that Secretary Reich has
Q
Georqe, just technically in terms of the
President's announcement, will there be a certain cutoff time? How
will we be notified if and when an announcement is pending? Are we
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supposed to just sit at our desks until 9:00 p.m. at night? I mean,
just give us some reference -- what we're dealing with here, because
we're kind of in a -MR. STEPHANOPOULOS: I'm not exactly sure.
and give you adequate notice before we get it out.
We'll try
Q
can I follow up on an earlier question on the
stimulus -- earlier this week you said that a stimulus plan is very
likely. And given today's fourth quarter report on gross domestic
product, is it still very likely?
MR. STEPHANOPOULOS: Well, again, as I said before,
even if you look at the report and take a look at the good economic
growth numbers, we still are lagging in job growth. We need a
stimulus plan to create jobs.
Q
A number of economists are saying that a big part
of that fourth quarter stimulus was people buying things on credit,
that there was an unusual increase in credit. And there is some
concern among economists that when people find out in a month or so
that they're not getting tax refunds because of the change that was
made in withholding, that there could be a sharp drop in consumer
spending, because people won't be getting the tax refunds that they
would be counting on to pay off the credit card bills that they ran
up. Is there a concern about that as a problem that you're going to
be facing this spring?
MR. STEPHANOPOULOS: Well, it's certainly something
that's been pointed out to us and we've studied. And again, we're
committed to getting a package that will lead to sustained growth in
the economy, increased jobs, increased incomes over the long term.
so our package is designed to address just that problem.
Q
You say that you're concerned about it, and
you've studied it. What have the studies shown? I mean, how serious
a potential problem --
MR. STEPHANOPOULOS: I don't have the specifics, but
this is something that we are aware of.
Q
George, can I get my question in?
MR. STEPHANOPOULOS:
Sure.
Q
Thank you. Iraq has been pretty quiet -- the
Iraqi front, for the.past few days. Are there any communications
through third parties between the Iraqi government and the u.s.
government?
MR. STEPHANOPOULOS:
Not
tha~
I know of, no.
Q
And will President Clinton be receiving Foreign
Minister Shimon Peres when he comes to Washington in the next few
days?
MR. STEPHANOPOULOS:
Again, I don't know about that. I
don't think so.
physician?
Q
How far along is the President in selecting a
And what's taking so long?
MR. STEPHANOPOULOS: I'll have to get back to you.
don't know exactly when he's going to have the physician. He's
focusing on the attorney general right now. (Laughter.)
Q
I
And to whom were the medical records sent?
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MR. STEPHANOPOULOS: I believe if they're here now,
that they're in possession of the White House Physician's Office,
which is
Q
Dr. Lee said that medicine was sent through the
mail, no letter, nothing to -- not even registered mail or anything
else and he was supposed to apply this medicine -- give a shot to the
President. And he asked for his medical records and it took many
days and never got them.
MR. STEPHANOPOULOS: I believe they're in the
possession of the White House physician's office now and the
President is being served by the military doctors in that office.
Q
It would have been legitimate for him, though, to
see the records, wouldn't he, before he gives a --
MR. STEPHANOPOULOS:
President's doctor.
If he was serving as the
Q
But if he was asked to give a shot, wouldn't he
have -- should have known what -- have some of the background?
MR. STEPHANOPOULOS: Again, Dr. Lee is not serving as
the President's doctor. He will not serve as the President's doctor.
Q
But he was on deck before?
MR. STEPHANOPOULOS: Again, I don't know the details
of when that all happened, but the President is being served by the
military physicians in the White House office.
Q
Has the President interviewed either any
candidates for his personal physician or candidates for attorney
general? (Laughter.)
MR. STEPHANOPOULOS:
Q
Yes.
Which?
MR. STEPHANOPOULOS: I believe he has talked to some
candidates for attorney general, but I can't go into any details.
Q
Can you tell us --
Q
How many?
When?
MR. STEPHANOPOULOS:
he has had interviews.
I'm not sure how many, but I know
Q
Q
today.
Today or prior -Today?
Because yesterday you said you --
MR. STEPHANOPOULOS:
Q
I believe he's had an interview
Male or female?
MR. STEPHANOPOULOS:
I can't go into the details.
Q
Why does the President need a personal physician
with the military offices provided by the government? What's the
reason for it?
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01/28-#9
�- 16 -
MR. STEPHANOPOULOS: I'll have to go back to my
history books. I just know that the President has always had one and
we intend to continue that.
Q
George, the President has said on several
occasions before he was -- he assumed office that he intended to hit
the ground running. I think you've already observed the consensus
maybe inside the Beltway is that he's not exactly hit the ground
running -- that he falls behind schedule getting the economic plan to
Congress. You're behind schedule, I believe, on filling sub-Cabinet
jobs.
MR. STEPHANOPOULOS: I think we're ahead of most
administrations -- at least, most -- in the recent past on filling
sub-Cabinet jobs. We intend to present our economic program on
February 17th, and we expect it will be good. It's important to get
these things right. And ultimately the President is going to be
judged by the policies he presents to the country and how they affect
the lives of real people. And that's the test that we're going by.
Q
the ground running?
Is it the administration's view that you have hit
MR. STEPHANOPOULOS: We feel we're making good
progress in laying the groundwork for a successful administration,
yes.
Q
What's your overall plan? If you're calling for
shared sacrifices, wouldn't it be inconsistent not to include some
adjustment in Social Security, whether it's a cap or a delay?
MR. STEPHANOPOULOS:
going to be looking at everything.
fair.
Q
Not necessarily. I mean, we're
And when we have one, it will be
Thank you.
MR. STEPHANOPOULOS:
Thank you, Helen.
END
4:17 P.M. EST
01/28-#9
�THE WHITE HOUSE
Office of the Press secretary
For Immed1ate Release
February 4, 1993
PRESS BRIEFING
BY DEE DEE MYERS
The Briefing Room
9:49 A.M. EST
MS. MYERS: one addition to the President's schedule
from yesterday -- it's been confirmed that he will attend a New
Jersey Chamber of Commerce dinner honoring the New Jersey
congressional delegation at the Sheraton Washington Hotel at 7:00
p.m. tonight. Actually, he's scheduled to arrive there around 7:15
p.m. And also, just to -Q
Dee Dee, can we get some PA on you?
MS. MYERS: Oh, there's no PA still? The President will
attend a New Jersey Chamber of Commerce meeting honoring the New
Jersey congressional delegation at the Washington Hilton tonight -excuse me, the Sheraton Washington. The other clarification from
yesterday is that the meeting with freshmen is House and Senate and
it's bipartisan. It will be the new members and their wives or
husbands or significant others. Very politically correct.
Q
White House.
The reception today?
MS. MYERS:
Q
That's the 6:00 p.m. reception here at the
At 6:00 p.m. or 5:00 p.m.?
MS. MYERS:
I'm sorry -- 5:00 p.m. to 6:00 p.m.
Q
The New Jersey event, if it is thrown by the
Chamber of commerce, is that lobbyists throwing a party for members
of -- is that the kind of power relationship .that President Clinton
wanted to discourage?
MS. MYERS: I'm not sure who's hosting it. It's the
Chamber of commerce, but I'm not sure what the purpose of it is.
I'll have to get back to you on who's going to be there and what the
set-up is.
Q
But that doesn't go against the kind of encouraging
special interest groups as something that -- as candidate he always
discouraged?
MS. MYERS : No, I think that the Chamber of commerce
obviously has an interest in encouraging business. That's an
interest they share with the President. I'm not sure of the specific
arrangements of this dinner, but I don't think that working with
groups to create business and create jobs conflicts with the
President's goals.
Q
Are we going to have an attorney general today,
Q
In our lifetime?
tomorrow --
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MS. MYERS:
Q
Yes, in your lifetime.
(Laughter.)
And is it Judge Wood?
MS. MYERS: You know I can't comment on who it might be.
I expect it to be soon. Probably sometime in the next several days.
I don't know whether it'll be tomorrow.
Q
Not today?
MS. MYERS:
Q
Not today.
It might be over the weekend then?
MS. MYERS: I think that's probably not. I wouldn't
totally rule it out, but I think it's going to happen soon. I don't
think it will happen over the weekend. The President's going to do a
radio address on Saturday, but I don't think -Q
Where?
MS. MYERS: From the White House probably, although the
final details have not been arranged.
Q
How long?
Q
On what?
MS. MYERS:
Q
leaves tomorrow.
Don't have the topic yet.
Five minutes.
so that would make the AG tomorrow then.
That
MS. MYERS: Not necessarily. But I wouldn't completely
rule it out. It will happen sometime in the next few days. I can't
tell you exactly when. He's close to making a decision. I think
he's going to do it this saturday and look toward possibly making it
a regular feature.
Q
MS.
Q
Why?
MYERS:
It would be live.
Why?
MS. MYERS: Why? Because it's an opportunity for him to
address the nation about topics of import.
Q
What time are you going to do this, for anybody who
would want to carry it?
MS. MYERS: I don't know. We'll let you know as soon as
we have it. I think it's early afternoon is what we're looking at
one o'clock-ish.
Q
Will he show up on time?
Q
Who is he talking to?
MS.
MYERS:
I don't know yet.
Q
can you talk about the President's setback in
discussing campaign finance reform? ·
MS. MYERS: I think it was an excellent meeting
yesterday. I think we were a little surprised by some of the
coverage of it. It was a general meeting with House and Senate
leaders. There was broad consensus that they wanted to move, and
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move quickly on campaign finance reform. They didn't discuss the
specifics; that was never the intention of the meeting. What they
did do was agree to set up a working process to move quickly on it.
Q
realistic date?
Was he, in fact, told that March 15th is not a
MS. MYERS: They didn't go to discuss specific deadlines
or specific details of the package. But there was broad agreement
among the members and the President that they wanted to move forward
on this quickly.
Q
Dee Dee, why is he going up on the Hill so much? I
mean, he seems in general to be concerned about his relationships up
there.
MS. MYERS: I think he's concerned about building good
working relationships with members. I think that's something that
he'll do periodically throughout his administration. I think it's
something he feels is important to do, particularly in the opening
weeks. And I think he'll continue to do it. I think it's been very
productive for him. The members feel that he's paid great attention
to them and consulted with them on a wide variety of issues, and they
share his legislative goals.
Q
Dee Dee, i~ there anything significant with it?
Will he make any remarks or do anything outside of meet and greet the
new members?
MS. MYERS: Yes, I think he'll make -- oh, at the
congressional? He'll probably make brief remarks, but it's not
scheduled to be any sort of policy announcement. It's largely
informal.
Q
with the Speaker?
What is the subject for the trip to the Hill today
MS. MYERS: He's meeting with House Democratic whips
it's a general meeting on a variety of topics, including the
President's economic plan and campaign finance reform, as well as
family medical leave.
·
Q
Any plans to meet with Republicans anytime soon?
MS. MYERS: He was invited up, for example, a couple of
days ago to meet with the Policy Council. He meets with the
bipartisan leaders every other week. So this week it was Democratic
House and Senate leadership; next week is recess; the following week
it will be bipartisan leaders. so, yes, he meets with the Republican
leadership regularly.
Q
But he was invited, as you say, to this meeting.
He will go through his first month without having gone up to the Hill
to talk to Republican House members.
MS. MYERS: I think if he receives an invitation like he
did to address the Democratic Policy Council, he would take that
seriously.
Q
He's had an invitation to speak
Q
Yes, he's had an invitation.
Q
Dee Dee, he was invited to speak by Dole to the
Republican policy lunch and apparently said he would. Has anything
happened on the scheduling of that?
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�- 4 -
MS. MYERS:
wouldn't rule it out.
Q
service?
It hasn't been scheduled.
But he certainly
Is he being forced to cut back on his community
MS. MYERS: The community service -- the National
Service Trust FUnd is being developed right now. I think it was
always intended to be phased in, and I think the President's
committed to it. It's something he feels very strongly about -- that
the only thing that's risen faster than the cost of health care is
the cost of a college education. It's clearly out of the reach of
too many Americans now, and the President's committed to seeing that
changed. He's going to -- he's moving quickly now to develop a
national service plan and we'll let you know the details as soon as
they're available.
Q
Well, when you say it was always intended to be
phased-in, he campaigned across this country telling people that
every person who wants to go to college should have that opportunity.
committed to.
MS. MYERS:
Q
Absolutely.
And that's a goal he 1 s
He didn't talk about it
MS. MYERS: No, ·he did -- he never suggested that it
would be something that would be available to everybody immediately.
It's something that has to be phased in. But the current program is
costing us at least $3 billion a year, maybe $3.5 billion a year in
defaults on loans. Even people who have loans available to them
can't always afford to go to college. It is out of the reach of too
many people. And the President is going to work to change that.
achievable?
Q
When does he think that his goal would be
MS. MYERS: He doesn't have a particular timetable on
it. He's moving quickly to implement the first phase. And, as you
know, Eli Segal is heading that up, and they're making good progress.
Eli Segal's been up to the Hill, had meetings with a number of
members of congress and there's broad support, I think, across the
country for the program.
Q
But given the deficit situation being worse than
originally expected, he is having to phase it in more slowly or, you
know --
MS. MYERS: I think he's had to reconsider a lot of his
options based on the higher deficit numbers. Nobody expected the
deficit would be $60 billion to $100 billion higher than it was last
spring when Putting People First was drafted. I think that's one of
the reasons the President had to reconsider a broad array of his
options. And we're looking at that now.
Q
Dee Dee, is he thinking about raising the income
tax rate on the wealthy to 38 percent instead of 36? I mean, that
would be one way to pay for some of this.
MS. MYERS: Well, he always said he would raise the top
tax rate; he intends to do that. There's no final decisions about
what exactly the package will look like. Again, we'll have to wait
to the 17th. But the President is committed to making sure that the
people who reap the greatest benefits in the 1980's pay their fair
share first before he looks anyplace else.
Q
Then is 38 percent a possibility?
considered?
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Is it being
�- 5 -
now.
MS. MYERS:
I think that those decisions are being made
Q
How do you go about identifying those people? Just
by income class, or do you try to find out who actually made out in
the 90's -- or in the SO's, as opposed to the 90 1 s, or the 70's or
some time?
MS. MYERS: No, I think you look at people -- I mean,
you can make broad generalizations about who did well in the 1980's.
I mean, people in the upper end of the income scale made the most:
their incomes went up and their taxes went down. I think that the
President is committed to turning that around.
Q
Do you have relief of people who did badly in the
SO's but have done a whole lot better in the 90 1 s? (Laughter.)
Q
Is this a personal question?
MS. MYERS:
I
think we're making those decisions now.
Q
Is it true that he neutral on the Bosnia plan -- on
the British/U.S. plan?
MS. MYERS: Well, what he said about that is two things:
one, that he want -- he supports the process and supports the good
work that Lord OWen and former Secretary Vance have done. But it's
something that -- and if all the parties aqree to participate then he
would be supportive of that. In the meantime, he's continuing to
consider his options. He's working with his advisors, and as you
know, National Security staff is meeting regularly on this and they
are considering their options with great urgency.
Q
Is he trying to block that plan?
MS. MYERS: He is just now saying that if the parties
agree to it, that he would support it. But so far, all the parties
involved have not agreed to it. The Bosnian government and the Serbs
have not agreed to it.
Q
Is he trying to sell it in anyway or is he trying
to put the kibosh on it?
MS. MYERS: Right now he is supportive of the process
and if the sides -- if the different factions agree to support it he
would be supportive of that in the -Q
But he's not going to take a leadership role in it?
MS. MYERS: In the interim -- he's neither ruling it in
or ruling it out, but in the interim he's continuinq to consider his
options.
Q
How lonq will he qive it to qain support of all
factions before he takes some position on this one way or the other?
MS. MYERS: Well, he moving quickly riqht now, working
with his national security advisors to come up to review his options
and to come up with some kind of alternative.
Q
Is he sympathetic to the Muslim view that this plan
rewards ethnic cleansing?
MS. MYERS: That certainly is somethinq that he is
concerned about. But again, his position on this is that if all the
parties agree to the plan, he would be supportive of that. But so
far the parties have not aqreed. In the meantime, he is workinq with
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his national security advisors in considerinq his options and we'll
have more to say about it soon.
policy today.
Q
It's not the usual role of the u.s. in foreiqn
You either lead or you qet out of the way.
MS. MYERS: The President will lead.
he's considerinq his options.
But at this point
Q
Dee Dee, can you tell us what principle he's qoinq
on here, other than he'll qo alonq if everybody else qoes alonq? I
mean, what concept, what idea, what principle is quidinq him as he
deals with this issue?
MS. MYERS: You have to have an enforceable solution to
the problem. And I think one of the thinqs that he -- and Secretary
Christopher has said this -- that they're lookinq for an enforceable
solution to this. This is obviously a very complicated problem. And
I think the Secretary and the President's other national security
advisers are considerinq their options riqht now very seriously.
Q
Are you talkinq about somethinq that would not
require massive infusions of Western military force to carry out?
that the idea, or what?
·
Is
MS. MYERS: I'm not qoinq to commit the President to a
position on that, but at this point he's considerinq his options.
Q
How can he be neutral on this plan? Does he -- he
either favors or doesn't favor the partitioninq that is proposed as
the basis for this plan.
MS. MYERS: He would -- it would be acceptable to him if
it were acceptable to all the parties. That is not the case riqht
now.
Q
He has no objection to this partitioninq, which
would, as has been suqqested, reward the Serbians for the land that
they have taken?
MS. MYERS: If all of the parties involved aqreed to it,
then that would be acceptable to him.
Q
Why has he not yet had a national security meeting?
MS. MYERS: His national security staff is meetinq on a
reqular basis. He is consultinq reqularly with national security
advisors on this and other topics. He just hasn't had a formal
national security meetinq, althouqh the staff is continuinq to meet
on a reqular basis and he's fully informed about all the issues that
they're considerinq.
Q
Well, let me pursue that for a moment. What is his
sense of the role of national security in terms of his work, his
daily schedule? It's a little bit stranqe that he hasn't scheduled a
National Security council meetinq since he's been in office.
MS. MYERS: No, it's not at all. He's fully informed
about national security issues and the work of both the Secretary of
state, Secretary of Defense and his National Security council. He
starts every day with a briefinq on security and intelliqence issues.
It's somethinq that he pays attention to throuqhout the day,
somethinq that he works on throughout the day. And it's something
aqain, on Bosnia, the national security staff is continuinq to meet,
Secretary Christopher is continuinq to work on this. And the
President will have some decisions on it soon.
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Q
So he doesn't think he needs to sit down with them
at the presidential level to move the process along?
MS. MYERS: He's conferring with them regularly
regularly. I think he's fully informed as to the options on Bosnia
and other issues and the obstacles of progress.
Q
He's still going to come out with a decision then
on this, or is that the decision?
MS. MYERS: No, he will have more to say about the
situation in Bosnia relatively soon.
Q
Because the Muslims have already said they do not
support this plan, so what you --
MS. MYERS:
Q
support it.
That's correct --
-- just said is effectively rejecting it.
MS. MYERS: If the parties were to agree, he would
But the parties have not agreed.
Q
Dee Dee, is there any comment from the President on
the postponement of the Middle East peace talks?
resume.
MS. MYERS:
We're hopeful that the peace talks will
Q
Will he convey to the Israelis that the peace
talks, which are supposed to take place next week -- the multilateral
talks have been canceled or postponed indefinitely -- so what's the
background of that?
MS. MYERS: Again, the President supports the peace
talks there in the Middle East. He hopes that they can resume soon.
He hopes that all sides will agree to come back to the table. He
believes that Israel's decision to return 100 of the deportees and to
work toward repatriating all of them will allow the peace process to
go forward.
Q
But isn't that an admission that your compromise
with Israel on the deportees has failed, that it is a failure,
because you have, in fact -- well, you admit that the peace talks
cannot resume now?
resume.
MS. MYERS: No, we're hopeful that the peace talks will
And we're working toward that.
Q
How soon?
MS. MYERS:
As soon as possible.
Q
Dee Dee, if the President is willing to accept the
fact that Serbia will gain territory out of all of this, does that
mean that the Helsinki Acts are dead? Is that a dead letter now?
MS. MYERS: No. Again, the President is working with
his national security advisors, and we'll have more to say about
this.
Q
If he accepts the fact that Serbia will wind up
with territory which it conquered, does that not kill the Helsinki
Final Act?
MS. MYERS: I will repeat one more time: If the parties
agreed to it, the President would support it. The parties have not
agreed to it.
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Q
The perception of the President's foreign policy so
far is either "me, too" or he hasn't paid any real -- I mean, he
certainly has made no pronouncements on foreign policy. Does he ever
intend to put this thing together? I know the urgency of the
domestic needs now. But it seems to me that -- is he neglecting
foreign policy? He's made no public stance on anything.
MS. MYERS: No. He's working on foreign policy every
day. We're working toward diplomatic solution to problems in Haiti.
We're working toward a diplomatic solution to the problems in the
Middle East. He's working toward a solution to problems in former
Yugoslavia. He's continuing to work with people to deal with the
problem in the former Soviet Union and in the Russian domestic
economy. I mean, he's working on a number of fronts right now to
deal with a number of pressing foreign policy issues, and he will
continue to do that. And he'll have more to say on specific cases,
like Bosnia, soon.
Q
Has the United States given up on restarting the
Middle East talks next week, as had been expected?
MS. MYERS: I think we 1 re pushing to restart those talks
as soon as possible. That may not happen next week.
Q
And you mentioned Haiti. There was a report from
Haiti today that some Aristide supporters are concerned that the
President's diplomatic initiative is dragging, and maybe it's hit a
dead end because the current government has rejected at least part of
the Caputo plan. Can you tell us what the state of play is on the
Haiti initiative?
MS. MYERS: Just that the President continues to support
the efforts by the U.N. and the OAS and Caputo's efforts to move
forward with the plan he outlined shortly before he was inaugurated.
well?
Q
Does he have his own effort underway on Haiti as
MS. MYERS: That, basically, is an effort that's very
much led by, or the President's been very involved in that -- that
the u.s. has been very involved in that effort, and we're going to
continue to pursue for full restoration of the Democratic government
in Haiti.
Q
Just one other thing on Haiti. Jesse Jackson's
suggestion for a 90-day promise that this will be resolved within 90
days -- what's the President's response on that?
MS. MYERS: He's reviewing it.
decision one way or another on it.
He hasn't made a
Q
Have you made a decision on the HIV positive
patients at Guantanamo?
MS. MYERS:
Q
No.
He's still thinking about it?
Q
Dee Dee, on some of these issues -- foreign policy
issues and on domestic issues, I guess there seems to be an
impression that President Clinton, before he was elected, came in
with quite specific plans. If you look at his book, he had all sorts
of ideas. He was pushing for more action in Bosnia. Now that he is
President, it seems that he has to study a lot of stuff, that he has
-- you know, domestic things have to be kind of farmed out for study,
Bosnia, there seems to be a lack of decision. How do you explain
that?
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MS. MYERS: Well, in terms of the economy, circumstances
change. I think the President's broad goals are still the same,
which is new investment that will create jobs and get the economy
moving again, debt reduction and just overall fairness. Those are
the same goals he outlined throughout the campaign. He's still
committed to many of the specific details that he outlined during the
campaign -- for example, more worker training things like that.
Those will all be -- all the final details that will be outlined on
the 17th. He's moving quickly toward a comprehensive economic plan.
The legislative details were always going to take time to work out.
On foreign policy issues, he's working carefully with
his advisors to make the best decisions and to move forward on a
variety of issues. I think that it's complicated and the President's
making good progress on a number of things. But you can't expect to
have all the details of those in the first two weeks.
Q
How specific will his address to Congress be?
MS. MYERS: I think it will be quite specific. I don't
expect that there will be legislative -- a specific legislative
package. I don't think the bills will be drafted, but I think that
the program itself will be quite specific.
Q
But at that time will he outline, for example, the
level of who's going to pay higher taxes and whether it's $150,000 or
$200,000 a year income?
MS. MYERS: I think the details on that will be quite
clear. Again, all of the final decisions haven't been made, but I
expect a high level of specificity in the February 17th plan.
Q
With regard to international issues, where is the
President making good progress?
MS. MYERS: He's working with his national security
advisors to come to some -- work out some kind of a decision on the
Bosnia situation. He's working on Haiti. I think there was a lot of
fear about a mass exodus; that hasn't happened. He's working in the
Middle East to resolve the situation there. I think that they've
made progress on resolving the deportee issue. And I think they'll
continue to make progress on a number of fronts.
Q
This assessment on Bosnia -- we'll support it if
all of the parties support it -- was that what emerged from this
meeting yesterday with his advisors?
MS. MYERS: No, that's been the position for a few days
now. Secretary Christopher did meet with Vance and owen a couple of
days ago in New York. He's bringing -- sort of relayed information
about that meeting and his thoughts on that meeting to the
President's national security advisors and they're moving forward
accessing the details there.
Q
That position implies that we would be willing to
commitment u.s. resources to keep this -- to enforce the plan, does
it not?
MS. MYERS:
Not necessarily.
Q
so we would support it if everybody else did, but
we wouldn't do anything to implement·it.
MS. MYERS: Again, if all the sides agreed to the plan
the President would support that. That has not happened.
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saying.
Q
That does not come without strings is what I'm
MS. MYERS:
But that has not happefied.
Q
Can we phrase it in reverse? Would it be accurate
to say the President will not support the Vance-owen plan unless the
Moslems in Bosnia support it?
I suppose
everybody
point, is
agreement
MS. MYERS: That's a conclusion that you draw. I mean,
it's -- I don't want to play rhetorical games. I mean, if
supports it the President would support it. He, at this
not going to move forward with implementing it without the
of the various parties.
Q
The point I'm trying to make is, does u.s. policy
hinge on whether the Moslems in Bosnia -- the position that they're
going to take? If they're going to continue to resist Serbian
onslaughts, or whatever, will that dictate what the Clinton
administration's policy will be?
MS. MYERS: It's certainly something that will be
considered. I can't speak for down the line what elements might
influence the President's thinking on that. But in terms of this
specific proposal, the one that is on the table now, if all the
parties agree to it, the Pre~ident will support it.
Q
How long is he willing to give it before he --
MS. MYERS: He's moving quickly toward making decisions
which he will talk about soon.
Q
His decisions are not contingent, then, on whether
-- I don't understand.
MS. MYERS: They're not contingent on it. He's moving
forward with his own -- he's looking at the situation himself. His
national security advisors are looking at it, and they're going to
make their own decisions based on their own information. That is not
necessarily related to the Vance-owen process. He's not waiting for
an outcome to the Vance-owen process to make decisions.
Q
By not supporting the plan, the President is making
sure the Muslims will never support it. Isn't it correct? Isn't it
correct to say that?
MS. MYERS: I will repeat once again -- if they support
it, the President will support moving forward with the process.
Q
Dee Dee, would he be willing to do anything to
encourage the Muslims to support the plan?
MS. MYERS:
He'll have more to say about that later.
Q
So you're not ruling that out as a distinct
possibility, I take it.
MS. MYERS: I'm not going to rule anything out, other
than to say that the President is going to have more to say about the
Bosnia situation. He's making decisions based on his own information
independent of the Vance-owen peace process.
Q
But is one of the things that he's considering
whether to encourage the Muslims to support that plan?
MS. MYERS:
I wouldn't rule it out.
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�'1
11 -
Q
Is he looking at military options as well as
diplomatic options?
MS. MYERS: Secretary Christopher said yesterday or the
day before that they had not considered military options yet. I
would refer you to the State Department and to Secretary
Christopher's comments on that.
Q
During the campaign there was discussion about
greater enforcement of the embargo and about lifting the embargo on
arming the Bosnians.
it.
MS. MYERS:
Q
considered.
Right.
The President said he would consider
Is that under consideration?
MS. MYERS:
It's one of the options that's being
Q
Why didn't he go to the meeting yesterday of his
advisors on this issue?
MS. MYERS: He's being kept fully informed on what their
decisions are. There are some things that are debated on a staff
level and looked at. The President's fully informed about the
process and he'll continue to work with them.
Q
Dee Dee, you mentioned the Soviet Union earlier.
Has the President been in touch with Yeltsin at all, and is there any
plans for a summit?
MS. MYERS: He hasn't spoken to him since the 23rd when
they spoke on the phone. They decided then that Kozyrev and
Christopher would get together to work out the details of their
meeting. They hope to do that soon.
Q
So nothing's pushed that on?
MS. MYERS:
No new details on that.
·Q
Is there any news out of Hillary Clinton's health
task force? Is there anything happening there? Are they still
meeting, and are they meeting in secret?
MS. MYERS:
Q
No, they will not meet in secret.
There are
-- will be able to attend their meetings?
MS. MYERS: When the full task force -- the full task
force hasn't had an official meeting yet. And we're -Q
They had one.
MS. MYERS: They had -- it was sort of an organizational
-- it was an announcement of the fact that Hillary Clinton would
share the health task force. There are working groups within the
task force that will meet regularly. The task force
Q
-- get to go to these meetings?
MS. MYERS: When the full task force meets, some of
those meetings and perhaps all of those meetings will be open, when
the full task force meets.
Q
can you tell us the purpose of her trip to the Hill
today?
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�- 12 -
care issues.
MS. MYERS:
Q
To meet with congressional leaders on health
And what is she going to be seeking from them?
MS. MYERS: Their input, as she will throughout this
process. I mean, obviously, the President has made his health care
priorities clear, and that we're going to continue to work with
members of Congress and find out what their priorities and thoughts
are on this in developing -- the President has said he wants to
develop a legislative agenda to start health care process within the
first 100 days, and that's what Hillary will be working on.
Q
Where does she stand on Senator Pryor's criticism
of the drug companies for exceeding the inflation rate on their
prices?
MS. MYERS:
soon.
I'll have to get back to you on that.
Q
-- the President is going to speak out on Bosnia
Are you talking about within a matter of days?
MS. MYERS:
Q
I don't have a specific time line for it.
Could it be on Saturday during his radio address?
MS. MYERS: No, I think that the radio address will
focus on domestic policy.
Q
weekend agenda?
Aside from that, what else do you have on the
MS. MYERS:
off over the weekend.
I think he's going to try to take some time
Q
But he'll be here?
anything on Sunday?
And Sunday -- does he have
MS. MYERS: As of right now, I don't think he has any
public schedule over the weekend. I think he's going to spend some
time continuing to get settled. And they haven't had a lot of time
to move into the White House.
Q
How would you characterize Mrs. Clinton's role in
the Attorney General selection process? It was noted this morning
that she had been impressed with one of the candidates.
MS. MYERS: She was present throughout the process of
Cabinet selection and she continues to play a role in that.
Q
What is the role?
MS. MYERS: I don't know if she's been in on every
meeting, but she sat in on a lot of interviews and certainly advised
the President, shared her opinion with him about various candidates.
Q
Has she been in all the interviews that he's had
with the candidates that are currently under consideration?
MS. MYERS: I don't know if she's been in all of them.
She's certainly welcome. And when it fits her schedule, she sits in
on the interviews.
Q
Has she sat in on the interviews for these
MS. MYERS:
I don 1 t know if she 1 s sat in on all them or
not.
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�- 13 -
Q
can you take that question?
MS. MYERS:
sure.
Q
-- a list of all the people who are in this -- I'm
sorry. Is there a list of all the people who are in this task force
headed up by Mrs. Clinton?
MS. MYERS: It was in the press release -- and I can
certainly get you a copy of it -- which was announced on, I guess
last week. And it includes certain members of the Cabinet7 the
President's domestic policy advisor7 his head of the National
Economic Council, Bob Rubin7 and a few others. There's also a lot of
staff that will be working and reporting back to the task force. But
the task force itself has not had any fully scheduled meetings yet.
be open?
Q
Has he concluded that those meetings by law have to
MS. MYERS: Counsel's opinion on that, which we can get
you more details on later, is that FACA does not apply to this.
Q
Why?
MS. MYERS: Why? Because -- and I will get you more on
this later -- because the First Lady -- it was not intended to apply
to the First Lady.
Q
No, no. There's legislation on the Hill which
would exempt the First Lady, but currently she is included.
MS. MYERS: But it's only to clarify what the intent of
the original bill was. I will get back to you on that, because I
know the counsel has an opinion that basically supports that.
Q
They've also expanded it to include governors, I
believe, and they're not federal employees either.
MS. MYERS: Not as members of the task force. And they
may be advising the task force or advising the working group
Q
If they're outside advisors, then it comes under
the law.
it.
MS. MYERS: That is not the way Counsel has interpreted
But let me get back to you, because I want to be clear on this.
Q
Dee Dee, why on something this crucial, that was
such a major domestic issue, would the administration conceivably
want to close any deliberations by this entire task force?
MS. MYERS:
Q
I haven't said that they will.
I know that, but
MS. MYERS: And I think that a great deal of this
process will be open to the public and open to people who want to
participate in and contribute to it. That is not the intent at all.
I mean, I think regardless of what Counsel's decision is, that great,
great portions of this process will be open to the public.
Q
Dee Dee, is the President doing anything today
regarding Republicans to try to break the filibuster that they're
threatened against the family leave bill?
L_
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MS. MYERS: I think we'll have to wait and see what
actually happens. But we won't be able to do anything to break a
filibuster unless we're sure there will be one.
Q
They've said there will be one.
MS. MYERS:
Q
what happens.
We'll see.
I think
Do you have information --
MS. MYERS:
No.
I think we'll just have to wait and see
Q
Dee Dee, is the President going to go beyond his
Putting People First in defense cuts? Is he planning on going beyond
the $60 billion? Or are these cuts that he's proposing just
effectively carrying out that promise?
MS. MYERS: Exactly. He said throughout the campaign
that he would cut the defense budget by roughly $100 billion, which
is roughly $60 billion more than the Cold war budget that was put
forward by President Bush. And now he's going through and
implementing those cuts. It's roughly a five percent cut in the
military budget over a five-year period.
Q
-- confirm these numbers that were in the paper
today of Aspin asking for I think it's $8.3 billion
that.
MS. MYERS: I refer you to the Defense Department on
I don't have those numbers.
Q
Dee Dee, you seem to be sending a message on
Bosnia, which was that the President's not going to pressure the
Muslims to accept the Vance-owen plan, that they're going to have to
do something, change the plan to satisfy the Muslims. Then when the
Muslims accept it he'll get behind it. But then, in answer to Brit's
question you said you wouldn't rule out putting pressure on the
Muslims to accept the plan. So which way is it? What's the message?
MS. MYERS: I don't want to rule it in and I don't want
to rule it out at this point, other than to say that the President
will have more to say about Bosnia later. In the meantime, if all
the parties agree, he would support implementation of the plan.
Q
Lord OWen says he's trying to block that plan.
MS. MYERS:
Q
He's not trying to block the plan.
How much later?
MS. MYERS:
Soon.
Q
Dee Dee, where does the President stand on his
analysis of the California decision on gays in the military?
MS. MYERS: I don't know whether Counsel's gotten back
to him with an opinion on that.
Q
Does he think that a person who fired -- terminated
two staff people because of their status can conduct a fair hearing
on gays in the military?
MS. MYERS: I think Senator Nunn is very capable of
conducting a fair hearing on this. The Senator said his mind is open
to be -- I don't know if changed is the right word, but he says he
can be influenced by these hearings and we'll take him at his word on
that.
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Q
So his conduct is less important, or his status is
more important than his conduct, is that correct? (Laughter.)
MS. MYERS: I will refer you to Senator Nunn•s previous
statements on that issue.
Q
George last week said that Counsel had ruled that
the California decision applied across the board, and the President
would get to review that.
MS. MYERS: I think that's just the general consensus of
the legal community on how -- the implication of that law.
opinion.
me?
Q
You said the White House Counsel had issued that
Is it in the in-basket somewhere? Can you clarify that for
MS. MYERS:
Yes.
I'll get back to you on that.
Q
How is the White House handling polling? How much
polling are you doing? Are you doing it on a daily basis --
MS. MYERS: The White House -- we don't have a polling
operation within the White House. We have access to polls that are
conducted by people outside the White House.
Q
Which would be, what, DNC or something?
MS. MYERS: And others. We have access to a number of
people who conduct polls on a regular basis, but there's no operation
within the White House on polls.
Q
Are you going to run your own polls? Are you going
to ask these polling companies to run polls on specific issues?
MS. MYERS: Well, I think we retain the right to do
that. But we'll pay attention to those things and we had, as you
know, an ongoing polling operation throughout the campaign. I think
we'll continue to take a look at public opinion polls from time to
time. But again, there's no polling operation within the White
House.
THE PRESS:
Thank you.
END
l.0:2l. A.M. EST
�THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release
February 8, 1993
PRESS BRIEFING
BY GEORGE STEPHANOPOULOS
The Briefing Room
12:445 P.M. :EST
SUBJECT
ANNOUNCEMENTS
The President's Schedule
••••••••••••••••• 1
DOMESTIC
Social security Law •
Kimba Wood Withdrawal
Paid consultants
Staff Reductions
• • •
Attorney General Candidates •
unemployment Compensation •
COLAs •
•
•
•
•
•
•
•
sunshine Laws • • • • •
Judge Sessions
Gays in the Military
• • • • • • • • 1-7;13-14
• • • • 7-8;15-16;18
9-10
11-12
14
. . . • • • • • .
15
15
• • • • 17
19
19
FOREIGN
Situation in Bosnia •
Israel • • • • • •
16
17
1:23 P.M. EST
#16/02-08
�THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release
February 8, 1993
PRESS BRIEFING
BY GEORGE STEPHANOPOULOS
The Briefing Room
12:45 P.M. EST
MR. STEPHANOPOULOS: Good afternoon. As you know, the
President will be meeting with Mr. ozal later this afternoon. And
he'll also be having an announcement related to unemployment
compensation at around 2:30 p.m. today.
Q
Where is that?
MR. STEPHANOPOULOS:
I think in the Roosevelt Room.
Q
Has any inquiry been made to determine whether both
the President and Vice President are okay on this question of Social
Security payments made and all reports filed on behalf of people who
may temporarily or permanently have worked for them in the years
past?
MR. STEPHANOPOULOS:
Q
Yes, they both are.
Both are clear on that?
MR. STEPHANOPOULOS:
Yes,
Q
And nobody looked after Chelsea who not properly
documented or paid or something?
MR. STEPHANOPOULOS:
Not that I know of.
Q
Well, has the same question been asked of all the
Cabinet officers now?
MR. STEPHANOPOULOS: I think that -- I mean, the policy
of the White House is very clear, that all the Cabinet officers are
supposed to comply with the law. I don't know about all of their
past histories. You can check with them.
Q
Have they been asked, though, to let you know, to
investigate this themselves to make sure that they don't have a Kimba
Wood problem?
MR. STEPHANOPOULOS: Not that I know of, but it's clear
that they are to comply with the law.
Q
Well, are you aware of how many Cabinet members or
White House staff people have not complied that are now making back
payments on Social security?
cases,
other.
MR. STEPHANOPOULOS: No, I don't know of any other
It doesn't mean there aren't any, I just don't know of any
Q
Is the counsel's office checking?
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�- 2 -
MR. STEPHANOPOULOS: I think the Counsel's office has
made it clear that all the Cabinet officials and senior White House
officials are to comply with the law.
Q
How do you do that, George?
Q
Has anyone followed up what Ron Brown said on a
show yesterday, or what others were questioned about? Is there any
kind of organized process to make sure that everyone is --
MR. STEPHANOPOULOS: We have an organized process to
make sure that all Cabinet officials and all senior White House staff
comply with the law, yes.
Q
Did you know that Ron Brown had not paid Social
Security taxes until yesterday morning? Did you know that before he
said it publicly?
MR. STEPHANOPOULOS: I think we did. I'm not sure -- as
I said this was an issue that we all became sensitized to after the
Zoe Baird case. It was a law that -- I think a lot of people were
not aware of all the implications of the law relating to Social
Security taxes prior to the Zoe Baird case. But now we are aware of
it and Cabinet officials are expected to comply.
Q
-- immediately in the wake of the Baird case?
MR. STEPHANOPOULOS:
think anybody knew before.
Q
No, I don't think so.
No, I don't
But you would expect that a lawyer would know this?
Q
Did you do something right after the Baird case to
bring it to people's attention? Did you send out a memo? Did you
say something?
Q
Did you send out a memo?
MR. STEPHANOPOULOS: I think the Counsel certainly
informed everybody that they were to comply with the law.
Q
In other words, if Brown didn't know about it
before the Baird case, did you bring it to his attention and
everybody else's, or did they just have to find out for themselves
and decide that it was the right thing to do?
MR. STEPHANOPOULOS: Is that I think that they were made
aware of the requirements of the law.
Q
Requirements by who?
Q
You have 13 lawyers or something in this Cabinet.
Why would a lawyer not be aware of the requirements of the law?
MR. STEPHANOPOULOS: Well, I'm not sure. I think that
most -- many American were not aware of this requirement. I think
that many members of the Cabinet were. But I just don't know of the
specific details of each individual case. When Ron Brown became
aware of it, he did pay the back taxes. And now, as I said, all
Cabinet officials will comply with the law.
Q
Do you think the law is too rigid? Do you think as
times have changed and things have become more expensive that $50 a
quarter is too low a threshold?
MR. STEPHANOPOULOS: Well, I think it is certainly
something that needs to be looked at. I mean, the $50 threshold was
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#16-02/08
�- 3 -
set in 1954. That's an awful long time ago; 28 years ago, and it's
something -- any common sense standard -- if you have a babysitter
once every three weeks and hire your next-door neighbor to mow your
lawn, technically you should be paying Social Security taxes.
Q
And have you not been able to fill certain deputies
jobs, certain deputy secretaries jobs because of this problem,
because other people have had illegal alien problem?
MR. STEPHANOPOULOS:
I'm not aware of that.
Q
George, some women's groups are complaining that
what happened first to Zoe Baird and now to her successor, Judge
Wood, would not have happened to a man and that this amounts to a
double standard being applied to women, potential women nominees.
MR. STEPHANOPOULOS: Well, there's no evidence to
support that contention. All people who are nominees now are being
asked the question. When we became aware of this situation we are
assuring that everybody complies with it. I would remind everybody
that Zoe Baird brought this to everyone's attention herself,
voluntarily. This was not something that there was a lot of
attention to. In the case of Judge Wood, we did ask several times,
as we have asked all potential nominees for attorney general, men and
women alike.
general?
Q
All nominees for all positions or just for attorney
MR. STEPHANOPOULOS: I think it's a question -- no, it's
a question that is generally asked now. I think that you can
Q
For all presidential senate confirmations?
MR. STEPHANOPOULOS: For all presidential senate
confirmations, as far as I know, yes.
Q
are clean on this?
records?
How do you know the President and Vice President
Were they, over the weekend, looking over their
MR. STEPHANOPOULOS: I think this is something -- again,
I'll double-check. But this is something that we've discussed, and I
believe they're in compliance, yes.
Q
George, will all these Cabinet members have to make
an accounting to the White House as to how they dispose of whatever
problem they may have in this regard?
MR. STEPHANOPOULOS:
fully comply with the law.
As I said, they will be expected to
Q
Yes, but will they make an accounting -- will they
explain their actions and provide some kind of documentation to the
White House as to their actions?
MR. STEPHANOPOULOS: I suppose if there's anything to
explain, but I don't know of any cases right now where there is.
Q
could you be a little bit more specific? You said,
you put it in the passive tense. You said, they were made aware of
the requirements
MR. STEPHANOPOULOS:
Q
I'm not exactly sure.
I know --
Did the counsel's Office after Zoe Baird-- did a
memo go out?
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#16-02/08
�- 4 -
MR. STEPHANOPOULOS: Counsel's Office made an
announcement at a senior staff meeting. I believe that was then
conveyed to the Cabinet officials in the morning conference call to
the chiefs of staff. I believe that was how it was done. I'm not
exactly sure.
Q
George, on the laws, will you now change it that
either INS is more stringent in deporting illegal aliens or,
conversely, will you modify the laws so illegal aliens, once they're
here, are allowed to work?
MR. STEPHANOPOULOS: Oh, I don't know if there are any
changes contemplated right now, but certainly the INS commissioner
and the new attorney general will review all of the regulations.
Q
Do you think you have a problem in the situation?
MR. STEPHANOPOULOS: I didn't say that. I said in their
continuing review of all of the laws and regulations in the
department, this might come up.
case closed?
Q
George, as far as Ron Brown is concerned, is the
MR. STEPHANOPOULOS:
Q
Sure.
so there's no other action or
MR. STEPHANOPOULOS:
Q
I believe so.
Not at all
-- requirement for him from the White House?
MR. STEPHANOPOULOS: He's to comply with the law, as all
Cabinet officials are, and he is.
Q
Now, these people -- getting back to the question
of who let them know what a problem was when it was, Zoe Baird came
up before these people were confirmed by the Senate, certainly before
they were sworn-in. Was there any attempt to vet them on this issue
before they became Cabinet members, or did you just figure they're
this far along in the process, we might as well let them go through?
MR. STEPHANOPOULOS: I believe that, as I said, there
was a communication with the counsel's office to the senior staff,
and then that was then communicated to the Cabinet officials. I
don't know the exact timing of it.
Q
George, you knew the Ron Brown situation before he
made it public on Sunday, is that correct? The White House knew?
MR. STEPHANOPOULOS: I believe either the day before or
something like that. I'm not sure when other people in the White
House might have known.
Q
Where does the President stand now on the new AG?
Where does he stand now?
MR. STEPHANOPOULOS:
The standard is that he must comply
with the law.
Q
Where does he stand now in terms of a search for
one?
MR. STEPHANOPOULOS: He's reviewing -- we expect to have
an announcement relatively soon, and he's just working on it.
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#16-02/08
�- 5 -
Q
disqualifying?
For future nominees, is a failure to pay taxes
MR. STEPHANOPOULOS: Again, I'm not sure if we can set a
hard standard on that at this time. Clearly, there are special
requirements for the post of attorney general. I mean, this person
will be asking others to enforce the law, and we want to make sure
that there's no question of any kind in that case.
Q
George, when you say "fully comply with the law,"
what do you mean? As long as you pay your back taxes, you're okay,
even though you knowingly broke the law?
MR. STEPHANOPOULOS: I think it's most important that
people pay taxes for any household help to be in compliance with the
law
Q
But it doesn't matter if you knowingly broke the
law as long as you pay up now --
MR. STEPHANOPOULOS: Well again, in this case and the
case of Ron Brown, I don't know if we have a case of knowing a
violation of any kind. This is something we all became aware of
after the Zoe Baird case.
·
Q
In the case of Judge Wood, she didn't break the
law. She knew what the law was and she followed it to a tee. And
now you are getting tremendous backlash from women and others who are
wondering why you acted so fast to pull her nomination. She abided
by the law at the time. Ron Brown has followed up after all the
publicity.
MR. STEPHANOPOULOS: The cases aren't comparable in any
way. Judge Wood was not nominated for a position in the Cabinet.
Judge Wood was not chosen for a position in the Cabinet. Judge Wood
was among several candidates for a position, number one.
Number two, I would just add that here we also had an
issue where she was questioned before any choice was made on three
separate occasions about this matter. But it was only after review
that we discovered all the facts. And I believe that, in and of
itself, also has an effect on the nomination selection process. Had
we had all the information at the beginning of the process, when it
was first asked it would clearly have affected the process. I think
there is no question about that. In that sense the situations are
not comparable.
Q
-- press factor or the flap factor? What I mean by
that is, do you think it possible that that prospective nomination
could have gone forward had she revealed everything in light of the
evident fact that no laws were broken?
MR. STEPHANOPOULOS:
don 1 t think we know.
I don't think we know.
I just
Q
Did you weigh at all the question of how much the
possible relationship of trust was hampered by her evident failure to
disclose as against this question of whether you all are willing to
stand the gab of having some excited talk-show host on the radio?
MR. STEPHANOPOULOS: Clearly, when you're dealing with
the position of attorney general, an important position, a position
-- the President's lawyer, in effect, as well as the nation's lawyer,
you have to have full and complete confidence in the nominee. The
President does respect Judge Wood. He respects her intelligence, he
respects her work in the court. But there is also some concern that,
in this case, she was not completely forthcoming.
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�- 6 -
I'm not suggesting that it was intentional, but it was
simply a case where we did not have all the facts at hand as the
process was going forward and we were not able to fully assess the
situation until we had all those facts. Had we had the facts earlier
clearly it would have affected the process of the nomination.
Q
You're saying then that she should have understood
the political implications when she was questioned those three times
and volunteered, because on a political basis, it might be damaging
following the Baird case? Is that the implication?
MR. STEPHANOPOULOS: It clearly would have been
reasonable to expect, and I think any reasonable person after the Zoe
Baird situation, when asked if they had any problems in the area
relating to the zoe Baird problem or related to the hiring of illegal
aliens or related to back taxes, would say, well, no, I don't think
so but -- and then give all the facts. And in this case, that simply
didn't happen. But these are -- I think that would be what you would
expect of a reasonable person at that point.
Q
How would it have affected the process if you had
known all of this up front?
MR. STEPHANOPOULOS: I honestly don't know. But it
clearly would have had an effect. The fact that we didn't know
clearly did affect the process.
Q
George, some people are angry --
Q
Can you tell us -- you just said a few minutes ago
that Ron Brown only told you about his case a day or so before he
said it on the air.
MR. STEPHANOPOULOS: I said that's when I found out.
I'm not certain when others in the White House may have found out.
Q
Do you know whether he informed the White House as
soon as he knew there was a problem; was he fully forthcoming?
MR. STEPHANOPOULOS:
the exact date.
Q
I believe he was, but I don't know
Could you get us some comment on that?
MR. STEPHANOPOULOS:
Sure.
Q
can you also tell us, to the best of your
knowledge, are there any other members of the Cabinet or the senior
staff who have had to regularize their situation the way that zoe
Baird did?
MR. STEPHANOPOULOS: I don't have the facts on that, but
if we have others we'll let you know, sure.
Q
George, some people are also angry that somebody in
the White House·apparently who had access to her files leaked
information over the weekend about her having been a trainee in
London at the Playboy Club. And that has offended many people who
feel that that was --
MR. STEPHANOPOULOS: The President is angry about that
as well. I'm not certain that they came from the White House. I
don't know that it did. I know that information was in circulation,
but the President is angry about that as well.
Q
Why is the President angry?
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MR. STEPHANOPOULOS: Well, he felt it was irrelevant to
the process and it's always wrong to leak any sort of information
from confidential files.
Q
Are you now asking that question to Cabinet and
sub-Cabinet officials and senior officials -- the question that
wasn't asked before? Is this slowing down the confirmation process?
MR. STEPHANOPOULOS: I don't think it will. It's one
more question that has to be asked in the vetting process, but it
doesn't take that long to ask and answer it.
Q
Yes, but then you're eliminating -- according to
most statistics, 75 percent of Americans, according to IRS, don't pay
Social Security in this fashion. You're eliminating a very large
pool for your sub-Cabinet.
MR. STEPHANOPOULOS: Not necessarily. Again, we have to
look at these cases and figure out what the situation is but that
hasn't happened to date.
Q
So people could pay back Social Security taxes and
still be qualified for an appointment?
MR. STEPHANOPOULOS:
Oh, I think so.
Q
What is the disqualifying standard here? Is hiring
an illegal alien at a time it was illegal -- would that disqualify
someone for an appointment that involves Senate confirmation?
MR. STEPHANOPOULOS: I don't know about the specific
standard. Clearly, it was complicating and disqualifying in the end
in the case of Zoe Baird. She decided to withdraw.
Q
But not in that particular case, but in general.
If you have someone you're considering for a job that involves Senate
confirmation and they employed an illegal alien at a time it was
illegal to do so, would that be disqualifying?
MR. STEPHANOPOULOS: Again, I think it would make it
very difficult and probably be disqualifying, yes.
Q
George, did anybody from the White House encourage
Kimba Wood to write her letter yesterday to reemphasize her view of
the events?
MR. STEPHANOPOULOS:
offered to write it.
Q
that?
As far as I know, she called and
There was no communication with her before she did
MR. STEPHANOPOULOS: To the best of my knowledge she
called White House Counsel Bernie Nussbaum yesterday morning and
offered to write the letter.
Q
George, you said that Judge Wood was not as
forthcoming as she could have been. Does the President feel that she
misled him?
MR. STEPHANOPOULOS: Again, that's your word. I think
that in the end it was just that we didn't have all the information
we needed to fully assess the situation. It would have been helpful
had we had that. I'm not suggesting that, again, that it was
intentional on her part, but clearly, she gave an answer that she
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�- 8 -
thought was true and indeed is true but it did not provide all the
details at the time.
Q
Let me ask you this, George. If that's the case
and you didn't have the information and she wasn't selected or
nominated, why did you even ask her to withdraw? Why not just
proceed with the process and select someone else?
MR. STEPHANOPOULOS: She chose to withdraw and she put
out the statement Friday afternoon.
Q
For the record, you -- the White House, Bernie
Nussbaum did not call her and tell her, her nomination would not go
forward and she should withdraw?
MR. STEPHANOPOULOS: That's different from withdrawing.
Whether or not
she chose to put out a statement saying she would
withdraw.
Q
Did he call her and do that?
MR. STEPHANOPOULOS: They had a discussion -- when they
were going through the records, I think he indicated to her that this
would be a significant problem, yes.
Q
But he asked her to withdraw her name from
consideration, did he not?
MR. STEPHANOPOULOS:
Nussbaum, she did withdraw.
to?
issue here.
Q
I
After the discussion with Bernie
know, but did he in that conversation, ask her
MR. STEPHANOPOULOS:
You're getting into a semantic
Q
publicly.
Narrow legalistic --
Q
The question is whether he asked her to do it
MR. STEPHANOPOULOS: There's a difference between saying
that there would be a problem in this going forward, and her taking
the affirmative step to withdraw herself publicly from the process.
Q
Did Bernie Nussbaum ever, in a conversation with
anybody else who was on the list who had been interviewed by the
President, did he ever go back to them and say you are not likely to
be considered, and did that person ever then feel the need to put up
-- whose name had appeared in a published list, feel the need to
release a letter saying they were withdrawing?
MR. STEPHANOPOULOS: I don't think that's ever happened
before, but I think there have been other cases clearly where people
have been interviewed or people have gone through the process and
they have been told that they either weren't selected or it wasn't
going any farther.
Q
More to the point, did he, in that conversation,
ask her to publicly withdraw?
MR. STEPHANOPOULOS:
No,
Q
George, there does seem to be a faint if not
intense sound of factional trouble here when the President has not
yet picked somebody and the newspapers are full of stories attributed
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�- 9 -
to an a~inistration official that say this.person is the choice
it certainly appears that someone inside the tent here is trying to
force the President's hand and make it more difficult for him to not
select that person. What's going on here?
MR. STEPHANOPOULOS: I don't know that that's
necessarily the case. I mean, I think we've seen throughout this
process in the selection of not only the attorney general, but
several other positions the names often get into the public domain
before a selection is made, before a decision is made. Sometimes the
newspapers are right, sometimes they're wrong. Sometimes they go a
little farther than the situation might be, sometimes they don't go
quite as far. And in this case, it clearly was out a little farther
than the President had been at the time.
Q
Is the President -- in addition to this leak about
her Playboy experience, is the President troubled by, and has he
taken any measures to deal with the leaks about the state of the
nomination or the prospective nomination?
MR. STEPHANOPOULOS: I don't know that he's taken any
new leaks -- as you know, from several discussions here over the past
two weeks, the President is concerned about leaks in his
administration of all kinds. He wishes they wouldn't happen. He
wishes people would get to work. And it's just something we're
dealing with.
Q
Is the standard that you're talking about between
Ron Brown and Kimba Wood -- I hate to keep going over old ground -is the standard for you that he was not asked the question and she
was, and was not as forthcoming as you would have liked?
MR. STEPHANOPOULOS: I think that it's complicated when
you're dealing with a nomination where a decision hasn't been made.
A lot of different factors go into your final decision on whether or
not to choose somebody for an important position. In this case, both
factors came into play with Judge Wood.
Q
If he had been asked the question --
MR. STEPHANOPOULOS: If he had been asked the question
and had not been forthcoming, I would expect that it would have
affected his nomination and confirmation process. But that didn't
happen. He was fully forthcoming, and he was in this case -Q
He wasn't asked.
MR. STEPHANOPOULOS:
Zoe Baird situation.
But nobody was asked before the
Q
can you get us a timing for when he did tell you
about the problem?
MR. STEPHANOPOULOS:
I will try to find out, yes.
Q
Why is Paul Begala, in fact, playing a high profile
role at this point and whose payroll is he own?
MR. STEPHANOPOULOS: He's just working in the White
House for a brief period of time as an unpaid employee. He's
volunteering his time.
Q
Who?
MR. STEPHANOPOULOS:
Q
Paul Begala.
Is James Carville as well?
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�- 10 -
MR. STEPHANOPOULOS: I don't think so.
James is working in the same capacity as Paul.
Q
What's Paul doing?
MR. STEPHANOPOULOS:
Q
Not in the same, no.
Isn't Paul being paid by the DNC?
MR. STEPHANOPOULOS:
does have a DNC contract, yes.
Q
That's a separate contract.
He
What's he doing here?
MR. STEPHANOPOULOS:
campaign for the economic plan.
Q
I don't think
He's just helping out with the
Damage control?
MR. STEPHANOPOULOS:
No.
Q
can I go back to this whose paying whom. There
were stories over the weekend about people actually being hired as
paid consultants to the White House on the health policy area.
MR. STEPHANOPOULOS:
the White House.
Q
Okay.
Paul is not a paid consultant to
He's a paid consultant to the DNC?
MR. STEPHANOPOULOS:
Right.
Q
Okay. The people who are paid consultants to the
White House -- who are these people?
MR. STEPHANOPOULOS: I don't know the answer to that.
I'll get an answer, I just don't have any information on that.
Q
Do you know how many there are and whether they
have to follow ethics rules and whether or not their businesses are
in the same field they're consulting on?
MR. STEPHANOPOULOS: I believe if you work for the White
House for more than 60 days during a year, you have to comply with
the ethics rules.
Q
But we'll
out.
Is this one way to reduce the White House staff?
MR. STEPHANOPOULOS: No, this is separate from that.
I just don't know of any paid consultants. I will find
Q
Are you going to pay them with these reports we're
seeing of increased money for the White House staff budget?
MR. STEPHANOPOULOS:
Q
No.
Are you working on a supplemental?
MR. STEPHANOPOULOS: I believe there is a supplemental
in the works. But the President has said, I believe in his interview
with Diane sawyer back in early January or late December, that in the
beginning of the term there's a kind of a bulge in employees in the
Personnel and the counsel's office because of judicial nominations
and because of the need to fill an awful lot of positions in the
first year. That's a very temporary bulge that would go away at the
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�- 11 -
end of the fiscal year. And if there is a supplemental that's
probably what it would be for.
Q
What would the amount of the supplemental be?
MR. STEPHANOPOULOS:
Q
I don't know.
George, can you define the carville relationship?
Q
can I just go back to this? If there is a
supplemental for White House costs, it would be to pay the salary
costs of extra people in Personnel and Counsel's office?
MR. STEPHANOPOULOS: I believe that's the case. I don't
know if that's exclusive, but I know that that's the primary reason
for it.
force?
Q
Do you know if it's to cover the health care task
MR. STEPHANOPOULOS: I don't know about the health care
task force consultants, but I'll find out.
Q
what Ann said.
Once again the bulk would be
I couldn't hear
MR. STEPHANOPOULOS: There's a bulge in Personnel and
Counsel employees in the first nine months or so.
reduction?
Q
How is that factored into a 25 percent staff
MR. STEPHANOPOULOS: We'll have an announcement on that
tomorrow, but the staff reduction would be fully implemented at the
end of the fiscal year.
Q
Will that actually swell it by 50 more employees?
Q
You're going to ask for $3 or $4 million more to
pay for extra people at the same time you're reducing the staff by 25
percent?
MR. STEPHANOPOULOS:
It will be a temporary increase.
Q
Why doesn't 25 percent total decrease cover a
temporary small increase?
MR. STEPHANOPOULOS: At the end of the fiscal year when
we make the announcement the 25 percent decrease will be fully
implemented.
Q
From which baseline?
MR. STEPHANOPOULOS:
later today and tomorrow.
Q
We're going to have an announcement
Phased-in decrease, is what you're saying.
MR. STEPHANOPOULOS: Any business -- again, we'll have
the announcement tomorrow -- any business makes their cuts over the
course of the fiscal year.
operation.
Q
You don't have people to cut in the political
They're just new hires. You're starting a business.
MR. STEPHANOPOULOS: That's not exactly true. There's
an awful lot of people here that are part of the permanent operation,
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�- 12 part of the political operation as well. But we will certainly be
hiring fewer political appointees and staffers of all kind acrossthe-board.
Q
Do you know yet whether that 25 percent, once it
factors out at the end of the fiscal year, will be a 25 percent
bodies cut or 25 percent --
MR. STEPHANOPOULOS:
We'll have an announcement on that
tomorrow.
Q
Are you eliminating the correspondence section -the firing of some 20 women who've been here for 20 years-plus?
MR. STEPHANOPOULOS: That's not exactly true. There
have been some replacements in the correspondence office. Not all of
them have been here for 20 years. The bulk -- the majority of them
are appointees who have been here for far less than that, and
basically political appointees in the correspondence section. And
the President wants to have people close to him writing his letters,
speaking in his voice, writing for him. And I think that's to be
expected and very normal.
Q
They're being replaced is
MR. STEPHANOPOULOS:
Q
can we go
social security taxes for a
facts about how many senior
problem or are taking moves
now.
Exactly.
back to the illegal alien and payment of
minute? You said you don't have all the
staff in the White House have this
to correct it. Are you saying --
MR. STEPHANOPOULOS: I know that none have the problem
Everybody is complying with the law.
Q
rid of any --
Right now everybody has paid up taxes or has gotten
MR. STEPHANOPOULOS: Everybody is complying with the
law. I don't know about the back -- any retroactivity. I know that
everybody is complying with the law.
Q
How do you know that if you don't know how many
people are affected?
MR. STEPHANOPOULOS: Well, they've been told to comply
with the law and they're expected to comply with the law. And
they've said they're complying with the law.
Q
How do you know that they're complying with the law
if you don't know who they are?
requirement.
MR. STEPHANOPOULOS:
Q
Because it's a universal
Do you know how many people are affected by it?
MR. STEPHANOPOULOS: I don't know how many people are
affected by any activity in the past, no.
Q
George, is the White House troubled by Ron Brown's
position that he didn't know about this aspect of the law?
MR. STEPHANOPOULOS: Again, as I said, I think a lot of
us learned a lot more about this after the zoe Baird case. Ron Brown
did, and when he found out about it he took action to correct it.
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�- 13 -
Q
Are you troubled by the fact that the Counsel, upon
learning that Judge Wood had live-in help or had someone whom she was
paying, that the Counsel didn't ask what the immigration history of
that person was? Shouldn't that have been a question that Counsel
asked?
MR. STEPHANOPOULOS: Again, I think the Counsel was
diligent in his effort. She asked on two separate occasions prior to
the interview, do you have any problem relating to illegal
immigrants, relating to Social Security taxes, anything relating to
the zoe Baird issue. He asked that question and was assured there
was no problem.
Q
Not just suggest do you have a Zoe Baird problem?
MR. STEPHANOPOULOS:
Q
of that person?
No.
What did the counsel assume the immigration history
MR. STEPHANOPOULOS: I don't think he knew that there
was necessarily a person or any one individual. He just knew that
there -- he was told there wasn't a problem. "I've always paid my
taxes," I believe was the response and that was it. There were no
details of the situation at all.
Q
Press accounts have said that they did have someone
who was involved in child care.
MR. STEPHANOPOULOS: Again, I don't know that he was
necessarily aware of that, but I know that he asked the question, was
assured there was no problem on two separate occasions before an
interview.
Q
George, Charles Ruff, who was said to have been one
of the candidates for attorney general, had a similar problem as Ron
Brown, and he supposedly took care of his back Social Security taxes.
Has he been ruled ineligible for the attorney general's post because
of that?
MR. STEPHANOPOULOS: I don't know whether he's being
considered for it at all. I just can't comment on that.
Q
George, isn't this about time we did something to
help poor immigration? We give the border patrol but a pittance of
money and they've got 100 vehicles right now south of San Diego that
were bought in 1990 that are disabled vehicles and nobody does a
thing about it. And illegal aliens are just pouring over the border.
MR. STEPHANOPOULOS: We have to make sure that we stop
that and we give all the resources we can to the INS.
Q
George, do I understand that if you don't pay $50
per quarter -- if you pay more than that for a babysitter that you
are breaking the law if you don't give Social Security taxes?
Q
That's right.
Q
There are millions of Americans who are now
supposedly breaking the law, whereas Kimba Wood is one of thos'e few
who apparently did break the law.
MR. STEPHANOPOULOS: Again, I would imagine there
probably millions of Americans, and I've said it time and time again,
I don't think that that was the entire issue. That was only one
factor in the decision on whether or not to name somebody attorney
general of the United States.
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�- 14 -
Q
Will there be a crackdown on this -- seriously, to
raise money for the deficit there has been a lot of talk about
cracking down on.cheaters. Will there be some kind of crackdown to
collect from all these people who are not paying?
MR. STEPHANOPOULOS: I don't know that that would make a
lot of sense, but we'll certainly be looking at everything.
Q
Do you think that provision of the law about $50
per quarter will change soon?
MR. STEPHANOPOULOS: I don't know for sure, but it's
certainly something I think we have to look at. And any commonsense standard would say that it appears to be a bit stringent.
Q
Follow-up, George. Do you have a new list of
attorney general candidates and is there a --
MR. STEPHANOPOULOS:
announcement soon.
Q
The President will make an
Are women ruled out of this job now?
MR. STEPHANOPOULOS:
Q
Of course not.
Has he done interviews this weekend or today?
MR. STEPHANOPOULOS:
Not that
I
know of.
Q
George, are any of the candidates that are under
consideration in the same situation as Judge Wood?
MR. STEPHANOPOULOS:
Not that
I
know of.
Q
You don't know of any. Did I understand you
earlier to say that for this job that probably would be
disqualifying?
MR. STEPHANOPOULOS: Well, I just think that there are
special requirements for the post of attorney general. I wouldn't
want to speak to any specific standard that would rule somebody in or
out, but clearly there are special requirements for attorney general.
Q
No, I mean somebody who had in fact complied with
the law, but because the law changed -- this exact situation as Judge
Wood, would that -- if that person had been very forthcoming and
explain all this, as she apparently didn't, would it nonetheless be a
disqualifying factor?
MR. STEPHANOPOULOS:
to look at it case by case.
I
just can't speak to that.
I have
Q
can you just define Jim Carville's relationship
with the White House now?
MR. STEPHANOPOULOS: Jim's a good friend of an awful lot
of people in the White House and a close advisor to the President and
Mrs. Clinton.
Q
Is he back here?
MR. STEPHANOPOULOS:
No, not in any formal way, no.
Q
can I follow up on that, George? With the Paul
back, temporarily at least, and Carville hanging around in one
capacity or another, given the bad news that you've had over the past
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�- 15 -
couple of weeks, do you think you have had any problem getting your
message out?
MR. STEPHANOPOULOS: I actually think that, for the bulk
of last week the President was very successful in getting his message
out.
Q
But do you think you need any change in the way
things are being done?
MR. STEPHANOPOULOS: I think that there's no question,
last week, the President made very good progress on all of his
legislative agenda and on -- there was great success at the end of
the week on signing the Family Leave bill after eight years. But
he's making progress, he's going to work. We've had some bad luck~
there's no question about that. But we're ready to move on.
Q
What is the economic announcement going to be?
MR. STEPHANOPOULOS:
unemployment compensation.
Q
He'll have an announcement on
About the extension of the emergency unemployment?
MR. STEPHANOPOULOS: He'll have it in about an hour.
But, yes, that's the general area.
Q
George, have you ruled out freezing COLAs? can you
specifically say that's no longer going to be done? I heard you talk
about this, this morning.
unlikely.
MR. STEPHANOPOULOS: As I said, I think it's very
It's something the President wants to do.
Q
What about something else on Social security? Are
those still -- what about something else, for instance, raising the
taxes on the upper income Social Security --
MR. STEPHANOPOULOS: The President hasn't made any final
decisions on the composition of the package. But as you know, he
talked about that during the campaign. I wouldn't rule it in or out.
Q
George, if you had to question Judge Kimba Wood
after the hell you went through with the Zoe Baird case, wouldn't you
have asked her, have you never hired an illegal alien? A simple
question she couldn't have been able to squirm out of. Why didn't
somebody just ask her the simple question: "Did you ever hire an
illegal alien?"
MR. STEPHANOPOULOS: Bernie Nussbaum asked her quite
directly if she had any issues involving illegal aliens.
Q
Did you ask her if she ever hired an illegal alien?
MR. STEPHANOPOULOS:
there for the conversation.
Q
I wasn't in the room.
I wasn't
Would you ask him that question?
MR. STEPHANOPOULOS:
I don't know --
Q
This is the whole heart of this thing. And nobody
asked the fundamental question: "Did you hire an illegal alien?"
MR. STEPHANOPOULOS: The fundamental question was, do
you have anything involving illegal aliens or Zoe Baird. I think -Q
He never asked the question, apparently.
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-------------------------------------------~~---
�- 16 -
MR. STEPHANOPOULOS: Well, no. A reasonable person
knows what they're being asked when they're asked about illegal
aliens or they're asked about Zoe Baird -- absolutely.
Q
Was she asked if she had hired an illegal alien?
MR. STEPHANOPOULOS: She was asked if she had any issues
or problems relating to illegal aliens. I don't know the exact
parsing of the sentence. But illegal alien was clearly in the
question.
Q
What other taxes are unlikely?
MR. STEPHANOPOULOS: I don't know.
have an announcement relatively soon.
The President will
Q
Friday the President met with his national security
advisors, apparently for the first time in an NSC type setting.
MR. STEPHANOPOULOS: It wasn 1 t.
meeting, it wasn't an NSC meeting.
It was a principal's
Q
Aspin said over the weekend he's -- or the
administration is likely to have some announcement or description of
their program for Bosnia by mid-week. Is that a timetable you're
working on?
Q
I don't know if that's the exact timing, but as the
President said, he's working on the Bosnia situation, it's under very
serious review, and we expect to have an announcement soon. I don't
know the exact timing.
Q
Do you have a plan that is out there?
Q
Is it likely that the President is going to give a
speech or make some announcement, or is this going to emerge from
some other quarter?
MR. STEPHANOPOULOS: I don't know that the President
would necessarily do it himself, but the administration policy will
be clear and we'll follow through clearly.
Q
Might it be this very week?
MR. STEPHANOPOULOS:
I don't have the exact timing.
Q
Do you actually have some sort of substitute for
Vance-owen that Aspin was taking through the other capitals to see
their opinion of it? Or he still in the research process?
MR. STEPHANOPOULOS: The President is reviewing it right
now and we'll have an announcement soon.
Q
So it's not something that's out there that other
capitals are looking at that we just haven't heard yet.
MR~
Q
STEPHANOPOULOS:
Not that I know of, no.
Is it a substitute?
MR. STEPHANOPOULOS: I think the President has said,· and
secretary Christopher have both made clear for the support of the
vance-owen process. I think there's no question about that and we're
going to do everything we can to help them help the parties achieve a
good-faith compromise.
Q
like the plan.
The process as opposed to the plan?
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They didn't
�- 17 -
MR. STEPHANOPOULOS:
had full support of the process.
Well again, the process -- we've
Q
A quickie on the Middle East, George. That protest
that the u.s. levied against Israel -- does that mean you're going to
take a harder line against Israel or be more even handed?
MR. STEPHANOPOULOS:
Which protest are you --
Q
About the three Americans
who are in jail in Israel.
the three Americans
MR. STEPHANOPOULOS: It stands on it's own and I would
refer you to the state Department for any further details.
Q
What is Mrs. Clinton's role Thursday at the town
meeting in Harrisburg and will the health forums be open?
MR. STEPHANOPOULOS: I believe that senator Wofford
invited her up to participate in this town meeting and she will be
participating. As far as the Health Care Task Force, Mr. Nussbaum
has issued an opinion that the federal advisory committee -- it was
not intended by Congress to apply to the Health care Task Force. The
participation of the First Lady on the task force does not trigger
application of the act. We have a letter we can release to you on
that.
Q
The committee who wrote that law says that that's
not true at all. They say it does affect the First Lady and that's
why they're suggesting legislation to --
MR. STEPHANOPOULOS:
Council that it doesn't.
Q
Well, it's the opinion of the
That doesn't explain why.
Q
It doesn't give any explanation except the one
sentence that says she's not covered. Why isn't she covered? Can we
get some details as to why?
MR. STEPHANOPOULOS:
closed.
Q
We can get some details, yes.
So you're saying definitively that they will be
MR. STEPHANOPOULOS: No, I'm just saying that it is our
opinion that it doesn't apply -- that this law does not apply to the
task force and it does not require them to be open.
Q
What's the White House feeling?
would you want
Q
Is a list available of who's on the task force yet?
them to --
MR. STEPHANOPOULOS:
That's in the letter.
Yes, it's in
the letter.
Q
You should know, George, that Congressman Clinger
to whom you wrote the letter totally disagrees with your counsel's
opinion. And he's the author, apparently, of this legislation. He
says that the meeting should be open and that the sunshine law does
apply.
MR. STEPHANOPOULOS:
Then we have a disagreement.
Q
George, when you said that one of the issues
involving Judge Wood is that she was not completely forthcoming
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�- 18 -
did the President feel he couldn't trust her?
went into -MR. STEPHANOPOULOS:
Is that part of what
Again, I didn't say that but I just
said
Q
You said that there was also a concern that in this
case she was completely forthcoming.
MR. STEPHANOPOULOS:
Q
I think that's the concern.
Meaning that he couldn't trust her?
MR. STEPHANOPOULOS:. Those are your words.
Q
George, in the interest of preventing any further
blow-up on this, is there a formal effort on the part of the White
House to survey Cabinet members and senior White House officials as
to domestic arrangements, child care arrangements and who --
MR. STEPHANOPOULOS: There is a clear direction that all
Cabinet officials and senior White House officials are to comply with
the law.
Q
might have any
law.
-- leave it up to them to let you know if they
MR. STEPHANOPOULOS:
Right, they are to comply with the
Q
George, can you confirm whether the suspension of
income tax indexation is one of the things you're looking at?
MR. STEPHANOPOULOS:
on any options.
Again, I can't go into any details
Q
can you take the question, specifically -- is the
administration considering any changes in the laws? And would
changes be retroactive, or would they start from the time --
MR. STEPHANOPOULOS: Again, I don't know if there would
be any changes that are retroactive. And there hasn't been any
decision to change the law at this time, but it's clearly something
we would look at.
Q
Would you let us know?
MR. STEPHANOPOULOS:
Sure.
Q
George, why has there not been a greater White
House expression of concern for these Americans arrested is Israel?
Is the u.s. involved, or being let in on the investigation, Israeli
police giving diplomats there the information they're coming up with?
MR. STEPHANOPOULOS: We have made contact with the
Israelis, but I would just refer you to the state Department and the
FBI for any details.
Q
I'm aware of.
There has been no White House protest of this that
There appears to be no official concern.
MR. STEPHANOPOULOS: No, we're monitoring the situation
and I would just ask you to go to the State Department for any
details.
Q
Is the President concerned that the FBI is running
adrift because of these problems? Without prejudging Judge Sessions,
Is there a concern now that the agency needs new leadership?
MORE
�- 19 -
MR. STEPHANOPOULOS: I wouldn't put it that way, but I
think the President is eager to review all of the files relating to
Judge Sessions. And he and the Counsel's office are doing that now.
Q
-- have an attorney general confirmed and in place?
MR. STEPHANOPOULOS: It 1 s unlikely that it would be
completely finished before we have an attorney general.
Q
Would the President meet with Judge Sessions when
such a request is made?
MR. STEPHANOPOULOS:
Let's see if there's a request.
Q
Is the President influenced at all by the fact that
this executive group who advises Judge Sessions has met with him and
MR. STEPHANOPOULOS:
take into account.
That•s certainly something we'll
Q
Outside of Wednesday's town meeting, is there
anything else scheduled for the President to try to release or
discuss details of his economic policy, and will he continue the
Saturday morning radio addresses?
MR. STEPHANOPOULOS: He'll certainly continue the
Saturday morning radio addresses, and we'll have other announcement
as the President makes decisions.
Q
Every Saturday or on a periodic basis?
MR. STEPHANOPOULOS: I think generally every Saturday
and there might be sometimes when we don•t have one.
Q
bit.
Same time?
MR. STEPHANOPOULOS: They might change around a little
Sometimes it might be noon or the afternoon.
Q
Has the President reviewed the White House
Counsel's decision on the California gays in the military?
MR. STEPHANOPOULOS:
It's not been completed yet, no.
Q
Just a return to the attorney general question once
more. Do you think there's any validity to the perception that many
have that women are being held to a higher, tougher standard when it
comes to child care and domestic help than men are being held to?
MR. STEPHANOPOULOS: I just don't think so. Everybody
is being asked the question. Meri and women alike are being asked
about this situation, and if they comply with the law there won•t be
any problem.
Q
Will you seek any kind of legislation to abolish
the CEQ or will it be done strictly administratively?
MR. STEPHANOPOULOS:
statutorily over time.
I believe it has to be done
Q
Will it be consistent to raise corporate rates to
meet with fairness standard for the economic package?
MR. STEPHANOPOULOS: It wouldn't necessarily be
inconsistent. I don't know that the President's made any decision on
that yet. But generally, if you raise the top individual rate, it
would make sense in certain circumstances to raise the corporate rate
as well so you don 1 t have a differential.
�- 20 -
THE PRESS:
Thank you.
END
1:23 P.M. EST
#16-02/08
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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FACA Documents [2]
Creator
An entity primarily responsible for making the resource
First Lady's Office
Maggie Williams
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 4
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-2194630-20060223F-004-003-2015
2194630
-
https://clinton.presidentiallibraries.us/files/original/973528385422ddbfc27eb18bd7c2331c.pdf
a981d4ab131f066d7e3bd5243134abbf
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
I
Subgroup/Office of Origin:
First Lady's Office
Series/Staff Member:
Maggie Williams
Subseries:
Misc. Subject Files
OA/ID Number:
10813
FolderiD:
Folder Title:
FACA Documents
Stack:
Row:
Section:
Shelf:
Position:
s
59
4
2
3
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. statement
SUBJECTfi'ITLE
DATE
Declaration of Marjorie Tanney. (4 pages)
n.d.
RESTRICTION
PS
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number: 10813
FOLDER TITLE:
FACA Documents [1]
2006-0223-F
ab862
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a))
Freedom of Information Ad -IS U.S.C. 552(b))
PI National Security Classified Information )(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information )(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted Invasion of
personal privacy )(a)(6) of the PRA)
b(l) National security classified information )(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency )(b)(2) of the FOIA)
b(3) Release would violate a Federal statute )(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information )(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy )(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions )(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs )(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record mlsf"de defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�THE WHITE HOUSE
WASHINGTON
July 11, 1993
MEMORANDUM TO:
Marge Tarmey, Melanne Verveer
FROM:
Pam
SUBJECT:
Task Force contacts
Barnett~
There are several individuals that Mrs. Clinton had an
interest in being contacted by the Task Force. In going through
the correspondence on her desk prior to her trip, and in
reviewing past requests I have made, I come up with the following
list. Please let me know if these individuals have been
contacted by phone or by mail by members of the Task Force
working groups or other senior White House officials.
Donald Colbert
Vice President, Stephens Inc., Little
Rock
Martha Katz
Associate Director for Policy, Planning
and Evaluation, CDC, Atlanta
Margaret Bogle
Pediatric Nutrition., Arkansas Children's
Hospital, Little Rock
Ronald Goux
representing American Health Care
Association
Liz Medley
Publisher, The Phys Ed Journal of Sports
Medicine
If these individuals have not been contacted, I believe they
should, and I am happy to provide phone numbers, etc.
�February 21, 1995
TO:
File
FROM:
Pam Cicetti
Executive Assistant to the First Lady
Today I gave to Associate Counsel Chris Cerf the following
recreated files in response to Joel Klein's memorandum of
February 8, 1995, requesting documents and records on the Health
Care Task Force and civil litigation entitled Association of
American Physicians, et al. v. Hillary Rodham Clinton, et al.:
\
Health Care - FACA
Health Care - Magaziner
Health Care - Process
~argaret
A. Williams
Chief of Staff to· the First Lady
�Notice: This opinion is subject to fonnal revision before publication in
the Federal Reporter or U.S.App.D.C. Reports. Users are requested to
notify the Clerk of any fonnal errors in order that corrections may be made
before the bound volumes go to press.
idntttb !Statts CICourt of
~pptals
FOR THE DISTRICT OF COLUMBIA CIRCUIT
Argued April 30, 1993
Decided June 22, 1993
No. 93-5086
AssOCIATION OF AMERICAN PHYSICIANS
AND SuRGEONS. INc.• ET AL .•
APPELLEES
v.
HILLARY RODHAM CLINTON, ET AL.,
APPELLANTS
No. 93-5092
AsSOCIATION OF AMERICAN PHYSICIANS
AND SURGEONS, INC .. ET AL.,
APPELLANTS
v.
HILLARY RoDHAM CLINTON. ET AL .•
APPELLEES
Bills of costs must be filed within 1-4 days after entry of judgment.
The court looks with disfavor upon motions to file bills of costs out
of time.
�2
Appeals from the United States District Court
for the District of Columbia
(93cv0399)
Mark B. Sterrr.. Attorney, U.S. Department of Justice,
argued the cause for appellants/cross-appellees Hillary Rodham Clinton, et al. With him on the briefs were J. Ramsey
Johnson, United States Attorney, Stuart E. Schiffer, Acting
Assistant Attorney General, Robert E. Kopp, Patricia A
Millett, and Malcolm L. Stewart, Attorneys, U.S. Department
of Justice. Stuart M. Gerson, Attorney, U.S. Department of
Justice, entered an appearance for appellants/cross-appellees.
Kent Masterson Brown argued the cause for appellees/cross-appellants Association of American Physicians and
Surgeons, Inc., et al. With him on the briefs were Frank M.
Northam and Alan P. Dye.
Steven R. Ross, General Counsel, and Charles 'Fiefer, Deputy General Counsel, Office of General Counsel, United
States House of Representatives, f'Iled the brief for amicus
curiae Speaker and Bipartisan Leadership Group.
Ronald A Zumbrun, Anthony T. Caso, and Robin L.
Rivett f'lled the brief for amici curiae Pacific Legal Foundation and the National Taxpayers Union.
Jane E. Kirtley, J. Laurent Scharff, James E. Grossberg,
Richard M. Schmidt, Jr., Allan R. Adler, Bruce W. Sanford,
Henry S. Hoberman, and Whitney M. Adams f'lled the brief
for amici curiae Reporters Committee for Freedom of the
Press, et al.
Joseph Gregory Sidak filed the brief for amicus curiae J.
Gregory Sidak.
Samuel B. Wallace, rv; filed the brief for amicus curiae
Samuel B. Wallace, IV.
�3
Before:
Judges.
SILBERMAN, BucKLEY, and WILLIAMS, Circuit
Opinion for the Court filed by Circuit Judge SILBERMAN.
Opinion concurring in the judgment filed by Circuit Judge
BUCKLEY.
SILBERMAN, Circuit Judge: This expedited appeal presents
the question whether the President's Task Force on National
Health Care Reform ("Task Force") and its working group
are advisory committees for purposes of the Federal Advisory
Committee Act ("FACA"). If they are, we are asked to
decide whether F ACA unconstitutionally encroaches on the
President's Article II executive powers. We hold that the
Task Force is not an advisory group subject to F ACA, but
remand to the district court for further proceedings to determine the status of the working group.
I.
On January 25, 1993, President Clinton established the
President's Task Force on National Health Care Reform.
The President named his wife, Hillary Rodham Clinton, as
the chairman of the Task Force, and appointed as its other
members the Secretaries of the Treasury, Defense, Veterans
Affairs, Health and Human Services, Labor, and Commerce
Departments, the Director of the Office of Management and
Budget, the chairman of the Council of Economic Advisers,
and three White House advisers. President Clinton charged
this body with the task of "listen[ing] to all parties" and then
"prepar[ing] health care reform legislation to be submitted to
Congress within 100 days of our taking office." 29 WEEKLY
CoMP. PRES. Doc. 96 (Feb. 1, 1993).
On the same day, the President also announced the formation of an interdepartmental working group. According to
the government, the working group was responsible for gathering information and developing various options on health
care reform. It was composed of three types of members: (i)
approximately 300 permanent federal government employees
drawn from the Executive Office of the President, the federal
�..
4
agencies, and Congress; (ii) about 40 "special government
employeesu hired by the agencies and the Executive Office of
the President for a limited duration; and (iii) an unknown
number of "consultantsu who, it is asserted, "attend working
group meetings on an intermittent basis. 19 Ira Magaziner,
the senior adviser to the President for Policy Development,
headed the working group and was the only member of the
Task Force who attended the group's meetings.
According to the government, the working group had no
contact with the President. In addition to gathering information, the working group developed alternative health care
policies for use by the Task Force. But only the Task Force,
it was contemplated, would directly advise and present recommendations to the President. On March 29, 1993, the
Task Force held one public hearing where interested parties
could present comments on health care reform. See 58 Fed.
Reg. 16,264 (1993). However, the Task Force met behind
closed doors at least 20 times in April and May to "formulateu
and "deliberate" on its advice to the President. As the
government publicly has announced, in those meetings "the
Task Force reviewed materials it received from the interdepartmental working group; formulated proposals and options
for health care reform; and presented those proposals and
options to the President." Statement of the White House
Press Secretary (June 4, 1993). In accordance with its
charter, the Task Force then terminated its operations on
May 30. 1 All of the working group's meetings remained
closed to the public.
Appellees are the Association of American Physicians and
Surgeons, which represents physicians; the American Council
for Health Care Reform, which represents health care consumers; and the National Legal & Policy Center, which seeks
to promote ethics in government. They sought access to the
1 The
Task Force's "tennination" does not render this case moot.
AIJ both parties, in anticipation of this event, agreed before oral
argument, this case still presents a live controversy concerning the
availability of Task Force and working group documents, which the
appellees sought below pursuant to F ACA.
�5
Task Force's meetings under the Federal Advisory Committee Act. Pub. L. No. 92-463, 86 Stat. 770 (1972) (reproduced
at 5 U.S.C. App. 1 (1988)). Their efforts were rebuffed by
the Counsel to the President, who informed them that the
Task Force was not an advisory committee subject to F ACA.
Appellees thereupon brought suit against the Task Force in
district court. They claimed that the Task Force was a
F ACA committee because it was chaired by Mrs. Clinton, a
private citizen, and that the Task Force had violated F ACA
by failing to file an advisory committee charter. They further asserted that F ACA permitted them to attend all of the
meetings of the Task Force and of any of its subgroups.
Appellees sought a temporary restraining order and a preliminary injunction halting the operation of the Task Force until
it complied with F ACA and allowed the public to attend its
meetings. The government responded that the Task Force
was exempt from F ACA because all of its members-including Mrs. Clinton-were government officers and employees.
The government alternatively challenged any application of
F ACA to the Task Force as an unconstitutional infringement
on the President's executive power.
In a memorandum opinion issued on .March 10, 1993, the
district court granted in part appellees' motion for a preliminary injunction. The court determined that appellees had a
substantial likelihood of success on the merits. Mrs. Clinton,
the court held, was not an officer or employee of the federal
government merely by virtue of her status as "First Lady."
Therefore, the Task Force could not qualify for an exemption
from F ACA as an advisory group composed solely of "fulltime officers or employees" of the government. See Association of Am. Physicians & Surgeons v. Hillary Rodham
Clinton, Civil Action No. 93-0399, Mem. Op. at 16-17 (D.D.C.
March 10, 1993) ("Mem. Op."); see also 5 U.S.C. App. 1
§ 3(2)(iii). The court, however, agreed with the government
that F ACA encroached on the President's constitutional authority to receive confidential advice for the purpose of
recommending legislation. But the court thought that executive prerogatives were implicated only when the Task Force
�I •
6
was advising the President, not when it engaged in information-gathering. The district court accordingly granted a preliminary injunction requiring the Task Force to meet all the
requirements of F ACA except when it met to formulate
advice or recommendations for the President.
As to the working group, the district court concluded that
appellees had failed to state a claim under FED. R. Cxv. P.
12(b)(6) that the subordinate body was covered by FACA.
Relying on National Anti-Hunger Coalition v. Executive
Committee, 557 F. Supp. 524 (D.D.C.), afj'd, 711 F .2d 1071
(D.C. Cir. 1983), the court held that the working group was
not an advisory committee because it was engaged in factgathering and did not provide advice directly to the President. The court denied appellees motion for expedited discovery concerning the actions and status of the working
group, but nevertheless determined that there were no issues
of material fact and that it could have dismissed on summary
judgment grounds as well. Mem. Op. at 15 n.ll.
The government filed this appeal on March 22, 1993. Appellees subsequently filed a cross-appeal. We have jurisdiction to review a grant of a preliminary injunction under 28
U.S.C. § 1292(a), and we expedited the appeal due to the
short time frame within which the Task Force and the
working group operated.
II.
The government, as appellant and cross-appellee, and the
plaintiffs below, as appellees and cross-appellants, together
challenge much of the district court's ruling. The government takes issue primarily with the court's determination that
Mrs. Clinton is not an "officer or employee" for purposes of
section 3(2) of F ACA. It is claimed that as the "First Lady,"
Mrs. Clinton is the functional equivalent of a government
officer or employee, that the Task Force, therefore, is composed solely of full-time government officials-indeed officers
drawn from among the President's closest official advisersand that thus the Task Force is exempt from F ACA. In the
alternative, the government reiterates its claim that FACA
�7
cannot be applied constitutionally to the Task Force. We are
urgedt in that regardt to discard the distinction drawn by the
district court between the infonnation-gathering function of
the Task Force and its role in advising the President. As
would be expectedt the government is content with the district court's ruling concerning the status of the working
groupt and it argues that the district court's dismissal of
appellees' claim is an unappealable interlocutory order.
Appelleest on the other handt support the district court's
determination that F ACA covers the Task Force because
Mrs. Clinton is not an officer or employee of the federal
government. Howevert they challenge the court's ruling as
to the status of the working groupt which they contend is also
covered by F ACA. They further maintain that applying
F ACA to either body raises no serious constitutional issuest
andt in any eventt that the district court prematurely decided
the constitutional issue. Appellees also contend that the
court should have permitted discoveryt which would have
shown more clearly the F ACA status of both groupst and that
a straightforward application of FACAts procedural requirements would not curtail the President's constitutional powers.
We firSt consider the status of the Task Force and then
turn to the working group issues.
III.
Congress passed FACA in 1972 to control the growth and
operation of the "numerous committeest boardst commissionst
councilst and similar groups which have been established to
advise officers and agencies in the executive branch of the
Federal Government.lt 5 U.S.C. App. It§ 2(a). As Congress
put itt F ACNs purpose was: to eliminate unnecessary advisory committees; to limit the fonnation of new committees to
the minimum number necessary; to keep the function of the
commit~es advisory in nature; to hold the committees to
uniform standards and procedures; and to keep Congress
and the public infonned of their activities. See id. § 2(b)(l)(6). The statute orders agency heads to promulgate guide-
�8
lines and regulations to govern the administration and operations of advisory committees. See id. § 8.
F ACA places a number of restrictions on the advisory
committees themselves. Before it can meet or take any
action, a committee first must file a detailed charter, see id.
§ 9(c). The committee must give advance notice in the
Federal Register of any meetings, see id. § 10(a)(2); and it
must hold all meetings in public, see id. § lO(a)(l). Under
section 10, the committee must keep detailed minutes of each
meeting, see id. § lO(c), and make the records available- .
along with any reports, records, or other documents used by
the committee-to the public, provided they do not fall within
the exemptions of the Freedom of Information Act (FOIA),
see id. § lO(b). Under section 5, an advisory committee
established by the President or by legislation must be "fairly
balanced in terms of the points of view represented," id.
§ 5(b)(2).2 The Act also requires that precautions be taken to
ensure that the advice and recommendations of the committee
''will not be inappropriately intlueAced by the appointing
authority or by any special interest." Id. § 5(b)(3).
The Act's definition of an "advisory" committee is· apparently rather sweeping. Section 3 sta~s:
The term "advisory committee" means any committee,
board, commission, council, conference, panel, task force,
or other similar group, or any subcommittee or other
subgroup thereof (hereinafter in this paragraph referred
to as "committee"), which is . . . (B) established or
utilized by the President . . . in the interest of obtaining
advice or recommendations for the President or one or
more agencies or officers of the Federal Government.
/d. § 3(2). The government does not contend that the Task
Force was not "established" or "utilized" by the President in
2
F ACA's "balanced viewpoint" requirement may not be justiciable, however, because it does not provide a standard that is susceptible of judicial application. See Public Citizen v. National Advisory Comm., 885 F.2d 419, 426 (D.C. Cir. 1989) (Silberman, J.,
concurring).
�9
the interest of obtaining advice or recommendations.
FACA's definition contains one important proviso, however.
Section 3(2)(iii) exempts "any committee which is composed
wholly of full-time officers or employees of the Federal
Government." And, according to the government, the Task
Force was not only wholly composed of government officers,
it was actually (like the Task Force we encountered in Meyer
v. Bush, 981 F .2d 1288 (D.C. Cir. 1993)) a partial, yet
somewhat augmented, cabinet grouping. Thus, subjecting
the Task Force to F ACA would fall outside Congress' purpose of regulating the growth and use of committees composed of outsiders called in to advise government officials.
Appellees would have no quarrel with the government's characterization of the Task Force, except for the description of
its chairman, Mrs. Clinton. Appellees contend that she is not
an officer or employee of the federal government despite her
traditional and ceremonial status as "First Lady." This is not
just a technicality according to appellees; she is statutorily
barred from appointment as an officer because of the AntiNepotism Act. See 5 U.S.C. § 3110(b).
The district court, finding no definition of officer or employee of the federal government in F ACA itself, quite reasonably
turned to Title 5 of the U.S. Code to find a definition. See 5
U.S.C. §§ 2104 & 2105. An officer or employee according to
those sections must be: (i) appointed to the civil service; (ii)
engaged in the performance of a federal function; and (iii)
subject to supervision by a higher elected or appointed official. As the district court held, and as appellees correctly
point out, Mrs. Clinton has not been appointed to the civil
service. Reading these definitions in pari materia with
F ACA would seem to suggest that the Task Force is not
exempt.
Nevertheless, it is true, as the government insists, that
Congress did not adopt explicitly all of Title 5's definitions in
FACA. F ACA is not part of Title 5, which was enacted six
years before FACA's passage, see Pub. L. No. 89-554, 80
Stat. 378 (1966), but, instead is only temporarily housed there
as an appendix. Typically, when Congress wishes to add a
statute to Title 5, it amends the Title. See, e.g., Government
�10
in the Sunshine Act, § 3(a), Pub. L. No. 92-409, 90 Stat. 1241
(1976); Privacy Act of 1974, Pub. L. No. 93-579, 88 Stat. 1896
(1974). It did not do so when it passed F ACA, but at that
time it specifically did adopt certain Title 6 definitions. For
example, adjacent to the defmition of an advisory committee
is F ACA's definition of an agency, which incorporates the
definition in Title 5: " 'agency' has the same meaning as in
section 661(1) of title 6, United States Code." 6 U.S.C. App.
1, § 3(3). But Congress actually deleted from the Senate
version of F ACA defmitions of "officer" and "employee" that
paralleled those of sections 2104 and 2106. See H.R. REP. No.
1403, 92d Cong., 2d Sess. (1972), reprinted in 1972 U.S. ConE
CoNG. & ADMIN. NEWS 3508, 3609. And the Code contains
another definition of a federal officer which tends to support
the government's position. Title 1 provides that a federal
officer "includes any person authorized by law to perform the
duties of the office." 1 U.S.C. § 1. That definition could
cover a situation in which Congress authorizes someone who
is not formally an officer (such as the President's spouse) to
perform federal duties. Even if, as our concurring colleague
argues, Mrs. Clinton does not occupy an "office" specifically
created by Congress, she could still be regarded as an
"employee."
The government would have us conclude that the traditional, if informal, status and "duties" of the President's wife as
"First Lady'' gives her de facto officer or employee status.
The government invokes what it describes as "a longstanding
tradition of public service" by First Ladies-including, we are
told, Sarah Polk, Edith Wilson, Eleanor Roosevelt, Rosalynn
Carter, and Nancy Reagan-who have acted (albeit in the
background) as advisers and personal representatives of their
husbands. We are not confident that this traditional perception of the President's wife, as a virtual extension of her
husband, is widely held today. As this very case suggests, it
may not even be a fair portrayal of Mrs. Clinton, who
certainly is performing more openly than is typical of a First
Lady. Indeed, in the future we may see a male presidential
�11
spouse, which could make the term "First Lady" anachronistic.
More persuasive, however, is the government's argument
that Congress itself has recognized that the President's
spouse acts as the functional equivalent of an assistant to the
President. The legislative authorization to the President to
pay his White House aides includes the following provision:
Assistance and services authorized pursuant to this section to the President are authorized to be provided to the
spouse of the President in connection with assistance
provided by such spouse to the President in the ·discharge of the President's duties and responsibilities. If
the President does not have a spouse, such assistance
and services may be provided for such purposes to a
member of the President's family whom the President
designates.
3 U.S.C. § 105(e) (emphasis added). Of course, even without
section 105(e), the President presumably could draw upon his
spouse for assistance. The statute's importance, rather, lies
in its assistance in helping us interpret the ambiguous terms
of F ACA in pari materia.
It may well be, as appellees argue, that many in Congress
had in mind "ceremonial duties," but we do not think the
presidency can be so easily divided between its substantive
political and ceremonial functions. In any event, section
105(e) neither limits the particular kind of "assistance" rendered to the President, nor circumscribes the types of presidential duties and responsibilities that.are to be aided. We
see no reason why a President could not use his or her spouse
to carry out a task that the President might delegate to one
of his White House aides. It is reasonable, therefore, to
construe section 105(e) as treating the presidential spouse as
a de facto officer or employee. Otherwise, if the President's
spouse routinely attended, and participated in, cabinet meetings, he or she would convert an all-government group,
established or used by the President, into a F ACA advisory
committee.
Pursuant to this section, morrl)ver, the President's spouse
is supported by a substantial staff who are undeniably fulltime government officers or empioyees. Therefore, the Pres-
�12
ident could have-as the government points out--easily designated Mrs. Clinton's chief of staff as a member of the Task
Force, perhaps even as the chairman, who would then be
expected to report to Mrs. Clinton. It would seem quite
anomalous to conclude that F ACA would apply if the President's spouse were a member of the committee, but not if her
chief of staff were the actual member.
The President's implicit authority to enlist his spouse in aid
.r' the discharge of his federal duties also undermines appellees' claim that treating the President's spouse as an officer
or employee would violate the anti-nepotism provisions of 5
U.S.C. § 3110. That section prohibits any ..public official"
from appointing or employing a relative, such as a spouse, 11 in
the agency in which he is serving or over which he exercises
jurisdiction or control." /d. § 3110(b). Although section
3110(a}(1}(B) defines agency as 11 an executive agency," we
doubt that Congress intended to include the White House or
the Executive Office of the President. Cf. Franklin v. Massachusetts, 112 S. Ct. 2767, 2775 (1992) (holding that President is not .. agency" for purposes of Administrative Procedure Act}; Meyer, 981 F.2d at 1298 (President's advisers are
not .. agency'' under FOIA); Armstrong v. Bush, 924 F.2d
282, 289 (D.C. Cir. 1991) (President not'APA .. agency"). So,
for example, a President would be barred from appointing his
brother as Attorney General, but perhaps not as a White
House special assistant. Be that as it may, it is not reasonable to interpret that provision to bring it into conflict with
Congress' recognition of (and apparent authorization for} the
President's delegation of duties to his spouse. The antinepotism statute, moreover, may well bar appointment only to
paid positions in government. See 5 U.S.C. § 3110(c). Thus,
even if it would prevent the President from putting his spouse
on the federal payroll, it does not preclude his spouse from
aiding the President in the performance of his duties.
In sum, the government musters a strong argument in
support of its interpretation of "full-time officer or employee"
under F ACA as including the President's spouse-whether or
not a 11 First Lady." But it is by no means overwhelming.
Indeed, the government is uncomfortable at having to choose
�13
whether Mrs. Clinton should be thought of as an officer or
employee. The government's discomfort is quite understandable. ·Mrs. Clinton has not in any sense been appointed or
elected to office, and, assuming she is an officer under Title 1,
due to the duties delegated to her under 3 U.S.C. § 105(e),
how, one might ask, could she be removed? All officers and
employees of the United States, except the Vice President,
can be removed, at least for cause, through the ultimate
authority of the President. We suppose the President could
withdraw any or all authority delegated to his spouse, but
then he would be left without the official assistance of any
family member. The very provision authorizing the delegation to the spouse provides for a delegation to another
member of the President's family only "[i]f the President does
not have a spouse." 3 U.S.C. § 105(e) (emphasis added).
That language seems to present the President with rather
extreme alternatives.
What is more, section 105(e) would seem to apply whether
or not the President's spouse held another job that an officer
or employee of the government could not possibly hold.
Suppose, for instance, that the President's spouse was counsel
to a major law firm and spent a good portion of his or her
time practicing law. Presumably, the spouse would still be
authorized to provide assistance to the President under section 105(e) and would, thereby, also be an officer or employee
of the government. The government suggests that this hypothetical does not create a problem under F ACA, because a
spouse in that situation, whether or not an officer or employee, would not be full-time and so would not qualify for the
exemption. But that answer may be too facile. How would
we determine how much or what kind of outside activity was
inconsistent with full-time status?
Suffice it to say that the question whether Mrs. Clinton's
membership on the Task Force triggers FACA is not an easy
one.3 The government argues, therefore, that we should
3 It is not clear how F ACA applies if only one member of an
advisory committee is not a full-time government officer or employee. How does the government carry out its obligation to ensure
�14
construe the statute not to apply here, because otherwise we
would face a serious constitutional issue. The Supreme Court
has noted many times that ''where an otherwise acceptable
construction of a statute would raise serious constitutional
problems, the Court will construe the statute to avoid such
problems unless such construction is plainly contrary to the
intent of Congress." Public Citizen v. Department of Justice, 491 U.S. 440, 466 (1989) (quoting Edward J. DeBartolo
Corp. v. Florida Gulf Cocut Building & Construction Trades
Counci~ 485 U.S. 568, 575 (1988)). Only a few years ago the
Court employed that very maxim of statutory construction to
avoid applying FACA to the ABA committee that advised the
Attorney General on the qualifications of prospective federal
judicial nominees. See id. The government there argued
that applying F ACA would impair the effectiveness of the
committee's deliberations (by exposing them to public examination), and thus would interfere with the advice that the
committee provided to the Attorney General and ultimately, it
was assumed, to the President. Such interference would
encroach on the President's appointment power-his sole
responsibility to nominate federal judges.4 In order to escape that constitutional question, the Court held that the
ABA committee was not "utilized" by the President because it
was established and run by a private organization, even
though the Act covers advisory committees established or
utilized by the executive branch. See id. at 455-65. The
Court adopted, we think it is fair to say, an extremely
strained construction of the word "utilized" in order to avoid
the constitutional question. The gravity of the constitutional
that the committee is "fairly'' balanced in terms of the points of
view represented?
4
Ironically, the ABA committee's role in advising administrations
as to the qualifications of putative judges has over the years become
more of an impediment (reflecting certain ABA institutional and,
perhaps, political interests) than an aid to Presidents. R. Marcus &
S. Torry, ABA Judicial Evaluation Again Under Fire, WASH. PoST,
May 7, 1989, A6; M. Thornton, The ABA's Judljments on Judljes,
WASH. PosT, Sept. 25, 1987, A23.
�15
issue was revealed by the three concurring justices who were
unable to accept the Court's statutory construction and believed that F ACA was unconstitutional as applied to the ABA
committee. /d. at 467-89 (Kennedy, J., concurring).
It is, of course, necessary before considering the maxim of
statutory · construction to determine whether the government's constitutional argument in this case is a powerful one.
In other words, are we truly faced, as the Court thought it
was in Public Citizen, with a grave question of constitutional
law? The government relies primarily on the claim that an
explicit presidential power is implicated. Article II of the
Constitution provides that the President "shall from time to
time give to the Congress Information of the State of the
Union, and recommend to their Consideration such Measures
as he shall judge necessary and expedient." U.S. CaNST. art.
II, § 3, cl.l. According to the government, this clause gives
the President the sole discretion to decide what measures to
propose to Congress, and it leaves no room for congressional
interference. To exercise this power, the government claims,
the President also must have the constitutional right to
receive confidential advice on proposed legislation.
Under the government's theory, F ACA would interfere
with the President's unbounded discretion to propose legislation. President Clinton formed the Task Force specifically to
recommend legislation dealing with health care reform.
F ACA's requirement of public meetings would inhibit both
candid discussion· within the Task Force and its presentation
of advice to the President. Challenging the district court's
ruling, the government argues that this encroachment occurs
regardless of whether the Task Force is engaged in information-gathering or internal deliberation. In either situation,
the glare of publicity would inhibit the free flow of frank
advice and would handicap the President's ability to develop
legislation.
Appellees point out that the c0ncurring opinion in Public
Citizen commanded the votes of only three justices and rely,
�16
instead, on the Court's opinion in Morrison v. Olson, 487 U.S.
654 (1988).6 Morrison upheld the Ethics in Government
Act's creation of an independent counsel because it did not
prevent the President "from accomplishing [his] constitutionally assigned functions," id. at 695 (quoting Nixon v. Administrator of General Services, 433 U.S. 425, 443 (1977)), even
though the counsel was largely immune from the executive
branch's operational control (she was appointed by a panel of
judges and was removable only for good cause). Applying
F ACA to the Task Force, according to appellees, has a rather
minor impact on the institution of the presidency compared to
the much greater encroachment on the President's core executive function sanctioned in Morrison.
Nevertheless, the government maintains that Morrison is
not directly on point. Picking up on Justice Kennedy's
concurrence in Public Citizen, the government contends that
the Morrison Court's imprecise balancing test, which is apparently less favorable to the President, does not apply when
a textual grant of presidential authority is implicated. In
distinguishing Morris on, Justice Kennedy said:
Thus, for example, the relevant aspect of our decision in
Morrison involved the President's power to remove Executive Officers, a power we had recognized is not conferred by any explicit provision of the text of the Constitution (as is the appointment power) but rather is inferred to be a necessary part of the grant of the "Executive Power."
Public Citizen, 491 U.S. at 484 (Kennedy, J., concurring). 6
But because Public Citizen involved the President's textually
5 Justice Kennedy, who was recused in Morrison, was joined by
Chief Justice Rehnquist and Justice O'Connor in Public Citizen.
Justice Scalia, who dissented in Morrison, was, in turn, recused in
Public Citizen.
6 But see Bowsher v. Synar. 478 U.S. 714, 721-27 (1986) (removal
power more important than appointment power in controlling subordinate officials).
�17
granted power to appoint federal judges, the concurrence
would have struck F ACA down:
Where a power has been committed to a particular
Branch of the Government in the text of the Constitution,
the balance already has been struck by the Constitution
itself.
Id. at 486. The government argues that here, as in Public
Citizen, but unlike in Morris on, we have an explicit textual
delegation to the President to propose legislation.
We perceive several weaknesses in the government's position. First, the government ignores the Morrison Court's
consideration of the President's Article II, section 3 responsibility to "take Care that the Laws be faithfully executed."
See Morrison, 487 U.S. at 692-93. The Court specifically
recognized that the statute before it encroached upon or
burdened that responsibility, but concluded that the burden
was not great enough to be unconstitutional.
This is not a case in which the power to remove an
executive official has been completely stripped from the
President, thus providing no means for. the President to
ensure the "faithful execution" of the laws. . . . We do
not think this limitation as it presently stands sufficiently deprives the President of control over the independent
counsel to interfere impermissibly with his constitutional
obligations to ensure the faithful execution of the laws.
/d. (emphasis added) (footnote omitted). Morrison v. Olson,
thus, cannot be easily disposed of in accordance with the
government's (and Justice Kennedy's) suggested distinction.
The President's constitutional duty to take care that the
laws be faithfully executed, moreover, seems far greater in
importance than his authority to recommend legislation. The
Framers intended the Take Care Clause to be an afrJ.rmative
duty on. the President and the President alone. In contrast,
the Recommendation Clause is less an obligation than a right.
The President has the undisputed authority to recommend
legislation, but he need not exercise that authority with
�18
respect to any particular subject or, for that matter, any
subject. 7 Only the President can ensure that the laws be
faithfully executed, but anyone in the country can propose
legislation.
The government's focus on the Recommendation Clause
seems somewhat artificial. Discussions on policy-whether
they take place in executive branch groups or in pure FACA
advisory committees-to some extent always implicate proposed legislation. Whenever an executive branch group considers policy initiatives, it discusses interchangeably new legislation, executive orders, or other administrative directives.
Thus, virtually anytime an advisory group meets to discuss a
problem, it will implicate the Recommendation Clause, from
which all executive branch authority to recommend legislation
derives. Accordingly, if the application of F ACA to groups
advising the President or anyone else in the executive branch
were constitutionally problematic, insofar as those groups
were advising on proposed legislation, F ACA would be problematic with regard to virtually all policy advice. Under
that reasoning F ACA would be constitutionally suspect on its
face-an argument the government declined to make.
We do think that the government's alternative, albeit implicit, argument is more persuasive. Application of F ACA to
7 To
be sure, during the Constitutional Convention in Philadelphia, the Framers changed the language of the clause from "may
recommend" to "shall recommend." AB James Madison recorded in
his notes· of the convention for August 24, 1787:
On motion of Mr. Govr Morris, "he may'' was struck out, &
"and" inserted before "recommend" in the clause 2d. sect 2d
art: X in order to make it the duty of the President to
recommend, & thence prevent umbrage or cavil at his doing it.
J. MADISON, NOTES OF DEBATES IN THE FEDERAL CONVENTION OF 1787,
464 (G. Hunt & J. Scott, eds. 1987). Gouverneur Morris' amendment suggests that the clause was intended to squelch any congressional objections to the President's right to recommend legislationhence the prevention of "u:nbrage or cavil." See J. Sidak, The
Recommendation Clause, 77 GEO. L.J. 2079, 2082 (1989).
�19
th~
Task Force clearly would interfere with the President's
capacity to solicit direct advice on any subject related to his
duties from a group of private citizens, separate from or
together with his closest governmental associates. That advice might be sought on a broad range of issues in an
informal or formal fashion. Presidents have created advisory
groups composed of private citizens (sometimes in conjunction
with government officials) to meet periodically and advise
them (hence the phrase "kitchen cabinets") on matters such
as the conduct of a war.8 Presidents have even created
formal "cabinet committees" composed in part of private
citizens. 9 This case is no different. Here, the President has
formed a committee of his closest advisers-eabinet secretaries, White House advisers, and his wife-to advise him on
a domestic issue he considers of the utmost priority.
8
For example, President Johnson often sought advice from Clark
Clifford and Justice Fortas, "two old and trusted friends from
outside the Executive Branch," along with government officials on
matters concerning the Vietnam War. See, e.g., L. JoHNSON. THE
VANTAGE POINT: PERSPECTIVES OF THE PRESIDENCY 1963-1969 at 23537 (1971)
9 President Ford, in 1975, convened a "cabinet committee" composed of the Secretary of State, the Secretary of Commerce, the
Secretary of Labor, the President of the AFL-CIO, and the President of the Chamber of Commerce to formulate the government's
policy toward the International Labor Organization. President
Carter continued the same body. See, e.g., Committee Fails to
Agree on U.S. ILO Membership, WASH. PoST, Oct. 13, 1977, A24.
Neither President apparently acknowledged F ACA's application.
See, e.g., GENERAL SERVICES ADMINISTRATION, FEDERAL ADVISORY
COMMITTEES: FOURTH ANNUAL REPORT OF THE PRESIDENT COVERING
CALENDAR YEAR 1975 at 54-55 (1976) (no mention of ILO committee
in list of presidential advisory committees); see also GENERAL
SERVICES ADMINISTRATION. FEDERAL ADVISORY COMMITTEES: FIFTH
ANNUAL REPORT OF THE PRESIDENT CO\'ERING CALENDAR YEAR 1976 at
55-56 (1977) (same). In 1980, however, President Carter continued
that structure, but explicitly recognized F ACA's coverage (after the
issue that gave rise to the committee-whether the United States
should withdraw from the ILO-had been resolved). See Exec.
Order No. 12,216, 45 Fed. Reg. 41.619 (1980).
�20
Applying F ACA to the Task Force does not raise constitutional problems simply because the Task Force is involved in
proposing legislation. Instead, difficulties arise because of
the Task Force's operational proximity to the President himself-that is, because the Task Force provides advice and
recommendations directly to the President. The Supreme
Court has recognized that a President has a great need to
receive advice confidentially:
[There is a] valid need for protection of communications
between high Government officials and those who advise
and assist them in the performance of their manifold
duties; the importance of this confidentiality is too plain
to require further discussion. Human experience teaches that those who expect public dissemination of their
remarks may well temper candor with a concern for
appearances and for their own interests to the detriment
of the decisionmaking process. Whatever the nature of
the privilege of confidentiality of Presidential communications in the exercise of Art. II powers, the privilege can
be said to derive from the supremacy of each branch
within its own assigned area of constitutional duties.
United States v. Nixon. 418 U.S. 683, 705-06 (1974) (footnotes
omitted); see also Nixon v. Administrator of Gen. Servs., 433
U.S. 425, 441-49 (1977). Nixon v. Administrator of General
Serr.rices further explains that the President is entitled to
confidentiality in the performance of his "responsibilities" and
"his office," and " 'in the process of shaping policies and
making decisions.'" 433 U.S. at 449 (quoting United States
v. Nixon. 418 U.S. at 708). Article II not only gives the
President the ability to consult v.ith his advisers confidentially, but also, as a corollary, it gives him the flexibility to
organize his advisers and seek advice from them as he wishes.
In Meyer v. Bush, 981 F.2d at 1293-97, for example, we held
that the President could create a Task Force composed of
cabinet secretaries and other close advisers to study regulatory reform without having to comply with FOIA. In this
regard, F ACA's requirement that an advisory committee
must be "fairly balanced in terms of the view represented"
�21
would-if enforceable and applied to groups of presidential
advisers-restrict the President's ability to seek advice from
whom and in the fashion he chooses.
The ability to discuss matters confidentially is surely an
important condition to the exercise of executive power. Without it, the President's performance of any of his dutiestextually explicit or implicit in Article II's grant of executive
power-would be made more difficult. In designing the
Constitution, the Framers vested the executive power in one
man for the very reason that he might maintain secrecy in ·
executive operations. As Alexander Hamilton wrote in the
Federalist Papers:
Decision, activity, secrecy, and dispatch will generally
characterise (sic] the proceedings of one man, in a much
more eminent degree, than the proceedings of any greater number; and in proportion as the number is increased, these qualities will be diminished.
THE FEDERALIST No. 70, at 472 (J. Cooke, ed., 1961) (emphasis
added). The Framers thus understood that secrecy was
related to the executive's ability to decide and to act quickly-a quality lacking in the government established by the
Articles of Confederation. If a President cannot deliberate in
confidence, it is hard to imagine how he can decide and act
quickly.
This Article II right to confidential communications attaches not only to direct communications with the President,
but also to discussions between his senior advisers. Certainly
Department Secretaries and White House aides must be able
to hold confidential meetings to discuss advice they secretly
will render to the President. Congress, in another context,
has recognized that the President's right to confidential communications extends to meetings between his top advisers.
For example, FOIA, 5 U.S.C. § 552, exempts "the President's
immediate personal staff or units in the Executive Office
whose sole function is to advise and assist the President."
See Kissinger v. Reporters Com m. for Freedom of the Press,
445 U.S. 136, 156 (1980) (quoting H.R. REP. No. 1380, 93d
�22
Cong., 2d Sess. 14 (1974)); Meyer v. BU8h, 981 F.2d at 129192.
A statute interfering with a President's ability to seek
advice directly from private citizens as a group, intermixed,
or not, with government officials, therefore raises Article II
concerns. This is all the more so when the sole ground for
asserting that the statute applies is that the President's own
spouse, a member of the Task Force, is not a government
official. For if the President seeks advice from those closest
to him, whether in or out of government, the President's
spouse, typically, would be regarded as among those closest
advisers.
As we have indicated, we do not place much significance on
the government's claim that this sort of interference is qualitatively, in constitutional terms, more troublesome insofar as
it relates to advice the President seeks concerning the exercise of an enumerated power. If we were to go on to decide
the constitutionality question, we· would be obliged to ask
whether, in Morris on v. Olson terms, this asserted application of FACA "impermissibly" burdens executive power.
Morrison tells us to balance how much the interference with
the President's executive power prevents the President "from
accomplishing his constitutionally assigned functions," Morrison, 487 U.S. at 695, against the "overriding need to promote
objectives within the constitutional authority of Congress."
Nixon v. Administrator of Gen. Servs., 433 U.S. at 443. We
readily confess that this balancing test is not one that, as
judges, we can apply with confidence. This is all the more
reason to view the constitutional issue soberly. We are
satisfied that tht: application of F ACA to the Task Force
seriously burdens executive power. And our reading of Morrison does not lead us easily to a conclusion that the burden
placed is a permissible one.
The court below correctly recognized the constitutional
difficulties that F ACA's application to the Task Force created. The court, therefore. ruled the Act partially unconstitutional, insofar as it was applied to the meetings in which the
Task Force actually advised the President. When the Task
�I •
I
I
23
Force was engaged in "information-gathering and information-reporting," however, the court thought that the President's constitutional interests were not so seriously implicated.
We believe it is the Task Force's operational proximity to
the President, and not its exact function at any given moment, that implicates executive powers and therefore forces
consideration of the Morrison test. The President's confidentiality interest is strong regardless of the particular role
the Task Force is playing on any given day. Indeed, the two
functions naturally interrelate and can only be divided artificially. If public disclosure of the real information-gathering
process is required, the confidentiality of the advice-giving
funetion inevitably would be compromised. If you know what
information people seek, you can usually determine why they
seek it. A group directly reporting and advising the President must have confidentiality at each stage in the formulation of advice to him. As we said in Meyer, "[p]roximity to
the President, in the sense of continuing interaction, is surely
in part what Congress had in mind when it exempted [from
FOIA] the President's 'immediate personal staff.'" 981 F.2d
at 1293 (citation omitted). And, as we recognized in Soucie v.
David, 448 F.2d 1067 (D.C. Cir. 1971), FOIA's exemption may
be constitutionally required to protect the President's executive powers. In any event, the district judge decided to
truncate the statute in light of constitutional concerns only
because it determined that F ACA applied to the Task Force.
We think the district court should have acted otherwise.
Prudent use of the maxim of statutory construction allows us
to avoid the difficult constitutional issue posed by this case.
The question whether the President's spouse is "a full-time
officer or employee" of the government is close enough for us
properly to construe F ACA not to apply to the Task Force
merely because Mrs. Clinton is a member. We follow the
Supreme Court's lead, if not its strict precedent, in recognizing that [if the Act] were "(r]ead unqualifiedly, it would
extend F ACA's requirements to any group of two or more
persons, or at least any formal organization, from which the
President or an executive agency seeks advice." Public
Citizen, 491 U.S. at 452 (footnote omitted). Because it be-
�24
lieved that Congress could not have intended such a result,
the Public Citizen majority read "utilize" to exclude the ABA
committee. If the Supreme Court correctly construed the
statute not to cover the advice the Attorney General receives,
on behalf of the President, from the ABA, the statutory
construction issue we face should be resolved a fortiori in
favor of the government.
We, therefore, read the phrase "full-time officer or employee of the government" in F ACA to apply to Mrs. Clinton.
In doing so, we express no view as to her status under any
other statute. 10
IV.
The district court, having concluded that the Task Force
was a F ACA advisory committee, dismissed under Rule
12(b)(6) appellees' claim that the working group was also
covered by F ACA. The court thought that under National
Anti-Hunger Co·alition v. Executive Committee, 557 F. Supp.
524 (D.D.C.), ajj'd, 711 F.2d 1071 (D.C. Cir. 1983) ("AntiHunger"), subgroups of a FACA committee should be regarded as staff of the advisory committee and not as advisory
committees themselves. See Anti-Hunger, 557 F. Supp. at
529. Based on Mr. Magaziner's affidavit, the district court
determined that the working group merely gathered information to be passed on to the Task Force. Appellees crossappeal the district court's ruling and its corollary refusal to
permit further discovery into the status and operations of the
working group.
The government challenges our jurisdiction to consider the
cross-appeal because the district court's rulings on the working group are neither independent final judgments, nor covered by the preliminary injunction against the Task Force
which is before us on an interlocutory appeal pursuant to 2B
.
lOWe do not need to consider whether Mrs. Clinton's presence on
the Task Force violates the Hatch Act, 5 U.S.C. § 7324(a), the
Anti-Deficiency Act, 31 l' .S.C. § 1342, or any conflict of interest
statutes.
�25
U.S.C. § 1292(a). We have said that our jurisdiction over an
interlocutory appeal, however, is considerably broader:
[R]eview quite properly extends to all matters inextricably bound up with the remedial decision . . . . [T]he
scope of review may extend further to allow disposition
of all matters appropriately raised by the record, including entry of final judgment. Jurisdiction of the interlocutory appeal is in large measure jurisdiction to deal with
all aspects of the case that have been sufficiently illuminated to enable decision by the court of appeals without
further trial court development.
Wagner v. Taylor, 836 F .2d 578, 585 (D.C. Cir. 1987) (emphasis added) (quoting Energy Action Educational Found. v.
Andrus, 654 F.2d 735, 745 n. 54 (D.C. Cir. 1980), rev'd on
other grounds, 454 U.S. 151 (1981)); see also 16 C. WRIGHT. A.
MILLER. E. CooPER & E. GRESSMAN. FEDERAL PRACTICE &
PROCEDURE § 3921, at 17-20 (1977). The 'district court's final
disposition of the claim against the working group was
"bound up" with its reasons for granting the injunction
against the Task Force. Once it is determined that the Task
Force is not covered by F ACA, the implicit ·analytical premises of the district court's decision as to the working group are
removed. Moreover, had the district court determined, as
have we, that the claim against the Task Force was invalid
and then also dismissed the claim against the working group,
the latter unquestionably would be appealable as well. Under these circumstances, we think it is appropriate to consider the cross-appeal. 11
11
The lower court dismissed appellees' claim under Rule 12(b)(6)
because it found that appellees had failed to state a claim upon
which relief could be granted. Mem. Op. at 15. It also noted that
it could have dismissed appellees' claims under FED. R. CIV. P. 56,
because appellees had failed to state that further discovery was
necessary before summary judgment could be granted. I d. at 15
n.ll. AS we will discuss, the legal ba.•is for the Rule 12(b)(6) ruling,
or a Rule 56 ruling, was incorrect. Furthermore, contrary to the
district court's decision, Rule 56 does not require a party to state in
its discovery motion that discovery is necessary before a court may
�26
As it argued below, the government claims that the working group is not in contact with the President and is not,
therefore, "utilized" by him. That seems to us a strange
argument. There are two exceptions to F ACA's inclusion of
all presidential advisory groups: (i) where the advisory committee is independently established and operated by a private
organization, see Public Citi:z:e~ 491 U.S. at 457-59; and (ii)
where the group is composed wholly of full-time government
officials. See 5 U.S.C. App. 1, § 3(2)(iii). We have construed
the second exception here to extend to a cabinet committee
that includes the First Lady. The government now presses
upon us a third exception, one for advisory committees that
do not meet face-to-face with the President. The government's argument, however, conflicts with the serious constitutional concerns we have recognized concerning the Task
Force. The statute cannot be properly interpreted as applying only to those advisory committees, established in the
Executive Office of the President, that present the most
delicate constitutional problems. 12 Otherwise~ the government's argument effectively would render almost all presidential advisory committees free from FACA. Committees in
direct contact with the President implicate the President's
executive power and hence cannot be covered by FACA,
while committees not directly in contact are not "utilized." In
rule on summary judgment. Indeed, a party's filing of a discovery
motion would seem implicitly to assert just that. But under Rule
12(b)(6), once the Magaziner affidavit was filed and considered the
district judge was obliged to permit reasonable discovery as to the
facts set forth in the affidavit. See First Chicago Int'l v. United
Exchange Co., 836 F.2d 1375, 1380 (D.C. Cir. 1988).
12 The government, only at oral argument, and rather tentatively,
suggested that application of F ACA to any advisory groups established and utilized by the President, because they advise someone in
the Executive Office of the President, raises constitutional problems. We do not think we should entertain a constitutional argument of such enormous signi:icance made in so glancing a fashion.
After all, it could be thought :o come close to an argument that the
government disavowed-that F ACA is unconstitutional on its face.
�•
27
any event, the statutory language does not remotely support
the government. Not only does F ACA define an advisory
committee as a task force or "any subcommittee · or other
subgroup thereof," 5 U.S.C. App. 1, § 3(2), but it also specifies that an advisory committee is a group that is either
established or utilized by the President. See id. Certainly
the President can establish an advisory group that he does
not meet with face-to-face. In Public Citizen the Court did
not suggest that F ACA could be avoided merely because the
ABA committee communicated with the Justice Department
rather than with the President.
The district court accepted a variation of the government's
argument by concluding that the working group was not
really a subgroup of the Task Force within the meaning of
F ACA, but rather only staff to the Task Force. The court
relied, as we noted, on the Anti-Hunger case, in which we
affirmed Judge Gesell's decision to similarly treat subordinate
working groups operating under the Executive Committee of
the Private Sector Survey. Although we affirmed the decision, we did not explicitly approve the judge's reasoning
relating to the supposed staff groups; rather, we rejected an
effort to challenge his decision based on new information not
in the record. See National Anti-Hunger Coalition v. Executive Committee, 711 F.2d 1071, 1075 (D.C. Cir. 1983). In
any event, Anti-Hunger presented crucially different facts.
That case involved the Executive Committee of the Private
Sector Survey, formed by President Reagan to obtain management and cost control advice from the private sector. The
Executive Committee, composed of 150 private citizens, had a
subcommittee composed of 30 members and also had 36 task
forces that performed the preliminary work of the survey.
Anti-Hunger, 557 F. Supp. at 525-26. The government
conceded, in that litigation, that the Executive Committee and
the subcommittee were both F .\CA committees and it was
only thereafter that the district court determined that the
task forces were not F ACA committees, but staff.
Our conclusion that the Task F' orce is a committee wholly
composed of government ofticiuis makes this case entirely
different. In contrast to the situation here, in Anti-Hunger
�28
the top levels of the outside advisory groups were covered by
F ACA-both the executive committee of 150 and the subcommittee of 30. In that scenario, there is less reason to focus on
subordinate advisers or consultants who are presumably under the control of the superior groups. It is the superior
groups, after all, that will give the advice to the government,
and which, in accordance with the statute, must be "reasonably" balanced. But when the Task Force itself is considered
part of the government-due to the government officials
exemption-we must consider more closely F ACA's relevance
to the working group. For it is the working group now that
is the point of contact between the public and the government. The district court's conclusion that the working group
could be disregarded as staff depended on its determination
that the Task Force was covered by F ACA. Our disagreement with :he district court on the latter issue therefore
compels a different analysis of the working group's status.
Alternatively, the government argues that the working
group is not, as a matter of law, a F ACA advisory committee
because it is not expected to offer consensus advice. In
making this argument, the government relies on a regulation
issued by the General Services Administration:
The following are examples of advisory meetings or
groups not covered by the Act or this subpart; . . . (i)
Any meeting initiated by a Federal ofticial(s) with more
than one individual for the purpose of obtaining the
advice of individual attendees and not for the purpose of
utilizing the group to obtain consensus advice or recommendations. However, agencies should be aware that
such a group would be covered by the Act when an
agency accepts the group's deliberations as a source of
consensus advice or recommendations.
41 C.F.R. § 101-S.1004(i) (1992).
As we have so often noted, we do not defer to an agency's
construction of a statute interpreted by more than one agency, see, e.g., FLRA ·v. Department of Treasury, 884 F.2d 1446,
1451 (D.C. Cir. 1989). let alone one applicable to all agencies,
see Reporters Comm. for Freedom of the Press v. Department
�•
29
of Justice, 816 F.2d 730, 734 (D.C. Cir. 1987), rev'd on other
grounds, 489 U.S. 749 (1989).
Nevertheless, we think the
government's regulation expresses a concept similar to one
that we find embedded in the statute. It is not so much that
a group is not a F ACA advisory committee unless it gives
"consensus" advice. To be sure, many committees are convened with that expectation. See, e.g., The Commission on
the Future of Worker-Management Relations, 58 Fed. Reg.
27,311 (1993). Others, however, are established presumably
with the full expectation that the positions to be taken and
the advice to be offered may well be sharply divided. See,
e.g., The Presidential Commission or the Assignment of Women in the Armed Forces, 57 Fed. Reg. 49,394 (1992). And
since one of the purposes of F ACA is to achieve some
balance, and thereby diverse views on advisory committees, it
would be passing strange if F ACA only applied to those
committees that would offer consensus recommendations.
The point, it seems to us, is that a group is a FACA
advisory committee when it is asked to render advice or
recommendations, CI8 a group, and not as a collection of
individuals. The group's activities are expected to, and appear to, benefit from the interaction among the members both
internally and externally. Advisory committees not only provide ideas to the government. they also often bestow political ·
legitimacy on that advice. As the House Committee that
investigated advisory committees before F ACA's passage
.stated: "The work product of a committee composed of
distinguished and knowledgeable individuals appointed by the
President to advise him is presumed to have value and should
be considered." H.R. REP. No. 1731, 91st Cong., 2d Sess. 12
(1970).
Advisory committees are not just mechanisms for transmitting policy advice on a particular subject matter to the
government. These committees also possess a kind of political legitimacy as representative bodies. Membership on a
committee is often highly prized and sought after because it
carries recognition and even p:·estige. When the executive
branch endorses its advice and 5eeks to promote the policy
course suggested by the committee, the executive branch
�30
draws upon the committee's political legitimacy. Congress'
effort to ensure that these committees are balanced in terms
of viewpoint recognizes their usefulness for political (and
patronage) purposes. But committees bestow these various
benefits only insofar as their members act as a group. The
whole, in other words, must be greater than the sum of the
parts.
Thus, an important factor in determining the presence of
an advisory committee becomes the formality and structure of
the group. Judge Gesell, in another district court case.
Nader v. Baroody, 396 F. Supp. 1231 (D.D.C. 1975), seems to
have approached the same notion by focusing on the word
"established" in F ACA. Nader involved meetings between
an assistant to the President and a changing slate of federal
officials and private sector groups. See id. The groups met
for the express purpose of exchanging views on a variety ot
subjects. In exempting these meetings from F ACA, the
court noted that "the committees were not formally organizec
and there is little or no continuity." !d. at 1234.
Since form is a factor, it would appear that the governmen•
has a good deal of control over whether a group constitutes ~
F ACA advisory committee. Perhaps, for that reason, it is ~
rare case when a court holds that a particular group is ~
F ACA advisory committee over the objection of the executivE
branch. In order to implicate F ACA, the President, or hh
subordinates, must create an advisory group that has, in larg(
measure, an organized structure, a fiXed membership, and :
specific purpose. The government suggests that the workinJ
groups, composed as they are of a crowd of 340 virtuall:
anonymous persons, do not bear the characteristics of th~
paradigm F ACA advisory committee. That may well be sc
The working groups. as a whole, seem more like a horde tha:
a committee. On the other hand, the groups have beet
created ("established") with a good deal of formality an1
perhaps are better understood as a number of advisor:
committees. We simply cannot determine how to classify th
working groups based on the record before us.
Finally, the government claims that all of the members <
the working groups are full-time officers or employees of th
�31
government, and, for that reason alone, the working groups
are not F ACA advisory committees. The three-hundred
members drawn from the agencies, the Executive Office of
the President, and from the congressional staffs are concededly within that category. The working group also includes, however, 40 "special government employees." The
government claims that these individuals are also "full-time"
government employees, even though they have been employed by an agency or the Executive Office of the President
for less than 130 days in a year, some without compensation.
The record does not reflect where these persons come from,
nor does it show how many hours they work. We are,
moreover, unsure whether F ACA's definition of "full-time"
extends to a person who works for the government for less
than 130 days out of a year. The government directs us to
the conflict of interest provisions of Title 18, which define a
"special Government employee" as:
an officer or employee of the executive or legislative
branch of the United States Government . . . who is
retained, designated, appointed, or employed to perform,
with or without compensation, for not to exceed [130]
days during any period of [365] consecutive days, tempora:ry duties either on a fuU-time or intermittent basis.
18 U.S.C. § 202(a) (1988) (emphasis added}. The government
argues that section 202 clearly implies that a temporary
employee can be "full-time." Intermittent (or non-full-time)
applies, according to the government, to those who work less
than a full day.
We do not believe section 202(a) helps the government.
Just as we did not read 5 U.S.C. §§ 2104, 2105 to govern the
question of whether Mrs. Clinton is a federal officer or
employee, we do not think that Title 18's definitions should
necessarily control F ACA. We must construe F ACA in light
of its purpose to regulate the growth and operation of advisory committees. F ACA would be rather easy to avoid if an
agency could simply appoint 10 private citizens as special
government employees for two days, and then have the
committee receive the section 3(2) exemption as a body
�32
composed of full-time government employees. Moreover, section 202 contrasts "full-time" with "intermittent," and so "fulltime" seems to mean no more than not "intermittent." There
is no reason to think that not "intermittent" for section 202
purposes has any bearing on whether the employee is "fulltime" for F ACA purposes. Whether the special government
employees are full-time, however, is, in part, a factual issue
that was not developed below due to the lack of discovery.
A third class of persons are described as consultants.
According to the government, the consultants attend meetings on an intermittent basis, with or without compensation,
and have no "supervisory role or decision-making authority."
Drawn from the ranks of the medical profession, the academy, and from business, they only provide information and
opinion. These consultants raise a different question from
that presented by the other two classes of working group
employees. The key issue, it seems to us, is not whether
these consultants are "full-time" government employees under section 3(2), but whether they can be considered members of the working group at all. When an advisory committee of wholly government officials brings in a "consultant" for
a one-time meeting, F ACA is not triggered because the
consultant is not really a member of the advisory committee.
In that situation, the relationship between the temporary
consultant and committee is very similar to the one between
the White House officials and various private sector representatives exempted from FACA in Nader. We are confident
that Congress did not intend F ACA to extend to episodic
meetings between government officials and a consultant. To
do so would achieve the absurd result Public Citizen warned
against: reading F ACA to cover every instance when the
President (or an agency) informally seeks advice from two or
more private citizens.
But a consultant may still be properly described as a
member of an advisory committee if his involvement and role
are functionally indistinguishable from those of the other
members. Whether they exercise any supervisory or decisionmaking authority is irrelevant. If a "consultant" regularly attends and fully participates in working group meetings as
�33
if he were a "member," he should be regarded as a member.
Then his status as a private citizen would disqualify the
working group from the section 3(2) exemption for meetings
of full-time government officials.
•
•
*
•
When we examine a particular group or committee to
determine whether F ACA applies, we must bear in mind that
a range of variations exist in terms of the purpose, structure,
and personnel of the group. Perhaps it is best characterized
as a continuum. At one end one can visualize a formal group
of a limited number of private citizens who are brought
together to give publicized ·advice as a group. That model
would seem covered by the statute regardless of other fortuities such as whether the members are called "consultants."
At the other end of the continuum is an unstructured arrangement in which the government seeks advice from what
is only a collection of individuals who do not significantly
interact with each other. That model, we think, does not
trigger F ACA. ·
We simply have insufficient material in the record to
determine the character of the working group and its members. We understand why the district .court, believing the
Task Force covered by F ACA, thought it unnecessary and
inappropriate to put the working group under further scrutiny. But, as we have indicated, because we differ with the
district court concerning the Task Force, we believe further
proceedings, including expedited discovery, are necessary before the district court can confidently decide whether the
working group is a F ACA committee.
Accordingly, we reverse the district court and lift the
preliminary injunction on the operations of the Task Force.
The Task Force need not comply with the requirements of
FACA because it is a committee composed wholly of full-time
government officials. We also reverse the district court's
dismissal of appellees' claims as to the working group under
Rule l2(b)(6). We remand for further proceedings, including
expedited discovery, regarding the working group.
So ordered.
�-1
BucKLEY, Circuit Judge, concurring in the judgment: I
admit at the outset the persuasive force of the majority's
opinion-a force derived, I think, from a comparison of the
most obvious facts of this case with those of Public Citizen v.
United States Department of Justice, 491 U.S. 441 (1989).
Public Citizen interpreted the word "utilized" so as to exclude the Justice Department's use of a committee of the
American Bar Association whose only mission was to advise
on appointments to the federal judiciary. In concluding that
Congress did not intend to subject the ABA Committee on
the Judiciary to F ACA's requirements, the Court acknowledged that what "tip[ped] the balance decisively against
F ACA's application," id. at 465, was the "cardinal principle"
that where "a serious doubt of constitutionality is raised, ...
the Court will first ascertain whether a construction of the
statute is fairly possible by which the question may be
avoided." /d. at 46~6. Here, to achieve a similar end, we
are asked only to stretch the phrase "officer or employee of
the Federal Government" far enough to include a person who
is greeted like a head of state, guarded by the Secret Service,
and funded from the public fisc. On f1rst appearances, Public
Citizen would seem to support both the majority's result and
the reasoning used to reach it.
If this case is to be distinguished from Public Citizen, it is
not because of a lack of gravity in the constitutional issues it
presents. In United States v. Nixon, 418 U.S. 683 (1974)
("Nixon I "), and Nixon v. Administrator of General Services, 433 U.S. 425 (1977) ("Nixon II"), the Supreme Court
recognized a constitutionally grounded doctrine of executive
privilege which holds that Presidential communications are
presumptively privileged against disclosure:
Human experience teaches that those who expect public
dissemination of their remarks may well temper candor
with a concern for appearances and for their own interests to the detriment of the decisionmaking process ....
A President . . . must be free to explore alternatives in
the process of shaping policies and making decisions and
�2
to do so in a way many would be unwilling to express
except privately. These are the considerations justifying
a presumptive privilege for Presidential communications.
The privilege is fundamental to the operation of Government and inextricably rooted in the separation of powers
under the Constitution.
Nixon /, 418 U.S. at 705, 708. The Court found that this
privilege extends
to communications in performance of a President's responsibilities . . . and made in the process of shaping
policies and making decisions.
Nixon II, 433 U.S. at 449 (quoting Nixon/, 418 U.S. at 708,
711, 713) (internal quotation marks, brackets, and citations
omitted). And it set forth standards for evaluating intrusions
on privileged communications:
[l]n determining whether the Act disrupts the proper
balance between the coordinate branches, the proper
inquiry focuses on the extent to which it prevents the
Executive Branch from accomplishing its constitutionally
assigned functions. Only where the potential for disruption is present must we then determine whether that
impact is justified by an overriding need to promote
objectives within the constitutional authority of Congress.
/d. at 443 (citations to Nixon I omitted).
We confront in this case a task force consisting of the
President's closest advisors that was established to address a
paramount political priority. Because it included his wifeby all accounts, a person whose policy advice he has relied on
throughout his public life-the Task Force on National
Health Care Reform arguably was bound by law to conduct
its proceedings in public. Given these circumstances, the
considerations animating the Presidential privilege, like the
President's claim of privilege itself, are before us in pointed
fashion. My colleagues, sensing the weight of these issues,
hold that we may avoid addressing them through "prudent
�3
use" of Public Citizen's "maxim of statutory construction."
Maj. Op. at p. 23, I cannot agree.
I begin with the axiom that in interpreting a statute, a
court must ascertain the will of the enacting Congress. Here
I admit to detecting something of an implicit argument in the
Government's pleadings before this court. To the extent that
it may be discerned, this argument begins with an assumption
that Public Citizen's result could not have been reached
through genuine interpretation-interpretation that is consistent with the will of Congress-and ends with the conclusion
that Public Citizen authorizes courts to avoid constitutional
issues by ascribing implausible meanings to the most unambiguous language. The suggestion, I admit, is tempting. But
it is also barred by the very decision on which the Government places its principal reliance. Public Citizen states
explicitly that courts "cannot press statutory construction to
the point of disingenuous evasion, even to avoid a constitutional question." 491 U.S. at 467 (internal quotation marks
and citation omitted).
The weakness of the position that F ACA may be interpreted to exclude the Task Force is suggested by the Government's vacillation on the question of Mrs. Clinton's status.
Before the district court, the Government argued that the
Task Force was not subject to FACA because Mrs. Clinton
was the functional equivalent of a federal employee. In its ·
opening brief here, it argued that she was either an officer or
an employee without saying which. On reply, it said explicitly that Mrs. Clinton was an "officer." And at argument, it
retreated to ambiguity and again refused to categorize her.
In fact, the Government's only consistent position has been
that FACA is not subject to those statutory definitions of
"officer" and "employee" that most logically apply to it.
FACA appears in the appendix to Title 5 of the United
States Code. Sections 2104 and 2105 of Title 5 contain the
following dermitions:
�4
§ 2104. Officer
(a) For the purpose of this title, "officer", except as
otherwise provided by this section or when specifically
modified, means a justice or judge of the United States
and an individual who is(1) required by law to be appointed in the civil
service by one of the following acting in an official
capacity(A) the President;
(B) a court of the United States;
(C) the head of an Executive agency; or
(D) the Secretary of a military department;
(2) engaged in the performance of a Federal function under authority of law or an Executive act; and
(3) subject to the supervision of an authority
named by paragraph (1) of this section, or the
Judicial Conference of the United States, while engaged in the performance of the duties of his office ....
§ 2105. Employee
(a) For the purpose of this title, "employee", except as
otherwise provided by this section or when specifically
modified, means an officer and an individual who is(1) appointed in the civil service by one of the
following acting in an official capacity(A) the President;
(B) a Member or Members of Congress, or
the Congress;
(C) a member of a uniformed service;
(D) an individual who is an employee under
this section;
(E) the head of a Government controlled corporation; or
(F) an adjutant general designated by the
Secretary concerned under section 709(c) of title
32;
�5
(2) engaged in the performance of a Federal function under authority of law or an Executive act; and
(3) subject to the supervision of an individual
named by paragraph (1) of this subsection while
engaged in the performance of the duties of his
position ....
5 U.S.C. §§ 2104, 2105 (emphasis added).
The common denominator of these provisions is the requirement that both officers and employees be "appointed in
the civil service." In the Executive Branch, the civil service
consists of (1) positions requiring Senate confirmation, (2) the
"Senior Executive Service," (3) the "competitive service," and
(4) "positions which are specifically excepted from the competitive service by or under statute." 5 U.S.C. § 2102(a).
Mrs. Clinton does not wear any of these labels. See, e.g., 5
U.S.C. § 3132(a)(2) (defming "Senior Executive Service position"). The Government's (and the majority's) strategy, then,
is to argue that she need not satisfy the section 2104 and 2105
definitions because they do not apply to F ACA. Specifically,
because F ACA has been codified in an appendix to Title 5,
not in the title proper, the Government contends that the
sections do not govern the meaning of "officer'' and "employee" as used in the defmition of "advisory committee." For
several reasons, I disagree.
First, there is the plain meaning of the statutory language.
An appendix to a title of the United States Code necessarily
qualities as a part of that title. If it did not, then the
appendix would be part of no title whatever and would be an
appendix to the Code as a whole. Yet F ACA appears in the
Code under the banner, "Title 5, Appendix." Because sections 2104 and 2105 state plainly that they apply "[f]or the
purpose of'' Title 5, and because F ACA is a part of that title,
the definitions apply to FACA.
Second, Congress surely knew that F ACA would be codified under Title 5. The same statute that adopted sections
2104 and 2105 also stipulated that Title 5 be captioned:
"Government Organization and Employees." Pub. L. No. 89554, 80 Stat. 378, 408-09 (1966). A glance at the captions of
�'
6
the remaining 49 titles in the Code confirms that Title 5 is the
only one under which F ACA could have been codified.
Third, there are the practical considerations. The Ethics
in Government Act, codified alongside F ACA in Title 5's
appendix, requires fmancial disclosures from "each officer or
employee in the executive branch" who meets certain criteria.
Ethics in Government Act of 1978, 5 U.S.C. App. 3, §§ 101(a),
101(t)(3) (1991 Supp.). F ACA imposes open-meeting and
other requirements on committees not "composed wholly of
full-time officers or employees of the Federal Government."
5 U.S.C. App. 1, § 3(2) (1988). And, although each of those
statutes contains a sizable definitional section, neither defines
either "officer" or "employee." See 5 U.S.C. App. 1, § 3
(1988); 5 U.S.C. App. 3, § 109 (1991 Supp.). The Government tells us that those terms are intentionally left undefined
even though Congress took the trouble, in those statutes, to
define terms that are of far less significance. See, e.g., 5
U.S.C. App. 1, § 3(4) (1988) ("The term 'Presidential advisory
committee' means an advisory committee which advises the
·President"); 5 U.S.C. App. 3, § 109(3) (1991 Supp.) (" 'designated agency ethics offlci;ll' means an officer or employee who
is designated to administer the provisions of this title within
an agency''). But without definitions of "officer'' and "employee," neither statute could be sensibly administered. The
better explanation for the absence of these defmitions is that
their repetition in F ACA and the Ethics in Government Act
would have been redundant.
Finally, there is the apparent reasoning behind F ACA's
location in Title 5's appendix. The United States Code is
published pursuant to 1 U.S.C. §§ 201-13 (1988). That law
requires the codification of new laws in annual Code supplements and permits the publication of an entirely new Code
every five years. See id. § 202. Thus, the current United
States Code and supplement contain all laws of the United
States that are "general and permanent in their nature." /d.
§ 204(a). As of 1988, ten of the fifty U.S.C. titles contained
an appendix. See 5, 10, 11, 18, 26. 28, 40, 46, 49, 50 U.S.C.
(1988). Some statutes have been placed in appendices because, while considered more than temporary, they are
viewed as less than permanent additions to the Code. See 40
U.S.C. App. (Appalachian Regional Development Act of 1965).
�7
Other statutes have been relegated to appendices because
they were not enacted directly by Congress. See 11 U.S.C.
App. (Bankruptcy Rules and Official Forms as promulgated
by Supreme Court pursuant to 28 U.S.C. § 2075). With
respect to Title 5, Congress has divided it into three parts:
"The Agencies Generally'' (Part 1), "Civil Service Functions
and Responsibilities" (Part II), and "Employees" (Part III).
See Pub. L. No. 89-554, 80 Stat. 378 (1966), as amended by
Pub. L. No. 96-54, § 2(a)(l), 93 Stat. 381 (1979). An appendix to Title 5, then, is the natural place to codify statutes that
relate to "Government Organization and Employees" but do
not pertain to "The Agencies Generally," "Civil Service Functions and Responsibilities," or "Employees." As of 1988, five
acts, including F ACA, had been codified in Title 5's appendix.
None of these fits within any of the three pigeonholes into
which the main body of the title has been divided.
As against all of this-the statute's plain language, the
imputed knowledge of its draftsmen, the practical need for
Title 5's defmitions to apply to its appendix, and the apparent
reasons for F ACA's placement there-the Government can
offer a bare shred of legislative history. It points out that
the Senate version of F ACA explicitly incorporated the Title
5 defmitions of "officer'' and "empl9yee," but that these were
dropped at conference. The question, of course, is whether
the conferees discarded the definitions because they were
redundant (as F ACA was destined for codification under Title
5), or because they wished the definitions not to apply to
FACA.
The evidence on this issue consists of statements from the
reports of the Senate Committee on Government Operations
and the House-Senate Conference Committee. Referring to
the section of the Senate bill that incorporated definitions to
be found in the main body of Title 5, namely, those for
"agency'' (5 U.S.C. § 551(1 )), "officer'' (5 U.S.C. § 2104), and
"employee" (5 U.S.C. § 2105), the Senate Report stated only
that these three defmitions had "been chosen to give the
broadest interpretation to the coverage commensurate with
generally accepted principles of law." S. Rep. No. 1098, 92d
Cong., 2d Sess. 8 (1972). The Conference Committee Report
�,...
8
merely noted that "(t]he conference substitute deletes the
Senate amendment definitions of 'officer' and 'employee.' "
H.R. Conf. Rep. No. 1403, 92d Cong., 2d Sess. 9 (1972). The
definition of "agency," however, was retained.
The Government infers, from the deletion of two of the
Senate definitions and the retention of the third, that the
conferees found the definitions of "officer" and "employee"
inapplicable to F ACA. There is a far more plausible explanation. As sections 2104 ("officer'') and 2105 ("employee") were
applicable to all statutes codified under Title 5, they were
superfluous. The definition of "agency," by contrast, appears
under the heading, "For the purpose of this subchapter-," 5
U.S.C. § 551 (emphasis added), and therefore would not
apply to F ACA unless specifically incorporated into that Act.
Even if we could disregard the definitions found in Title 5,
we would still be compelled to attach meanings to the words
"officer" and "employee" that Congress tl').ight reasonably
have had in mind. To this end, I have examined other
sources for defmitions of these terms. At the outset, I
dismiss the possibility that Mrs. Clinton might be considered
an employee. In these proceedings, the Government has not
attempted to argue that Mrs. Clinton is an employee for
purposes of F ACA-no doubt because her services are unpaid. Cf. Black's Law Dictionary 471 (5th ed. 1979) (defining
employee as "[o]ne who works for an employer; a person
working for salary or wages"). And while the majority does
assert that Mrs. Clinton "could still be regarded as an
'employee'" under FACA, Maj. Op. at p. 10, it too lacks an
argument in support of the proposition. In particular, it
ignores the fact that, while subsections (a) and (b) of 3 U.S.C.
§ 105 explicitly "authorize[]" the President "to appoint and
fix the pay of [White House] employees," subsection 105(e),
the statutory acknowledgment of the First Lady's role, is
carefully phrased so as not to authorize her appointment as
an employee or any remuneration for her services. An
"unpaid employee" is an oxymoron. although an "unpaid
officer" is not. F ACA's strictures can be avoided, then, only
if it can credibly be argued that Mrs. Clinton is an officer of
the Federal Government. I can find no such argument.
\
I
'
�9
To begin with the beginning, the Constitution imposes
certain requirements on those who are to serve as officers of
the United States. Such persons must be appointed by the
President with the consent of the Senate unless Congress, by
law, has vested the power of appointment "in the President
alone, in the Courts of Law, or in the Heads of Departments,"
U.S. Canst. art. II, § 2, cl. 2. Furthermore, all officers must
take an oath to support the Constitution. I d., art. VI, cl. 3.
Congress has enacted laws to implement these requirements.
See, e.g., 5 U.S.C. § 3331 (officers of the United States
required to swear an oath); 5 U.S.C. § 2906 (officers' oath to
be "preserved"); 5 U.S.C. § 2902 ("officer(s] appointed by the
President" must have commissions made out and sealed by
the Secretary of State); 5 U.S.C. §§ 3333, 7311 (anyone who
accepts either "office or employment in the Government of
the United States" required to swear their loyalty by affidavit). We have received no indication that any of these
requirements have been met with regard to Mrs. Clinton.
More generally, an officer implies an office, and an office
implies duties. Title 1 of the United States Code defines
"officer'' by reference to an "office" with "duties"-" 'officer'
includes any person authorized by law to perform the duties
of the office." 1 U.S.C. § 1. And the Supreme Court has
interpreted "officer" similarly with reference to the Constitution. In Burnap v. United States, 252 U.S. 512, 516 (1920),
the Court reasoned: "Whether the incumbent is an officer or
an employee is determined by the manner in which Congress
has specifically provided for the creation of the several positions, their duties and appointment thereto." Burnap held
that a "landscape architect" was an employee, not an officer,
because "(t]here (was] no statute which creates an office of
landscape architect . . . nor any which defines the duties of
the position," id. at 517, and because "(t]here (was] no statute
which provides specifically by whom the landscape architect
... shall be appointed." ld.
The undoubted value of the services that the wives of
Presidents have rendered their husbands and their country
notwithstanding, it cannot be said that they have occupied an
office with duties. The provision of the U.S. Code on which
�r.
10
the majority relies, 3 U.S.C. § 105(e), is carefully phrased so
as not to name a position or prescribe duties a President's
spouse is to fulfill. In fact, section 105(e), strictly speaking,
does not even authorize a First Lady to assist the President;
rather it authorizes federal employees to assist the First
Lady, and, in the course of doing so, acknowledges the
assistance that First Ladies commonly render their spouses.
In sum, Mrs. Clinton carries none of the indicia of a federal
officer. She has neither been appointed to nor confirmed in
the position of "First Lady," she has taken no oath of office,
and she neither holds a statutory office nor performs statutory duties.
Having searched the U.S. Code and the Government's
briefs in vain for definitions of "officer" that might give aid
and comfort to the Government, I conclude that under any
fair interpretation of the term, Mrs. Clinton is not an officer
of the United States. But to complete this tour through the
statute books, I note that section 105(e) does not, as the
Government and the majority contend, require a fmding that
Congress has acknowledged that a President's spouse performs the duties of an officer. Another direct congressional
statement on the subject of the First Lady's duties appears in
the Anti-Nepotism Act. That Act declares that public officials (expressly including "the President") may not employ
relatives (expressly including a ''wife") in i•a civilian position
in the agency in which he is serving or over which he
exercises jurisdiction or control." 5 U.S.C. § 3110(a), (b).
The use of the defmite article in the phrase "the agency in
which he is serving'' appears to imply that every "public
official" belongs to some agency and that their relatives may
not be employed in that agency, whatever it happens to be.
Moreover, as a matter of policy and consistency, the restrictions on the President under the Anti-Nepotism Act must be
viewed to be as broad as the Executive Branch: It is inconceivable that Congress, in combatting nepotism, intended to
forbid Mrs. Clinton's service as Attorney General while permitting her appointment as National Security Advisor.
Viewed purely as a matter of congressional intent, the argument that the Anti-Nepotism Act applies only to the Depart-
�11
ments and not to the White House, see Maj. Op. at p. 12, is a
weak one. As a result, any gravitational pull exerted in the
· direction of congressional acceptance of a President's spouse
as a "de fado officer'' attributable to section 105{e) is overwhelmed by the opposite force exerted by the Anti-Nepotism
Act.
One final consideration. Although we may assume that,
when drafting F ACA, Congress gave no thought to the
possibility that a President might appoint his spouse to an
advisory committee, we may not assume that it failed to
contemplate the relationship between F ACA and the legal
obligations and sanctions imposed on officers and employees
of the Federal Government.
As one reviews the affidavit filed with the district court by
Ira Magaziner, Senior Advisor to the President for Policy
Development, one is struck by the fact that every member of
the Task Force and Interdepartmental Working Group, but
one, was subject to one or more of the statutes that Congress
has enacted to ensure the proper conduct of members of the
Federal Government--the "insiders," as the Government describes those who qualify as "full-time officers and employees" within the meaning of FACA. These laws impose burdensome ethics requirements. See, e.g., Ethics in Government Act of 1978, 5 U.S.C. App. 3, § 101<0(3) (1991 Supp.)
(applying financial disclosure requirements on all higher paid
"officers and employees" in the Executive Branch); id.
§§ 501(a)(1), 505(2) (1991 Supp.) (applying outside income
limitations on all higher paid officers and employees except
"special government employees"); 18 U.S.C. § 205 (1991
Supp.) (prohibiting any "officer or employee" from representing outsiders in "matters affecting the Government"); id.
§ 207 (prohibiting anyone who formerly was an "officer or
employee" from participating in certain governmental proceedings and decisions after leaving government employment); id. § 208 (prohibiting an "officer or employee" from
"participat[ing] personally" in a matter affecting "a financial
interest"); 5 U.S.C. § i324 (1988) (prohibiting an "employee
in an Executive agency" from taking "an active part" in
political campaigns). And even though the Government argues that the Interdepartmental Working Group was not an
�•
12
advisory committee within the meaning of F ACA, Mr. Magaziner nevertheless took pains to stress the fact that every
member of and consultant to the Group-whether a regular
or special government employee, whether working full time or
part, for pay or without-was required to file a fmancial
disclosure statement and to comply with other requirements
of these laws. See Magaziner Affidavit, Gov't App. at 41-43.
These requirements, then, appear as a signal distinction
between what would normally be considered to be "inside"
and "outside" members of advisory committees. In fact, this
distinction-the legal obligations and sanctions imposed on
officers and employees of the Government as opposed to
private citizens-undoubtedly provides a substantial part of
the justification for the very different requirements imposed
by F ACA on committees that are composed exclusively of
federal officers and employees and those that are not. In
enacting F ACA, Congress found that "[o]ne of the great
dangers in the unregulated use of advisory committees is that
special interest groups may use their membership on such
bodies to promote their· private concerns." H.R. Rep. No.
1017, 92 Cong., 2d Sess. 6 (1972). Because committees not
composed exclusively of federal officers and employees have
members who are not required to foreswear their private
associations and insulate themselves against potential conflicts of interest, F ACA requires, as an alternative check, that
their deliberations be conducted in the open.
When the majority states that we "need [not] consider
whether Mrs. Clinton's presence on the Task Force violates
. . . any conflict of interest statutes," Maj. Op. at p. 24 n.lO, it
indicates that we have not been presented with claims under
these statutes that call for adjudication. The question remains, however, whether Congress. if it had ever considered
that the President's spouse might be appointed an official
member of a Presidential advisory committee, would have
labelled her an "officer or employee" within the meaning of
FACA. To put it another way, could Congress have intended
that Mrs. Clinton, alone of the tweive members of the Task
Force and 340 members of the Working Group, would be
�13
entirely exempt from the reach of ethics laws that Congress
has imposed on the President himselr! I think not.
In visiting these sundry provisions, I doubt I have said very
much with which my brethren in the majority would disagree.
Our disagreement centers, I think, not on Congress's intent
in enacting the relevant statutes, but on the lens through
which we must view that intent in this particular case. The
majority argues (1) that construing the phrase, "officers and
employees," to exclude Mrs. Clinton would give rise to
weighty constitutional issues, Maj. Op. at p. 22; (2) that the
Public Citizen Court avoided deciding similar issues by embracing "an extremely strained construction of the word
'utilized,' " Maj. Op. at p. 14; (3) that "[i]t is reasonable ... to
construe section 105(e) as treating the President's spouse as a
de facto officer or employee," Maj. Op. at p. 11; and hence (4)
that the phrase "full-time officer or employee of the government" must a fortiori be read to apply to Mrs. Clinton, Maj.
Op. at p. 24. I remain unconvin~ed.
First, I do not think that section 105(e) can reasonably be
read to create an officer or employee, either de facto or
otherwise; and even if it could, I do not think we could avail
ourselves of such a reading in this case. I noted above that
section 105(e) has been carefully phrased so as not to recognize an office, an officer, or an employee. But equally
important, I know of no case in which the Supreme Court has
saved one provision from constitutional difficulty by liberally
construing another, entirely unrelated provision. In Public
Citizen itself, as well as in every case cited in Public Citizen
in which the Court avoided a constitutional challenge, the
Court sidestepped the constitutional claims presented
through an interpretation of the statute under attack. See
Public Citizen, 491 U.S. at 465-66 (citing cases); see also id.
at 465, 467 (avoiding a constitutional challenge to F ACA by
construing F ACA § 3(2)); see also, e.g., Edward J. DeBartolo
Corp. v. Florida Gulf CoMt Bldg. & Constr. Trades Council,
485 U.S. 568, 575, 588 (1988) (avoiding a constitutional challenge to the National Labor Relations Act by construing
NLRA § 8(b)(4)); St. Martin Evangelical Lutheran Church
v. South Dakota, 451 U.S. 772, 780-81, 788 (1981) (avoiding a
�r.
14
constitutional challenge to the Federal Unemployment Tax
Act by construing FUTA § 3309(b)). Because it is FACA
that is under attack, I think that any additional degree of
interpretive freedom we enjoy in construing F ACA cannot be
extended to a statute authorizing expenditures for White
House staff.
Second, I cannot believe that Public Citizen establishes the
rule my colleagues tacitly embrace. In reaching their holding, the majority implicitly distinguishes between "extremely
strained construction," which, under their reading, Public
Citizen permits or even requires, and "disingenuous evasion,"
which it explicitly forbids. Compare Maj. Op. at p. 14 with
491 U.S. at 467. The rule the majority appears to adopt,
then, is that judges must strain (but may not evade) the plain
meaning of a statute before they may entertain an "asapplied" constitutional challenge. If my colleagues are right,
the line between "extremely strained construction" and "disingenuous evasion" will determine the outcome in every case
involving an as-applied challenge presenting "formidable constitutional difficulties.'~ Public Citizen, 491 U.S. at 466.
While I suspect my colleagues may have some sympathy (as I
do) with Justice Kennedy's position that the Supreme Court
majority in Public Citizen had stretched· its interpretation of
FACA "beyond the point at which such a construction remains 'fairly possible,'" ici at 481 (Kennedy, J., concurring in
judgment) (emphasis in original), I cannot believe the Court
intended to establish a rule requiring such constructions in
cases posing serious constitutional questions.
A review of its reasoning demonstrates that Public Citizen
neither explicitly nor implicitly sanctions "strained" statutory
interpretation. Its holding-that the ABA Committee was
not "utilized" by the President within the meaning of
F ACA-was based principally on three considerations. The
first of these was that, in the Court's memorable phrase,
" 'utilize' is a woolly verb," ici at 452, which necessarily
requires judicial definition. Second, it recognized that a
"dictionary reading [of the word "utilize" in] FACA's definition of 'advisory committee' " would lead to a statute of
"almost unfettered breadth" and produce "absurd results."
�15
Id. at 452 & n.8, 452-04. Taken literally, F ACA's definition
would have endowed the President with Midas ears capable of
turning any continuing source of consensus opinion into a
F ACA committee. In such a world, the physicians jointly
consulted to protect the President's health, the editorial board
of the President's favorite newspaper, and two dietitians
jointly planning the President's meals could all be classified
as "Presidential advisory committees" subject to regulation.
Because "the literal reading of [utilize] would 'compel an odd
result,'" the Court "search[ed] for other evidence of congressional intent to lend the term its proper scope." I d. at 454
(citation omitted). Third, on examining F ACA's origins and
legislative history, the Court concluded that while "it seems
to us a close question whether F ACA should be construed to
apply to the ABA Committee, . . . we are fairly confident it
should not." I d. at 465.
The Court reached this last conclusion in significant part on
the basis of the following passage from the F ACA Conference
Report: "The Act does not apply to persons or organizations
which have contractual relationships with Federal agencies
nor to advisory committees not directly established by or for
such agencies." /d. at 462 (emphasis added by Public Citizen ). The Court also noted that the relationship between the
ABA Committee and the Justice Department had not fallen
within the scope of President Kennedy's Executive Order No.
11007, from which FACA was derived. Id. at 462-03. From
this, the Court concluded that "[t]he phrase 'or utilized'
therefore appears to have been added simply to clarify that
F ACA applies to ad\;sory committees established by the
Federal Government in a generous sense of that term," id. at
462; and that "[r]ead in this way, ... the word 'utilize' does
not describe the Justice Department's use of the ABA Committee," id. at 463.
In applying what the majority, Maj. Op. at p. 8, has
laconically (and accurately) described as a "rather sweeping"
statutory definition of "advisory committee" to the unique
relationship between the Justice Department and the ABA
Committee, the Court concluded that it was more probable
than not that Congress did not intend that F ACA apply to
·•
.
--------------------------------------~~
�I
16
such privately organized groups. Nevertheless, because it
considered the question close in light of the broad sweep of
the definition, literally interpreted, it applied its venerable
rule of statutory construction to tip the balance away from
one that would have presented "formidable constitutional
difficulties." I d. at 466.
In this case, we deal not with woolly terms but with the
meaning of two words in common legal usage, "officer'' and
"employee." Far from creating absurdity, literal interpretations of these terms are necessary in order to give effect to
the congressional policy of drawing sharp distinctions between individuals outside the Government and those within it.
And in contrast with Public Citizen, in which no statutory
definition of "utilize" was available and great weight was
placed on legislative history, definitions of both "officer'' and
"employee" have been enacted into law by Congress. In this
case, none of the considerations animating Public Citizen are
remotely presented; and because we do not deal with ambiguous terms, there is no "balance" to be tipped by resort to
legal maxims. Despite appearances, Public Citizen has little
to do with the case we decide today.
Finally, to conclude my statutory analysis, I note that the
Nixon I Court engaged in a patently straightforward interpretation of Federal Rule of Criminal Procedure 17(c), 418
U.S. at 697-702, even though it recognized that "[i]f we
sustain[ ] this challenge, there [will] be no occasion to reach
the claim of privilege asserted." I d. at 698. Needless to say,
the considerations counseling avoidance of difficult constitutional issues were never more pressing than on the facts of
Nixon I. Because I can find no credible argument to the
contrary, and because I cannot bring myself to strain the
meaning of "officer'' or "employee" to produce one, I would
hold that the Task Force was not exempt from the public
disclosure requirements of F ACA; and having done so, I
would address the constitutional implications of that holding.
As I pointed out earlier, the Supreme Court has acknowledged a Presidential right to confidentiality that "is fundamental to the operation of Government and inextricably root-
�17
ed in the separation of powers under the Constitution."
Nixon I, 418 U.S. at 708. Although the privilege is not
absolute, the Court has only twice found that it must yield to
competing constitutional interests, such as "the primary constitutional duty of the Judicial Branch to do justice in criminal
prosecutions," id. at 707; and in each case, it has protected
the confidentiality of Presidential communications from unwarranted disclosure.
In Nixon I, in which President Nixon sought to enjoin the
subpoenaing of certain of his papers, the Court found it
necessary to
weigh the importance of the general principle of confidentiality of Presidential communications in performance
of the President's responsibilities against the inroads of
such a privilege on the fair administration of criminal
justice.
ld. at 711-12. It concluded that the President's "generalized
interest in confidentiality . . . cannot prevail over the fundamental demands of due process of law in the fair administration of crimmal justice." ld. at 713. Accordingly, it ordered
the examination in camera of the papers subject to an
instruction that the district .court be scrupulous in "protect[ing] against any release or publication of material not
found by the court [to be1 probably admissible in evidence
and relevant to the issues of the trial for which it is sought."
ld. at 714.
Nixon II involved a balancing of the President's interest in
the confidentiality of his communications against other national interests. In that case, former President Nixon asserted
the Presidential privilege in a challenge to the constitutionality of the Presidential Recordings and Materials Preservation
Act, which placed his papers in the custody of the Administrator of General Services. See 433 U.S. at 429-30. The
Supreme Court found that the statute was constitutional
because of the Nixon papers' historical importance and their
possible significance as aids to the legislative process, and
because of "the safeguards built into the Act to prevent
disclosure of [confidential] materials and the minimal nature
.•.
�-18
. of the intrusion into the confidentiality of the Presidency."
I d. at 454. Those safeguards included the requirement that
"any party's opportunity to assert any . . . constitutionally
based right or privilege" be protected. ld. at 450 (quoting
section 104 of the Act). The Court concluded "that the
screening process contemplated by the Act [, which was to be
conducted by Executive Branch archivists,] . . . will not constitute a more severe intrusion into Presidential confidentiality than the in camera inspection by the District Court
approved in [Nixon I ]." I d. at 455.
In these two cases, the Court permitted only the most
limited intrusions on the privilege. FACA, by contrast,
would have required that the Task Force operate in the full
glare of provisions requiring public meetings and disclosure
of records. It is hard to imagine conditions better calculated
to suppress the "candid, objective, and even blunt or harsh
opinions," Nixon I, 418 U.S. at 708, that the President was
entitled to receive from the twelve advisors he had appointed
to his Task Force. Because none of Congress's purposes in
enacting F ACA are of a gravity that would justify overriding
the Presidential privilege in this case,· I would conclude that
F ACA is unconstitutional as applied to the Task Force.
For the foregoing reasons, I concur only in the majority's
conclusion, in Part III of its opinion, that FACA's public
disclosure provisions may not be applied to the Task Force.
With respect to Part IV, I agree that the district court must
develop further facts before it can determine whether the
Working Group, or any division thereof, qualified as an
advisory committee under F ACA.
•
�PAGE
1
LEVEL 1 - 1 OF 25 STORIES
Proprietary to the United Press International 1993
February
14, 1993, Sunday, BC cycle
ADVANCED-DATE: February 10, 1993, Wednesday
SECTION: Commentary
LENGTH: 786 words
BYLINE: BY HELEN THOMAS UPI White House Reporter
DATELINE: WASHINGTON
KEYWORD: BACKSTAIRS
BODY:
The White House counsel has ruled that Hillary Rodham Clinton's task force
on health care reform does not have to operate in the open under the so-called
sunshine laws.
Some congressmen had suggested that the rules for advisory groups that
include non-governmental experts must make their meetings open to the public and
reporters.
But the White House says that stipulation does not apply to the first lady's
group, which has a May deadline to produce a blueprint to make sure that
everyone in the country is covered with some health plan. An estimated 37
million people do not have such insurance.
But the first lady and Tipper Gore, wife of the vice president, will be
criss crossing the country to cull ideas on the best approach to a pressing
problem.
French reporters are saying that if Mrs. Clinton visits Paris with the
president at some point she will be lionized. They say that the first lady is
more popular than the president and there is much more curiosity about her in
every way, including, of course, her fashion sense.
It's recalled that when President John F. Kennedy and his stunning wife
Jacqueline were honored at a state dinner at Versailles, Kennedy spoke a
memorable line: ''I'm the man who came to Paris with Jackie Kennedy.''
Signs of the times: In the botched-up search for an attorney general to
complete the Clinton Cabinet things got so bad that when George Stephanopoulous,
director of communications, celebrated his birthday on Feb. 10 and was asked
what he wanted for his birthday, he replied: ''An attorney general.''
James Carville and Paul Begala, the two political strategists, who kept the
Clinton campaign on track and on the road to victory, are back at the White
House as consultants.
�PAGE
Proprietary to the United Press International, February 14, 1993
2
Carville, who put up the sign ''The economy stupid'' as a constant reminder
to the troops that the economy was the issue and nothing else in the last
campaign, has been SOSed to get back on board.
He and Begala, who apparently will be paid by the Democratic National
Committee, have been summoned to help put over the president's economic package,
which reportedly will hit all constituencies in the pocketbook.
The two image makers, who passed up a chance to join the Clinton staff,
seeking greener fields and probably more money on the outside with their
expertise, will be around to help the president deliver his message.
The call came to them after the Clinton honeymoon was pronounced almost over
by Washington scribes and broadcasters.
The role of commander in chief is not usually played up in a presidential
campaign with the constitutional accent on civilian rule. But it is very much a
part of the presidency as Clinton has learned. When he steps aboard his
helicopter there are two Marines waiting to salute him. He is followed by a
military aide carrying a briefcase, the so-called football that contains the
nuclear codes. The ''president's own band'' is drawn from the u.s. Marine Corps.
Wth all of that, President Clinton is now getting used to returning the
military salute.
The
and was
he sold
tips on
president has complained about the telephone system in the White House
concerned that he could not put in a call without someone tuning in. But
the operators and the operations short since all he needed was a few
how the system works.
He could have pressed a ''private'' line and no one could listen in unless
he allowed it. He could also arrange to have his calls scrambled.
Contrary to widespread belief the old ''hotline'' between Washington and
Moscow was not a telephone to warn against an impending doomsday attack, but
rather a teletype manned at the Pentagon.
1
The president is a coffee drinker, but he does not suffer from coffee nerves
since he drinks the decaffeinated brand. The coffee·pots outside the oval Office
and the Roosevelt Room are constantly percolating.
I
jog.
And a cup of coffee is the first thing the president wants after a morning
Hillary Rodham Clinton's creation of a smoke-free environment at the White
: House does not appear to have caused much hardship.
1
She had been preceded by ABC-TV correspondent Sam Donaldson who four years
ago conducted a one-man crusade against smoking in the press room. And he
succeeded in clearing the air.
-~------
�•
' •
PAGE
Proprietary to the United Press International, February 14, 1993
3
In the old days, the small White House press room was indeed smoke filled
and even had some broken whiskey bottles around but those days are gone forever.
Former first lady Nancy Reagan decreed a no smoking ban on Air Force one and
wiped out the packages of cigarettes doled out as mementos that were engraved
with the insignia of Air Force One.
�. TIIEI"AS!IJNC'nN¥ PosT
.WmNESDAY, 11/NE 23:i993
'' .
------------------------------~--
Health· TaSk Force
Oosed Doors Baclied~
.....
Ruling Could Lead to Release of Papers-;~,:::~
.... .:···.
·.
----~~~~-.~~YM~k----
......., . . 5111 .....
A U.S. Court of Appeals panel
yesterday ruled the White House
legally was not required. to hold
open meetillgs of the ~-dis
banded health care task force head·
ed by Hillary Rodbam ClintoiL :
The tliree-judge paneJ.suggested
that the essential work of the :task
force was clone by subgroups of
more than 500 people, and it sent
the caae back to the trial judge With.
a legal road map that could lead to
release of thowiluuls of documents· ·
c:Ompi)ed by the task force staff.·
The task . force, .wbicb was ..
charged with developing a prilposa1
for national health care reform.' was
disbanded May 30, but.tbe'Wbite.
House is clelaying release :ol the .
legi!dative package.
.
·..
YesterdaY'II ~written by ..
Appeals Judge ~ H. Silber- .
man for the panel that ioc:hided ap. .. . . ..
,. .,
; 1 :~!..·.!
peals judges James L Buckley and •confirms that .the task force opeJto~
Stephen F. WiDiams-was based .on. ated in full compliance with the Jaw .
how the judges, all Reagan admin·
Kent Masterson Brown, a ·
istration appointees. viewed' the ingtoa, Ky., lawyer who ~u
legal status of Hillary Clintoa.
. the health care groups, hailed y~"
Because Congress bas for, years terday's decision. "The real stuff:ia),
authorized presidents to hire aides in the working groups ••• and D8Jio.o
for their spouses, Silberman wrote, we're given the green light on ~~
Hillary .Clinton is a •de facto [fed·.. issue.~ he said. ."AU the [task fora:J....i
eral) officer or employee: And be- · documents were generated and .aJl...:
ca~ f~ law recpmes ooly. the pnpsals were made by ~tl,le:•..
those · advisoly' COJDJDJttees . that · working JP'Oup&, and now we ~~
-containp(ivatecitizens.toholdopeo proceed (to get them relea&e!tk.~
meetings, SDberman said, the CJin.. We're i-eally thrilled to death:
ton administration's task force is . . Silberman said in his opinion that_
exempt from the law.
the lower court must reconsider the ·
Silbermall Cl!ftCeded · that the · ~ issue of whether the . woriQiqr·~
court was~h'berally COiistruillg' one .f group's material must be made P.Air .
law:la ardeir·to avoid ruling that an- ! lie because it is unclear wbethei-cbi!
other.li..-tbe _advisory c:olilmittee •,. group includes P"':a~ ci~ _ . .
act•ISUnCODStitutlonaL· . ·· ., · ':.
The Clinton administratiOn~
'lbualie startecHo late Febnmry:i! in court that onlY government epif
whea two .health care 'lfOIIPt and a ,.; ployees · were amana those who·'"
public, iaterest•. organization sued ·, served OD the working groups,. but •
Hillaty Clinton, asking the coua ·to .·i SDberman said that assertion is opQ;
order tl)at.the taskforc8's. ~r~- to q~ Qf ~.Jnm~ of~.
be DPI!Il to.the public. . . . · .,, « .. . pie mvolved, SDberman said, some
l4W:b."''Silberman'8 ~vmJi were classified as "special gOV{!Dl
~~-:the so-called. WOrfiiiit:~ •ne••Umplo~ while others ·~·
·grQUpS, Jh) 30'subgroups that: pro-:.:; termed "toDSUitants: SDberman • .
viiled resean:b, clrafting·llllllliC!Iic1
aSsistatu:e to the task forte.' •' · · · ·
· The. '!bite House yesterday issued''·
a stafl!meat· that said the dedsioft· ..
. ' ! . ·.
.
.•
\" . :.:
~
it is now up to the lower court tp ~ •
cide whether those classificatioDS are
accurate and whether the advisoyy_.
committee law·applits.
.
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LEVEL 1 - 2 OF 25 STORIES
Copyriqht 1993 Globe Newspaper Company
The Boston Globe
February
12, 1993, Friday, City Edition
SECTION: NATIONAL/FOREIGN; Pq. 1
LENGTH: 914 words
HEADLINE: On the road, Hillary Clinton shows resolve on health care
BYLINE: By Elizabeth Neuffer, GLOBE STAFF
DATELINE: HARRISBURG, Pa •.
KEYWORD: NAME-RODHAM-CLINTON TRIP HEALTH CARE
BODY:
She cited statistics without notes. She listened qraciously to lenqthy
speeches. She smiled warmly. She was careful to refer to the promised national
health care overhaul as "the president's" plan.
Hillary Rodham Clinton, the architect of President Clinton's most ambitious
domestic challenqe, went on the road yesterday, meldinq substance and style and issuinq a clear call for sweepinq chanqes in the country's "patchwork and
broken down" health network.
In her first public appearance as the administration's ambassador for health
care reform, she suqqested that powerful special interests will stand in the way
of change, and cited as an example the risinq costs of childhood immunizations,
which have jumped more than 1200 percent in the last decade.
Shakinq off the confines of Washinqton, a relaxed Clinton participated in a
round table conference and talked with health care providers and patients in a
visit that spoke volumes about how she will handle her assiqnment as the head of
the National Task Force on Health Care Reform.
With Tipper Gore, the vice president's wife, by her side, Clinton waded
throuqh ponderous details and appeared a gracious listener as the long afternoon
wore on. But she also pointedly vowed that health care reform legislation would
"be in action" by the end of the year.
"We are already spending more money than any nation on Earth" on health
care, she said, "but we are not doinq a qood job in providinq the kind of health
care that money should provide."
She gave few hints as to what the administration's health care reform would
ultimately look like. She stressed themes that were emphasized on the campaign
trail, including: standardizing complex medical forms; cutting costs; protecting
small businesses and generatinq more personal responsibility for care. She also
said insurers would have to start including everyone, regardless of existing
medical conditions.
"We don't have a system of health care, we have a patchwork broken system"
she said.
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5
The Boston Globe, February 12, 1993
Tipper Gore said she would be advising Clinton on mental health care issues.
Since its formation was announced two weeks ago, little has been revealed
about the task force and its work. The task force, slated to propose a plan
by the end of May, is made up of many members of the Cabinet.
Participants say they have since split into smaller groups, where they have
been meeting with health care authorities to examine how managed competition - a
system in which health-purchasing cooperatives would buy insurance for patients
- might affect health areas, such as rural clinics or longterm care.
Criticism has been swift in coming. There are those who have accused the
president of nepotism in the assignment. Others have attacked the secrecy that
has surrounded the task force's work.
Rep. William F. Clinger Jr., the ranking minority member on the House
Government Operations Committee, this week asked the General Accounting Office
to review whether Hillary Clinton is violating federal law by conducting the
groups meetings in private. The Federal Advisory Committee Act says task
force meetings must be held publicly if its members are not government
employees. But there is some dispute whether the act applies to her.
Her appointment to a more visible and powerful role than has usually been
held by presidential spouses has drawn ire. And though the White House may have
wished that only health care was be on the discussion agenda yesterday,
Clinton's newly defined role was, too.
Sen. Harris Wofford, who organized yesterday's conference at Pennsylvania
State University, noted the difficulties Clinton faced as he gave his
introduction yesterday.
"It's been said that taking on health care reform and putting Mrs. Clinton
in charge is a big political risk for the president," Wofford said in prepared
remarks. "Not acting on health care reform is the riskiest, and most costly,
strateqy of all."
The high-stakes gamble of her assignment has not been lost on the White
House. "She appreciates the magnitude of the undertaking," said one White House
aide.
But yesterday, Hillary Clinton drew only applause, both from waiting school
children outside the campus and from participants within.
"I applaud her courage and his courage," said Lynn Yeakel, an unsuccessful
Senate candidate from Pennsylvania.
"I'm glad you are down here, taking an interest," said Donal Diem, an
electrician who is recuperating from burns at the hospital. She spent an hour
meeting privately with administrators and physicians at the hospital, as well as
visiting a physical therapy room.
In Harrisburg, as she had on the campaign trail, she worked the crowd while
largely skirting the press with a wave and smile.
�..
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The Boston Globe, February 12, 1993
Clinton, a graduate of Wellsley College and Yale Law School, impressed many
Capitol Hill lawmakers when she went to speak with them last week. She is not
stranger to heading task forces, having spearheaded an Arkansas effort on
educational reform.
A member of a regional Southern task force on infant mortality, and a
member of the board of the Children's Defense Fund since 1976, Clinton left her
mark on health care in Arkansas, too.
"She thinks like a pediatrician," said Dr. Robert Fiser, chairmain of
pediatrics at Arkansas' Children's Hosptial, where Clinton helped raise funds.
"She is capable of instilling a development of consensus that medicine doesn't
normally think about."
GRAPHIC: PHOTO, Tipper Gore (center left) and Hillary Rodham Clinton visit with
occupational therapy patients during their tour of St. Agnes Medical Center
yesterday in Philadelphia. REUTERS PHOTO
6
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LEVEL 1 - 3 OF 25 STORIES
Copyright 1993 American Political Network, Inc.
Health Line
February
11, 1993
SECTION: POLITICS & POLICY
LENGTH: 1200 words
HEADLINE: THE ROAD TO REFORM: SPECULATION CONTINUES
BODY:
OPTIONS: w.s. JOURNAL reports Clinton's advisers have
suggested freezing Medicare payment rates to doctors and
hospitals as one method of curbing health costs in the short run.
According to a CBO report, freezing the Medicare reimbursement
rates at '93 levels could save $1.3B in fiscal year '94 and
$16.1B over the next five years (Hilary Stout/David Rogers,
2/11). BOSTON GLOBE reports the admin. is considering limits on
Medicaid and Medicare as federal deficit-reduction measures.
GLOBE: "Until now, the (admin.) was believed to be reserving
potential savings from changes in Medicare and Medicaid programs
to fund its plans to overhaul the nation's health care system."
GLOBE reports the WH also "appear(s) to be discussing the much
more controversial idea of imposing some sort of government price
controls on private medical services" (Peter G. Gosselin, 2/11).
Another option under consideration is allocating any increases in
"sin taxes" on alcohol and tobacco to finance reform. JOURNAL:
"Implicit in this decision is the assumption that additional
taxes could be needed to pay for the president's ambitious goals
of curbing health care costs and overhauling the system to
provide coverage for all Americans." According to estimates by
the Joint Cmte. on Taxation, doubling the tobacco tax to
$.48/pack would generate $3.5B in new revenue/year while an
increase in the alcohol tax to $16/gallon of 50% alcohol would
generate $4.7Bfyear. JOURNAL: "No final decisions have been
made. But people with knowledge of the deliberations said Mr.
Clinton wants a stop-gap measure that would save money on health
care while Congress debates his long-term proposal to restructure
the health care system" (Stout/Rogers, 2/11).
11
SUNSHINE LAW" DILEMMA: ARKANSAS DEMOCRAT-GAZETTE: "Only
about two weeks old, the presidential health care task force
headed by Hillary Rodham Clinton already is drawing Republican
fire" (Jane Fullerton, 2/11). In response to Rep. William
Clinger's (R-PA) request for an investigation into the legality
of Mrs. Clinton's position on the task force (see AHL, 2/9), Rep.
Tom Foglietta (D-PA) issued a statement urging cooperation on
reform. Foglietta: "This is the type of inside-the-beltway,
continue-the-gridlock, stop-the-progress, partisan bickering that
voters rebelled against in the 1992 campaign season •••• Hillary
Clinton has volunteered to take on one of the toughest jobs in
the country" (2/10).
HILLARY HITS THE ROAD: USA TODAY: "Even before the
president has a specific plan, ••• Hillary Rodham Clinton is
promoting reform at a health care conference (2/11) in
7
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Health Line, February 11, 1993
Harrisburg, PA" convened by Sen. Harris Wofford (D-PA)(see AHL,
2/10). According to USA TODAY, the conference "opens what's
expected to be a public relations contest with physicians,
hospitals and insurers over who has the best plan to guarantee
care and limit soaring costs." WH spokesperson Dee Dee Meyers:
"You can expect to see her out there talking to the American
people and trying to understand what their problems are, what
they see as the obstacles to a better health care system" (Judi
Hasson, 2/11).
WOFFORD: AP/PHILA. INQUIRER: "While pushing for his agenda
to establish national health care, ••• Wofford has received
thousands of dollars in campaign contributions from insurance
companies, hospitals and doctors with a financial stake in the
outcome of his effort •••• A list of Wofford's benefactors reads
like a who's who in the medical industry." Reportedly, Wofford
received $74,000 in PAC money since '91, with total campaign
contributions reaching $3.9M. Center for Responsive Politics'
Larry Makinson: "It presents a prickly problem for Wofford, but
he's hardly alone •••• That's the way the game is played in
Washington." Wofford spokesperson David stone, who says the
$74,000 figure is off by $15,000: "Harris Wofford's record and
approach to health care reform speaks for itself. He's taken a
very strong position that is opposed by many of the traditional
sources of funding in the health care field" (Michael Blood,
2/11).
DOLE: Sen. Min. Ldr. Bob Dole (R-KS) on where the task
force is heading: "I don't think we ought to be staking out
parameters ••• until we've really looked at all the options ••••
Let's take our time and get it right because if we don't get it
right it's not going to pass." On the uninsured: "We've got a
health care delivery system now that does a pretty good job for
200 million Americans, (but) we've got to reach out and pick up
the 37 to 40 million that don't have affordable and accessible
care. But in the process we want to keep the good parts of the
present system •••• Keep in mind that all of those 30 to 40
million aren't in the poverty class, some are young people"
("Larry King Live," CNN, 2/10).
GEKAS: Rep. George w. Gekas (R-PA) "has introduced new
health care reform legislation, the American Consumers' Health
Care Reform Act (ACHRA), which he says 'would enact statuary
changes in the public and private health care delivery systems to
increase the emphasis given in treating people before they get
sick.'" The bill is currently under consideration in five House
cmtes. (Gekas release, 2/12).
8
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LEVEL 1 - 4 OF 25 STORIES
Copyright 1993 The Washington Post
The Washington Post
February
10, 1993, Wednesday, Final Edition
SECTION: FIRST SECTION; PAGE AS
LENGTH: 634 words
HEADLINE: GOP Congressman Questions Hillary Clinton's Closed-Door Meetings
SERIES: Occasional
BYLINE: Dana Priest, Washinqton Post staff Writer
BODY:
Hillary Rodham Clinton's new policy- making role on the presidential health
care task force is beinq questioned by a Republican lawmaker who believes she
may be violatinq federal rules qoverninq advisory commissions.
Rep. William F. Clinger Jr. (R-Pa.), rankinq minority member on the House
Government Operations Committee, this week asked the General Accounting Office
to review whether Hillary Clinton, who was appointed by her husband to head the
President's Task Force on Health Care Reform, is allowed to conduct any of the
qroup's meetinqs in private. The GAO is the investiqative arm of Conqress.
White House qeneral counsel Bernard Nussbaum has told Clinger he believes
Hillary Clinton's participation does not violate the Federal Advisory
Committee Act, which says that task force meetings must be conducted in
public if any members of the task force are not employees of the federal
qovernment.
Hillary Clinton is not a government employee. But the White House contends
that she also is not the type of "outside influence" the statute was enacted to
guard aqainst.
According to Leonard Weiss, staff director of the Senate Governmental Affairs
Committee, the legislation was intended to protect the president from appointinq
someone outside the qovernment to a task force who might, unbeknownst to the
president, advocate the interests of private qroups over that of the qovernment.
Weiss, who consulted with the Senate's leqal counsel on the matter, said
Hillary Clinton does not appear to be the type of outside participant the law
seeks to protect the president aqainst.
The federal act requires that advisory committee meetings be held in public
unless the committee "is composed wholly of full-time officers or employees of
the federal government."
A 1988 Supreme Court decision, in Public Citizen v. Department of Justice,
said, in part, that the statute should not be literally interpreted because to
do so would prohibit the president from qettinq advice from any qroup of two or
more persons whose deliberations are not public.
�......... ,
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10
The Washinqton Post, February 10, 1993
A literal interpretation of the statute in this case would mean that Hillary
Clinton's chief of staff, as a federal employee, would be able to serve on a
task force that did not hold public meetinqs, but not the First Lady.
A Clinqer aide said the conqressman aqrees the statute probably does not
apply to Hillary Clinton but believes the law should be amended to reflect that.
Separately, Clinqer and others have raised concerns about the status of
outside consultants workinq with the task force and whether their
participation would triqqer the provisions under the act for public meetinqs.
The White House has said that the only members on the task force are
Hillary Clinton, six Cabinet secretaries, the director of the Office of
Manaqement and Budqet and several senior White House advisers.
Another qroup of hiqh-rankinq federal employees is manaqinq the operation of
20 workinq qroups, some of which include outside consultants. Their job is to
' provide the task force with information -- much of it detailed and technical
in nature -- on various aspects of health care reform.
It is the task force that will take the information from the workinq qroups
to make policy recommendations to the president. The administration believes
that because the workinq qroups' participants are not part of the
decision-makinq process, they are not subject to provisions that qovern advisory
committees.
The task force, which has not met in full since it was appointed two weeks
aqo, plans to hold many or all of its meetinqs in public, said administration
sources. Members of the task force, includinq Hillary Clinton, have held
numerous meetinqs since then on matters dealinq with the development of a
national health care reform proposal.
TYPE: NATIONAL NEWS
SUBJECT: FIRST LADY; HOUSE OF REPRESENTATIVES; FEDERAL GOVERNMENT; POLITICAL
PARTIES; APPOINTMENTS
ORGANIZATION: GENERAL ACCOUNTING OFFICE;
FEDERAL ADVISORY COMMITTEE ACT
TASK FORCE
ON HEALTH CARE REFORM;
NAMED-PERSONS: HILLARY RODHAM CLINTON; WILLIAM F. CLINGER JR.; BERNARD NUSSBAUM
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LEVEL 1 - 5 OF 25 STORIES
The Associated Press
The materials in the AP file were compiled by The Associated Press. These
materials may not be republished without the express written consent of The
Associated Press.
February
9, 1993, Tuesday, PM cycle
SECTION: Washington Dateline
LENGTH: 695 words
HEADLINE: Health
Task Force
Plans Both Public and Closed Meetings.
DATELINE: WASHINGTON
KEYWORD: Washington Briefs
BODY:
The new health care task force, headed by First Lady Hillary Rodham
Clinton, has no obligation to open all of its meetings to the public, says White
House counsel Bernard Nussbaum.
Nussbaum told congressional Republicans on Monday that the task force,
nevertheless, plans some open meetings during its deliberations over how to
reform the nation's health care system.
But he argued Mrs. Clinton's group is not subject to federal " sunshine"
requirements under the Federal Advisory Committee Act.
In a letter, Rep. William Clinger, R-Pa., a member of the House Government
Operations Committee, had complained to Nussbaum that Mrs. Clinton had violated
the public meeting requirement and asked "that no further violations ••• occur."
Nussbaum, responding to the letter, said the task force had not yet held an
official meeting, although members gathered when the group was announced, and
that Mrs. Clinton's involvement does not trigger the " sunshine" requirement.
Fed Wants Protection for Users of Welfare Electronic Debit Cards.
WASHINGTON (AP) - The Federal Reserve is proposing that welfare recipients
who use debit cards be given the same protection against loss of a card or fraud
as given to bank credit card holders.
But some government officials argue such a move could expose the government
to greater losses to fraud and keep some states from adopting the "paperless
welfare" programs known as EBT, or electronic benefits transfer.
In a number of states people now can use debit cards to draw benefits and buy ·
groceries, but they do not have the same protection against loss of the cars as
do bank credit card customers.
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12
The Associated Press, February 9, 1993
The Federal Reserve Board said Monday it wants to extend the same liability
' limits to welfare recipients who use the EBT cards. ·
Although many state officials like the debit cards because it reduces
administration costs and generally is less susceptible to fraud, they also fear
that losses to states could mount quickly if unscrupulous recipients take
advantage of the system.
Some 200,000 households currently receive food stamps electronically, and by
spring, 100,000 families are expected to receive welfare benefits
electronically.
IRS Plans Stricter Home-Office Deduction Rules for 1992 Returns.
WASHINGTON (AP) - Taxpayers filing 1992 returns will have to comply with a
stricter interpretation of what expenses they may deduct for business use of a
home, says the Internal Revenue Service.
But the IRS said Monday that it does not plan to apply the new interpretation
outlined by the Supreme Court in a ruling last month to taxes covering years
prior to 1992.
The court on Jan. 12 held that a taxpayer must consider the relative
importance of activities conducted at his normal workplace and in his home, and
then calculate the amount of time spent at each in determining deductions.
The IRS noted that its Publication 587, "Business Use of Your Home," was
printed before the court decision, but that a new edition reflecting the ruling
will be printed by the end of February.
As for deductions in previous years, IRS spokesman Henry Holmes said, "We
will not challenge those deductions."
Canada, United States Confident On Meeting Trade Pact Deadline.
WASHINGTON (AP) - Canadian and u.s. trade officials say they are confident a
North American free trade agreement can be put into effect as scheduled by the
end of the year, although President Clinton wants a number of issues added in
separate agreements.
·
Canadian Trade Minister Michael Wilson told reporters following a meeting
with u.s. Trade Representative Mickey Kantor on Monday that both countries are
committed to meetinq the Jan. 1, 1994 deadline.
Durinq the campaign, Clinton gave qualified support to the North American
Free Trade Agreement, but said he would seek side aqreements to strengthen
provisions on the environment, worker riqhts and protection against a sudden
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The Associated Press, February 9, 1993
surge in imports.
The pact would create the world's largest and richest trading bloc by
' removing tariffs and other barriers to the movement of goods, services and
investment among the United States, canada and Mexico.
13
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LEVEL 1 - 7 OF 25 STORIES
Copyright 1993 American Political Network, Inc.
Health Line
February
9, 1993
SECTION: POLITICS & POLICY
LENGTH: 934 words
HEADLINE: PLANNING FOR REFORM: EVERYONE SEEMS TO BE SEEKING A VOICE
BODY:
L.A. TIMES reports, "Representatives of labor, large
corporations and the insurance industry have formed the first
major coalition to publicly oppose the Clinton (admin.) on health
care reform." According to the TIMES, the Coalition to Preserve
Health Benefits -- whose members include the AFL-CIO and the
Employers Council on Flexible Compensation -- is planning "an
orchestrated campaign" against taxation of health benefits.
Employers Council on Flexible Compensation's Kenneth Feltman:
"This is a (WH) that can't get it right on choosing an attorney
general. Why should we think they will get it right on health
care, which is infinitely more complicated?" The coalition has
scheduled a press conference 2/9 to unveil its campaign which
will include demonstrations in Austin, TX; Indianapolis, IN;
Portland, ME; Kansas City, MO; and Houston, TX. Feltman: "We
think that with all the policy wonks massaging health care and
all the organizations coming up with solutions that, in essence,
feather their own nest first, it's about time we hear from the
people who pay the bills and those for whom the health care
system is designed -- the public." Feltman said if the (admin.)
stops considering the taxation of health benefits, the coalition
will "disband" (Robert A. Rosenblat/Edwin Chen, 2/9).
LAWSUIT ON THE HORIZON: WASH. TIMES reports that the
American Assn. of Physicians and surgeons plans to file a lawsuit
in fed. court to require the WH health care task force to comply
with " sunshine laws" and operate in public. " sunshine laws"
the Federal Advisory Cmte. Act -- requires that presidentiallyappointed task forces with a member who is a nonfederal employee
must hold meetings in public, provide transcripts and give twoweeks' notice of all meetings. Ken Brown, counsel for the AAPS:
"These doctors are acutely sensitive to what is happening in
health care and are terrified by what is coming out. They are
genuinely concerned about what is being discussed in secret." WH
Counsel Bernard Nussbaum released a legal opinion 2/5 to ranking
GOP member on the House Gov't Operations cmte., William F.
Clinger (R-PA), saying that the First Lady's position on the task
force does not violate the act. Anonymous "federal legal
expert": "The (WH) is just making up laws. They are in clear
violation and are hoping no one catches them" (Paul Bedard, 2/9).
A DIFFERENT LACK OF ACCESS: N.Y. TIMES reports that
although the Clinton admin. promised "to listen to outside voices
in drafting" health care legislation, "the outreach has fallen
short" and AMA officials "feel neglected." AMA Chair Dr. Raymond
Scalettar: "We have not had any direct contacts with Hillary's
14
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Health Line, February 9, 1993
commission •••• Of course, we want a seat on the task force. • ••
' We know how medicine is practiced. We can provide the input they
need." Scalettar said that in March when hundreds of physicians
qo to Washinqton to lobby Conqress and the admin., "she'll qet
the messaqe" (Robert Pear, 2/9). Robert Barrow, spokesman for
the Nat'l Granqe, is said to be "up in arms" over the lack of
representation of rural America on the WH health task force.
Barrow: "We're qettinq off to a bad start if approximately 25%
' of the nation's population is set aside" (Richard Orr, CHICAGO
TRIBUNE, 2/8).
NEW ACRONYMS: Accordinq to the N.Y. TIMES, federal
employees are now sayinq that HHS now stands for "Hillary's
Health Service" and HCFA now means "Hillary Can Fix Anythinq"
(Pear, 2/9).
THE CHICKEN OR THE EGG?: THE ECONOMIST: "The trouble is
that these two aspects of the (health care) mess, spirallinq
costs and the potentially untended sick, cannot reasonably be
tackled at the same time •••• Unfortunately, the political mood
probably dictates that both problems be tackled toqether. Bill
Clinton himself seems to believe that they ouqht to be" (2/6
issue).
SPECIAL INTERESTS: THE ECONOMIST: "So many conflictinq
interests in health care remain that reform could still founder
upon indecision. cuttinq throuqh that tanqle is what presidents
are for" (2/6 issue).
1
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LEVEL 1 - 8 OF 25 STORIES
Copyright 1993 Gannett Company, Inc.
USA TODAY
February
9, 1993, Tuesday, FINAL EDITION
SECTION: NEWS; IN WASHINGTON; Pg. 6A
LENGTH: 295 words
HEADLINE: 1st lady's actions OK
BYLINE: Jessica Lee
KEYWORD: HILLARY RODHAM CLINTON: HEALTH CARE REFORM: LAWRENCE WALSH: BUSH
PARDON:CLINTON JOGGING:IRAN CONTRA SCANDAL
BODY:
Hillary Rodham Clinton is not required to hold open meetings of her
health-care task force, White House counsel Bernard Nussbaum said after
complaints by congressional Republicans that she was violating the federal
" sunshine" law. The law requires that any presidential task force that
includes a non-federal employee, such as the first lady, must hold meetings in
public. But Nussbaum claims, "the participation of the first lady on the task
force does not trigger applications of the act." TAKING THE PULSE: Republicans
are cranking up their campaign-style "spin" operations in preparation for
President Clinton's first town meeting, Wednesday in Detroit. It will be
broadcast nationally in the USA.
Michigan-based Market Strategies Inc., a polling firm formerly run by
ex-president George Bush's pollster, Robert Teeter, invited 40 voters
some
Democrat-leaning, some GOP-leaning, some independent
to watch Clinton's talk
show and have their reactions recorded.
Responses will be measured by a "perception dial" that tests popularity
ratings. Reporters have been invited to watch Clinton and the voters. The GOP
pollsters will stand ready to interpret the reaction.
- Jessica Lee
RUNNING JAM: When President Clinton goes for a morning jog, he guarantees a
traffic jam. It took a 10-car motorcade to get Clinton from the White House to
Haines Point, a park along the Potomac River. Using the isolated park avoided
some of the traffic tie-ups his downtown jogs caused last week, but the
motorcade still snagged rush hour. The motorcade, like most used by the
president, was led by at least two police motorcycles and included police cars,
a Secret Service SWAT team vehicle, a communications truck, ambulance, cars for
guests and two press'vans.
SUBJECT: JOGGING; HEALTH CARE; IRAN; SCANDAL; INVESTIGATION
NOTES: WASHINGTON AND THE WORLD; WASHINGTON; A QUICK LOOK AT WHAT'S GOING ON IN
THE NATION'S CAPITAL
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LEVEL 1 - 9 OF 25 STORIES
Copyright 1993 News World Communications, Inc.
The washington Times
February
9, 1993, Tuesday, Final Edition
SECTION: Part A; Pg. A1
r
LENGTH: 862 words
1
HEADLINE: Suit planned to open Hillary's meetings
BYLINE: Paul Bedard; THE WASHINGTON TIMES
BODY:
A major medical group, angry that the first lady plans to hold closed
meetings on health care reform, intends to file suit in federal court to force
the presidential task force to operate in public.
Meanwhile, the General Accounting Office has been ordered to investigate
allegations that Hillary Rodham Clinton is breaking federal " sunshine laws."
This comes just hours after the White House released a legal opinion that
Mrs. Clinton is not breaking the law requiring public meetings. Release of the
Feb. 5 opinion by White House Counsel Bernard Nussbaum was requested by The
Washington Times, which first detailed the alleged violations.
Kent Masterson Brown, counsel for the American Association of Physicians and
Surgeons, said he plans to file suit in u.s. District Court here - probably for
a restraining order - to block Mrs. Clinton from holding future meetings in
secret.
"It's doable and it ought to be done," he said in an interview. Mr. Brown
is currently seeking to win the support of other medical groups that would "tag
along" in the legal effort.
He said several medical groups and doctors around the nation are angry that
the health care task force plans to work in secret, cutting out the doctors
and medical providers who will be affected by the reforms the group unveils in
May.
~
"These doctors are acutely sensitive to what is happening in health care and
are terrified by what is coming out," he said. "They are genuinely concerned
about what is being discussed in secret."
Several medical groups have complained that their advice to the
is being ignored.
task force
Mr. Nussbaum, in his Feb. 5 opinion to Rep. William F. Clinger of
Pennsylvania, the ranking Republican on the House Government Operations
Committee, said the Federal Advisory committee Act was not meant to cover the
first lady's chairmanship of the health care task force or the membership of
Tipper Gore, the vice president's wife. He gave no explanation or basis for his
opinion.
�PAGE
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The Washington Times, February 9, 1993
Mr. Clinger has demanded that Mrs. Clinton stop holding meetings in
private. In his Feb. 1 letter to the White House, Mr. Clinger asked President
Clinton to "take immediate steps to ensure that no further violations" of the
sunshine laws take place.
Mr. Clinger, whose committee has oversight for the sunshine act, said
yesterday that despite the White House opinion, he believes Mrs. Clinton is
violating the law. He has ordered the GAO to investigate the charges and settle
the issue within two weeks.
The law requires that a presidentially appointed task force not made up
"wholly" of federal workers hold all meetings in public, provide the public with
working documents and transcripts, and give the public two weeks' notice of
meetings.
While other task force members are federal employees - Cabinet officials
and top White House domestic policy aides - Mrs. Clinton and Mrs. Gore are not
considered federal workers. As a result, the task force must meet in public,
Mr. Clinger said.
But Mr. Nussbaum wrote: "It is our opinion that the Federal Advisory
Committee Act (FACA] does not, and was not intended by Congress to, apply to
the health care task force.
The participation of the first lady on the task
force does not trigger application of the act."
A federal legal expert responded: "Show me in the federal law where the
first lady is exempt, or anyone in the president's family. Where does it say
that she is any different than any other American?"
The lawyer, who requested anonymity, added: "The White House is just making
up laws. They are in clear violation and are hoping no one catches them on it."
Lawyers for federal agencies also said yesterday that Mr. Clinton's
decision to add four governors to the task force and let private groups advise
the panel was another "clear violation" of the open-meeting laws because they
aren't considered federal workers.
The White House lawyer said in his letter that Mrs.
hold "some" task force meetings in public.
Clinton plans only to
Mr. Nussbaum also rebuffed Mr. Clinger's offer to propose an amendment to
FACA exempting the first lady. "We believe • • • that the existing statute
already provides for such a result."
White House spokesman George Stephanopoulos provided no details on the basis
for Mr. Nussbaum's decision. "I'm just saying that it is our opinion that this
law does not apply to the task force and it does not require them to be open,"
he said.
David Fuscus, Mr. Clinger's spokesman, said, "Mr. Clinger obviously
disagrees and feels that law does apply to her (Mrs. Clinton]."
Two White House deputies who Mr. Nussbaum said could provide further
clarification did not return phone calls yesterday.
�s
' '
PAGE
19
The Washington Times, February 9, 1993
A spokesman for Republicans on the Government Operations Committee said they
were stunned by the lack of detail in Mr. Nussbaum's two-page letter. nit
wasn't at all what we expected," the official said.
Mr. Clinton also responded to Mr.
legal tangle.
Clinger's letter but didn't refer to the
�-.
"'
;
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20
LEVEL 1 - 10 OF 25 STORIES
The Associated Press
The materials in the AP file were compiled by The Associated Press. These
materials may not be republished without the express written consent of The
Associated Press.
February
8, 1993, Monday, AM cycle
SECTION: Washington Dateline
LENGTH: 428 words
HEADLINE: White House Disputes Republicans On Mrs. Clinton's Meetings
DATELINE: WASHINGTON
KEYWORD: Mrs Clinton-Meetings
BODY:
Hillary Rodham Clinton is not required to hold open meetings of her
health-care task force even though some public sessions are planned, the White
House told protesting congressional Republicans on Monday.
White House counsel Bernard Nussbaum disputed contentions by House
Republicans on an oversight committee that the first lady was violating a
federal " sunshine" law by holding sessions behind closed doors.
Writing to Rep. William Clinger, R-Pa., Nussbaum said a law requiring open
meetings of government advisory panels and committees does not apply to Mrs.
Clinton's group.
Clinger is the senior Republican member on the House Government Operations
Committee.
"It is our opinion that the Federal Advisory Committee Act does not, and
was not intended by Congress to, apply to the health care task force. The
participation of the first lady on the task force does not trigger
applications of the act," Nussbaum told Clinger.
President Clinton made his wife his senior adviser on health-care issues and
put her in charge of a task force created to make recommendations on universal
health care legislation - a Clinton campaign vow.
"I must ask that you take immediate steps to ensure that no further
violations ••• occur," Clinger told Clinton in a Feb. 1 letter.
The act in question requires that any presidential task force that includes
a nonfederal employee must hold meetings in public. Clinger contended that Mrs.
Clinton's presence on the panel triggers the law.
Clinton, in a separate letter to Clinger released by the White House, said:
"It is my intention to develop a plan for high quality, affordable health care
for all Americans, and I have asked the health care task force to help me
develop legislation for comprehensive health care reform."
�The Associated Press, February s, 1993
PAGE
21
Nussbaum, in his letter, said that the task force "has not yet held a
meeting" even though the whole group was present on Jan. 25 when the president
announced its formation.
"The task force is planning to hold some public meetings in the future," he
added. "Those meetings have not yet been scheduled."
White House Communications Director George
when asked later why the White House felt the
Mrs. Clinton's task force - particularly in
some other Republicans are contending that it
Stephanopoulus did not elaborate
open-meeting law did not apply to
light of the fact that Clinger and
does.
"We have a disagreement," he said.
"I'm just saying that it is our opinion that it doesn't apply - that this law
does not apply to the task force and it does not require them to be open," he
' said.
�PAGE
22
LEVEL 1 - 17 OF 25 STORIES
Copyright 1993 News World Communications, Inc.
The Washington Times
February
5, 1993, Friday, Final Edition
SECTION: Part A; Pg. A1
LENGTH: 722 words
HEADLINE: GOP knocks for Hillary ;
Demands open door at health meetings
BYLINE: Paul Bedard; THE WASHINGTON TIMES
BODY:
Republicans on a House oversight committee are demanding that Hillary Rodham
Clinton stop holding closed meetings of her health care task force and are
investigating whether the first lady is violating federal " sunshine" laws.
"I must ask that you take immediate steps to ensure that no further
violations • • • occur," Pennsylvania Rep. William F. Clinger, the ranking
Republican member of the House Government Operations Committee, said in a letter
to President Clinton.
"The purpose of this letter is to seek immediate action to ensure no further
, violation of federal law. "
Meanwhile, the White House, responding to the alleged violations of the
sunshine law raised by The Washington Times, said yesterday that some meetings
will be held in public, but major working meetings will continue behind closed
doors.
Mr. Clinger said yesterday he has "asked the minority staff on the House
Government Operations Committee to conduct a further inquiry to ensure that no
further violations of [the Federal Advisory Committee Act] occurs and no other
federal statute has been violated through the conduct of these meetings."
An aide said later that Mr.
Clinger, who has the support of other committee
Republicans, is "strongly" considering calling in the General Accounting Office
to investigate the alleged violations.
A spokesman for committee Democrats said they were unaware of Mr.
action.
Clinger's
The health task force, chaired by Mrs. Clinton, has held one secret
meeting. The group was created by Mr. Clinton last month and is charqed by the
president with drawinq up a health care action plan by May. Mr. Clinton made
health care a cornerstone of his campaiqn last year.
Mr. Clinqer and some lawyers with
House say secret meetinqs of the task
Committee Act (FACA) , which requires
includes any nonfederal employee, such
public.
federal aqencies outside of
force violate the Federal
that any presidential task
as Mrs. Clinton, must hold
the White
Advisory
force that
meetings in
�PAGE
23
The Washington Times, February 5, 1993
"When the full task force meets, some of those meetings and perhaps all of
those meetings will be open," White House spokeswoman Dee Dee Myers said
yesterday.
But, she added, working group meetings, where legislative plans for the
president's health care program will be discussed, will.continue to be held
behind closed doors.
Miss Myers said White House counsel Bernie Nussbaum has determined that Mrs.
Clinton is exempt from FACA, an opinion rejected by Mr. Clinger and lawyers
considered experts on the law.
The sunshine
secretary said.
law "was not intended to apply to the first lady," the press
Plans to release the counsel's opinion to the media yesterday were delayed
until today to give the president a chance to review and approve it, according
to an administration official who asked not to be identified.
A House Government Operations Committee official said Mr. Clinger will
"seek some outside review" of the White House counsel's opinion that the first
lady is exempt.
"If they continue to believe they are exempt, we will expand our inquiry,"
the committee official said.
"The law is clear, and Hillary Clinton's breaking it," a committee GOP
attorney said.
The FACA law requires that any presidential task force not "wholly"
composed of federal employees must hold all meetings in public, make transcripts
and working papers such as draft legislation public, and give a 14-day
announcement of all future meetings.
The issue was further muddied this week when the White House announced that
four governors will be added as members of the task force, expanding the list
of nonfederal employees to six. The sixth is Vice President Al Gore's wife,
Tipper.
Federal law also requires that after a president sets up a task force, the
White House counsel must file a charter detailing the organization's mission and
expiration date with the General services Administration - a path the White
House has ignored so far.
The Clinger aide said the congressman is not opposed to the work of the
health care task force but simply wants the law to be followed. To help the
White House, he has even offered to pen an amendment to FACA that would exempt
the first lady.
GRAPHIC: Photo, President Clinton, his wife, Hillary, and the Rev. Billy Graham
attend the National Prayer Breakfast yesterday with political and military
leaders. , By AP
----------------
�.PAGE
24
LEVEL 1 - 18 OF 25 STORIES
Copyright 1993 The Atlanta constitution
The Atlanta Journal and Constitution
February
4, 1993
SECTION: EDITORIAL; Section A; Page 12
LENGTH: 446 words
HEADLINE: Keep public health care discussion in public
BYLINE: suzanne Fields
KEYWORD: health; care; government; leaders; public; reaction
BODY:
WASHINGTON - Physicians are about to join the public hit list, just after
lawyers and journalists. Too bad. A few rotten greedheads have poisoned the well
(and the sick).
A woman reports that a neurosurgeon in Washington refuses to talk to her over
the phone about the results of her elderly mother's Magnetic Resonance Imaging
(MRI), because the doctor couldn't charge for his time on the phone.
It's easy to collect horror stories of insensitive bedside and deskside
manners. One woman complains that an internist told her to follow his orders or
she would die.
Many doctors are in such a hurry that patients are intimidated even though
it's their time they're paying for. General practitioners spend less than seven
minutes on average actually talking to a patient and often don't hear all of a
patient's complaints.
It doesn't have to be this way. Medical treatment requires explanations as
well as diagnosis and treatment. Patients respond positively when they trust
their doctors.
Some doctors complain that insurance forms, including Medicaid and Medicare,
require time-consuming reports, rules and regulations that take up time they
otherwise could afford their patients personally. Based on his frustrations as
governor of Arkansas, President Clinton offered states a more flexible approach
to Medicaid this week.
The president's task force on health care, headed by the first lady, will
have to work hard to separate the chaff of greed and insensitivity from the
wheat of increased diagnostic, drug and treatment capabilities. Health reform
should not be dictated by reference to the worst doctors but to the best. Most
doctors want to care for their patients and earn a comfortable living. These two
values aren't incompatible.
But most of us don't have a clue to the problems facing health care reform.
That's why - in addition to the law - the presidential task force meetings
ought to be in public.
�. ...,
...!
-, ....,.
PAGE
25
1993 The Atlanta Journal and Constitution, February 4, 1993
Reporters were enraqed when they were cut out of the first meetinq of the
health care panel headed by Hillary. The 1972 Federal Advisory Committee Act,
or "sunshine law," prohibits any presidentially appointed advisory task
force that includes nonqovernmental employees or outside advisers from
operatinq in secret. Hillary and Tipper are not federal officials.
Like a patient, we need information to understand the diaqnosis and to trust
the "doctor" who offers the prescription. "Doctor Hillary" is supposed to shed
some liqht. Let's hope the qreedheads feel the heat, and the rest of us can feel
some relief.-(c1993)
Suzanne Fields is distributed by the Los Anqeles Times Syndicate. Her column
appears in The Journal on Monday and Thursday.
�PAGE
26
LEVEL 1 - 20 OF 25 STORIES
Copyright 1993 News World communications, Inc.
The Washingt~n Times
February
4, 1993, Thursday, Final Edition.
SECTION: Part G; COMMENTARY; Pg. G1
LENGTH: 695 words
HEADLINE: In need of intensive care
BYLINE: Suzanne Fields; THE WASHINGTON TIMES
BODY:
Physicians are about to join the public hit list, just after lawyers and
journalists.
Too bad.
A few rotten greedheads have poisoned the well (and the sick).
A woman reports that a neurosurgeon in Washington refuses to talk to her
over the phone about her elderly mother's Magnetic Resonance Imaging (MRI), an
expensive test covered by insurance, because the doctor couldn't charge for a
telephone call.
"Make an appointment for a visit and Medicare will pay," he said. "My time
is as valuable as an attorney's and they get paid by the hour, on the phone or
off." It's a good thing for him (and us) that house calls ar.e out of fashion.
He'd probably charge for gasoline, anti-freeze and window washer, too. And the
leather shoes he wears away on the front walk.
Certain doctors with an overzealous entrepreneurial spirit refer patients
for services or to institutions where they have a financial stake. It's
sometimes difficult to separate the incentive to help the patient from the
incentive to help the doc's bank account. Doctors are the logical investors in
expensive technological medical equipment and in private hospitals, but how can
we trust their professional objectivity when they stand to gain huge sums by
certain referrals? (What does this say about their medical judgment?)
It's easy to collect horror stories of insensitive bedside and deskside
manners. One woman complains that an internist told her to follow his orders or
she would die. The doctor could have gently prepared her for the bad news.
Many doctors are in such a hurry that patients are intimidated even though
it's their time they're paying for. General practitioners spend less than seven
minutes actually talking to an average patient and often don't hear all of a
patient's complaints.
There are studies aplenty to document such failings, including one conducted
by a pharmaceutical house, which found that 1 of every 4 patients in the United
States switch physicians because a doctor has created more emotional discomfort
than confidence.
It doesn't have to be this way. Medical treatment requires explanations as
well as diagnosis and treatment. Patients respond positively when they trust
their doctors. Some doctors complain that insurance forms, including Medicaid
L
�.......
PAGE
27
The Washington Times, February 4, 1993
and Medicare, require time-consuming reports, rules and regulations, that take
up time they otherwise could afford their patients personally. Based on his
frustrations as governor of Arkansas, President Clinton offered states a more
flexible approach to Medicaid this week.
1
I
I
The president's task force on health care, headed by the first lady, will
have to work hard to separate the chaff of greed and insensivity from the wheat
of increased diagnostic, drug and treatment capabilities. Health reform should
not be dictated by reference to the worst doctors but to the best. Most doctors
want to care for their patients and earn a comfortable living. These two values
aren't incompatible.
But most of us don't have a clue to the problems facing health care reform.
That's why - in addition to the law - the presidential task force meetings
ought to be in public. We could learn considerably more from forthright
testimony about different points of view over medical practice than we did from
two days at an "economic summit" taken over by grandstanders and windbags.
Reporters were enraged when they were cut out of the first meeting of the
health care panel headed by Hillary. The 1972 Federal Advisory Committee Act,
or "sunshine law," prohibits any presidentially appointed advisory task
force that includes nongovernmental employees or outside advisers from
operating in secret. Hillary and Tipper are not federal officials.
Like a patient, we need information to understand the diagnosis and to trust
the "doctor" who offers the prescription. "Doctor Hillary" is supposed to shed
some light. Let's hope the greedheads feel the heat, and the rest of us can
feel some relief.
Suzanne Fields, a columnist for The Washington Times, is nationally
syndicated.
GRAPHIC: Cartoon, SORRY, DR. WILLIAMS IS NOT ACCEPTING ANY NEW PATIENTS.
IN A HIGH ENOUGH TAX BRACKET ALREADY, By Schwadron
HE'S
�.
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29
LEVEL 1 - 22 OF 25 STORIES
Copyright 1993 American Political Network, Inc.
The Hotline
February
1, 1993
SECTION: THE NEW ADMINISTRATION
LENGTH: 720 words
HEADLINE: HILLARY 2000: AS IN PRESIDENT RODHAM CLINTON (HYPHEN, TOO?)
BODY:
u.s. NEWS' Cooper et. al write the idea of puttinq First
Lady Hillary Rodham Clinton in charge of health care "was
considered for weeks ••• and quickly emerqed as by far the most
loqical choice" because the health care team "lacked a
commander." Many "doubted the ability" of health care adviser
Ira Magaziner and Pres. Clinton "didn't want to hand off the
coveted job" to campaign experts "whom he respected but did not
totally embrace" (12/8 issue). GOP pollster Glen Bolger calls it
a "lose-lose situation": "Either she does a qood job and
outshines him or she does a bad job, and it's going to be mighty
hard for him to fire her" (RICHMOND TIMES DISPATCH, 1/31).
"Certainly the quick, authoritative way she bolted out of the
starting qate last week, stood in bold relief aqainst the
disarray that overtook the White House" following the Zoe Baird
situation. Bush health adviser Gail Wilensky: "It's an odd
arrangement to have powerful Cabinet members, confirmed by the
Senate, reporting in a formal way to the president's wife. I
don't envy them" (Chen, L.A. TIMES, 1/31). NEWSWEEK's cw arrow
is sideways: "CW likes your job, power and flying commercial.
But stow the middle name" (2/8 issue). u.s. NEWS' Roberts on
whether they can come up with a plan in 100 days: "They're goinq
to have a very difficult time doing that •••• During the last
Congress the Democrats wanted very much to propose a health care
plan in order to embarrass Geroge Bush -- they never even got one
written up" ("Washington Week In Review," PBS, 1/29). Charles
Krauthammer: "To get a reform that's goinq to work in 100 days, I
think is pushing it" ("Inside Washington," 1/30).
CLINTON 2000: If Hillary Clinton is able to untangle the
health-care mess, she will be seen as such a miracle worker that
she may become the leading candidate for President in the year
2000. If not at least the country will be able criticize her for
something more meaningful than using her maiden name and wearing
a headband" (Carlson, TIME, 2/8 issue). "McLaughlin Group" exit
question: If Clinton emerqes as a popular and successful
President, will Hillary run for President in 2000? Clarence
Page: "Of course." Eleanor Clift: "She'll have to not only
tackle Al Gore, but Tipper Gore." John McLaughlin said she would
run also (1/30).
MISCELLANY: Maqaziner said he will look into the " sunshine"
act which requires presidential advisory groups with non-gov't
appointees to publish a 14-day advance notice of all meetings,
open all meeting to the press and public and provide papers
drafted by the group. The health task force took "none of these
l
�''
PAGE
(c) 1993 The Hotline, February 1, 1993
steps" for their first meetinq. Groups like Public Citizen "have
indicated their intent to explore whether a violation has taken
place" (Riley, w. TIMES, 1/30). Balto. SUN's Theo Lippman
predicts she is soon to be Hillary Rodham-Clinton, "maybe even
soon to be Hillary Rodham. Compared to a another former First
Lady: "Eleanor was know by her maiden name. Of course, her
maiden name was Roosevelt" (2/1). Pat Buchanan: "Why would she
want to be a West Winq staffer when she's First Lady of the
United states?" ("Today," NBC, 2/1).
30
�.
·-
PAGE
LEVEL 1 - 21 OF 25 STORIES
Copyright 1993 American Political Network, Inc.
Health Line
February
1, 1993
SECTION: POLITICS & POLICY
LENGTH: 400 words
HEADLINE: ADMINISTRATION: A CLOSER LOOK AT
1
HEALTH CARE TASK FORCE
BODY:
WH adviser Ira Magaziner, who is running the day-to-day
operations of the health care task force, said it "has divided
into more than 20 teams whose work will pass through a series of
tests, or 'tollgates,' before being presented to President
Clinton." WASH. POST: "The first, he said, is to establish
'whether the right questions are answered' by using the correct
methodology. The next test narrows the focus or option of broad
subjects, such as strategies for achieving cost containment or
universal coverage. After that, auditors will check the cost or
savings projections. Lawyers then will scrutinize the plans to
make sure the legal ramifications have been taken into account.
Finally, the White House will bring in the 'contrarians,'
Magaziner said, whose job will be to 'tear apart everything
you've come up with.'" Magaziner: "For people who have talked
about health care reform for decades and decades, it's show time"
(Dana Priest, 1/30). POST writes that Clinton is "borrowing one
of the hot new management techniques from corporate America ••••
Some of the most successful American enterprises have embraced
this new organizational approach" which replaces hierarchies with
small "work teams" (Steven Pearlstein, 1/31). Responding to
criticism from gov't lawyers and public interest groups,
Magaziner said he would "look into" whether the task force had
"violated federal open-meeting laws by convening in secret this
week to plan reforms." WASH. TIMES: "Under the Sunshine Act,
presidential advisory groups with non-governmental appointees
must publish a 14-day notice of all meetings in the Federal
Register, open all meetings to the public and provide the press
and public all papers drawn up by the group" (Karen Riley, 1/30).
28
�;
.
.
PAGE
31
LEVEL 1 - 23 OF 25 STORIES
Copyright 1993 News World Communications, Inc.
The Washington Times
January
30, 1993, saturday, Final Edition
SECTION: Part A; Pg. A1
LENGTH: 980 words
1
HEADLINE: Health-care panel's procedures checked ;
Official to look into ' sunshine' laws
BYLINE: Karen Riley; THE WASHINGTON TIMES
BODY:
Til~ senior. White Hous.e official coordinating the. president's
task fore~ on
health ·care promised yesterday to "look into" whether the group violated federal
open-meeting laws by convening in secret this week to plan reforms.
Ira Magaziner made that pledge early yesterday, after The Washington Times
reported that several government lawyers and public interest groups have raised
concerns that the task force meetings are not being conducted in accord with
' the 1972 Federal Advisory Committee Act, or "sunshine" act.
"This is the first time I've heard of it," said Mr. Magaziner, who is
responsible for the day-to-day work of the group chaired by first lady Hillary
Rodham Clinton.
"I'll look into it, now that I've heard about it," he added.
Late yesterday, Robert Boorstin, special assistant to the president for
policy coordination, said the general counsel's staff "is reviewing" the issue.
No date has been set for the next meeting, he added.
Under the sunshine act, presidential advisory groups with nongovernmental
appointees must publish a 14-day notice of all meetings in the Federal Register,
open all meetings to the public and provide the press and public all papers
drawn up by the group.
None of those steps were taken as the
this week.
task force
met for the first time
Several public interest groups~ including Public Citizen, have indicated
their intent to explore whether a violation has taken place.
Mr. Magaziner was interviewed after a speech before a Washington business
group in which he promised to "work day and night" for the next 100 days to
produce legislation that can be enacted this year.
"It is now showtime," he said. "It's going to happen this year, there is
going to be comprehensive legislation submitted, and there's going to be the
full force of the presidency put behind that legislation."
President Clinton has said he wants to produce a health care bill because 37
million Americans have no health care coverage and 60 million to 70 million
�PAGE
32
The Washington Times, January 30, 1993
are underinsured. Many more are insecure about whether their health insurance
will cover catastrophic illnesses as well as regular kinds of services for their
families.
To accomplish that the president favors a plan that would create
private-sector buying cooperatives to bargain for the best care at the lowest
rates combined with cost controls on doctors and hospitals.
Reinforcing the president's case for health care reform yesterday were new
federal projections on the rapid escalation of health care spending if current
laws and practices continue.
By the year 2000, annual health care costs could reach $1.7 trillion a year,
or $9,637 for every American, according to estimates from the Health care
Financing Administration (HCFA).
Health costs could reach a whopping $16 trillion, or $47,936 per American,
by the year 2030, the HCFA report said, which would be nearly a third of the
nation's gross domestic product.
This year health care expenditures are expected to total over $900 billion
or over $6,000 per capita.
"These estimates show us the course we are on today, and our urgent need to
change that course," said Health and Human Services Secretary Donna Shalala in
releasing the projections. "The nation cannot sustain spending growth at this
rate," she said.
"We need a health system that delivers quality care for all our people, at a
reasonable cost," she said.
The HCFA report also underscored the extent to which soaring health costs
are putting a strain on the federal budget.
By the year 2000, federal spending on health care in Medicaid, Medicare and
veterans and military care, will nearly double to 29.3 percent of the total
federal budget, up from 15.4 percent in 1990.
The sunshine act requires that any presidentially appointed advisory
task force that includes nongovernmental employees or outside advisers must
keep all events and meetings public.
the
Mrs. Clinton and Tipper Gore, Vice President Al Gore's wife who is also on
task force, are not federal officials.
Mr. Magaziner told the business group yesterday that the task force
intends to involve many experts from the private sector, including health care
experts, business, labor and the "broader citizenry at large."
The goal, he said, is to "get a broad base."
The task force also plans to hold formal hearings and will request formal
comment in writing on various health care issues, he added.
�PAGE
33
The Washington Times, January 30, 1993
,
1
Mr. Magaziner, who made millions as a consultant on strategic planning, was
named administrator of the task force because he has experience coordinating
major projects that needed quick completion for companies such as General
Electric Co. and Wang Laboratories.
The task force intends to adopt a management approach used in business
called the "tollgate process" in drafting a bill, he said.
Over 20 teams will focus on narrow subject areas, seeking to determine
whether they have answered all possible questions and reached out to all
appropriate constituencies, including Congress, he said.
once the teams have narrowed the policy options, the proposal will be
examined by outside analysts and outside lawyers to question every number and
every assumption.
Finally, the task force intends to get the reaction of a contrarian group
before actually unveiling the package, he said.
Putting the proposed bill through these checkpoints will avoid some of the
, problems that plagued the ill-fated effort to provide catastrophic health
insurance to older Americans paid for by taxing the Social Security benefits of
middle-income recipients, Mr. Magaziner said. Senior citizens, who were never
properly consulted about the issue, rebelled and Congress was forced to rescind
the law
GRAPHIC: Chart, EXPLODING HEALTH CARE COSTS, By The Washington Times
�PAGE
34
LEVEL 1 - 24 OF 25 STORIES
Copyright 1993 News World Communications, Inc.
The Washington Times
January
29, 1993, Friday, Final Edition
SECTION: Part A; Pg. A1
LENGTH: 899 words
HEADLINE: First lady's
task force
broke law on secrecy
BYLINE: Paul Bedard; THE WASHINGTON TIMES
BODY:
First lady Hillary Rodham Clinton's task force on health care violated
federal open-meeting laws this week when it met in secret to plan reforms,
according to congressional and federal lawyers.
President Clinton formed the advisory panel this week and named his wife as
chairwoman Monday.
Under a 1972 so-called 11 sunshine" law, the 13-member panel must publish a
14-day notice of all meetings in the Federal Register, open all meetings to the
public, and provide the press and public all papers drawn up by the group,
according to lawyers familiar with the Federal Advisory Committee Act (FACA) •
But White House officials yesterday barred reporters and the public from
attending Mrs. Clinton's first formal meeting and denied requests to attend
future meetings.
The FACA law requires that any presidentially appointed advisory task
force that includes nongovernmental employees or outside advisers must keep
all events and meetings public. Under the law, only advisory groups made up
"wholly" of federal workers can hold secret meetings.
Federal and congressional lawyers said yesterday that the presence of Mrs.
Clinton as chairwoman of the task force and Tipper Gore, wife of Vice
President Al Gore, as a regular participant makes the panel subject to the
open-meeting law because both women are not federal employees.
In addition, the panel plans to get advice from private health care groups
and businesses - also nongovernmental members.
"If the panel advises the executive branch and some membership is
nongovernment, then the open-meeting law applies," said a federal lawyer
involved in overseeing implementation of the law.
"On the face of it, the meetings should be open.
• The press and public
should have a right to see this task force in action," said the lawyer, who
requested anonymity. He added that the new administration's confusion about the ,
law is no excuse for breaking it.
"Welcome to Washington," the lawyer said.
�PAGE
35
The Washington Times, January 29, 1993
Mr. Clinton wants the panel to develop a health care reform package by May.
The president made health care reform and governmental ethics cornerstones of
his 1992 candidacy.
Before holding any meetings, the law requires groups such as Mrs. Clinton's
to file a charter with the General Services Administration detailing the
committee's objective, name, deadline, estimated costs and duties. White House
officials were unaware of any charter filed in support of the presidential
health care task force.
Once the task force has met those requirements, the law says, "each
advisory committee shall be open to the public • • • timely notice of each such
meeting shall be published in the Federal Register • • • [and] the records,
reports, transcripts, minutes, appendixes, working papers, drafts, studies,
agenda, or other documents which were made available for or by each advisory
committee shall be available for public inspection and copying."
Only meetings dealing with things such as classified information can be held
behind closed doors, the lawyers said.
Several public interest groups, including Public Citizen, are looking into
the situation. A similar battle occurred last year when public interest qroups
tried to gain entry into former Vice President Dan Quayle's Competitiveness
Council meetings, but that group was allowed to meet in private because no
nongovernment workers were involved.
The FACA law includes no penalties for violation, so only a civil lawsuit
can compel the task force to open its meetings.
The apparent violation of the open-meeting law follows earlier concerns that
Mr. Clinton violated a federal nepotism law that appears to forbid the
president from appointing his wife to any government position.
But Jed Babbin, a former Bush administration lawyer who is an expert on
federal law, said that because Mrs. Clinton is not getting paid, technically
she is not a federal employee.
"That's where
said.
FACA
comes in, and they are not following the law there," he
White House press secretary Dee Dee Myers said White House counsel Bernie
Nussbaum and others had checked applicable laws and "I think they are very
comfortable with her role."
Asked why this week's meetings were closed to the public, Miss Myers said,
"Because the task force meetings will continue to be closed throughout the
development of the policy."
George Stephanopoulos, White House communications director, added, "We don't
have to open up every single staff meeting for the press."
Miss Myers said yesterday that Mrs.
employee.
Clinton is not considered a federal
�i
•
I','~
PAGE
36
The Washington Times, January 29, 1993
Because of their status, Mrs. Clinton and Mrs. Gore are not paid and have
not signed Mr. Clinton's strict ethics rules, which he has required his
appointees to sign before starting work.
****BOX
LAWBREAKERS
The presence of Hillary Rodham Clinton and Tipper Gore on the president's
health care task force requires the group to comply with the Federal
Advisory committee Act, known as the open-meeting law. The act specifically
, says any task force that includes nongovernment employees, such as Mrs. Gore
and Mrs. Clinton, must:
*
*
*
Advertise all meetings in advance.
Make all meetings public.
Open all records, transcripts and drafts to the public.
GRAPHIC: Box, LAWBREAKERS, By The Washington Times
�----
-~--
--~---------
---~~
----
--~~===-=::-:::-=-=------------------------------------
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. statement
DATE
SUBJECTffiTLE
n.d.
Declaration of Marjorie Tanney. (4 pages)
RESTRICTION
PS
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
FACADocuments [1)
2006-0223-F
ab862
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. SS2(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf"J.Ie defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�
Dublin Core
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Title
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Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
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White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
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1993
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2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
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72 files in 6 boxes
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Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
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William J. Clinton Presidential Library & Museum
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<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
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FACA Documents [1]
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First Lady's Office
Maggie Williams
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Box 4
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
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Clinton Presidential Records: White House Staff and Office Files
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2194630
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https://clinton.presidentiallibraries.us/files/original/7ee4224454a4020c293e26113cdf75a4.pdf
284e65fb270d6bb06cde7a6e7ebe8f30
PDF Text
Text
· CHILD HEALTH
USA
'
�12:49
Ol=lSPI=l f'lEt..IS DJi.,l
~LEASE
FROM
Contacts
TO
P.02
HRSA Press Office
(301) 443-3376
94566485
Nearly 9 million children
rel~ased
from public assistance programs,
primarily
in 1992,
accordinq to
~ild
a
Without
insurance· system is
in more Children on the Medicaid rolls.
our private health
Bealth USA,
Shalala notE'.d.
-MORE -
lose their private coveraqe in the coming months and years,·"
universal health care coverage, more and more of our children will
resultinq
"The erosion of
compilation of current statistics on child health.
to 23.7 percent
assistance programs has risen dramatically from 19 percent in 1988
The numl:>er of children enrolled in Medicaid and other public
Medicaid.
received coverage
were without any insurance at all in 1992; and another 15.6 million
today by HHS Secretary Donna E. Shalala.
private health insurance, according to a new publication
Approximately one-third of American children do not have
REPOR'l' SBCMS A '!l.'BIRD OF CHILDREN LACK PRIVMB 11BALR IBSURAliCB
FOR IMMEDIATE
(date)
JUL-20-1994
�12: 5121
FROM
OASPA ~·IEW'5 D l 1...1
'
-
65.7
TO
94566485
P.1213
percent
and
only 14.6 percent had private
66.5
u.s.
and Child Health
A
total of
ll • 7 mi.ll ion
children under 18 lived in poverty
Cases of suspected child abuse and neqlect rose 8 percent
An es.ti'IDBted 1r~61 children died
-MORE -
• Homicide has become 1::be seoonc! leading ('!ause of death amonq
adolescents who are 15 to 19 years of aqe, third for those between
the ages of 10 and 14, and j:ourth for children 1•9 years old.
as a result of abuse or neqlect in 1992.
in 1992 to more than 2.9 million.
•
•
The leading cause of death amonq children ages 1 to 19
remains unintentional inj~riaa.
• Children in poverty had fewer physician visits than those
above the poverty line. When poor children did see a physician it
was more likely to be in a hospital than in a private office.
children since 1980.
in 1991, an increase of 500,000 children from 1990 and 2.5 million
•
in
Both aqencies
PUblic Health Service within HHS.
The report also_ includes the follcwinq:
u.s.
~ureau,·
Centers for Disease- Control and
_Ma~ernal
National Center for Health Statistics.
are part of the
Prev~ntion's
collaboration with the-
ancl services Administration's
Cbild Health_USA is produced annually by the Health Resources
.
.
percent received coverage through public
Another 2 2. 7 percent of poor children had no
assistance proqrams.
coverage,
health coveraqe.
Amonq chilclren in poverty,
percent of children had no coveraqe at all.
received coverage through public assistance proqrams, ancl 14. 8
23.7
percent of American
children had private health cnverage in 1992. Another
.According to Child Jie.alth USA,
JUL -2121-1994
·~
�OA~PA
TO
94566485
P.04
in 1991 declined to 8.9 deaths per 1,000
i'IEIA1'3 Dll..,i
mortalit~r
FROM
Infant
12:50
u.s.
Lee,
u.s.
"I hope our
assistant secretary far
Public Bealth·Service.
M.D.,
aopies-
o~
Child Hoaltb CJSA are available at
Documents.
H#
may also be purchased from the
u.s.
o~
Copies
SUperintendent
22102, or by calling 70~-B2l-8955, ertension 254.
clearinghouse, 8201 Greensboro Dr., Ste. 600, McLean, va.
no charge from the National Maternal and Child Health
sing~o
followed by appropriate soci.al, educational, and family support."
That llUSt be
care tlirouqh health care retora ia an
Sumaya, ·M.D., said: "Improvinq
essential step t.owarcl impr.ovinq thAir health.
children's access to
HRSA Administrator Ciro V.
accidents."
insurance coveraqe and measures to protect them from violence and
answer will be to protect these children through universal health
hAalth, who directs the
are," said Philip R.
"This report brin9s into question what kind of society we
• AS of June 30, 1993, 4, 710 children younger than age iJ had
been diaqnosed with AIDS, representil\9 1. 5 percent of all cases
reported.
The majority of those cases resulted from perinatal
transmission, with a disproportionate number of cases occurring in
African-American and Hispanic children.
is up from 6. 8 percent i11 19 8 0. Low birthweiqht is the factor most
closely associated with neonatal mortality.
• In 1991, 7.1 percent of all live births in the u.s. were of
low birthweiqht, weighinq less than 5.5 pounds at birth. That rate
live births, a 3 percent reduction from the previous year. While
the infant mortality rate amor.'lq African-American children declined,
it was still 2.4 times hiqher than for white infants.
•
JUL-20-1994
�'\,.• :
; "!
-:
..
Contact:
. . : ~ ....
(301) 443-3376
HRSA Presa Office
Shala~a.
a
publication released to<lay by
Some 14.8 percent, or 9.8 million
nQW
cover~;e
from public assistance proqrama,
rise~
t~e
com1~g
mo~e an~
private coveraqe in the
health care coverage,
more of our children on to
Without universal
- MORE -
months and years,• Shalala
no~ed.
more of our children will lose their
Medicaid rolls.
"The erosion of our private health insurance system is foreinq
survey of current statistics on child hQalth.
a
dramatically from 15.5 percent in
l9H8 to 23.7 percent in 1992, accordinq to Child Health USA,
assistance programs has
The number of children enrolled in Medicaid and other pUblic
primarily Medicaid.
23.7 percent received
children, were without any insurance at all in 1992; and another
HHS Secretary Donna E.
health insurance, accordinq t.o
More than one-third of American children do not have private
RBPOR'l' SBCMS A '!'BIRD OF CHILDREN LACX PtaVA!'B IIKALTll LlfSURANCB
FOR IMMEDIAT~ RELEASE
(date)
..·. •: ,-. ,I.:. '
�. : : ":
: ~ ...... ~ ....
only
65.7
percent received coverage throuqh public assistance programs,
and
66.5
USA
coveraqe
through public
is produced annually by the Health Resources
received
u.s.
centers
Public
~ealth
Service within HHS.
----------------
- - - - - - - - - - - - - - - - - - -
- MORE •
•
The rate of death .among children ages 1 to 19 due to
homicide has nearly tripled since 1960, becominq the second leading
cause ot death amonq adolescents who are 15 to 19 years of age,
third for those between tho agea of 10 and 14, end fourth far
children 1-9 years old.
• Cases of suspected child abuse and neglect rosa 8 percent
in 1992 to mora than 2. 9 million. An estimated 1, 261 children died
as a result of abuse or neqlect in 1992.
• The leading cause of death among children ages 1 to 19
remains unintentional injuries.
• Children in poverty had fewer physician visits than those
above ~he poverty line. When poor children did see a physician it
was more likely to be in a hospital than in a private office.
• A total of 13.7 million children under 18 lived in poverty
in 1991, an increase of 500,000 children from 1990 and 2.5 million
childron since 1980.
The report also includes the following:
u.s.
and
Bath agencies
for Disease Control
National Center for Health Statistic•·
are part of the
Prevention'~
collaboration with the
_....--
and Services Administration's Maternal and Child Health Bureau,- in
Child Health
percent
Another 2 2 • 7 . percent of poor chi lclren hacl no
aasistance proqrams.
coverage,
he a 1th coveraqe.
Among children in pove:::-ty, only 14.6 percent had private
and 14.8 percent of children had no.coverage at all.
23.7
Another
percent of all
American children had private health coverage in 1992.
USA,
- 2 -
Accorc:Ung to Child Health
•
·'-' . ... ..
�.. . ·'· ....... ·'-
- 3 -
:"' ..... ': ..
.
..
~
. -.
Lee, M.D.,
o~
M.D.,
saic!:
"Iaproving
Documents.
~rem
'23 are available
Ill
tne Natlonal Maternal Gnd Child Bealth
Clearinghouse, 8201 Greensboro Dr., Ste. 600, llcLean, Va.
22102, or by calling 703•821-8955 1 extension 254. Copies
may also be purchased !rom the u.s. SUperintendent ot
at no charge
Single copies ot Child Nealth USA
followed by appropriate social, educational, and family support."
That must be
access to care throuqh health care refora · is an
Sumaya,
essential step toward improvinq their health.
child::-en • s
HRSA Administrator. ciro V.
accidenta."
insurance coverage and measures to protect them from violence and
answer will be to protect thgse children through universal health
"I hope
u.s. assistant secretary for
health, who directs the U.S. Public Health Service.
are," said Philip R.
"This report brings into question what kind of society we
• As of June 30, 1993, 4,710 children younger than aqe 13 had
been diaqnosed with AIDS, rapresentinq 1.5 percent of all cases
reported.
The majority of thoaa eases resulted froa perinatal
transmission, with a disproportionate number of cases occurring in
African American and Hispanic children.
• In 1991, 7.1 percent of all live births in the u.s. were of
low birthweiqht, weighinq less than s.s pounds at birth. '!'hat rate
is up from 6. 8 percent in l.980. Low birthweiqht is the tactor most
closely associated with neonatal mortality.
• Infant mortality· in 1991 declined to 8.9 death• per 1,000
live births, a 0.3 percent drop from the previous year. While the
infant mortality rate among African American children declined, it
was still 2.4 times hiqher than for white infanta.
.
�.:
:~
··- .. -·
..
Donna E. Shalala
Remarks
:.,:::~::
~embers
eompreh~nsive
wo~ka,
health care reform.
1
lf we are to leave our next
guarantee.
tba~
I am releasing today a report by the Bureau of
Sadlyt today, tar too many children do not have
guarantee of private health coverage for all of our children.
generation better off than our own, we must provide a rock-solid
any other ia our children.
one group of Americans who needs this guarantee more than
tor every American.
system that provides the security of quarantaed private coverage
When this debate is completed, we must have a health care
historic debate over
In the next few
of Congress will beqin a
July 21, 1994
Conferen;e on Children'• Health
(Thanks and acknowledge·;nents]
Pr•••
at
Secretary of Health and Human Service•
···-~:.-.
GOOD MORNINC:
:: . q
�-
.
..
:-: ....
"":-.
It shows
insurance or must depend on
One in three children in
2
Accordinq to this report, nearly 10 million children, or
de~end
Today, 23.7 percent of all American
ehil~ren
each day
w~th
the niqhtmare of bein9 uninsured,
and qo to work, who dream the American dream for their kids, live
In other words, millions cf parents who get up every morning.
with at lea•t ono, and often two, tull-time workers.
Children's Defense FUnd, 73 percent of children live in tamilies
And, aceordinq to the
make up one-quarter of the
uninsured people in this country.
The fact is that
That's up from 15.5 percent in 1988.
on Medicaid, or· other forms of public assistance;
for their health coverage.
children
Medicaid for their coverage.
And an inereaain9 number of children are havin9 to rely on
14.8 percent, have no health eoveraqe at all.
need.
public assistance proqrams like Medicaid to qet the coverage they
~ealth
et~tistic.
this country either have no
That's an incredible
insurance.
that one-third of American children do not have private health
Maternal and Chfl4 Health entitled "Child Health USA,"
•'-
�..
.:
; -:
~or
~e~
little or no preventive care.
than in a private office.
As a
~he
or
abuse or
without
i~suranee,
children do not gat that
birthweiqht babies.
9et prenatal care and, tnerafore, more likely to have low
Without insurance, preqnant women also are less likely to
kind of attention.
neglect to appear.
takes several visits to the same doctor for a pattern of abuse or
But it
best ways to detect child abuse
1,261 children diad
We know that one of
estim~tea
or neglect is consistent prinary care by a physician.
neqlect.
In 1992, an
children.
of domestic violence in this country and its impact on women and
This report. also brings disturbing news about the epiclam_ic
result, these children
r~ther
When poor children do 5aa a doctor, it is
likely to be in a hospital
than those who do.
Children vithout health insurance see a physician less often
private health insurance.
ehil4ren a•e pGyinq a v'ry dear prlca tor their lack o!
million fewer children had coverage from their parents' employer.
In 1992, one
this increase has been the decline in
amployer-ba•ed eoveraqe for dependent children.
one reason
3
�. : :-:
t.~is
country were
And !ow birthwei9ht is the
I
He told me that when his_
~illiona
receive health covera9e.
encourage families with children to remain in poverty in order to
worst, it creates a systea of perverse incentives that would
At
to subsidize coveraqe for people only once they
At be8t, thia ia a Sand-Aid approach to health reform.
are in poverty.
spend
To aome, the anawer is to further expand Medicaid oc to
We've qot to give families like that a chance.
His daughter is three ye4rs old and he'& still paying that bill.
daughter was born, the cost Qf a healthy delivery was $4,000.
still can't afford health insurance.
Be works two jobs but
recently visited a free
There, I met a man and his dau9hter.
clinic in Sioux Falls, south Dakota.
coveraqe was brought home to me when
The price children pay for the holes in our health care
tactor most closely associated with infant mortality.
That's up from 6.8 percent in 1980.
of low birthweiqht, weiqhinq less than 5.5 pounds at birth.
In 1991, 7 ;1 percent of C:lll live birtha in
4
�l
I
: "!
- ..
.............
bri~hter
future.
favor
of
dependence.
Thank you.
there this year.
few baby steps away.
just a
Now, let's qo those last few teet and get
We are so close to achieving this critical qoal
health insurance that can never be taken away.
thinq to do -- is to provide every child with guaranteed private
The best thing to do; the riqht thinq to do; and the smart
do i:s to warp the syste1n in
those on welfare to join the workforce, the last thinq we need to
At a time when we are •orking to create new incentives for
for all Americans, especially those wno work hard every day.
But they can't rise if we don•t provide universal coveraqe
·rhey want to rise to a
That un and hia fuil)· c1on • t want to sink into poverty to
qat health insurance.
-·
\.- .....
• ' : l\ :
- ' • -
\,
-..
: : . .. ·'·
�-_.,;;
401 Wythe Street, Alexandria, V1rgin1& 22314 • Phone 708/684-l?.M • FAX 7031684-1588
Tht N«tt:mal Auct:IDtitJn f1/ Childrtm 'r Hcspitall ilNi /Wt:tttld f,l3tltvltons (IIAc;HRI) Lr the only IIDIIOMl
organizalion <:f cltlldrel& ·, hMpitDll i11 the CQIIIItly. Ill I 37 membm ilfCI._ ji'f11Htl:1fdlng Getllt t:art cltlldnn '.t
hospitals, pediatric tieptlrtmenu qf majql' mtldit:al ocntm and uther hospttflll fZIIIJ ~itJity holpitDJ.s tiwol*l to
rehelbilitDtive Q1lfj/ lo11g-t1111'111 Clll'e /01' childTM.
##N
It's time for everyone concerned about the no.tion's GS million children to ask members or
Congress, who's for kids and who's just kidding?
Healthy children are thP. foundation of today's Cl.lw.:litional system aDd of tomorrow's bnsfmss
and commerce. That'=' why any system of health care in this countrY must t'Mvide UDiv.sal
envemge -- e:~pocially for cbllctten. NAl.:HRI suppons health care refonn that gives childlal a
guarantee of secure coverage.
'We must see that cbUdren come into the health care system sooDcr, not sicker. If
smaU buslllesses refuse tc;t do their share, 1m•ll chiJdreD wiD pay the price.
The situation for children has not improved. Our patients are the fai.1SS behind tbesc appalliJ:ls
numbers. When 'hildnm whose workmg parena cannot afford private insurance become sic1r
or i~iurecl. they arP. treated at p~blic expew-=, either through Medicaid or throuah charity.
Adults Debate."
Five years aao, NACHRl conducted a study of the insurance rtatus of children adwiu.ed to
our hospi~l'k We found that contrary to popular stereotypes, they typically come from a small
two·parcnt family. At least one parent works. often fCir a s.aWl Brm In either the service or
construcdon industries where the employer does not offer family coverage, if any at all. Tn
presenting the!l:P. findinQ& to Congress, we sa14- as we say now- •Kids Can't Wait WhUe
need for universal coverage.
Todi:ly's publlca1ion of Child Health USA's Statistics on the number of children without
private health insurance validates the experience of children's bosphals and underseores the
Statemeut bv Lawrence A. !\tcA.ndrews
"
Presideat and Chief Executive Ofticer
The National Association of Children's Hospitals a ad Related Institutions
July ll, 1994
The National Association of Children's Hospitals
and Belated IDstitntlons, Ine.
_:,._
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. PIZZA HUT
J
�Today, working
Americans lose out. In
Germany and Japan,
every company, including
American firms is required to
pay for health insurance-and
almost everyone who works is
covered. But in America, Pizza
Hut and some other big corpora·
tions get a free ride and leave many of
their hourly employees out in the cold.
Now some large companies are lobbying
Congress to kill health insurance at work.
PersiCo even told Congress that if they had
to cover all of their employees, it would
"reduce employment opportuniry...by tens of
thousands of jobs." Yet, the real story is that Piz:a
Hut is ex-panding rapidly in Germany and Japan
where they pay for health insurance and sell lots of
pi::as at the same time. Pi:a Hut's real message to
Cmgress is: Jo as we say, not as we do overseas.
It's time: American workers get a slice of the pie. Every
Amc:rican doel'\·es hc:alth coverage at work. So pick up
ynur rhone anJ rlace your order with Congress. Tell them
to side with ,A,.meric:an workers, nut big companies that pay
ior homc:r hc:alrh 1-c:nctits o1vc:rscms. Ask them to guarantee
l'vcry Amcril:;tn health insurance: <It work.
Paid for by the Health Care Reform Project
For more information call 202-783-6323
H Pizza Hut Wins, American Workers Lose
That's why America needs health reform. Becau..<e hugely
profitable American companies like Pi:a Hut Jon't pay h'
cover many of their employees in the: United State:~. an.!
that forces othc:r businesses and fumilic:s that ha"c: hc:alrh
illllurance to r-ay mure for thc:irs.
Piz:a Hut says that 71% of its hourly employees
have coverage from other sources, 15% have no
coverage, and only 14% avail themselves of the company plan.
In the United States, Pizza Hut's hourly
employees must pay the full cost of health
insurance for six months before Pizza Hut will
make any contribution-and then the contri·
bution is only for additional coverage, not the
basic plan.
PIZZA HUT PAYS FOR HEALTH
INSURANCE BENEFITS FOR
THEIR WORKERS IN GERMANY
AND jAPAN, BUT FOR MANY
HOURLY RESTAURANT EMPLOYEES
IN AMERICA, PIZZA HUT PAYS NO
HEALTH INSURANCE. Zero. Mean·
while Pizza Hut, a division of PepsiCo,
one of America's largest corporations,
made $3 72 million in profits worldwide
last year.
Pizza Hut Does Not Deliver
The Same Health Benefits In America
As It Does in Germany and Japan
No Matter How You Slice It...
�REPORT:
Contact: Mark Johnson
202-289-5900
The report was based on extensive research of corporate fmancial
reports and other public data, plus interviews with company personnel and
staff at foreign government offices. It cites specific figures for each company
and country included in the report.
"These companies [Pizza Hut and McDonald's] are living proof that
shared responsbility works for employers and employees, and as a means for a
nation to achieve universal coverage," the report says. "But instead of
applying their successful experiences abroad to the United States, these
companies have effectively said to Congress and the American people: Do as
we say, not as we do overseas!"
Yet, as the report confirms, Pizza Hut is tremendously successful and
employment is on the rise within the company in Germany and Japan. The
same is true for McDonald's in these countries, plus Belgium and The
Netherlands. All four countries cited in the report have some version of
shared responsibility to pay for health coverage.
The report cites PepsiCo's Pizza Hut subsidiary and McDonald's as
two very profitable companies that have lobbied hard against the mandate,
claiming it would impose dire fmancial burdens and job losses in the United
States if enacted by Congress. For example, David Scherb, PepsiCo's vice
president for compensation, told the House Ways & Means Committee in
December that a mandate would cost "tens of thousands" of job opportunities at
·
his company.
WASHINGTON -- Some of the most visible opponents of employeremployee shared responsibility for health care fmancing -- companies that pay
little or nothing to cover many of their hourly employees -- not only pay to
cover comparable employees overseas but are achieving tremendous business
success in these foreign markets, a report released today by the Health Care
Reform Project shows.
AND THRIVE - DESPITE CLAIMS MADE TO CONGRESS
PAY :FOR EMPLOYEE COVERAGE OVERSEAS
PROMINENT U.S. OPPONENTS OF SHARED RESPONSmn.ITY
Grassroots Orgonizatlan: 202/783·6323
Fax: 202/783·6327
Press &Othtr Inquiries: 202/219·5900
' Fax: 202/289-4141
1400 l Stnet, NW WasfingtOI\ DC 20005
THE VOICE OF
AMERICANS FOR
CHANGE, NOW.
HEALTH CARE
REFORM PROJEa
For Immediate Release
July 15, 1994
�###
PepsiCo/Pizza Hut and McDonald's were chosen for this study .because
both sit on the steering committee of the Healthcare Equity Action League
(HEAL), a coalition that opposes the mandate, and because they have
operations in countries with mandates and thus are qualified for comparison.
"Clearly, McDonald's is having no trouble selling its burgers overseas
even though it pays for health insurance," the report concludes.
For example,
McDonald's is tremendously successful overseas.
"Germany is one of McDonald's' six largest markets," the report says. It had
27,000 employees there in 1992 with revenues of nearly $1 billion. Likewise,
in The Netherlands, McDonald's now has 100 stores, a 17.6% increase over
last year. In Japan, the number of McDonald's restaurants (1,048) has
increased 8% since 1993.
McDonald's does not cover hourly or part-time workers at its U.S.
restaurants. However, McDonald's does pay for coverage for its workers in
Belgium, Germany, Japan and The Netherlands, as the laws in these countries
require.
By contrast, in Gennany, Pizza Hut is required to pay 50% of its
employees' premiums. As of 1991, there were 64 Pizza Hut restaurants in
Gennany with revenues of $39 million and 2,100 employees. In Japan, Pizza
Hut is required to pay 50% of the premiums for employees who work at least
30 hours per week (most do) at any of the company's 65 Japanese restaurants.
Japan is such a strong market for Pizza Hut that the company, in 1992,
publicly stated its intention to boost the total number of Pizza Huts in Japan by
more than 300 percent within five years. And while the company does not
disclose country-specific results, it has said that international sales "posted
double-digit growth" in 1993.
For example, the report notes that Pizza Hut, which earned a net profit
last year of $372 million worldwide, "does not contribute to health insurance
for many of its hourly restaurant workers in the United States." The company
does make a group insurance plan available to these hourly workers, but
employees are required to pay the full amount. After six · months, the
company will contribute to the cost of added coverage, but the basic plan is
still entirely the responsibility of the employee.
·
�lifllllaDIS
Contact:
Fax II
:Mark Johnson 202/289-5900
·
·
Below are the major responses Pizza Hut has made to the Project report
followed by the Project's factual responses:
"First, Pizza Hut hired an army of lawyers to accuse us of libel and to
intimidate TV stations into nc't IUDDing our ad last week," said Bob Chlopak, a
consultant to the Project and author of the report. "Now Pi72a Hut is trying to
scare consumers by making outlandish claims about the price of pizza under an
employer mandate. The fact is that Pizza Hut is slicing up the tnlth in order to
justify cutting out American workers from their health insurance pie."
employees.
The Project also issued an analysis of Pizu But's claim that it would be forced
to raise the price of a Pizza to $19 or even $25 if it had to pay for health care
benefits for its American employees like it pays for many of its foreip
shared respOhsibility.
Meanwhile in Washington, Project volunteers delivered Pizza Hut pizzas at
lunchtime today to SO congressional offices, topped with a message to support
Today at Pizza Hut restaurant:; in 25 states the Project staged demonstrations to
focus on Pizza Hut's hypocrisy and tum up the pressure on key members of
Congress who do not yet support shared employer-employee responsibility. The
Project bas shupened its message to Congress, telling Memben to stand with
American workers instead of ~::ompanies that give better health benefits to their
foreign workers.
Washington, D.C.- The Health Care Reform Project today escalated its
campaign in support of shared responsibility with a continued focus on Pizza
Hut, a company that pays for its workers' health insurance overseas while
denying insurance to many American workers.
Pizza Hut's Prediction of '$19 Pizzas' Rebuffed
Project Delivers Piz:us to Congress; Bolds 2.0 Events at Pizza Huts
Nationwide
FOR IMMEDIATE RELEASE
July 19,1994
14IXI L5traet, NW Wahiug101• DC mlS
Otglllnizollol: %02/713·6323
Fu: 102/71Hl27
Press &Otller 1-.nrits: 202/219-StOG
Fta: 2021219·4141
CHANGE, NOW.
THE YOKE OF
AMERICANS FOR
HEALTH CARE
REFORM PROJEa
Fax//
I
�~002·003
The fact is, according to the Hoppenstedt Companies and Executives in
Germany, a respected compendium of information on businesses.
employment at Pizza Hut in Germany increased by 400 employees from
3. Pizza Hut says growth in Ge.nnany has been stagnant and that only 240 jobs
have been created in five years. (AP story, 7/15/94, by Christopher
Connell). Pizza Hut's ad also implies that employer mandates are the cause
of higher unemployment rates in Germany.
The fact is that Pizza Hut repeatedly bas tried to blur the difference between
"offering" insurance and "paying" for it. The claim that Pizza Hut shares
the cost for all employees including part-timers is totally false. PepsiCo•s
study included in its Ways and Means testimony says that only 14% of
hourly restaurant wotken at Pizza Hut participate in the insmance program,
largely because they have to pay 100% of the cost. Pizza But•s own health
insurance;plan description and its lawyers' letter to the Project make clear
that the company contributes to health insurance for these employees only
after they have paid 100% of its cost for six consecutive months. Then the
company pays for added coverage if the employee continues to pay 100% of
the cost for basic coverage. The bottom line; only 14% of hourly
restaurant employees participate in the Pizza Hut insurance progmn and
many fewer, given the 150% annual turnover in employment, get a
contribution from Pizza Hut for their. insurance.
U.S. , full-time and part· time. And we share the costs of that insurance with
them." (Pizza Hut's ad, '\Vichita Eagle, July 18, 1994).
2 Pizza Hut says: ""W"e offer health insw:ance to all of our employees in the
The fact is virtually everything costs more in Gennany and Japan than in the
U~S. But the claim that P:1zza Hut will have to raise pizza prices from $11
to $19 or $25 to pay for health insurance has no basis in fact. Indeed,
Pepsico•s own numbers show these estimates to be 20--35 times greater than
the actual increase needed. It's VP for Compensation told the Ways and
Means Committee that labor costs at its restaurants amount to about 30% of
sales. Under the Kennedy bill, as one example, health insurance costs for a
large employer in a low wage business could not exceed 12% of payroll.
Thus, to recover the increase costs for health insurance, Pizza Hut would
only need to Iaise prices by 30% of 12% or 3.6%. On an $11 pizza, the
increase is just $.40. The $8 and $14 increases suggested by Pizza Hut are
20-35 times this amount.
1. Pizza Hut says: "To cove:1· the costs of mandated health care and other
benefits, we are forced to 1:-.U.se the prices of our pizzas. In Gennany we
charge $19 for a pizza that costs $11 in the U.S. In Japan, we charge $25."
(Pizza Hut's ad, Wichita F~gle, July 18, 1994).
1.-nLUI":\l\, U:.U.'o ..UW,
�l.J
t ' .1.-tJ,· tJ-t
.l"';
.uo.3:00J
the company appears to backing off their original claims that the ad was
false and libelous. Now tltley're claiming that our ads are misleading or
bogus, while still providirtg no documentation to support their charges.
The fact is there is only 1 script and spot and it bas not been changed. Pizza
Hut has produced no evidt~nce to the contrary. Now that Pizza Hut's
attempt to the intimidate the Project and local TV stations has been exposed,
Times, 7/16/94)
Friday differed from one that allegedly said Pizza Hut "did not offer
insurance or pay for insurance for any of our employees. (New York
Pizza Hut says the Project changed the ad because the script released last
1992 to 1993, an increase of23.4%. In Japan, Pizza Hut has forecast a 3
l/2 fold increase in the number of stores in-five years. Clearly, the
. employer mandate L1 Germany and Japan is not restraining Pizza Hut's
foreign growth. Indeed, l'iua Hut's growth and success under the mandate
proves the opposite of their argument: that they can provide health
insurance, provide more jobs and thrive all at the same time.
CHLUl"'AK, LEU:"ARD.
##
The fact is that, by not paying for insurance for all of its employees, Pizza
Hut is responsible for ma.~:sive east-shifting, making other employers and
fami1ie$··pay the cost of insurance for Pizza Hut employees. Again, using
PepsiCo's own survey and plan description, fewer than 14% of Pizza Hut
hourly ~ployees have health insurance to which Pizza Hut contributes.
That means the rest of us with health insul'3llce pay to cover over 86% of its
hourly employees through ~::est-shifting and uncompensated care. With
upwards of 100,000 hourly employees in the.United States, Pizza Hut is
shifting a huge burden onto other businesses and families. The fact tbat
everyone else is picking up Pizza Hut's tab is hardly a justification for the
company to shirk its responsibility.
S. Pizza Hut says that colllpany surveys show that 70% of its restautant
workers already have health insurance from other sources. "Therefore, to
state or imply that most Pizza Hut employees want, seek or need health
insurance... is false and n:dsleadiug." (Letter from Pizza Hut lawyers to the
Project, July 14, 1994)
4
~I)
�•
CHLOPAK.LEO~ARD.
Tues4ay, July
12:00
~~
no.:)l1.
Noon
Pl:t:~a
12:00 noon
Prt55 & Ot•er lnquiriiS: 202/289-5900
Fo: 202/289-4141
GrCKSIOOI$ OrgonizatioD: 702/783-6323
N!a: 207fl83-6327
Wanngt11~ 1)(20005
Baton RQuge, LA 12:00 noon
Pizza Hut at 3347 Hig"hlancl R·oad (close to LSU)
Dallas, Texas
Location T80
Austin, Texas
Location T:SD
Wednesday, July 20
Pizza Hut at 2720 Hylan Blvd
Staten Island
Manhattan 11:00 am
Pizza Hut at 162 West 34th Street
Kenosha, WI 11:30
Pizza Hut at 4608 75th Str<3et
Pizza Hut at John Fitch
Trenton, NJ Noon
Omaha, NE 1l:30am
Pizza Hut at 7515 Pacific St.
Albany, NY Noon
Pizza Hut at 954-960 Ce-ntral Ave.
Middletown, CT 12:30pm
Pizza Hut at 595 Washington Street
Pizza Hut at 1112 Resevoir Ave.
Cranston, RI
Pizza Hut at 1301 University Avenue
1400 LSlraet,NW
141002
Pizza Hut actions are scheduled this week in the cities listed
below.
Minneapolis, MN
THE YOKE Of
AMERICANS FOR
CHANGE, NOW.
HEALTH CARE
lffOIM PROJECT
'0'202 289 HH
�rso
Syracuse, NY
Location TBD
Atlanta, GA
Location TBO
Birminqham, AL
Location TBD
Location
Chicago; IL
~,r::..ll
.( II iJ .;
be a part of a Radio call-in show.
July 21 or 22.
The Pizza Hut inforn.ation
Portland, OR
Madison, WI
Locat.ion TBO
Location TBO
St. Louis, MO
Indianapolis, IN
Location TBD
F~14ay
of Pizza Hut events
ThUZ84ay or
2
Wichita, I<S
Location TBO
Paqe
(_Hl..•)P . ~K. Uu\.-\F..D.
�-"
-
....
The Health Care Reform Project
JUly 1994
...
�-
..
This report takes a ftesh look at the concept of shared responsibility.
DesP,ite all of the congressional hearings, months of debate, and examination
by the press and academics, one critical chapter in the story of shared
responsibility ··bas been overlooked. As this report reveals, soine American
companies that don't pay for coverage for many of their workers in the United
States already contribute to health insurance for comparable workers overseas
under shared responsibility systems similar to those approved by
congressional committees. Moreover, these companies have opposed ·shared
responsibility throughout the health care debate. They have argued, including
in testimony to Congress, that shared responsibility would stifle their growth
Public support for shared responsibility remains very high. Coincidentally,
just as three of four committees approved shared responsibility, the latest
polls show that Americans support the idea by roughly the same margin 72% in an ABC News/Washington Post poll released June 27. Nevertheless,
opponents of shared responsibility like the Natiot:W Federation of
Independent Busmess (NFIB) have skillfully . generated opposition in
Congress despite having no success in moving public opinion. Both the
House and Senate are expected to have close votes on shared responsibility in
the coming weeks.
As health care reform legislation moves to the floor of the House and Senate,
one. of the most significant unresolved issues is the financing mechanism to
achieve universal coverage. Shared responsibility - the requirement. that ·
employers and employees each contribute to the cost of health insurance - is
included in three of the four congressional bills.
Introduction
�.
.
-
of
Finally, it is worth noting that two _ the countries that require shared
responsibility - Germany and Japan - are America's major economic
competitors, so any suggestion that shared responsibility would undermine
America's international competitiveness is specious, at best. German and ·
Japanese businesses manage to maintain their competitive edges while paying
for health insurance. Perhaps, more importandy, many American businesses
Two further points deserve consideration. The major arguments against
shared responsibility have centered on alleged adverse impacts· on small
businesses. But this report reveals that some very large companies do not pay
for health insurance coverage for many of their hourly employees.
Consequently, members of Congress who vote against all forms of shared
responsibility,·- inclwting proposals that exempt or phase in requirements for
small employers, would ..be siding with these giant companies at the expense
of their midcDe and low income workers.
This report is a case study of two companies that practice a double standard
when it comes to contributing to health insurance: Pizza Hut, a division of
PepsiCo, and McDonald's. Though these are the only companies the Project
examined in detail, there are hundreds of American companies doing business
in the same four countries included in this report where shared responsibility
is the law: 449 in Belgium; 805 in Germany; 660 in Japan; and 492 in The
Netherlands, according to the Directory of American Firms Operating in
Foreign Countries. This is not to suggest that all or any of these firms
· practice a. double standard like Pizza Hut and McDonald's. But these ·
.
.
numbers ~o raise an interesting dilemma for some in Congress.. By voting
against shared responsibility, members of Congress would risk denying
American workers benefits that comparable foreign -workers at hundreds of
the same U.S. companies already get.
Ironically, these companies are living proof that shared responsibility works
for employers and employees, and as a means for a nation to achieve
Wliversal coverage. But instead of applying their successful experiences
abroad to the United States, these companies have effectively said to
Congress and the American people: do as we say, not as we do overseas.
and lead to job layoffs in the United States, but they are rapidly expanding
their foreign operations and contributing to health insurance at the same time.
�.
I
1
..
PepsiCo's 10K filed with tbe SEC, 3/23/94, pap 2.
Pizza Hut Summary Plan Deseriptioa.. ..Your Guide to Great Beadits." Mal Plus Program.
page 11. Pizza Hut also offen an accident only plan, Accident 5000 Propam. wbich also
requires tbe employee to pay 1000/e.
Pizza Hut, a division of PepsiCo, operates approximately 4, 720 restaurants in
- the United States. 1 The company does not contribute to health insurance. for
many ~fits homiy restaurant workers in the United States.~ Hut~
~ ins~~_plan available to these hourly em loyees Diil;is the
~~<! Plus plap offered_!?Y_ Pizza Hut to these emp oyees states, "~e
c_ontriliulions are required for the full amount of the premiums. "2 In addition,
Project. researchers placed several _cans to- Pi.Zi8"Hut'Sliemdf insurance hot
Pizza Hut
PepsiCo/Pizza Hut and McDonald's were chosen for this study because both
sit on the steering committee of the Healthcare Equity Action League
(HEAL), a coalition that includes some large companies opposed to the
mandate. In addition, both PepsiCo and McDonald's have operatioQS in at·
least two of the countries that have employer mandates. PepsiCo also has
been an outspoken critic of shared responsibility.
For this report, we have concentrated on four countries with employer-based
health care systems much as the President and others in Congress have
proposed.
These countries are Belgium, Germany, Japan and The
Netherlands. Their universal health care policies are described in the
Appendix. Employers in three of these countries must contribute to their
employees' health insurance premiunis, including part time workers. In
Japan, contributions are required for any employee working at least three
quarter time.
The Report
operating in Germany and Japan are competitive and also provide health
insurance.
�10
9
8
6
s
l
.
-
..
The average annual exchange rate for 1991 was 1.6610 marks to the dollar.
713/94.
from
These COIMIS8ticml eoa&rmed tbat hourly workers leaviq Pizza Hut 8lld IIIOViq onto COBRA
would not bave an ~ in their premiums because they are already payiq the eotiR cost of
the iDsuraDce plan. Cosmrsation with Tracy Timmerman at Pizza Hut's hotline. 1-800-99S.
· PHUT. First call was pla::ed at 8:40 am. on 6/23/94. Second call was pla::ed at 4:45 p.m.
and tbe same response was given by LacbeUe Bowen.
Letter
Micbael S. HOme of CovingtOn & Burling's DC oftic:e. Pizza Hut's attomeys.
Received by fax 7114/94.
PepsiCo's 10K filed with the SEC, 3/23/94, page 2.
Copyright 1994 WID PartDm. Worldscope. Kentucky Fried Cbicbn Japan Ltd.
Graig, Laurene A.• Healtb of Nations: An International Perspectiye on U.S. Health Reform.
·Second Edition, 1993 (Wasbington, D.C.: Congressional Quarterly Inc.), pap 96.
Japan Eeonomic Institute (IEI) Report, 10/15/93, page 10.
Conversation with Bill Stasicwicz in Tokyo, Pizza Hut America, Public· Affairs Represcn1ative,
In Germany, the subsidiary is known as Pizza Hut Restaurations GmbH.
There were 64 Pizza Hut restaurants in Germany, employing 2,100 people
with revenues ofDM 64.8 Mio (over $39 million 10 ) in 1991, the last year for
In Germany, Pizza Hut is required to pay 50% of its employees' premiums.?
Premiums are tied to income so employers pay the same percentage, though a
. smaller amount, for part-time employees. In Japan, Pizza Hut is required to
pay 50% of the premiums for employees who work at least 30 hours per
week. 8 The Project made several inquiries to determine the scheduling
routine for Pizza Hut employees in Japan. Eventually, Project researchers
were directed to an executive of Pizza Hut America working in Japan. who
stated that the majority of Pizza Hut's part-time employees in Japan work
more than 30 hours per week. 9 Therefore, most Pizza Hut workers in Japan
receive health insurance at work and Pizza Hut pays 50% of their premiums.
Pizza Hut operates 77 5 restaurants and has 420 joint ventures outside the
United States including subsidiaries in Germany5 and major invesbnents in
Pizza Hut Japan. 6 Pizza Hut does pay health insurance for hourly or parttime workers at its Genilan and Japanese restaurants without the same
limitations that apply in the United States. (See the Appendix for a complete
description of the health care policies in these countries).
line and received additional confinnation. 3 Only after an hourly employee has
paid the full cost of health insurance for six months and only if this employee
continues to pay 100 % of the basic coverage, does Pizza Hut contribute. At
that point, the company pays for higher maximum limits on coverage. 4
�21
20
19
II
17
16
IS
14
13
12
II
...
Copyript 1994 Hoppeastedt Winscbaftsdatenbank GmbH. Hoppeastedt Compmies aad
· Executives in Germany, Pizza Hut Restauralioas • GmbH aDd Co. KG.
Copyrisbt 1994 WID Pannen, Worldscope, Kentucky Fried Cbicken Japan Ltd.
"KFC J.piD to Operite Pizza Hut Restaurants," Jiji Press Ticker SeMc:e, 10129/92.
Conversalion with Richard Detwiler, Director of Public Relations. Pepsico, PurdJase. N.Y.,
6/22/94.
Jiji Press Ticker Service. 10/29/92.
PepsiCo lOK. pap 20.
Rand McNally 1994 Commercial Atlas and Marketins Guide, 125th edition., pap 48.
PepsiCo 1993 Annual Report, page 1.
PepsiCo 10K. page 20.
Copyright 1994. Disclosure Incorporated. PepsiCo Inc., Number P340600000.
Peps.iCo 10K. page 20.
.,
elect it is a heavy burden, even though the coverage itself could best be
On the other hand, the cost of health insurance to Pizza Hut workers who
In addition to Pizza Hut, PepsiCo owns and operates a number of food chains
including Taco Bell (worldwide profits of $253 million), Kentucky Fried
Chicken ($153 million) and California Pizza Kitchen (NA).21
PepsiCo and its Pizza Hut subsidiary clearly can afford to pay for their
workers' health insurance. Last year Pizza Hut earned $372 million in
profits, an 11% increas~ over 1992 on sales of $4.1 billion. 16 Its parent
company is the 15th largest industrial corporation17 and earned profits of
$3.077 billion in 1993, a 23% increase over the prior year. 18 Pizza Hut.does.
not report sales and profits by country, but they. do report that· international
sales" posted double-digit growth." 19 And, PepsiCo paid itS CEO, Wayne D.
Calloway, $2,986,32~ last year. 20
In Japan, PepsiCo has a joint venture with Pizza Hut Japan through its
Kentucky Fried Chicken subsidiary. PepsiCo is KFC Japan's largest
shareholder, with 30.53 percent of the outstanding stock. 12 In 1992 KFC
Japan signed a contract with PepsiCo Food Services International that gives
the company exclusive rights to operate the Pizza Hut chain in Japan. 13 There
are 65 Pizza Hut outlets and 1,100 Kentucky Fried Chicken restaurants in
Japan. 14 In October 1992, press reports indicated that the ratio of companyowned stores to franchises was about equally divided: 16 owned and 17
franchises at that time. 15
which figures are available. 11 Pizza Hut does not disclose how many of its
restaurants in.Gennany are company owned versus franchises.
�:za
:1.7
Z6
l5
l4
2l
-·
-
Committee; 12115193. ·
Ibid.
Annual sa1aly of$5.500 divided by $600 (esrirnatrd cost ofMalth CcMraae> equals 10.9% of
salary. Annual salary computed by multiplyiq S5 per hour· times l2 baun per week times 50
weeks.
Scherb Testimony. 12/15/93.
Healtbcare Equity ActioD Leape. Goals aDd steeriq committee members list, 2114194.
Healthcare Equity ActioD League, "CliDtoD Health Plan Trades Away Jobs." News Re1eale.
4/14/94.
Scherb testimony. 12115/93
Pizza Hut~s MedPlus Propam [page 4] pays 50% of medic:al expel. . up to a limit of $20.000.
After 6 mootbs of COidiDuous employment, the c:Overap expaads to also cover 100% of
reasoaable aDd CUSIDIII8I)' cbaqes for eligible expeases up to $100.000 ($80.000 lifetime
mavimum benefit). Tbe company also offers an aa:ident only policy (see 12) tbal piO¥ides ewa
· less CCMrap.
Testimony of David E. Scbcrb. PepsiCo VP for Compensation. Won House Ways aDd MeaDs
A PepsiCo executive ·has testified before the Ways and Means Committee
against shared responsibilitY9 and press reports state the company has
PepsiCo's opposition to shared responsibility is a well established fact. The
company sits on the steering committee of the Healthcare Equity Action
League (HEAL), an organization that contends "employer mandates are
unacceptable" m. its goals statemerit.27 HEAL also released a study
comparing five different health proposals in which they claimed that the
Clinton plan would "translate into $27.6 billion in lost compensation."28
However, most of the cost of covering Pizza Hut's part-time workers falls on
other employers and their employees who pay to cover Pizza Hut workers
through family coverage, or through cost shifting for uncompensated care. In
his testimony, Scherb cited a survey which found that 71% of Pizza Hut's
hourly employees had coverage elsewhere, and 15% declined insurance for
cost reasons or said they did not need insurance. Thus, only 14% of the
company's hourly employees are covered by a Pizza Hut policy, which the
employees pay for entirely on their own for the first six months.16
described as bare bones. 22 David E. Scherb, PepsiCo's Vice President for
Compensation, told Congress that employees pay an average of $600 a year
for a single person, and about $1,300 for family coverage. 23 Later, Scherb
testified that an average worker in their restaurants is single and works 22
hours per week at $5 per hour. 24 At an annual salary of $5,500, Pizza Hut
workers pay II% of their compensation for health insurance. 25
�.
mmcate
36
lS
]4
ll .
ll
lO
"Same Players. New Teams in Health Debate," The NationalJoumal, 111/94, pap 24.
..Burger. Fries - andiDsurance?" The NationalJoumal. 4/16/94, page 886.
PepsiCo 10K. page 9.
Scherb Testimony, 12115/93 .
Ibid.
"KFC Japan To Operate Pizza Hut Restaurants." Jiji Press Ltd.. 10129192. PepsiCo bad 33
restaunnts at the time, so 150 more equals a three and a balffo1d iDclase in 5 yean.
.
Hoppeostadt Companies and Executives in Oenilany. Dollan calc:ulated using anaua1 average
exchange rates of 1.6610 for 19918DCI1.8808 for 1989.
However, a year before IJlaldng these claims to Congress, Kentucky Fried
Chicken Japan Ltd., which runs the Pizza Huts in Japan, publicly stated its
plans to boost the total number of Pizza Hut shops in Japan to 150 in five
years, more than a three and a half fold increase. 35 Similarly, Pizza Hut's
revenues in Germany between 1989 and 1991 grew 38.4% from $28 million
to $39 million. Furthermore, the number of employees increased 23 .4%, from
1,700 emplQy~s in 1992 to 2,100 in 1993.36 Clearly, if PepsiCo has already
adopted the mitigation measures in Japan which they told Congress would be
need~d in the United States, these steps have not impeded the company's
Most interesting, though, are the claims in PepsiCo's Congressional
testimony. Scherb told Congress that shared responsibility in the Unit
States " will r~duce ~mployment opportunity at PepsiCo by tens of thousandS
Qf-jobs"!-~ Scherb later-·elaooratea on a litany of steps PepsiCo. would
probably take if Congress enacted a mandate including automation, reducing
labor inte~sity, and raising the hurdles for capital investment.and expwion. 34
The clear implication of Scherb's testimony was that shared responsibility
would eliminate jobs and hurt the economy.
PepsiCo even included its opposition to this provision in its 1OK filing with
the FEC, writing: "PepsiCo is opposed to proposals that replace the
competitive marketplace with a government-run healthcare system and
employer mandates. nll The document does not mention that the company
already operates under shared responsibility requirements in other countries.
the company has been instrumental in assisting the National Feder~tion of
Independent Business, a small business coalition that has spearheaded antimandate lobbying. This relationship serves PepsiCo's political interest by
reinforcing the impression that opponents· of shared responsibility are
exclusively small businesses. 31
fonn~~~J.o~~!:n~~ss ~ru ~ro
�39
38
37
7nt94.
Based on field reports and confirmed in a telephone conversation with Linda Hadraba, Benefits
Administrator, Beacfits and Compensation Department, McDonald's, 6/29/94. McDonald's only
makes contributions for full time employees with manapment responsibility, defined u those
working at least 35 houn per week.
See the Appendix for information and full docwnentalion on the policies of Belgium, Germany,
Japan, and The Netherlands.
ConVersation with Akito Tsutsumi, Personnel Depanment, McDonald's Japan, Tokyo, Japan.
~
McDonald's does not cover hourly or part-time workers at its U.S.
restaurants. 37 However, like Pizza Hut, McDonald's does cover hourly or
part-time workers at their stores in Belgium, Germany, Japan and The
Netherlands, as the laws in these countries require. (See the Appendix for a
. description of country requirements.) . Three of these countries require
employer contiibutions. ~en for part time workers. 38 As noted earlier, Japan
requires employer contributions for all employees working more than 30
houn per week, a schedule that applies to many McDonald's employees. 39
. .
McDonald's
Pizza Hut At A Glance
growth. Alternatively, if they haven't adopted these measures in Japan, there
is solid evidence to suggest that they won't be needed in the United States
under shared responsibility either.
�49
48
47
46
45
44
43
4%
41
40
·McDonald's 10Kfiled with the SEC 3/29/94, page 21.
Ibid.
Copyright 1994 Graliam incl Trotman Limited. Company lntellipnce, McDouald's DeutschlaDd .
Inc.
·
"Management Perspectives on 1994 Reported Results and Business Prospects." McDouald's'
Investor Release, 4/21/94, page 6.
Ibid.
. Ibid.
McDonald's 10Q filed with SEC '/10/94, page 11.
HOOYer's Handbook of America's Business 1994, page 746.
Rand McNally 1994 Commercial Atlas and Marketing Guide, 12'th edition.
McDonald's 10K Filing with the SEC, page 10.
Like Pizza Hut, McDonald's can well afford to pay for health insurance for
their American workers. McDonald's is the world's largest food service
organization.47 The company ranks 21st in the United States among retailing
companies. 48 McDonald's reported worldwide profits of $1.083 billion on
worldwide sales of $23.587 billion in 1992, including over $9 billion in sales
from oversea$: operations.49 The company reported a 6% growth in
.....
McDonald's does not report franchises and company-owned stores by
country, but there. is. evidence that a substantial number·of stores outside of
the· United States are company-owned. McDonald's 10Q filing reports that
the company owned over one quarter of its stores overseas: 1,283 versus
2,258 franchises and 1,254 affiliates. 46
stores). 45
. In Japan, there are 1,048 McDonald's, an increase of 8% since 1993 (970
McDonald's has 100 restaurants in The Netherlands, a 17.6% increase over
the 85 stores it had last year. 44
Gennany is one of McDonald's six largest markets. 41 McDonald's
Deutschland Inc. reports 27,000 employees with 1992 revenues of
$943, 955,000. 42 There are 501 McDonald's outlets in Germany currently,
which reflects a 13.7% increase over existing facilities one year ago (440
restaurants). 43 Clearly, McDonald's is having no trouble selling its burgers in
Germany, even though it provides health insurance.
Little detail is available on McDonald's Belgium operation, but reports do
indicate that the subsidiary has excellent sales on a local currency basis. 40
�51
sz
Sl
...
-
-
"Management Perspectives on 1994 Reported Results 8DCl Business Prospects," McDonald's'
Investor Release, 4121/94, page 6.
Copyright 1994 Disclosure Incorporated, McDonald's S Corp., Disclo Company Number
M314600000.
Healthcare Equity Action League, Goals and steering committee memben list. 2114194. See
also HEAL News Release, "Clinton Health Plan Trades Away Jobs, 4/14/94.
'
...
McDonald's is also a steering committee member of HEAL, one of the
leading opponents of shared responsibility, which has alleged that the
employer mandate would result in a massive loss of jobs. 52
$2,079, 176.
.
performance for the first quarter for 1994, and its international operations are
up a little higher at 9%,. 50 McDonald's pays its CEO, Michael Quinlan
�..
companies like Pizza Hut and McDonald's in every Congressional district in
America. It is time for Congressional opponents of the employer mandate to
And, finally there are the millions of low-wage, hard working Americans at
Congress will· soon vote on shared respo.nsibility and we call upon them to
look beyond the self•serving rhetoric of companies like Pizza Hut and
McDonald's and examiiie the performance and practices of these companies.
There is no conceivable rationale for letting these extremely profitable giants
off the hook. · There ·is no· reason why small businesses and hard working
Americans who pay for health insurance should contiriue to subsidize large
businesses (through cost shifting) that don't pay their fair share.
responsibility. But their growth overseas - where they already provide health
insurance under comparable shared responsibility systems - testifies more
clearly to the success of ·this ·financing system. ·These companies may
continue to provide better coverage to foreign workers, but they can no longer
cloak their policies and opposition to shared responsibility in fear and false
claims about job loss. Their own experiences overseas demonstrate that,
even in low wage businesses, employers can pay for health insurance for their ·
hourly workers without qualification and make significant 'Profits at the same
time. Their own experiences expose just how wrong their job loss claims.
have been.
Pizza Hut and McDonald's have made their arguments against shared
Conclusion
McDonald's At A Glance
�·~
-
consider their plight. How will Congress explain to hard working Americans
that they chose to protect huge companies that pay for benefits for their
foreign workers, but do not provide similar benefits in the United States?
How will Congress justify that, under the guise of serving small business,
they protected some of the largest and most profitable companies in America?
How will Congress justify guaranteeing these workers less health care than
foreign workers get at the same companies?
�..
• Summary Descriptions of Foreign Health Care Systems: Belgiu.m,
Germany, Japan, The Netherlands
• Insurance in the International Workplace: A Four Nation Comparison
APPENDIX
�"OFGDP
EXPENDnvRES AS
HEALTH CARE
SMAU BUSINESS
EXEMP110NS
EMPLOYEE
CONTRIBUTIONS '
EMPLOYER/
PARTTIMB
EMPLOYEES
Covered
GEJl!WIY
Employers 4.95% of
wages
Employees 3.IS% of
wages + nominal
premium
Covered
NETHERLANDS
None
8.2% (1990)
Employees 500/o
Employers 3.SO/o of
wages;
Employees 2.55% of
wages
Covered if work
30 hours or more
·Employers 500/o
JAPAN
For less than 5 employees
6.5% (1990)
Employees 500/o
Employers 500/o
Covered
.
....
BELGIUM
INSURANCE IN THE INTERNATIONAL WORKPLACE: A FOUR NATION COMPARISON
None
8.1% (1990)
None
6.5% (1991)
�60
59
51
57
S6
55
54
..
Fact sheet on the Adininiiuation of Health. Sickness and Disability IDsurance in Belgium,
Belgium Embassy, pap 1.
·
Ibid page 3.
Ibid, pages 1 and 3.
. Ibid, page 3.
Confirmed by conversation with Diedier Sceuws at Belgium Embassy 7/5194 at 4:10 pm.
Fact sheet on the Administration of Health. Sickness and Disability IDsurala in Belgium,
Belgium Embassy, page 2.
Ibid, page 2.
Ibid, page 3.
The insurance program for wage earners covers inpatient and outpatient care
with choice. o( doctors and other health care providers. Patients pay a
coinsurance of 25 pereetit for routine medical care and procedures, and a
daily lUmp sum for inpatient care. Dental care is partially reimbursed, while
The National Institute for Health Sickness-Disability Insurance (INAMI) is
the government agency that regulates health care. The agency is governed by
a General Board made up of representatives of employers' organizations,
trade unions, organizations of self-employed, mutualities, doctors, nurses,
hospitals and pharmacists.60
· Health care benefits in Belgium are administered to beneficiaries through
mutualities, which take care of reimbursement and coverage of medical
costs. 58 Benefits distributed for .sic~ess and disability amounted to 6.5
percent of GOP. 59
Part-time employees are covered by employer contributions and there is no
exemption for small businesses. 57
Employers and employees are the major players in the health care system
since they contribute 55 percent of health care costs. State subsidies
contribute 40 percent of overall cost. 55 Since 1982, employers contribute 3.8
percent of wages paid, while employees pay 2.55 percent. The self employed
contributed 3.3 percent of income for the compulsory health insurance. 56
Health care insurance is provided under Belgium's compulsory social security
system. 53 The entire population is covered by health insurance. 54
·
Belgium
�65
6<1
6l
62
61
Ibid.
Ibid. pap4.
Ibid. pap'·
Ibid. page '·
Ibid, pap4
..
..
Self employed persons are insured only for major risks, like inpatient care,
surgery and specialized care.64 They can, however, subscribe to a voluntary
insurance coverage program with their mutuality, and 70 percent of Belgium's
self-employed elect to purchase this coverage~ 65
prescription drugs are covered in full for life-saving medication and partially
for other classes of drugs. 61 Clinical lab tests are paid on a fee for service
basis except for inpatients. Fee schedules are negotiated between the
insurance carriers and the medical profession. 62 Fees for nurses and other
health care professionals, hospital rates and pharmaceuticals are negotiated
by the government. 63
�:
69
68
61
-
O'Connor, Kathleen, "What Do Our Competitors DoT', Egm1qyee Rpcfit5 Iqumal.. 12191,
page 29.
'
Kaps. Carola. "Health Care in Germany," Europe. 4193. pap 11.
Confirmed by conversation with Karl Fcldengut at German Embassy 716194 at 11:55 am.
Graig, Laurene A. Health of Nations: An Intet!!!tioaal Perspective on U.S. Health Rdma.
Second Edition, 1993. (WashingtOn, D.C.: Congressioaal Quarterly Inc:.), p. 96.
Health insurance premiums range from 8 percent to 16 percent. ' The average
payment in. 1992 was. 12.5 percent. Employer/employee contributions·
represent 60 percent of health care expenditures in Germany. 70
..
• Fees imposed on public and private employers to pay for sickness
allowances .for up ~ s~ weeks .
• Direct payments in the form of out of pocket expenditures and copayments (added in 1970).
• Private insurance premiums (for additional coverage or for those who opt
out of the sickness funds).
• PayroU deductions for health insurance preDllums are ·shared equally
between employers and employees.
• Local, state, and federal taxes.
Health care benefits are financed with revenue from five sources:69
Part-time employees are covered by employer contributions and there is no
exemption for small businesses.68
Germany has a work-based health care system that features private insurance,
near universal coverage (99%), employer-based participation in health care
costs, choice of health care providers, global budgeting with negotiated rates
and a comprehensive health benefits package.66 There are no exclusions to
coverage, so Germans do not fear losing their health insurance as some
Americans do. 67
Germany
�70
79
71
11
76
15
74
73
71
11
Grai& LaUreae A. pqe 93 and 96.
Graig. LaureDe A. pap 90.
Helms, Robert B. (editor), Health Care Policy and Politics. pap 25.
Graig. Launme A. pap 90.
Graig.l.auleDi A. pap 91.
Graig. Laureae A. pap 96.
Graig. Laureae A. pap 95.
Graig. Laureae A. paps 91 • 92.
fact sbeet from German Embassy, page 4.
Graig. Laureae A. pap 96.
·•
•
Germans are permitted to purchase private i.Dsurance to cover supplemental
benefits like private hospital rooms, medical coverage for overseas travel, etc.
Nearly five Qlillion Germans elect to purchase this coverage.79
In addition to membership in a statutory sickness fund or private plan,
German health care benefits are among the most comprehensive in the world,
and include an income replacement feature. 77 Preventative care and regular
checkups, dental care, vision, hospital treatment and home health care are
covered. 71
funds. Contributions for these self-insured plans are slightly lower, with an
average contribution of 11.4 percent. 76 .
As in the United States, many large companies sponsor their own sickness
Health care benefits are administered by 1, 150 sickness funds, 71 which are
similar to American Blue Cross and Blue Shield plans. 72 Membership in a
sickness fund is mandatory for employees earning less than a government-set
ceiling, currently $41,000 in the western states and $30,000 in the former
East German states. 73 Employees earning more are pennitted to opt out of
the fund and purchase private health insurance, but most chose sickness fund
coverage}4 Employers contribute to their employees' health care costs for
either sickness fund or private insurance coverage. 75
�87
16
85
114
83
82
It
80
..
. Laulale A. Graig, Tbc Health Nations. An lntel'llilfioaal Pe!'sJR.1iYe oa u.s. Halthgm
Reform. pap 130.
Graig, page 130. .
Masataka Kobda. "How Does Japan Do It? Universal Health lnsurm:e Coverap iD Japan."
EBRI Issue Brief. April1993, pap 35.
Pat Murdo. "Parts of Clinton's Health Care Proposal ParallclJapauese Plan," JBI Report No.
388, 10/15/93, page 10.
Conversation with Pat Murdo from the Japan Economic Institute on Tuesday, 7/5194 at 4:~ p.m.
Graig, page 139.
Graig, page 139.
Pat Murdo, "Parts of Clinton's Health Care proposal Parallel Japanese PlaD," JEI Report No.
388, 10/15/93, pap 10.
or
Large firms in Japan are permitted to set up health societies to provide
benefits. Premiums are not fixed by law and range from 3 percent to 9.5
percent of insurance premiums. In principle, these premiums are split evenly
between employer and employees, but the companies are allowed to pay the
entire cost. In 1992, the average contribution for these societies was 8.3
percent. 87
Health insurance premiums in Japan are income-based for government
managed plans. as Premiums are fixed by law, with employer and employee
contributing equal amounts to the plan. In 1992, employers and employees
each contributed an amount equal to 4.1 percent of the employee's salary. 86
Part-time employees are covered by their employer's contributions if they
work 3/4 of a full-time schedule or more (at lea5t 30 hours per week). 83 An
exemption exists for small businesses - firms with less than five employees
are not required to contribute to employees' health care costs.84
Japan has an employment-based, multipayer system with health care provided
through private channels. Patients are given freedom to choose their own
providers. 80 Government regulation requires all employers to provide health
coverage to all employees and their dependents either by financing an
independent health insurance plan or contributing to a government-run plan.81
Japan adopted universal health coverage in 1961.82
JAPAN
�90
89
a
Ibid. page 10.
Ibid.
Ibi~ page 9.
.
The system operates under fee for service, with choice of provider, as long as
the provider agrees to a government set fee schedule. 89 Basic medical care is
provided, as are allowances for maternity care. There are copayments, but
they are limited to 30 percent or less. 90
The unemployed and self employed are covered by a national health
insurance plan with premiums dependent on income. 88
�91
-
...
Graig. Laurene A Tbe Health of Nations: An Iptmyatiogal PersrjociM on U.S. Hpltb Care
Reform. p. 115.
Graig. Laurene A., pages 117 ·118.
Ibid, pap 118.
Ibid, pap 119.
.
Coafirmecl by conversalion with IcaDDCtiDa Veldhujozon afDutdl Embassy, 715194114:15 p.m.
Graig. Laurene A., pap 118.
Ibid, pap 119.
Dutch health care is financed by income-based premiums, paid by employers,
employees, retirement and unemployment funds. In 1989, health care·
premiums represented eight percent of gross wages. Employers contributed
4.95 percent, while employees paid 3.15 percent plus a nominal premium.
Employers .contribute the same amount to their employees' insurance
regardless of whether tbey belong to the public or private plans.97
The remaining ·sj.x percent .of the papulation is covered ·under mandatory
insurance for persons in the public sector. Civil servants employed by the
provincial and municipal governments are covered under this plan, and
premiums are income-related.96
Part-time employees are covered by employer contributions and there is no
exemption for small businesses. 95
Persons earning more can purchase private insurance, which is optional and
covers 32 percent of the population. Premiums are fixed and there are some
out-of-pocket payments. 93 About one-third of private insurance is group
insurance, and large firms may self-insure. 94
The public insurance program, ZFW, is mandatory for all residents earning
less than a specific income - $32,000 in 1992. ZFW covers 62 percent of the
popUlation, and the premiums for this coverage are income-related. 91
The Netherlands' health care system combines public and private financing
with private delivery of care. 91
The Netherlands
�100
99
91
-
Ibid. pap 115.
.
Freidea. Joyce. "Is DtEb bealtb can: a Model for tbe U.S. bealtb care lf*IA'l" Bulnu6 tllld
Healtll. May 1992, pap 34.
Ibid. page 38.
Health care benefits are provided through a network of independent nonprofit
sickness funds and private organizations. 98 There are 30 regional funds, each
of which contracts with a single insurer. A person must use the fund in their
geographical area. 99 Both public and private plans cover all inpatient and
outpatient care. 100
�Robert Chlopak •·
Chlopak, Leonard, Schecter, and Associates
Washington, DC
Dr. William Fisher
National Restaurant Association
Washington, DC
·'·
David R. Henderson
John M~ Olin ~VIsiting Professor
Washington UniVersity
St. Louis, MO
·
Panel Ill
Jonathan Gruber, Ph. D
Assistant Professor of Economics, M.I.T. ·
FacultY Research Fellow, .
National~ Bureau of. Economic Research
Washington, D.C.
Panel II
Mr. Allan Huston
President and CEO
Pizza Hut Incorporated
Wichita, ·KS
Ms. Deborah Accuardl
Accuardl's Old Time Pizza
Portland, OR
Ms. Nellie Kincer
Whitesburg, KY
Panel I
James and Brenda Newman
Whitesburg; KY .
July 22, 1994 at 10:00 AM
Dirksen 430
Witness Ust
Dual Standard: Health Insurance for American
and Foreign Employees of Multinational Companies
hearing on
u.s. Senate Commmee on Labor and Human Resources
�We have both been in Kentucky all of our lives.
We
When I
However, several
We went
medical bills as everybody does and it was hard but we paid them
So we had
Thank goodness neither of
us got too sick but we both did have to see doctors.
to pay for doctor's bills ourselves.
for over eight months without health insurance and both of us had
That was a very hard time for my husband and me.
company and neither of us had any health insurance.
months later my husband was laid off unexpectedly by the coal
and I was covered through his policy at work.
couldn't afford health insurance because my husband was working
When I first took the_job I wasn't too concerned that I
Kentucky and tips didn't come too easy.
Times were hard in that part of
took the job I knew that it wasn't going to pay too much.
$2.09 cents an hour plus tips.
I made
I first began working at Pizza Hut sometime in 1988.
that everyone must be covered.
We believe health insurance is very important and feel strongly
appreciate the opportunity to come before the Committee today.
the state.
we are from Whitesburg, Kentucky which is in the eastern part of
My name is Brenda -Newman, I am here with my husband James.
JULY 22, 1994
SENATE COMMITTEE ON LABOR AND HUMAN RESOURCES
STATEMENT OF BRENDA NEWMAN
-
�I was willing to
Pizza Hut was able to pay for
We came to Washington because we hope
And I
We learned that something can happen to you wheri you
will be a hard road.
don't expect it at all and that if you don't have insurance it
insurance.
that we could help other people who might get caught without
think that's wrong too.
workers in other countries but not for American workers.
I have been told that Pizza Hut pays for insurance of
think that is wrong.
And I
health insurance for
the manager, but it wouldn't pay for me or other workers.
for it all.
pay my fair share of insurance, but I just couldn't afford to pay
and that they do not have any way to get it.
their lives can sometimes find that they do not have insurance,
...
�Even
I hope my story can show you how
I'm happy to be here.
.
I
. '.
When I was
h~.
In fact
somet~es
I think the hardest part of the
He was an excellent doctor, and we could afford to
•
:
I was
~portantly
My medication for my heart
Working at KPC I was
\
....
. .
~-·
only able to get about 35-36 hours a week • . On this salary I had
ulcer drug which costs $60 a month too.
And I'm also suppose to take an
no health insurance.
condition costs $60 a month.
most
making $3.35 an hour with no retirement, no paid vacation, and
I
and I began working as a cook for Kentucky Fried Chicken:.
I was unable to .find a job that provided health insurance,
.• ' !
divorce was losing my Blue Cross/Blue Shield •
see
Lexington.
some health problems and I was able to see a specialist in
covered under my husband's Blue Cross/Blue Shield plan, I had·
'
have a heart condition and need to take medication.
wanted to find a job that provided health insurance because I·
..
After my divorce I had to look for work to support myself.
After thirty-five years of marriage I was divorced in 1986.
important health insurance is.
though I'm a little anxious,
two more grandchildren on the way.
I'm 62 years old with four kids, six grandchildren, and I have
My name is Nellie Kincer and I'm from Whitesburg, Kentucky.
JULY 22, 1994
(
SENATE COMMITTEE ON LABOR AND HUMAN RESOURCES
STATEMENT OF NELLIE KINCER
�I don't think it is right that I need to choose
I
·,,
don't think anybody else should have to make that choice either.
between getting medication and putting food on the table.
insurance.
others who work hard and have families and do not have any health
�I have urged the employees who can qualify to sign up for the Oregon Health
Plan, but many are on the borderline for that. Their only other alternative is to go to
the free clinics available. They do not offer preventive help. When the flu season hit
last year, many were not able to get In because of the large amount of people already :
there.
Until this year, we had between 25 and 50 percent of our employees using the
health Insurance. ·. Thla year we are at an all-time low of ·three employees. This past
winter, we were~at:an·all-tirntf high for employees being out sick~ Every employee was
out at least two· daye, while t.had three employees that were sick for a total of three
weeks each with the flu.
We are also unique in that we don't have a very high turnover of employees.
Many come to us as freshmen in college and leave as they graduate. This is not
because we offer a high wage. I feel it is because of the fact that we are willing to
work around their school schedules, offer health insurance and generally care about
their well-being. My husband and I have become very good friends with many of our
employees and have kept in dose contact with those of them who have gone on to
other career opportunities.
W~ have offered health care to our employees since 1988 through Kaiser. We
are covered for medical, dental, and optical. lhe pizza parlor pays for half, as does
the employee. This usually amounts to about 12 percent of our operating budget.
We see this as a cost of doing business. If we were abre, we would pay 100 percent.
At this time we are unable to, as we are so small and there Is quite a bit of
competition in our market. I'm sure that customers pass as many as eight other pizza
parlors on their way to our establishment. They do still come here, though. We try to
instill a sense of family both with our customers and our employees. We try to excel
in this market. We offer high quality ingredients and our family recipes to customers
who, in ·some cases, have been coming in here for twenty .years.
My name is Deborah Accuardi. I run Accuardi's Old Town Pizza in Portland,
Oregon. My father-in-law opened the restaurant in 1974. My husband and I have
been involved In the operations since 1987. We have between twenty-five and twentyeight employees at any given time. Most are under the age of twenty-five and are
students. Except for myself and my prep cook, all are part-time employees.
JULY 22, 1994
DUAL STANDARDS: HEALTH INSURANCE FOR
EMPLOYEES OF MULTINATIONAL CORPORATIONS
STATEMENT OF DEBORAH ACCUARDI
BEFORE THE SENATE COMMilTEE ON LABOR & HUMAN RESOURCES
�I appreciate the opportunity
to
appear before the
.-
·the Pizza Hut system employs 195,000people, 9S~ of which work part-
in the Pizza Hut system exceeds 235,000 workers. In the United States,
Today, there ire 10,000 Pizza Huts in 87 countries. Total employment
mandates in particular.
all_ here to productively discuss health care reform in general and
Committee on Labor and Human Resources and I sincerely hope we're
home town.
Wichita, Kansas in 19S8 and we continue to be headquartered in our
Hut's President and Chief Executive Officer.· Pizza Hut was bom in
My name is Allan Huston and I have the privilege of serving as Pizza
Presented to Tbe Committee OD
Labor ud Boman Resources
UDited States SeDate
July 22, ltM
Statement of Allan S. Huston
President and Chief Executive Omcer
PIZZA BUT, INC.
�.. ·-
.
3
but in the end, more importantly. extinguishes any meaningful dialogue.
overcharged, adversarial atmosphere that is not only unfamiliar to us,
Accusations have been made about Pizza Hut that have created an
.
ads and plans to disrupt our business .
Project launched a campaign against us including derogatory television
Seemingly out of nowhere, a group called the Health Care Reform
political debate.
were somehow transformed from a pizza baker to a target in a national
friends and family. It came as a shock to all of us that overnight we
We have built our business on the fun of sharing a piping hot pizza with
Andrew.
feed those who are victims of national disasters such as Hurricane
members. Through our Harvest program we feed the needy and help
Little League baseball to police department basketball programs for gang
�to the
plan to supplemeDt their
,•
s
alliances, and other reforms that will contain costs such as ton reform
reforms that will enhance competition, such as voluntary purchasing
that Pizza Hut oppose$ health care reform. That's untnle. We suppon
The rece~ debate has become confusing to all of us. I even have heard
unique in all American industry.
hours per year, they participate in a stock option program, and that, is
vacations. Finally, if they stay with us for one year and work ·1 ,500
discounts, a discount shopping network, a retirement plan and paid
For instance, we also provide a student loan service, child care
Health care is not the only benefit we provide our part-time employees.
is approximately $11.
benefits. The average weekly cost for a single employee to participate
employment, after which we contribute
cost of their health insurance for the first six months of their
Under the plan we put in place for our part-time workers, they pay the
�Despite the
7
•
prices, lower profits, unemployment and even~y stifles investment.
Our experience is that the high cost of mandates contributes to higher
though Pizza Huts in Japan average over $1 million each year in sales.
Our franchisee in Japan has yet to make a return on investment, even
revenues, has been unprofitable in 10 of the last 11 years.
operation in Germany, with only 65 restaurants, despite increased
Care Reform Project during the last week, the answer is no. Our
Contrary to some of the misleading information published by the Health
burdensome costs of Gennany and Japan, have we been successful?
opportunities we have enjoyed in the United States.
develop the ldnd · of business that generates the new jobs and
In markets with burdensome social costs, Pizza Hut has been unable to
Germany. I will leave that discussion to others.
of the mandate-driven health care systems such as m Japan and
�and
9
..
success. Nothing is more certain to destroy a viable business than
At Pizza Hut, as well as any business, cost structures are a linchpin of
eventually lost jobs, or eliminate jobs at the stan. Poor choices, indeed~
choice: Either raise prices, which will lead to a fall-off in sales
With increased costs due to mandates we would be left with a Hobson's
(CHART)
equivalent to the loss of 16,500 jobs.
no effect on our business-untrue.· In fact, it led to a staffing decrease
increase. Some people claim that the 1991 minimum wage increase had
A similar myth is that we can somehow magically absorb the cost
jobs.
Less traffic means less sales and declining sales inevitably lead to fewer
(CHART)
Let's take a look at an actual example of Pizza Hut elasticity:
�issue .. It's time we all tum our attention to the issues. As
/
11
//l (A
f\)\1;
~
Thank you for listening.
villains.
•
Senator Kassebaum so aptly put it, it is time to seek solutions rather tban
mandate
one reason alone: We disagree with certain pressure groups on the
We have been unfairly singled out for criticism for one reason-and for
I
�'*''*
.......
...
8oth eaonomlo theory and pelt emplrfoll evidence auggt~t~1hlt, In t.ct. thflle
will be 11tt1t Jot to. In the medlui'IHong run
there wUI be no net rile In the
coat of ~. In one study which 1 COIUthored with Alln ~ of
Princeton UftMrllty, M looted It the effac:t of large I , . . _ in the 001t1 ofworketl
oornpenutlon, 1he oldeat nndatec:t benefit in the u.s., on Mt• MCI efl'll)loyment.
TheM coat lnoteiiM lara- then the propoud coat of hMith lnlurance under moat
employer menciMe pllne: 1hev exceeded 10" of payroll for 10me lnduatrlelln some
etatea. v• we found 1hlt over II" of the 001t Inc,... wa peeHCI omo worlolrs
wagea. 10 thlt there was Uttle net ..._ In the coat of employing worker~ due to
workn compenudon. Ale result, we found no lignlllt:Mt effect on elrfJ/OymMt of
lnctMMCI wortcer. comp.,..tlon coeta.
·
The logic behind the dlaemployment clllmlll that tlnnl which do not currently
off•r health Insurance, but which will be mandated to do ao, will - their 00111 of
compenlltlon rlae, and wUI as a reault lay off • large number of worlcerl. 1"he key
point Ia that, for these firm~, the extent of job losa wll be detllrmlned by the extent
to which 1hl cotta of thll health Insurance can be shifted to their workera' w.gea.
If fullehlftlng takea place, then the total coat of compenution to the firm wil not ,....,
and there wiR be need for the firm to ley off workera. If It cloea not. then .
compensation coats will rile, 1nd there will be layoff~.
G.,.,./ Employment Elfecm of •n Employer ,.nd«e
'
A oennl feature of mcm propoHis to reform the health care I'J'Itam II
mandated employer provision of health insurance. This provlllon t.a ettriCtM much
crltfcfam, on the grounds that forcing employera.to offer lnaurence to their previously
uninsured employ... will cause ma~~lve diAmployment. 11111 crltlclam h8l been
levied moat stridently by the service Industries. auch • fast food ratauranta. The
purpo. . of thlt teatlmony II to argue that thll criticism It mil.--: ell of the.
compelling economic evidence auggeau that the job 1011 frOm en employer mandata,
If any, Ia likely to be minimal.
July 22, 1894
u.s. Congre~~
Senate Labor and Human Resource~ Committee
before the
Alala18nt Profeuor of Econornica, Maaaechuaetta Institute of TechnolOGY
FecultY Ae...rch Fellow, The National Bureau of Economic Relearch
Jona1han Gruber
Testimony of
Health Care Reform and Employment
r
i
!
;
�,._.Ita
.
.....
lnaurance coverage. Such lowered coetl wiD arl.. In the short run through aublidiel
ltUd._
·flunhlnncn, theM ltUdlta make two eddltlonal rnlltlk... Firwt, In 1helr Job loll
eetlmatea the
conelder both full and part time Jobs. In f8ct. rn8ftY of the )obi
loat will be l*t time. Second, they asaume that there will be no Job GIN from the
lowered coat of health lniUranct to the maJority of firm~ thee c1o now provide
•·wea•
the mandate II puc Into piiOI. AA 1 have U'ltd to ernohlllze, 1111 of the previoua
available ·~ au...- that thla II • DOOr illumptton. It one -umea i~
that the 001t wll be ahiMd
for warkera above the minimum W81'· the Job
1011 lrJ .._ tMn on.cauerter a large 11 that found by theM ltUdiel.
Job lou. from an employer mandm. Thatetudlea all make one common mlltike:
they aaume 1M! the colt of employ• compensation will rile for many workll8 when
I should note that several other atudl• hew lt81Jd that the,. will be very large
l'lwlous Stud/N
effect.
confirmed •rller flndlnga from a almDer study by Krueger and LlwNnoe Kea of fait
food Nltlurantaln Taxa• when the federal minimum wage lncnaMCI. So 1hl evidence
euggel'll that even for the low waa• lnduatrlll auch • the fait food lndUitiY, large
· lncru••• In the coat of employing low wage labor does not • • to layoffa. Thua, a
similar rt•ln the coat of such labor under a mandate 1hould have little dtaemployment
Thla atudy is important becauae if foculld txQIIc;ltly on the felt food lnciUID'Y
joba which ere· auppoeedly moat •at rlek• from the Qlnton plan. Punhetmore, It
w•
Third, recent evidence suggeau that minimum w.ge I~ which .,. of a
a&rnllar (or larger) maGnitude have no effect on employment, even In ..W:.IndUitrfea.
A large number of recent studies have shown thet incr.aea In tho minimum wage In
the 1880. and 11101 did not cause any f811 In employment. PerhiPI 1M mott
compeiUng finding comes from a study by David Card and Alan Krueger of Princeton
Unlvershy, who found that when New JfJIMy
minimum wage IJy 10 centa
In April, 1112. thetw
no '-H In ....,loyment In the fat food lnduafrl. Thla
minimum wage tncr.... Ia mUCh larger than the cost Inc,.... for ony minimum wage
employee under this Convnlttea's plan.
2"
Under thll Committee'• pten, the most that en employer wfR pay for healttl
insurance Ia 1
of an Individual'• wage. For smaller firma, this riM will be much
lower, with only a 1" Increase in compenaetion costs for firma below 5 employees.
This means thlt for minimum wage workers, the co•ta of compensetion will rlae by
et fiJNt 51 eMil PM hour. For most minimum wage workefl, the C08t rile wiU be
much 1888, ·• 71" of uninsured minimum wage workn work l!n IInne below 100
employees. Due to the subaidln for amaller firma, I 8111mate that the averege COlt
Increase for uninsured minimum w.ge worker~ under 1hia Commlftee'a plan will be
only 33 cema par hour.
redistributing to lower wage workers In a more efficient manner.
I
I
i
I
�a.
H.ndar.an,, Pb.D.
st.
H~ON
~uia, 110
tbe
united stat•• saaau
.1•95~
st.
Lou1a.
tor: tile
'P9DPPto•. 1
fta
v:lll Juwa thne aain affeata.
P:lrat,
1,
Tbirct, t.ba volU118 of vooda and aenicaa prod.uaed by
314 935 5630
~
~
07-21-94 05:49PM
Dav 14 •· Ban4erll0n, ed. 1 TM rprt;ypo lnqyQlpswUa Of
Bccmomie• 1 Raw YorJu War:DaE' looks, 1tt3.
2•
'1'be viewa exp1"a88ecl in ~. tutlaoftY are J1Y own and do
not necaaaarily repr:•ant tboaa or tiLe C8Dtw for 1:ba StUdy of
A11arican Buain•• or the Raval Poatgz'aduata labool.
joba.
worken • wav• will tall.· Second, a011a worJcara will loaa t:haizo
~
A goven.ent aandata that •ployer:. pay for: tlae1r:
eaployeea• haal.G
Bconollica 101.
analyaill Of the artaota Of ..,loyar wndat• 18 atraitJltfOftlal'd
aployara provide health iDauranaa tor thail' eaploy-.
I have been aakadl to tMtifY OD tile effect of undating that
alao the editor or Da lQrt;PM lftmrptopwlia ot
I aa
Pnvioua to tbat, I vu MIUOI' aooDoaill't for Jlealtb
policy with tba Preaidant•a council or aaonaaio Adviaera.
aoonOIDica.
an aaaooiate prot•aol' of
t . . on l•v• froa tba Raval. Poa1:qZ"adu11ta School
St.u4y o~ Muioan BUaineaa, Waall~on U'ftivezaity,
in xontaray, calitomia, wllera % a
in
canter:
•••~aa
currently the Jolm •· Olin Vlait1D9 Prof-01' at til•
Hr. Chalnan and llembera of the COJiaittee:
I -
IIIIIDAI'I8
Jabll H. Olin Villitint Proteaaor
Cant.r for the Sbcly ot Aaeriaan Bwliua
WUbift9tOn Vftiveni'ty
David
•mm~a"
'l'..tiaony of
Tan 008'1 OJI
SeDate co-itt. . on x.bor and ll1mlm
a.
"
POOl
•og
�'l'hia 1a in the ballpark ot ao.t astilllataa.
ln a
8peftt ~
'1111111,
Jd.4 tll-elvu
Dllvi4 X. Cl\Uezo, vbo defenclecl
no~
Bconoai.ata, Yheth8Z'
~incU.nq.
In Ilia voda,
•~~oat
So 1 it
$3 1 000, tban, by Kz'uiiiJK'a asti•ta 1 tbe
see Alan B. JCneCJ•r, •Obaanationa on Bapl~t-BaACl
OJ:
Hai"Vard
'.
...
...
x. CUtler, • A cuide to B•ltb cue Rafo1:21, •
unpubliabed u., Pebl:'Wiry 119~ •
Univerai~y,
DaY 14
'. Jonathan Gruber &Dd Ala la'U89U', '"file Inc:1danca ot
Manda'tad bployer-Provide4 :rnam-ancec LMaons fi"'OI woran'
Compensa'tioD Insurance, • in David Bradtol'd, eel. , ,.., !qliqy and
tb• lcgngay, Vol. 5, caabridte, IIAa tilT Preu, 1991.
Government Maftda~-. With PaRic:ular Ratwenca to Baaltb
%nauzanae, • ft'iDcet:on 01\ivaraity, Baonoaic:a Dap&Z'taen~,
unpublished • · 1 october 15 1 1993, p. 22.
3•
pay lOt ot tJUat,
the :aandata coat.a, aay, $3,500 aDd the aploye ia required to
mandata, not an the a.ployea • • 1ncaaa barora tba aandate.
'l'be reduction 1n eJIPlOJMS' pay depends on the coat ot tba
coat of employer-provided aandatea.
adminutration itaalt, agree that aaployeu pay a1110at. all the
BudCJat: Office, in ita a'tudiM ot aandata 1 aDd t!aa Clillton
Die CODgnaaional
ot t.heH cost: cba.ft9u are
Clinton•a council of Bconcaic Adviaera, aqraea with
likely t.o ahov up aa ch&ftCiJU iD vapa ••• • 1
thia
Praai~ent
Aaaociation, and vllo vaa until reoantly a aeDiozo. eccmaaift wi'th
amployer •andatea at: the annual ...tinp of the AMric:aD Baonoaic
that aployara pay tor thea.
or not they believe 1D aployer undatea, 4o
warkera. · 'l'hia tinclinCJ ia not aonuavanial.
tbe coat at tbe mandata ia al.,.t eDtiz'ely put on the backa ot
80 to 100 c.nta acmaa au~ ot varten• vapa.•
and Alan xru_,ar round that tor wary $1
a~~plcyen,
c;~r
aaparata atucly of tba workers' coapenAt1on proqram, Jonat.Jum
in pay. 1
�Why?
Bec:au. for
loa~.
-rile -
war~•
Por that worker'• pay b» adju..t by, aay, t1,tiO, hie ozo
so t!la't vorlcazo ia
lJlcaly to loae
about tlw
ove~ll
bpact on joba?
Aa you aigbt. expect,
of tile orivinally propoad Clinmn 11Uldat.a.
Acc:OZ'diD9
b)
the .
Seaancl, aoat of
....
6
•
• • • -:rune z. o••eill aad Dave •· o•He11l, '"!Jaa Bllployaen~
and Distributional Bf~acta o~ Kanda~ed Benefits,• Waabiftt'ton,
c. c., American Bnterpriae Institute, 1994.
the studiea find a aubai:antial job 1011a.
Pirat,. alaoat all tl\e atu41• find a job loa.
But two thinp ea81"C)e aleuly froa the abldiea of job loaa.
becauaa econoaiaa ia an Japu'fec:t acieace, the Ht1Jiatee vary.
Wba~
~air jo~• JMoaa.e
all, they eatillate tbat about 781, 000 lov-wqe worku'a would loaa
whoa• pay waa below t6.50 an hour would not have their pay cut at
By &aii1DiiDCJ that varkera
Their averaCJe iDcc:ae waa $1,172 bacauae, on
average, they were world.ng pazt-tiae.
t.haD $1.50 an h~.
1993, 19.9 million wozokers who vera uninaured ware .akiDg 1...
clana a caretul atudy of t.hia iaaua.6 They point out tllat, iD
fozo the study ot BUaiD- and Qovar:maent at Banab COllege, hava
Bcono•iata June o•wa111 and Dave 0 1 Reill, both a't tbe CeDtar
his job.
the cunoent $4. 25 ldnbnm wage.
ber hourly pay woul4 have to tall to t3.84, Wbicb ia well below
$5,500.
$5.50 an hour and work1D9 1000 boura a year, tor an annual pay ot
I
ftlce a WC*ku" aaniDCJ
ia b"11e for Wa&"ken MZ'ftinCJ
at. the mDillula wap, their
were inatantaDeoua, any jaba would
only a little above the Jainimua R9•·
va9•• cannot 189ally tall.
be loat.
liveD it tile a4jWitaent
takaa, during that time a large number of jaba will be
'twc aontha or two :r•ara, INt, whatever tille that adjuatllent
�___,_i_.. A
_-
,_ -
Because goverruaenu require eaployer-provid..S health
r~
b'*
n~
iD tbG Vllitad
Aa We Az'e
Po~
~oa
ata~•
o.s.
the oae the
CJOVeJ:1'1118Dtll••ai: the
o~
tho. . -
!'he ruult:
the ratio na reversed.
20
...
...
•. rot: 110re oa 1:111•, David a. Benda~n, •'l'be
Europeanization of the u.s. Labor Harke~, • '!'be Pybllc Jpteres~,
NuabeZ' 113, Pall 1993.
tba only
Indeed, Burope aa a Wbala has !aUed ~o creai:a uy net
nev 'obs in the privata ..:tor over the paat 20 yean'
only 10•.
Wb11a real la!M)r costa ill the BC zoose by 60t, _,loylllant roM
mandates on a~~ployera. •
yeazoa, govarn.enta in the BGropean CODUnity have add8d uny
DurinG
l:'eal labor costa iD tha Uftited states rose by only about
lOt while the nabor of jobs soared l2Y 52t.
zo..Wta
'lba
lavel•--vce aucm aon III:Jdeat thaD their
Batveen 1970 and 1990,
B1u:'ope, nt 1t ia the exac:t oppoaite
There ia a 1888011 to be
Buropean counterparts in illpoaing aandatu on aployen.
tedazoal and
report dl:'llva.
learned
to Do. •
for ita repoft
personally, I'm CJl&cl that tbe Bealth care Rafona h'ojact
say, Bot
An aaoua~e t:i~le
niaed the exaaple of IUropean worJceZ's.
But
would be •Do Aa We
Project would be found CJQUty.
the law required trui:h in lobbying, the Health care ltefarll
If
they had their dmthera, they would probably aboliah
~pe
employer •edatea in Europe aa well aa avoiding th-. here.
stataa.
advocated employer unctatea in
Pia1a BUt and XcDonal4'a would be bypocritical oDly if they
mandate.
inauranca in IUrope, Pizza Rut and McDonald's coaply vi1:h the
actiana.
hypocritical w'hataaevez:o abaut these two companies• zoeportecl
�company.
operations in Germany. That is the half-truth that has been used
.
to
malign the
insurance in those countries, they comply. That is the case with Pizza Hut's
of those countries. If there are mandates that rcquin: employers to pay for health
reality. American corporations that operate in European countries abide by the laws
And what about these allccations? They are at best balf·truths that obscure the
advertisements are also being run that bring allegations against these companies.
their units presumably in an attempt to alienate their tustomers. Full-page
President's health care proposals are encouraging operatives everywhere to picket
Because of the views expressed by these two companies, proponents of the
conducted in a democratic country:
corporate character assassination, and that is not the way public debate should be
opposition to legislation that would cripple our business. That attack amounts to
An attack wu made on these two companies because they have stated their
last week was an affront to the entire foodscrvic:e industry.
say that the treatment received by two of our members, Pizza Hut and McDonald's,
that operate 150,000 establishments across the nation. I speak for all of them when I
Association, a full-service trade association representing 25,000 member companies
I am Bill Fisher, executive vice president of the National Restaurant
Statement of
WILLIAM P. FISHER,
Executive Vice President, National Restaurant Association,
to the Senate Labor and Human Resources Committee,
July 22, 1994
�U.S. workers will end up paying with their jobs.
In the end, an employer mandate is a tax on workers, pure and simple-and
level for most employers in the low profit margin, labor-intensive restaurant industry.
the Clinton plan-because it would artificially raise the cost of labor beyond a viable
The association has consistently opposed an employer mandate-the linchpin of
standardized claims system.
eliminating costly state-mandated health benefits; and devdoping a computerized,
insurance; eliminating pre-existing exclusions; reforming malpractice laws;
purchasing pools; allowing businesses to take a 100 percent tax deduction for health
-3-
�,
fll
IJP
-~~
QJf
··I'~
~ ~
tiff
· -Iii
p -
~
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-~(1; Wll
.. . So _'I 8 ~
ta
Is.
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i
1!11 IIi illl!~t;~ ,~
PJ~J
li
Jii i~ ;
.
~
I
'I
~~en
~ JI
!M_aulf. - - ...
'II :r ...
~~~~ ~~~ ~~w~~fli
~~~~~ ~. wFI i;l~ ~~i rti l ~-1
llfJ,t! Ill
Jl-fl
t
ill
~.,,
I
I'
-a
�..
n.. ........... ....., .....
Ill•'•• ••'""
.
.
\
'l1IIDk you. l'd be blppy tD auwer lilY 9....., fmm tile commilll.
JapiiL
ltbd 1D COWl' Ia AJPerlQa wodrcn, jute De tl COwrl ta woA&iiD G•••'IJ ...
llld
baaldacae.._to..Ube±c•c• Mllllllll'-* •••1ao.r8n11111111•
bad it il tD baild a .cr±' allllpli& 1111,-. ciD Ill& Ja. -.a&af._ ,_ k
Jarae t-•m•• Jib Pllalluc ad McDonekl'a (owr l,cm ...,.,_ 4JIIpJos owr
ZOS afdiD waddaa 1111iaand- till&' a.m, 7 .. m;m A"'''icua trcdlu llld ....
famtlieL n.e ts no •adoMie tor 1e11na Pizza Hat
oet.r llqe
ID lldft illt.Jda Cl1'e COlli tD dllrelt af 111, paztir"dJ lila Pirza lr.t eaald ..ay
La- CCJM)Ide . . . ODe a.I ........
Yr. ChatnneJ, we 11M I bdaf~ ICtlv""C ab:r tae rJmalt IDidllbolt _.
npart dalt I woaJd lib to .._. Ill tbe JICOid.
ecmcr-
costs $11 in the U.S., will JO up to $19 or $25 aa tbe CODlpllly aow cbarpa in
GermaDy aad Iapa, lllpfiCdvlly, if
enacu an emploJ\w IDIMere. Bat
accoldiii81D dl8 COIDpUJ'I an dala, d-. bap price.__ jail cko~ ldd up.
Sclaabllidfled tlllt labor coatiiCCCMd for rouply 30S of.- • J1a ~...- .
'lbaa, uDder diD Scallle Labar Om"IIN bDl wldcla Clpl ~ apradouafbr br
wap hpjnee•a& 121, Plaa a. woald ...t -'J 13.61 (301 ~ 121) iDe-• ia
tilt COlt mpizia tD CXMir ill~ lu"B'P CIDIII. n.'i • ilatluD oljul& S.«) par
pizza, ........_ aD ~tile COIIIamiJIIII'd all 1D cauu•ea.
�i
••
CEOs
�.,
JULY 22, 1994
July 21 - Press Conference on Hill with 7 CEOs {Manpower,
Safeway, GEC Marconi Electronic Systems Corporation, Fortis
Inc., American Automobile Manufacturers Association, Corn
Growers·of America, and Majority Leader Gephardt, Chairman
Gibbons, Senator Kennedy, Senator Daschle and Senator
Metzenbaum, as well as many representatives of Fortune 200
companies. Message: do health reform this year and include
universal coverage and employer responsibility in it. Well
covered by print and radio and some television. Good
July 20 - Pre-event planning for both CEO lunch and press
conference on Hill July 21. Follow up to small business
coa.lition events including mailing press photos.
July 19 - Bus trip support calls to McDonnell Douglas, H. J.
Heinz, Nike, Independent Drivers, Pharmacists, RV and
campgrounds, Architects, Parking Lots and other small
business coalition members .to support the bus trip.
Recruitment for Secretary Brown's event with ILGWU in NYC on
July 25; recruitment of National Leadership Coalition and
companies for Hill event July 10. Recruitment of Secretary
Cisneros to address 2500 members of the Cooperative movement
on health care and economic accomplishments of the
administration for July 20. Follow-up to Atkins group
letter.
July 18 - Meeting with Ameritech, IBM, GE, Allied Signal
and Hershey Foods and their representative Larry Atkins, to
discuss a letter they and over twenty companies had sent to
the President regarding health -care reform. Greg Lawler and
Jack Lew as well as Steve Hilton were also at the meeting.
Letter and follow up memo are attached.
This week there were several private meetings with the business
community on the subject of health care, support for future
events with the business community and encouragement to the
business community to be helpful on other events, as well as two
specific outreach events.
DATE:
WILC~-
ACTIVITIES OF WEEK OF JULY 18, 1994
CAREN
SUBJECT:
FROM:
MEMORANDUM FOR ALEXIS HERMAN
GREG LAWLER
OFFICE OF PUBLIC LIAISON
THE WHITE HOUSE
�cc:
Steve Hilton
Planning for next few weeks events, briefings and meetings.
July 22 - Meeting of Alexis Herman and Caren Wilcox with
David Lambert and Phil Schneider of National Association of
Chain Drugs regarding activities of small business coalition
including planned media tour and planned event with Hawaii
representatives of small business. Discussion of their
issues.
Lunch with Bob Rubin, Greg Lawler and Alexis Herman with the
seven CEOs in the White House mess.
reporting on NPR, and in print. Primary organizers - Jim
Moody and Letitia Chambers of Chambers Associates with
participation by National Leadership Coalition and
cooperation from Atkins group members and Anne Wexler's
organization.
�Press Conference with Ad Hoc Lobbying coalition, National
Leadership Coalition and Senators Kennedy, Daschle and Metzenbaum
and Majority Leader Gephardt and Chairman Gibbons.
Meeting/lunch at The White House with 7 CEOs supportive of health
care reform now, universal coverage and employer responsibility.
Meeting. with National Association of Chain Drug Stores
Meeting with IBM, Ameritech, GE, Allied Signal and Hershey Foods
OPL BUSINESS 7/18-22
SPECIFIC EVENTS
�July 18, 1994
that we felt that the Hill was dealing with many of
in their favor, but that no one would get everything
any bill, and that before Con.ference the House and
would probably not satisfy their concerns.
cc: Steve Hilton, Jack Lew, Melanne Verveer, Mike Lux, Amy
Zisook
We will pursue having some calls made CEO to· CEO to this group.•
Of the companies, Allied Signal seemed the most inclined to fall
off the eli££, and GE indicated that there were •many" companies
which were already backing away from reform, without naming them.
They did specifically indicate that they are close to achieving
some un.jerstanding with a group of state representatives on the
issues of state interim financing, and they have given a document
to Sena·tor Mitchell reflecting that agreement. They do not know
if he h.:ts ·accepted it. It does not represent an agreement with
the NGA or DGA, because such direct discussions have not
occurred •.
We indicated
their issues
they want in
Senate bills
If asked about the letter we believe we should indica~e that it
continues to reflect their continuing cOmmitment to health care
reform, universal coverage,. employer mandates and cost
·
containment. .It also. reflects their very ·real concerns abOut
multi-state company issues in an interim state-dominated
environment: single payer -requirements; the •anti-managed care•
provisions of Ways and Means: and financing of benefits from
their tax dollars in the absence of an employer mandate.
They delivered the attached letter for the President, and we had
a discussion of their issues. While we tried to encourage them
to unde:rstand that many, but not all of their issues may be
solved, they were clearly trying to deliver a very serious
message. We also urged that they keep their CEOs pumped up
during this complex and difficult period of concern. ·on the Hill.
we met with representatives of Ameritech, Allied Signal, IBM,
Hershey Foods, and GE and Larry Atkins, their representative
· today. Jack Lew and Steve Hilton attended most of the meeting.
DATE:
x
Corporate Health care Coalition
Greg Lawler, Caren
SUBJECT:
FROM:
MEMORANDUM TO HAROLD ICKES~
ALEXIS HERMAN
OFFICE OF PUBLIC LIAISON
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Specifically, legislation that would give the states ·the fte.xipility to
independently design their ownoealth car~ _S)'Slems not only would .
undermine national reform. but also would unde~ our companies': .. ·
national cost containment strategies. A major·reasog for our SUPP90 ~
national reform this year is preserve (ederal_go~ernance of our ~ ~ ·-.\~;<
multistate plans, which now oc~ under ERIS~~ National reform ~•.t::
grants new state authority over our plans is_ .r~ wo~ f9r us than ·~o· ~ ;.~ -..:·
reform..· ,
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Our companies are committed. to providing qua!itJ,· cost effec:Uve health ;
benefits for our employees and their dcpe~ .This commitment is
consistent with. and indeed. ~ental 10, the goals or universal coverage
and cost containment. We cannot suppon health care reform that coDflids.
with these goals by putting our _health plan and OW' employees' health care
benefits at rislc.
·
•
.
.eontinue .
A! leaders or some of the lalgest Fortune Soo ~es. we have
~.. ·
supponed .the health care reform &oals of COJUrO,lliD& costs and acbievio& .
universal coverage.. We have assumed the fonMarioD for aD)' national ·
reform would be the su~. co~rebensift_beab) plaDs that lara~.. ·
multistate empleyers prcmde for their employees a.Da their ·dependents. As
we have worked to help mcm bealth care reform throop the COiim1iitees
or the Congress, we have become· increasingly CODCerJ;led that the' eiile1JiD&
legislation would make it ~alit. if not i~le, ·for us .to
.operating _our plans or mana~ng. our COS1S.::~~~;:~--: _:
·.-.:. :·· . '
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1600 Pennsylvania Avenue, N.W.
W&SJlin&ton, DC 20500 ..
. .
.
.
The Honorable William J. Cinton
The White House
. July 18. 1994
1133 Connecticut Ave .• N.W .• Suile 1200. Washillftoo. DC 20036
(202) 775-9834 Pboac (202) 833-8491 fu
\JvnrvnR 1 a;;
..
.
�Olief Executive Officer
Pacific Telesis Group
Ola.irman. President and
PJ. Quigley
Louis V. Gemner, Jr.
OlairmaD or the Board and
Clief Executive Officer
lnternatio·nal Business
Machines Corpor~tion
~ry~/
Of6cer
MC Communicatio~ Corp.
President and
Clief Executive Officer
Digital Equipment Corporation
'Ben C.
Jr.
'/
CWrmu and OJief Executive
~cl~/~
Robert\.
~~.
Roben B. Palmer
Sincerely,
House and Senate Ooon, we ask for your assistance iD ensuriJl& that the
efforts of large, multistate employers are not undenDined and the goals of
health care reform undercut by the final bills presented to the full House
a.od Senate.
A5 health care reform moves to the congressional leadership and the
Moreover, it is unreasonable to impose new taxes or assessments on those
who alreaey pay for the millions of uninsured Americans through cost
shifting. if the Congress is unwilling to impose any obligations on
employers and individuals wbo now pay nothing.. Additional financing for
•social responsibilitf is acceptable· only if it is society wide and only in the
context of universal coverage.
Emerging legislation would also undo the success we have had in
controlling costs by placin& prohibitions on provider selection and other
managed care techniques that have been integral to our succes.\. The new
•anti-managed-care· provisions which some committees have adopted would
e1iminate our ability to manage our programs and substantially raise our
costs and national health expenditures as well
�I
Rldlard D. McCormick
-Clairman of the Board and
alief Executive Officer
. U S West Incorporated
Edward E. Whitacre. Jr.
CllaintaD aDd OUef
E.xeanive Officer
-Soutlr.estem Bell Corporation
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Exeaaive Officer
Amoco Corporation
Clairman and Clief ·
l..anJ Faller
~t~~-~
.
Ray Smi1h
OlairmaD and Olief
Exec:utNe Officer
BeD Atlantic
Executive Officer
Dow Clemical Company
'{::;;P. Popoff
Clairman and alief
L ..O~
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·
Richard C. Notebaen
Clairman and alief
Executive Officer
Ameritedl
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Olairman
and Odd Executive Officer
GTE Coq:>oration
Executive Officer
United Parcel Service
or ~ Boarcf
Olarles R. Lee
awiman and alief
Kent C Nelson
Intel Corporation
Exeartive Officer
AlliedSignal. Inc.
C./~41{{~
Qairmu
""
Gorden E. Moore
AI~
Hershey Foods Corporation
Kenneth L. Wolfe
' ,..__
Clairmam and Clief
&ecu1ive Officer
. .
Clairman and alief
Larry Bossidy
L~~
•
Elec:utive Officer
DuPont Compa.uy
Edgar S. Woolard. Jr.
Clairman and Clief
8~~ _s; .w~Jc.rJ
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.
.
or the Board and
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Officer
..· ·..
Boeq Company
&.eaJtive
Frank Shrootz
ClairmaD and alief
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Oeoeral Electric Company
Oief Executive Officer
Qairma.n
ohll F. Welch. Jr.
McDonnell Doaglas Corporation
E.lecutive Officer ·
Qlairman and Olief
John F. McDonnell
and C:Uef E.lecutive Officer
Eastma.n Kodak Compa.ay
George M.C. rlSber
Chairman. President
____ ..,._. --·- ·--·-·-·-··-· ... --
.,
�'
. ..
.-/
The Honorable Richard A. Gephardt
United States House of Representatives
1432 LHOB
Washington, DC 20510
· The Honorable George J. Mitchell
United States Senate
SR-176
Washington, DC 20510
We are confident that Congress has the vtsJon, the courage, and the
commitment to the greater good of our· country to enact comprehensive reform
over the next few precious months.
Now is the time for leadership. If Congress fails to act this year, it is
unlikely to have another chance at comprehensive reform in this century. Tbe
103rd Congress would be remembered as one which missed a historic opportunity .
.This must not happen.
It is time to place the health security of all Americans at the top of the
national agenda. This year offers a unique opportunity to address one of the major·
causes of fear and anguish among our citizens; and one of the major threats to
America's long-term economic well-being-.
Now is the time for action. The failings of our current system are weD
documented - large numbers of citizens are uninsured, many lack affordable
coverage, and tber.e is damagmg cost shifting and excessive inflation in the health
care ·sector. Only comprehensive reform can address th~ problems.
As companies which are among the nation's largest ~ployers, we urg~:'yoii" ·
to suppon passage this year of comprehensive health care reform that provides for
universal coverage thr~gh shared employer responsibility, thus ensuring health.
care coverage for all Americans.
·
Dear Majority Leader:
REFORM
· July 21, 1994
HEALm CARE
ON
AD HOC BUSINESS GROUP
�- ·'
· Fortis, Inc.
Ford 1\fotor Company
Food for Less Grocery
EDS
Eagle Picher Industries
Drummond Company
Chrysler Corporation
Champion International Corporation
Bethlehem Steel Corporation
Armco Inc.
Archer Daniels Midland Com~y
AMR Corporatio. ~ (American AirHnes)
American Iron lDd Steel Institute
'
American Automobile Manufacturers Association
American Corn Growers
AEL Industries
Acme Steel
ABB Inc.
A & P (Great Atlantic and Pacific Tea Company)
�Giant Food
General Motors
Electronic Systems Corporation
Douglas
Rohm & Haas
Ralphs Grocery
Pioneer Hi-Bred International, Inc.
Pella Corporation
Norfolk Southern Corporation
National Association of Chain Drug Stores
National Steel
~lcDonneU
Maytag
Manpower Inc.
Loral
ln1a .1d Steel
lngersoii-R tnd Company
mM
HJ. Heinz
Hechinger Company
GEC-~Iarconi
�Eckerd Corporation .
Zenith Electronic Corporation
Wisconsin Public Service Corporation
Westinghouse
The Vons Companies
usx
United DistiiJc rs North America
Time " arner, Inc.
The Principal Financial Group
The LTV Steel Company
Southern California Edison Company
Scott Paper Company
Safeway, Inc.
�~ \\
Hmn· E. S.m-.. !\.1.0.. !\.t.r.H.
The Ho1a2blr Paull;. R.'F•"'· I. I'l
The Honcw•bk Robert 0. R.i.·. Lt. II
f.anMr Prnaclrnr hmrm· un.,
Fonnn l'modmr Gnald Fnrd
:.:o:' b3-·<>83(l
DL . .:ouu-
1.'":"1-! S71l: ;: .
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~H
REFOR~t
HE:~LTH CARE
COALITIO~ FOR
· LEADERSHIP
~HE NATIONAl
amona
. Co-Chair
Paul G. Rogers
Sincerely,
Robert D. Ray ·
Co·Chair
.
4"a;c-{)
lf.y·
The debate about health care reform offers an oppottunity for Congress to help Americans and their employers
simultaneously •• and. more broadly, to build a better health care system to serve the interests of our people
and our ec.cxx:»my in the decades to come. We look forward to working with, and standing with. members of
Congress to belp achieve a great victory in the months just ahead.
Tbc members of our Coalition - businesses, unions. consumer groups. and usoriarions of health care
providen - recognize that in the sbort term comprehensive reform would require mooey. and we stand ready
to support equitable measures to finance such reform. We believe that reform would pay for its eost many
times over- by slowing the~ at which health care spending escalates, for goveaDIDdllS and businesses and
fBmiDes. We also believe that reform should permit large employers to continue to self-insure their employees
- and that it should DOt eDCOUriSe wide variations in requirements from state to swe that would· make any
new system ioordinately complicated for multi·state firms.
spiraliDg bedh care costs under better control, aod eDd tbe desuuetive siJiftq rl costs to aod
AmericaD businesses.
Lesislatioa tt.t meets these three tests wouJd enhance the beaJth and peace ~ miDd or American familles, brin&
(3) iaJproving the qualitY of beahh care ·through an increased commitmeD to outcomes research,
malpractice refonr4, and the development and dissemination of practice guideliDes.
·
·
(2) comaini.Dg health care costs through a combination of c:ompetitioa. deliYery system reforDJS.
expeodituR targets. and rate.setting for the fee-for·savice segment of the heaJtb care system.
(I)
through a combination of ..n employer mandate and ID
individual mandate - health coverage for aU Americ: .ns by a time certain and SOOIL
assuriDa -
do, that the need for effective reform transcendsa>nsiderationsm
partis8n pofi6cs. We will cootimae to be rigorously nonpartisan in our efforts on behalf'
oflegislatioa that will achieve the foDowing three obj 'dives:
We~ as you
We are writil:l@ to reaffirm our strong support for comprehensive health care ref'orm
and our CO!'' 'ia u ~ to working with you and your coDeagues to. secure it - this year.
iD this sessioe of Congress.
Dear Senator !ditcheU:
t;nited Swes Senate
WashingtOG.. D C. 20S 10
The HonorL~ George J. Mitchell
Majority Lea.ier
July ·! 2. 1994
�OF THE NATIONAL •cEADERSHIP COALIUQN fOR
HEALTH CARE REFORM
July 18, 1994
Acme Steel CompaDy
Amalgamated Clothiag & Tntilc Workers Uaion, AFL·CIO
A·mericu Academy of Family Pbysicius
American Academy of Pediatrics
American Associatioa of Retired Persoa.s
Americaa Automobile Maaufacturers' Associatioa
Americaa College of Physiciaa.s
America• FederatioD of Teachen, AfL·CIO
AmeriCa• lroa ct Steel lastitute
AmericaD Nurses Association, lac.
American Ph ysieal Tlterapy Associatioa
America• Psycholosieal Associatioa
Americaa SubaCllte Care Associatioa
.Associatioa of Academic Health Ceaten
Assodatioa of Miaority Health Professional Schook
B. C. EDtt rprises
Baaaoa J search
Bethlehem Stet" Corporatioa
Blue Diamo~ ! Growen
Browa A C' .>le Stores
Burliagtoa C,., Factory
Ceridiu Corporatioa
Christiu Oildrea's Fuad
Chrysler Corporatioe
Cold Fiaishecl Steel Bu la.stitute
CoreStates Fiaucial Corp.
Del Moatc· Foods
Desipworb IDe.
Drummoad Compuy lac.
Families USA Fouaclatioa
Filter Materials
First latentate Baacorp
Ford Motor Compaay
GeaeraJ Moton Corporatioa
Georgia· Pacific Corporatioa
Giut Foocl lac.
The Great Atlaatic A Pacific Tea Compaay, lac.
Gross Electric lac.
The Heights Group
H. l. Heiaz Co.
lalaad Steel Compaay
.
INSIGHT Treatmeat Services, lac.
lateraatioaal Brotherhood of Electrical Workers
lateraatioDaJ Multifoocls
laterutioaal Uaioa of Bricklayers aad Allied Craftsmea
James River Corporatioa
Johnstowa Corporatioa
Keebler Company
Keller Glass Company
Lincoln Telephone &. Telegraph Co.
LTV Steel Company
Lukens Inc.
Mankoff, Inc.
\~EMBERS
�I
'.
.
.-
-
July 18, 1994 .
Uaited Air U.es, lac.
Uaited Food ud Commercial Worken laterutioaaJ Uaioa. APL.OO
UaitecS Paperworken lateraatioaaJ Uaioa, AFL·CO
Uaited States Catholic Coafereace
Uaited Steelworkers of America, AFL·CIO
. U.S. Bucorp
WestiDgbousc Electric Corporatioa
Wheat, First Secarities. lac.
Wbeeliaa· Pitubura~ Steel Corp.
The Wkitmu Group
Wiscoasia Public Service Corporatioa
Xeroz Corpoiatioa
Tillie Waracr be.
NatioD&I Associatioa of Cbildbcariag Cnters
Natioaal Associatioa of State Boards of Educatioa
Natioaal Education Association
National Steel Corporatioa
Navistar laterllltional Transportatioa Corporatioa, lac.
Norwest Corporatioa
Olympia West Plaza, lac.
PAR Associates
Pella Corporatioa
Preferred Beaefiu
R. R. Doa-aelley at Soas Co.
Ralphs Grocery Compuy
Regis CorporatiOil
Robm &: Haas Compuy
Safeway be.
Sara Lft Corporatioa
Scou Pa1 er Co.
Service EmpJoyee5 lateraa \oaaJ Uaioa, AFL·CO
SokoJov Strat , ic AUiaace
Soutben Califonai· Edisoa Compuy
Suategic Martetiat lstformatioa, lac.
·
Tnu Hea•t tastinate
MEDNET
Materaity CcaL:r Associatioa
Maytag Corporatioa
�.
Systems
Hechinger Company
· John W. Hechinger, Sr.
Ola inn an of the Board-
Mark H. Ronald
President & CEO
GEC-M~ni
CEO
American Com Growers Association
Gary Goldberg
Carl Schramm
CEO
Fortis. Inc.
CEO
ADdR:w Card
Americ8n Automobile Association
..
CEO & Presideilt
Safeway Inc.
S&:w:D A. Burd
CEO
Manpower Inc.
Miu:bell Fronstein
List or Attendees
Press Conf'ereace
July, 21, 1.994
HEALTH CARE REFORM .
ON
AD HOC BUSINESS GROUP
-
�-
Champion International Corporation
Jeanne Connelly
Vice President
Vice President, Federal Government Affairs
Betbelem Steel
William Wickert
Archer Daniels Midland Company
Manm Sorkin
Economic Consultant
Director, Federal Relations (Congressional)
Dorodly Walsh
Ameritech
American Iron &. Steel
. Peter Hernandez
VJCe President, Employee Relations
American Com .Growers· Association
David Senter
Direaor of Congressional & Public Affairs
Director, Health cl Benefits Policy
Mel Bass
American AutomobDe Association
Legislative Represemative
American Airlines
Ed Faberman
Vice President, Government Affairs
Cynthia E. Berry
AEL
Cbadcs Cronin.
Senior Vice Presidem of Business Developmem
fun ~loody
Cbamhers Associates Incorporated
Letitia Chambers
Ad H.x Business Group on Health Care Reform
A&.P nne Great Atlantic & Pacific Tea Company
Michael Rourke
Senio:- Vice President of Communications & Corporate Affairs
-
�L'IV Steel Company
Gael Sullivan ·
Director, Federal Relations
Manager. Governmental Programs
Chris Caine
mM
HJ. Heinz
Garry Matson
Director. Compensation and Benefits
Giant Food
Barry Scher
V~ee President, Public Affairs·
Motors CorpOration
BiD Ball
Direaor, Washington Office
~-
Bruce Fried
Washington Representative
Fartis.. Inc.
Elliott Hall
Va President, Washington Affairs.
BiD Little
Legislative Associate
Ford Motor Company
EDS
William Sweeney
Direcior, Government Relations
Washington Representative
Eagle-Picher Industries, Inc.
Jobn B. F. Hoving
Direcmr, Federal Relations
Wally Maher
Rober. Liberatore
Vice President. Washington Affaiors
Chrysler Corporation
·-
�Terrence Straub
V'k:e President, Public Affairs
usx
Tu:nodly A. Boggs
Senior Vice President for Public Policy
Art Sadder
·
Vke President, Law &. Public Policy
Tme Warner
Sman I. Brahs
V"ICe President
Tbe Principal Financial Group
Peggy Rhoades
Direclor
Dr. Henry Simmons
The National Leadership Coalition for Health Care Reform
Scoa Paper
fun Morrill
V~ee President, Government &. Community Relations
Direaor of Government Relations .
Rolan and Haas
Geoff Hurowitz
Pioneer H-Bred International, Inc.
Robert J. Foster .
Direaor of Benefits
Norfolk Southern Corporation
Jobn F. Corcoran
V"~ee President, Public Affairs
David Lamben
V"t:e President of Government Affairs
Na.tioo:a.l AssOciation of Chain Drug Stores
McDonnell Douglas Micbe1e Sorenson
Manager, Legislative Liaison
Horstman
Corporate Vice Presidept
Mayu~
Dou~las
-
�Westinghouse
John ~ybumVice President, Govenunent Programs
,.
..
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Cll.a:a
-~COl.TOll.~
rr- ~
.JMICI - " - _ , COUIOS&. AIC rT- DIIIKYCIII
~
SUP~~RT
Ellen Dadisman
(202) 225-8933 ..
POR BMPLOYBR PARTNERSHIP
C"'NTACT:
WASHINGTON. DC 20515-UU
U.S. HOUSE OF REPRESENTATIV£5
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' # #
,
WASHINQTON, O.C.--House Ways and Means Comadttee Chairman
Sam Gibbons today praised CEOs from SO top national companies as
they endorsed employer partnership in providing universal health.
care coverage. The executives urged Congress to act this year to
add---ess in.flation, cost--shifting and the large num!:)er. of
uninsured citizens.
·
"American business· needs health care refonll, • said Gibbons.
•There's a reason 80 percent of American corporations help
pro~de health care to their employees -- it's good business.•
Gibbons pointed out that employer-employee cost sharing
•si~ply builds on the system we have i~ America today that
already covers 80 percent of our workers and their families.•
The Ways and Means bill is financed by requiring employers
tc share in the cost of health insurance for their employees.
"If there is a more sensible way to pay for universal health
ca~e. I don't know what it is,• Gibbons said.
•I believe
emp~oyer participation in universal coverage is the right thing
to do. It's the smart thing to do. Let's do it.•
AND OlfiY.·.:JtSAL COVBRAOB
GIBBONS PRAISES CBO
FOR ~MMEDIATE RELEASE
July 21, 1994
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0WUS I
COMMITTEE ON WAYS AND MEANS
--~-~------·---------------------------------------
...,._,__..,~
�THIS
McDonnell Douglas
Maytag
Manpower lne.
National Steel
National Association of Chain Drua Stores .
Norfolk Southern Corporation
PeDa Corporation
•
Lora!
Bechlnger Company
ILJ, Belu
·IBM
lDgersoD·RIDd Company
[nJand Steel
Gialll Food
GEC-Marconi ElectroDic Systems Corporatloa
General Motors
·· Fords, IDe.
. . - Food for Less Grocery
Ford Motor CompanJ
·:ms
Drummond CompanJ
EaJ)e Pidler IDdnstrles
Champion Interm.donal· Corporation
Chrpler (;orporatloa ·
Armt Inc.
Bethlehem Stt- t Corporation
ArCher Daniels N 'tdlaud CompaDJ
.
American Con Growers
American Automobile Manufacturers A ssoctafiOD
Ameriam Iron and Steel Institute
AMR Corporatioa (American Airlines)
AEL Industries
Acme~
ABB Ine.
A & P (Great Atlantic and Paclfic Tea Compaliy)
.
US1' is EMBARGOED UNTIL 10:15 A.M. JULY 21,.1994
.
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United Distfllen North America
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The Vons C mpanies
Westin[" ouse
Wbconsin Public Sc.: "'ce Corporatl~a
Zenith Eleetromc: Corporation
The Prindpal Plnandal Group
'llme Warner, IDe.
Safeway, lac.
Scott Paper Company
Southern California Edison Company
The LTV Steel Company
Pioneer Hi-Bred International, Inc.
Ralphs Grocel1
Rohm & Haas
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covering~
companies worken too-- the companies wbo free load of the
to
the corporations, large and small, that do the responsible thin& by covering their
disadva.r.~tage
domestically, when competiting with companies that don't provide insurance,
the proc ucts and services of companies covering their workers, which .puts them at· an unfair
. is usuaD)· twice that of the rest of the economy. This in tum further drives up the costs. of
Sot only~is th'at not fair, it also drives the rate of inflation in the health sector, which
workers..
shifted
system• . Unless everyone is insured, health care costs of the uninsured will continue to be
they're also
•Most American companies are already covering their workers. • it ~ noted. •But
and insure tens of millions, including worken, their familieS and former worken.
,.
emPloyer responsibility. The companies sigrung the letters employ millions of Americans
Congress in 1994, and enc,torsing the twin principles of universal covezace and shared .
more companies and employees, released two letten today calling for decisive action by
J-fore than one hundred and twenty c ,mpanies and associations, which represent many
already in place .in America.
uni-.ersaJ coverage by maintaining and extenoing the employer-based insurance system
A wide and diverse group of large corporations petitionelfCongress today to enact
Wasbi.qton, DC, July ll, 1994.
LARGE CORPORATIONS RAISE VOICE FOR UNIVERSAL COVERAGE,
.
EMPLOYER COST SHARING
PRESS RELEASE
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to
lose millions of
CONTACT:
857~70
Chambers Associates
.Jim M.oodY (202)
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contain costs, or be fair to responsible, work:r and family-friendly companies .
coverage. There is no other way to achieve adequate health coverage for our citizens, and to
The economic and social health of our country and our people requires universal
home and abroad, or of dropping coverage althogether.
be forcee to face the hard choices of continuing to be placed at a competitive disadvantage at
jobs as world competition becomes more fierce. Employers who do provide insurance will
If left. unchanged._ the current system will cause the U.S. economy
and it also makes U.S. companies Jess competitive in the world market.
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not
pay their fair share.
control our health costs, but we cannot control costs shifted_ to us because of those who do
minion people •• that's one out of every 90 Americans. We have moved aggressively to
Most~can businesses provide health insurance to their employees. Last year,.
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the three auti'eompanies spent nearly $6 billion in providing health coverage for-2~
.
. cost-shifting from various sources.
families, this burden is a heavy one. These firms pay 28 percent higher health costs due
manufacturing fums, which generally provide colllprehensive coverage to their employees and
they can't afford it, or they choose not to buy it, others end up paying for iL For.
Wben individuals do not.have coverage either because their employer does not.provide_it,
We need to remember that. all health care costs must ultimately be paid by sOmeone.
employers· wh~ ~o provide ins~ce ~overage lWl. pick ~P ~e siack. ~ ~ that dO nOt.
insurance coverage to their employees. Often overlooked is the bwdeD incurred by those
lhe burden, or increased costs, that would oe incurred by businesses lhat do not provide
Throughout this national debate or. , .ealth reform, the focus of anention has been on
for America's workers and their families.
unh•ersal coverage, with Ill employers sharing in the responsibility to help fmance coverage
and General Motors -- all of whom believe it essential that health reform legislation achieve
I am very pleased to be here on behalf of America's car companies- Chrysler, Ford,·
STATEMENT BY ANDREW H. CARD, JR.
PRESIDENT & CEO
A~ERICAN AliOMOBILE MASUFACTl'RERS ASSOCIATION
··:.:
HEALTH REFORM PRESS COSFERESCE
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THURSDAY, JULY 21, 1994
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health
to
provide fCI' equitable·fUlllicinl or
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aoveriuneot. individualS, ind Ill
to
keep their free ride.
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oo~rage and shared responsibillty the same way we do.
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h2l& we. will be able
to support. the legislation which ultimately emerges from each. House of Congress in. August.
un!'\.·ersal
i.ft~:
We:know the White House and the Congressional leaders hm today see the need for
provide coverage. while allowing other businesses
Fir.ance Committee bill. which imposes substantial new taxes on businesses ·which now
\liiD.·ersaJ coverage by a date cenain. Nor can we suppon Iegislatioo. such as the Senate
We cannot suppon legislation which fails
employers.
require universal coverage and shared responsibility between
m\JSI have reform legislation which spreads the cost of health.care equitably. This will
Let me be very clear about where America's car companieS staDd in this debac. We ·
paying for health care fairly throughout their economies.
successful than the U.S. in containing ove. JI health costs •• and iD sprwiing the burden of
aboUt $500 less per vehicle in health costs. Other indusuialized nations have been far more
disadvantage versus their primary competitors. The Japanese companies. for example. pay
.As a result of high health costs, the American auto companies operate at a competitive
wage jobs for Anierican citizens.
costs mean less money for product development. new plants, and growth of high-skilled. high-
con_cumers of our products. Health care costs average more than $1100 per car.
This $6 billion ·burden has a very substantial impact on our companies and on the
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arid President of the American
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This is the gr·~ country in the world. It is also the breadbasket of
wo~ld. But if it .
wants to CQntrn~e to have hard working men and women feed this country the tastiest,
safes: and leaSt-expensive food in the wortd, it must develop a health care system that
is workable and affordable.
·
Anything less than these frveitems will continue to jeopardize the health of agriculture
and rural America.
•• reQuire shared financial responsibility among employers. individuals and the
. government.
·
- Prohibit the denial of coverage for pre-existing conditions•
-ReQuire t_hat health insurance be lransferable from wort-place to work-place.·.
- 100% tax deductibility ~f health care costs tor employers and the _self;.employed.
-Guaranteed comprehensive health insurance benefits for all.
.
The American Corn Growers Association believes that any health care solutiOn must}
include:
··
care crisis continues for American Agriculture and Rural America
shoUld pay for it. But while the different porecies are debated back and forth, the health
There is alot of debate about what kind c. f health care system we should have and who
Some say that there .is no crisis in health care. In agriculture. there is. in fact, a crisis.
Almost one third of all farmers are eith u un-insured or under-insured. This is the
second most dangerous occupation in th1 United States. When farmers can't pay their
bills. the first thing to go is insurance. St.. "'ething must be done.
Com Growers Association. wnich represents large and small farming businesses.
I'm Gary Goldberg, a Kearney Nebraska Corn Farmer
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lincDin. NE 68542-2994
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~headquarters:
American Corn Growers Association
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785·3286
National Association c..f Chain Drug Stores
Telephone
Company
Name
The Great Atlantic & Pacific Tea Company
Com?2Jty
Name
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Name
Company
Fax
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682-1280
682-1412
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20 1·930-4236
201-930-4034
Michael Rourke
457-8~61
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457-8582
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·Time Warner
Arthur B. Saclder
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Safeway
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Represented by Henry Simmon, Mark Goldberg, Peggy Rhoades •
Company
Name
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637-5910
703-549~771
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Telephone
David Lambert
703·549·3000
Tdepbone
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Champion lntemationa'.
Jeanne Connelly
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Corporation Representatives A vaUable to Speak oo Health Care Reform
HEALTH CAR£ REFORM
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637-5600
414-299-1272
Fortis, Inc
Carl Schramm
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Telephone (21st)
Telephone (22nd)
Chambers Associates
Jim Moody
857-0670
867-0668
Name
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Fax
Compan~
Ford
Elliott Hall
962-5371
962-5456
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American· Automotive Manufacturers Association
Mel Bass
326-5518
326-5567
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Chrysler
Wally Maher
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�He ordered Anthony Lake, White House national security
adviser, J. Brian Atwood, administnltor of the Agency for ·
lnterr.ational Development, and Pentagon officials to
develop a plan for U.S. emergency relief.
Atwood said .the riTSI priority was to send water,
medicine a.od medical equipment to help check the cholera
·epidemie. The Pentagon plans to use as many as 1,000 U.S.
service personnel to deliver ·relief supplies.
"The international eommunity has never 11een anything
like this,• Atwood said, announcing an additional $41.4 .
million in U.S. aid.
Atwood said the only long-term solution to the crisis
was to persuade Rwandans still in their homes to stay
there a.od to get refugees to return home.
Ref\lgee eamps are a misnomer. Hundreds of thousands or
people simply squat by the roadside, awaiting their fate.
Survivors lead bleating goats and long-homed cattle; a
(Optional add end)
(End optional trim)
The epidemic is the latest tragedy of Rwanda's
four-month civil 'lllo'll' and alaugbtcr that bas caused an
estimated 1.2 million Hutu refugees to flee for fear of
retribution from victorious Tutsi-led rebels back in
Rwanda.
In Washington. President Clinton said the United States
was ready "to lead the United Nations in responding to
the cholera problem and in dealing with the other aspects
of this human catastrophe."
"We've only got one runway and you can't just pound it
and pound it or you'll have to close it," said Paul
Gilham, in charge of the airlift here. Moreover, only lix
planes can be parked and unloaded one time fewer if they
IIR large cargo planes.
Still, relief supplies IIR increasing. Some 80 1DDS of
food wu distributed Thursday and 200 tons are plaDDCd for
Friday. Up to 400 tons may arrive by next week. About 600
tons .of food are needed each da):; however.
The (!J"St tru:k c.onvoy is expected late Friday or
Saturday, officials said. They hope the road liDk from
from Kampala, 420 miles away in neighboring Uganda, may
open a lifeline for faster provision of supplies.
(Begin optional trim)
(End optional trim)
Doctors predict that the ebolera which causes severe
diarrhea, vomiting and sometimes death within five hours
is likely to infect 10,000 to 50,000 refugees. Untreated,
half will probably die. "You cannot stop it at the
moment,• warned Henckaerts.
Cholera initially spreads in contaminated water, but
then can be passed directly from person to person. Corpses
IIR especially contagious, so quick burial is critical.
The chief treatment for those infected is immediate
rehydration with special solutions to replace lost fluids.
And the only reliable prevention is chlorinated d.rinlcing
water. But both the solutions and clean water are in
impossibly shon supply.
The rust air shipment of I 0,000 liters of solution
urived Thursday but most bad been used by nightfall.
Another shipment wu expected Friday, but the airpon is
already operating at near-capacity.
300 by nightfall. ''It's literally lib a eonveyor belt,"
Noone said u be worked. ·'They bring them in and we load
them on the truck.. •
Noone said be bad rented a 40·foot trailer truck to
carry bodies Friday, an indication of the horrors expected
ahead.
.
.
of
8~
WASimlGTON As President Clinton received a show of
big business support Thursday for his proposal to mab all
employers provide health illsurmce for workers, eongresaional
leaders sought to heal painful diviJiona within Democratic
ranks over the scope and cost of health care reform.
House and Senate Democratic leaders met with Clinton
Thursday night at the White House tO brier him on their
effons to. reach agreement on bills to take to the noon
of their respective chambers and to discuss plans and
strategy for the legislative floor fights to c.ome.
After the White House session with the president and
rllll lady Hillary Rodham Clinton. the congressional leaders
proclaimed a "new spirit• of agrecmeut but offered no new
· details ~ back up that claim.
The bills that House ~jority Lead~r JUcbard A.
Oephardt, D-Mo., and Senate Majority Leader George J.
Mitchell, D·Maine, plan to present, probably next week.
will pursue Clinton's goal of universal c.overage but will
be "less bureaucratic, more voluntary and phased in over
a longer period of time• than Clinton's original proposal
from last year, Mitchell said, echoing statements that
Clinton and his top aides have been making for several
weeks.
Earlier in the day, a coalition of 50 of America's
largest corporate employers endorsed the "employer
mandate• that has emerged as the biggest single stumbling
block to passage of Clinton's health plan.
The coalition. whose membership includes the Big Three
automakers, Bethlehem Steel, Safeway and Manpower Inc.,
warned that if Congress fails to enact a major health
measure this year, "it is unlikely to have another chance
at comprehensive reform in this century." Many of the
individual companies have been longtime supponers the
mandate.
With House and Senate leaden wrangling over rmat'
details of their own health caR bills, the big business
endorsement was offered to counter recent indications the
president bas failed in efTorta to rec~t any significant
blisiness backing for his reform plBD.
·
The bills being negotiated behind closed doors by
congressional Democrats will provide the components of the
blueprint thet Clinton and his party will take to the
rlllll battle over the legislation.
In bOth houses, Democratic leaders spent much or
Thursday plotting their strategy for bringing health bills
to their respective floora.
·
In the.House, Speaker Thomas S. Foley, D·Wasb.,
presented. crucial committee chairmen with a complicated
eomproiDise proposal. He hoped the plan would end a nasty
squabble over jurisdiction that bas prevented any progress
Bi& Business Coalition Favon HeaJtb Plan's
Employer Mandate (Wasbn) By Robert A.
Rosenblatt and Karen Tumult)'= (c) 1994, Los
An&eles Times=
few sell yams and com by the road. Rwandan soldiers,
routed by rebels, strut by in their camouflage uniforms.
Long lines of people shu1Tie endlessly down the road.
Many carry yello""' plastic jugs of water on their heads
from Lake Kivu, about four miles south. Others bead nonh
to promised food distribution sites. Those who can, cover
their noses with handkerehiefs, towe\s or surgical masks
to cut the odor of death, dust and diesel fumes.
The sun, dimmed by the smoky haze, is a dull orb
overhead. The refugees have stripped many of the trees for
firewood.
Their countless cooking rii'Cs were the only sign of
life u night fell like a shroud.
�. ~lscr, Ford and General Moton spent nearly $6
btlbon last year to provide health insurance for 2.8
million people, workers, retirees and dependents, said
Andrew Card, president of the American Automobile·
Manufacturers Association.
"We have moved aggressively to control our health
costs,· but we cannot control health costs shifted to us
because of those who do not pay their· fair share," Card,
a former U.S. Transportation secretary, said at the newa
(Optional add end)
Major business organizations such as the U.S. Chamber
of Commerce, the National Association of Manufacturers and
the Business Roundtable have decided the employer mandate
for health insurance is a new and collly intrusion of
government into business. They refused to accept·it,
despite promises from the president that the reforms would
slow down the rapid increase in cost of health care, and
that smaller companies with low-wage workm would be
given fmancial subsidies to offset the effect of the new
mandate.
And many individual eompanies once enrolled on the
president's side arc now having seeond thoughts. On
Monday, a corporate coalition of 21 fU111.1 ineluding
General Electric, Pacific Telesis, DuPont, Atlantic
Richfield, McDonnell Douglas and U.S. West, all early
supporters of health reform, sent Clinton a letter with a
b~unt wa.ming that they could never back any legislation
gt\1..111! states the power to design independent health care
structures.
These companies which now operate throughout the
counuy with a standard package of benefits set by
management, are fearful they would be confronted with a
new patchwork of rules and varying benefits in different
states.
Eager to show they still ha \'e some corporate allies,
the administration and congressional Democrats arranged a
oews confereo.ce Tbu:-sday by an ad hoc coalition of SO
f = that have been stroog supporters of the mandate
because they already provide generous health benefits to
their workers.
(End optional trim)
Even when Democratic leaden satisfy their fnlctious
committee chairmen, they will face the ultimate battle 011
the floor of the House and the Senate, tzying to usemble
a majority for the controversial core of the president's
plan: a new federal law requiring cmployen to provide
health insurance for all workers.
However, that plan drew objections from the chairmen
and subcommittee chairmen of the other two committees with
jurisdiction over the health issue the Education and
Labor Committee and the Energy and Commerce Committee
in
large part because doing so would remove much of their
influence over health-related issues in the future.
The heated intramural battle has set back by several
days the effort to put together a bill to take to the
floor. ''The problem is that we have nothing to sell yet.
We thought by now we'd be two weeks into the selling
job," said one member of the House Democratic leadership.
(Begin optional trim)
from being made on other substantive issues t!Us week.
Foley and House Majority Leader Richard A. Gephardt,
::>-Mo., plan to use a bill written by the Ways and Means
Committee as the vehicle from which they will build the
legislation they will take to the floor.
,
... ,
8)
. LOS. ANGELES Against a backdrop of inereasing
dissension by moderate Republican leaders, the national
Republican hierarchy gathered in Los Anse1es Thursday ·
intent on burying its nascent problems and celebrating an
increasing optimism about the party's prospects this
November.
·
R~ublican National Committee ehairman Haley Barbour,
spealcing to reporters as the twiee-yearly gathering began,
sent a strong signal to his OOP brethren to keep their
attention riveted on 1994 and leave until later any
contentious battles over ideology.
"The focus has to be on 1994," he said.. ··ne best
thing thai we can do to elect a Republican president in
'1996 is to have a big Republiean vieiory in 1994. ...
We'll worry about 1996 and all that after Nov. 8."
Republican prospects, indeed, are far sunnier now than
might have been imagined after the party's thundering
losses in 1992, which saw the election or the filS!
Democratic president in 12 yean and sweeps by the
perennially losing Democrats in many states.
Barbour estimated that 17~ House seats, out of a total
of 435, are up for grabs this year, imd he said that the
CUJ'I'Cilt Democratic majorities in the House and Senate are
threatened.. He said he believes that Republicans could
walk away with more scats than they have held in more than
a generation.
··1 think it is reasonable to expect that we may be
~ble to put together working control, working majorities
Ill the House on many issues," Barbour said. He added that
while it is conceh·able that Republicans could win an
outright majority, such an outcome was unlikely.
In the Senate, where the retirement of several
Democrats has opened up more balanced battles than c~uld
have been predicted, Republicans would have to gain seven
scats to take control. "That is uphill but it is not
·
nearly as u?hill as it was in the beginning of the year,"
Barbour satd..
The Republicans, however, are not without their own
p~blems, whic~ .Barbour and other OOP .leaders hope to
dtsc~ only Dl1l11ID.Illy during the three-day Los Angeles
meeting.
Moderate Republicans have been grumbling about the
growing prominence of religiouS eonservatives. So far,
most of the discontent has surfaced in di$putes about the
party's anti-abortion stance. In reeent weeks two ·
Republican governors California's Pete Wilson and
Christine Todd Whitman of New Jersey have called for the
deletion of the anti-abortion plank in the GOP's 1996
platform.
Barbour, clearly seeking to avoid any intra-party
Republicans Look Forward to Fall Elections (Los
Angeles) By Cathleen Decker= (e) 1994, Los·
Augeles Times=
eonference.
Steve Burd, chief executive officer of Safeway, said
his-company competes "with some very large companies that
don't offer the same kind of coverage. • If health reform
doesn't pass with the employer mandate, Safe\\·ay might be
forced to curtail its coverage "to level the playing
field," Burd said.
Administration business supporters are in a distinct
minority. At another news conference on Thursday, Herman
Cain, the president of Godfather's Pizza and the National
Restaurant Association, denounced mandates as a new form
of tax that would wipe out jobs. "Mandate, mandate, any
way you say it, we oppose it, • he said.
· endit
,
�
Dublin Core
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Title
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Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
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White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
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1993
Identifier
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2006-0223-F
Description
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This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
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72 files in 6 boxes
Provenance
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Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
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William J. Clinton Presidential Library & Museum
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<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
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[Background on Health Reform] [5]
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First Lady's Office
Melanne Verveer
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2006-0223-F
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Box 4
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2068127" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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1/8/2015
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42-t-2068127-20060223F-004-001-2015
2068127
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https://clinton.presidentiallibraries.us/files/original/005ebd4c7810ad6feecca275b840263b.pdf
56e54983ef48a0d82cd5adb914588475
PDF Text
Text
�President
Executive Director
Eugene Glover
Lawrence T. Smedley
National Council
Silver Spring, MD
Washington, DC
of Senior Citizens
1331 F Street, N.W. • Washington, DC 20004-1171 • (202) 347-8800 • FAX (202) 624-9595
Six Reasons the
Dole Health Care Bill is Bad Medicine:
•
NO universal coverage: More than 22 million Americans would remain
uncovered under the Dole health care bill.
•
NO home and community-based long-term care: Under the Dole bill,
senior citizens needing assistance would continue to be forced into highpriced nursing homes rather than being allowed to stay at home with low-cost
assistance.
•
NO prescription drug coverage: More than 31 million Americans under
age 65, and over 18.5 million Americans over age 65 would be denied
prescription drug coverage under the Dole bill.
•
NO private sector cost containment. Under the Dole bill, health care costs
in the private marketplace would continue to spiral upward out of control.
More and more Americans would fmd themselves unable to afford health
msurance.
•
NO new benefits extended to senior citizens: The Dole bill would cut and
cap Medicare, but would not invest any of the money saved into new benefits
for older Americans.
•
NO end to insurance company discrimination: Under the Dole bill
insurance companies would be allowed to deny insurance coverage for
preexisting conditions for up to one year, would be allowed to raise rates
when people got sick, and would be allowed to discriminate against
applicants on the basis of age.
I
I
For further information, contact Patrick Burns,
Director of Communications, NCSC: (202) 624-9583
I
i
I
First Vice President, Dr. Mary C. Mulvey, Providence, Rhode Island Second Vice President, George J. Kourpias, Washington, DC
Third Vice President, Dorothy Walker, Detroit, Michigan Fourth Vice President, Royetta K. Sanford, Washington, DC
Secretary-Treasurer, Jack Turner, Detroit, Michigan General Counse~ Robert J. Mozer, New York
··~"'
�National Council
Senior Citizens
1331 F Street, NW • Washington, DC 20004-1171 • (202) 347·8800" FAX (202) 624-9595 ..____ _ ___,
~··
Remarks of Larry Smedley,
Chair of the
Leadership Council of Aging Organizations
and Executive Director,
National Council of Senior Citizens
July 19, 1994
Press Conference on the Dole Health Care Bill
GOOP MORNING.
My name is Larry Smedley and I am Executive Director of the National Council
. of Senior Citizens and the current chair of the Leadership Council of Aging
Organizations.
_The LCAO is an umbrella coalition of 37 nonprofit membership groups and
provider organizations working on behalf of America's 40 million senior citizens.
Joining me today on behalf of the LCAO are Lucretia Paschall of the American
Association of Retired Persons, Dan Thursz of the National Council of Aging and a
cochair of the LCAO, Samuel Simmons of the National Caucus and Center on Black
Aged, and Dianna Porter of OWL, the Older Women's League.
Also joining us today are Senator David Pryor of Arkansas and Senator Bob
Graham of Florida, who will give their own take on health care legislation now before
the Senate.
The Leadership Council of Aging Organizations, which represents 40 million
older Americans, is here today to serve notice that ... WE WILL NOT SUPPORT,
AND MOST OF US WILL ACfiVELY OPPOSE, THE DOLE HEALTH CARE
LEGISLATION.
�Mr. Dole offers the American people a bill that does not extend universal coyerage
to all Americans.
He offers us a bill that provides for no home and community-based long-term
~for handicapped older and younger Americans.
He ignores the spiraling costs of prescription drugs. and fails to extend
prescription drug coverage to the elderly and the young.
The Dole bill ignores the urgent need for cost containment and allows health
care costs in the private marketplace to continue to rise unfettered.
Finally, the Dole bill would cut and cap Medicare, but give nothing back to
senior citizens in return.
This is a bill that takes. but does not giye. A bill that would cut Medicare. but
not reinvest in long-term care or prescription drug coverage.
u.
In short, this legislation is as hollow as a kettle drum and
we are not bqyins
We do not believe this is a serious attempt at reform. It is posturing at its
worst - posturing when real lives are at stake and when real solutions are very near
passage.
This is part of the great Washington end game of SAYING ANYTHING, AND
DOING NOTI-ITNG and we are not playing.
We will not support Senator Dole's legislation which would leave more than
twenty-two million of our children and grandchildren uncovered.
We will not support legislation that does not reinvest Medicare savings into
long-term care and prescription drug coverage.
And we will not support legislation that does not provide for the kind of~
containment needed to assure that ALL Americans will be able to afford health care
into the future.
The American people have extended far better health care coverage to Senator
�Dole than he appears to be willing to extend to them.
a
Senator Dole's legislation would leave us with health care system that is
neither healthy, nor caring. nor a system.
It is not the best this great nation can do, and it is certainly not the best bill now
before Congress.
Even the Senate F.nance Committee bill-- a bill we in the aging community also
find woe.fullll inadequate- is marginally better than the legislation Senator Dole has
crafted.
And while we in the LCAO believe the Senate Finance Committee bill also takes
too much and gives too little. we are at least hopeful that the Democratic leadership
will craft a reconciliation bill that will set right what that Finance Committee has made
wrong.
Senator Dole's bill, however, makes clear that we cannot expect compromise
language from his end of the leadership aisle. Senator Dole continues to show far more
enthusiasm for cutting existing health care benefits to older Americans than he does for
extending universal coverage to ALL Americans.
In short, the Dole bill is a prescription for disaster. not a prescription for change.
It would give older Americans less and cost. them more. It would force millions of
senior citizens deeper into poverty as they struggle to pay mounting out-of-pocket
health care costs. It is BAD MEDICINE, plain and simple.
To steal a phrase, when asked to support or cosponsor Senator Dole's legislation,
every Senator should "just say no" or risk being accused of being "soft on health" and of
turning their back on the health care needs of the elderly.
With that, I'll close and turn the mike over to Senator David Pryor of Arkansas,
Chairman of the Senate Aging Committee, followed by Senator Bob Graham of Florida.
Senator Pryor ....
###
�For fitrtiJtT illquii:Y. cmttaa .-\;n,-;Ht:/1 _.1_,-_,oontiol!
.
·~I 1~,-:t:·,-,i
!iOl E Street ..\'.\\'. • 1L7.dll;'!'r""· JU ·.
i',-;·_,·,n:- • ( · ,:n:.t:t:t! .. !i!u:t: ! '!:·:.,- ....
.;on-N • .:o:::
CONTACT:
FOR IMMEDIATE RELEASE
July 19, 1994
-f 1-t-::~(11)
Peter Ashkenaz
202/434-2560
AARP CALLS SENATOR DOLE'S HEALTH CARE REFORM PROPOSAL
A HARMFUL PRESCRIPTION FOR OLDER AMERICANS
VASHINGTON, D.C. -- The health care reform proposal
introduced by Sen. Robert Dole (R-KS) will harm the current health
care system for seniors and would leave most of the 37 million
uninsured Americans without health coverage, according to AARP.
"Senator Dole's plan will not help older Americans," said
Lucretia Paschall, a member of AARP's National Legislative Council.
"This plan would leave millions of American families without any
health care coverage, does not address the high cost of
prescription drugs and long-term care and shifts costs to the
private sec tor.
"This proposal is a long way from providing health security to
all Americans, nor does it control skyrocketing health care costs,
leaving the young and old at the mercy of higher health care
costs," continued Paschall.
"And by simply cutting Medicare,
employers anti families will see their insurance premiums rise and
Medicare beneficiaries could find it even harder to get into their
doctor's offices.
"None of these savings will be re-invested into helping
Americans. pay for prescription drugs or long-term care, important
elements-for Americans of all ages," Paschall said.
-- more --
�,.----·
AARP/Dole Proposal
July 19, 1994
Page 2
"AARP is committed to the enactment of comprehensive health
care reform this year," Paschall said.
"Congress needs to consider
real solutions, not proposals that fall far short of the mark."
Real health care reform must:
o
o
o
o
make sure that all Americans have health coverage;
include important benefits like prescription drugs and
long-term care for young and old;
control skyrocketing health care costs; and
be financed fairly - not primarily with Medicare cuts.
AARP is the nation's leading organization for people 50 and
older.
It serves their needs and interests through legislative
advocacy, research, informative programs and community services
provided by a network of local chapters and experienced volunteers
throughout the country.
The organization also offers members a
wide range of special benefits, including Modern Maturity and the
monthly Bulletin.
# # # #
�news
The
Norionol
Caucus
NEWS RELEASE
FOR IMMEDIATE RELEASE
and Cenrer
on Olocl~ Aged
Inc.
CONTACT: SAMUEL J. SIMMONS
(202) 637-8400
NCBA CONDEMNS SENATE FINANCE COMMITTEE AND DOLE
PROPOSED HEALTH CARE REFORM PLANS
Washington, D.C. (July 19, 1994) -- The National Caucus and Center on Black Aged
(NCBA), condemns the reported proposed Senate Finance Committee "breakthrough
agreement" on Health Care Reform and the Dole proposal for Health Care Reform. Stated
NCBA President Samuel J. Simmons, "We are very disturbed that these proposals will not
bring about Health Care Reform but a mere patch job on a defective health care system.
Neither responds to the needs of low and moderate income families in our nation."
NCBA's position is that any Health Care Reform plan must guarantee adequate
comprehensive health care coverage by a date certain. Further, such a system will fail unless
it is financed by mandated payments by the Federal Government or employers. The
organization also strongly opposes any plan to finance Health Care Reform by drastically
reducing the Medicaid program. NCBA applauds the House of Representatives Education
and Labor and Ways and Means Committees, and the Senate Labor and Human Resources
Committee for adopting Health Care Reform plans that provide for universal coverage and
mandated employer payment of health insurance premiums.
Stated Simmons, "NCBA is urging the members of its thirty-six chapters and affiliated
organizations to contact their Senators and Congresspersons to push for guaranteed
universal coverage and mandated employer payment of premiums." ·
The National Caucus and Center on Black Aged is the only national organization that
dedicates itself solely to improving life for the nation's 2.5 million African American elderly
-- particularly those of low income.
###
Office of Communications
1424 K Street. NW. Suite 500 Washington. DC 20005/202-637-8400/8428
,.
�STATEMENT OF THE OLDER WOMEN'S LEAGUE
July 19, 1994
The Older Women's League is committed to working to ensure
that the health care reform legislation passed in this Congress
includes universal coverage and comprehensive benefits includin ...
long-term care and prescription drugs. The Dole proposal does nof
address any of these principles.
We call upon Congress to demonstrate genuine courage by
guaranteeing all Americans that they will never again worry about
how they will pay for the health care they need.
All Americans lose without universal coverage, even those who
Legislation without universal coverage is
may now feel safe.
particularly
detrimental
to
women
who
are
traditionall~
marginalized in health care. Older women will lose because they
will experience an erosion of benefits under Medicare. Poor women
will lose because a patchwork system of health care that does not
include universal coverage will continue to allow women just above
the poverty level to slip through the cracks. And all women will
lose because women represent a disproportionate number of those
without health care coverage. Neither the Dole nor the Senate
Finance Committee plans will provide universal coverage.
Health care legislation must mandate a full range of
preventive, primary, reproductive health, mental health and longterm care services for women. Under the Dole proposal, 1nsurance
companies can still decide which benefits to cover and which to
deny. The proposal also repeals existing state laws guaranteeiny
insurance for certain services, including mammograms.
The Dole proposal does not provide for a long-term care
program--only tax deductions for those who can afford long-term
care services on their own. Long-term care is not an issue for the
older population only. Chronic and disabling illnesses affect
people of all ages. It is a vital concern for women who both
provide the majority of family caregiving and are most likely to
require such care as they age.
Women outlive men by an average of seven years, and are the
majority of the older population.
Sixty percent of those age 65
and over are women. Sixty-eight percent of persons 80 years of age
and older are women. Women are more likely to suffer from chronic
illness, while being least able to pay for health care.
In addition, three out of every four caregivers to the elderly
are women. The average caregiver is a 45-year-old married woman.
�-
'' '
.1. ...
1:S -•1.:
.:• t
~hirty-five
-
.)~.)
;.":111~·
percent of
careg::..·~~·ers
to :.he elder:i..y are ove.= age 6"5.
Many women asst.:.me elderca.r-~ responsibilities at a ti:ne of crisis
and rr.ay continue to p~ov.:.de t:-:.e q:ualit:tr care tb.ey feel tb.eir lo·Jed.
one deserves for yea:rs
·.... ~.::h no outsid.; support.
O~r
nation's ~ealt~ care system can, aud must, pe~it
i.::J.di,tiC:'..:.als to receive tt1e sLpporti.ve ser.:ices they 'WCL.nt:. ~c enable
t.h·:!:r::-. +:c remain in their :::o-:nes and co age with dignity. At. tl:.e sarr..e ·
time, :r-esponsibility f:Jr t:;is care for lons- periods carL"lct ce
placed solely on the sl:Lc·.;.!.:i;::::s of fa7!',il:r members.
!r.:.-l"'.:.o~.e ~:1d
corr.::r..:.::i::y se:::,rices are ~ced~:::. L::t2..:: pr::;;note quality ca::-c ~nc. c.hat
prot.a=t. the caregiver's o•·r~1. :.1ealt.h.
'I'he Older Women . s :Le;::~g-:1'~ is the convenor of c:,.e Car:rpaign far
Women's Eealt:h.
T:C.e c~·.':-{ is a national coalition of 98 wome::' s,
:abel.- a.."'lC. heal ':h ca~e o::.·s:aniz.,i~ ic:ls repr~senting o·,rer- eight rr.i11:.or..
Ameri::e..ns. T!:rcugh theE:e C<:··ilition efforts I 0\'1"L nas er~s"J.red :.hat
preven:.:ive, primary, spe·:ia:~~zeC., a.n.d rep.:-oduc~ive se::-..rices as ·.vell
,:..s long-term care are :recog:1:ized as ·..rital concerns of >·:omen.
!he co·.rerage of ;?resc::iption drugs is also of crucial
importance.
Older wom·~n h.;:se an ar'l....
"lual medi.:u"l income of only
$8,189 and m.ust frequer:.:::y forego purchasing prescription drugs
that 'H"ould alle-v·ia.te 1:h·.::ir ch:!:'onic conditions.
There is no
provis·ion for prescripti·:on druJ
~der the nole plan.
covel·ag~
for iv!edicare beneficiaries
We call upon the membe=s of Congress in the Senate and House
of R~presenta.::ives to r:~eet. their responsibility to the .Amer:.can
people a..'"ld to complete ::.ealth care reform this year. We must all
wo:r~ together., not c..pa=-c, to ensure a health care system in America
~ha~ guarantees every person comprehensive health care.
Older \Vomen·s league
666 11th Street NW, Suite 700 • Wasl'lin!ltOn OC 20001 • (202)783-6686 • (2021638-2356 FAX
I.
.~
..
�The National Council
on the Aging Itt
409 Third Street SW,
Washington, DC 20024
FOR IMMEDIATE RELEASE
Phone: (202) 479-1200
FAX: (202) 479-0735
TDD: (202) 479-6674
CONTACT: LOUISE CLEVELAND
202/479-6975
"TRUE" HEALTH CARE REFORM MUST INCLUDE LONG-TERM CARE
AND UNIVERSAL COVERAGE, SAYS NCOA
WASHINGTON DC, JULY 19--Dr. Daniel Thursz, President of The National Council on
the Aging, Inc. (NCOA), today expressed The Council's "long-standing, unequivocal position"
toward health care reform:
"The National Council on the Aging, representing millions of Americans of all ages,
will not settle for any plan that does not include universal coverage; home and
community-based long-term care; prescription drug coverage; and the maintenance of
Medicare. Versions such as Senator Dole's and that of the Senate Finance Committee
do not meet these objectives and would. take unfair advantage of millions of older
· persons across America."
"Now is the time to l"e!!pond to the health care crisis," added Thursz, co-chair of the
Leadership Council of Aging Organizations. "We have enormous power to act, and cannot
afford to wait one more minute."
Thursz said NCOA applauds the effons of congressional leaders such as Senator Jay
Rockefeller, who has worked diligently over the years on behalf of older Americans.
The National Council on the Aging, Inc., is a nonprofit organization that serves as resource for infonnation,
training, technical assistance, public policy advocacy, and publications on every aspect of aging. It has a national
membership of thousands of individuals and organizations. professional and voluntary, who serve millions of older
persons and their f8milies.
�Press Conference on the
Dole Health Care Bill
Jul.y 19, 1994
•
Lawrence T. Smedley, Chair of the Leadership Council of Aging
Organizations, and Executive Director of the National Council of
Senior Citizens.
•
Senator David Pryor of Arkansas, Chairman of the Senate
Committee on Aging ·
•
Senator Bob Graham of Florida
•
Lucretia Paschall, American Association of Retired Persons
•
Dan Thursz, President, National Council of the Aging
•
Samuel J. Simmons, National Caucus and Center on Black Aged
•
Dianna Porter, Older Women's League
The Leadership Council of Aging Organizations is an umbrella coalition of
37 nonprofit membership groups and provider organizations working on behalf
of America•s·senior citizens. The LCAO has a combined membership of
approximately 40 million older Americans.
1331 F Street, NW, Suite 500, Washington, DC 20004-1171 (202) 347-8800 Fax: (202) 624-9595
�STATEMENT OF THE ALZHEIMER'S ASSOCIATION
July 19, 1994
The Alzheimer's Association supports health reform that will provide universal
coverage for all Americans, bring health costs under control, and address the central issues
for families facing Alzheimer's disease --long term care and funding for research. We
cannot settle for anything less.
That is why we oppose the alternative health care plan that Senator Dole has offered.
The Dole proposal is not real reform. It offers no way to achieve universal coverage or real
cost containment. And it does nothing to address long term care. The 4 million Americans
who have Alzheimer's disease and the 19 million people in the families that care for them
will be left right where they are today -- paying everything out of their own pockets until
they lose their life savings and qualify for welfare.
Tax incentives to help the healthy and wealthy pay for private long term care
insurance are no answer for most American families. This is not the place to spend the next
dollar on long term care. The President set out a reasonable and affordable proposal for
home and community based long term care which has been incorporated, in one form or
another, in the health care bills reported by every Committee with jurisdiction on this issue.
Alzheimer families understand that we cannot get adequate long term care, or full
funding for research, until we bring health care costs under control -- a goal we can only
achieve through comprehensive reform.
We call on Congress to seize this historic opportunity to provide real health security
for all Americans. Don't dole out health care!
for further information contact:
Stephen McConnell
Senior Vice President, Public Policy
202/393-7737
ALZHEIMER'S DISEASE AND RELATED DISORDERS ASSOC. INC.
Washington Office: 1319 F St., NW, Suite ilO • Washington, DC 20004 • Phone: (202) 393-7737 • Fax: (202) 393-2109
�UNITED STATES SENATE • SPECIAL COMMITTEE ON AGING
SENATOR DAVID PRYOR, CHAIRMAN
Statement of Senator David Pryor (D·Ark.)
Chairman
U.S. Senate Special Committee on Aging
July 19, 1994
Recently the distinguished Minority Leader unveiled his own health reform
proposal. We are here today to expre9S our concems about how this plan will affect
older Americans.
Under the Dole plan, not only w;tt tfle ranks of the uninsured continue to grow,
but also older Americans
wm see their coverage deteriorate.
At first when I read the
Dole proposal I thought a few pages were missing since the plan leaves out the key
elements of health reform. In fact, this plan looks remarkably· like what former
President Bush proposed in the final months of his presidency - the plan that was
designed to appease strong public sentiment for health care reform. This plan. makes
a mockery of true efforts to refonn our health care system.
By relying almost entirely on Medicare and Medicaid cuts for financing, this plan
places an unfair bur~en on the poor and the elderly. And after asking them to pay for
his plan, Dole puts the Medicare program and its· 34 miiHon beneficiaries at risk.
Instead of strengthening the Medicare ;Jrogram by adding benefits that seniors want
and need, the Dole plan threatens the ·iiabirlty of the Medicare program. Wrth
Medicare cuts of this level coupled with the continuation of spiraling health
car~
costs
on the private side, seniors may see reduced access to the care they have now. Also.
by capping Medicaid spending, the Dole plan would place the lowest income seniors
at the highest risk by threatening that safety net program.
,,
Although some claim this proposal improves Medicare managed care, it does
----~
�.
.
• •.•.•• "''rW-
~
- -··
-· ·- ----;a;e
Exte:~:ec
just the opposite. Benefits that have tracfrtlonally attracted beneficiaries to Medicare
managed care - like preventive care - would be offered In the form of supplemental
policies for additicnaf premiums. Since many HMOs currently offer beneficiaries these
kind of benefits without an additional premium, many people may be forced to pay
more for benefits they currently receive as part of their coverage.
United states Senate Special Committee on Aging, G-31
Washil,gtcn, O.C. 2051o.&400
(202) 224-6384
F'u (2Q2) 224-9926
Dirksen Building
·.:...
�This plan provides no real prota(.;tion against the cost of prescription drugs and
!ong-term care, which ~re the largest cu~-of-pocket costs fer elder Americans. Undei
Dole's plan, Medicare recipients will continue to go without coverage for prescription
drugs. And disabled people of all ages will get no help wit1-: home and community·
based long-term care.
The only long-term care provisio.:-1 is a tax deduction for indMduals who
purchase private long-term care insur~n·~ Oil their own. 111is may be of some heip to
higher il-:come individuals vmo cen
affo~·d
to purchase long-term care
ir.suranc~J
policies 1Jr. tile front end, but giver. th~ ;,:~11 price of those policies, tha~ is a luxury
most Americans can't afford.
Unce:- the Dole plan, discriminatQry practices by the insurance industry will
continue. insurance companies will be able to charge older people as much as four
times more than younger pe-ople.
This plan fails to provide r.ew bc.i;cfits for seniors. N. tho same time, it puts
their primar'J source of health care at r'~k. I urge the sponsors of this plan to
reconsider their support.
�'o
JUL 19 '94
04:20PM HHS/AOA/ASA
P.4
, JOHN D. ROCKIFILLIA IV
WIST VIIIGIMIA
mnittd
~tattJ ~matt
WASHINGTON. DC 2051()..4802
Statement of Senator John D. Rockefeller IV
Press Conference on Dole H~th Plan and Seniors
July 19, 1994
We are here to explain why we think the American people should
·reject Senator Dole's health care plan. It's possible that_ some of our
colleagues are still taldrig a look at this so-called plan. Just dig into its
contents, and the answer is easy.
. This is poison for Americans who expect
acure.
Senator Dole's· so-called plan is an inadequate, non-universal
sol~tion which takes more than $60 b::lion from the Medicare. program
to pay for health care reform, without providing a single improvem~nt
for seniors.
This .is a proposal that says health refonn should fall on the
shoulders of America's senior ·citizens. Its name should be changed to
the Bob Dole ·Grandparents Tax.
How about some truth-in-labelling: the Dole plan doesn't ask
employers ·to help pay for health care coverage, but it makes seniors ~
grandparents ·- pay· more. It hits seniors and the poor the hardest and
asks little of anyone else. And what do senior citizens get for these
Medicare cu~? No new benefits. No long term care. No prescription
drug. coVerage. And a much shakier Medicare system. PlU$ no universal
coverage,.
.
That's the Dole health care plan: Ask nothing of employers, but'
dip straig~t into the wallets and pocketbooks and bank accounts of
. · senior cititens and retirees.
·
If Congress swallows Bob Dole~s prescription for health care
reform, over $60 billion will be taken out of Medicare to pay far other
health care expenses. This is where the alarm bells go off~ A $60
�P.S
billion cut, without a single step to strengthen the program, will throw
up roadblocks for seniors who count on Medicare for accessible, good
quality health care. The Dole plan says that the folks who depend on
Medicare will just have to make do with less health care.
The Dole plan does nothing to extend prescription drug coverage
to Medicare beneficiaries, meaning that his plan says sony, no help for
the millions Qf older Americans who are desperately hoping ·reform will
mean relief from their greatest out-of-pocket expense. I bet a lot of our
colleagues have told the senior citizens of their states that they'd try to
do something about the plight of choosing between expensive
medicines and vital needs like food and heat. The Dole plan will keep
millions of senior citizens in this painful predicament.
Without even an attempt to expand ·long term care, Senator Dole's
plan will continue to force millions into· nursing homes when the care
they really need could be giv.en at home. Insurance companies would.
still run the. show, allowed to deny coverage for up to a year, randomly
· raise rates, ·and even charge older Americans 400°AI more than younger
·
·
people.
Universal coverage ~d shared responsibility are the foundation of
meaningful, effec~ve refonn. That goes for the young and old.-grandparents and grandkids. So Bob Dole's non-universal plan, and the
Grandparents Tax it's built on, should be sent packing. And Congress
should put its remaining time and energy into health care refonn that
delivers wh~t the American people, young and old, expect and des~.
�,
JUL 19 '94
04:20PM
-
HHS/ROR/RS~
P.o
S!ATEMENT BY SENATOR BOB GRAHAM·
· JOLY 19, 1994
THE DOLB BILL VERSUS TBB ELDERLY
•
The Oole Bill, recently introduced and co-sponsored.by 39 ·
Republicans, is a prescription for failure.
•
Every generation cr just about every 30 years, the
Republican·Party puts forth a position on health·care or
·income security in direct opposition to the interests of the
elderly of our nation.
•
In the 30's, the Republican Party opposed Social
Security •..
*
In the 60's, the GOP opposed Medicare .••
*
and we have Senator Dole's bill this year, which
continues that unfortunate tradition.
Long Te:r:m Care
*
Upon the introduction of'the Secure Choice Act with Sepator
Packwood in October 19931 Senator Dole made the following
statement:
" ••• over the next several months, Congress will likely make
historic decisions regarding health care in the United
States. However, these efforts will be incampl$te unless
the long-term ca%e needs of America's seniors and
individuals who· b~come disabled are adequately addressed.
This, perhaps will be the greatest challenge of health care
reform."
*
He ad.ded:
••During tha coming months, as we, in Congress, continue. to
debate heal~h care reform, we must keep in mind tha~ there
is no true. reform without lonq-ter.m care refor.m."
*
I fully agree with Senator Dole's comments in 1993.
Howeve%, x.was dismayed to read that Senator Dole has failed
the challenge and instead taken the path of no true reform.
The Dole bill contains no funding, no hame- and communitybased long ter.m care program and only minor chan;•• in the
tax provisions for long term care insuranc•.
This is a radical departure fram his position ju•t nine
montha ago, and it fail• both the eld.erly and di•abled
citizens of this country.
·
�l
JUL 19 '94
04:21PM HHS/ROR/RSR
P.7
Prescription Drug Cov•rage
•
Senator Dole has also failed the elderly by not including
Medicare prescription drug coverage. 13.8 million elderly
Medicare patients would continue to bear the high cost of
prescription drugs.
•
·As Stephen Lonq, senior economist for RAND said, "'l'here is
little question ~hat prescription drugs are an essential
part of current medical treatment technology, which is why
nearly all private insurance plans, managed care
organizations, and even state Medicaid programs cover their
enrolles for prescription druqs. Medicare stands alone
among the major insurers in not covering prescribed
medicines." The Dole bill would continue this exclusive
burden on the elderly.
While I can understand a debate over how to pay for
prescription drugs, I cannot understand Senator Dole's
failure to even consider the possibility. According to
recent estimates, sst of.the elderly use at least one.
prescription medicine during the year. They will be left at
risk under the Dole plan.
No Cost Containment, ·Except for M~icare and Medicaid, and
Rampant Cost Shifting to the Private Sector
•
Senator Dole's bill takes an estimated $60 billion fram
Medicare over the nex~ five years and, according to the
National Governors' Association, $80 billion· from Medicaid.
In comparison to the private sector, public programs are
already underfund,d. Fundinq for public programs should
only be reduced in conjunction with the private sector and
not apart from it.
•
According to the Prospective ~ayment Assessment Commission,
in 1992, hospitals faced losses totaling $26 billion from
Medicare, ·Medicaid, other government programs, and
·uncompensated care . . These losses were balanced by $29.5
billion in'qains fro~ private insurera."
11
•
This qap would widen dramatically under the Dole plan and
force providers to rapidly increase cost ahiftinq,· limit
their Medicare and Medicaid patient load, or ration care
substantially to the elderly, disabled and poor. In short,
the Dole plan fails to increase health insurance coverage
and jeopardizes the health care security of the elderly,
'disabled and poor.
�'
JUL 19
~94
04!21PM
HHS/~0~/~S~
P.8
Cost Shifting to State 'taxpayers and the Blcierly/Disabled
Requiring Institutional Care
•
The National Governors' Association recently release a.
bipartisan letter critical of the Dcie plan's impact on its
citizens. The .July 13th letter says, ."Governors could not
be more uni~ed in their opposition to this proposal. A. cap
on the federal share of Medicaid spending would assure-that
states bear a 'disproportionate share of a program that was
intended as a state and f~deral partnership. This action
imposes a significant unfunded mandate on states and could
result in state budget crises."
•
Senator Dole· seemed to agree with this point just a few
months ago when, in March of this year, he said:
"We pass mandates back to the states. We tell the_State
they have to do 'x'. That is a tax on the people in those
states, because the states have to go out and raise money
because we passed a law and we did not send the money. ••
*
Where does Senator Dole and his Republican co.lleaques think
that the states, which are mandated to comply with variou•
federally-imposed eligibility criteria, benefits and
financing, are supposed to come up with this money? Taxes
and massive budget cuts are the only op~iQns'to st~tes.
*
In 1990, accordinq to the Xaiser Commission on the Future of
Medicaid, 71' of all Medicaid expenditures were to the
nonelderly disabled, lonq-ter.m care elderly and Medigap
.elderly. When lookinq for $80 billion, state• will
undoubtedly tap thi• ;roup and Medicaid long tar.m care .
programs for much'of the funding. Again, .the elderly and
vulnerable populations 'of this country will bear ~he risk of
the Dole plan.
�~l.Jt.l.:
k8l
LR4DERSHIP Cor..JNCIL OF I
1)1.)
AGING ORGAZVIZATIONS
Lawrence T. Smedley, Chairman
Press Conference on the
Dole Health Care Bill
July 19, 1994
•
Lawrence T. Smedley, Chair of the Leadership Council of Aging
Organizations, and Executive Director of the National Council of
Senior Citizens.
•
Senator David Pryor of .L\.rkansas, Chairman of the Senate.
•
•
Committee on Aging
" H-cw-,...1 :s vJ~~ Q....
Senator Bob Graham of Florida
...
J~~e~lllvt-
Lucretia Paschall, American Association of Retired Persons
•
Dan Thursz, President, National Council of the Aging
•
Samuel J. Simmons, National Caucus and Center on Black Aged
•
Dianna Porter, Older Women's League
The Leadership Council of Aging Organizations is an umbrella coalition of
37 nonprofit membership groups and provider organizations working on behalf.
of America's senior citizens. The LCAO has a combined membership of
approXimately 40 miiHon older Americans.
I~
1331 F Street, NW. Suite 500, Washingtcr:. DC ~1171 (202) 347-,WJO Fax: (202} 624-9595
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FAMILIES USA
tal 002/003
FD~
GRASSROO'I'S ACTION FOR HEALTH AND LONG TERM CARE
.
~:l.on Alert
I
,1:7
To:
FRoM:
Jul~ 1994
a.s.a.p. Participants
a.s.a.p. National Groups
WARNING TO SENIOR CITIZENS:
The U.S. Senate May Be Bad for Your Health!
Call Senato:r Boren TODAY!
'The Senate will begin floor debate on health reform soon- probably before the end of the ·
month. Many Senators are now searching anxiously for ways to avoid making the hard
C.ecisions needed to solve the crisis. Some have taken refuge by biding behind two bad bills.
-bills that are especially unfair to America's senior citizens. Your Senator has not decided
whether he will support REAL REFORM or a cheap imitation that hurts seniors. YOUR. HELP
IS NEEDED TO TELL THE SENATE: DON'T TREAD ON SENIOR Cl"l'IZENS!
EllCB:GROtTND: Two health care refonn bills now before the u.s~ Senate are inadequate
· r.~es to the health crisis- and both are unfair to senior citizens. One is the bm recently
approved by the Finance Conunittee. The other is a proposal recently unveiled by Senate
1\finority Leader Bob Dole (R·KS), which has been endorsed by 40 of the 44 Republicans in
the Senate. These bills do little for Americans who are too young for Medicare. but they are
downright hannful to senior qtizens. Senator Boren has not yet decided if he will support
real reform or, instead, vote for either the Dole bill or the Finance Committee bill.
Both the Finance Committee-approved bW and Sen. Dole's alternative are sertously flawed.
!\either of them will provide universal access to health care, and neither has meaningful
provisions to bring spiralling health care costs under controL Both bills have sipific:aD.t
. cuts ill Medicare. Unlike the President's proposal. which would have used Medicare
savings to finance expanded benefits for seniors- chiefly long term care and prescription
drugs- th& Finance bm and the Dole bm have little or nothing that will benefit seniors.
TBE DOLE BILL has no prescription drug coverage for seniors and 110 long tenn care.
THE FINANCE BILL does not provide prescription tlnlg coverage for seniors. Although
this bill does include a long term care pravfslon. the benefits are not adequately funded
(despite the deep Medicare cuts) and further cuts in Medicare probably would be neeessary
to make it more than a paper program..
·
!.
TBE Tl!fUNG: Right now, Sena~ors are working behind the scenes to .make deals and
develop details in anticipation of the floor debate. It is .crucial that we send a message to
undecided Senators, whose votes are up for grabs, that senior citizens will not stand by and
take it on the chin.
WHAT YOU CAN DO: Call Senator Boren at (202) 2244721 TODAY! Tell him you are
o·ltraged by the Dole bill and you don't like the Finance bill either (although you like the
.
. ...
-
.
..
...
-.
�EX~JM!~l!}e
term care provision in it). Let him know yo1.1 are dismayed that so much of the legislation is
financed through deep cuts in the Medicare program. Urge him to support the REAL THING
instead of cheap imitations. And tell him you'll stand up for him if he'll stand up to the special
interests and give us all what he has- guaranteed health insurance that is paid for by his
employer (YOU)t
-
.
.
··--- ·--·-- ,-----;;J··
1 __
2.
1
Than call Senator Dole at (202) 224-6521 to register your disapproval of his bill!
And don't forget to tell at least five other people about this alert- fn fact, tell everyone you
know who is concerned iibout Medicare and about fa.fmess to senior citizens!
---------·--·---.----------------------13:54 G STREET, NW ·WASHINGTON, :OC 20005-SlS9 ·PHONE: (202) 73'1-6~40 • FAX: (202) 34'1-2417
A PROJECT OF FAMILIES USA
•-&-"
�I -
7- 7-94
SENT BY:NCSC
4566485:# 2
2026249595...;
, 'i': 05
Prtlldent
Exeaullve Dlreotor
Eugene Glover
NatioDBI Council
of Senior Qtlzens
Silv8rSpring, MD
Lawrence T. Smedley
Wunln;ton. DC
1331 F Street. N.W. • Washington, DC 20004·1171 • (202) 347~8800 • FAX (202) 624"9695
June 30, 1994
Dear Senator:
The National Council of Senior Citizens (NCSC), representing five million
older Americans organized in five thousand grassroots clubs and Councils, hu been
fighting for a national health program for three decades. As parents and grandparents,
we have worked to secure health care coverage for all citizens, young and old.
. !'
~CSC believes that the health bill proposed by Senator Bob Dole will
drastically set ~ack the cause of health reform and we urge all Senators to neither
support nor co-sponsor his bill.
The Minority Leader's proposal fails to. provide universal coverage, woul~
punish older persons ·by permitting risk adjusted premiums based on age, allo:ws
insurance companies to deny coverage t'or preexisting conditions for up to a year,
and cuts the growth in Medicare payments without providing for corresponding benefit
improvements such as long-term care or prescription drugs.
Senator Dole's bill would continue to allow insurance companies to gouge small
business, older persons, persons with chronic needs and self-employed persons. The
ranks of the uninsured will continue to arow.
·
In short, Senator Dole's bill would simply codify and protect by statute some of
the ·wont market practices of the health insurance and provider industry, and would
carry the system distortions far into the future.
We urge that no Senator support Senator Dole and those who have already cosponsored his bill should reconsider that cosponsorship and withdraw.
Older Americans want real health reform now. Senator Doie' s bill is bad
medicine in the extreme.
Sincerely,
/s/_
Uw~nce T. Smedley
Executive Director
First VIce Preaident, Dr. Marv C. Mulvey, ~rov!denoe, Flhode Island Seaand VIce President, George J. Kourr:llll, Washington. DC
Thlrtl Vtca President, Dorothy Walker. Cetroit, Michigan Fourth Vloe Prealdent, Rgyetta K. Sanford, Wuhlngton. DC
Seoreterv-Treeaurer, Jack'T\Imer, Detroit, Michigan General
�7-12-94
SENT iJY:NCSC
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JULy 12, 1994
TO: NCSC Executive Board, State Council Presidents and Executive
Directors, Activists and Clubs
·
FR~J,.awrcnoo T. Smedley, Executive Director
RE: Senate Action
Senate will begin floor debate on health reform soon-probably before the end of
th:! month. :Many Senators have taken refuge by hiding behind two bad bills-bills that
an especially unfair to America's senior citizens. The Senators listed on the back
have not clearly commit~ to a Senate bill that incorporates R:EAL REFORM. YO'UR
HELP IS NEEDED TO TELL THE SENATE: DON~T TREAD ON SENIOR
The
CITIZENS!
Background: Two health care reform bills now before the U.S. Senate are inadequate
re'\ponses to the health crisis-and both are unfair to senior citizens. One is the bill
approved by the Senate Finance Committee on July 2, 1994. The other is a proposal
rer:ently unveiled by Senate Minority Leader Bob Dole (R-KS), which has been endorsed by
4C of the 44 Republicans in the Senate. These bills do little for most Americans and they
are harniful to senior citizens! Your Senator(s)-see target list on back-has not yet decided
to support real reform and may vote for either the Dole bill or the Finance Committee bill.
or a .. compromise" between them.
Bgth the Finance Committee bill and the Dole alternative are seriously flawed proposals
which take health care backwards. NCSC Q,P.poses both these hills. Neither of them will
grqyide universal coveraie to health care~and neither has meaningful proviaions to brin¥
.ij2irallin& hea)tb care costs undet control.
·
Both bills have huge cuts in Medicare, The Kennedy proposal (Senate Labor Committee)
wCluld use some Medicare savings to finance needed benefits for seniors like long-term care
and prescription drugs. The Finance and Dole bills have little or n<?thing to benefit seniors
and still they cut and slash Medicare!
THE DOLE BD.,L has no prescription drugs for seniors and no long-term care!
It would allow insurance companies to cha:rge higher premiums to older persons and would
allow the companies to delay coverage for preexisting conditions
�SENT :JY!NCSC
.
..
7-12-94 : 1a:5a
4566485:# 3
2026249595 ...
.
.
WHAT YOU MVST DO: Call your Senator(s) at (202) 224-3121 TODAY! Tell
him/her you are outraged by the Dole hilt and you can't support the Finance bill. Let
hlmlher know you are dismayed that so much of the legislation is paid for through deep cuts
in the Medicare program. Urge him/her r.o support the REAL THING instead of cheap
imitations. And tell your Senator to stand up to the special interests. Tell your Senator that
all Americans must get what every Senator gets-guaranteed health insurance paid for by the
senator's employer-the American people-YOU!
Tell others about this alert. Tell everyone you know who is concerned about Medicare
and about fairness to senior citizens! Together we can pass a real health care bill!
TARGET·UST
SWI
Senator
Senator
Alabama
Heflin (D)
DeConcini (D)
Shelby (D)
Arizona
California
Colorado
Connecticut
Delaware
GeorJia
Kansas
Kentucky
Louisiana
Maine
Minnesota
Missouri
·Montana
. Nebraska
Nevada
Feinstein (D)
Campbell (D)
Leibenrian '(D)
Biden (D)
Nunn (D)
Kassenbaurn (R)
Potd (D)
Johnston (D)
Cohen (R)
Durcnbergcr (R)
Bond.(R)
Baucus (0)
Bxon (D)
Bradley (D)
Moynihan (D)
New Mexico
Domenici (D)
Conrad (D)
Oklahoma
Oregon
Pennsylvania
Rhode Island
Danforth (R)
Kerrey (D)
Bcyan (D)
New Jersey
Ne~ York
North Dakota
Breaux (D)
Boren (D)
Hatfield (R)
Specter (R)
Lautenberg (D)
Dorgan (D)
.Packwood (R)
�TREASURY
UNINSURED
�;,;,·
- . - . -- - ..
THE SECRETARY OF THE TREASURY
•
W,\!iH INGTON
July 20, 1994
The Honorable Wally Herqer
u.s. House of Representatives
Washington, o.c. 20515
Dear Mr. Herger:
Enclosed for your use is a study, carried out by the Treasury
Department, of the characteristics of those Americana who lack
health care insurance -- their distribution across states and
conqressional districts.
Three of the major conclusions deserve special mention:
Four out of five of the uninsured are in workinqfamilies;
Nearly one-third of the \lninsured live in families with
incomes of more than $30,000 a year. The majority of the
uninsured have incomes above the poverty level; and
For most people, lack· of insurance is a lonq-term problem.
Specifically, fifty-five percent of the uninsured remain
uninsured for more than two years.
Since nine out of every ten Americans with private insurance
obtain it through their employers, an employer-based system is
one of the least disruptive ways to extend covaraqe to the
uninsured.
I hope that you find this study helpful during the course of the
Congressional debate over health care reform.
Enclosure
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
Publications have not been scanned in their entirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
�l
.
Estimates of the Uninsured
in ~orking Fart:Jilies and
Un1nsure~ Ch1ld~en
_by .
Congressional D1stnct
'.
J
'
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•
Department of the Treasury . ··.
·. ·.·· July···19.- 1·994 · ·
'
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.
FARMERS ON
DOLE
I
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I
.
�4.1
ToM DAscHLE
U.S. Senator for South Dakota
810 S.Mimesota
Sioux Palls, SO S7101
605-334-95%
20 6th Avcn~ SW. Suite n
Abc:tdeen. SO 57401
605-225-8823
FOR IMMEDIATE RELEASE
Wed., July 20, 1994
816 6th Street
Rapid City, SO 57701
605-348.7551
Washington, DC 2051 0
202-224-2321
1-800424-9094
Contact: Ranit Schmelzer or
Troy Murphy
(202) 224-2321
STATEMENT OF SENATOR TOM DASCHLE
Over the past several weeks, even mc11.ths or years~ we have heard countless reasons
why universal coverage is crudal. And, in poll after poll, the American people have
expressed their support for univ~rsal coverage. A recent Nw York Times poll reported
that 8 out of 10 people said it was very irnportant that every American have health
insurance coverage.
We are hear today to say that there is yet another reason: to protect farm families and
rural residents.
· On June 29, Senator Bob Dole unveil!i:d the so-called "Dole compromise" health plan an inaemental bill that at best will achieve partial reform. But, his compromise is built
on the backs of hard working rural Amefican families. The message from his partial
reform plan is simple: let's shortchange rural America. By failing to provide universal
coverage, it protects the powerful specia.l interests at the expense of rural families. And, it
does little to address the dimensions of the rural health care crisis that are unique to
America" There are at least three solid r1~asons why partial reform leaves rural America
out in the cold.
Partial reform shortchanges rural America because it leaves 9 million rural Americans
without health insurance coverage. While universal coverage plans guarantee health
insurance for all Americans, partial reform offers no such guarantee. Only the poorestthose earning $13,300 or less for a family of four-- would receive premium subsidies.
This would help c:over 2.3 million peop:e, leaving about 6 million rural Americans
without insurance.
Partial reform shortchanges rural Arnerica because it fails to make health coverage
affordable for rural Americans. Farmers often pay the highest rates for health insurance
becam;e they tend to be older, their occupation is considered 'high risk' by insurance
companies, and they lack bargaining power with insurers. U:n.iversal coverage plans
outlaw unfair insurance practices. Senator Dole's partial reform plan leaves the insurance
companies in charge, allowing them to charge older farmers up to four times more for
uu;,:
�coverage, and denying coverage for pre-E:~':isting conditiol'tS for up to a full year.
Partial reform shortchanges nU"al America because it robs self-employed families of
$16 billion in tax deductions. UndP..r cun·cnt law, the rural self-employed may deduct 25
percent of the cost of health coverage. Universal coverage plans make health insurance
premiums 100 percent deductible beginning in 1994. Dole's partial reform plan phases in
deductibility beginning in 1996, robbing .rural families of significant tax deductions into
the next century.
Universal coverage plans address the health care crisis that threatens rural American
families. Partial reform does little to help rural families. That'5 why we want guaranteed
health coverage for rural Americans that is affordable, and will never be taken away; we
want 100 percent deductibility for rural self-employed; we want to increase the number of
qualified health professionals in rural ar1:~as; and, we want to outlaw insurance practices
that leave farmers and other rural residents without coverage.
Senator Dole has tW'ned his bar:k on rural America, presenting a plan that
shortchanges rural American families. The bottom line is that partial reform is an insult
to rural America. It promises little, and delivers less.
***
�16;2~
·iii uu~
UnltH St•tt•
Office af
News Distribution
Deptlltment of
Communir;ation$
Room 506·A
Agtieu/trn
Washington, o.C. 20250
Release No. 0553.94
•
Mary Dixon (202) 720-4623
Julie Demeo (202) 720-4623
ESPY JOINS FARM L!AD!RS AND SENATOE!.S TO VOICE SUPPORT FOR HEALm CAAE REFORM
\1ASHINGTON, July 20 -- Agric:uJ..ture Secretary Mike Espy joined Senators
and farm leaders today on Capitol Hill to sho~ support for the Presidenc's
healeh care reform effort that: will help rural Americans.
He was scheduled to be joined by Senators Tom Daschle (D·SD), Patrick
Leahy (0-Vt.), Tom Harkin (D·IA), :l~aul Simon (O·IL), and Carol' Moseley-Braun
(1)-IL), Lee Swenson of the National Farmers Union, Ka.t:hy Ozer of the American
Family Farm Coalition, Gary Goldberi of the American Corn Growers Association,
and Frank Matheson of the National .~sociation of Farmer Elected Committeemen.
"ltealt:h care reform is i.mport.a.nt for the health of rural Americans and
the health of rural communities,• said Espy. "If we neglect to pass universal
coverage, we will be short-changing many rural families. •
Under the current health care system, rural Americans and farmers are
struggling. Only one in five rural Americans have health insurance, including
only 31 percent of agr1eul tural wc:·rken. Many face insurance discrimination
and lack bargaining power.. Univenal coverage will end insurance
discrimination against small busirLesses, the self-employed, people in highrisk occupations such as agr.icult.u.re, older Americans, and those with previous
illnesses.
"The bottom line 1s that fan~ers and rural Americans are not being given
a fair shake. Universal eoverage will give hard-working Americans the level
playing field they deserve," Espy said.
Rural providers are also struggling_ under the current system and many ar~
leaving rural areas because they lack financial security. In fact, the number
of rural families living in medic.ally undenerved areas increased from 37
percent in 1978, to 51 percent by 1989. America lost 20.5 percent of its
rural hospitals from 1980 to 1992. BerweeD 1985 and 1988, the rate of rural
hospital closures was 29 perc&nt higher that in urban areas.
"Unhrersal eoveraga is vital to solving the access problem in rural
eommun1ties. It means that rural provid~rs and rural hospitAls will get paid
for their medical services. Righe n~w. rural hospitals are providing $1.5
billion 1n uncompensated c:are annually and they can't afford to do this," Espy
said..
"As I travel the country, I am constantly reminded that the economic
viability of rural areas is tied to ehe strength of their rural health
syste~.
I am pleased to see tha~ our rural voice is being heard in the
health care debate."
�t4J OU5
Ne~vs
Relec1se
fOR I~~EDIATE RELEASE
Contact: Jodie Silverman or Chris Beiter
202/224-3254
July 20, 1994
HARKIN HITS DOLE HEALTH CAF«E PLAN FOR HURTING RURAL AMERICA:
·sTANDS BY UNIVERSAL COVERAGE, ACCESS TO CARE
WASHINGTON -- stating that under a proposal offered by senator
Robert Dole (R-KS), 6 million rural Americans will be left
without health care coverage or the ability to pay for health
insurance, Senator Tom Harkin (D-IA)sto6d by his call for a
health care reform plan that provides universal health care
coverage. At a press conference today with Agriculture secretary
Mike Espy, Harkin said that the Dole alternative offers up the
status quo and will hurt rur;ll Americans who are already
suffering from a lack of health care coverage.
"Senator Dole must kno,., that we already have universal
access and it isn•t workinq, particularly for the 6 million rural
Americans who are uninsured," Harkin said. "But his plan does
little to change that."
"Without universal coverage, farmers and rural Americans
will not be able to afford health care and will not have access
to quality health care, yet that is what Mr. Dole is offerinq the
people of rural and small to·ioln America."
Harkin pointed out that under the Dole plan, the lack of
universal coverage would have a d~vastating domino effect on
farmers and rural Americans. Harkin said that in his own state
of Iowa, 220,000 people currently lack· health insurance and rural
residents are more likely to be uninsured. Without universal
coverage, many farmers won•t. be able to take advantage of
purchasing pools which keep the cost of health care down.
Universal cov3rage bills, such as those moving through congress,
are based on purchasing pools.
Harkin pointed out that a recent poll indicates 8 out of lG
Americans want universal health ca.re coverage.
"Bob Dole should start li~ateninq to the people of America
and understand that they are demanding universal health care
coverage."
�~006
''It's the same old story with Bob Dole and the Republicans the very ri~h and the very poor will be taken care of, while
the middle class is left taking the hits."
;rn addition, Harkln note:d that under Dole's plan, tax
deductions for far.m fam11ies ~rould be phased in beginning in
1996, rather.than a 100 percent deduction beginning in 1994 as
proposed by the President. Currently, farmers can take only a 25
percent deductlon.The bottom :ine, Harkin said, is that Dole's
plan does not address the skyrockecing costs of health care which
will leave fewer and fewer farm families with the ability to
purchase health insurance.
Harkin also noted that under Dole's health care proposal,
provisions for long-term cart:3 and prescription drugs are not
offered, vi tal to elderly Am•~rica11s. Iowa has the third largest
percentage of people over th~ age of 65 and is first with people
over the ate of 85, many of whom live in rural areas.
one of the most critically important issues facinq rural
America _is the lack of proviaers, Harkin added. Without
universal coverage and consumer choice, more and more providers
will be unable to stay in rural communities. While the Dole plan
offers little incentive to providers to settle in rural areas,
the President's plan offers a host of incentives to bring primary
care physicians, physicians assistants an nurse practitioners to
rural and small towns. Harkin noted that without provider
incentives, rural hospitals and health care clinics will continue
to close, which in turn will force businesses to move or close
down. The domino effect results in the decline of rural economic
growth and stability.
Harkin noted that he expects Congress to vote on a health
care plan before the summer recess.
Appearing with Harkin and Secretary Espy at the press
conference were Senators Tom Daschle (0-SO), Carol Mosely-Braun
(D-ILL), Simon. (D-ILL) and J::..eahy (0-VT), National Farmers Union
President Lee Swensen and a host of farm and agriculture
organizations.
,,
�07:20:9~
16:25
!41007
NEwrs FROM--------------------
SEN~t\TOR CL~R.OL ~10SELEY·BRAUN
OF ILLINOLS
FOR LMMEDIATE RELEASE
July 20, 1994
Contact:
Joanna Slaney
202/224-8538
SENATOR MOSELEY-BRAUN SAYS .RURAL HEALTH CARE IS A PRIORITY
AT PRESS CONFERENCE TODAY
{WASHINGTON, O.C.)--U. S. Carol Moseley-Braun (O-IL) today
joined Agriculture Secretary Mike Espy and Sens. Tom Harkin (D-IA),
Thomas Daschle (D-SD), and Paul Simon (O-IL) at a press conference to
discuss rural health care refon.1 and the failure of the Dole plan to
meet rural health needs.
"To be effective, any ref<::IJ:m must ensure the achievement of
universal coverage, cost containment, quality, and choice of
provider. Senator Dole's plan fails in almost every area essential
to reform -- especially in rure1~1 communi ties," the Senator stated.
"We now have the beat he~~J..th care in the world if you can access
it -- and fewer and fe"-"'er people can. Under the Dole plan 26 million
people would be stranded without ooveraqe, including many of the 7.7
million citizens in rural areas who lack basic health insurance,"
Senator Moseley-Braun commented.
"What the Dole plan does, is ehift health care coste to.the
states instead of finding areal solution," the Senator said.
Senator Moseley-Braun point:ed out that the Dole plan would
reduce incentives for providers to provide care for underserved
populations -- including rural populations -- because it is financed
on spending cuts in Medicare payments to hospitals and doctors.
The Senator also said that: the Dole plan would phase out
payments to hoe pi tals that. ser'!.re a disproportionate share of low
income people and their familic;~:;, while at the same time leavinq
millions uninsured for these hospitals to serve.
"The Dole plan would enco1.trage managed competition and managed
care without checks and balance3. We kriow that in places like rural
Illinois, and the rural areas :c•epreeented by my colleagues, managed
competition will not flourish, because it does not exist, 11 the
Senator remarked.
Senator Moseley-Braun. called attention to the fact that in 19
rural counties there is no hospital, in 21 Illinois counties in there
�--· --- ........
is no .Health Maintenance Organ ..Lzation, and in the last few years as
many as 4 6 counties have been w·i thout an obstetrician.
"The lack of providers in rural communities is not new news.
Unfortunately, that figure will grow substantially if measures are
not taken," the senator sa.id.
I am working closely with my colleagues in the Senate to craft
the kind of legislation that will make health care available and
affordable for every American. I am committed to seeing a strong
bill enacted, one that meets t.l:1e unique needs of our rural
communities," she stated.
--30--
io
�nATIOnAL
FRAmERS
un1on
STATEMENT OF LELA.Wffi S'NENSON, PRESIDENT. NATONAL
FA.Rl\1'ERS UNION
Health Care Reti:'rm News Conference
July 20. 1994
My name is Leland Swenson. I serve as president of the 250,000-member National Farn1ers
Union, an organization that has been on record in suppon of universal health care since 1938.
Because of our. more than half-century of concern about health care for rural Americans, we are
increasingly alamed about proposals by some: in Congress that would only provide a band-aid to a
gaping health-care wound.
Let me say first and foremost tlmt rural Americans can not, will not and should nol accept
anything less than universal coverage tbr all JtJnericans, because it will be rural Americans in many
cases who \\ill he without coverage w1der su::h plans. (Chart 1)
Under Senator Dole's proposal, for example, much of the funding for health care reform would
come from cuts in Medicare and Medicaid, which would spell disaster for hospitals as well as the
aging populaltion of rural America. Alread)', reimbursement rates under Medicare are lower in rural
areas than in urban centers even though the cost of health care is sometimes actually higher in remote
rural areas. Federal reduction in suppr.1rt for Medicare and Medicaid will put additional pressure on
state and local government with a bottom line effect of increased property taxes. This is ~
unacceptable. (Chart 2)
.
.,
I
-
i
If we choose to take an incremental step aLld tey to cover 85% or 90% of the population under a
health care reform proposal, it will be working rural Americans who will make up a large part of the
10% to 15% who are not covered. In rural America, you have a high percentage of self-employed
people. many of who, unfortunately, because of cost, are doing without health insurance today. The
self-employed should at least be able to dedu,;t their health premiums from thejr taxes at l 00%. The
fact is that happens under the President's plan but not under the Dole alternative.
In rural America, group insurance covemge is difficult to formulate and afford, another reason
universal coverage is critical to small busi.n.esspersons and farmers. The universal health care
proposal includes incentives for small busin.ess and farmers, including a cap on cost.
Another critical issue for rural American:; is access to health care. We must, under any refom1
proposal. meet the challenge we have today, which is to maintain local hospitals and bring more
primary care doctors to rural areas through the National Health Service Corps and other incentives. (Chart 3)
Many of the Uildecided votes in Congress on health care reform today are :from rural states. I want
to say today that we must not abandon rural Americans in this debate. A half a loaf is no loaf at all
for rural people. We cannot afford not to make universal coverage the number one priority of any
reform proposal. Thank you.
600 Maryland Avenue, S.W. • Suite 2(12W • Washington, D.C. 20024 • Phone (202) 554-1600
�Non-Universal Reform Neglects
M.illions Of Rural Americans
Percentage of Rural Americans With Health Coverage
100%
95%
90o/o
85%
800/o
75%
o/,
70 995 .
2000
.--~LJ.:-... :.
·-
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~: Na~l
f_iirmars Union, July 20, 1994
-- - --- .
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�Non-Universal Reform Will
Bankrupt Rural Hospitals·.
Billions
Net Savings to ·Rural Hospitals
~~------------------------~
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-$2
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Universal Coverag~ Brings
·
More Doctors To Under-Served Rural Areas ...
Doctors
5,000
4,000
. 3,000
2000'
1,000
fggs
2002
The Dole Approach Neglects Rural
Source: National Farmers Union, July 20, 1994
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American Corn Growers Association
I'M GARY GOLDBERG. AKEAANE.Y NEBRASKA CORN FARMERA..~D
PRESIDENT OF THE AMERICAN CORN GROWERS ASSOCIATION.
SOME SAY THAT THERE IS NO CR.iSIS IN H.£ALTH CARE. TN.AGRICUL TtJRE,
THERE IS, IN fACT, A CRJSIS. ALMOST ONE THlRD OF ALL FARMERS ARE
EITHER UN-lNSl.TR.ED OR UND'ER~INSLUD. THIS FOR THE SECOND MOST
DANGEROUS OCCUPATION IN 1HE UNITED STATES. \VHEN FARMERS CAN'T
PA V THEIR BILLS, THE FIRST THJNG TO GO IS INSURANCE. SOMETHING
MUST BE DONE.
THERE IS ALOT OF DEBATE ABOC'T WHAT KIND OF HEALTH CARE SYSTEM
WE SHOULD HAVE A..'ID ABOUT WHO SHOULD PAY FOR. IT. BUT WHILE THE
DIFFERENT POLICIES ARE DEBATED BACK AND FORTH, THE HEALTH CARE
CRISIS CONTINUES FOR AM.E.IUC.o\."'1 AGJUCULTURE A."'D .RURAL AM£1UC A.
THf A..\{ERICAN CORN GRO'\\<'E.RS ASSOCIATIONS BELIEVES THAT ANY
HEALTH CARE SOLUTION MUST INCLUDE:
·-GUARANTEED COMPREHENSIVE HEALTH INSURANCE BENEFITS FOR ALL.
-100% TAX DEDUCTABUJTY OF HEALTH CARE COSTS FOR THE SELF·
EMPLOYED
--REQUIRE THAT HEALTH INSUR.A.'JCE BE TR.A.o'ISFERABL£ FROM
WORKPLACE TO WORKPLACE.
·-PROHIBIT lHE. Dm.-1AL OF COVERAGE FOR PRE·EXISTING CONDITIONS. .
--REQUIRE SHARED FINANCIAL R!SPONSIBILITY AMONG EMPLOYERS.
INDIVIDUALS AND THE OOVER.NMENT.
ANYTHING LESS THAN THESE FIVE ITEMS WILL CONTINUE TO JEOPAJU>IZE
TH~ HEALTH OF AGIUCOLTli'R.E AND F<.UllAL AMEIUCA.
THIS IS THE GREATEST COUNTRY I.N TK£ WORLD. IT IS ALSO THE.
BR.EADSASI<ET OF THE WOPJ.D. BUT IF IT WANTS TO CONTINUE TO HAVE
HARD WORKING MEN AND WOivmN FEED THIS COU'NTRY WITH THE
TASTIEST. SAFEST AND LEST.E)J>£NSIVE FOOD IN THE WOIU..D, IT MUST
DEVELOP A HEALTH CARE SYSTEM THAT IS WORKABLE AND
AFFORDABLE.
National HeadCiuarters: P.O. Box 18,57
•••--L' -·-- """' "'""l!le
131\., o~cr.l'\~~1'1
.
l!e .. • ~1'1, .4~0.!\&::CIO
President'& Field Office: P.O. 8ox 22994 ·
40.2-475-ACGA Fl)(: 402•47S·22S1
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TO DO ANYTHING LESS, IS ;o DO NOTHING AT ALL.
IN CONCLUSION, THERE AF.R. Ml.NY PlANS OUT THER.E FLOATING
AROUND. BUT LETS APPRECIATE THE JOB THAT PRESIDENT CLINTON HAS
DONE TO BRING HEAL1'H C.u.E REFOR..\i TO THE BONT OF THE STAGE. NO
MATTER WHAT HAPPE~S WITH rUS ll'.'DIVIDUAL PLAN. HE WILL DESERVE
THE C"UDIT FOR. A.."'N PLk\l' THAT ULTlMATEL Y S.ECOMES LAW.
. 01 ..
�07120,.9-1
16:JO
Arnerican Agriculture Movement, Inc.
'·:H) ~~~~r;'!and Ave .. N.E .. Suite 500A. Box 69. Washirgrnn. D.C 20002
(202\ 544-5750
American Rgliculture Mouement rress Release
July 28, 1 994
Today, our members from across rural America are sending Congress a
message. We will no longer be satisfied With the status quo.
Unluersal health care couerage at affordable rates must be auailable.
A declining ifrastructure and the aging of rural nmerica has created
an euan more serious problem. We will no longer be ignored.
We haue prouided our nation Wi'th an abundant supply of safe,
wholesome. and nutritious food. Howeuer, we haue been unable to
keep pace with the rest of the American economy. Economics and 'the
whole nature of today•s health care system has put tens of thousands
or rural Americans at risk. Dur nation CRN do better.
Bob Thornton, Rnna TeHas, lfiHM President stated today, 11 We support
the President's initiatiue and applaud him for hauing the courage to
tackle one of todays most serious problems."
Strenq·:h From The Land
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Clw:ison. MlS5SSSlppt 38'146
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National Association of Farmer Elected Committeemen
VICE PRISIDENT
OF~e:lSH1P
i.i SowmAII
5all42.
Oftclda.!Waols 6t415i
MEDIA STATEMENT
ON
(!a9) 483·~3:6
HJ::.ALTH CARE REFORM
ARU DIAE.CTORS
ik AL.TERNAf&.ii
NoMwl
Jclf Llp!GII
4.5:Z Sowh Raad
So!OOS. ~eut 060'1 1
Frank Matheson, President
National Association of Fam:~er Elected Committeemen
DanPUlsbwy
aJt2
WllllitOII. Vmnont 054,$
Mldwea
R11&.:t Malllle
Rll;
Rcac:ld'on:!, lll'lla SOoit18
wwrcn= McCloy
R.R 1. eo~u
MIIIOn.ll.llnoLJ. 61"'3
Noi\biiiC$1
DtM~
UC 16. Baa I
· Itr.pcrtal, H~lmlsu
E.vect=~l
c.;o33
lA:h
601& Rolling tlilb Urive
0111. Ncbn~j:l<n 68162
Solltll~
Our nation is in the middle of a rural health care crisis. Millions of people have no
health insurance. Minions more are paying rising premiums for declining 'oenents.
No where is lhe health care crisis felt more ttwl in rural <;:cmmunities and on the
farms across this nation. P~mers are under arra.c:k from all sides as costs rise and
incomes decline. Is it any wonder that many fanners do not have health insurance
for themsctlves and their famllies?
.
Because many farmers are older thel' havo more health we problems. The average
age of farmers in the U.S. h about 58 years old which means they are not eligible
for Medicare coverage. Farming is hard physical work and many can not conrinuc
tO
work until they are 65 because of health relate<i problems and other reasons
beyond their conaol. Health care reform must actdress the needs of American$ who
are no longer working but not yet eligible for Medicare.
The National Association of fanner Ele~ Committeemen believe& that health care
reform must ¢0\'er all family farmers, old and young, worldng and non-working.
llltllft Slda
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a.&lbeu. T,.. 111201
JohnK)"'IIk
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lbnD""· KIVIW 66\'14 ~
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!lobby M!Uet
RR l,Bn466
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DaVid ICIII
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ICI&e. 0=&11 31049
lgcyiQ& Agriculture Since 1965
�1;2120'
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National Family Farm Coalition
11·o MarylaniA.,.enue. NE. Suite 3o_7_e_w_a-5h-in-~-F)-n-.-o-c-~-o-oo-~-.-,2-0-2)-S43·567s •
F'a.x: C20l) 543•0978
!
PRESS RELEASE
: Contact; Katby Ozer or Jane Kochersperger
at (202) ~43-561.S
NFFC ParUdpali!s in National :Preu Conference on Healtb Care Reform
I
NFFC ond other national fann organization:f joined. USDA Secretary Mike Espy and farm state
senators in a pRss conference this aftemoo:h to show strong ~uppon for passage of
comprehensive health cans reform. Farm leftkers of the National Family Farm COa.hnon belie'VC
that Congress mua~t continue to move forwqd on pushins health c~ reform. "Family farms are
rural businc:sses that suppon the Administr~on's efforts to achieve universal coverage. We
suppon an employer ma.adam ~ help ensu-"F the access and affordability of quality health care for
all. " said NFFC ex~ulive dizec~or Ka.th~
9zer.
For many family fanners, the escalating co· s of health care coverage in conjunction with
declining net farm income has lefl many wi h no choice but to drastically redu~ coverage: or
forego health insurance alrDgether. Low F' cc:s and narural diYSlers have drained farmers and
rheir familie5 of any emotional. ph)'sical or conomic reserve.
E~onomisrs ~ prediciring that many dairy ~am1ers will face a 20% loss in farm income this
surmner as a result of a major drop in milk prices at the fQI"m gale. This will further th~aten their
ability to survive as family farmers. For rrWly others. the only hope of adequate health care
. coverdgc is through off.farm employme:$1
. However, these jobs are scarce and often pan·rime,
require nvelllng long dismnces and oftert not provide adequate hcaldl c:are coverage. This
coverage moreo'Ver~ could specify that f:
·related accidents aze not covered under the policy.
Increasing numbers of small busines5.es ir. $rll ~ do not even provide he~th insurance
CO\'erage for their employea. AQ:ording, l a national Federarion of Independ.ent business repon
released in 1989. this level of non-coverag was 46CJI, in rural areas comparm to 28% in urban
areas.
The health and v.·elfar~ of fann families an
occupation arul the co'Verage inadequate.
of high dcdu~tiblcs. co-payments, scarcity
Pn!venti.ve care su~h as basic ph.ysic:3ls, 1
afFordable. Adoption af a unhfersal plan t
their employees is in jeopardy. Farming is a high risk
ut of pocket expenses are often excenive as a result
f medical fa~ilities and limitation~t on preventive care.
grams and pap smears are currently nor
at meets the~e needs i! absoluwly crttic::al.
�AMA/AFL-CIO/
AARP
�........
·'
'C:.LC:.•-Lor- l r.;.;,
JUL 20 '94
''"' U.,1
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09:Za::f1 ~RIC~ MEDI~'A$oc:IATI0i'l WDC
P.2/S
hter Ashkenaz (AARP):
202/434-2560
Muriel Cooper (AFL-CIO):
Jim Stacey (AMA):
CONTACTS:
C:~<::63?5e5Es;l:i
202/637-5010
202/189-7419
FOR IMMEDIATE RELEASE
July 20, 1994
AARP, AI'L·CIO, AND AMA URGE CONGRESS TO PASS
COMPREHENSIVE HEALTH SYSTEM REFORl\i LEGISLATION
Grcups Glftl on c"verage, choice and qffordablllr.~ lt'r all
WASHINGTON, D.C.--The American Association· of Retired Persons (AARP), AFL-CIO
and the American Medical Association (AMA). today urged Congress to pass comprehensive
health system reform legislation that achieves uninrsal co·verage; assures freedom of patient
choice of physicians and health plam; and effectiv~1.y slows the rate of increase tn health
spendina in the priYate and public sectors.
According to the joint statement: "Millions of .Am~ri-;ans are still shut out of the system.
Millions of others are locked in their jobs for fear of losing their health insurance. Still
others are being fmancially ruined because of healt:1 care expenses. And structural changes
in the health care market pose au increasin& threat
to
patieru--centered decision maldng. "
The three organizations utged Congress to pass health system reform legislation that
"achieves universal coverage wieh a standard
set
of comprehensive healdl benefits for every
American - regardless of employment, economic, or health status."
"We know there are no euy answers. but the goal can be achievc<1 most readily by building
OQ
the current employment-based system," the statement said. "For workers ancl theit
families, coveraae can be achieved through shared employer/individual responsibilitY with a
required level of employer contributions."
ZO'd ZOO'ON lP:6
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JUL 20 '94
08l28~M AME~ICAN MEDIC~ A$SOCIAT:~
--
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page 2
They also called for legislation chat N assures that individuaas can choose from a wide range of
physicians and health plans·· fee-for-service, HM03, including point-of-service plans, and
other forms of managed care - whh important protec~lons for c.onsumers and health care
providers, including physicians. Such protections are key to promoting consumer choice
across all plans and enhancing continuity of patient care. Patients need infonnation up·Cront
about their plan coverage, exclusions, and. performa·:1ce, ~ the statement said.
Finally, tho three groups c:alled for reform that
•effr~ctively
slows the rate of increase in
health spending in the private and public sectors thr•J\lgh a system-wide approach that
combines governmental action ancl market forces. Unnecessary and inappropriate health
spending takes its toll on the federal budset. In addition, we sttongly believe that cutting
Medic~re
and Medicaid disproportionately is not the way to finance refonn: such action
would Shift ~osts and do little more than exp3nd the nul!lber of under- and uninsured
Americans, • lhe statement said.
The AARP, AFL-CIO and AMA joined two years ago to call on the presidential candidates
to engage in "$ubstantive debate'' on comprehensive health system reform. The three
or1anizatlons represent more than 49 million Americ1111S and 300,000 physicians and medical
,
students.
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HEALTH SYSTEM REFORM JOINT STATEMENT .
American Association of .Rt!tired Persons
American Federation of Labor and Conal'ess of Industrial Organizat1ons
· American Medical Asiociation
Today, the working men and women represented by the AFL-ClO. the retirees represented
by the AARP, and Che physicians represented by the .\.MA, have come together to uraently
call upon the Congress to seek common ground in establishing an improved health care
system for all. Although our o~sa.n.izatlons have sorn~ differences in specific approaches to
reforming the health care system, we do agree on what needs to be accomplished this year.
Two years ago, we jointly called upon all interested parties to engage in substantive debate
on comprehensive health system reform, with the hope that such a debate would lead to
legislative action. DisappointinalY, much of the ensuing public dialogue bas been clouded by
misinformation, scare tactics, and negative messages. That's why we feel it is necessary
today to remind Americans of the fundamentals - why there must be real refonn of the
country's health care system in 1994.
Mlllions of Americans are still shut out of the syste:m. Millions of others are locked in their
jobs for fear of losins their health insurance. Still \)tbers are belng financially ruined because
of healdl care expenses. And struerural change$ in the health care market pose an increasing
threat to patient-centered decision making.
· The members we represent and the American pub!i•; suppon congressional action on health
5ystem· reform. We jointly urge the Coneress to I'Ui comprehensive health system refonn
legislation that:
1.
achieves universal coverage with a standard s::t of comprehensive health benefits for
every American-· regardless of employment, economic, or health status ··by a date
certain. Covering all Alnericans is essentia~ to effective insurance re!onn, eliminadna
co5t-shifting, and ensuring patient choice of ~hysician and health plan. We know
there are no easy answers. but the goal can b·: achieved most readily by building on
the current employment-based system. For "'Otkers and their families, coverage can
be achieved through shared employer/indi"i':1ual re~ponsibility. with a required level
of e~nplo)'er contributions. Government conlributions will be necessary to help lowincome individuals and families obtain coverage.
2..
assures that individual$ can choose from a wide range of physicians and.health plans- fee .. for-service, HMOs. including point-of.. ~er.,ice plans, and other fonns of
managed care - with imponant protections f•>r consumers and h~alth c:are providers,
including physicians. Such protections arc k")' to promoting consumer choice across
all plans and enhancina continuity or patient care. Patients need \nfonnation up-front
about their plan coverage, exclusions, and PC'rfonnance.
-2-
t76,~~
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3~~JIH!l~3H-OIJ/l~~
�3.
effectively slows the rate of increase in health spending in the private and public
sectors throush a system~wide approach tha~ combines sovermnentai action and
market forces. This is essential to keeping h.ea:th care coverage affordable for family
budsets and corpor~ balance sheets. Unnecessary and inappropriate health
spending takes its toll on che federal budget as well. In addition, we strongly believe
that cutting Medicare and Medicaid dlsproport~.onately is not the way co finance
reform; suth action would shift costs and do little more than expand the numbers of
under· and uninsured Americans.
Maintaining the status quo chreatens coverage, choice, and afto:.-dability of health care for all.
The historic opponunity for congressional action musr not be lost - the lons·tenn health of
the American people depends upon action this year. We once again pledse to continue our
organizations' support to help enact scnuine health fiystem reform legislation ill the critical
months ahead.
SO'd
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This ad wW appear in the Thursday, July 21, Washington Post and New York Time.a and
In the Friday, July 22, Wall Street Journal.
.
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'If the AMA, AFL-CI,O, ·and AARP . ·• .•
Gan agree on these aspects ·.· ··.
.
. of health system reform; '. .·. ,
.
I
so can Congress.
The combined 49 mllJion members of the AMA,
AFL-CIO, and AARP Jointly urge Congress to
pus a health system reform bill that: ·
Addewt UBhana1 oowrace wlth a standard set of oomprehenatve health beneftta
for ewry American by bu!ldlna on our current amployment-bued system. For
workers and their tamillee, ccwerage can be achlewd through abated e.mplOJW/
IDdMdual reapolW!bW1¥, witl\ anqulred lMl of empl~ oontrtbutlons.
Asnrel that padeata Ull chOOH from a wide mn&e of. physicians and health
plana, lncludlnl HMO., other forma of managed om, and fe&-for-aervtce.
BffectlveJJ alon health eare bdladon throua.':l a system·wfde approach tbaC
comblnea aovemmentaiactlon and market forces.
'
.
.
Malntalnlnl the atatua quo threatens coverase, clio1C4, and dordablllty of
health care for aU. We atroR&Il believe UW all tl~ of these element& mul
be a part of q health care bill and that we mtu~t act "ow to make sure we
don'& lose thla ldatDrlc opportunlty. Pleue, Join 1:11tn urging Consreu m
come
to an acreemenc on theee baalca. And help makt dectf.ve health 8J8tem
reform analltJ tor each and M1J American.
AARP
----~-90"d
~OO"ON
6~:6
3~~J1Hll~3H-OIJ/l~~
�
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Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
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White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
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1993
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2006-0223-F
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This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
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72 files in 6 boxes
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Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
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William J. Clinton Presidential Library & Museum
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<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
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[Background on Health Reform] [4]
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First Lady's Office
Melanne Verveer
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2006-0223-F
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Box 3
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2068127" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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42-t-2068127-20060223F-003-006-2015
2068127
-
https://clinton.presidentiallibraries.us/files/original/5f843d4ec5ba12aea70c2a1de2649cb0.pdf
cd4268b8e085f9832e940b8ebce07a3b
PDF Text
Text
MEMORANDUM
TO:
The First Lady
FROM:
Harold. Ickes@
DATE:
·25 July 1994
RE:
.Health care activities and materials during
the week ending 22 July 194
.
---------------------------------------------------------------.
Attached is a copy of a description of "Health Care: The
Week In Review" for the week ending 22 July 1994 listing some of
the activities undertaken during the .last·week.
Also attached is a memorandum to me from Dana Hyde and Jason
Goldberg, dated 20 July 1994,· listing the Cabinet health care
editorial board interviews for the period 14 July - 1 August.
Thirty additional editorial board interviews ar.e in the process
of being confirmed.
Finally, attached are various press releases, .studies and
the Administration's economic team's briefing book for.health
care. as follows: ·
study released by AFSCME regarding the impact of
Senator Dole's health reform plan on state
budgets, dated 15 July 1994
Catholic Health Association study
the SEIU sponsored study captioned "The Dole Plan"
the effect of the _Dole Plan on seniors issued by
Grass Roots Action For Health And Long Term Care,
a project of Families~ USA
the 19 July 1994 study of the Treasury Department
captioned· "Estimates Of The Uninsured In Working
Families And Uninsured Children By Congressi~nal
Dis_tricts"
press release and related materials issued by
Senator Daschl~ concerning the effects of the Dole
Plan on farmers
·
press release of the AMA/AFL-CIO/AARP, dated 20
July 1994
�j
\
Memorandum to the First Lady
I
·
a study released ·by HRSA showing that
approximately 1/3 of American children do not have
private health insurance, according to.a new
publication released by HHS Secretary Donna E.
Shalala
·
for Alexis Herman and Greg Lawler from
Caren Wilcox concerning the activities with large
corporations in favor of health care reform
·
memorand~m
the Pizza Hut study released by the Health Care
Reform Project
a.looseleaf binder captioned "Economic
·Briefing/Pundits", which is used by the
Administration's economic team for press
briefings, of which 2 were held last week
cc:
Melanne Verveer
2
�Health Care: The Week in Review
MONDAY:
•
Briefing (or Economic Team
The Health Care Delivery Room organized a pre-briefing for all of the economic
members of the Cabinet. Each of the four principals scheduled to brief the pundits
gave their presentation and a discussion followed. The participants posed likely
questions that would be asked and discussed possible responses. A detailed briefing
book written by members of the Health Care Delivery Room was distributed.
Attendees:
Secretary Bentsen
Secretary Brown
Secretary Reich
Director Rivlin
Chairman Tyson
Administrator Bowles
NEC Head Rubin
•
•
AFSCME study on the Effects o(Dole's "Medicaid Cap"
AFSCME released a study on "Squeezing the States: The Impact of Senator Dole's
Reform Plan on State Budgets", which calculated, state by state, the shift of additional
costs to state and local governments. The study found that Dole's "Medicaid cap"
would cost states $115 billion over 8 years. Governors from both parties sent a letter
to Senator Dole objecting to this unfunded mandate. The Health Care Delivery Room
provided the statistics and calculations upon which this study was based. This study
has been distributed to a wide network of groups and field organizers.
CHA study on Dole's Impact on Premiums
The Catholic Health Association (CHA) released "Coverage, Premium, and Household
Spending Implications of Health Reform", a study conducted by Lewin-Vlfl. The
study found that non-universal health care reform would increase the average premium
significantly more than universal reform. A plan, such as Senator Dole's, that includes
only insurance market reforms with subsidies, will be more than twice as much as
under universal coverage. In addition, working Americans who currently have health
insurance will. pay more under a plan that includes only incremental reforms. This
study has been distributed to a wide network of groups and field organizers.
TUESDAY:
•
SEIU study on Dole's Impact on States
SEIU (Service Employees International Union) released a study done by Lewin- VIfl
on the effect of the Dole plan on states. The study concludes that at best, the Dole
plan will reach only 25% of those currently uninsured at a cost to taxpayers of over
�$106 billion in new subsidies and tax deductions by the year 2000. The Health Care
Delivery Room provided Lewin-VHI with the information to complete this study.
This study has been distributed to a wide network of groups and field organizers.
•
"Dole is Bad Medicine for Seniors"
The Health Care Delivery Room and Public Liaison worked with the seniors
community to organize a series of activities that focus on how Dole is "Bad Medicine"
for seniors. We created talking points and supplied state specific statistics on losses
and gains for seniors under the Dole proposal.
In a press conference, Senators Graham, Wofford, Rockefeller, and Pryor joined the
Leadership Council of Aging Organizations, including AARP, NCSC, NCOA arid
OWL to speak out against the effects of Senator Dole's plan on Medicare
beneficiaries. The groups pointed out that under Dole's plan, insurance companies
would still be able to charge older workers as much as four times more than younger
people for insurance. The Dole plan takes money from Medicare without reinvesting
the savings to enhance coverage for older Americans, and provides no new coverage
for prescription drugs or long-term care.
There were a series of regional press conferences this week organized by AARP and
NCSC on how Dole is Bad Medicine for Seniors. The press conferences were held in
Iowa, New Hampshire, Missouri, Maine, Minnesota, Oregon, Pennsylvania, New
York and Rhode Island.
Other activities include nationwide teleconferences organized by AARP and the Long
Term Care Campaign and action alerts sent out by National Council of Senior
Citizens, Families USA, the OWL, Natic.:mal Council on the Aging, AFSCME Retirees.
WEDNESDAY:
•
Pundit Lunches -- #1
These luncheons were completely organized by the Health Care Delivery Room.
Secretary Bentsen hosted this substantive examination of the need for universal
coverage in the Diplomatic Reception Room at the Treasury Department. Laura
Tyson started with an explanation of why insurance market reforms in the absence of
universal coverage could actually decrease the affordability of insurance and increase
the number of uninsured. Alice Rivlin followed with an explanation of how we cannot
contain costs -- for the nation, the deficit, businesses, or families -- without universal
coverage. Secretary Bentsen outlined the new Treasury study discussion myths about
the unins~red. Bob Rubin closed with why universal coverage is an economic
imperatiye and is essential to achieving the economic agenda of this administration.
.Mack McLarty discussed health care reform and businesses.
�Attendees:
Albert Hunt
Adam Clymer
Timothy Russert
Nina Totenberg
E. J. Dionne
David Ignatius
Andrea Mitchell
Alan Murray
Gordon Peterson
Michael Kinsley
Linda Douglas
•
Wall Street Journal
New York Times
NBC
NPR
Washington Post
Washington Post
NBC
Wall Street Journal
WUSA/Inside Washington
CNN/The New Republic
CBS
Treasury Studv Documenting Working Uninsured
Secretary Bentsen released a Treasury Department study which found that 83.6% of
all uninsured come from working families. The study breaks down the number of
uninsured by State and by Congressional district. The Health Care Delivery Room
worked with the Treasury Department in developing the study. As Secretary Bentsen
said "Who are these Americans without insurance? -- They're middle income
Americans that are your neighbors. " The Delivery Room also converted the study
into a format that was distributed to the regional press throughout the country.
•
Dole's Proposal Hurts Rural Americans
The Health Care Delivery Room and Public Liaison worked with farm groups and the
DPC to organize a press conference on Capitol Hill, including the development of
charts and talking points. The press conference focused on how Senator Dole's
proposal -- as an example of reform that does not achieve universal coverage -- in bad
for rural America.
Secretary Espy joined with farm leaders and Senators Harkin, Daschle and MoseleyBraun, in calling for a plan based on universal coverage. Secretary Espy said, "If we
neglect to pass universal coverage we will be short-changing many rural families. "
In addition, the groups released a series of charts that showed the Dole plan would not
significantly increase the amount of doctors in rural areas, nor remove the unfair tax
burden for the self-employed.
Regional press conferences or press interviews occurred in Kansas, North Dakota,
Arkansas, South Dakota, Minnesota, Nebraska and Iowa.
•
AFL-C/0, AMA and AARP Voice Support for Universal Coverage & Shared
Responsibility
The AFL-CIO, the AMA and the AARP held a joint press conference voicing their
support for universal coverage and shared responsibility between employers and
employees. The group's leaders said in a joint statement: "Covering all Americans is
essential to effective insurance reform, eliminating cost-shifting, and ensuring patient
choice ofphysician and health plan".
�THURSDAY:
•
Child Health USA, '93 Demonstrates Need for Universal Coverage
The Department of Health and Human Services released a study, Child Health USA,
'93, docu~enting the need for universal coverage to provide our nation's children
adequate health care and to provide welfare-dependent families the opportunity to
leave welfare and still guarantee health care for their children. The study found that
only one third of all children had private health insurance. As Secretary Shalala said:
"Without universal health care coverage, more and more of our children will lose
their private coverage in the coming months and years. "
The Health Care Delivery Room and Public Liaison worked with HHS, the
Department of Education and the DPC to organize a press conference with members
of Congress, Secretarys Shalala and Riley, the American Academy of Pediatrics, the
National Association of Children's Hospitals and Related Institutions, and the
Children's Defense Fund. The Delivery Room also edited the press release and
Secretary Shalala's speech to focus the release on the need for universal coverage.
•
Pundit Lunches -- #2
The second pundit lunch was very similar to the first. Held at the Treasury
Department, the five presenters made the substantive case behind universal coverage.
Attendees:
Charles Bierbauer
David Broder
Rich Thomas
Mark Halperin
Gloria Borger
Judy Woodruff
Dave Lauter
Peter Milius
Dick Thompson
Richard Wolf
Dick Cooper
•
CNN
Washington Post
News Week
ABC
US News & World Report
CNN
Los Angeles Times
Washington Post
Time Magazine
USA Today
Los Angeles Times
CPI Study Documents Lobbying Expenses
The Center for Public Integrity, a Washington-based watchdog group, released a study
documenting the intensive lobbying of health care reform that the Administration and
the Congress has faced. Among the findings: health care interests have donated more
than $25 million to Congressional campaigns and more than $50 million in paid
advertisements.
•
CEO's Support Universal Coverage & Employer Mandates
The Health Care Delivery Room and Public Liaison organized a wide and diverse
group of large corporations stood with Senators Kennedy and Daschle, Majority
Leader Gephardt and Acting-Chairman of Ways and Means Committee Gibbons in
support of universal coverage achieved by building on the current employer-based
�-...~
system. They released two letters to Congress representing over 120 companies and
associations, companies that employ millions of Americans and insure tens of millions,
including workers, their families and former workers.
•
Tyson Speaks in Favor of Universal Coverage
Laura Tyson spoke to a group of 400 women financial professionals on the need for
universal coverage. Her speech focused on how insurance market reforms in
incremental health reform proposals could at best only marginally increase access to
and affordability of health insurance and, at worst, actually reduce affordability of
insurance and increase the number of uninsured. She used the Dole plan as an
example of a worst-case reform. A Dow Jones News wire story coving the speech
was titled: "Tyson says Republican Health Plan Will Fail."
•
Vice President Voices Concern (or Middle Class
The Health Care Delivery Room. organized a speaking engagement given by Vice
President Gore at the Center for National Policy. The speech drafted by the Delivery
Room emphasized the message that non-universal reform doesn't work for middle
class Americans.
FRIDAY:
•
Veterans Groups Launch Ad Campaign
Secretary Brown, Senators Rockefeller, Mikulski and Robb and a number ofVeteran's
groups (VV A, DAV, the American Legion, and the VFW) launched a joint print ad
campaign calling for comprehensive reform that would not leave out veterans.
•
Senate Finance Committee on Pizza Hut & McDonalds
Senator Kennedy held a hearing to follow up on a disturbing study by the Health Care
Reform Project documenting the fact that though Pizza Hut and McDonalds provide
health insurance for their workers in Germany and Japan, they provide little or no
coverage for their workers in the United States. The study has touched off a storm of
controversy around the fast-food chains, including pickets and other protests calling
for coverage for all employees through shared employer-employee responsibility. The
Health Care Delivery Room gave the analysis for the Kennedy hearing and pulled
together material on the National Restaurant Association to show that the claims made
by the report were accurate. The Delivery Room also found and veted witnesses for
the hearing -- including two women who could not afford health insurance on their
minimum wage salaries while they were working for Pizza Hut and Kentucky Fried
Chicken and the owner of a pizzeria in Portland, Oregon who does provide health
insurance for her employees even though is costs 12% of her payroll to do so.
�•
ON GOING PROJECTS:
•
Editorial Boards
This week, the Cabinet conducted 47 editorial board interviews on the importance of
health care reform with universal coverage (see attached list). Each editorial board
interview was arranged by the Health Care Delivery Room, and every editorial board
was Fed-Ex a copy of our universal coverage message document and color charts.
Next week, the Cabinet will participate in another 50 editorial board interviews.
•
Health Security Express
The Health Security Express kicked off its week long bus tour today in Portland,
Oregon with the First Lady. Thousands of Americans will ride on caravans of buses
from every region of the country, and rally at stops along the way, demanding health
care reform that achieves universal coverage. They will arrive at the Capitol
throughout the first week in August. The Health Care Delivery Room has worked
very closely with Health Security Express to get Cabinet members there and to build
crowds along the way with supporters.
�.
'
.
~·
ED BOARDS
�THE WHITE HOUSE
WASHINGTON
July 22, 1994
ME110RANDUM FOR THE MANCHESTER JOURNAL- INQUIRER
FROM:
HAROLD ICKES
White House Deputy Chief Of Staff
SUBJECT:
THE CASE FOR UNIVERSAL COVERAGE
The attached document outlines why Universal Coverage is imperative for
real health care reform.
Environmental Protection Agency Administrator Carol Browner will
reference this document in her editorial board interview with you on Monday,
August 1 at 2:00 (eastern time).
Opponents of real reform would have us believe that our goals can be met by
incremental, piecemeal reform. That approach won't work, and will leave
millions of hard working Americans at risk.
The coming weeks will be marked by House and Senate consideration of
health care reform legislation. The Administration's position is clear:
universal coverage is imperative if we are to deliver on our promise to
guarantee true health security to every American.
•
•
•
•
•
•
Message Overview
What They Claim, What They Deliver
Why Non-Universal Reforms Hurt The Middle Class
State Experience Shows It's Not Enough
Hidden Tax On The Middle Class And On Business
Fails Every Key Test
1
2
3-4
5-7
8-9
10
�July 20, 1994
MEMORANDUM FOR HAROLD ICKES
THE HEALTH CARE DELIVERY ROOM
FROM:
DANA HYDE
JASON GOLDBERG
SUBJECT:
CABINET HEALTH CARE EDITORIAL BOARD
INTERVIEWS
This week we began a strong push to have members of the
Cabinet conduct editorial board interviews with newspapers
in all of our key media markets. The following editorial
boards have been completed:
·7 /14
7/14
7/18
7/18
7/18
7/18
7/18
7/19
7/19
7/20
7/20
7/20
7/20
7/20
7/20
7/20
Cisneros
Brown, Ron
Brown,Ron
Altman
Shalala
Shalala
Shalala
Shalala
Broadnax
Reich
O'Leary
Cisneros
Babbitt
O'Leary
O'Leary
Cisneros
TX
.. ?ai1 Antqnio E:>e~rfa$$.. _....
CA
LA Times
OR
Eugene Register
National Business Week
ND
Grand Forks Herald
ND
Fargo Forum
ND
Minot Daily News
FL
Miami Herald
co
Denver Post
OH
Columbus Dispatch
wv
Wheeling News
TX
Dallas Morning News
ID
Idaho Statesman
PA
Harrisburg Patriot
OH
Cinncinatti.Post
PA
Pitts Post Gazette
The following editorial interviews have been confirmed for
the week of 7/21-8/1:
7/21
7/21
7/21
7/21
7/21
7/21
7/21
7/21
7/21
7/21
7/21
Browner
Tyson
Shalala
Brown,Ron
Pen a
Bowles
Bowles
Bowles
Tyson
Babbitt
Reich
FL
PA
DC
MI
co
NC
VA
VA
MI
AZ
PA
Palm Beach Post
Philly Daily News
Washington Time
Saginaw News
Boulder Daily Camera
Charlotte Observer
Newport News Press
Roanoke Times
Detroit Free Press
Arizona Republic
Allentown Morning
�..
'
·.•.
Shalala
7/22
Pena
7/22
Babbitt
7/22
O'Leary
7/22
Tyson
7/25
O'Leary
7/25
Browner
7/25
Bowles
7/25
Bowles
7/26
Cisneros
7/26
Pen a
7/26
Shalala
7/26
Tyson
7/27
O'Leary
7/28
O'Leary
7/28
Bowles
7/29
Bowles
7/29
____ Pena _____ _
--------7/29 ______ --------- 8/01
8/01
Cisneros
Babbitt
MD
AZ
IL
IL
MI
DE
FL
CT
IA
LA
Baltimore sun
Arizona Daily Star
Chicago Sun
Chicago Tribune
Flint Journal
New Castel Journal
Tallahassee Democrat
New Haven Register
Des Moines Register
The Times Picayune
MN
Minneapolis Star
OH
Cleveland Plain
FL
Florida - Times
co
Rocky Mtn News
KY
Courier Journal
NC
Raleigh News
AL
Birmingham News
______ .WI ___________ ··-· .. Mil waukee . Journal -·-------------- FL
Orlando Sentinel
TX
Austin American
Thirty additional editorial board interviews are in the
process of being confirmed. We will forward additional
information to you as it becomes available.
�•
..
._IJi·
J
..
THE: WHITE: HOUSE:
WASHINGTON
July 22, 1994
MEMORANDUM FOR HAROLD ICKES
THE HEALTH CARE DELIVERY ROOM
FROM:
DANA HYDE
JASON GOLDBERG
SUBJECT:
ADDENDUM
CABINET HEALTH CARE EDITORIAL BOARD INTERVIEWS
In addition to Ed-boards mentioned in the July 20 memorandum, The following editorial board
interviews have been scheduled:
07/22
07/25
07/28
07/28
07/28
07/28
07/29
07/29
08/01
08/01
08/01
08/01
Bowles
Reich
Rivlin
Brown, Ron
Brown, Ron
Pena
Rivlin
Pena
Cisneros
Browner
Browner
Browner
TX
CA
co
WI
MO
AL
CA
sc
NV
NH
FL
FL
El Paso Times
Sacremento Bee
Colorado Springs Gazette
Wisconsin State Journal
,,
Springfield News Leader
Montgomery Advertiser
San Francisco Chronicle
Greenville News
Las Vegas Review-Journal
Manchester Journal-Inquirer
Daytona Beach News Journal
Sarasota Herald-Tribune
Secretary Espy has committed to completing the following interviews this week (dates TBD):
1N
Memphis Commercial Appeal
1N
The Tennesean (Nashville)
1N
Knoxville News-Sentinel
AL
Huntsville Times
Deputy Secretary Roger Altman has committed to completing the following interviews this week
(dates TBD):
Asbury Park
NJ
The Bergen Record
NJ
We will continue to pursue other possibilities.
�.. t :
;
INTRODUCTION
Making History. We are on the verge of an historic step forward for the American
people. Since Franklin Roosevelt, Presidents have been trying to pass health care
reform. Three years ago the issue was not on the political radar screen. All that has
changed. Amidst polls showing overwhelming popular support for reform, committees in
both houses of Congress have approved bills that guarantee health coverage to every
American family.
Improvements in the Proposal. The legislative process has transformed our original
proposal. We have listened to the ideas and apprehensions of the American people. With
Congressional help, many important improvements have been incorporated into the bills
now under consideration. While different committees have taken varying approaches,
these bills contain a number of features that will ultimately be included in a better and
more effective reform plan. Among the improvements under consideration are: cutbacks
in bureaucracy and regulation; the transformation of mandatory alliances into smaller
voluntary purchasing cooperatives; greater protection for small businesses; and greater
choice for consumers and businesses. A stronger fail-safe budget protection device is
under consideration, to ensure that the program does indeed pay for itself.
Congressional Challenge Ahead. We have made dramatic progress in our effort to
guarantee lifetime health security for every American. But there remains one major
stumbling block to overcome. Opponents of true reform would have us believe that our
goals can be met by incremental, piecemeal reform. Having bought the land, surveyed
the site, and designed the structure, they would have us build the bridge only half way
across the river. That approach won't work, and will leave millions at risk.
The coming weeks will be marked by House and Senate consideration of their respective
reforms. As the nation watches, they will choose either true reform --true security for
every single American -- or an unfortunate, piecemeal reform that may actually leave
working families worse off.
The Administration's position is clear: universal coverage is imperative if we are to
deliver on our promise to guarantee true health security to every American.
Today, we want to talk to you about why non-universal reforms just don't work.
�•
l
.
NON-UNIVERSAL REFORMS:
\Vhat They Claim, \Vhat They Deliver
Thae are several non-uni\·ersal reform alternatives tloating around Washington. They claim to be kss
tilling than universal coverage but taste just as great. These alternatives fall short of what they
prom1se.
looLE PLAN
I
CLA.l.\!S:
The Dole plan claims that insurance market reforms alone will enable more people to
get coverage and that -- according to GOP strategist Bill Kristol -- it will "bring more
people into the system and provide more security and tlexibility for those already in it."
DELn ERS:
The Boston Globe said that "a number of health policy analysts from all parts of the
ideological spectrum" have reached a "remarkably congruent verdict: It's not likely to do
much to expand access to health insurance. And it might make things worse for many
who are nO\V insured." [Bosron Globe. - 39.tj
A conservative health economist. \-fark Pauley at the University of Pennsylvania.
predicts that such measures would "probably do almost nothing, or maybe even make
things worse" for the millions of people \vho aren't poor enough to get subsidies. f/l.QsJ.QJ:J.
G.J.QM, -..3/9-J I
2
�NON-UNIVERSAL REFORM:
Hurts The Middle Class
"I'll tell you why I'm fighting so hard for real health care reform ... People like Jim Bryant,
who told the Boston Globe he works 70 hours a week but has no health insurance for his
family. He wonders if it's fair that he misses his sons' soccer games to go to his Saturday
job while people who depend on welfare have health benefits. In a moment of frustration,
he even suggested to his wife that they might be better off if they broke up, so that she and
their sons could get the benefits that working families like theirs can't afford."
PRESIDENT BILL CLINTON
"I guess I'm a little bitter. It is harder for working people to make ends meet, pay for their
own medical, get jobs." --JIM BRYANT, SOMERVILLE, MASSACHUSETTS.
1) Non-universal reforms cover the poor, but not the middle class.
Half-measures and quick fixes would leave every American at risk of losing their
insurance. And at least
Partial refonn does not help the middle class
24 million Americans~
most of whom work for
Mllions left uninsured under current system v. "91 %" reform by incorre category
a living~ would have no
16r-----------------------------------------------.
coverage at all. tcno
14
analysis, 5/94, p. 20/
The Congressional
Budget Office also says
that under a 91%
proposal, "health
insurance coverage
would probably be more
limited for middleincome people than the
•
riCh or poor. !CBO analysis,
12
10
8
6
"91%" Reforms Insure Many of the Poor. ..
/
But do not help the middle class
4
2
0
In Poverty
150-200% ($23-30<)
30Q.400% ($46-61k)
100-150% ($15-23k)
200-300% ($30-46k)
400% + ($61 k +)
I•
II
5/94, p. 17/
Source: COO, 5/94; T~es4-1, 2
lncorres categorized by~
for farily of four.
Current 9tstem
D "91%" Refoon
I
m
poverty; della- rmges shOIM1
A 91% solution would help 11 of the 15 million uninsured Americans in poverty get
health coverage, but would leave 16 of the 18 million middle-class Americans without
insurance.
According to a new study by Families USA, over one million Americans a month will lose
their insurance under a partial solution. /Families USA Special .Report, 6/94, p.l/ We need universal
coverage because all families -- including the middle-class -- must be protected.
3
�'
.
While the U.S. po.pulation as a whole grew by only 1.3 million between 1988 and 1993. the
number of uninsured Americans grew by 6.4 million peo.ple. Of the newly uninsured,
nearly 4.8 million of them -- more than 75% -- work. [1988 and 1993 March CPS, Bureau of the Census]
2) Non-universal reforms increase insurance premiums.
Impact of Health Care Reform
Proposals on Insured Household
Spending (With wage Effects)
"[W]e estimate that middle
income families that currently
have insurance will pay more in
general for health care under
partial reform than under reform
that includes universal
coverage." [Lewin- VHI, July 18,
$300
$200
1994]
$100
"With a portion of the population
uninsured, per capita insurance
costs for the insured population
would be higher, compared to
universal coverage." [CBO, April
$0
-$100
·$200
Save Under
Universal
Co vera
L........:'~~~----,,------------------1
$20. 29,999
$30-39,999
$40-49,999
$50-74,999
Annual Household Income
ourc•:
Catholic Health Aooociatlon band on Lewin· VHf Study: Cover•g•. Premium 4nd Hou••hold Spending Implication• of
Health Roform, July 11184
1994,p. 9]
And The Wall Street Journal says: "The result.. .is the start of an upward spiral in rates"
for those who still have insurance.
3) Non-universal reforms tell working Americans that their health is less
important than the health of Members of Congress, federal employees, welfare
families, and jailed felons.
Think of the message that non-universal reform would send to literally millions and
millions of working Americans: If you are very poor, we'll guarantee your health
care. If you get elected to Congress, we'll guarantee your health care. If you are
employed by the federal government, we'll guarantee your health care. If you get
thrown in jail, we'll guarantee your health care. If you are rich, you can guarantee
your own health care. But, if you get up every day and work for a living, your
health coverage is always at risk.
'1.16 RE~UBUCA"'s· HA\JS
A SIMP£&' OH&-STIIP
PLAN 1HI«' OOARANTSSS
'rlOU UNIVERSAL HEALTH
CARE.,,·~---~
~----'·•
4
�NON-UNIVERSAL REFORMS:
State Experience Shows It's Not Enough
'~t least 37 states have enacted insurance reforms essentially identical to the [nonuniversal] reforms proposed· in Congress. I think any insurance commissioner would say
these reforms are a necessary but not sufficient way to decrease the number of uninsured.
To say they're going to improve access is a bit misguided." -- PATRICIA BUTLER, HEALTH
CARE CONSULTANT, BOSTON GLOBE 7/3/94
Many federal health reform proposals, such as the Dole plan, reject the goal of universal
coverage and focus instead on expanding "access" through a patchwork of incremental
reforms including small group market reforms, insurance reforms, low-income subsidies,
community rating, medical savings accounts, voluntary alliances, tax credits and
malpractice reforms. All told. more than 45 states have passed many of the reforms
proposed in the Cooper and Dole bills.
However. state-level experience with non-universal reforms, implemented in recent
years. has demonstrated no appreciable effect on total coverage levels or costs. Since the
late 1980s, state-level health care reform activity has significantly increased, with more
than 32 states passing incremental health reform measures between 1989 and 1992, and
more than a dozen more acting in 1993 and 1994. [Intergovernmental Health Policy Project, George
Washington University]
•
The recent experience of one state, where community rating was implemented
without universal coverage, bears out the unfortunate forecasts. A Wall Street
Journal analysis noted that almost one year after this state had "adopted stiff
insurance reforms, fewer people have health coverage than under the old system."
£Wall Street Journal, 5/27/94] The reason: young people dropped coverage as rates went
up, causing rates to rise further: between 20-35% for some insurers.
•
In Hawaii, however, where reforms include universal employer/employee.
contributions, coverage approaches universal and, "health insurance premiums are
about 30 percent cheaper, while almost everything else in Hawaii is more expensive
than on the mainland. New York Times, 5/6/94;)
II [
Nor has the promise of better rates or cheaper benefits brought non-insuring small
businesses into the system.
•
Beginning in 1986, 11 states and non-profit groups began a demonstration program
specifically aimed at increasing coverage by making health insurance more affordable
and available to uninsured small businesses and individuals.
Of the 11
demonstration projects, all used voluntary measures: 10 developed new, less
expensive insurance products or subsidized existing insurance products, and one
developed a health insurance information and referral service.
5
-~-~-~-
~~~---------
---
~~~~--~~--'
�.
.
These demonstrations reached relatively few of the small businesses and individuals
previously uninsured, leading the study to conclude that "there is little evidence that
voluntary efforts alone will close the gap on the uninsured problem." /testimony ofW. David Helms,
Ph.D., before the U.S. Senate Committee on Finance/
[ States Have Already tried Non-Universal Reforms [
~~~w;'1ll~#f;t'J·:)~~·t~~r1t5{~trfJJ,~~"~Bi~fi:if)~<),~1Y¥Jf\;~{~~~t£t~J--1 :~~f\*t.\4~,-:!?f~:,~g::?J ~;"[;}~{~~ ~7f}
1
1'£i~.,.,
·~.f..~~-~ 1 ..-:.,•.r. --t.<.U:~utl.l;::;,,,.w~.:.-;}f..:' J._~l{H~)l' ••
~,b ,.....,'f},:i_l: t.§.c.~ ~kJi,~(o!-'[' ....~~~-~ .... ~~.::·.'<:'t;;~,'"'1-thr,~M:;~',1~-.\l:i*.~. . ~ J•,..t:f.l1"'~ l<.{{i). .!•~}t' ,§, )';"i ,"'i·_. •~'·Pf~.:::.
. 'w. : , ""'"'...1- ~~·:-.f1l-;:~ (,.,t,~;.\,._;.,~:;&.!e.:?J><~
A.
.
Guarantee Issue
35
Guarantee Renewal
42
Portabilitv
37
Community Ratina
19
Ratina Bands
34
Voluntarv Alliances
20
Tax Incentives
13
Medical Savinas Accounts
Low-Income
Subsidies/Medicaid
Expansions
7
The results of these reforms
are illuminating: tens of
thousands more working
people left uninsured, and
massive increases in insurance
costs. Even in the states that
successfully increased the total
number of individuals covered
from 1988 to 1993, half had a
decrease in coverage among
working people /March CPS, 1988 and
1993, Bu.rcau of the Census/.
46
~~~···~:.:
~~~m ~;;.M0.-.'~m~c
«
».1'.'
. '
"'
Source: Intergovernmental Health Polley Project, Geotge Washingotn University, June 1994
6
�'..
·.
A brief examination of representative states gives a taste of the differing outcomes that
follow universal and non-universal reforms. Iowa's reforms resemble those suggested by
the Dole plan. South Carolina's resemble the Cooper/Finance Committee plans. Hawaii is
the state that has come closest to providing universal care.
1) Non-umD.versallreforms leave moli:'e worlldng peopne uncovered.
Insurance Reforms Without
Expanded Coverage IFor Workers
IOWA
210
Insurance Reforms With
Expanded Coverage For Workers
200
190
180
HAWAII
170
48
160
ISO
48
140
1990
44
1993
SOUTH CAROLINA
42
40
38
1988
1990
Sources: 1988, 1990, 1993 CPS
1993
So!Hces: 1988, 1990, 1993 CPS
2) Non-11llniiversall reforms have h11llrt state !budgets-- and raised. working people's
taxes.
Iowa and South Carolina-- states that most closely resemble the Dole and Cooper/Senate Finance plans
--enacted insurance market reforms with subsidies for poor people. Since reform, state spending on
health care has continued to increase, forcing state officials to reduce funding for education and crime
prevention. In these states, income taxes on working people continue to rise, even as more working
people go without insurance. The message is clear: non-universal reform means that working people pay
more for insurance and in taxes for the poor -- even as they lose health coverage themselves. !Sources:
1988, 1993 CPS. State Government Finances 1988, 1992. U.S. Bureau of Census, State Government Tax Collection, 1988, 19921
7
�'•
NON-UNIVERSAL REFORM IS A HIDDEN TAX
ON THE MIDDLE CLASS AND ON BUSINESS
"[S}o long as millions of Americans remain underinsured and uninsured, cost shifting
will continue, leaving a mechanism for unwarranted price inflation in health care." -MINNEAPOLIS STAR TRIBUNE, 6/16/94.
1) Non-universal reform. leaves a hidden tax on working families.
People without health care coverage still get health care. But many of them don't pay for
it. Their costs are shifted onto everyone who does pay an insurance premium. And their
costs are higher because the uninsured often seek treatment after a problem has become
a crisis, in a hospital emergency room.
A recent Department of Health and Human Services Study found that of the 90 million
emergency room visits in 1992, fifty million were for ailments that could have been
treated in a doctor's office-- at one-third the COSt. !Source: National Hospital Ambulatory Care Survey; 1992
Emergency Department Summary; HHS, National Center for Health Statistical
The methodology used
by the Congressional
Budget Office to
analyze a similar plan
indicates that the Dole
plan would cover only
1 in 5 uninsured.
With 80% still
uninsured,
uncompensated care
will remain at $18
billion in 1998 alone.
So the Dole plan
leaves $18 billion to be
paid by working people
who do have
msurance.
Hidden Health Care Tax
Of Non-Universal Coverage
$150
$125
$100
$75
$50
$25
$OJ__
__._
1998-2003
Uncompensated Care Cost Shift
Sources: Calculallonas Flnandallmpacl ol the Managed CofTllOIHion Acl; Lei'M Ana~~sollhe Healhl Securlly Acl,; The Dole Plan;CID Aprll\994.
8
�'
·.
2) Incremental reform is a hidden tax on businesses that provide coverage.
Another way to think of this Dole cost-shift is as a tax on businesses who provide
coverage. Since most Americans get their insurance through work, businesses are forced
to cut dividends, divert money from needed R&D, and cut back on hiring.
DOLE PLAN
Hidden Tax On Manufacturers
Billions
$25
$20
$15
$10
$5
$0
Sources:
ear 2000 Under Dole
991 (actual)
Cost Shift
Calculations Based On Data from Lewin, VHf report for National Association of Manufacturers, 1993;
The Dole Plan
The middle class gets squeezed coming and going-- either paying
higher premiums themselves, or seeing jobs lost as employers cut
back to cover costs shifted onto them by businesses that don't
insure their employees.
9
�......, '.....
'
INCREMENTAL REFORM FAILS OTHER KEY TESTS
1) Half-measures perpetuate "job-lock" by failing to ensure portability.
"/have great trouble seeing how you get portability without universal coverage." --U.S. SENATOR
JOHNCHAFEE
•
If you move to a new job and your new employer doesn't contribute, all incremental reforms
give you is the right to assume the .fiill burden by yourself-- whether or not your family can
afford it. Incremental reform means millions could still lose coverage when they change jobs,
be dropped if they can't afford their premium, or forced to wait six months for new coverage.
That's not portability.
•
Until we have true portability, we will never eliminate "job lock". Surveys suggest that as
many as one in three working Americans are trapped in their current jobs because they fear
losing the health insurance their families depend on. The CBO concluded that incremental
reforms can "reduce" -- but not solye -- this problem. ("Health Benefits Found to Deter Switches in Jobs,"~
New York Times. 9/26/91 ; QIQ, 4/94, p. 28]
2) Non-universal reform cannot eliminate pre-existing condition exclusions.
"It will be nearly impossible without universal coverage ... to outlaw the common industry practice of
refusing to cover people with known medical problems, so called pre-existing conditions. "
-- THEW ALL STREET JOURNAL 6/15/94
•
Without universal coverage, pre-existing exclusions would mean many healthy people would
choose to "ride free" and go without insurance, knowing they could buy it when they get sick.
This would drive up costs for all the people in the system. <Wail StreetJoumaL6/IS/94)
3) Incremental reforms perpetuate welfare lock and discourage work.
''At least one million adults and children are on welfare because it's the only way their families can
get health care coverage"-- MOFFIT AND WOLFE, 1190. "[an incremental approach] would produce
devastating disincentives to work . . . the creation of a near poverty trap . . . would result. " -- AARON
IN NEW YORK TIMES, 2/13/94
•
Even if the Dole proposal were fully funded -- which it is not -- it would only subsidize a
portion of the premium for those families and individuals well~ the poverty line. Welfare
mothers going back to work would not only pay their own premiums, their taxes would pay for
health care for those still on welfare. One expert says that the Dole plan would "make working
irrational." On the other hand, an analysis of the effects of a universal proposal estimates that at
least 840,000 people-- 15% of welfare rolls-- will seek jobs ifthe President's reform passes.
{Wolfe, University of Wiscon.fin, LA Tjmu I /1/8193: Boston Globe, 713194}
10
�'
'
.
,i
THE WHITE HOUSE
WASHINGTON
Memorandum
From: Health Care Delivery Room
The attached news clips demonstrate why Universal Coverage is imperative in
real health care reform. Opponents of real reform would have us believe that
our goals can be met by incremental, piecemeal reform. That approach won't
work, and will leave millions of hard working Americans at risk.
Included in this packet:
o Community-Rated Health Plans Prove Popular, But Success May Depend on
Universal Coverage
o Health Bill Seen Falling Short of 95% Coverage
o Let the Employer Provide
o New York Finds Fewer People Have Health Insurance a Year After Reform
o With Dole's Mainstream GOP Proposal, the Debate is Joined.
o An Unpleasant Choice if Employers Won't Pay for Health Care
o Peril Seen in Reform Limited to Insurance
'
'.
�communtty-natea neattn rtans rrove ropuLar,
'
But Success May Depend on Universal Coverage
THE WALL STREET JOURNAL WEDNESDAY, JUNE 15, 1994
By HILARY STOUT
Staff Reporter of THE
WALL STREET JOURNAL
WASHINGTON - It's the health·care
proposal everyone loves: the notion that
msurance companies shouldn't be allowed
t? jack up rates for sick people or others at
r1sk of piling up big medical bills.
So attractive is the concept, known as
"co~munity rating," that even many Re·
publicans and conservative Democrats say
Congress should go ahead and enact it
along with a set of other insurance-market
revisions. and forget about universal
health coverage for now. A new GOP
television advertising campaign pushes
for bipartisan insurance-market reforms
to "fix health care."
There's just one problem with the idea
experts insist and real·life evidence shows:
It probably won't work without universal
coverage. Indeed,severaloftheinsurance
changes that reformers are clamoring for
may depend for their success on bringing
nearly everybody into the insurance pool.
. For the past year New York state has
tr1ed. ~ommunity rating without a law
requmng everyone to have health insur·
ance. The result has been a rise in insur·
ance premiums for younger. healthier
peopl.e and a drop in rates for older. sicker
IndiVIduals. Consequently, young people
have bailed out of the system figuring
they either W?n't need coverage' or they'll
be able to get 1t at a reasonable price when
they do.
Older. Sicker People
. Now. insurers are raising prices again
m order to cover the medical needs of those
?lder, sicker people left in the pool. State
msurance department figures show that as
of Jan. 1. nine months after the new law
~ook effect. 25.477 fewer people had health
msurance individually or in small· ,.
employer groups. That's a 1.2o/o decline.·
The only way to avoid this chain reac· '
tion. many experts say, is to set up a
system where people can't drop out. Uwe
Reinhardt, a Princeton University health
economist. says that when he heard Re·
publican calls to enact insurance market
reforms alone ..... . way to vastly improve
the current system he reacted with "total
disbelief." Community rating without unl·
v~rsal coverage "will trigger the worst
kind of behavior among insurers and pa·
tients." he says.
. "If you can go in and out of a system at
~Ill, then the only people who will buy
msurance are those who need it." says
Barbara Ragle. legal counsel at Central
Reserve Life Insurance Co.
Nor is community rating the only popu·
lar insurance reform that would be nearly
impossible without universal coverage.
The same thing is true of propOsals to
outlaw the common industry practice of
refusing to cover people with known medi·
cal problems, so-called pre-existing condi·
tions. Most health bills that stop short' of
universal coverage, such as the bipartisan
Managed Competition Act championed by
Democratic Rep. Jim Cooper of Tennessee,
allow insurance companies to exclude cov·
erage of a pre-existing condition for up to
six months unless the prospective policy
holder is switching from one policy to
another. Again, the reason is that if
the government requires companies to
cover pre-existing conditions without requiring everyone to have insurance, people ·
will buy policies only when they expect
high medical expenses.
· ·
Seeing the Insurers Side
Even GaU Shearer, who as manager of
policy analysis for Consumers Union is
usually no friend of insurance companies
says: "You can understand why the in:
surers want protection."
· In a pure community-rated insurance
system, everyone in a region would pay the
same premium for the same package of
health benefits, regardless of age, sex,
medical history, lifestyle Qr place of resi·
dence, despite cancer or severe disabil·
ity-or perfect health.
·
Some supporters of community rating
are pushing to allow some adjustments,
~ such as for age and habits that affect
h.ealth, like smoking. And for all the rhetonc embracing community rating, most
of the actual bOis under consideration in
Congress would adopt only a modified
version of the concept.
·
"Nobody is proposing pure community
rating," says Henry Aaron, an economist
at the Brookings Institution in Washing·
. ton. Even the sweeping Clinton proposal
would allow four different types of regional
~k pools, based on family type - for indi·
vtduals, for single parents with children
for couples and for two-parent familie~ [
with children.
.
The House Ways and Means Commit· .
tee, under pressure from the insurance
industry, is considering a bill with five
different, market sectors, based largely on
a person .s employer. Each sector would be
commumty rated, but insurers wouldn't
have to sell policies in every sector. The
, leading Senate Republican bill, written by
John Chafee of Rhode Island, aliows in·
surers to adjust for age and geography in
some markets.
In fact. many people argue that the only
legislation that guarantees a true commu·
nity·rated approach are bills establishing a
"single-payer" health system. where the
government pays people's medical bills
with tax revenues.
Other things that make community
ratings work are also opposed by supporters of the concept. A successful com·
munity·rated system requires a bureau·
cratic structure to oversee it. Yet many of
the people calling for insurance-market
reforms are the same ones decrying the
large regional health alliances that Presi·
dent Clinton has proposed.
The alliances, which would be set up by
the states, would include employees of all
businesses with fewer than 5,000 workers.
The White House says they were conceived
to establish a large pool over which to
spread insurance risks. And they are also
intended to take care of a difficult but
critical job known as risk adjusting.
"Community rating violates basic actu·
aria! principles," says Princeton's Prof.
Reinhardt. "A community-rated system
forces a competing private ins~.r to look
at a deathly Ill patient, seeing a ·Sioo.ooo
bill. and cheerfully enroll that person for
$2,000. It goes against human nature. So in
order to overcome normal human nature,
you need some coercion."
That means that while everyone pays
the same amount into a community-rated
system, a mechanism must be set up so
Insurance companies receive varying
amounts. depending on the risk levels of
their beneficiary pools. Otherwise, a plan
that for some reason was chosen by a
disproportionate number of, say, HIV·posi·
tive people, would be in bad financial
shape. Ultimately, health plans overloaded
with bad risks who pay low premiums
could collapse. Risk-adjusting basically
requires plans with better risk pools to
subsidize those with Worse risk pools.
The administration proposed health al·
liances to accomplish that task. However,
most of the people pushing insurance reforms are balking at alliances. Conse·
quently, large mandatory alliances are
all but dead in Congress.
Alliances aren't the. only entitles that
could perform such functions. "It could be
done through state Insurance regulation,··
says Mr. Aaron. The virtue of alliances
Prof. Reinhardt points out, is that they als~
WC?uld collect the health-insurance premiums, and could then turn around and
pay money out to plans in the form of a
::risk-adjusted premium." He says.
That•s a lot different than having to go in
there and fight with their lawyers."
�How the major health-reform plans deal with the issue of community rating:
• CLINTON: No premium variations
allowed for age. medical status. geography or lifestyle. Separate pools
according to family size.
in four separate pools: individuals,
employers with 2·250 employees;
employers with more than 250 workers;
association plans and health alliances.
• SENATE WOR AND HUMAN RESOURCES
(approved June 9): Same as Clinton but
phased in over four years.
• SENATE FINANCE (currently under can·
slderatlan): Premium variations
according to family size, geography and
age. Highest age-adjusted premium
may be no more than twice the lowest
age-adjusted premium.
• CHAFEE: Health pl~ns must otf~r a
modified commumty rate premium for
people and businesses of under 100
workers who buy insurance through a
purchasing cooperative.
• HOUSE WAYS AND MEANS (currently
under consideration): Community rating
.
• COOPER·BREAU~: No ad1ustments
allowed f~r med~cal status. or number of
past med1cal cla1ms: premiUms can be
varied according to geography and, to
some degree, age.
�-Health Btil~-een
·-....
I
---·-
.Democrats, Republicans Say J
Senate Finance Proposal i
Outspends Its Provisions ,
THE WALL STREET JOUR.~AL FRIDAY;'JlJLY'8,' 199'4 ..
By DAVID WESSEL
And HILARY STOUT
Staff Reporters of TilE WALL STREET JOURNAL
WASHINGTON - The slapdash health
bill that the Senate Finance Committee approved last week promises health insurance for 95% or Americans, but doesn't
raise enough money to achieve that goal,
administration and congressional officials
say.
The bill was heralded as proof the
government could get close to President
Clinton's goal or universal coverage without requiring employers to provide health
insurance as Mr. Clinton proposes.
But Democratic and Republican congressional staffers and administration of-
States Slow the Pace
States ranging from Florida to Wuhing·
ton continue to be laboratories of health·
care innovation, but they increuingly
are opting for a step-by-step approach
instead of aiming for an across-theboard revamping. Article on page A12.
ficials privately say the bill can't deliver
what it promises. The bill even provides a
mechanism for breaking the promise; a
fail-safe provision designed to avoid increasing the federal deficit would automatically scale back subsidies and new tax
deductions if the financing proved inadequate.
The Finance Committee hasn't provided any cost estimates for the bill even to
the senators on the committee, several of
whom acknowledged they were voting ·
. on it with even less than the usual analysis.
But estimates prepared for comparable
proposals and preliminary calculations
circulating within the government suggest
that, over the next five years, the prograin
the bill ,envisions would cost tens of billions
of dollars more than it provides - perhaps
as much as SlOO billion more.
"Wi" ··t additional funding, I don't
think there's any way the bill will lead to
95% coverage," says Thomas Scully, who
oversaw health spending for the Bush
administration's budget offirP and now
represents a number of chem.. in the
health-care industry. "There's a big fi·
nancing gap, and it's not any fun to close
it. Your choices are A: raise taxes. which
isn't doable: orB: cut entitlements, which
is also highly unpleasant." .....
The Finance Committee's bill is one of
two health·refonn measures approved by
Senate committees. The other promises ·
universal coverage by requiring employers
to pay part of the tab for their workers'
insurance, but it's unlikely that a majority
of the Senate would vote for such a mandate. Senate Majority Leader George
Mitchell of Maine has said he will meld the
two measures and bring a bill to the Senate
floor by the end of this month.
In the more liberal House, two committees have approved bills with employer
mandates. A floor vote also is expected on
a bill that would create a government-run,
taxpayer-financed health system.
To make health insurance affordable to
lower-income Americans and to encourage
them to buy it, the Finance Committee's
bill would offer subsidies for all families
with incomes up to twice the poverty level ,
(up to about $29,500 in today's dollars for a
family of fourl. The poorest of those would
get insurance free; the government would
pick up part of the premium for others.
ACongressional Budget Office analysis
of a rival program crafted by Rep. Jim
Cooper (D., Tenn.) and Sen. John Breaux
<D.. La.l puts the five-year price for a
similar subsidy plan at $400 billion to S500
billion, depending on the scope of the
benefit package. And the CBO says that
sum would lift the fraction of Americans
with insurance to only 91% from the present85%.
The Senate panel's bill appears to aim
at a benefit package in the middle of the
CBO's range, suggesting the promised
subsidies will cost roughly $450 billion over
five years. (There are differences between
the Cooper and Finance Comm~ttee plans,
but some would make the Senate version
more costly and others would make it less
costly.)
After rejecting a number of tax in~
creases suggested by Chairman Daniel
Patrick Moynihan <D .• rl.Y.l, the Finance
committee Saturday approved a blll that
I appears to raise little more than $100
billion in revenue over five years, after
a( • 'J •ling for the cost of expanded tax
deductions for the self-employed and those
workers who buy their own policies.
The biggest chunk would come ftom
higher tobacco taxes, about $65 billion over
five years. Another $30 billion or so would
come from a new 1.76% tax on health-insurance premiums, though the btu would
dedicate that money exclusively to research. Another S4 billion would come
from raising Medicare premiums for upper-income elderly people. The hardest
tax to estimate in the legislation is Sen.
Bill Bradley's (D., N.J.l tax on high-cost
insurance plans. The Treasury's top tax
official has indicated the tax might produce Sl4 billion to S17 billion over 10
vears.
The remaining $350 billion or so needed
to provide the subsidies would have to
come from money-saving changes to Medicare and Medicaid, the federal insurance
programs for the elderly and the poor.
Medicaid spending would fall because
many beneficiaries would be shifted to
government-subsidized private insurance
under the Senate committee's bill, but
none of the preliminary estimates suggest
the Medicare and Medicaid savings come
close to making up the shortfall.
During the committee deliberations,
Sen. Robert Packwood (R., Ore) who
voted against the bill, said back.;,f-theenvelope calculations by GOP staff found
the bill $91 billion short over five years.
Afterward, Sen. Bradley, who voted for it
said he was "concerned that this bill i~
short on funding." Under the fail-safe,
provision if financing is inadequate, phasing in subsidies and expanding tax deductions would be delayed beyond 2000. The
bill also creates a commission to make
recommendations to Congress if fewer
than 95% of Americans have health insurance in 2002; Congress would have to vote
on those recommendations.
The Finance Committee bill isn't the
only proposal that would deliver less than
coverage for 95% of Americans. There
essentially are three ways to assure universal coverage: require individuals to
obtain it, require employers to provide it
establish a government program, or som~
combination. None of those seems to
attract a majority in the Senate, so the
alternative is to offer subsidies to encourage the uninsured to buy insurance. With
more generous subsidies, more of the
uninsured are expected to take the bait.
But generous subsidies are costly.
A proposal put together hastily by Senate Republican Leader Bob Dole and endorsed by 39 other Senate Republicans
would give subsidies to Americans with
i~com~s up to 150% of the feder4. ;,;•·verty
lme Without raising taxes. But the stillsketchv ~roposal is difficult to evaluate
becaust: ,t doesn't specify how generous a
benefit plan would be offered.
Some of the Democratic universal-coverage biDs also may come up short. An
employer mandate reduces the need for
large government expenditures. To fund
subsidies to small, low-wage companies
and ·tow-income people, most of the bills
rely on higher tobacco taxes, Medicare and
Medicaid savings and a payroll tax on
large companies.
~====
�.-1rtlwr S. I~1t•mmilll{ and Elliot L. Ricluirdsnn
-----··--·
-
-··
----·-----··-----
-··--
Let the Employer Provide
Tar. If t•HI~GTO' Po~T I
812
rrt>sident Clinton has done our nation a ~:n·:~t
o;('rv1re hy pullm~ hralth cart' rf'form at lht• tnp
of our national aJ:rnda. llis approach is thought·
ful and consrrv11tive. huilding on the existing
systt'm to guanmtf't' roverage to evf>ry Amt'ri·
ran. And as thf' lf'Rislative dcb:.te moves forward, tht' centerpiece of his approach-a guar~
antee that all employt'rs will provide health
insur:.nce to thf'ir t>mpiOYt'f'!l-rllU!lt 1M' discussed in it!l proper historical contf'xt.
:
The link between health benefits and t'mploy·
ment- !(Of's back 50 year!!. Ouring World War II,
when wa~t' and prict' fret'7.t'S wert' in f'ffect,
many f'mployer!' found th:.t offering benefits was
a good way to reward and attr:.ct workf'r!l-a
particul:.rly attractive option because of the tax·
t>xempt status of he:.lth insurance. By the middle
of lhf' 1950s, he:.lth coverage through the work·
plare w:.s widt>spread.
The growth in employer-provided health in·
surance continued through the late 1970s. But
since thl"n, the percentagt' of employed AmPri·
cans who lack health insurance has begun to
incrP:.se. This reflt'Cts in part the ch:.nging joh
markt't-:.s m:.nuf:.cturing jobs with generous
benefits have given way to St>rvice jobs with few
or no benefits during the 1980s. Recently, rt'·
searrhers at the Harvard School of Public He:.lth
predictt'd th:.t 30 percent of sm:.ll businesses
would drop coverage for their l"mployt't's m the
coming years because of rising costs.
Extending our current system of employerprovided insurance builds on what we have.
Today, thf' v:.!lt m:.jonty of Americans with
private insurance get it through their employers,
yet eight out of 10 American!! who have no
. insurance :.re in working families. By extending
the employer-based system, we can cover most
Amerirans. ThP govt'mment can help by prott'rl·
ing small husinPs!lf's and the unc.'mployrd. This
approach is the easiest, simplest and fain!st wav
to get to univrrMI rovt'rage.
.
In 1971, Pre!lident Nixon first proposed rom·
prehensivl" he:.lth rf'form-with an approarh
very similar to Prf'sident Clinton's. Nixori pro·
--------
Sl"\0.\Y. JnE l ~. i ~94
posed that all t•mployers provide a standard
benl'fils p:trk:tge to tlwir employt>eli and pay 75
pcrc('nt of thf' ··ost!l, with tht> govt'rnmt"nt ht•lping to covt'r thf' unf'mployed. Prt'!lidf'nt Clinton'~>
propoAAI call!4 for the same, except employers
would P"Y 80 percent.
The Nixon proposal-the Nation:.l Health In·
sur:.nce Stand:.rd!l Art-w:.!l ctr:dtt'd at the ~Jta.
patment of Health, F..duration and W«'lfare wht"n
we were colleagues there. It called for "employ·
ers to provide basic ht>alth insurance rovt'ral(e
for their employees." Pre!lident Nixon saw this As
part of a tradition of government guaranteeinl(
basic worker protections. "In the past, we have
taken similu action!! to assure workers a mini·
mum wage, to provide them with dis:~bility :.nd
retirement benefits, and to set occupational with
disability and rt'tiremf'nt bf'nefits, and to set
occupation:.l health and safety standards. Now
we should go one step further and guarantee th:.t
all workers will receive adequate health in.'lur·
anr.e protection," he argued in his mes.o;age to
Con~rress.
Further. the expcrienn· uf Hawaii-the on
state that has alrt>ady askf'•l all employers t
provide insur:.nre In their t•mployt't'!l-bodf>
Wt'll for sm:.ll businPs.". Sinre Hawaii pa!l!lt'·
reform in 1974, tht' unemploymPnt rate ha
dropped to one ·of the lowest in the nation; sma
busines.'l crf'ation ratt's h:.ve- remained high; an
the rate of bt1sines." failure!! h:.!l bf'f'n l~s tha
half the national rate. In addition, Hawaii's "rain
day" fund, set up to help small busin~St'S provid
.insurance, has only bt'en US("d fivE' times over t·
years.
llel;pite the "sky·is·fallinJ!" rhf'tnri<' of snm
lohbyists {rh«'torir th:.t i!l f:.miliar from P"~
debates), MNne kind of emplnn'!r·based approac
should be adopted. l'ropoS('«I by prf'sidents Nixo
and Clinton, it is St>nsiblr and c:onservaliv•
buildinR on the E-xisting systt•m th:.t covPrs mo·
Americans. And it is nf'C"es.o;ary In arhit>vr un
Vt"rsal coveragt'.
As former !l('('rf'taril"s of hf'alth, t'duc:.tion ar
welfarl' in Rl"pnhlican administrations, we ha'
seen past health rt>form t>frort!; start and fail. H•
we bt'lieve that the dr.dkiltion of the presidt•
and tht' First l.ady, tht' puhli•· dt'mand fur a.-li•
·and the commitment of vetrran l:.wm:.kt>rs w
m:.ke universal coverage a rf'ality thi,_ timl". Wi
lilt' coopt>ration of moderate Rl"publir:.ns. tt
<':In 1M' :1 hipartiMn effort that shows the AmP
ran people what happ('ns when Conl(rf'ss wor
tOgether to get thinKs done.
W.- want tiM> presidt'nt to sur<'f't'd-not
DP.mocrats or Repuhlirans-but ~s Amt'rir
riti7A'ns. This y«':.r'!t Conj!rP!;!t should hr prourl
leavE' comprehensive h«'alth <'lrl" rt'form as
leJ(ai:y .
Today, the vast majority of businesses provide
insuranre, and most of the re11t say they would if
thry <'ould afford it. Du.•linesses that prnvickinsur:.nce today will undoubtedly pin from both
cost-containment efforts and. \lfliversal coverage,
whirh will Pliminate cost-shifting. And though
f1rms that do not now provide iasurance would no
longl"r get a free ride, President Clinton's approach protf'Cts Rmall husines.'lel by providing
tht'm very gent.>rous di~ounts on inRUrance.
TIM> Congre!l!lional 8udget Offia- analysis of
thr Clinton pl:.n-pr:.ised by IJemocrats and
Republicans alike-is valuable in evaluatinK thl"
impact on busines.'l. 1-:vt"n when new !!pending
ArthurS. Flemmin/l. ,ft'('rtlary of hmlllt.
from thoSt> busint>s!lf's that do not now providfo
msuranre is indul'frd, tht! COO <'Onc:ludf'd that· l"'lur.atiolf mrd rllt'l/tlrr '"'drr Prr.fidi'Prl
1-:i.•nltott'f'r, ;,, rhaimum of a coalition of
Amc•nran busint!!!Sl's :1!1 a wholr. would Mve $90
billion by the year 2004. The cno also concludt•s ll""'l'·' conr.r.nrnl willa Social Sn-urily and
that thr prt'sident's approach will havt' a nt>glip,i·
lrtV~Ith carr.. Elliot L. Rirhard.mn, .'ff'.Crrla,.., of
hlr net l"fff'C·t un I"IIIJ,Ioyml"nt -dt'fusing a mmn · lrmllh, education and ,,.lfarr '"'drr Prrs'utr1
rharl(e by cr1tin;.
Nixon, is a Wa.thinRiorr l~wvrr.
�[Vew York Finds Fetfier People :Have ·-~
, Health Insurance a Year A her Reform
companies, health-maintenance organiza~
tions as well as Blue Cross/Blue Shield.
Insurance-department officials down·
Almost one year after New York State.
adopted stiff insurance reforms, fewer play the slight drop in overall enrollment,
people have .,Plllth·care coverage than citing a "disruptive phase·in period." /' ~~;
for the steeper drop in individual coverage,
under the old system.
The surprising decline provides ammu· they suggest some people previously cov·
nition to supporters of nationwide man· ered individually are now in small groups,
datory insurance, and could prove trouble- perhaps- because their employers were
some for advocates pushing for incremen· prompted to add coverage.
tal insurance reforms.
'Unqualified Success'
Under New York's system, insurers are
New York Insurance Superintendent
required to offer one·size·fits·all pricing, a Salvatore Curiale calls the state's effort an
method that sharply decreased rates for "unqualified
older, sicker people but increased them for the system to success" because it opened
those
others. The law also forces insurers to take most. "The reason needing insurance the
for
to
all comers, and, as a result, some insurers portray this as a failureall the effortthe
is because
contend that disproportionate numbers of health-insurance industry is deathly afraid
young, healthy people are dropping cover· it will be taken up as a national policy,"
age on the assumption they can buy it later Mr. Curiale says. "What they're afraid of
if needed.
is that their
With increasingly fewer healthy people can't make profits will decrease" if they
money "on the backs of
counterbalancing the sick, the result, ac·
cording to the insurers, is the start of an young, healthy people." companies that
Many insurance
upward spiral in rates for those still in the
the
say
pool. If the trend continues, insurers con· strongly opposed and New York lawbusi·
their individual
small-group
tend, the very people that the program was nesses have always had thin profit mar·
intended to help could again be priced out gins. Although they are allowed under the
of the market.
law to raise rates anytime they wish, the
Crumbling Barriers
insurers contend that forcing them to take
"There should have been a substantial on a disproportionate number of less·
gain in people insured [in New York) healthy policyholders makes it even
because a number of barriers for people to tougher to turn a profit, making rate
be insured came down," says Robert Las· increases necessary.
zewski, a partner with Health Policy &
The insurance ind!lStry's practice of
Strategy Associates, a Washington con· rejecting sick people, or charging them
suiting firm. But the abrupt increase in exorbitant rates, has long been one of
rates for young, healthy people has "af· Hillary Clinton's biggest complaints. But
fected the ability of New York to achieve a her calls for change have generally been in
lower-cost pool. Now we may have a pool in the context of sweeping reform that would
New York skewed toward the sick, and in bring all Americans into the health-care
the long run that doesn't help the con· system, mostly by forcing employers to
·sumer."
pay for premiums. The debate over insur·
Ronald Pollack, executive director of · ance-underwriting practices has revved up
Washington-based Families USA Founda· recently as some leading legislators have
tion, a consumer group that backs Presi· . suggested tbat Congress enact moderate
dent Clinton's plan of mandated cov· refonns now and revisit the issue of a
erage, adds: "New York's experience massive system overhaul later.
gives very little comfort to those who just 'Balling OUt'
want incremental insurance refonns." Mr.
In New York's case, the state
Pollack insists that reforms, in isolation, "community rating" system, adopted a
so-named
"can't keep insurance affordable and because insurers must charge all people
available for families."
within given
same
New York's effort is one of the nation's regardless ofcommunities theas age price
such factors
and
most sweeping attempts at reforin and is medical condition. While considered a rev·
close.fy watched by national policy makers. olutionary effort, the state still allows
New York Insurance Department figures insurers to refuse to
show that, overall, 1.2% fewer people - or . conditions during an cover prior medical
individual's first 12
25,477 fewer people-were insured individ· months of coverage. The idea is that the
ually or in small-employer groups as of exclusion will induce healthy people into
Jan. 1. nine months after the law, which the system before they get sick.
covered those categories, took effect. The
But Cecil Bykerk, chief actuary for
decline was particularly pronounced
among individual policyholders-12.4%, or Mutual of Omaba, which along with HMOS
43,666 people. The figures respresents peo- and Blue cross/Blue Shield provides indi·
.,IP inc:.nr:Pn .,v l'nnvPntinnal _in~mranrP., ..
. .
.
.
..
. ...
By LEsLIE SciSM
Staff Reporter of THE WALL STREET J OURNAJ.
• •
'.: 0
...
• •••;
•
:
· : •••••
vidual coverage in New York. says young,
healthy people are nonetheless "bailing
out." The average age of the company's
New York policyholders has gone up 3.5
years under the new law, to 45 years, he
says. The average New York claim more
than doubled, to $7,900, while the com·
pany's claims nationally rose just $400 to
$3,800.
The result at Mutual . of Omaha:
average 35% rate increases in New York
this year, which come on top of increases
for some young, healthy people of as much
as 79% when the law took effect in April
1993. Before the reform, a 25-year·old male
in Albany paid Mutual of Omaha $64.45 a
month for coverage, and a 55-year-old paid
$141.79; in the law's first year, each paid
$107.33, and. with the newest rate increase,
the bill is $145.10.
At New York Life Insurance Co .• a
small-group insurer, the average age of
insured New York employees is up three
years. Chubb LifeAmerica. a unit of Chubb
Corp. that also sells small-group insUi"·
ance, says people over 50 years old now
represent 26% of New York enrollment, up
from 20%.
"There's no question we have an ad·
verse-selection cycle setting in," says Sey·
mour Sternberg, a New York Life execu·
tive vice president, calling the situation
"very unstable."
John Swope, president of Chubb LifeA·
merica, meanwhile, speculates that some
small employers with mostly young
workers ended coverage because of the
rate increases imposed when the law took
effect, while employers with older workers
"grabbed it because it was such a bar·
gain."
At Chubb and New York Life, rates are
jumping more than 20% this year. But Mr.
Curiale says some small-group insurers
with double-digit increases underpriced
their policies last year and are playing
catch-up. He says more representative
increases are in the single-digit range.
For now, the state has no plans to
reconsider the law, saying the problems
are overdramatized. "The figures still
don't show the system isn't working," Mr.
Curiale says. "There's no doubt that there
are younger, healthier people who decided
not to pay the premium increases. But you
can extrapolate that these are people who
can get back into the system if they want
to."
�·.·
.,
J.
'.
With Dole's mainstream lJUP
pr()posal, the debate is joined :n
By Richard A. Knox
GLOBE ~"'T:\H
In the eight months since Presi·
dent Clinton introduced his health
refonn plan. mainstream Republi·
cans have been saying what they
don't want in the way of refonn.
Last week they finally said what
they are for. And now they will have
to defend it.
It isn't universal health insur·
ance. Senate Republican leader Bob
Dole. who supported health coverage
for all Americans before he began to
consider running for the GOP presi·
dential nomination in 1996. intro·
duced a proposal that makes no pretense of aiming for that goal.
Instead, Dole's 27-page plan of·
fers modest federal :;ubsidies and
other inducement.s for people to buy
health coverage. tinanced by more
than $100 billion in cuts frurn :'>1edi·
care and Medicaid and nu new ta.xes.
Dole's quintessentially Republi·
can proposal is not just the umpteenth plan in the hopper. It daims
the backing of 39 other Republican
senators. Thus. it clarifies the health
care debate in a way that has been
lacking in the morass of pennuta·
tions on Clinton's blueprint and oth·
er schemes.
In other words. the debate is fi.
nally joined. "It is now our plan ver·
sus theirs," exulted conservative
GOP strcltegist William Kristol of
the Project for the Republican Future.
The Dole plan, Kristol said,
"must be treated as a final and authoritative Republican position." not
as an opener in the next round of
horse-trading. Republicans must
proudly sell it, he advises, as
"straightforward refonns that make
insurance more stable, accessible
and affordable."
It is a program that "brings more
people into the system and provides
more security and nexibility for
those already in it." he adds.
A senior White House health ad·
viser greeted the Dole plan with
similar relish. At last, ·he said, the
public: will begin to understand what
the debate is all about ~ and when
people understand. they will pnu
for real refonn.
In t'..~ct. a number of health polky
analyst.s from all parts of the ideological spectrum last week began to
raise doubts about the Dole plan.
Their earlv but remarkably congru·
ent verdict: It's not likely to do much
to expand access to health insurance.
And it might make things worse for
many who are now insured.
Mark Pauley. a conservative
economist at the University of Penn·
sylvania who is no supporter of the
Clinton plan or it.s cousins. labels
Dule':s federal insurance subsidies
for the poor "stingy."
Dole's plan would offer subsidies
to Americans earning less than 11-"z
times the federal po\·e~y level $:!2.200 this year for a family of four.
The a\·erage 1994 premium for such
a family is nearly $6.800. or more
than :31) percent uf the family's gross
income.
":'>ly guess is that Cungress will
want subsidies that reach somewhat
higher." Pauley said. "They don't
want to be that beastly - even the
conservative ones."
How far would Dole's subsidies
take the nation in reducing the number of uninsured people. now esti·
mated at 39 million?
Pauley notes that the Congressional Budget Office this spring concluded that a proposal by Rep. Jim
Cooper. Democrat of Tennessee. and
Sen. John Breaux. Democrat of Louisiana. would cover about 40 percent
of the uninsured with a more generous subsidy scheme that reached
people earning up to twice the poverty level.
"Given the relative stinginess of
Dole's subsidies, I would say the
Dole plan could pick up between
one-third and one-half of the uninsured." Pauley said in an interview.
This would leave between 19.5
million and 26 million uninsured
Americans. at 1994 levels, wtio would
have to be brought into the system
through other means. For many of
them Dole proposes insurance market ~fonns, such as rules designed
to even out the wide disparities in
health insurance premiums that now
exist between the young and old, the
sick and healthv.
The Ll•de plar.
m~e~r•.-r>·
\llll;ld
ab•
c-!inil·
refu~ ...
c11\'er·
age t'or pree\isting medical conriitions. a practice that currently
make:; an P.:'timated 1 million Ameri·
cans "uninsurable."
But Pauley predicts such mea·
sures "probably do almost nothing.
or maybe even make things worse"
in the effort to reduce the remaining
millions of people who would lack
health coverage but could not qualify
nate
f•Jr
ahliny tu
~ubsidie:s.
"To the extent you force insurers
to take all comers or in other ways
not charge what they cost, the insur·
er has to raise what they charge oth·
er people.'' Pauley explains. "Yuu exchar. .:e some insured healthy people
for ~ume uninsured unhealthy people. The net effect of that is probably
somewhat of a loss."
Other analysts concur, and they
point out that such outcomes are not
merely hypothetical. ..At least 37
states have eruteted iruiur.mce refonns essentially identical to the refonns proposed in Congress," said
Patricia Butler, an independent
health consultant from Boulder,
Colo.. who often works \\ith state
governments.
"I think any insurance commis·
sioner would say these reforms are a
necessary but not sufficient way to
decrease the number of uninsured,"
Butler said. "To say they're going to
improve access is a little bit misguided."
New York state is often cited
these days as one real-world example ot' the unintended consequences
of health iru~ur.mce market refonns
in the absence of any requirement
that either employers or individuals
purchase insurance. (Dole and almost all other Repilblic:ans have rejected such "mandates.")
New York passed a law requiring .
insurers to average premiums across
an entire community rather than
pricing coverage according to their
estimate of whether a subscriber
was likely to get sick. Nine months
after the law took efl'ec:t. the number
of New Yorkers insured individually
or through small employer groupe
dropped by 26,477, or 1.2 pereent.
�.
.
-,
.,
... ·.
-
? I?
_,
Analysts llll!O point out that the
seemingly sensible idea of offering
federal subsidies to help the poor
and near-poor to buy health insurance contains some hidden pitfalls.
The problem has to do with the
fact that subsidies pro.,i.je a perverse incentive for people not to
work or increase their earnings. if
they would no longer qualify for subsidies.
"Take a family oi four just above
the poverty line . . . earning about
$19.000 a year." explains David A.
Super of the nonpartisan Center on
Budget and Policy Priorities, a
Washington-based organization that
studies how government spending
affects low-income Americans.
For each additional dollar such a
familv t•arns. Sup~::r says. they now
lose ~bout 72 cents by having to pay
more federal and state income tax.
FICA tax and through reduced
eamed income credit and decreased
food stamps. They keep 28 cents.
Adding a health insurance subsidv for low-income families adds to
the amount they risk losing if they
exceed the income limits. Under the
subsidy scheme approved yesterday
hy the :5enate Finance Committee,
Super estimates, the $19,0()0-a-year
familv "would lo~e an additional 18
cent.s- un the dollar" once they exceed
the income limit. So they could keep
not 28 cents orevery additional dollal' carnt'tl, hut only 10 cents, giving
them even le&~ intoentive to earn
more.
It' ~u~.:h a t'<.~uuly happen~! to live
in an area \\ith relatively high health
care costs. Super said, they could
ea:;ily reach the point where they are
eal'niu~ more but taking home even
II I), •le and his colleagues want
t" minirniz~ this problem. there are
wa\·.• t" do it. aualysts say. But the
~~d~tl<lll~ rna\' not be congenial to
L'"ll='~"'" ;&ll\ t'"• .,,. the: ir constituent.s.
Fe~r e\ampk·. go1·emment sub&i,lh·.- l·;u• ht• ,;tnh.:tured tu reach into
hi~hl!r income levels, t~uch as up to
:!'t'l to :' times the poverty level, 10
that the ph~L~~e-out of aubaidiel can
be made more gradual. But thia
swells federal spending on aubaidiel,
especiall~· when there is no requirement that employers share the burden.
Benefits also could be reduced to
make insurance less costly. But even
a stripped-down benefit package,
'oltith no mental health coverage or
prescription. drugs and only 15 hospital days per year. would reduce the
work disincentive by only a few
cents on the dollar.
"It's one thing to ask people to
work hard and get only 28 eents on
the dollar," Super said. "It's another
when you make working irrational."
.·
�'.
)
An l!ilpleasant Choice if Employers
Won't Pay for Health Care
By ROBERT PEAR
n.. ""' Yortl n,..
S-••l•o
.
WASHINGTON, July 7- President
Clinton's goal or health InSUrance for
all Amencans ts often described as a
moral imperauve or a poliucal ob)ec·
tive. but u ts also a pocketbook issue.
In one sense. there ts no mystery
about how to reduce the number of
unmsured: 11 JUSt takes money. The
question ts who should pay.
In trymg to achteve · universal
health msuran<:e coverage. Mr. Clin·
ton and Con!Zress wtll confront an
unpleasant chotce m the next few
weeks. If employers do not pay most
of the cost. as :'>1r. Clinton has proposed. thE'n the Government and con·
sumers must pay more.
Many peoplE' descnbe Mr. Clinton's
proposal for an "employer mandate"
as an alternam·e to taxes. Sttll. the
public would ulttmately pay. Econo·
mists say that employers would pass
on the costs to their workers by re·
ducing the amount of money avatl·
abl~ for wages or future pay ra1ses.
Guarantees, but Not for All
Members of Congress are skittish
about requirmg everyone to obtain
Insurance, and many natty oppose
Mr. Clinton's proposal to make em·
ployers pay most of the cost. Many
lawmakers now sugest that the Gov·
ernment should mitially try to guar·
antee coverage for some fraction of
the population. perhaps 95 percent, as
the Senate Finance Committee has
proposed.
What difference does it make
whether 95 percent or 100 percent of
the people have insurance? And who
Is most likely to remain uninsured?
'Those questions are at the hean of
the current debate over how to redePin the nation's health care system.
CUrrently, the Goftmmeat estl·
mates that 3t million Amertcans, ac·
counting for 15 percent of the popula·
tton, have no health lnsunnce. But
such numbers imply far lllCJI1 preci·
slon than is possible with any meas·
urlftl tools now available. People's
lntUrance status is continually chana·
. - as they chanae jobs, marry and
cf:Vorce. move fro~ one state to an·
other and go on and off the roll_s ~f
programs ltke Medtcatd and MeOt·
care.
Vtrtuallv all the maJor health care
proposals· now m Congress would
make health msuranc.:e more ava1l·
able. prohtbll msurers from denymg
coverage to people wtth a htstory of
tllness or disabthty and prevent m·
surers from charg.tng extremely htgh
prem1ums to people wtth htgh medi·
cal nsks.
But such changes. by themselves.
would not solve the problem. and ex·
perts warn that half measures could
have unmtended adverse effects ..~l
ice F Rosenblatt an actuary at Coo·
pers & L•·brand. tht' ac('ounttn!l firm.
satd thai .. a small propornon of th('
unmsurrd. probably less than i pN·
cent. have been dented covera[le be·
cause of pre~xtslln[l condtttons like
cancer and cardiOvascular prob·
lems."
Moreover. unless there ts some
mechantsm for enrolling all people tn
health ~;ans. mtlltons of Amert('Jn~
are likely to remam umnsured he·
cause they do not want to be bothered.
see no need for coverage or cannot
afford their share of the cost.
"Many people may rationally
choose not to purchase health insur·
ance coverage, either because they
have low income or because they
believe thev have a low risk of need·
'"ll health 'care services," said \llil·
ham S. Custer, research director of
the Employee Benefit Research lnstl·
tute, a nonpartisatt organization
whose members include bus~nesses
and labor unions.
The Youna May Go Without
1f there is no requirement for peo·
pie to have insurance, many who are
young and healthy will probably go
Without it because they see no imme·
diate need, given the cost. lf signifi·
cant numbers of healthy people ~o
without insurance, t'ne average risk of
the policyholders rises, and their pre·
miums mcrease as a result.
At least 11.6 mtllion people 18 to 29
vears ol•' have no health Insurance.
They account for 30 percent of the
~It II delira. 10
Mft
le In the
I'IIDI
becaute their medical COlla ue . . .
eraDy lower than those of older peo.
pie, actuanes say.
Under most of the proposals In
Congress. poor people would pay little
or nothang for health insurance. 'The
Government would pay the premi·
ums for people with incomes below
the official poverty level, now $14,714
for a fam1ly of four. Lawmuen assume that affluent people can buy
prtvate health insurance. COiting
S4.000 to 18.000 a year for a family, tf
they do not receive coverage through
employers.
So, health policy experts ;av. if
employers are not required r~ ;:''Oo
vide tnsurance ~o the1r employees,
the people most ltkely to be uninsured
are people in the mtddle-tnc:ome
range, particularly those who work
for small companies.
"All the major proposals would
give full coveraae to people below the
poverty line," said Mr. Custer of the
Employee Benefit Research lnstl·
tute. "That's the first group that
would pick up coverage. Uninsured:
people at the poor end of the middle
class are least likely to pick up cover·
qe as a result of these reforms."
Eleven million people without In·
surance, or 28 percent of the uninsured. have incomes below the poY·
eny level. They could get coverqe ali
little or no charge under most of the
proposals pendiftl in Congrest.
(f the Government provided cover·
aae similar to what the averaae em·
ployer now offers, It would cost S2.000'
a year for each uninsured person. For
every million people who receiVed
fully subsidiZed coverqe, the Gov·
ernment would have to pay at least S2
billion a yfiU. .
Nearly OMAIIIId of the uninsured
- 12.5 millialr af die 31 million people
without coveraae - have incomes
between the official oovertv level and
twice that amount. Under
major
proposals, these people 'wauld let
some financial assistance from the
Government to help them buy lnsur·
ance.
Whether such subsidies would be
adequate d:pends on many ques·
uons: the amount of• the assis~~e.
m...-
·me
�2..'2
tne -
po~
fl the IDauruce &M Ullit
IUJ, paid by emp..,...
ar.remelJ.....,
Mr. C:::.. IGUDdl a cauttaaarY
.-.. "1111
lbat
limply ...,.rtlll the COib flf ....,..
ance
acldiYe IDIM!ru.l ....,.
qe," be Mid.
Cltnc.l AdmlniJtratJan aftlcllll
say tJW universal cover~~~ II Dlllt
wen
Concem lor CIUNIWI
Conaress has for years Mown special concern for the medical oeedl at
chaldren, and that lmpulle II clear In
many proposals to OYethaul tile
health care system. lbe Ftaanc:e
Committee, for example. ~ o
proposal by Sf!nator Donald 91. "aae
Jr .. Democrat of Mlchlpn, to pnmde
extra subsidies to help pay lnlurance
premiums for children In falllillel
w1th incomes up to 1.4 times lhe povertv level.
r-;earlv 10 million children under 18
years oid have no health ansurance
coverage. and most of them could
ol)tam it under the balls now pendinl
in Conaress.
About nne-third of lhe uninsured
ch1ldren are in poor familia. Another
th1rd live an families with inComes
be1ween the poverty level and twice
·hal amount. The rematnder have
'.~ n111v m<"ome:; exceedina twace rhe
but=
................ ......, ....
only IIIOd beald\ poUcr
polleX& , . . . care •
a
i~. . . . . . , . , . . . .
im
by medk:al billa.
left beblnd when we reform lbe t.ltll
care system," saki Gnea17 I.
Lawler. a lawyer coonliDaUnl the
heaJtb cart campacn Ill tM ~
House. "'Tbey lhould haw~
teed private insurance."
More than half of the Uldnlured an
worlltnl ac:l\llts. Eilhty-feur pilftlftt
of the uninsured Uve in famtllet hea~
ed by workers. But in recent yean,
there has been a decline In coverqe
provided by companies w1th fewer
lhan 25 employees. Such companies
say they are often unable to obtain
affordable health insurance for u.etr
workers because insurers c:hai'Je
them higher premiums. renecuna the
mks and the admmastrative costs
associated wath small arouPL
.OV!'r!V it'\'Pi
'.
DEMOGRAPHICS
The Uninsured, by Income
The percentage of uninsured Americans in each family income
category 1992 figures •
110,000
andftW
.......
.......
Under
u.ooo
.....
•.oooto
ao,ooo
S10,-
to114MI
120,000
Sourc•
111,000
10111,111
E""'""'" Btlnelrt ~ref't tnstttute
·excludes elderly D8QPI8.
Because of rounding. figures
do not add 10 100 percent.
�..
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.
Peril Seen in Reform Limited to Insurance
• Health care: Analysts
rh.tr~~mgress \~uu!J
. . h~)rt~ighced to focus
\\;lrn
ne
eralf
discrimination.
t)nl~
t)n
~o ..
Bv EDWIN CHEN
Tl.loiES STAfF WRITER
ASHINGTON -It sounds so
W s1mple: Ban s1ck peoplefrom
insurers
Jacktng up rates on
and
agenda for change.
"Insurance ::eforT.s w::! solve
":"' ..i ;- .'
.: :
..- 7
:: :- . :-
~-
. . . . . _:
. - ..i •.
•. :"'
.l
:·,.·v :llggest cr.a •. e::~es .--~ ';.c~. ·
sa1d Drew Altman. prestdent of :he
Ka1ser Fam1ly Foundation. a
health care phtlanthropy based 1n
Menlo Park. Call!.
"You buy some ttme. but costs
w11l conttnue to escalate." added
Edward F. Howard. executtve v1ce
pres1dent of the Alltance for Health
Reform. a nonparttsan e<iucattonal
~roup here. "So you !ay·· the
~:·":•;:-:-:·.~.·or!< :::: .i =::~g~r -=xpius:on
;:-. a :e·o~.· ·.ears. ·
Y-=t. a3 Cor.gre~s pr~pares ·.o
beg1n ~loor debate on health :-e.
form. :he appea1 Ji :nsurance re.
for:':'\3 :-na:.- pr•Jve ail but :r:-es:5tl·
ble
Almost every heal~h reform b11l
:ntroduce<i :n recent years contams
5uch measures-tr.cl:.Jdtng all four
b:lls reporte<i out recer.ti~· by two
cor.1m1t~ees :n each c::amber
1:-:~urar.ce ::~!or:r.s .. ;ol ... e real
probleMs for r~a1 people. And :t
can happen Without turntng the
system on Its head." satd Gat!
Wilensky. a health expert m for·
mer President George Bush':!
Whtte House who now advises
congresstonal Republicans.
Wilensky. former head of the
Health Care Financmg Admmis·
tratton. sa1d that "it's 1mportant for
Congress to say to the Amencan
people: 'We can do somethmg, and
here's one piece. s1gned. 'sealed and
delivered.'"
She and other advocates of tn·
crementalism acknow !edge that
msurance reforms alone w11l do
little for the esumated 38 m1Uion
uninlured Americ:ans. But they say
that suc:h measures are a good and
realiltic: belinrun1.
force them to accept all applicants.
offermg the same rates regardless
)(a~~ -Jr h~al:h stat~s.
:\.~ -'""~:!! :1ealth ~efor:-:-: :Jrccc:'a.
~n!o:.-; broace:: 5uppor~ a~or.g ~he
publiC •)r memcers of Cong:-ess.
And :10 wonder.
Er:<::::~g 1J.<cr:m:natory :r.sunnce
p:: lC'.:ce; ·.4.·o·.wj :nstant1;.- allay
aeep ·seated iears of m1ddle -c:ass
Amer.cans that they m1ght :ose
~l)v~r::t~e when they change JObs or
he pr:ced -;ut .)f the :narKet '""'ht!n
·.he:.- :ecome 5er:ously :11. In poi:
1:·.~!' :JOil. >)1):::, to '50·"'~ or more -:f
····-pur.•-::en•.s :a·;:)r :;:.;ch :-eiorms.
But :here 5 a :"J1g httch.
1.·:1:ess accompanted by a re·
c;'~::-ement :hat everyone be in·
:;:,.re<i. :nsurance reforms would
:nean h1gher premtums · for the
:nsured and actually &nc,.east the
ranks of the umnsured.
That's because such reforms
would enable the s1ck and the
vulnerable to buy msurance. often
for the first ttme. Thetr h1gh health
costs would force tnsurers to tn·
crease premtums across the board.
What's more. the young and the
~P.Jlt!":y -cor. fronted by rtstng
~Jtes-mtght drop coverage. secure tn the knowledge that they
could buy insurance when they
r.eeded 1t. That in turn would
mcrease premtwna for everyone
eLse.
. ..
pponentl arsue that insurance
Thus would .._~cycle
that. experu la'J,
n the
reform.e alone are doomed to
deteriorauon of tbe
's health fail unlea they are ac:companied
care financllll sylteiL
by a requirement leadin1 to uni·
The proapec:t II JI'CIWinl that
venal ~verqe, suc:h u Clinton's
Co111"SS Will abuldan comprecon&roverlial propoaal to require
hensive health care retonn thil
all employ. . to pay a& least 80" of
year· and instead do little more than
workers' lnluranc:e premiums, wtth
try to remedy. the apparent short· . indivtduala pic:kinc up the rest.
comings of today's insuranc:e sys.
lnsuranc:e reforms alone "iuat
tem:
won't work," said Marvin B. Hall,
That approach could do more
president of the Hawaii Medical
harm than SOOC1 Dire warninp of
Servic:e .\an., the laraest iMUr·
the unintended c:orwequences of.
anc:e company in that state. ··You'd
inlnnnc:e reform are betniiOUnd·
puth COita even htfher."
ed by suc:h disparate analyst~ and
"lnlurance refOI'IIII by tbeal·
adveca~ u CONe"auve holpital
•lves W11l increue premiUIDI aub·
l&lnually beca.- you'd be alloW•
~ Mic:hMl Bramberl and
Flnt Lld,J Hllllry Rodllam CUD· till blck tn&o uw paup peapae no
tan. arcbl&ecl of PresideD& Clilnaa'a bave been al:luded prtmaril1 be·
0
I
cause of costs." satd John Rother.
lell:siau ··~ 1:re~:or )f ·. ~e A!'!'ter..
...
·,;:-
5hO:-'. :~:""!"!":.
.4·Gt.,;~ ~
.]
-.
-
~-:
:e !::".a ..
~~Sl·
nesses. ~ost 5\.:Ch refor:':'\.s be1r.g·
contemplated by Congress would:
glVe them a cho1ce of health plans:
by pooling them mto large. volun·
tary purchastng groups. thus af.
fcrdtng them lower rates en,10yed.
by large groups.
The btggest losers would be!
younger people. whose rates wouldt
:-:~e ;ha!1Ji:.- "You'll 5ee a bunch
t~at 5 ~ct:-:i§ :o •:ircp out. · ;a1d
R1c ~ar~ I. Sm1th. an analyst at the
Assn. oi P:wate Penston and Wei·
fare P!ar.s. .. And what problems
are ;~,·e sol ... tng tf ·oNe end up ;ust
producmg :nore unmsur~a·"
:-.·~a.-: ·)f
D. GradJson Jr.
W tllts Health lnsurar.c
the
of Amenca. agreed. ;a:•::-:z
~ .\.'En.
·~at
msurance ~eforms "CO'-"· : ... ,,/
have ;ust ~he oppos1te
· Ji
what IS Intended." He c:~e-l rJ\e1
expenence of New York state aa 1
pnme example.
There. a law took effect in April
of 1993 that barred trwurers from
settirt~ premiwna baaed on ap...
or health status and required them
to suarantee coverace to all.
After just nine monthl.
of
polic:yholders at Mutual of Omaha.
the larpst underwriter of indlvtd·
ua1 policies in New. York. aw their
premiums drop, ac:eordinf to Yedl·
c:ine 6 Health. a weekly ne'Wilet·
ter. But 60' experienced increases
of as muchu60,.
Meamvhile. tbe number of unift.
aured arew bf more Ulan 25,000.
Hoptnc to pave the WQ tar
national lnlurance marke& refarma
u a tll'l\ step CDWarcl braMer
reforma.
J. Rft1IDd
(D·GL)
Btllraldl (R·
Fla.) have ill&l'odue8d jull sucb a
bilL 117ia1 &bat i& II •dlqned to
N·d'Hirh tM lllltJl refanD ......
40"
a.
and..._.
.......................
........... fl.~
......... ot~
.clair tlaal &bat's • fir • tMJ l1lill
Wil1lnl to ..,... llicl Mu1in Carry.
A.AB.Pa dlree&or of federal ~&in.
'"But . . ~ &ba&'l pn&&ylbar\·
ltlbted..
Wlllalk7. eM ........ - -
"* - -...
CaD·
aul&a&. - - lip .... Will ,
,.... CDIId -
.........." ............
.............
..... - -·'
,... ce ,.....
. ..
oa .. , . _ .
'!~.'.
-···.
��.
;··
~~~~~~p~~;_;~;-~.c~,
·.
, ,.
;: .
~~~~~~~~~;;;~;
.-_:i ;Jtg)r~~~_:.···' :
C-"
··h ··_,: . . :·~,.i;)·.;:~::.:~).?r•·: . ,,~;:,:):.;;.,:~y.:Y.. ){.l·:·'>··n+ .
.:_;'
. ::;··'
.,
.
��"'U.OME. A ..J, .
uuD r:ss·•AAl\1
coNeR~ ~~,. ·
����$137
$101
biDion
billion
�Year 2000 Under Dole
!
I •
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'
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�- - - - - - - - - - ----··-
�AFSCME
!
I
I
I
.
�For Release on Monday,
July 18, 1994 at 12:15 p.m.
FOR MORE INFORMATION, CONTACT:
Janet Rivera or Sondra Dimond at
· 202-429-1130 or Ann Kempski at 202-429-1163
STATE MEDICAID COSTS WOUlD SKYROCKET
UNDER DOLE HEALm CARE BD.J.
Boston - A study released today at a news conference in Boston finds that Senator
Robert Dole's (R·KS) incremental health care reform proposal would put each and every
state in a "fiscal straitjacket" by shifting the burden of covering the poor and uninsured
from Washington to the states.
The study, conducted by the American Federation of State, County and Municipal
Employees (AFSCME), AFL·CIO, analyzed how each state would be affected by the Dole
plan, which calls for capping the amount of federal money spent on the joint state-federal
Medicaid program. The study was released today by AFSCME President Gerald W.
McEntee.
"There's a very basic: reason why America needs universal coverage," said McEntee,
"and the Dole plan makes it crystal c:lear. Unless every American has health insurance,
the rest of us will be stuck with their bills. The Dole bill is nothing more than a shell
game."
According to the AFSCME study, under the Dole bill, State Medicaid spending
would have to increase by $115 billion in the first eight years because the bill would
forbid the states from cutting Medicaid eligibility and offset the federal spending cap.
Costs of the Medicaid program doubled between 1981 and 1988, and then again
between 1988 and 1992. The nation's governors have been looking to President Clinton
and Congress for comprehensive national health care reform to contain those costs. States
now spend more on Medicaid than they do on higher education, according to the National
Association of State Budget officers.
The AFSCME study shows that the Dole plan .would only shift costs from
Washington to the states.
Over eight years, California will face $13.1 billion in additional costs, Texas will
face$ 8.4 billion, and New York will face $13.4 billion in new costs.
·
The Dole plan would limit the growth in federal Medicaid spending to six percent
per recipient per year from 1996 to the year 2000, and five percent each year thereafter.
The AFSCME study stressed the fiscal straitjacket this will put on states, since there is no
universal coverage under the Dole plan and no system-wide cost containment to keep the
costs of covering the uninsured and underinsured from falling on state governments. In
fact, the study points out that the Dole plan (Section III, p. 22) specifically prohibits states
from offsetting new costs by eliminating health coverage for anyone now covered by
Medicaid.
In addition, the Dole plan would make an across-the-board 25 percent c:ut in the
Medicaid "disproportionate share" program, which gives states additional funds for
hospitals and other providers that treat a large number of low-income patients.
Disproportiop.ate s~are payments are particularly important to N:ew York, California,
.
Texas, and Florida, which have a high number of undocumented immigrants.
-MOREAmerican Federation of State, County
and Municipal Employees, AFL·CIO
1625 L Street, Nw, Washington, DC 2003~-5687
Telephone (202) 429-1130
Fax (202) 429-1293
~~~
~~-·
�The Dole cuts in disproportionate share will translate into new costs to the states
of $41 billion over the first eight years of implementation, with $3 billion in new costs in
the first year alone. The report found this cut to be "particularly ironic, given that the
states most likely face an increase in costs for uncompensated care resulting from the Dole
plan's lack of employer mandate, insufficient subsidies, and incentives for small business
to drop coverage for low-wage workers."
The Dole changes in the Medicaid program would force the states to spend more
and more of their own money to cover the costs of the Medicaid program, according to
the AFSCME study. Instead of spending 20 percent of their general fund budget for
Medicaid in the year 2000 under current projections, the Dole plan states would force
states to increase that percentage to 23 percent in the year 2000.
'''
The following individuals are available for comment on the study:
•
Diane Rowland, Director, Kaiser Foundation Commission on Medicaid
(202-347-5270)
•
fun Verdier, Assistant Seaetary for the Office of Medicaid Policy/Planning
for Inidana Family and Social Administration (317-233-4455)
�••
SQUEEZING THE STATES:
The Impact of Senator Dole's
Health Reform Plan
On State Budgets
July 15, 1994
A joint study prepared by:
American federation of Sute, County and
Municipal Employees
and
Citizen Action
�I
Introduction
Senator Bob Dole has presented an alternative national health reform proposal
"'·hich takes a more ..incremental" approach to soh·ing the crisis in health care costs and
rising rates of uninsured Americans. The Dole plan would impose strict cost controls on
the federal share of the federal-state Medicaid program, which provides health care to over
30 million low income and elderly Americans. ~pecifically, the Dole proposal would cap
the growth in the federal share of acute care Medicaid to 6% per recipient per year from
1996 to 2000, and 5% each year thereafter. In addition, it would impose a 25% across-the·
board cut in the "disproportionate share" (DSH) program of Medicaid, which provides
additional money to states to help them compensate hospitals that have significant
amounts of uncompensated care.
This study assesses the impact these federal "cost containment" measures v.·ill have
on state budgets, since states are partners with the federal government in the Medicaid
program. The major findings are summarized below:
•
Absent uni,.·ersal coverage and system·v.·ide cost containment, the Dole plan "'·ould
simply pass additional costs dov.·n to state and local governments. In total, state
governments would have to spend 55 billion more from their ov.·n funds to cover
Medicaid costs in the first year of implementation than they would without
reform. Costs o\·er the 8 year period 1997·2003 would total an astounding 5115
billion.·
·
•
Some states v.·ould be particularly hard hit. Increased costs to state governments
v.·ould range from a low of S1.4 million in the first year for Wyoming to 5606
million in the first year for California. ~·er 8 years, California will face $7.5
billion in additional costs, Texas will face $4.8 billion, and New York will face
S12.7 billion more in total Medicaid costs.
•
The plans' proposed cut in the "disproportionate share hospital" (DSH) program
alone v.·ould mean states must find an additional $41 billion over 8 years to keep
the program funded. This would have a direct negative effect on the hospitals that
act as safety nets for uninsured and low-income patients. The plan also presents
the option of phasing out DSH altogether, which would represent a loss to the
states of $15 billion in 1997 alone.
e
States would have to spend more of their own tax doltars to compensate for the
loss in federal assistance. Whereas states are projected to spend 20% of their
general fund budgets for Medicaid in the year 2000 without comprehensive reform,
they would be forced to increase that to 23% if the Dole plan were to become law.
This will squeeze other programs states must fund, such as education and anti·
crime measures.
�Ironically, many state leaders have been looking to national health reform as means
of providing some fiscal relief from the constantly rising Medicaid costs, but the Dole plan
"-·ould only exacerbate the stress on state and local go\;ernments.
Summary of the Dole Plan
Senator Dole's alternative health plan is not detailed enough to assess all of its
implications on state budgets. However, its provisions which cap the federal share of
Medicaid and cut disproportionate share hospital payments (DSH) would result in clear
and measurable new costs to the states.
The Dole proposal would subject federal Medicaid spending for acute care services,
less DSH spending, to an annual payment cap for each state. This cap would be
determined by multiplying the per-capita amount times the number of Medicaid recipients
in the state. The cap "-'Ould allow this per-capita federal spending amount to increase only
6% a year from FY 1996 through FY 2000, and then only 5% each year beyond FY 2000.
The proposal also reduces Medicaid payments for disproportionate share by 25%, starting
in 1996, to help pay for subsidies for low-income individuals and families v;ithout health
insurance.
New Costs To States Will Be Unavoidable
.
.
The Dole plan specifically prec:ludes states from taking such actions as limiting
Medicaid coverage as a means to help off set these new mandated Medicaid costs. In
addition, the plan does not guarantee universal health care coverage nor require that
employers cover their employees. As a result, there will still be large nu·mbers of
uninsured and underinsured populations for Vr·hich state and local governments will
continue to be health care providers of last resort. Hospitals will still have to absorb
uncompensated care costs, especially public and teaching institutions, Vr'ithout the same
amount of offsetting assistance from the federal government. .
.
In fact, the Dole plan could induce small employers to drop coverage for low-wage
workers, increasing the burden on the public sector. The combination of subsidies for
low·Vr·age workers and no required employer contribution towards insurance may
· encourage employers to let federal taxpayers shoulder the burden of insuring the working
poor. The Dole plan even anticipates this effect by saying, "An employer that finances
health care coverage for any employee Vr'ould not be allowed to discriminate against any
employee based on his/her eligibility for a. low-income subsidy. Employers who violate
this rule would be assessed a penalty••• "1 How such a system would be enforceable is
very unclear.
1
sec Section C. 3., p. 7.
�Even the Dole plan's pro\'isions for cost containment from "managed competition"
are v.-eak. Purchasing cooperatives would be voluntary. The insurance reforms in the
small group sector could actually lead to higher premiums for that market, further
discouraging small employers from contributing tov.-ards health insurance for their
employees.
Like other versions of health reform currently under debate in Congress, the Dole
plan does riot assist sutes in providing care for undocumented immigrants. Moreover,
it takes disproportionate share funds "urrently u5ed by states to defray these costs, and
allocates them instead for lov•·income subsidies. Furthermore, the Dole plan makes cuts
in Medicare that will adversely impact public hospitals and teaching institutions which
also rely on sute financial support for both operations and capital investment.
All of these aspects of the Dole plan imply significant cost-shifting from the federal
government to sute go\·ernments, and from the private to the public sector. Since there
is no framev.. ork for overall cost containment in the Dole plan, states will be unlikely to
find snings v.·ithin their ov.·n programs to offset the new federal costs.
The Additional Financial Burden on the States
The total additional costs to state governments from h~ving to. absorb .Senator
Dole's proposed cap o~ federal acute care Medicaid spending ·and cuts to disproportionate
share total S115 billion over the first 8 years of implementation.
YEAR
1996
1997
1998
1999
2000
2001
2002
2003
Total Over 8 Yean
TOTAL NEW COST TO STATES
S 3.5
S 4.7
S 7.1
S 9.4
billion
billion.
billion
billion
S U.3 billion
$19.6 billioa
S25.2 billion
Slt.S billion
Stt5.0 billion
�TABLE l
\l1 hilc the cost· to state goHrnment of the federal cap compounds o\·er time, all
states will see additional burdens immediately. The following chart shov.·s the
implications of the Medicaid cap on a yearly basis for each state:
COST OF DOLE CAP (Dole Plan vs. No Reform)
,...,
...
TOTA&.
A&.
A6dltcNI
Colt ID I \ale
D.W,OI?
ll.m.•l
L7'0 7' dt.nt
Ale
a.••.a
AZ
,Y,C07.2'20
tO,CIC I»
as.•U.IIU
t.aeo.CM
Alii
CA
co
CT
01
cc
"'
...
CIA
..
...
ID
~
lA
ICS
rtf
I.A
"CI
..
...
1M
YN
we
...
.,'!'
~
Nl1
....
N.l
~
NC
NO
OM
oc
Olt
~A
"
IC
SD
1N
TX
UT
Vf
VA
WA
""
WI
W"f
,.,..
AMIIOWI
Coli to ....
IDdiOII
........
t.nlal
1,071,.,...
...,.....
a::a.•···"'
IWCILW
Uti.M
10.111 . . .
1:2..7,.161
7.1•?.W
7.CIIQ.sal
11171 &Sol
10,'111 . •,
•. U4.077
... .,1 ...7
lt . • ICII
11 . . . 111
110o008
11 ..... ,1
12.117.118
a ec~.7t7
11231.111
1.1'11.111
1.111.1.
........
·~--
lti,CIII&,I.
lt,ttt.ltO
u.o,l•
111.&11.617
lOdlCo~~
s..t•o•
IW.161
!IC llo6l. sa 1
~.QM,I ..
1'1.163.561
a.w.e.w
30,311.•.MC,'I'It
I I. I 11.&211
IUta.t"
17.131.511
7,064.111
1.1• a.ooe
.......,
...........
....., '·'"
11.580.1~
11.1... 251
tl.tct,.ltl
U.la7.8011
""*·'..
IUOO.MO
IO.Ma.4PI
• .011 . . .
Soi.UI.st7
38161 . .
10~-
tUIS.011
1.127. . .
•. ~.Ill
1171C..,
tt.2tol.lll
m.azs.M
......
Mcllcr'lll
.0,511.-
tii.JU.CIIO
tUU.017
IUIUC
COlli • ..,.
IDdiCIII
c.. ....
I Dale_,
lOGe_,
•.,.,...a.•
*
,,• .-.su
IC..ICQ
H.lta.~
•.oe:a..,...
loa.$41,1.0
417,, .....
10 .... ~.
».U6.6oll
.... ?,0.1
ll.ies,l?l
lti.JaO Ill
....
~-
11,111.II..... .,
tN,UII.OIO_
111.1101.-1 ..
17,12111,174
17,010...7
.,I'?I.MO
1lt,OOI.OU
.... ,.....
71.131•• 11
llt,i7t.lll
ID,NI,. .
ea.eu..a1
eo.s.o•r
...017,011
It, 117,CICW
····.. ..
11 ..... ,., .117
1U.M.IOI
• •,. •• 11
.?,111.101
tll,.nc,. .
1,«11 .• 71 ....
.. .aaa.JOO
eeeeeooo
ICO,Oit.W
U.121.001
.,,..,,I.
••. 001.117
10.721t.a7
~~.
'"'"I'MI
• . 101.111
n.A•o.Ot1
111.5oll,l17
17'0 ..... 161
..,_
11,717,010
..,••••,0
. . . . . . .7
a.ttr.a"
t71.1:11.0tl
·~ ...... 1
101 ..... 110
tOT ... r.ar
. . . . 101
17....17'11
11.100.....
11,?17.N
I""·"'
H.&&U71
til ..... ,
11,101.7ta
111,IY .• 7
1.~71 ...,
,.,..,,,.
.......
.....
···~··'
.,..
7,171,711
11.711.017..111
•••• ~1.«11,612
Ill.-.11.1 . . . .
.....7,a
m.llt,ta1
n.au71,7"
. . . I. . . .
,,,01'1. ...
1.MC.II7,11SC
1•. 101. . .
1tO.D.III
at.eec,, ..
7.SSU11 ...
7al,tii,UI
·ttO,IU,J"'I
t,11U01,14S
..7.117,:101
.. 71)1.7.
.......CIQI
-
a2.0iol
... 1... :10?
SU.J21 ... t
IC7,7'tl,107
uuaa.ao
a:uoua
Ml.t&S .•7
•.tti.OCII
. . . . . . .1
.......101
sse.&as,llt
ICII.ot1. ...
107.117. . .
11'1 .141 6lli
...001 .•
117. . . . . .
111.1171,.,1
117'1,011.1171
.......
• .101 ...
11.110.4
•.oa....
1.... ,1.111
ltl,r'O,M
.I.M.tOI
. . . 71C . . .
101.411 ,.,.
111,00.. . .
?1.72:11.1.
.......,.
..........
17,410,0N
... '191,711
. . . . . 711
I IO,ID7, n 7
1..........
.. ...
,..
a.at7.M
1CO.IOI.I'I
11,7'11,1 ..
.. .MS. . .
17,., . . . ,
too. no,,.
tlt,IIO•• t4
117,M• •
111Mt,711
11.077. . .
....
~~~..
···--,
......•
"···- ......,.
......
......u ..
t'l'I,IIO,t ?I
as .....,
..IIUII
11'1.01..011
ft.III,Ja7
.... teo.••
111 ,ltO,It t
...
. 7"l''.I4S-
10........
•..no.a
,.,.,., ,
18.1&1. . .
....07·121,017#»
10,741. . .
t,OIIJII.I74
tiO.D ..,..
.0,1111,1 ..
17• . • • •
.........711
1.,. ......7
IIUU,I71
2&31.111111
111.1'10. . .
-.s~ti.IOt
101.11'7...
71.7tU.
111.710...07
D.CO?.D
I.SM,tiO.IIO
, W.So17,011
110,.,1111
Itt.?... .-.
...,• • 7tot
t.IOollll,III,ClC7,1?1
17..........
I ,.. 7,461.017
m ... , ....
....11'1,,.
261.1'1...
...1117,111
11107.-
t7,llol.•••• ,, . . 171
111,101,1"
... ICIO.Ia
Ut.llt.a:M
101.?10.1:11
171.117.1'71
Ill .• ,.. . .
II .•UII
111.720..1.,
t:IC,IOI. 'I'QO
...,...
D,PIUal
lllt,.,..,l •
•o,~o~r.-
lot.IIO.OI7
..........7
•. ~.711
... 7'15.111
-~
ICIOI111.-.'17
1,101,7......
11.1'17,114
tll.-.7c
1U.SU.I •
ICiale-.
• .....Cial
1M.1'17.-
••• 71... ,
UOMt.N
••••7.1711,17t,ll71
10.11'1.174
...Oit,IOol
ec.a ....
ICIII•81J
......... . ,.... ......,....
......
.........
........ .......
••.ao•.•"'
............ w.···......
.....
........,.
"·'"·"·
...... .......
,........
....... .........., .,_......, •.•,,a.,. .........
........
,.,,,....
......... --···
........ ......... •...,,,. .,.,........
..........
,..... .........
. ,,,., I.,,.,...,
11,110.111
TOTA&.
AOOlOCCIIT
TO ITATI
c.r .....
... IDQ,C61
101,&U . . .
11.711.?11
....100...1
M,4S1,.o.l
•••. 161 ...
.........., ........ ........ ..,..,,.,
...... ........... .,,..,,.,,
.....,....
11.101aa
.. ........ ,...,.....
,.,..
,.,...
,...
A4cftcNI
COif IDI. .
.....• ..,.,.... •••..-a.ecw
.., ,..
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.......,.
...,..,.
........ ,..
•• Ill, I..
......1
tOO,• . JU
...... &10
n'JaQO
All•crw
. . . . .011
aa.t,Otl.•ec7.a11
ttUIIeo. • . • ,
lt,017..a
-,.1110,071
11'1..111.M
I.I07.ftt.aa
•w.o?a
.....,.
.......
.,......
.,.,
....11.007
IM.'l'l7. . .
'' 101.001,,.
11'!,171....
a .... .-
lt,I,.,NI
11'1......
111,?17.17.
1.0..,017, 101
. ..•71,. .
7.411..... , ..
'·" 1,100... ,
. . . . .1117
1,711,1U,.
1'11,111.11'1
•et.OI7
.........
........
,
117.-.7'01
tU.IJa• •
UIUQI,D7
1......071
U,loiO.111.017. . .
«11.101.711
I?I,DID,IG
407,111,101
D.I?I.M
~.ot . .tl
..... .......,.
.......
.......,
lttiiiMf
....... .......
... ,..,110
.....,.,
17.G.07t
1.......,
• . M ...
t.ltO.O..,JIO
1,07l.all,. .
.......,,,.
111 ••.111
.
�TABLE 2
The cut in the disproportionate share program alone represents a significant Joss
to many state govern~.ents. For example, as the follovring chart shows, California, New
York, Texas and LouiSiana v.·ould suffer the greatest losses in federal aid from the Dole
plan, and would have to turn to their own state resources to compensate hospitals.
TOTAL LOSS IN DISPROPORTIONATE SHARE
..
.......
......
.....
...
..
TOf~
.,
M
lA
eA
co
Cf
01
DC
"'
..
GoA
c
...
.L
..
ICY
...
""
MD
lilA
..
.,,.
...
Ill
1110
Ill
...
..,
w·
..,
.,.,
•c
110
~
Clio
,,.
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IU
IC
10
"'
Tl
"'
~
...
VA
..,
wv
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D
...
""'
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..
.. ...
.. ....... ....... ..... ...... ......
.. ,...., "'.. .. "'..
...
....... ......
......
...
,.
,.,.
.,....,.,,.
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..
...........
..,......
, ..... ..,...,..
.,.
.,.. ,....
.....
....
,.,.,.
..,
.....
.....,
....... ,,.......
.,..•, ...... .......... ....... .....,..., .
.......
...........
"....,.,..... ...,.., .....
.. .,
......
..... ........ ...... .......... .,..... .........
....... ...
............. ...... ··.,....
,
....,
........
..,....,. ...... ......,., ...,...... .......... .·-·-- .....,.
....
.......
...... .........
....... ,.,.... ,.......
......... ...... ......... ,....... .....
...•. "
·····',.. .... .,. .......... ........ ....... ,........
........
...,...,
....... ..,..
,.....
tyiK
U».71UDI
1•., ... "
.~~~~
III,WI.l'll
•o.aa..u
a.M.••
·~.ua.-
••••• .0141
I&MLI ..
a. a•.~•
.....
• . tOt
712 ...
l11.t7t.l71
• M.III
aa.N7.1U
1.661.11:111
11.011.011
I • . , ...
1».171
U.t?'l,_.
-~,
Tl ..a.CTt
1,1?'1.111
..... na
DO."" ....
U.661.111
....... 1.
10t.I'IC.I7e
I ......
11.6&1.117
l..m7.1t7
10.717,&17
10.1'\1,,.
ft»f ...
•o•'·"'
lti.IIO
UIO.a&.UI
117.117 ell
ll.tD.III
U.IOI.I.
I.OM.IIt
7DU71.7..
. . . .171
111.7·lf.l . . .
.,. . l.nl
1,171...
711.e\O,JII
...I .
1.......
La All
........ 1
211.011.111
u.n..a11
,
I ......
,.,..... ,
....
~
I,IDI . . .
as..aa.•
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4Utt.tiT
,
,
10.»1.-
······?D
U.DI.tlol
JIU ......
.,,,.,1•
tt.»UU
........
....,.... '""·'"
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., .,. .......
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..........
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.... .,,,..,,,
···'"*
.,,...,... ......,
.... ,.
....... ......,....
IILI?'I.tf7
IIC.tti#Tt
• . ., ... I
.,.1.711
.. .,,Itt
lnt.ltl
II.TIUII
,., .... I,
14.-a..a.
, .... I....
, ..... 1•
11.-.1 •
,.,,
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117.•1
....,. ,.
,..,
_..,...,
11.171....
111.111.111
...nt.MI
f7 ...... 1
II.IIA.M
1'1..... 11
lti..M4.Pa
.... 1..., •
... lit."'
I I _ ...
Ull
117 .......
, ..... 1.
Itt .-..a
,
?DMD.-
..,.
tiU....,,..,
, ,.
....,
.......
11,117...
.~,,.;,ttl
1. . .,..
...
_.,
,. ,
D.lll.at
,.
ttf,lll-
,
,,,.~
,
17.11 ....
lUll ...
,.
,,
16t.I14AII
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,
..,,..,,,.
,
'""""
•m.aa
,
Lilt
,
.....,,
I
.,.....
.... 111.111
ur?.rPI
,,,,.,
,,. ,
, ...,.
,..,,J.
lAtA liM
,.
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""'""
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111,17D,tll
17t,tll.lll
•...... 1.
..
,.,, __
"''"tO.wa.••
...,
,..,a.,,
,
~---
,
Ull-
om.-
..,..
••••
.....
····- .......
ttl .Ill-
1.1. . . .,,..
....... I.
• ......1.
I• •,,,.
10.111-
...........
..,....
..,.,. ,. ,....,,.
ua.••
.... I ...
1..........
...... I. .
1.001. .,
IU.OII
11-M""
--~-
IIMI.44f
. .... ..... ...........
...... .......... . . , ···-....
....... ........ ........
. .....
.......
...
... ..
........ ··-.. _ ....... . ... ...
.... ..,.
....... .,.... ........ .........
...
........ .. . .... .. ·.. ·- ........··-,. .···"' ......... .........
.•.
......
•.. .... all- ........ .
....... ....,. ....... ......
..... .
........
...... ... .......
........ . ....
... ...
..... ·····7U. ...
IIC .......
WIMTMI
,..I •. ICT
,
Ill1,ttl.117
I .Ill.1.110.101 ...
1.711.112
........71,
17.~.. ••
"1. . . . . . .
Ill ......
. . . . .M
eoa.a?D.I11
, . . .7.141
&A7UII
11..177.'11
1&1111-
..
.... ,.,,......
'"....
. ....... ..,...... .......
l .....m
T.I&I.IIT
61.III.IU
17Q711 ...
llriK
...m.•tt
Ill.»·-
DIM
...... ···"' ....,.,...
......
........
,..... .......,. .......
.....
.. ,.. ....... .........
......,..
.,... .
.,. .. ......... .,.,,.,,.
....
......... ........ ---,.... ....,.
..... ,.....,.... ..,...
...
......... .......,... ........
...,.....
,
...,... ..........
......... ...,.....
.,..,.,..,,.,. ....... ........
..,,.... .
,.......
.....
...,., .,.........,.,..,.....,. ........
.... ..... ........
,.,.. .
....... ......
..... ......... ..........I
....... . ··-JI'
.......
....... ..,... .....
..•,. ,,.......... .........
..,.
.. .. ,,.. "....
........ ...... ........
........ ..... ........
U'l , ... ........
.,.......l- .....,...... .......,.
......
•••••
....
.... ...,......, .......,,,
...... . .....,. ...........,.
....... ........ ....,...,.
...,..,. .....
.,....
. ...... ....... .......
...... . ,...
......."
. ..... ....... .........
""'""" ........ ........
....,.......
fUll.toraa.an
IIIII-
'"'..
......
,.,._
,
Clef
I .I MMD
II.IS1..,
auDI
,
,.,.I
IM.IU-
.
• ... 1..,., ...
1........
Uti
,,,,,..,.
•
T811TJII
...,.
.....t?D
--
�TABLE 3
'.
- Total Shortfall Due to Dole Medicaid Cuu
-
. TOTAL SHORTFAll.
ACUT!&DSH
Nawoo:l
Sta,.
TOTAL
AL.
AK
11 ••711.121,4H
2.238.23t.ID
AZ
2a3.02e.:l70
1.14, ,511.211
AA
CA
00
CT
13.071 • . •
1,oeo.t17.Ht
1,44t,f/JJ7.270
ce
oc
Fl.
GA
HI
10
IL
IN
lA
KS
KY
I.A
ME
MO
MA
Ml
MN
MS
MO
MT
Ne
NY
NH
NJ
NM
NY
NC
NO
OH
OK
OR
PA
AI
~.8N.112
1~.024,581
430,070.512
3.957.78S.375
2.M7.278.a.c2
286.318.710
21e.nuu
2.91'.682.500
1.887.812.230
5Q5.882.T71
1,040,751,113
1.t2::U02.4N
l.e:M. 100,801
130.668,010
1.3:11.043.132
2.77'!.540,451
3,1S7,121.5e1
1.053.011,718
1,4e1 .881,824
2.W,87i.Ht·
2M.S4t,283
~1.110,442
381.131.7M
2CU57,785
4,411,117,M4
581.122,141
1S.37'S.en .2M
l.7'00,CIIO,U1
282.184.004
3,Me,OSI.1M
112,141,210
7$C,CXM,SM
1.240,$84.112
111.110.117
sc
so
2.321,081.121
182.d,417
TN
TX
UT
VT
1,117.801.204
•.314,..,.. .,
447.024,431
WA
201,T7t$
, .211,171,151
1,124.«*.221'
WI
1.232.211.
VA
wv
WY
1.
1,417,<*~
, , , . , , .
0
�..
.
METHODOLOGY
t.
The 6% Per Recipient Cap on Federal Medicaid Acute Spending
Medicaid expenditures for medical assistance arc based on Health Care
Financing Administration (HCFA) form 64. From this total, skilled nursing
facilities, ICF/MR, and DSH expenses were subtracted.
Recipient data taken from HCFA form 2082. Skilled nursing facility and
ICF/MR recipients were subtracted to give acute care recipients. Projections for
the number of Medicaid recipients are based on HCFA's national estimates.
Projections for federal cost per capita arc based on Congressional Budget Office
(CBO) estimates.
Federal cost per capita
a
Acute care expenditures/FY 93 acute recipients.
The difference in the cost per capita under Dole is the uncapped projections less
the Dole capped projections for each year. This difference is then multiplied by
total recipients and added to each s~ate's share of total Medicaid costs.
2.
Disproportionate Share Cut of 2$%
HCFA projections for disproportionate share for· 1996 through 2003 :were
reduced 25°1~, and these cuts were distributed across all 50 states according to
their 1993 shares of total disproportionate share spending.
3.
State Budget Projections
All state general fund FY 1993 figures come from the National· AssoCiation of
State Budget Officers (NASBO), as reported in Fiscal Survey of the States, 4/94.
State· Medicaid expenditures are derived from HCFA cost reports for FY 1993.
These were compared with total state Meditaid spending as reported by
NASBO, and in most cases agree (sec notes at bottom of tables).
Budget data was projected based on the following assumptions:
a.
State general fund budgets will increase on average by 7% annually (this
is the nominal average from FY t 979-94, according to NASBO).
b.
Total state Medicaid spending will increase 9% annually without system·
vdde health care reform (i.e. the DQie Plan). This is lower than recent
experience, and is taken from 1994 CBO projections and HCFA
preliminary estimates.
c.
The "Dole effect" of capping federal Medicaid expenditures per recipient
is then added to the state share in each year beginning in FY 1997.
�CHA
�' 't
..
For Release: Immediate
~tonday. July 18. 1994
Contact: Laura Quinn. 202-224-6472
Senaror Rockefeller's Office
Charles Leonard, 202-289-5900
for the Catholic HeaLth Association
Lawrence Lewin, 703-218-5500
for Lewin- VHI
Sn.JDY CONCLUDES THAT INCREMENTAL REFOR.\IS WOt.JLD FORCE
~liDDLE I~coME FA.\ULIES To PAY ~loRE FoR THEIR
IIEALm CARE
Insurance Reform Proposals, Without Universal Coverage, Found to Drive Up
Health Care Spending for Insured Families Making Between $20,000 -$75,000
Senator Jay Rockefeller (0-West Virginia) and Senator Patty Murray (0. Washington) today released the fmdings of a new Lewin-VIU Study that was
commissioned by the Catholic Health Association to measure the impact of several ·
health reform plans on household SJ)ending for health care at various iricome levels. A
central fmding of the study is that a 'lnanaged competition" approach, or insurance
reforms linked to subsidies, but without universal health coverage, significantly
increases household health costs for families making between $20,000 and $7S,OOO per
year.
'What this study shows is that an incremental approach to health care. reform,
and failure to enact universal coverage, will have a substantial impact on virtually all
but the wealthiest families in America. Any Senator who advocates a non-universal
approach will now have to explain why he or she is backing a plan that forces middle
class families to pay more for health care without giving them any additional health
security, .. Senator Rockefeller said.
'tncmnental reform will force families making between $20,000 and S7S,OOO
per year-- aDd that's almost 60% of the families in America-- to spend more on health
care. In contrast, a universal coverage approach, linked to cost controls and employer
· contributions, would lower spending on health care for every insured family making
less than $100,000. What this information tells us is that the ..o slow idea" on bealth
reform is the equivalent of putting a 10 m.p.h. speed limit on ambulances- it's
costly and it's dangerous," Senator Murray said.
care
1nsurance reforms, without universal coverage, causes higher premiums
because coverage would be extended to older adults and people with pre-existing
- - - -
----------~---------
- ---
------
�2
conditions -- people who typically consume more health care -- without the offsetting
factor of extending coverage to all of the presently uninsured. many of whom are
young and healthy. Higher premium costs would in rum cause many small businesses
and young people t6 drop their insurance coverage. Year after year. the result would be
a vicious cycle of upwardly spiraling health insurance premium costs. The failure of
incremental reform can already be seen in New York State. which enacted insurance
reforms without universal coverage, and insurance premiums shot up 18% in the fl.rst
year," said William Cox, vice-president of the Catholic Health Association, who
commissio~ed the study.
'First the opponents of comprehensive health care reform said no to cost
constraints. Then they said no to requiring employers and employees share costs. Now
they are saying no to universal coverage. Every time the incrementalists and
obstructionists say no to real reform, what they are really saying is yes to higher health
care spending for every insured middle income family in America. The time has come
to say no to the incrementalists, and reject their phony reform ideas, before they ever
get the chance to give the rich a break and put billions more on the backs of the middle
class," Senator Rockefeller said.
The Catholic Health Association of the United States, a member of the
Management Committee of the Health Care Reform Project, represents more than
1,200 Catholic-sponsored facilities and organizations. The members, located across the.·
country, make up the nation's largest group of not-for-profit health care facilities under
a single form of sponsorship.
-30-
�Household Spending Implications of Health Reform
"Our analysis shows that premiums are lower under universal coverage than under
i11surance market reform linked to subsidies. Further, we estimate that middle income families .
tllat currently have insurance will pay more in general for health care under partilll refonn thtm'
u11der reform that includes universal coverage. In addition, for currently insured households
ean1i11g less than $100,000 annually, health spending will decline under universal coverage with
a11 etnployer mandate a11d cost constraints.''
-uwin-VHI
July 18, 1994
�Impact of Health Care Reform on
Insured_, Middle· Income Households
(with wage effects)
• Universal Coverage Wrth Cost Constralrrts 0 Incremental Reform With Subalclea
(Health Security Act) .
(Managed Competition Actt
3500
3000
2500
2000
$7.8 Billion
In~rease in Spending
1500
1000
500
0
...
-500
-1000
-1500
-2000
$20-29.999
$30-39.999
$40-49,999
Annual Household Income
~oatn:
t:atltnlk Rnlth
A.~tian
bawd on Lf'win-VRI sa.dy:
Co.,.,,., l'rr"'lu"' 111111 Housrho/4 S,f'IIIIIIIR l,klltloru of Hf'lllth Rrfimll, Ju/1 IP94
$60-74,999
�Impact of Health Care Reform On
Insured, Middle Income Households
(without wage etTects)
• Universal Coverage With Cost Constraints D Incremental Reform With Subtldles
(Managed Competition ActJ
(Health Security Act)
~00.---------------r---------------~------------~
4000
-b===-----------
3000
$15.9 Billion
Increase in Spendiq
2000
1000
0
-1000
-2000 +--.......;:
-3000 + - - - - - - _ _ _ ; ; :
4000+---------------~----~------~~------~
-5000 ...________________
L.._.._ _ _ _ _ _ _ _ _ _ _ _
$20-29.999
$30-39.999
____...J.____ _ _ _ _ _ _ _ _ _---J
$40-49.999
Annual Household Income
Soarte: Catholic' Hf'JIIth AMoriatioll ba.wd 1111 f.Aowia-VHI Study:
Co•mtl'· l"rrmlum off4 Hoarltolll Sp,Ubll lrrrpllnlloa of Rftlllh Rrform, }"" 1994
.&0-74.999
�Impact of Health Care Reform Proposals on
Insured Household Spending.
(with wage etTects).
• Universal Coverage With Cost Constraints 0 Incremental Reform With Subsidies
(Managed Competition Act)
(Health Security Act)
$400
$300
$200
$100
$344
$201
$137
$0
($39)
.,
($100)
($200)
$20-29~999
$30-39.999
$40-49.999
Annual Household Income
Soan'P: t:adlalir H..... A.UIIC'iatinn bawd on l....nn-VHI Study: .
l'flt'-fr, l'rrlfllulfl • • Hourlro/4 .'ipr-btr l,katlo, of Hrallll Rrfon~~, } , 1994
$50-74.999
�Impact of Health Care Reform Proposals on
Insured Household. Spending
(without wage efT~ts)
• Universal Coverage With Cost Constraints C Incremental Reform With Subsidies
(Health Security Act)
(Managed Competition ActJ
$500
$400
$300
$200
$472
$358
$340
$293
$100
$0
($100)
($200)
($300)
($400)
$20-29.999
$30-39.999
$40-49,999
$50-74,999
Annual Household Income
Snuwn: t:athniK Hl'lllth A.'Wil'iatinn hawd on LPwia-VHI Sctnly:
f"oa·rmRr. Prrmlrlm orr4 Hor.urhold !iprrr411fR lrrrpliclllloa of Hftllth Rrform, Jut, 1994
. i
�The Vicious, Upward Spiral
The Impact of Incremental Reform on Insurance Premiums
Insurance refonns extend
coverage to the sick and ·
older higher users of health
services
Additional premium
increases drive out more
young, healthy people and
small businesses
insurance
pools further increase
the level of risk for
those who remain in the
. pool, which in tum,
escalates premium costs
Without universal coverage
to ensure· that low-risk
individuals are included in
insurance pools, the average
level of risk increases
~hr-inlr·in ..
Higher risk insurance pools
result in premium increases
for the currently insured
causesing many healthy
individuals and small
businesses to drop out
�..;·
,,,;
.......·...........•..;,.,; .·..... :.
;
:·::::.;-;;;.;·.
;;.".
.;.;.·:::-.:::.···.
PREPARED FOR:
THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES
DIVISION OF GOVERNMENT SERVICES
WASmNGTON, D.C. .
PREPARED BY:
ALLEN DOBSON, PH.D.
JEFFREY K. BLEND
ROBERT MECHANIC
LEWIN· VID, INc.
JULY 18, 1994
94FM0/80
�EXEClli'\"E Sl"'DDARY
The ongoing debate on national healthcare reform has recently focused on President
Clinton's insistence that the final bill include universal coverage. Three congressional committees
have reported-out bills with universal coverage while the Senate Fmance Committee recently
completed work on a bill which achieves partial coverage. This paper estimates the number of
persons covered under selected partial approaches to health reform and then quantifies the
differences among partial and universal approaches with regard to: health spending for persons
who remain uninsured; insurance premiums for those who are currently insured; and household
spending on health care. We compare:
•
Insurance market reforms alone;
•
Insurance market reforms combined with premium subsidies as in the Managed
Competition Act (whose lead sponsors are Representative Jim Cooper (D, TN) in the
House and Senator John Breaux (D, LA) in the Senate);
•
Universal coverage as applied to the Managed Competition Act (individual mandate)ES- 1 ;
and
•
Universal coverage under the President's Health Security Ac;:t (employer mandate) ..
The bills recently reported-out by the Senate Labor and Human Resources Committee and
the House Education and Labor Committee include universal coverage and are similar to the
Health Security Act. The bill reported-out by the Senate Fmance Committee and legislation
recently introduced by Senator Bob Dole include insurance market reform and s1,1bsidies, but not
universal coverage.
Our analysis shows that premiums are lower under universal coverage than under
insurance market reform or insurance market reform linked to subsidies. Further, we estimate that
middle income families that cwtently have insurance will pay more in general for health care
under partial reform than under reform that includes universal coverage. In addition for cwtently
insured households earning less than $100,000 annually, health spending will decline under
universal coverage with an employer mandate and cost constraints.
ES-1
lbe Managed Competition Act as written does not include universal coverage. For illustrative purposes only, this
analysis assumes an expansion of tbe Act to include aU persons.
94FM0/80
i
LEWIN· VHI, INC.
�l.VSC:RA.VCE COVERAGE
We estimate that il)surance market reforms alone will cover about 1.1 million persons. or
about three percent of all persons projected to be uninsured in 1998 (Table ES-1). When these
refonns are linked with subsidies as specified in the Managed Competition Act, about 40 percent
of the uninsured would be covered. This would leave about 22.3 million uninsured persons in
1998.
TABLEES-1
Nl'MBER OF PERSONS REMAL--.ISG UNISSURED UNDER SELECTED APPROACHES IN 1998
•· N&Jmber of Penons 'Daat:
.··
.
..
Become
Insured
(millions)
Remain
Uninsured
(millions)
37.2
·.. Percent.·
Reduction
Insurance Market Reform Onlya
1.1
36.0
3.0%
Insurance Market Reform with Subsidiesb
14.9
22.3
40.0%
· · Reforin Scenario ···
·Current System
a
Insurance market reform includes guaranteed .renewability and portability, Hmits on pre-existing condition
exclusions and community rating for individual and small group (under 100) mUkets.
b As specified in the Managed Competition Act. 100 percent premium subsidy for persons with income below
poverty and sliding scale subsidies for persons up to 200 percent of poverty. Tbe Act also includes changes in
the tax deductibility of premium payments.
· Source: Lewin- VHI estimates using the Health Benefits Simulation Model (HBSM)
EXPENDITURES FOR THE REMAINING UNINSURED
Under current policy, the uninsured would consume about $45.4 billion in health Services
in 1998.ES·2 Persons who remain uninsured under the Managed Competition Act would continue
to consume about 55 percent of this amount, or $24.8 billion. This amount includes out-of-pocket
spending, free care provided by physicians, hospital uncompensated care, and care provided in
public hospitals and clinics. Overall, about 97 percent of national health spending would be
covered through insurance under the Managed Competition Act.
Much of the remaining care for the uninsured would continue to be financed through cost
shifting to the privately insured. As markets become increasingly competitive, physicians and
. hospitals will be put under increasing pressure to either avoid the unins~d or lose financially. In
this way partial reform could perpetuate the destabilizing effects of the cost shift.
ES-2
Assuming a benefits package comparable to that of tbe President's Health Security AcL
94FM0/80
u
LEWIN• VBI, INC.
�CH.4..\'GES IN INSURANCE PREJIIUJIS FOR THE CURR.E.VTL'f 1.\'SFRED
In general, we fin~ that average premiums would increase if coverage were expanded
through insurance market refonns and premium subsidies (See Table ES-2). This is because those
who would obtain coverage under these policies would tend to be individuals in relatively poor
health who are above average users of health services.
TABLEES-2
NUMBER OF PERSONS AND NATIONAL AVERAGE PREMIUMS FOR
PERSONS UNDER ALTERNATIVE REFORM SCENARIOS IN 1998
Reform Scenario
Currently Insured
Insurance Market Reform Only'
Insurance Market Reform with
Subsidiesb
Universal Coveragec
National Avera2e
Monthly
Size of Pool
(in millions)
Per-Capita
Premium
a
Premium for an
Insured Family41 ·
---
$172
$176
$182
185.6
186.8
200.5
222.8
Increase In
Average Annual
..
$104
$260
$175
$78
0.
. .
..
Insurance market reform mcludes guaranteed renewabaliry and portabaliry. limits on pre-eXJsnng condinon ·
exclusions and community rating for individual and small group (under 100) markets. . .
b As specified in the Managed Competition Act. 100 percent premium subsidy for persons with income below
poverty and sliding scale subsidies for persons up to 200 percent of poverty. The Act also includes changes in
the rax deductibility of premium payments.
c For consistent analysis. universal coverage is based on the Managed Competition Act expanded to include an
individual mandate. An employer mandate could be used to attain universal coverage as in the Health Security
Act The premium changes shown in this analysis would be the same under either mandate because we focus
only on premium amounts regardless of payer.
d Change in average premium compared to premium without reform. All premiums have been standardized to
the Health Security Act benefits package.
Source: Lewin-VHI estimates using the Health Benefits Simulation Model (HBSM)
lbis increase in average premiums is largely averted under a program of universal
coverage because such a plan would require all individuals to participate in the insurance pool
including ~thier individuals who receive little health care. Specifically:
•
ES-3
Without refonn. the overall average monthly premium for currently insured persons would
be $172 per person in 1998.ES-3
This premium amount for 1998 is standardized to reflect the standard benefits package in the Health Secwity Act. The
benefit package is used throughout this analysis because the Managed Competition Act does not specify a standard
benefit package.
9-IFM0/80
iii
LEWIN· VHI, INC.
�•
Subsidies linked to insurance market refonns (as in the Managed Competition Act) would
increase average monthly premiums from S 172 to $182 for persons who already have
coverage. This amount translates into an annual increase of $260 for currently insured
families.
t
Going beyond the Managed Competition Act to provide for unive:sal coverage would
lower the average monthly premium to $175 per person as healthier persons are brought
into the insurance pool, less than 2 percent higher than the average premium paid by the
currently insured. This translates into an annual increase of about $78 for a currently
insured family in 1998.
It is impOrtant to note that a universal coverage program would require a net increase in
federal premium subsidies. For example, we estimate that an expansion of the Managed
Competition Act to include universal coverage would increase federal subsidy costs by S17 billion
and reduce tax revenues by $11 billion in 1998. However, federal subsidy costs would vary by
specific proposal.
Universal coverage also reduces consumer exit and entry into health insurance markets
because if people can move freely in and out of the system, the healthy will tend to avoid
insurance coverage until they become ill. The Managed Competition Act addresses this by
permitting six month pre-existing condition exclusions which encourages people to maintain
insurance coverage. To the extent that this issue is not addressed in a reform proposal, premiums
are driven up, encouraging more people to become uninsured.
CHANGES IN HOUSEHOLD HEALTH SPENDING
In addition to the effects on premiums, we examine the impact of insurance reform linked
to premium subsidies and universal coverage on ~et household health care spending. This analysis
accounts for household premium payments, subsidy policies, tax deduction re\jsions; and wage
effects resulting from changes in employer costs under health reform. Specifically, we compare
changes in household health spending for the under 65 population across: the Managed
Competition Act as written: the Managed Competition Act coupled with universal coverage: the
President's Health Security Act as written; and the Health Security Act without premium growth
constraints.
On average, all reform scenarios reduce spending of households earning less than $10,000.
- The Health Security Act also reduces spending for families earning less than S100,000, assuming
that employers absorb the 80 percent share of the premium they are required to pay under the
Act. Generally accepted economic theory suggests that most of these employer costs are shifted
to employees in the fonn of wage reductions. When this "wage effect" is considered, all of the
reform scenarios result in some additional costs for families earning $20,000 to $75,000, although
the amounts are generally higher for the Managed Competition Act with universal coverage than .
for the Health Security Act.
94FM0/80
iv
LEWIN•VHI, INC.
�For the 76.5 million households that currently have insurance. we estimate that health
spending is generally higher under partial reform than under universal coverage with or without
wage effects.ES 4 Figure _ES-1 shows the net changes in household health spending for the
currently insured population in 1998 by family income accounting for wage effects. Figure ES-2
shows the same effects but does not include the wage effect. .
Currently insured families earning less than $10,000 a year see a net decrease in health
spending under all four approaches, but middle income families that already have insurance
generally see an increase in spending under the Managed Competition Act with or without
universal coverage. These middle income families also spend slightly less under the Managed
Competition Act if it includes universal coverage because average premiums are lower when all
persons are brought into the pool.
Of the three universal coverage approaches, the Health Security Act as written is the only
one that reduces household spending for currently insured middle income families, with or without
wage effects.
ES-4
To estimate the wage effect. we assume that 88 percent of new employer costs (based on econometric studies) are
eventually passed on to employees in the form of wage reductions, tlllll that 88 percent of new employer savings are
generally passed on to employees in the form of wage increases._
94FMOJ80
v
LEWIN·VHI, INC.
�FIGlllE ES-1
NET CHA..'iGES L'i HOt:SEHOLD HEALTH SPE~Dl'tG l' 1998 FOR CURRE~TL Y I~St:RED
POPt:LA1101" UNDER AGE 65 BY L'iCOME
WITH \\'AGE EFFECT
$600
$400
$200
·······a······
...
so
"""'d!'--~
····•······· ....•·
.··•
. ·· ...•....... ····•·················
($200)
($400)
($600)
-Managed Competition Act As Written
-Managed Competition Act With Universal Coverage
··• ··Health Security Act With No Premium Growth Constraints
· · • ··Health Security Act With Premium Growth Constraints
($800)
($1.000)
($1.200_1
Under
$10,000
SlO.OOO •
$14,999
SlS.OOO •
$19.999
$20.000 •
$29,999
$30.000 •
$39,999
$40.000 •
$49,999
$50,000 •
$74,999
$75,000$99,999
$100,000
aad Over
Source: Lewin-VIn estimates using the Health Benefits· Simulation Model (HBSM).
FIGURE ES-2
NET CHA'iGES l'i HOUSEHOLD HEALTH SPESDL'iG IN 1998 FOR CURRENTLY INSURED
POPULATION UNDER AGE 65 BY INCOME
WITHOUT WAGE EFFECT
$600
$400
$200
$0
($200)
($400)
-Managed Competition Act As Written
-Managed Competition Act With Universal Coverage
··•··Health Security Act With No Premium Growth Constraints
($600)
($800)
--•·· Health Security Act With Premium Growth Constraints
($1.000)
($ 1.200)
l'nder
$10,000
$10,000.
$15,000.
$20,000 •
$30.000 •
$40.000 •
$50.000 •
$75,000·
$100,000
$14,999
$19,999
$29,999
$39,999
$49,999
$74,999
$99,999
and Over
Source: Lewin· Yin estimates using the Health Benefits Simulation Model (HBSM).
94FMOJ80
vi
LEWIN· VHI, INC.
�COVERAGE, PRE:\tlt':\1, A!'\D HOUSEHOLD SPDiDL~G hiPLICA TIO~S
OF IlEALTH REFOR\1
The ongoing debate over national health care refonn has recently focused on President
Clinton's continued insistence that any bill he signs must provide health insurance coverage for all
Americans. The President's Health Se.::urity Act requires that all employers provide health
insurance coverage to their workers while non-workers would be eligible for subsidized coverage
through regional alliances. In contrast, a number of bills which attempt to expand insurance
coverage without a mandate have received significant attention on Capital Hill including the one
passed recently by the Senate Finance Committee. These bills range from incremental refonn
based on restructuring the small group insurance market to the Managed Competition Act
(MCA).
In recent weeks. considerable attention has been given to the Managed Competition Act
for its potential to cover 91 percent of all Americans while accounting for about 97 percent of
potential national health spending. 1 Relatively little attention has been paid, however, to some of
the important financial implications of expanding insurance coverage without universal coverage,
especially the impact on health care financing for the remaining uninsured and insurance premium
.levels for families who are currently msuredo
0
In this study we compare four reform approaches:
•
Insurance market reforms alone;
•
Insurance market reforms combined with subsidies as in the Managed Competition Act;
•
Universal coverage as applied to the Managed Competition Act (individual mandate)2; and
•
Universal coverage under the Health Security Act (employer mandate).
The pwpose of the analysis is first to determine how many people remain uninsured under
the various refonn options and then to determine the consequences of leaving portions of the
population uninsured in tenns of:
•
Health spending for persons who remain uninsured;
See "Expanding Inswance Coverage Without a Mandate" prepared for the Health Care Leadership Council by Lewin· VHI.
May 18. 19940 The estimate of covered national health spending assumes those insured have. the standard benefits package
specified in the Health Security Acl
2 The Managed Competition Act as wriaen does not include universal coverage. For illustrative purposes only, tbis analysis
assumes an expansion of the Act to include all persons.
·
I
94FMOJ80
l
LEWIN· VHI; INC.
0
�•
Per-capita health insurance premiums for persons currentlv insured: and
•
Average household health spending.
The report addresses each of these issiJes in tum.
COVERAGE U~nER THE REFOR..\f AL TER!IJA TIYES
I.
We estimate that there will be about 37.2 million uninsured persons at any given point in
time during 1998. 3 This estimate is based upon detailed insurance coverage data reported in the
1987 National Medical Expenditures Survey (NMES) data projected to future years based upon
insurance coverage trends reponed in the Current Population Survey (CPS) data for 1987
through 1993.4
A.
Insurance Market Reform
Insurance market reforms are intended to regulate medical undeNTiting and other barriers
to coverage. Medical underwriting is a process by which insurers review the health status of
individuals (or firms) who apply for insurance to detennine whether they are an acceptable risk ..
Insurers often decline to cover individuals and/or groups due to their' health status and are· allowed
to vary premiu~ with the health status. of the individual nl.akiiig cove~ge more expensive for
some populations. These insurer practices leave many individuals uninsured, either because they
(or their f1Ill1) are denied coverage or cannot afford the higher-than-average premiums.
The most common insurance market reform proposals attempt to address these problems
by assuring that all individuals can obtain insurance at a group rate regardless of their health
status. For this analysis, we also assumed that pre-existing condition exclusions would be limited,
insurers would be required to renew policies upon request, and that premiums would be
community rated for individuals and small groups (under 100) markets. We estimate that these
insurance market refonns would reduce the uninsured population by about 1.1 million persons
(Table 1).
3
4
This and the other estimates of tbe uninsured in this paper are described in more detail. including data sources ~d ·
methodologies in: Lewin-VHI. "Expanding Insurance Coverage Without a Mandate." prepared for the Health Care
Leadership Council. May 18. 1994.
The NMES data is used because it provides a detailed account of insurance coverage by calendar quarter. NMES reports
about 15 percent fewer uninsured persons that the CPS for any given year. It is for this reason that the total number d
uninsured used in this study may differ from the total used in other studies.
94FM0/80
2
LEWIN·VBI, INC.
�TABLE 1
NC~ER OF PERSONS REMAL'iL'iG USL'ISl"RED l'SDER SELECTED APPROACHES l'i 1998
:.·:=· .... ~< ·
: ...-:::·.
··.····· -::.....
.. . .... .......
. · ·-:· : :-: : .: ·: ·: : .:·: :- ::\::.: t:::·:: ... ·. :-.::;.:.:;...
. . . . . . . . . . . . . ,. ..... ·., . . .
::= :::,.:
:.. .......
.. .. . . .. .
. .
.
...·..
.: :;
.. .
Number of' Persons That:
-:::.::·:_. ..
;.::;. -:..:~-.-:·.:-:.~.:
~:-
=·. ,_· =
..
u~:: ~:: ._: ~:::
:==::::=::::=:·aetomis~b·•• ·=· == =:
...::..
.:.:·::·-::::',::::::::·);~{:;
. . :. : ~ . : ' .
.)
...
:::
.: ·: ~ : ~ : ;> : : . : :: ... :> : : .. : . .
Current System ·
1
Insurance Market reform Only
Insurance Market Reform with Subsidiesb
Become
Insured
(millions)
Remain :Percent . •
Uninsured Jteduction··
(millions) ·•• .. :::::·'· .,, ...
1.1
14.9
.
37.2
36.1
22.3
:
3.0%
40.0%
a
Insurance market reform includes guaranteed renewability and portability, limits on pre-existing condition
exclusions and community rating for individual and small group (under 100) markets.
b As specified in the Manag~ Competition Act. 100 percent premium subsidy for persons with income below
poverty and sliding scale subsidies for persons up to 200 percent of poverty. The Act also includes changes in
the tax deductibility of premium payments.
Source: Lewin-VHI estimates using the Health Benefits Simulation Model (HBSM)
B.
Insurance Market Reform Combined with Subsidies
The Managed Competition Act (MCA) includes the above insurance refonns, but it
further encourages increased insurance coverage ~hrough premium subsidies for low-income
individuals and tax deduction changes for individuals' premium p~yments. Under the subsidy
schedule in. the Act, individuals with incomes up to 100 percent of the poverty level would be
eligible for full premium and cost sharing subsidies while subsidies would be phased down as
income increases from 100 percent to 200 percent of poverty. Premium subsidies also would be
available for Medicare recipients with incomes below 120 percent of poverty.
The Act also allows individuals to deduct premium payments for non~group insurance
coverage.
To facilitate businesses and individuals purchasing coverage, states would be required to
establish one or more Health Plan Purchasing Cooperatives (HPPC). Any individual or small
business with fewer than 100 employees would obtain coverage through a HPPC which offers
participants more market power in negotiating coverage with health plans.
Overall, about 61 percent of all uninsured persons would be eligible for premium subsidies
under the program. Given past experience_ with Medicaid, however, we assume that many
individuals will not obtain coverage even if they are eligible for full subsidies. For example, about
25 percent of those who are now eligible for Medicaid do not enroll. In addition, many persons
eligible for partial subsidies are unlikely to obtain coverage, in part because the subsidized
premiums will still be high compared to their income.
94FM0/80
3
LEWIN·VHI, INC.
�V.'e estimated the number of uninsured persons who would participate in the subsidized
insurance program based upon an analysis of participation rates in the Medicaid program for
individuals with various demographic and health status characteristics using the 1987 National
Medical Care Expenditure- Study (NMES) data. These Medicaid enrollment rates were adjusted to
account for individuals who are eligible for only partial subsidies (i.e .. incomes between poveny
1
and 200 percent ofpoveny).
Based on these calculations, we estimate that the MCA would increase the number of
insured persons by about 14.9 million, leaving about 22.3 million individuals uninsured. This
estimate includes the impact of insurance market refonns, subsidies, and increased tax
deductibility of insurance policies.
The uninsured persons who would become covered under the program would tend to be
older individuals who are higher users of care. For example, under the Act, about 46 percent of
cwrently uninsured persons age 55 to 64 would become insured compared with only about 31
percent of those between the ages of 18 and 24.
II.
HEALTH SPDiDL'iG FOR PERSOSS WHO REMAIN Ul'T-tSL'RED
.
.
.
Under current policy, the uninsured will consume about $45.4 billion iii health services in
1998 (Table 2). This estimate includes the value of all health services consumed by the uninsured
which meet the definition of covered services under the benefits package proposed in the HSA.
This includes: family out-of-pocket payments ($10.7 billion); the value of free care provided by
physicians ($1.1 billion); the.value of uncompensated care in hospitals ($15.4 billion); and the cost
of free care provided in public hospitals and clinics ($18.2 billion).
As noted above, we estimate that about 14.9 million of the 37.2 million currently
uninsured would become insured under the MCA. Those who remain uninsured will account for
about $24.6 billion in health spending or about 55 percent of the $45.4 billion expended on behalf
of the uninsured under current policy. This amount includes: out-of-pocket spending ($5.7
billion); free care provided by physicians ($0.5 billion); hospital uncompensated care .($8.1
billion); and care provided in public hospitals and clinics ($10.3 billion).
The remainiilg $8.1 billion of hospital uncompensated care and the $0.5 billion free
physician care would ultimately be cross subsidized by private payers through higher patient
charges and insurance premiums. Partial refonn will perpetuate the destabilizing effects of this ·
cost shift as much of the care provided to the uninsured would continue to be shifted to the
privately insured.
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�TABLE
2
HEALTH EXPESDITURES FOR USl'iSuRED PERSO~S POITSTIALL Y COVERED USDER THE
HSA BEl'"EflTS PACKAGE l'i 1998a
Persons Wbo Remain
Uninsured
UDder Current Uninsuied Under the
.
·MCA .
·Policy.
Out-of-Pocket
$10.7
$5.7
Free from Physician
$1.1
$0.5
Hospital Uncompensated Care
$15.4
$8.1
Public Hospitals/Clinics
$18.2
$10.3
TOTAL.
a.
. $45.4
$24.6 .
These estimates are based upon health expenditures data for the uninsured as reported in the National Medical
Expenditures Survey (NMES) data. These data report utilization for insured and uninsured persons including
care provided free by providers. The value of free care was estimated by the Agency for Health Care Policy
Research (AHCPR) based upon charges for comparable services reported by insured persons. We calibrated the
:"l'MES data (for insured and uninsured persons) to reflect: 1) projections of health spending by source of
payment and type of service in 1998 developed by the Health Care Financing Administration (HCF A) and the
Congressional Budget Office (C80); and 2) projections of hospit,al uncompensated care based upon data
provided by the American Hospital Association (AHA).
These figures exclude spending for services that are not covered under the Health Security . Act benefits
package such as adult dental care and eyeglasses for adults. These figures also exclude health spending for tbis
group that is covered under the workers compensation program and/or auto insurance. (Tbis should not be an
issue since this care is in fact covered by these sources). These figl.i.res also do not include the increase in
utilization that would occur among those who remain uninsured if they were provided with insurance.
Source: Lewin-VHI estimates using the Health
Ill.
Benefi~
Simulation Model (HBSM).
CHA.'iGES l'i PER CAPITA HEALTH INSURANCE PREMIUMS
In general, we find that average premiums are higher if coverage is expanded only through
insurance market reforms and premium subsidies because those who would obtain coverage under
these policies would tend to be individuals in relatively poor health who are above average users
of health services. This increase in average premiums is largely averted under a program of
universal coverage because such a plan would require all individuals to participate in the insurance
pool including healthier individuals who receive little health care.
To estimate changes in health insurance premiums under three reform approaches, we
assumed the standard benefits package proposed in the President's Health Security Act (HSA).
The President's package is used to standardize comparisons across refonn options because the
MCA does not specify a standard package. The Congressional Budget Office also makes this
assumption in its analysis of the MCA.
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�A.
Insurance Market Reform
We estimate that tJ'le average monthly premium for all persons already insured in 1998
would be $172 per person under the HSA benefits package (Table 3).5 Under insurance market
reforms only, all individuals may obtain insurance at a group rate regardless of their health status.
Most of the 1.1 million per:;ons that would obtain insurance under these reforms are persons in
relatively poor health who are above average users of care, and this would increase the overall
average monthly per person premium for the currently insured population from $172 to $176.
B.
Insurance Market Reform Linked to Premium Subsidies
Under a program that links the insurance market reforms to subsidies, most of the 14.9
million persons who would obtain insurance would be above~average users of health care. This
would ··increase the overall average monthly per-capita premium for the currently insured from
$172 to S182. For a family already receiving insurance in 1998, this would translate into a average
annual premium increase of $260.
C.
Universal Cc;»verage
Under a program of universal coverage, all individuals would be required to obtain
. insurance broadening the insurance pool to include healthier individuals who would otheiWise
decline to obtain insurance even if subsidies were available. 6 This broader insurance pool would
lower the average premium to· $175 per person per month, about two percent greater than the
average premium cost for the cunently insured population ($172 per person per month). Thus, a
universal coverage program would raise average annual premiums for families already insured by
about $78 compared to $260 per year under the MCA.
It is important to note, however, that a universal coverage program would require a net
increase in federal premium subsidy payments because many of those who would become insured
are lower income persons who would qualify for premium subsidies under the Act. We estimate
that universal coverage under the MCA would entail an additional $17 billion in federal subsidy
5 The premium estimate is based on fee-for-service cost sharing and includes coverage for these cunently enrolled in
Medicaid. The previously insured population excludes the over 65 Medicare beneficiaries.
6 As specified in the Managed Competition Act. 100 percent premium subsidy for persons with income below poveny and
sliding scale subsidies for persons up to 200 percent of poveny. The Act also includes cbanges in the tax deductibility c:l
premium payments.
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�TARU:J
NUMBER OF PERSONS, NATIONAl.
A VERMa•: t•RI~MiliMS AND CIIAN(:F.IN IIOUSI.;HOI.U HEALTH SPENmNG
UNUER AI.T..:RNATIV ..: RE ..'ORM SCI~NARIOS IN 1998
.. ·... ::=::·.':)::·:::.:.:.:::.
National Average
....... ·... ·.·.·.·..·.·•·.·..·.·.
·.: .. :·::::.:: .. ·.:_··.:·
Increase bl
Average Annual
Premium for a._ .
Insured Famllyd
Size of Pool
(in millions)
Monthly
Per-Capita
t•remium
Currently Insured
185.7
$172
---
Insurance Market Refonn Only 8
186.8
$176
$104
Insurance Market Reform with Subsidicsh
200.5
$182
$260
Universal Coveragec
222.8
$115
$78
·.·.:.:.: ....... ·.· .-.-.·:·.·.·. . :-:.:::Reform Scenario
a
Insurance market reform includes guaranteed renewability and portabilily, limits on pre-existing conditinn exclusiuns and community rating fur individual
and small group (under 100) markets.
·
b As specified in the Managed Competition Act, 100 percent premium subsidy for persons with income below poverty and sliding scale subsidies for pt•rsuns
up to 200 percent of poverty. The Act also includes changes in the tax deductibility of premium payments.
c Por consistent analysis, universal coverage is based on the Managed Competition Act expanded to include an individual mandate. An employer mandate
could be used to attain universal coverage as in the llealth Security Act. The premium changes shnwn in this analysis would be the same under either
mandate because we focus only on premium amounts regardless of payer.
d Change in. average premium compared to premium without reform. All premiums.have been slandardiled to the lleallh Security Act benefits package.
Source: Lewi~-VHI estimates using the Health Benefits Simulation Model (IIBSM)
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.
payments and S 11 billion in reduced tax revenue for a total federal cost of $28 billion. However.
federal subsidy costs will vary by the approach to universal coverage. 7
-D.
Community Rating Inside a HPPC
Another factor that will affect premium levels under healthcare reform is the degree to
which community rating is applied broadly across all finns and persons. Under the President's
proposal, for exainple, premiums are adjusted for family composition but othetwise are the same
across all workers in flrms of fewer than 5,000 employees, as well as all non-workers.
The MCA as drafted would place workers in small firms (less than 100 employees) and
their dependents as well as various non-workers in HPPCs. Premiums both in and out of HPPCs
are set on an age adjusted community rated basis which leads to a relatively high premium
increase for employees in small flrrns.
Non-workers in the HPPCs will have significantly higher health care costs than workers in
either large or small firms because a ponion ·of non-workers are disabled persons currently
covered under the Supplemental Security Income program (SSI). Disabled persons and other nonworkers make the HPP~ pool expensive to cover because their health.costs are so high. · .
Table 4 indicates how community rating inside HPPCs would affect monthly per capita
premiums under three reform strategies. 8 If no health reform were implemented other than
community rating within HPPCs, the currently ~nsured would pay, on average, $205 monthly
premiums. Under insurance reform, the average premium in HPPCs would rise to.$215 and under
the MCA to $227.
In comparison, Table 4 indicates that premiums in HPPCs will be about $50 to $75 higher
than out of HPPCs. This difference in premiums in and out of HPPCs creates a major problem
implementing the Act. 1be primary incentive for cost containment under the Act is an excise tax
on employer premium contributions in excess of the lowest cost health plan in the HPPC. Given
_ the inherently higher costs for HPPC enrollees, most non- HPPC health plans will have premiums
below this level even if these plans are minimally effective in controlling costs. Thus, basing the
tax cap limit on the lowest cost HPPC premiums will create little incentive for employers and
health plans to control costs undermining the long tenn viability of the program.
7
8
See Lewin-VHI: "Expanding Insurance Coverage Without A Mandate." May. 1994.
Note that Table 4 findings are due to tbe effects of pooling wbicb are independent of the organizational structure (e.g .•
HPPC, bealtb alliance, or other small group reforms) used to create the pools.
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·~--~
�TADU:4
NUMBER OF PERSONS ANni-.:R-CAPITA MONTHLY
IIEAI.TH PLAN PuRCHASING COOPft:RATIVES
.
.. ··.·.···.·.·.·.·.·.·;·,·.·.··.·,·.·,·,·.···
····· .. ······
.. ::.::: ..:.::·.:.:.:".:.:.:.:::
..
... ··.··
······.····
H
• •••
•
•
:
Refonn Stenarhi
.·..· ...·.. ·.-.·
.....
::.:.:
.·.·..· ....
.......·....
·.··.·,•.·,··
·..·
.·.·.··.···
. . ·....·.·. ·.·...·..·...
··. ·.·.·....
.
·:
..
··
·. '
(HPt•Cs)
1
1 RF.MIUMS FOR PERSONS IN AND OUT OF THE
UNtn-:R At:fF.RNATIVE REFORM SCENARIOS IN
Inside HPPC8 .
·(Individuals & Firms <100)
..
..
Size of t•oot
(in millions)
l'er-Capita .
Premium
Out of UPPCh
(Firms> 100)
1998
National Average
Size of t•oot
(in millions)
t•er-Capita
Premium
Size of t•oot
(in millions)
rer-Capita
t•remium
Currently Insured
Insurance Markel Reform Onlyc
72.8
$205
112.9
$150
185.7
$172
73.7
$215
1133
$151
186.8
$176
Insurance Markel Reform wilh Subsidiesd
83.3
$227
117.2
$150
200.5
$1X2
Universal Coveragee
95.6
$213
127.2
$147
222.8
$175
Persons in lhe HPPC include workers and dependenls in firms wilh less lhan 100 workers, persons in lhe individual insurance marker, Me<'icaid r~dpicnls
and lhe non-working uninsured. The revised version of lhe Managed Cornpelilion Acl would require that premiums within the· HPPC be rated scpararcly
for (I) lhe disabled; (2) finns lhal provide coverage; and (3) all other persons.
b Persons oulside lhe UPPC include workers (including public employees) and their dependents in finns with 100 ur more employees.
c Insurance markel refonn includes guaranleed renewability and portability, limits on pre-existing condition exclusions and community rating for individual
and small group (under 100) markers.
·
d As specified in lhe Managed Compelilion Acl, 100 percenl premium subsidy for persons with income below poverty and sliding scale subsidies for persons
up t~ 200 percenl of poverty. The Act also includes changes in the tax deductibmty of premium j)ayments.
e For consislenl analysis, universal coverage is based on the Managed Competition Act with an individual mandate. An employer mandate could he used to
auain universal coverage as in the Heallh Security Act The premium changes shown in this analysis would be the same under either mandate hecausc we
focus only on premium amounts regardless of payer.
Source: Lewin-VHI e•timates using lhe Health Benefits Simulation Model (HBSM):
,a
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�The authors of the Act have acknowledged these problems and have indicated to the
Congressional Budget Office that they intend to separately rate non-workers in HPPCs. A
potential solution would_ be to create three premium pools within HPPCs: workers and
dependents in small finns providing insurance: persons without employer provided insurance: and
aged and disabled cash recipients.
Using three premium pools within HPPCs, we estimate that the average premium within
the HPPC would remain at $227 a month, but premiums for workers and their dependents would
be much lower at $153 a month, comparable to premiums for workers and their dependents
outside HPPCs allowing the tax cap incentive to trigger cost controls.
A secondary effect of this revision would be to make monthly premiums higher for
persons without employer provided insurance ($279 per month) and for disabled. persons ($71 0
per month). As a result. aggregate federal subsidy payments in HPPCs would be higher because a
large portion of these individuals also are low-income.
Under universal coverage. Table 4 indicates that average premiums in HPPCs would fall
to $213 per month as younger and healthier populations are brought into the HPPC pool. Because
enrollees in HPPCs could be divided into three premium pools under possible revisions to the Act,
reduced costs from an infusion of healthier populations could be distributed across theSe pool~.
However. the disabled pool would see little change in monthly premiums since· we assume that
most of this population would participate in HPPCs without universal coverage provisions.s
The types of premium discrepancies discussed above are not unique to the HPPC
arrangement contained in the MCA. lbey are likely to occur under other fonns of community
rating limited to voluntary enrollment of small firms and individuals.
IV.
CHA.~GES l'i A\'ERAGE HOUSEHOLD SPENDL~G
The financial implications of health reform extend beyond the impact on premium
payments for individuals, families, and employers. This analysis also examines the effects on
overall net changes in household (non-Medicare) health care spending by accounting for
household premium payments, subsidies, tax deductions, changes in premium contributions,
changes in out-of-pocket spending, and wage effects resulting from changes in employer costs. In
addition, this analysis addresses changes in household health spending for the 185.6 million
S
For a more detailed analysis of premium changes under various HPPC sizes and community rating schemes. see: Sheils.
John F. '"Permitting Voluntary Enrollment in Regional Alliances Under the Heallb Security Ac:t," prepared for the Henry J.
Kaiser Foundatio!' by Lewin-VHI. March 1994.
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�persons that are currently insured (r.on-Medicare) and for the 5.7 million households in which all
members are uninsured.
·.
We also examine the effect of universal coverage on household health spending as
compared to the MCA as written. Because there are a number of options for achieving universal
coverage, this analysis compares the effects of universal coverage under the MCA and the
President's HSA. We examine two versions of the HSA, one with premium growth restraints and
one without.
Please . note that the following discussion focuses on households headed by individuals
under age 65. This population is consistent with the one addressed in the previous premium
section. Detailed fmdings for the over 65 population are presented in Appendix A.
We present the fmancial impact on households in the following sections:
•
Net Changes in Household Health Spending Without Wage Effects
•
Net Changes in Household Health Spending With Wage Effects
•
Net Change in Household Spending by Income
A.
Net Changes in Household Health Spending Without Wage Effects
We estimate that under the MCA, the average household headed by a person under age 65
will see health care spending increase by $98 in 1998 as compared to health spending in the
absence of reform (Table 5) . .This average applies to all households in the nation, regardless of
whether they currently purchase health insurance or will purchase health insurance under refonn
and subsumes wide variations in health spending changes by income group as discussed below in
Section C.
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�...--------------
TABLES
NET CHA.'iGES L'i HOUSEHOLD HEALTH SPE~DL'iG FOR HOL'SEHOLDS
HEADED BY A~ INDIVIDUAL U!'liDER AGE 65
(WITHOUT WAGE EFFE~CT::..::S:.!...)----r-:------:---r-=------:-.
Currently
UniDsuredb ·
(82.2 million .. {76.5 :inDUon {5.7 miDion
housetaolds) . bou5eholds) households)
$98
$105
d
AU . . .
. Currently
Hou5eb01ck · lnsured8
Managed Competition Act As Written
Managed Competition Act With Universal Coveragec
Health Security Act Without Premium Growth Constraints
Health Security Act With Premium Growth Constraints
$322
(S180)
(S254)
S69
($223)
($300)
$1,406
$350
$310
a
b
c
AD insured household is defined as household with at least one person insured.
AD uninsured household is defined as a household in which no one is insured.
Universal eove~ge under the Managed Competition Act would increase federal subsidy costs relative to the
Act as written. Our estimates in this analysis assume the federal government absorbs the costs. To the extent
that financing sources are sought through taxes, household spending would increase.
d We estimate the average currently uninsured household will spend an additional $2 under the Managed
Competition Act as written. However. under the Managed Competition Act as written. many currently
uninsured households still will not purchase coverage. For these households. health spending will not change.
This $2 estimate reflects the average change in health spending for all currently uninsured households,
including those that will experience no change.
Source: Lewin-VHI estimates using tbe Health Benefits Simulation Model (HBSM).
an
The average change in household health spending reflects
increase in private premium
payments partially offset by federal premium subsidies and "cashed-out" benefits. We assume that
finns providing coverage above the standard benefits package will downgrade coverage to the
minimum level and distribute the cash savings to employees which we then assume are used to
purchase supplemental coverage.
Expanding the MCA to include universal coverage would increase average household
health spending for those under age 65 by $322 in 1998. While the influx of healthier populations
would reduce per capita premiums under universal coverage, in aggregate more households will
be paying premiums and using more health care thus raising the average. In comparison, we
estimate that the HSA will decrease average household health spending for those under age 65 by
$180 in 1998 a5suming no premium growth constraints and will decrease spending by $254
assuming constraints.
However, overall household health spending fails to highlight an important distinction: the
currently insured population spends less or saves more under universal coverage. As shown in
Table 5, the average currently insured household will spend an additional $105 on health care in
1998 under the MCA as written compared to $69 under the Act coupled with universal coverage.
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�More striking is the difference between all families and the currently insured under the Act with
universal coverage. This difference indicates that the majority of increased health spending under
this version of the Act will be borne by the currently uninsured population-an average increase
Of $1,406 in health spending in 1998.
An analogous effect is seen under the HSA with or without premium constraints. Under
either assumption, the average family headed by a person under age 65 sees reduced health
spending in 1998 ($180 in savings without premium growth constraints, $254 in savings with
premium growth constraints). Compared to the total under 65 population, the currently insured
save more under both scenarios ($223 in savings without premium constraints, $300 in savings
with premium constraints). Once again, the uninsured see an increase in health spending although
not as large as under the MCA with universal coverage. This is true because we assume that
universal coverage under the MCA is achieved through an individual mandate while the HSA
relies on an employer mandate.
B.
Net Changes in Household Health Spending With \\'age Effects
Generally accepted economic theory suggests that most employer savings and new costs
eventuall.Y are passed on to workers in the form of increased or decreas~d wages. This "wage
effect" further reduces or increases household health spending under health refonn.9 For example,
we estimate that employer health care expenses will decrease under the MCA and that wages will
rise as a result of three factors: ( 1) employer premium contributions will decrease due to the cap
on tax deductibility; (2) some firms will discontinue providing health benefits altogether; and (3)
firms continuing coverage will see savings resulting from managed care and reduced cost
shifting 10.
Table 6 shows the changes in household health spending accounting for the wage effect.
As noted above, the MCA reduces employer health care costs ultimately resulting in the reduced
health care spending shown in the table for the currently insured population. In contrast, the HSA
increases employer health care costs through an employer mandate which are passed on to
employees through lower wages.
9 We estimate that about 88% of changes in costs are passed on to employees through wage effec:ts. See, for example,
Jonathan Gruber and Alan B. Krueger. "The Incidence of Mandated Employer-Provided lnswuce: Lessons from Workers
Compensation Insurance," in Tax Policy and the Ecoraomy ( 1991 }; Jonathan Gruber, "lbe l!lcidence of Mandated Maternity
Benefits.ft American Ecoraomic Re.,.iev.:. fonhcoming; and Lawrence H. Summers, "Some Simple Economics of \iandated
Benefits." Americara Ecoraomic Review, v. 79. no. 2. May 1989.
10 We estimate significant managed care savings under the Managed Competition Act that ultimately lower employer
premium costs. For a detailed discussion of managed care savings see: Lewin-VHL "Managed Care: Does it Woric?"
February 1993, and Lewin· VHI. "New Evidence on Savings from Network Models of Managed Care," May 1994.
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�TABLE
6
NET CHA~GES I~ HOUSEHOLD SPE!\"Dl~G FOR HOl'SEHOLDS
HEADED BY A~ 1!\"DIYIDl'Al. U!\"DER AGE 65 l'i 1998
(WITII WAGE EfFECTS)
Currently ·Currently
.... All
Households Insurecr' Uninsuredb ·
(82.2 million (16.5 million (5~7 million
households) households) households)
--
d
Managed Competition Act As Written
($38)
($41)
Managed Competition Act With Universal Coveragec
$186
($77)
$1.406
Health Security Act Without Premium Growth Constraints
$191
$71
$1,478
$14
($161)
$1.343
Health Security Act With Premium Growth Constraints
a
b
c
An msured household 1s defined as household w1th at least one person msured.
An uninsured household is defined as a household in wh..ich no one is insured.
t:niversal coverage under the Managed Competition Act would increase federal subsidy costs relative to the
Act as written. Our estimates in this analysis assume the federal government .1bsorbs the costs. To the extent
that financing sources are sought through taxes. household spending would increase.
d We estimate the average currently uninsured household will spend an additional $2 under the Managed
Competition Act as written. However. under the Managed Competition Act as written, many currently
uninsured households still will not purchase coverage. For these households. health spending will not change.
This $2 estimate reflects the average change in health spending for all currently uninsured households.
including those that will e:~tperience no change.
Source: Lewin-VHI estirna~s using the Health Benefits Simulation Model (HBSM).
Employers who currently do not provide insurance will see a proportionally larger increase
in employee health care costs under the HSA than employers who do provide insurance.
Therefore. the currently uninsured will experience a greater wage effect than the currently insured
as reflected in Table 6.
While the wage effect tempers the increased health spending under the. MCA, it is
imponant to consider the sources of the wage effect enumerated above. The fact that some tinns
will reduce costs by discontinuing or reducing coverage certainly has policy implications for
health reform.
C.
Household Spending by Income
Fmally, our analysis allows us to display changes in household health spending by income
group (Figure I). the changes in spending shown in Figure 1 are for households headed by
persons under age 65 and do not include wage effects. Furthermore, these estimates include all
households whether previously insured or not.
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�FIGl"RE 1
NET CHA.~GES L~ HOCSEHOLD HEALTH SPE~DL~G L~ 1998
FOR AGGREGATE USDER AGE 65 POPt:LATIO~
WITHOt:T WAGE EFFECT
$800
$600
$400
$200
$0
.
·.·.·.·.·•:::: ::::::::
($200)
... .......
...::: ........ . ........................................·.·
.. ··
.........................................·.·
($400)
($600)
($800)
-Man aged Competition Act As Written
-Managed Competition Act With Universal Coverage
.... ·Health Security Act With No Premium Growth Contraints
..... Health Security Act With Premium Growth Contraints
($1.000)
t:nder
$10,000
$10.000 • $15.000 •
$14.999 . $19.999
$20,000 •
$29,999
$30.000 •
$39,999
Source: Lewin· VHI estimates using the Health Benefi~
Sim~:~lation
$40,000.
$49,999
$50.000.
$74,999
$75,000· $100,000
$99,999 and Over
Model (HBSM).
Our analysis shows that all four versions of health reform discussed in this paper reduce
health spending for the lowest income groups while the MCA results in increased health spending
for middle and higher income. groups. The HSA with or without premium growth constraints
lowers health spending for all but those households earning more than $100,000 per year. As
noted above, a major reason for the observed differences between the MCA and the HSA are the
Acts' approach to universal coverage. Without wage effects, the HSA's reliance on an employer
mandate shifts a smaller portion of insurance costs onto households because employers are paying
80% of premiums.
Figure 2 takes into account the wage effect and shows that the HSA's employer mandate
ultimately costs households through reduced wages. The MCA with universal coverage still
shows the largest increases for middle income households, but both versions of the. HSA also
indicate health spending increases for these groups. Both versions of the HSA show increased
health spending for households earning between $10,000 and $14,999 while the Managed Care
Act with univ.efSal coverage decreases spending for this group. However, the HSA is consistently
less costly than the universal coverage version of the Managed Care Act for middle income
I
households earning betwee~ $20,000 and $49,999.
·
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�'
I
FIGt!RE 2
NET CHA.:'iGES L~ HOL"SEHOLD HEALTH SPE~Dl~G L~ 1998
FOR AGGREGATE U~DER AGE 65 POPt.iLA TIOS
WITH WAGE EFFECT
...
..
·•····
·····•····
-Managed Competition Act As Written
-Managed Competition Act With Universal Coverage
··• ··Health Security Act With No Premium Growth Constraints
··•·· Health Security Act With Premium Growth Constraints
($1.000)
t:nder
· $10.000
$10.000 •
$14.999
$15.000 • UO.OOO •
$19,999 · $29,999
$30.000 •
$39,999
$40,000 •
$49,999.
$50,000 •
.574,999
$75,000. $100,000
$99,999 aad Onr
· Source: Lewin-VHI estimates. using the Health Benefits Simulation Model (HBSM).
As in the earlier tables. our analysis also examines the changes in household health
spending for the currently insured under 65 population (185.7 million people). For the currently
insured, the MCA with unive~al coverage is consistently less costly than the Act as written across
all income groups with or without wage effects. However, without wage effects, both versions
result in increased health spending for households earning more than $20,000 a year (Figure 3).
94FMOI80
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�FIGCRE 3
NET CHA.SGES L"'; HOt:SEHOLD HEALTH SPE.SDL"';G L"'; 1998 FOR
CtJRRESTL Y ["~;SCRED PO PULA TIOS UNDER AGE 65 BY ["~;COME
1
\ \ ITHOUT WAGE EFFECT
$600
$400
$200
so
($200)
.....·.·.·::::.t::::::::::::~:::::::·:: ........................................... ···_ ... ····
···•···········•···········•···········•·.
($400)
-Managed Competition Act As Written
($600)
-Managed Competition Act With Universal Coverage
··•·· Health Security Act With No Premium Growth Constraints
·· • ··Health Security Act With Premium Growth Constraints
($800)
($1.000)
($1.200)
Under
$10,000
$10.000 •
· $14,999
$15.000 •
$19.999
$20.000 •
$29,999
$30.000 •
$39,999
$40,000.
$49,999
$50,000.
$74,999
$75,000· $100.000
$99,999 aDd Over ·
Source: Lewin-VHI. estimates using the Health Benefits Simulation Model (J:ijlSM).
In comparison, both versions of the HSA reduce health care spending for the cunently
insured population across most income groups without wage effects.
Factoring in the wage effect creates a more complex picture. Figure 4 shows that even
with the wage effect. the HSA with premium constraints reduces health spending for tbe cunently
insured across all but the highest income groups. The MCA results in increased health spending
for middle income currently insured earning between $20.000 and $49.999.
The HSA without premium constraints increases health spending for all the currently
insured earning more than $10.000. accounting for wage effects. However. spending increases are
less than ~e MCA with universal coverage for the cunently ·insured earning between $20,000 and
$39.999. Spending increases are greater than under the MCA for income groups earning more
than $40.000 (Figure 4).
94FMOJ80
17
LEWIN• VHI, INC.
�FIGURE 4
l'ET CHASGES l~ HOl"SEHOLD HEALTH SPESDL"'iG L~ 1998 FOR
CURRESTL Y l~St:RED POPULA TIOS USDER AGE 65 BY l'iCO~IE
'WITH \\''AGE EFFECT
$600
$400
$200
-····
... ·-- .......•·
...... .........
$0
...
($200)
················•·················
($400)
($600)
-Managed Competition Act As Written
-Managed Competition Act With Universal Coverage
· · • ··Health Security Act With No Premium Growth Constraints
· · •, ·Health Security Act With Premium Growth Constraints
($800)
($ 1.000)
($ 1.200)
Under
$10,000
$10,000 •
$14.999
$15.000 •
$19.999
$20.000-$29.999
$30,000 •
$39,999
$40,000$49,999
$50,000 •
$74,999
$75.000$99,999
$100.000
aad Over
Source: Lewin-VHI estimates using the Health Benefits Simulation Model (HBSM).
Tables displaying detailed changes in household spending under the various refonn scenarios
and accounting for insurance status, wage effect, and income are available in Appendix A.
V.
CONCLUSION
This analysis highlights some of the important trade-offs involved in achieving universal
coverage as compared to more limited reforms. Insurance market refonns alone will have little
impact on coverage, covering an estimated 3 percent of the currently uninsured. When combined
with subsidies as in the MCA, however, about 40 percent of the uninsured would be covered,
accounting for about 45 percent of all current health spending on the uninsured. As a previous
Lewin-VHI study showed, 97 percent of health spending is covered by the MCA because persons
- who become covered voluntarily will tend to be more expensive than average. II
One of the trade-offs in pursuing a voluntary strategy, however, is the impact on
premiums for persons who are already insured. Because persons who obtain coverage under the.
MCA will tend to be less healthy and more costly than persons who do not obtain coverage,
average premiums will rise more for those already insured than they would under universal .
It Lewin- VHI, Expanding Insurance Coverage Wjthout a Mandue. prepared for tbe Health Care Leadership Council, May 18.
1994.
94FM0180
18
LEWIN•VHI, INC.
�coverage. Accordingly, the average 1998 family premium amount would increase by $260 per
year under the MCA compared to an increase of about $78 under universal coverage.
·-
Changes in household health spending vary significantly by family income level and current
health insurance status. Largely because of premium subsidies,· all of the refonn approaches result
in a net decrease in spending for families earning less than $10,000. Middle income families that
currently have insurance, however, generally experience a larger increase in health spending
without universal coverage. Their change in health spending is also influenced by the structure of
the refonn proposal itself, such as whether or not the proposal utilizes an employer mandate and
includes premium growth constraints like those in the HSA. Of the universal coverage approaches
examined, only the HSA with premium caps reduces household health spending for currently
insured middle income families with or without wage effects.
Universal coverage would entail higher federal subsidies for the additional low incoine
persons who become insured. It would also require a mandate for insurance coverage. These
costs will have to be weighed against the problems of higher average premiums and household
spending for the currently insured, cost shifting, and constrained access for the remaining
uninsured under more limited refonns.
94FM0/80
19
LEWIN· VHI, INC.
�--
.
,.
·· ....... :
APPENi>IX A :·:
94FMOI80
A-S
: ··.·:.·:
.....·:::·:"
···:·.·::
.
.·,.··.·
· ...··.····
;;.;
:-:··
..·
···:
·.
.... ::: .; ~~:·: .·
:
:··:···
<:···
...· .·.;. :::::·:>:::: ::
LEWIN· VHI, INC.
�TABLE A-1
CHA~GE Lit\ Hot.:SEHOLD HEALTH SPE~'DL'iG BY I~CO~IE L'i
1998 U~DER THE
MA~AGED COMPEllTIO~ ACT AND UNDER TilE ACT \\lTH USIVERSAL COVERAGE
With Wage Effects
Household Income UDder 65and
. ·(in thousands) · .• 65 •. ···Over
Without Wage Effects
Total
Under 65 anci . Total·
65 . • Over
• •• As WIUTTEN · ..
Under $10,000
($946) ($2,603) ($1,459)
($963) ($2,601) ($1,470)
sw;ooo- $14.999
($266) ($1.498)
($757)
($285) ($1,481)
($762)
$15.000- $19.999
$13
($537)
($161)
$49
($544)
($138)
$20.000 - $29.999
$231
$551
$304
$358
$519
$395
$30.000- $39.999
$344
$757
$421
$464
$742
$517
. $40,000- $49,999
$143
$833
$220
$358
$833
$411
$50.000- $74.999
$80
$763
$142
$293
$848
$343
$75.000- $99.999
($197)
($88)
($187)
$127
$25
$118
$62
$212
$73
$201
$162
$198
($38)
($629)
($156)
$98
($624)
($46)
S 100.000 and Over
TOTAL
..
Under $10,000
•. ... ·::::·
..
....... •···.·· .·· ·.··· :>:::····•:
($988) ($2.623) ($1,494) ($1,006) ($2,620) ($1,506)
$10.000- $14.999
($200) ($1,481)
·UNIVERSAL COVERAGE
($711)
.·.·.···
..
($219) ($1,463)
($715)
($549) . ($72)
$183
($556)
($49)
$782
$667
$760
$751
$758
$696
$994
$752
$817
$979
$848
$40.000 - $49,999
$335
$1,101
$421
$551
$1,101
$612
$50.000 - $74.999
$339
$1,006
$399
$552
$1.(>91
$601
$75,000- $99,999
$74
($106)
$57
$399
$7
$362
$100.000 and Over
$309
$534
$325
$447
$483
$449
TOTAL
$186
($523)
$45
$322
($518)
$155
$15.000- $19.999
$147
$20.000- $29.999
$633
$30,000 - $39.999
SOURCE: LEWIN•VHI ESTIMATES USING THE HEALTH BENEm'S SIMULAnON MODEL (HBSM)
94FMOJ80
A-1
LEWIN·VBI, INC.
�TABLE A-2
CHANGE IN HOUSEHOLD HEALTH SECL'RITY BY IS COME ~ 1998 UNDER THE
HEALTH SECURin· ACT WITH AND \VITHOt:T PRE~m.;M GROWTH CONSTRAL'IiTS
..
.
With Wage Effects
·Under 6Sand
Household
•. .Income.· ·······. 65· ·.·Over Total
.• ·
..
. . .. ... ..
;..
•. (in thot!s8i"ld5f
.
;
....
··.···.·
... ··. ·.·.·.
. .··.···,·.·. ·::.. . .
..
::;····: .....·::·:::.-;.
'·.•
.. -.···.··.·
Without Wage Effects
Under ·c;s and
.. Over·
..
_:~.:::: ::.. ... > .
.....
Total·
.
· · · •· lVITBhEMIUMCoNSliWNrsY.·:}::!,.
.
·.·.· ··· .
·····.·.·.. ····.···
($801)
($478)
($701)
($671)
($456)
($605)
$10.000-$14,999
$236
($569)
($85)
($216)
($561)
($353)
$15.000- $19,999
$226
($638)
($76)
($179)
($648)
($327)
$20.000- $29,999
$239
($322)
$111
($53)
($436)
($140)
$30.000- $39,999
$50
($483)
($51)
($266)
($404)
($292)
$40.000- $49,999
($51)
($495)
($101)
($293)
($546)
($231)
$50.000- $74,999
$47
($470)
$0
($248)
($285)
($251)
$75,000- $99,999
$38
($683)
($30)
($287)
($425)
($300)
$388 . $3,361
$599
($8)
($383)
($65)
($254)
Under $10,000
$100.000 and Over
TOTAL
$14
$3,484 .
($365)
WITHOUT PREMiuM CoNsTRAINTS•• ··•·'•.' , .,. ;;: :.
............... ........... ,.....
$239"
($276)
:T: .............
•.: . ·:(::•)=
($767)
($473)
($676)
($674)
($456)
($607)
$10,000- $14.999
$295
($563)
($47)
($205)
($557)
($345)
$15.000-$19,999
$306
($602)
$20
($150)
($637)
($303)
$20,000- $29,999
$353
($263)
$213
($3)
($412)
($97)
$30,000- $39,999
$218
($281)
$124
($187)
($367)
($221)
$40,000 - $49,999
$239
($310)
$178
($198)
($496)
($232)
$50,000 - $74,999
$282
($256)
$233
($140)
($222)
($147)
$75,000- $99,999
$328
($361)
$262· ($160) ($3,658)
($178)
$100,000 and Over
$663
$3,736
$883
$132
$3,568
$376
TOTAL
$191
($294)
$95
($180)
($342)
($212)
Under $10,000
SoURCE: LEWIN·VID ESTIMATES USING THE HEALTH BENEnTS SIMULATION MODEL (IDSM)
94FMOI80
A-2
LEWIN· VHI, INC.
�TABLEA-3
CHAN(; ..;s IN HEATH SI•ENDING BY INCOM ..: IN 1998 ...OR THE CURRENTLY INSURED ANU UNINSURED HOUSEHOLDS UNtn:R TH ..:
MANAGED COMPETITION ALl ANU UNDER THE ACT WITH UNIVERSAL COVERAGE
...
CV.RRENTLV INS0R8D •.-· .
UNIVERSAl.
COVERAGE
As WRITTEN
-•··· HOUSEHOLD
·_.•••..- -~--INCOME .
•.
....
..
.. ·.· .. ··.···
,,••
CtJRRENTLY UNINSUUD
·-· .·.·
UNIVERSAL
COVERAGE
As WRITTEN
WITHOUT
NUMBER OF· WiTHOUT .WITH WITHOlTr . WITH WITHOUT WiTH
•- Wi'fli .
.
.
.
··wAtE
WAGE
WAGE .. 'WAGE
WAGE
.WAGE...
WAGE.
HOUSEHOLDS ·.WAGE ..
(IN MILLIONS) EFFICTS EFFECTS EFFECTS EFFECTS EFFECTS EFFECTS EJ'FEcr$. EFFECTS
Under $10,000
8.6
($1,025)
($1,004)
($f,025) ($1,005)
($627)
($627)
($793)
($793)
$10,000-$14,999
4.6
($311)
($288)
($332)
($309)
($166)
($166)
$362
$362
$15,000- $19,999
4.3
$15
($27)
($34)
($76)
$243
$243
$1,336
.$1,336
$20,000-$29,999
10.8
$340
$201
$~96
$157
$545
$545
$3,291
$3,291
$30,000- $39,999
9.4
$472
$344
$426
$29M
$339
$339
$3,450
$3,450
$40,000- $49,999
9.4
$358
$137
$317
$96
$363
$363
. $2,757
$2,757
$50,000 - $74,999
15.2
$293
$76
$4(
$279
$229
$4,333
$4,333
$75,000 - $99,999
6.5
$120
($211)
$251
$15
($256)
$505
$505
$3,750
$3,750
$100,000 and Over
7.8
$202
$63
$161
$22
$0
$0
$2,415
$2,415
76.5
$105
($41)
$69
($77)
--a
--a
$1,406
$1,406
TOTAL
a.
We estimate the average currently uninsured household will spend an additional $2 under the Managed Competition Act as written. llowever, under the
Managed Competition Act as written, many currently uninsured households still will not purchase coverage. For these households, health spending will
nul change. This $2 estimate reflects the average change in health spending for all currently uninsured households, including those that will experience no
change.
SouRn:: l.t:WIN-VH I
•:.~I'IMAn:s USINc; ·nt.: Ht:AI.TII
Bt:Nnns SIMlii.AnoN Mout:l. ( 11 IISM)
-·- ..
941-'MO/HO
A-3
------------
------I.E WIN- VIII, INC.
�TABLE A-4
CHA.~GE L~ HOUSEHOLD HEALTH SPE!'iDISG BY L~CO~IE L'"
1998 FOR THE Ct.:RRESTL y
l'iSUREDAND U..!'l.l'liSl"RED HOUSEHOLDS USDER THE HEALTH SECllUTY ACT
WITH A~l> 'WITHOt.:T PREMitJM GROWTH COSSTRAL,'TS
WITH PREMiuM
COSSTRA~'TS
:HOUSEHOLD • ·· .. NUMBEROF
:·: .INCOME0:......... ••HOUSEHOLDS
0,
.... ... . .. . . ..
.
{IN THOUSANDS) •(IN MILLIONS)
WITHOUT PREMIUM
CONSTRW-ITS
WITH. WIJBOUT
Wtm WmloUT
WAGE ••..• WAGE. WAGE •. . WAGE
EfFECTS ·EFFEcrs FnEci's' EFFEcrs
INstJRED.
Under $10,000
$10,000- $14,999
$15,000- $19,999
$20,000 - $29.999
$30.000- $39.999
$40,000 - $49,999
$50,000- $74.999
$75,000 - $99.999
$100.000 and Qver ·
8.6
4.6
4.3
10.8
9.4
9.4
15.2
6.5
7.8
($873)
($62)
($58)
($39)
($165)
($147)
($114)
($120)
$210
($709)
($308)
($263)
($144) .
($320)
($328)
($285)
($330)
($24)
TOTAL
76.6
($161)
($300)
UNI.'\'SURED ..··
($859)
$35
$81
$134
$65
$131
$187
$232
$605
($711)
($299)
($234)
($94)
($241)
($233)
($178)
($203)
$117
$71
($223)
. . .: ' :: ~:
. : ..: ·.·
·.
··········iZiC
Under $10,000
$10,000- $14,999
$15,000- $19.999
$20,000- $29,999
$30,000 - $39,999
$40,000 - $49,999
$50,000- $74,999
$75,000- $99,999
$100,000 and Over
1.6
1.0
0.8
1.0
0.5
0.3
0.3
0.1
0.1
($278)
$1,298
$1,407
$2,274
$2.194
$2.642
$3,093
$3,063
$2,878
($464)
$201
$302
$864
$578
$732
$1,397
$1,546
$1,159
($269)
$1,420
$1,538
$2,461
$2,410
$2,952
$3,385
$3,352
$3,176
($470)
$220
$329
$919
$669
$836
$1,522
$1,707
$1,274
TOTAL
5.7
$1,343
$3~
$1,478
$350
SOURCE: LEWIN-VlD ESTIMATES USING THE HEALTH BENEnTS SIMULATION MODEL (HBSM)
94FM0/80
.
A-4
LEWIN· VHI, INC.
�SEIU
__,______ _
_ _ _
- -
-
�• .f
It sldfts biDions to tile states, eats paymeots ·
to lleallll prowiders ud sO leaves
more titan 10" of Amerieaos uninsured.
An Analysis of the Dole Health Refonn Plan by Lewin-VHI
Prepared for the Service Employees International Union, AFL-CIO, CLC;
�.
......
.
~.
I
.
SERVICE.
,
EMPlO~u~ ~~;~:·:l·d
~
INTERNATIONAL
1313 L srREET
UNION.
AFL-CIO.
N.w:-:·w"As"HiNGToN.
CLC
.,,
. ~~
1..::;:./ ........ ,
~ ;.~... ~.
,. ~
o.c:· 2o00s • c2o2J 898-3200
RICHARD W. CORDTZ
INTERNAnONAL SECRETARY-TREASURER
July 18, 1994
DeM Member of Congress:
On June 30, 1994, Senator Bob Dole and 38 co-sponsors introduced their plan for reforming
nation's health care system. The Minority Leader characterizOO his plan as a significant move
~~d to univenal coverage that would be paid for through cuts in the Medicare and Medicaid
0
grams for the elderly and the poor. Premium subsidies would be available to low-income
~:ilies and tax deductions would be phased in for individuals who purchase health coverage.
The Service Employees International Union commissioned a study by Lewin-VHI, a leading
non-partisan health consulting ftrm, to examine the projected impact of Senator Dole's plan on the
numbers of uninsured in each state and the state-by-state impact of his proposal for fmancing it
through reductions in federal payments to states and health care providers.
The Lewin-VHI analysis, a conservative study, reveals that the Dole plan would accomplish
only a modest decrease in the number of uninsured, while imposing heavy new costs on the states
as well as on health care providers and private insurance plan members.
•
At full implementation and under th~ best of scenarios, the Dole plan would J.u•"•84bo
health eoverage from ss.s· peneat··'te·89.7 pereat, reaehing only 1 in 4 of those
currently uninsured- even with the federal government paying over $106 billion in
new subsidies and tax deductions by the year 2000. According to Lewin·VHI, that would
leave nearly 27 million Americans still without health insurance - mostly middle class
working families.
•
Medicaid cuts eaDed for by the Dele plan will sbift 535.8 bUUoa (Bet). from tile fedelal
cleficit.te1ttate budgeta.over 8¥e yeus. By requiring that states maintain their Medicaid
population while imposing a cap on federal Medicaid spending, the Dole proposal amounts
to yet another large unfunded mandate.
•
Medielw·euta·ealled for by·tbe Dole-plaa will eat pa7dfe11Utcrie&Ml &lie p~b\1CIM·~<>· •
.... 1101J11bds·aadfllyRIMa·-by W ldllloD over the:aat.~yean. Providers fn five
states will be especially hard hit - those loCated in Florida, Dlinois, Michigan, New York,
and Pennsylvania account for half of the total reduction called for under the Dole proposal.
Providers are likely to shift the cost of Medicare underpayments to privately insured health
caa: consumers, who already are paying higher premiums to cover the shifted cost of caring for the
UIUJlSUred. Middle class Americans are once again the losers.
�. rs
roassive co~ shifted. to .states hold the potential to devastate state budgets, already
.~:Oder multiplymg Medica.1d costs. These are costs the states have looked to health care
str'JggtiD lieve. not exacerbate.
refortll to re .
:
Th Clinton Health Security Act also proposes spending limits for the Medicare and
. .d erogr&DlS• but the c?~ ~not simply ~ fro~ the federal governm~t. to states and
McdJc&l .Pemployer respoD.Slbility 1s used to achieve uruversal coverage and md.igent care is
~'::~ LeWin·vm. for example, has estimated that states would~ $67 billion in Medicaid
~ PreSident Clinton's plan over the same five-year period analyzed in this study.
costSun
Despite its budget-roiling, t.lte Dole plan leaves many states with even more people uninsured
, a percent national average. In Alabama, for instance, 11.9 percent will remain uninsured
.3
1
t.1an ~implementation of the Dole plan; in California, 13.4 percent; in Florida, 13.0 percent; in
~~ 13.5 percent; in Texas, 14.9 percent.
Our nation needs universal coverage based on sharing the benefits and costs of reform fairly,
ong governments, employers, providers and consumers. This analysis points up the financial
:u-game that is triggered when any plan avoids requiring all employers to share responsibility for
. employee health coverag~. thus building on the current system. Only. by cov~~ 100 percent of
the population as the Pres1dent has proposed can we end the health-care cost shifting game.
]L'f]
John J. Sweeney
International President
�.,p
.
.
THE IMPACT OF SENATOR DOLE'S
HEALTH REFORM PLAN
ON STATES
PREPARED FOR:
SERVICE EMPLOYEES INTERNATIONAL UNION
PREPARED BY:
LEWIN·VHI, INC.
JULY 17, 1994
I
-..
�'
'
TABLE OF CO,TE~TS
LIST OF FIGURES································································································~····················· ii
EXECl'm"E SUl\'ll\tARY ......................................................................................................... iii
'I;ET FEDERAl COSTS ...................................................................................................................... 111
i.. sL'RA-"cE CoVERAGE .................................................................................................................. ~ii
L\fPACT ON STATE GOVERNME?'II"TS ................................................................................................... lV
L\1PACT O!S PROVIDERS .................................................................................................................... iv
(:_osc-;G .......................................................................................................................................... IV
I~IRODl. CTION
.•.••..•...•.•..•.••••••••••....•••...•..•.•.••..........•....•.....•.•..•.•.••.•.....••..•••.•.•.••••.••••••••••••••.••• 1
K.E't. PRO,lSIONS OF T'IIE BILL ..•..•.........•.•....•........••.•.••••.•••.•.•.•••...••••••••.•••••••••••.•••••••••.•.•... !
FEDER.:\.L EXPENDITU'RES UNDER TilE BILL .••••.•.••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 3
CR-\~GES
I!'J T'IIE Nt.~ER OF UNI.NSU'RED ..................................................................... 6
J,IP ..\C'f ON STATE GOVERNMENTS ••••••••••••••.••••••••.••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 8
l ~I~OSI~G ...........•.•...••••.•••••••••••••••••••••••••••..••.••••..••••..•••••.•.••.••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 10
LEwiN· VHI, INC.
�•
I
-
'
•
LIST OF FIGl'RES
Summary of the ,Vet lmpaSt of Senator Dole's Health Reform Proposal on Federal Spending:
1994-2000 ................................................................................................................................ 3
Detailed Summary of Sources and Uses of Funds Under Senator Dole's
Health Reform Proposal .......................................................................................................... 4
p rcenr of Uninsured Who Become Covered and Percent of Population Remaining Uninsured
e Under Senator Dole's Health Reform Proposal.. .................................................................... 7
Percent of Uninsured Who Become Covered and Percent of Population Remaining Uninsured
Cnder the Senator Dole's Health Reform Proposal by State .................................................. 9
r:>Jeral R-:venue Reductio·.s Net of State Program Savings b_v Stare: /996 through 2000 ........ //
R~Jucrions in Federal Medicaid Revenues Offset b_v Savings to State Indigent Care Programs
Cnder the Dole Proposal: 1996 through 2000 ...................................................................... 12
Change in Provider Revenues Under the Dole Proposal by State: 1996 through 2000 ............... 13
.\·er Annual Provider Revenue Change by State Under the Dole Proposal.. ................................. /4
--~ ...
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ii
LEWIN• VBI, INC.
�•
'I
..
•
:
ExEccnvE Snt,l.\RY
Senator Dole has introduced a health reform proposal designed to expand msur:u1ce
.;o\erage through msurance mark,et reforms and premium subsidies. Specifically, the proposal
·ould require insurers to provtde msurance to all individuals regardless of health status. It would
~ 50 provide premium subsidies to low income persons and would phase-in tax deductions for
. urance purchases by persons who do not have employer provided insurance. These tax
;esductions and pr~mium sub~idies would be financed with savings resulting from reduced
iunding for Medicatd and Med1care.
Eligibility for premium subsidies would be expanded as funding is reduced for Medicaid
.1nd \1-.!dicare. Beginning in 1996. premium subsidies would be available to families with
ncomes up to 90 percent _of.the pave~ level. Eligibility eventually would ?e increased to 150
1
percent of poverty as Med1catd and Med1care savings increase to levels suffictent to pay for these
.;ubsidies.
In this analysis. we estimated the net federal cost of the program. We also estimated the
ro!!ram·s impact on the number of persons without insurance by state. In addition. we estimated
~he ~mpact of the program on state governments and the net impact on provider revenues by state.
SET FEDERAL COSTS
We estimate that the proposal would result in a net reduction in the federal deficit' oflt
s1~.6 b1llion over the 1994 through 2000 period. The federal cost of premium . subsidies and tax~
JeJucuons over this period would be $106.3 billion. These new costs would be offset by about
s1:o.9 b1llion in savings to Medicaid and Medicare.
As discussed above, eligibility for subsidies would be expanded to 150 percent of poverty
,•nl~ as funds become available through savings in other programs. Our analysis indicates that
.;nJcr these criteria. eligibility would remain at 90 percent of poverty through 1997. Eligibility
.,., ould be mcreased to 100 percent of poverty in 1998 and 150 percent of poverty in 1999.
1.\'snU.:VCE COVERAGE
The proposal would expand insurance coverage in three ways. First, the proposal would
:-ttorm msurance markets so that individuals can obtain coverage regardless of their health status.
~cond. premium subsidies would be provided to lower-income persons to help them pay for the
1 1
' "'
of msurance. Third, individuals who do not have employer-based insurance would be
~~::.:!cd to deduct the cost of individually purchased non-group· coverage. (The deduct~on
.,.,. 1 be phased-in between 1994 and 1999.)
...
.,,
We estimate that in the first year of the program
.....-liJid obtain msurance coverage. This is about 17 percent
(i.e., 1996) about 6.2 million persons
of the 37.2 million persons who would
.... ~nln\u d ·
.
·~:n.&.~
re m 1996 under current pohcy. Overall, about 11.8 percent of all Americans would
· · n unmsured in 1996.
iii
LEWIN• VBI, INC.
�The number of persons who would obtain insurance under the proposal would gradually
:000 as eligibility for premium subsidies is expanded to !50 perc~nt of po\eny and
tn~.,~a~ deducubility of insurance is fully phased-in. We estimate that by 2000. about 10.3 million
the .ax _ \··ho would othef\nse have been umnsured 11.e .. - percent ot· the unmsured i would
·
·
.,8
·
person!) ·~
.
.
obtain coverage. Overall, about 10.3 percent of all Amencans would contmue to be without
.
msurance bv the end of the century.
•
.-~ . ·e bv
IMPACT ON STATE GOVERlVMENTS
The proposal would finance these expansions in coverage in part through reduced federal
vments to states under the Medicaid program of about $44.5 billion over the 1996 through
~~) period. The bill would cap the rate of growth in contributions to states for acute care .
~erdc~s provided under the program and ~ederal__f_unding for disproportionate share hospital
DSHl payments would be reduced by ab01i[2S_~ce~t. '.
1
These reductions in federal revenues for states would be offset by savings to existing state
mdigent care program~ ~f ab~ut $8.6 billion over this five-year period as persons se~ed by_ these
pro 2 rarns obtain subs1d1zed msurance coverage under the proposal. The net loss m fundmg to,
!;lat~s would be $35.8 billion over the 1996 through 2000 period.
/.t,fP:tCT ON PROVIDERS
These coverage expansions are also financed through various reductions in Medicare
-.pending. These include about $25.0 billion in reduced payments to hospitals and $28 billion in
reduced payments to physicians ovef'the 1996 through 2000 period.
These provider income reductions would be offset partially by reduced expenditures for
iree care provided to uninsured persons of about $38.5 billion over this five-year peried. This
mc ludes reduced hospital uncompensated care and free care provided in public hospitals. Thus,
the proposal would result in a net reduction in provider revenues of about $14.6 billion over~
1996 though 2000 period.
CUJS/NG
These estimates are based upon the most recent data and research available. However,
they are very sensitive to assumptions concerning spending growth rates and individual behavior.
1n pantcular, these estimates are quite sensitive to differences in health expenditure growth rates
~~oss states. Therefore, these estimates should be treated as illustrative of potential program
ettects rather than point estimates of actual program outcomes.
..
iv
LEWIN• VHI, INC.
�I~TRODtCTIO~
Senator Dole h~ introduced a health reform plan that is designed to expand health insuranc~
bv requiring insurers to accept all applicants regardless of their health status. The proposal
covera!!:e . provide su bs1.d. to enable 1
.
.
.
. uld -also
.1es
. ower-mcome persons to ~ btam coverage an d per~tts a tax
0
~
.
for health insurance prerruum payments for persons without employer-based msurance.
deducuon al does not 1mpose man dates to purchase he al th msurance on enher emp 1
.
.
.
oyers or .
The propOs
individuals.
Premium subsidies provided under the proposal would be financed wit~ savings in existing
roO'rams. Specifically. the proposal would limit the rate of growth tn federal Medicaid
rde.J. t~ t~ states for acute care. It also specifies reductions in provider reimbursement under the
pa~ men
~1edtcare program.
.
r
I
In this analysis. we estimated the net federal cost of the program. We also estimated the
ons who would obtain insurance under the program bv state. In addition. we estimate
num be r Of pers
.•
.
the net 1mpact of the program on state governments and the net 1mpact on prov1der revenues by
'tate.
The analysis is presented in_ the following sections:
• Key Provisions of the Proposal
• Federal Expenditures under the Proposal
• Changes in the Number of Uninsured
t
Impact on State Governments
• Impact on Providers
KEY PROVISIONS OF THE PROPOSAL
The proposal is designed to expand insurance coverage through insurance market reforms
and prenuum subsidies. Specifically, insurers would be prohibited from denying coverage to
md1' 1duals on the basis of health status and there would be limits on the extent to which insurers
could vary premiums with individual characteristics. Pre-existing condition .exclusions would be .,
proh1b1ted e~,e~ .where individuals have failed to maintain their insurance coverage.
Initially. premium subsidies would be provided to persons with incomes below 90 percent of
po ..·eny and a tax deduction is phased-in for insurance purchases by persons who do not have
employer-based insurance. These subsidies would be financed with reductions in provider
reimbursement under the Medicare program and a cap on the rate of growth in federal funding for
the ~1edicaid program. Eligibility for premium subsidies eventually would be expanded .to 150
percent of poverty as Medicare and Medicaid program savings increase over time.
1
LEWIN· VHI, INC.
�. The eligibility levels for premium subsidies would be tied t~ federal health savings. When
-al l:!nacted. premiUm subs1d1es would be available for tarruhes wnh incomes up to 90
the _
proro::. th~15 poverty line. El.1g1·b·l·lty for subsidies would be increased to 100 percent of poverty
f
1
0
pedr.ehnt t0 1"O percent of poverty as federal savines in ~tedicaid and \fedicare accumulate over
an c en
.
.
The subsidy would be phased-out for persons between poverty and 150 percent of poverty.)
1
tplme .. m subsidies would be provided for the full amount of the premium up to a maximum amount
re~u
bv the .Secretary of Healt h an dH uman Services (HHS) for all persons. below poverty.
spec! fi1e d .
Premium subsidies are applicable only to the purchase of a "FedMed" benefits package as
d fi1 d bv the Secretary of HHS. The FedMed package would include the minimum benefits
; ~~ed ~nder the Federal Employees_ Health Ben~fit progr~ (FEHBP) plu.s improvements in
~overa!Ze for mental health and prevention. The max1mum subs1dy amount available would be the
:~oun~ that the federal government uses to calculate its maximum employee contribution under
0
FEHBP.
The maximum contribution limitation in the proposal would effectively limit the amount of
dies
su bs1 available to low-income persons. Our analysis indicates that on average, the premium for
the population that is potentially eligible for subsidies would ex:eed the maximum contribution
amount under the proposal by about 10 percent. This reflects the fact that the low-income uninsured
population that is likely to obtain coverage under such a plan is in poor health and is therefore
e:<pected to have relatively above average health care costs. Consequently, the maximum subsidy
available to any individual under the program at any income level would· be equal to about 90
percent of the premium for eligible persons.
Subsides are not available to persons who are not U.S. citizens or permanent resident aliens,
\-1edicaid eligibles, Medicare beneficiaries, or persons who receive employer financed coverage.
The \1edicaid program continues. although states would be permitted to enroll Medicaid recipients
10 pnvate health plans. States also would be required to maintain current Medicaid eligibility levels.
As an added inducement to obtain insurance, self-employed individuals and other persons
who do not receive coverage through an employer eventually would be allowed to deduct the full
cost of their insurance premiums. The deductibility is phased-in at: 25 percent of premium payments
m 1994 and 1995; 50 percent in 1996 and 1997; 75 percent in 1998 and 1999; and 100 percent in
:!000 and thereafter.
In addition to the market reforms and subsidies discussed above, the proposal:
• Provides access to FEHBP health plans for individuals and small groups
• Allows people to establish tax exempt medical savings accounts
• Creates a "consumer value" program implemented by states to assure minimum quality
standards for health plans and to make comparative information available
• Pre-empts state anti-managed care laws ·
• Builds primary care capacity in underserved areaS
• Clarifies anti-trust treatment for providers
• Includes malpractice reforms such as a cap on non-economic damages
9>4CBOJ79.
2
LEWIN· VHI, INC.
�• Treats long-term care insurance premiums as medical expenses for purposes of potential
tncome tax deductwns
•
fEOER.~L £\PE~DIT~RES C~DER THE BILL
We estimate that the bill would result in a net reduction in the federal deficit of S 14.6 billion
. the 1994 through 2000 period. This includes premium subsidies and tax deductions of $106.3
~:~~;on over this period offset by about $120.9 billion in savings to existing federal programs (Table
I).
TABLE
1
SC\l\IARY OF THE NET IMPACT OF SENATOR DOLE'S HEALTH REFOR.\1 PROPOSAL
ON FEDERAL SPEND~G: 1994-2000 (L~ BU..LIONS)
NEW
EXPENDITURES8
1994
1995
$14.1
$15.3
1998
$19.0
1999
2000
$25.3
$29.4
· Total1996-2000
SAVINGS
$1.5
$1.7
1996
1997
PROGRAM
$106.3
..
NET INCREASE
(DECREASE) IN
FEDERAL DEFICIT
$0.0
$2.9
$9.5
$1.5
($1.2)
$14.3
$22.5
$31.8
$1.0
($3.5)
$39.9
($10.5)
$120.9
$4.6
($6.5)
..
($14.6)
Based upon the prov1s1ons specified m the b11l, we esumate that prenuum subs1d1es w11l ~ available to persons
through: 90 percent of poverty .in 1996 through 1997; 100 percent of poverty in 1998; and ISO percent of poverty in
1999 through 2000.
Source: Lewm· VHI estimates.
J
The $120.9 billion in savings under the program include:
• Medicare Savings - The bill would reduce Medicare spending by about $61.4 billion over
the 1994 through 2000 period primarily through reductions in provider reimbursement
(Table 2).
•
Medic~~n
Savings - The bill would cap the rate of growth in Medicaid contributions to six
percent per year beginning in 1996 (5 percent after 2000) resulting in savings of about $31.2
billion by 2000. Federal payments under the Medicaid disproponionate share hospital (DSH)
program are also reduced by 25 percent resulting in additional savings of about $13.3 billion
over this period.
• Pos141 Service Retirement - This proposal would require advance funding of the .Postal
Service Retirement Fund resulting in additional savings of S 1S billion through 2000..
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LEWIN· VHI, INC.
�.
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TARU: 2
D•:TAII.I.:O SUMMARY OF SOliR(~•:s ANU lls•:s Ut' I'liNUS llNUt:R St:NATC Ut Uuu:'s lh:t\1 :r11 lh H UtM PltnPOSAI. (IN Rll.l.lt )NS)
---,
1994
1995
1996
~--------
1997
PROGRAM SPENmNG
Premium Subsidies•
Tax Deductionsb
TOTAl. NEW PROGRAM SPENDING
$0.0
$1.5
$1.5
$0.0
$1.7
$1.1
1998
1
$10.7
$3.4
$14.1
$ll.6
$3.7
$15.3
$H.O
~6.0
$19.0
1999 I21MII;
$l K_t)
\
I
Tutu!
~!9~~2000
$2ti:y---:
$l)_2
$6.4 f-·-----$25.3
$29.4
---
$14.4
$3l.'J
--$106.3
PROGRAM SAVINGS
Pre-Fund Postal Service Retirementc
Medicare Savings
Reduces PPS Update Factord
Reduce Capital payments for lnpatient.Servicesc:
Phase-Down DSH Paymentsf
Reduce Indirect Medical Education Adjuslment1
Partially Extend Freeze on Updates to SNF Costsh
Partially Extend Freeze on Updates to Home Healthi
Medicare Volume Performance Standard to aopi
Cumulative Growth Targets for Physician Servicesk
1
Reduce Conversion Factor in 1995
Extend Secondary Payer Provisions
TOTAl. MEDICARE
Medicaid Savings
Reduce DSH Payments
Medicaid Capitation
TOTAl. MEDICAID
Total Program Savings
$0.0
$2.0
$2.0
$2.0
$3.0
$3.0
$]_()
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.7
$0.2
$0.0
$0.9
$0.0
$1.0
$0.3
$0.6
$0.2
$0.5
$0.0
$1.9
$0.4
$0.0
$4.9
$0.6
$1.1
$0.5
$0.6
$0.3
$0.5
$0.0
$3.0
$0.5
$0.0
$7.1
$2.0
$1.1
$0.7
$0.7
$0.3
$0.5
$1.0
$4.3
$0.5
$0.0
$11.1
$3.8
$1.3
$1.0
$0.7
$0.4
$0.6
$2.0
$5.3
$0.5
$1.2
'$16.8
$5.h
$1.')
$1.11
$11 7
$0 ·1
$0.7
$0 ')
$I. X
$20.(,
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$2.9
$2.0
$0.6
$2.6
$9.5
$2.4
$2.8
$5.2
$14.3
$2.6
$5.8
$8.4
$22.5
$3.0
$9.0
$12.0
$31.8
$1J_(l
$16.3
$39.CJ
---·-
($3.5)
($6.5)
($10.5)
$1.5
($1.2)
$4.6
$1.0
$h..t
$.1.3
-
---
$1J.J
$31.2
$44.5
$120.9
-
-
-1
$15.0
$12.0
$6.0
$3.5
$3.3
$1.6
$2.K
$5.0
$21.6
$2.6
$3.0
$61.4
$2 ()
NET INCREASE (DECREASE) IN FEDERAL DEFICIT
Net Increase (Decrease) in Federal Deficit
--
I 1:n·•,
--
($14.6)
-~-
'.,, """
�TABU:2
D•:TAIU:DSUMMAMY c,.· SnliRt.:•:s ANU
lls•:s u•· .,.liNUs UNm:M S•:NA'H)M nou:'s lh:.u:nt RuottM 11 Rm•usM. (IN tuu.aoNs)
(CONTINll.:i))
.Based upon rhe provisions specified in rhe prupc1sal. we esrimare Ihal prenuum subsuhes w11l he ava•l•ahle 111 llCI'illll'> lhmugh: YO llCI~o:enl ul p• '".,.' 111 I 996
through 1997; IUO percen1 of poverly in 199M; and 150 percent of poverty m 11)1)1) lhruugh 2000.
b Includes lax deductions for individual purchases of heahh insurance and self-empluyed tax dedm.:tum uffsel by 1educed tax tledm:lluns fur 11111 111 p ...:kd
spending. The tax deduction for premiums will be phased-in wilh: a 25 percen1 deduc1iun permilled in IY'J4 aml llJIJ5; a 5() percent dctlu~.:tiun pe•m•lll:d 111 1996
and 1997; a 75 percent deduction permilled in 1998 and 1999; and a full ded·uction permiued in 21KMI ami !hereafter.
··
c
Based upon Congressional Budge! Office estimates.
d The reductions in PPS update factors under OBRA 1993 are extended through 2000. Payments to non-I"PS hospitals are similarly reduced.
e
Assumed to begin in 1996. Federal capital payment rate reduced by 7.31 percent and hospital specific rate by 111.41 perce~:. Inpatient capital paymt-nl to1lcs fur
non-PPS is reduced by 15 percent. We assume that total Pan A capital payments are reduced hy HI percent in each year.
f
We assume DSH payments are phased down by 10 percent in 1998, 15 percent in 1997. 211 percent in 19lJ8, and 25 llCil"ent in 1999 and 2CKKl.
g The IME adjustment is reduced by 13 percent assumed to begin in 1996.
h OBRA 93 established a two year freeze on the updates to SNF costs while allowing a catch-up in FY 1996. We <~ssume rhe parlial catch-up all11wcd hy rhis
proposal reduces payments to skilled nursing facilities by about 3 percent beginning in IW6.
OBRA 93 established a two year freeze on the updates to SNF costs while allowing a t:alch-up in FY 1996. We assume the parlial cah:h-up all11wcd hy rhis
proposal reduces payments to home health services by about three percent beginning in 1996.
j
Same proposal in HSA. Based on CBO estimates in "An Analysis of the Administration's lfeahh Proposal," February 1994.
It Same proposal in HSA. The proposal establishes a cumulative performance slandard which slows the gruwlh in physician spending ro roughly 1 il )I• ph• ... an
allowance for increased enrollment.
The updare in the Medicare Fee Schedule Conversion Factor is reduced by 3 percent in 1995 except fur primary care physicians. Based on l'BO c.., 11111 a 1c-..
Source: Lewin-VHI estimates.
a
94("80179
5
I.EWIN- ,, Ill, I:Vl'.
�.\s discussed above. eligibility for subsidies would be expanded to 150 percent of poverty as
.. ,
. J ,,· be1..·om'-- available throu!Zh savm!Zs in other pro!Zrams. Our analvsis indicates that under
•
run ln~ na. c~ 112 ibility could be increased to 100 percent of poverty in 1998 and 150 percent of
·ne'e ._nte
~overty in t~J94.
CHA~GES 1 ~ THE Sl"MBER OF Cs~Sl:RED
The proposal would expa~d ~n~urance coverage in three ways. First, the proposal would
insurance markets so that md1v1duals can obtain coverage regardless of their health status.
~tonnd premium subsidies would be provided to lower-income persons to help them pay for the
0
.l~~r .~f insurance. Third. individuals would be permitted to deduct the cost of individually purchased
'"·
oup coverage. The 1mpact of these provisions is discussed below.
non-gr
.
I
,
Cnder the proposal's insurance market reforms. insurers would be required to accept
applications for coverage regardless of health status. The proposal also limits the variation in
premiums by he~th status. We e~ti~ate that these market reforms would reduce the
uninsured populauon by about 1.1 rrulhon persons.
Initially, the proposal would provide subsidies to families with incomes up to 90 percent of
poverty. As federal savings are achieved through Medicare spending reductions and a cap on.
federal Medicaid expendit~res for acute care, subsidies would be expanded to those with
incomes up to 100 percent of poverty and then up to 150 percent of poverty. For persons
below poverty. the subsidy will be equal to the full amount of the premium up to the
maximum allowed under the proposal (as discussed above, we estimate this to be equal to
about 90 percent of the premium). Subsidies are phased-out on a sliding scale with income
between the poverty line and 150 percent of poverty.
3. The proposal would phase-in a tax deduction for insurance premium payments by persons
without employer-based insurance and would increase the deduction for self-employed
persons to 100 percent of the premium cost. These deductions are phased-in with a 25
percent deduction in 1994 and 1995; a SO percent deduction in 1996 and 1997; a 75 percent
deduction in 1998 and 1999; and a full deduction in 2000. This effectively reduces the cost
of insurance for families resulting in an increase in insurance coverage. These provision
would tend to have their greatest impact on insurance coverage for middle and upper income
groups where marginal tax rates are highest. We estimate that this provision ultimately
would reduce the number of uninsured by 1.1 million perse>ns once the deductions are fully
phased-in.
As discussed above, we estimate that premium subsidies would be pre>vided only through 90
percent of poverty in 1996 and 1997. In addition, only a 50 percent tax deduction for insurance
purchases would be permitted in these years. Given these levels of subsidies, we estimate that in
1996 and 1997, about 16.9 percent of the 37 million persons who do not have insurance will obtain
coverage (Table 3).
We estimate that by 1998, Medicare and Medicaid program savings would be sufficient to
fund expanded eligibility for premium subsidies up to 100 percent of poverty. Tax deductions would
~CIOJ79
6
LEWIN·VRI, INC.
�'
TARU:J
Pt:at.·t:NT ot· UNINSURt:D WHO BtTUMt: CUVt:IU:U ANU Plo:Kn:N·rtwl•m•tJI.A'UUN RFMAININt; UNINSllK ..:U
UNDt:R St:NATOK Dou:•s lh:AI.nllb:t·nKM t•ttnPnSAI.
--
- ---·
t•EKC. ··:NT tuoJ•nPlii.ATit lN l!NINSI ·kEU --- ------· I
llNUt:R R ..:Hlltl\1 t•ROI'USt\1 . . 1996-1997
1998 Subsidies 1999 Subsidies 2000 Subsidies
Number of
I ' " SubslcUes 1999 Subsidies 2• Subsidies
Current Subsidies to 90'?'"
1o ISO .. of
lo 180., of
to 100.. or
lo ISO"' of
to ISO'Y" or
Uninsured Subollesto
to ISO"' or
Law
Poyerty
Poverty
of Poverty
Poverty
Poverty
Ponrly
Poverty
Ia 1,. 90., of Ponrty
(50'1. Deduction) I (75'1> Deduction) (75'11 Deducllon) lFull Dedudlonl
I(50-. Deducdoa) In5-. Deductloo> ,(75-. Deductloa) (Ji'ull Deduction)
PERCENT OF UNINSURED WHO 8t:COME COVERED
~-
·~·99'7
TarAL
37.l
16.9%
19.4%
26.9%
27.7%
14.2%
11.8%
11.4%
I0.4"k,
IO.J'Y.
INCOME
< $10,000
5.9
39.0%
39.0%
40.7%
40.7%
21.7%
13.2%
13.2%
12
l)'}i·
12.lJ'/;
$10-15,000
4.6
21.7%
26.1%
43.5%
24.2%
18.9%
17.9%
11 Pk
$15-20,000
4.1
43.9%
23.1%
17.4%
14.7%
21.4%
17.1 'if,
11 7'Yt
24.6%
17.4%
11.8%
24.4%
19.2%
18.4%
6.5
4.6
3.4
8.1
24.4%
10.8%
13.0%
11.8%
12.3%
13.7'1.
ll7';;
$20-30,000
$30-40,000
$40-50,000
$50,000+
12.2%
10.8%
10.9%
11.8%
11.1%
43.5%
43.9%
17.1%
14.5%
13.4%
13.1%
12.4'1.
6.8%
'J.X'Y.
-----
9.5'1.
13.6%
9.H'Yt·
6.9%
9.8~.
12.3%
15.0%
11.1%
7.8%
ll.X'Y.
6 7'1.
4 'Yt
9.3'7.
--.
14.8'/t
12.4';;
AGE
19.6%
21.6%
32.0%
33.0%
13.8%
11.1%
10.8%
2.8
25.0%
25.0%
32.1%
32.1%
29.8%
22.3%
22.3%
20.2'1..
202'%
4.1
19.5%
19.5%
24.4%
24.4%
29.0%
!. I IJ'Y.
21.9'Y.
25-34
7.8
21.8%
28.2%
29.5%
19.5%
23.3%
15.8'){.
23.3%
19.2%
15.3%
14 0'1.
13.8'/;
35-44
5.1
15.8%
19.3%
26.3%
28.1%
14.6%
12.:\%
11.8%
10 X'Y.
45-54
4.7%
9.3%
14.0%
14.0%
12.3%
11.7%
11.1%
----I II 6'1.
W.5'i.
4.3
55-64
2.7
ILl%
14.8%
25.9%
25.9%
11.2%
9.9')'i,
9.5%
X .\'1.
8
0.0%
0.1
Source: Lewm- VHI estimates.
0.0%
0.0%
0.0%
0.3%
0.3%
0.3%
II YY.
() ]';,
<18
18-21
21-24
65+
9.7
7
-·
l)
I()(J•;;
·---·---
·--
I.nnN-ri/1,/Nc.
_l'.;;
�..
•
--- - --- · ·· - · --------lllii•Rii!l?llllhllliS'Raaillltr..-.·.--p-:-_--
J.bo be increased to 75 percent of premium costs in that yeJI. Due to this expanded eligibility for
,;.~bsidies. about 19.4 percent of those who would otherwise have been unmsured 10 1998 would
btJ.Jn ..:overage (~able 3). By 2000. subsidies would be available! to all persons through I 50 percent
1
~t povertY and the full amount of the premium would be tax ded~ctible. ~7 nder these provisions.
about 28 percent of those who would otherwise have been unmsured m 2000 would obtain
coverage.
Table 4 shows the percent of uninsured who become covered and the percent of the
population remaining uninsured under the proposal in each state.
l'tf:\CT o~ STATE GOVER.,~IESTS
The proposal would finance expansions in coverage in-part through reduced federal
payments to states under the Medicaid program of about $44.5 billion over the 1996 through 2000
penod. The proposal would cap the rate of growth in contributions to states for acute care services
provided under the program, and federal funding for disproportionate share hospital payments
would be reduced by about 25 percent. These. reductions in federal revenues for states would be
offset by savings to existing state indigent care programs of about $8.6 billion as person served by
these programs obtain subsidized insurance coverage under the proposal. The net loss in funding to
states would be $35.8 billion over the 1996 through 2000 period.
As discussed above, the proposal would limit the rate of growth in federal Medicaid
payments for acute care per eligible individual not to exceed six percent beginning in 1996 (five
percent after 2000). The proposal also prohibits states from eliminating coverage for eligibility
groups covered by the state as of 1994. thus, limiting the state's ability to absorb the revenue cuts
through reductions in coverage. This per;-capita capitation of federal contributions for acute care
would result in a loss of revenues to states of about $31.2 billion over the 1996 through 2000 period.
Thus. states either would have to raise the revenues required to fund benefits costs that otherwise
would have been covered with federal funds or find some other way to reduce program costs.
The proposal also would reduce federal contributions for the disproportionate share hospital
10SH) program by $13.3 billion over the 1996 through 2000 period. The net impact these DSH
payment reductions on state governments is difficult to assess. In some states, the DSH funds are
passed-on to hospitals and/or locally funded public hospitals with no net fiscal impact on the state.
ln other cases states use the DSH funds to offset spending under other indigent care programs thus
providing fiscal relief for the states. It was not possible to perform a detailed analysis of the ultimate
tmpact of these DSH reductions on state and local governments due to data limitations.
These reductions in federal funding for states would be offset in-part by savings to other
mdigent care programs financed by states as low-income persons currently receiving care under
these programs obtain subsidized insurance coverage under the proposal. In particular, states with
··state only Medicaid" programs covering low-income persons who do not qualify for Medicaid are
hkely to see significant savings as some of these individuals obtain federally subsidized private
msurance under the proposal. We estimate these savings to be about $8.6 billion over the 1996
through 2000 period.
iocCIOJ79
8
LEWIN• VHI, INC.
�f
...
:
i
TABLE 4
P£RCE~T Of [~I'S.CRED WHo BECO~lE COVERED A~D PERCE~T Of POPCLA TIO~ RE\1:\I~l~G
[~I~SLRED l ~DE~ THE SE~A TOR DOLE's HEALTH REfOR..\1 PROPOSAL BY ST.-\ TEa
.
l'eftftl ot laianred Wllo
Become Covered
. PelUIII ot P_..lloa l!aaared
l'*r Rllona_I'Topcui
~hi
IIJ96.199'7
IIJ96.199'7
1998 SubUdles 10 1999 Subsidlel10 :ZOOO Sablldiel&~~
1998 Salllilllel&~~
1999 Sabsld:t
SublldleiiO 90' ot 100, ol Potei'IJ'
SalllldleiiO 90,
150' ol Potmy 150' ol Po•eny Carrm&Liw
100' ol Po•eny 150' oiPo• y 150' ol Po•ei'IJ' ~
tni-nclln
Po•ei'IJ' 150'
ol Po..ny \50'
(15" Dedllctlon ("15, Dedaclloa !Fun Dedact1on1
(15' Dedactlon !15" Dedactl
lhll Dedactlaal
1998
Deductlaal
Deductiaal
!'...
_.,
16.9 ...
19.4 ...
:16.!1 ...
11.1'
I J1.l0~
11.4'
10.4'
:7.1 ...
IO.J'
14..Z'
2~.0"4:
24 5"4:
13 9~
34 '"4:
'69.929
135"4:
12.0"4:
I
II 9"4:
I" 5"4:
l~ 4"4:1
216~
23.3'11:
II 9'11:
28 6'11:
'9.561
II 6'11:
14 4'11:
10 8'11:
10 ~"4:
I
29 4'11:1
26 4'11:
2H'II:
•)1),::9
I 3 3"4:
ll 5'11:
I 2.9'11:
16 ""4:
II 6'11:1
II S'll:
)-'~I\- I
I
:6 "t;t.
J4 ~~I
:• I'II:
418.049
IJ 0'11:
1Z.5~
lo J'll:
II!"':
; ; :"'1
'S 2'11:1
23 6'11:
25 8'11:
]26'11:
I 5 3'11:
~. 168.586
14 9'11:
1)4"4:
}] }~'
I8 9'11:
I J S'11:1
I
27 I'll:
239'11:
15.8'11:
87'11:
P8.539
8.3'11:
"3'11:
"2"4:
I
165'11:
10 9"
20.2'11:
5.9...
22.0'
27 3'11:
248.468
5.8'11:
54'11:
I
53'11:
28 I'll:
7 "'
239'11:
I
103.148
21.8"
139..,
ll.lt.
30 3"
10 I'll:
10.0'11:
311'11:
II'"
23.4'11:
25.9t.
333'11:
I 33.745
193'11:
18.7'11:
16 8'11:
240'11:
16 ''II:
340..
25.6..
23 2'11:
J3 J..
146<11.
I l I'll:
2.638.648
IJ 0'11:
J.l O'l(o
15 "'
18 '"
244<11.
26.6'11
32.8'11:
11.9'11
!.019.704
12.3'11
10 9'11:
10 8'11:
15.5'11:
JJ.$'1(o
23.0'11:
21 5'11:
84.875
286 ..
56'11
52'11:
5 I "4:
6.9'11
2H'II
5"
23 3'1(o
25.7'11:
n.9'1(o
13.3'11
12.0'1(o
18H86
II 9'11:
I 3 8'11
Pl'll
336'11:
2: 7'1(o
24 7'11:
8.8 ...
Jl 2...
9 ....
S I'll:
IJ85.725
80'11:
ll 9'1(o
II 2'11
'
27.6t.
34 7..
94t.
84...
25.4'
~ 5'11:
"20. 102
9.7'11o
35 5..,
12.4'11
I
26.3t.
2J8'11o
67'11
257.142
346'11:
60t.
59'11:
8 7'11:
J53t.
69'
24 4'11
27 Ot.
I
76'11:
304.126
35 Ot.
86'11:
""'II:
8.9'11:
15,..
II 2'11o
:7 9'11o
:5.2'11:
487.679
36.6 ...
97'11:
84'11:
10.0..
S.S'IIo
12.8 ..
3'3'11:
25J'IIo
27.8'11o
884.624
15.1'11o
l$.8'11o
13.6..
13 5..
35.3"
20.1 ..
36.0'*
77..,
24.0'11o
26.2..
143.172
33.7'11o
8.7'11o
7.8'11o
9.0'11o
11.2'11o
345t.
21.2'11
D.O'IIo
97'ilt
286 ..
10.6'11o
9.8 ..
654.354
10.8'11o
29 4..
13.1"
24.1'11o
2!.3 ..
29.4..
8. l'llo
618.839
7.5t.
8.3'11o
102t.
'4"
30 "'
22.8 ..
63..,
367.655
J 1.8'11
7.2'11o
7.0'11o
6.4'11:
89'11o
25 0"
32 6..
23.4 ...
25.9'11
411.966
33.2 ..
7.0..
7.2'11o
6J'IIo
6.2 ..
8.K
33 9..
25.3'11o
27.9'11o
529.592
3'-S'IIo
14.7'11o
l4.2'11o
18.8'11o
12.6..
12.S..
36.5'11o
24.4'11o
27.4'11o
35.4'11o
625.422
95'11o
9.1'11o
8.1'11o
8.0...
11.9'11o
36.2"
24 9..,
115.614
278..
36.8'11o
10.6'11o
10.2'1
8.9'11o
S.8'ilt
37 5'11o
IH'IIo
147,751
24.4'11
26.8'11o
345'ilt
6.7'11o
6.5'11o
5.8'11o
5.8 ..
!.5'11o
35.2"
234.841
22.9'11o
25.2'11o
31 .7'11o
14.6'11o
14.2'11o
12.8 ..
32.5 ..
181'11
12.9'11o
24.1'11o
31.1,.
7.9'11o
IIU67
22.2..
30.3'11:
97'11
77t.
7.1'11o
70'11
214'11o
23.2..
28.3'11o
7.9..
29.1'11o
10.6'11o
8.8'11o
8.6'11o
8.0'11o
863.081
23.4'11o
25.7'11o
33.4'11o
341 ..
16.8..
340.299
20.8'11o
16.3..
14.6'11o
30.7'11o
9.8..
8.9'11o
24.5'11o
22.4'11o
31.5'11o
12.3'11o
10.0..
9.0..
2.321.180
347 ..
14 7'11o
IO.I'IIo
23.9t.
26.5..
34.0..
II .8'11o
11.4..
10.1'11o
1.026.629
)49'11o
71 ..
26.7'11o
34.2'11o
4.9'11o
48'11:
47.062
24 6'11o
5.6'11o
5.4'11o
2S.8..
32.6'11o
33.3 ..
IO.O'IIo
8.1'11o
7. l'llo
23.6'11o
7.8'11o
1.168.185
~o"
36.1 ...
18.0..
35.4..
14.3..
12.1'11:
24.6'11o
27.2'11o
IJ.I'IIo
601.362
12.1"
93 ..
36.1'11o
13.9'11o
27.1 ..
ll.O'IIo
9.4'11o
433.260
2U'IIo
10.6..
35 ..5"
32.0..
8.6'11o
6.1 ..
7.0..
6.2'11o
22.4'11o
24.~
6.8'11o
1.098 ..568
31.2"
~9,
30.0..
10.8 ..
29.2..
8.8..
8.6'11o
8.0..
22.3'11o
ZJ.K
107.689
35.5'11o
14.7'11o
10.0'*
34.8...
11.6..
11.2..
IO.I'IIo
27.4..
24.9'i
546.478
34.6'11o
10.8'11o
8.6..
7.5'11o
Z6.4'11o
JJ.K
8.l'llo
78.185
24.0.
35.0..
13.9'11o
9.5'1
34.3'11o
11.1 ..
10.7..
9.6..
23....
Z6.4'11o
699.537
21.7'11o
34.8'11o
14.~..
34.1'11o
17.4'11o
15.0..
26.2'11o
16.8'11o
23.7..
3.877.162
32.2'11o
12.5'11o
8.9..
90..
24.5..
31 ..5'11o
10.2..
9.9..
ll.~
225.761
77,
339'11o
II l'llo
9.0..
7.8'11o
33.2'11o
8.7..
25.5'11o
67.768
23.2..
16J'IIo
116..
32.3"
u.,..
13.2..
12.8t.
11.7'11o
31.5'11o
24.9'11o
1.0.50.171
10.8..
32.7t.
7.7..
76'11o
31.9t.
8.~
8.4..
23.9'i
259'11o
56.5.632
36.9..
97 ..
14.6..
9....
11.6..
36.1..
11.2..
27.3..
24.3'11o
281.012
32.3..
5.2'11o
s....
5.3..
31.6'11o
6.0.
25.0'11o
2J.O'IIo
384.275
34.3..
11.7'11o
8.1 ..
94..
9.1 ..
8.1 ..
33.~
16.1 ..
234..
57.811
'liam~~trol
Toeal
..,.
'-"o.A.~
\
..
•::·'",.;
\.~~
~,,.....
-:-: ...n.~~
~cncut
~.~.-e
-::;:
"f=:_~
-·~~l"
-u:;-11!
~~
...
::i/"101)
:;;;.
:*a
u~w.\
~, ...
t:;WJD~
-;;,.
-;u...lltld
'1..,..~11JtrtS
""·"IIIII
\41nncs.ou
'111"""1JP1
\4!~"""'
\4~tanl
....
~
..... ..u
..... tWnpWte
't• Jerv~
"'"
\t,.\4UICO
"" Tort
'"" CMObna
''""!:Oaou
.~tO:
~~~~~
)UOII
"""'••lvarua
I1JIOCie lliland
,...,
louiiiC:Whna
louin Da&oca
~ennessee
Teus
·-:MI
·mnono
1
,!!1!nll
II'UllonJtOn
Illes~ Y_~t~~noa
1
Wuoc-
""
' ' '01111111
\l
a
The bill phases-in subsidy eligibility at 90 percent of poverty in 1996 and 1997, 100 percent of poveny in 1998. and ISO percent
of poveny in 1999 and 2000. Tax deductibility of non-group premsum payments is also phased-in at: SO percent of premium
payments in 1996 and 1997; 7S percent in 1998 and 1999; and 100 percent in 2000.
Source: Lewin-VHI estimates using the Health Benefits Simulation Model <HBSM).
. 94CBOJ79
9
LEWIN• VHI, INC•
�The net impact of the proposal on state government health spending over the 1996 through
:000 period is presented in Table 5 for the 50 states and the District of Columbia. Table 6 presents
the net impact of the proposal on state governments in each individual year between 1996 and 2000.
IMPACT ON PROVIDERS
The proposal is in large part financed through various Medicare program reductions.
Hospital revenues would be reduced by about $25 billion over the 1996 through 2000 period.
Reductions in Medicare physician payments over this period would be about $28 billion. These
provider income red~ctions would. ~ partly offset by about $38.5 billion in savings for care
provided free by hospitals and phys1c1ans as previously uninsured persons become covered through
subsidized insurance. Thus. the proposal would result in a net reduction in provider revenues of
1~.6 billion over the 1996 through 2000 period.
s
Table 7 shows the provider revenue effects by state for the 1996 through 2000 period. Table
s shows the annual net revenue effect by state for this period.
CLOSING
These estimates are based upon the most recent data and research available. However, they
are very sensitive to assumptions concerning spending growth rates and individual behavior. In
particular. these estimates are quite sensitive to differences in health expenditure growth rates across.
states. Therefore, these estimates should be treated as illustrative of potential program effects rather
than point estimates of actual program outcomes.
ii4CBOJ79
10
LEWIN· VHI, INC.
�!!!_ 7 , • •::...
II""
L'
..
T -\BlE s
FEDER-\l RE\ E~lE REDl'CTIO'iS SET OF ST . HE PROGR-\\1 SA \'l"iGS BY STATE:
19Q6 THROtGH 2000 f l'i \tiLLIO"iS l
'
Reducaoas
ID
Fed tl"'l
~td.ic:.lld
FuadiDI
Per..c.,Ha
Toca.l Fuad!DI
Paymeat Cap' DSH Reduclloasb
Lou
Total
"uabama
Ala.su
Anzon~
Ark~SilS
Cahfom1a
Colorado
Connecucut
Dela,..are
F1onda
Geor111
Haw an
Idaho
IUIIIOIS
Indiana
Iowa
IUnsa.s
Kentuckv
lAw~tana
Ma~~~e
MatYland
MassachusettS
Miclu1111
MiMesol&
MisliUIDOi
Misloun
Montana
Nebraska
Nevada
Nf'll HamDShtn:
Nf'\IJeney
Nf'll MelUCO
Nf'll Yort
Nonn Carolina
Nonn Oak01a
Ohio
Old ahoma
Ore1on
Plmnsylvuua
RJiode lslllld
Soudl Carolina
Soudl Dakoca
TITaa
Uflll
Vermanl
Vininia
wulliftiUIII
WatVirmiWI
Wi~eonsin
w-
Sll.ZOO.O
544~ 0
584 3
561-i 6
5382 0
F0678
SZ33 9
5300 8
56611
si 64:.5
S9790
S78.4
5m9
s1.214.0
57319
5243 4
5152.6
5728.0
51.339 4
5246.9
5.587 0
. 57505
51.003.0
5336.0
5443.2
5532.2
51099
5161.1
589.3
570.7
5S42.4
5234.9
S3.890.3
5835.8
554.6
51.32!.1
5325.3
S236.9
S981.1
51.50.5
S52U
$18.0
$1.(169.5
51.72!.9
5163.6
S72.0
$48.4.2
546.5.4
5.516.9
$415.3
S36.9
513.300.0
sn: 9
51:6
so 0
5~ 9
51.:89 8
5~68:
53'. ~ '
539
SI 54 3
5239 2
530.,
so 9
5241 0
51134
537
51474
5214 0
5823 4
5221 I
5947
53858
5438.1
513 9
5124.9
5563 6
S0.8
52.0
5.59.3
5315.3
58806
S6.1
52.244.6
5268.2
SOB
53642
520.9
514.0
57'79 9
532.5
5340.7
SOl
SJ55 ..5
51.219.7
56.0
518.3
5S43
5186.2
S.53.5
56.5
10.8
S.U.!OO.O
57"'9 9
S96 9
5614 6
5384 9
S-1.3~76
sso:
!
5618 3
570.0
5!."96 8
51.218.2
5109 1
S1:l8
51.455 0
58.51 4
5247 2
5300.1
5942.0
52.162.8
54680
56817
51.1364
51.441.1
53499
5568.1
51.0U7
5110.7
5163.1
5148.6
5385.9
51.722.9
5241.8
56.134.9
51.103.9
5.55.4
51.689.3
5346.2
Sl!O.B
51.767.6
5183.0
5865.2
S78.9
5 1.42.5.0
52.945..5
5169.6
S90.3
S568 ..5
56.51.6
S570.4
5421.8
S37.1
Sat1ap 1D State
ladtaeat Care
Proanms'
tS8.655.11
50.0
tS~l )I
I
$9)2.9)
so.o
01
·533 }\
S366 01
rSl}~
151~.81
. 561 91
50.0
500
!561 91
:596.7\
50.0
,551.91
15105 2)
50.0
50.0
so.o
SO.O
!515.5.21
15128.9
(5319.2
so.o
15716l
1524.0
152!.2
(558.0
$0.0
($71.2
$0.0
_tS3.854.3
so.o
so.o
($8698
so.o
_l$.52.6
($941.0
($4.0
so.o
so.o
so.o
so.o
($22.8
so.o
($.50.3
so.o
so.o
IS'TT 8
($4.3
Re•m•
Reducaou Nee
of Sat1ap
SJ5.1U4.9
5""9 Q
s·~ 6
5318.31
5384 Q
5-' ~:o 6
5-168 8
s:s: }
5~7)
51."34 9
51.:18.2
5109 1
561 9
5U58.2
5851 4
5195 3
5194 8
5942.0
52.162.8
5-'68 0
5681.7
5981.2
51.312.2
530.7
5568.1
$1.024.2
586.7
5137.9
590.5
538.5.9
51.651.7
5241.8
52.210.6
51.103.9
555.4
$819 ..5
5346.2
5198.2
5826.6
513.5.0
5865.2
S11.9
$1.42!.0
52.945 ..5
5146.7
590.3
S518.2
56.51.6
5.510.4
SJ.U.O
SJ3.4
The growth in federal Medicaid acure care paymencs per recaptent as capped noc to exceed six percent per year beaiMing in
1996 <~percent after 2000).
~ Federal Medicaid DSH payments are reduced by 25 percent
. .
Includes savings to swe indipnt care programs as persons now rec:eaVJng care tbroup these sources obcain subsidized c:overaae
1
WIC1er the proposal.
Soaute: l..ewin-VHI estirrwes.
11
LEWIN• VHI, INC.
�TABlE 6
REDl'CTIO'S 1:'\ FEDER-\L :\lEDlC.-\10 REVE:'\l'ES OFFSET BY SAVI"'GS TO STATE I:"DlGE:"T CARE
PROGR-\..\1S C:"DER THE DOLE Blll: 1996 THROLGH 2000 ([:'\ \11LUO,Sl
f ederaJ RevtDUt Reductioa.s ~et or SIYiDI~ 10 S&a&e PrcttrramS•
1996
Total
Alabama
Alaska
An zona
A!Xansas
Cahfomta
Color:ldo
CJMecucut
Delaware
Flonda
Gconna
Haw au
Idaho
llhnots
lndtana
Iowa
Kansas
Kentuekv
Lowsaana
Ma.tne
Marvland
Massachusem
Michiran
Minnesola
MiSSISSIDDI
Missouri
Montana
Nebraska
Nevada
New HIJIID5hite
New Jersey
New Mexico
New York
North Carolina
North Dakola
Oluo
Oltlaboma
lOman
Peanavlvlllia
Rbade Island
Soulb Carolina
Soudl Dakoca
Tennessee
Texas
Utah
· Vermont
Vimnia
WashiniiOft
WestVimnia
Wisconsin
tft'rlmllllll
1
1997
S1.1Zl.J
S!8.7
ISO.Il
15(47 ~I
578
5229.6
539:
I $9 01
t50JI
544.2
$.54.8
56.1
158.1)
. 543.1
531.2
153.6\
57.1
546.2
5149.6
538.0
52.5.5
$46.0
$63.2
1$46.0
527.3
$82.8
(51.9)
($0.9)
$0.7
$48.8
5136.5
5.5 ..5
($245.7)
556.4
Sl.l
.<..S68.3
$9.4
(52.3
($24.4
($0.4
S61.3
Sl.6
$74.0
5216.6
S0.2
$4.1
513.4
$36.9
518.0
($4.3
S3.511.2
S100.2
SO. I
1991
$6.,711.2
S141.2
5~.7
514 0
15126 91
I 567 81
534 B
Sil 6
5481 3
519.5.
56: 9 i
589 ~ I
51:.9
546.6
541
510.6
51632
5323.4
5131.0
5228.7
Sl2 6
520.6
!$0.9)
$10.9
5133 6
5253.9
$86.7
51.59 4
512.4
53.5.9
$19.8
536.7
51039
Sl ~7 2
$268 8
S409 9
$62.1
589.1
$698
$127 6
5106.7
$184.7
$143.9
$247.0
(529.6)
$2.9
$62.3
5106.8
5m.s
$19.5 I
5.5.3
51.5.9
59.9
525.4
57.4
$16.9
$63.2
$74.8
$220.6
5314.8
$4.5.0
522.3
$409.9
$2.1
$123.4
5207 8
ss.o
$10.3
$14.9
$147 8
S64.6
533.0
536.5
513.5
51.52.5
$45.8
525.0
510.0
5164.1
5108 ..5
$1,,7
57.1
5268.3
5160.1
5559.3
5375.0
$27.1
$11.3
517.0
59.8
596.7
$48.8
5122.9
$75.4
5106.5
$56.0
$63.3
523.3
$6.2
S2.6
1999
S10,100.1
$204.0
5:!:!.S
I 527.5)
SilO 8
Sl.l-'S 8
51 :o.
578.0
517 2
549.5.0
5336.4
529 5
522.1
53833
5238.4
559.7
5.54 2
52.58.3
5.572.1
5121.1
5190.7
5269 ..5
53.59.9
530.0
$1.56.0
5264.9
526.6
$41.4
526.4
$91.5
5426.0
$69.3
5782.4
5301.6
$15.9
$273 ..5
S91..5
$59.9
$2.54.3
$40.2
5221.1
522.7
5388.7
1773.0
$43 ..5
S24.9
5147.6
$176.2
5161.2
5104.2
59.9
2000
SIUOO.l
Sl68.9
533.6
5.513
51.59.9
51.568.2
51S6.7
5123.8
525.7
5709 I
$467J
S40.3
537.8
5544.4
533.5.6
591.0
$77.1
53.56.4
5762.4
5157.7
5268.1
5374.4
$498.3
573.4
$215.7
5345.9
$40.7
S62.1
$39.2
$107.7
$5.53.8
$99.6
51.331.8
$414.8
$23.0
$451.6
$140.7
590.6
$398 ..5
S60.2
$303.1
S32.7
$533.8
51.021.7
$64.6
$34..5
Slll.6
1240.1
S228.6
$157.6
514.6
1996
lhroup
2000
S3!MU
,,9,9
57.5.6
!5318.3)
5384 9
54.220.6
S468 8
5252.3
557.3
51.734.9
51.218.2
5109.1
561.9
51.358.2
5851.4
519.5.3
51948
5942.0
52.162.8
$468.0
$681.7
5981.2
51.312.2
530.7
$568.1
$1.024.2
$86.7
$137.9
$90..5
$38.5.9
$1,651.7
$241.8
52.210.6
51.103.9
S.55.4
$819..5
$346.2
$191.2
$826.6
$135.0
186.5.2
$78.9
$1,42.5.0
$2.94.5..5
$146.7
S90.3
S511.2
$6.51.6
$570.4
$344.0
S33.4
InclUdes reduced federal Medicaid fundiq for acute care (capilllion and DSH> offset by savinp to exisana swe indipnt care programs.
~: Lewin- VHI estinwes.
94CBOJ79
12
LEWIN· VBI, INC.
�TABLE 7
CH.\~GE r~; PROVIDER REvE~TES C~DER THE Dou BrtL BY STATE: 1996 THROl'GH 2000 11~ \ULLio.-..-
.
TOTAL
.J..Iabarna
J..laska
An zona
Arltansas
Califomta
Colorado
CoMecucut
Delaware
DC
Flonda
Geoma
Haw au
Idaho
llhnots
lndtana
Iowa
Kansas
Kenruckv
Lowstana
Maute
Maryland
MassaA:busetts
Micbiun
Minnesota
MiSSISSIDDI
Missoun
Montana
Nebraska
Nevada
New Hampshire
NewJeney
NewMaico
New Yoct
Nontl Carolina
Nontl Dakota
Ohio
Oklaboma
OrellOil
Pennsylvuia
RJiode lsllnd
Soulb Carolina
Soudl Dlltota
Tennessee
Tau
Utah
Vermont
VinMia
WuhinltDII
WesaVinMia
Wi.lcoalul
Wy~
'
Reduced
Reduced
Pbysiciaa
!
Hospi&aJ
· Total Provider
Reveaue
Reveau~•
Reveaues•
Reductions
521.300.0
553.087.8
Sl4.787.8
$490.~
5041 7
S451J
518 7
53:4
SIP
5440.9
57539
5313.0
5316.4
s~ 16.8
5200.4
53.082.0
5.5.914.2
52.832.2
5219.4
5392.6
5173 2
5431 I
5767.2
5336 I
569 0
5121 ~
552.
s7· • '
S2~9 9
SJ82.; I
52.739.7
54.:!04 7
51.52.5 0
5627 6
5 1.2.59.3
56316
568.1
5157::
589.1
5760
5109 4
533 3
51.226.0
52.3.56.0
51130.0
5.506.1
5943.3
S437.2
$268.2
S4Sl7
$185.5
$276.1
S44H
$169.~
$40!5.6
5781.3
537.5.6
$496.4
51.019 9
5.523 ..5
5120.3
5210.8
590~
5SSS.2
5937.6
5382.~
5717.6
SU38.2
5820.6
51.181.3
52.113.6
5932.3
S~.S.2
$608.7
5m ..s
5~6 ..5
$495.6
5239.0
5.568.!5
51.067.3
S498.9
570.0
$113.6
S43 ..5
514~.6
51~.6
5271.2
5148.1
S236.S
588.4
585.4
$694
5154.8
51.033.2
5760.6
51.793.7
Sl12.6
580 ..5
Sl93.0
$2.466.2
5.5.123.0
52.6.56.1
$591.9
$730.8
$1.322.7
$47.3
S62.0
5109.3
51.102.2
52.385.5
51.283.3
5240.1
5575.7
$335.6
5176.8
5403.5
S226.7
51.756.7
53.630.1
$1.873.4
595.2
52190
Sl23.1
5358.1
$639.2
S281.1
$44.5
$104.3
559.8
$412.7
5936.7
5524.0
5U50.1
S3.154.7
$1.604.6
$79.4
$170.4
591.0
534.6
S75.4
$40.8
$413.9
$1.020.0
S536.1
S321.0
S761.5
$440.5
5187.1
$396.7
$208.9
Sl51.2
$781.9
$437.7
518.0
S45.8
$27.7
ProVIder
Re•eaue
lncreuesb
538.535.2
S799 9
SS3:!
5203.7
s 196.4
S4.969.0
538H
S4i0.0
569J
5166.2
52.0.57.5
51.8014
598.0
582.9
5 1.073 ..5
5829.3
$433.3
$309.7
5372.!5
5650.9
$93.7
5734.3
51.191.0
$1.196.0
5603.7
554.5.0
5719.6
$73.9
5209.8
5212.7
576.6
St.311.7
S235.1
$3.958.9
$1.246.1
S33.1
$1.387.6
5603.3
$309.2
$1.065.6
$114.3
$836.3
$51.4
$1.048.9
S3.080.4
$143.0
S40.8
$1.()68.3
S535.7
S230.9
M59.6
$96.3
I~et Revenue/
Effect
1$14.552.6
!SI4Ul
S20.~
15~~0.::1
153:!0.41
I $945.11
156.9)
15297 21
15~2.41
· S93.31
152.207 21
5~42.1
15~9.2)
1526.4)
IS 1.282..5\
15113.9)
1520.41
iS13~.9l
1$408.8)
15369.11
J$117.1)
t5203.4)
($347.2
1$917.6
($5.0)
$49 ..5
($347.8)
($39.6)
($61.4)
1523.8)
($78.2
(5482.1)
$42.0
($1.164.1)
($76.7)
($76.2)
($997.9)
S27.6
($94.4)
($2.564.5)
($104.7)
5197.1
1552.9)
Sll2.2
($74.3
($27.4)
C$34.6)
548.3
($225.7)
($165.8)
IS329.2l
$50.5
1
Revenue reductions based on specific: Medicare PJ'OII'UII reducuons Jnc:luded 1" die Dole proposal (ellCludes payment reductions for long te!T:"
care and home health services).
l
Increased insurance c:overqe under the Dole proposal results in increased revenue for providers u uncompensared c:are expenses decline.
Source: Lewin-VHI estimates usinathe Health Benefits Simulalion Model <HBSMl and die Payments Simulalion Model (PSM).
94CBOJ79
13
LEWIN• VHI, INC.
�,.
TABLE
8
~ET A~~LAL PROVIDER REVE~LE (H.-\~GE BY STATE C~DER THE DOLE BILL a
1996
TOTAL
.~labama
Alaska
An zona
Arkansas
Cahfomta
Colorado
Connecticut
Delaware
DC
Flonda
Georsna
Haw au
Idaho
IllinOIS
lndtana
Iowa
Kansas
KenNclcy
Loutstana
M11ne
Maryland
Massachusetts
Michagan
MiMesolll
MiSSISSIPPI
Missouri
Monuana
Nebraska
Nevada
New Hamoshire
New Jersey
New Mex1co
New York
North Carolina
North Daltoca
Ohio
Oklahoma
Ore10n
Pennsvlvlllia
Rhode lslmlcl
Sou1b Carolina
Saudi DUaca
y_.
Tau
Utlb
Vermon&
Vimlua
WuhiniiOII
West VirJima
Wisc:onsan
Wyomin1
1998
199'7
1999
2000
tS6.02Jl
15781
IS8.S661
I 5 lJS'i
51
•5:!001
151311
158131
1$40)
15137)
15231
15481
I 591:!1
1$91
1531 I
tSI91
t5529l
tSI20l
tSS6l
($801
($1801
(SI97)
tSSOl
tSI26l
($214)
($410)
($71)
($47)
(S 183)
($22)
-($45)
1$29)
($32)
($265)
IS Ill
($7661
ISIS6l
C$301
C$449)
CSSil
($65)
CS931)
($44)
($20)
<S2Sl
$2.276
S6S
5593
tSl.IJJl
S}J
s·~·I
'
•
56
ss
·5~61
•561
~04
533
516
Sl
57
514
5211
54
56
•581
566
539
516
52
S34
tSll
$43
569
527
554
556
S32
S3
514
SIB
t$1)
$70
S2.5
S263
S109
C$3)
$35
sss
S22
CSI24)
Sl
S93
(SOl
S98
$262
Sll
so
$94
$32
S6
$14
$13
·SS4t
tS:7)
5:!!.5
521
1$7.1
I 531
51
~
's !0 7 1
15641
151701
I 531
15571
I SJJ)
'5161
SlJI;
SJ}JI
sr·~
5!06
IS! II
1$1 I
5:!
1$881
536
S24
51
1$27)
rSt1
1$9)
SIS
S28
tS391
537
S40
:$2)
!Sll
ss
SIO
($61
SIS
Sl9
$119
$70
($8)
15401
S37
sa
IS248)
($6)
S76
($4
S70
St70
S6
(S2
S6S
S7
l$81
I Sill
1561
t$249)
15211
t$61
15291
1S8Il
tS68l
t$24)
IS44l
t$66)
i$1791
so
58
tS70l
($9}
CSI3l
ISS!
($16)
(S97)
S7
t$202)
ISI41
ISI6)
tSI94)
S2
t$19)
1$497)
t$20
S40
!Sill
S16
($17)
ISS)
(S7
S6
($44)
<S34)
($66)
SJ
·51641
t59:!1
I 55811
t$191
•5112)
15!51
t$391
.57351
558
15201
($91
t$4081
IS7Sl
tS22l
tS441
151231
tSI37l
IS33l
tS91l
($164)
!S316)
tS26l
!S8)
<SI26)
($10)
($23)
($18)
($24)
($205)
SJ
<S5781
<5851
($20)
($351
($16)
($39)
($765
ISJ6)
S8
($13)
IS3)
ISI47)
($14
($9
($34)
($921
<S511
IS107l
($68
IS315)
1$24
1$16
ISM
lS129
($79
($158
1996-2000
To&a.l
t$14..553)
tSIJ:l
521
•55501
•53:!01
t594S1
1571
152971
155:!1
1$941
!5:!.2071
554:
15591
15261
rs 1.283!
1$114)
1$20)
•St36l
1$409)
1$369)
1SII7l
tS203l
($347
tS918l
($5)
$49
($348)
($40
(S6fi
($24)
<S71i
($482)
$42
C$1.164
($771
($76)
<S998)
S28
tS94l
($2.564)
(SIOSl
Sl97
. ($53)
5112
($74}
tS27)
(SJ~
S48
(s226J
($1661
($3291
sst
S10
Sll
S8
S7
Revenue reductions based on specific Medicare proaram reducuons tncluded •n the Dole Proposal (excludes payment reductions for long
term care and home health services). lncreased insurance c:overqe under the proposal results in increased revenue· for providen as
uncompensated care e~tpenses decline.
Source: Lewin-VHl estinwes using me Healm Benefits Simulation Model CHISM> and the Payments Simulalion Model CPSM).
a
IUCBOj79
14
LEWIN• VHI, INC.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
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Original Format
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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[Background on Health Reform] [3]
Creator
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First Lady's Office
Melanne Verveer
Identifier
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2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 3
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2068127" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
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42-t-2068127-20060223F-003-005-2015
2068127
-
https://clinton.presidentiallibraries.us/files/original/5ff6305fecacdab1060426241309a98a.pdf
1951c0c22ba97e725f082b74faf57d4b
PDF Text
Text
NBC HEAL1H CARE SPECIAL
June 16, 1994
[**Indicates missing or incomplete item; will be provided Wednesday night or
Thursday morning]
PROGRAM INFORMATION
•
•
•
Memo from Lisa Caputo
Opening question
Strategy memo from Ann Lewis
PANELISTS
•
•
•
•
•
•
Herman Cain, Godfather's Pizza, National Restaurant Association
Dr. William Kissick, University of Pennsylvania
Susan Tolley, Center for Ethics and Policy in Oregon
Ron Anderson, Parkland Memorial Hospital**
Margaret Jordan, Southern California Edison
Larry English, Ggna**
INSURANCE SfATISilCS
•
•
•
•
Mortality statistics on the uninsured
Sources of insurance breakdown
Back-up fact. sheet on.~u,r~. statistics . ,
Statistics on the rise in number of uninsitled
•'>'.
. '·
.•. ....
'
MEDICARF/ SOCIAL SECURIIY
·.~-·
•
•
•
. . . .:... i·.:·· ~-· •.. •.
'i.
:-~··•.· ' ~··
·.
,•.
Historical·.arguments· against Medi~~/Social Seetriity**
The vo- oi1 Medicare
History of Medicare
.
.
..
.; .. ~ '.
·.,
INFORMATION ON EXISilNG HEAL1H CARE PROGRAMs
•
•
Memo on Medicare administrative costs
Memo on FEHBP
WOl\tEN'S HEAL1H I$UES
•
•
•
0
Women's Health Checklist
Abortion
Mammogram coverage
�IXJCfOR I$UES
•
•
•
Gleason Charts
Medical school applications
Specialist/ generalist issue
PRO.UNIVERSt\1/ AGAINSf-INamMENTAL
•
•
•
•
The cost of doing nothing
Who would incremental reform really hurt?
"Health Care: Why We Failed the Last Time," Washington Post, 11/9/93
"Community-Rated Health Plans Prove Popular, But Success May Depend on
Universal Coverage," Wall Street Journal, 6/15/94
ARGUMENTS FOR 1HE EMPLOYER :MANDATE
•
•
The minimum wage ·effect on health care reform
Hawaii and the employer mandate
'MISLEADING ADVElUJ.SEMENTS.
•
•
•
•
Deliberate misinformation sheet
"Truth Lands in Intensive Care Unit as New Ads Seek to Demonize Clintons•
Health Reform Plan/ Wall Street Journal, 4/29/94
Transcript of HIAA ads
HIAA promotional materials
REPUBUCANS
•
•
•
•
Dole voting record on health issues
Republican comments on Medicare
<llafee/Dole record on universal coverage
Transcript of Packwood/Moynihan meeting
�,.
( ,,
'
HIGHLIGHTS FROM THE NBC POLL
Attached are selected results from the NBC survey on health care and other issues. Data do no
include "don't knows"; questions are abreviated.
Univeaal Coverage
Insurance Reform vs. Universal Coverage
[two statements read, one describing insurance reform, one describing universal coverage]
Prefer universal coverage:
Prefer insurance reform:
57%
34%
Most Important Reason for Reform
To cover those with inadequate or no insurance now:
To reduce and hold down costs
To reduce costs and improve competitive edge for US business
To improve quality of care
41%
29%
11%
10%
Costs/Financing
Best Way to Pay for Health Care
First choice:
cost controls, such as premium caps and limits on doctor fees:
requiring most employers to contribute
broad based taxes
62%
19%
10%
First and second choices combined:
cost controls:
employer contributions
taxes
80%
63%
31%
Cost Expectations
E~pect costs to increase
Costs will stay the same
Costs will decrease
56%
26%
14%
If the President and Congress pass a health care bill, do you think availability of health care services
will:
Increase
Stay about the same
Decrease
30%
35%
32%
�I-.
:
,r
If the President and Congress pass a health plan, do you think quality will get better, stay the same,
or get worse:
25%
32%
37%
Quality better:
About the same
Will get worse
Timing
Should Congress pass a plan this year, or continue and act next year?
~
~
37%
57%
This year
Wait
34%
58%
Should Congress and the President continue efforts, or leave the system as it is now?
Continue
71 %
Leave system as is:
25%
General Approval Ratings
~
Positive/Negatives
The President:
~
52%
39%
President's Approval Rating:
Approve
Disapprove
57%
37%
46 positive
36 negative
17 neutral
[in May 94: 48+/34-; 18 neutral]
Fall Elections
In congressional elections, do you plan to vote:
~
For the Republican candidate:
For the Democratic candidate:
General Approval on Handling of Health Care
Bill Clinton
Jan..
.l.OL2l
30%
35%
29%
34%
34%
32%
43% approve
47% disapprove
Congress
26% approve
61 % disapprove
Clinton Plan
Favor
Oppose
~
Mm.h
38%
46%
37%
45%
I
�Talking Points from the NBC Survey:
Universal Coverage
*
Deep divisions characterize the public on some issues, but one thing is clear:
Americans will accept no substitute for universal coverage. People favor a universal
plan 57% - 34%, when considered head-to-head with incremental reform.
* Band-aid solutions abP.ndon the middle class--shoring up coverage for the very poor
and very wealthy, but providing working people no security that they will have
insurance when they get sick. This explains why 41% cite universal coverage as tW:
most important reason for health care reform--far more than any other reason. (29%
cite keeping costs down, 11 % cite keeping our businesses competitive in the global
economy.)
* Despite the tens millions of dollars spent by special interests opposing real reform,
· working Americans are standing firmly for universal coverage because they know
band-aid coverage won't give them true health security. The President plans to stand
with these working Americans.
Quality
* Americans are increasingly satisfied with the quality of care they will get in a new
system: 65% expect availability of services to stay the same or increase; 57% think
quality will be the same or better.
Urgency
*
Americans will not forgive Washington if we give up on reform now: Over 70%
want the President and Congress to continue efforts.
* 57% may have told the pollsters they wanted Congress to continue debate and act
next year--but they present a false choice. Congressional Rules do not allow Congress
to just continue debate and pick up where they left off when they come back in
January. With a new Congress elected in November, we'll be required to start all
over from scratch: which means subcommittee hearing, committee hearings,
secondary referrals, etc. If people were asked "Should Congress finish the job or
start from scratch year?" they'd push for action now.
�Clinton Presidential Records
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Page 30
�TO:
FR:
RE:
DT:
Hillary, Maggie, Melanne, Mandy
Lisa
Key Points for senator Mitchell
June 15, 1994
fo~
NBC Special
----------------------------------------------------------------Senator Mitchell should focus on the following four points
for the NBC Health care Special:
1. Problems in the health care system cannot be solved unless
insurance is guaranteed to every American. A non-universal or_
incremental approach will not solve the problems (especially the
problems featured in the taped segments of the show). It will be
the middle class who pays the price if every American isn't
guaranteed coverage.
2. We want a bipartisan solution. I was troubled by Senator
Dole's comments last weekend threatening a filibuster. (Seize the
moral high ground.)
3. What we Democrats want is what every member of Congress has -guaranteed health coverage -- for every American. Senator Dole,
you and your colleagues don't want to give the American people
the same guarantee that you and I and every member of Congress
has.
4. Businesses that insure workers pay so percent of the costs;
Senator Dole, your proposal would take the burden off businesses
and put it all on the American people. That's just not fair; Itshould be a shared responsibility.
�FROM : .GRUNWALD, ESKE~J3.DOI'll LON
TEL: 202 973 9408
.:UN.15.1994
4:32PM
OPENING QUESTION
Mn. CUnton, you've apcnt ewer a year and alialr11ow workbag vn tb.: ()rublem ufhealtb
earo. How ean you C!:xplaln wby our poll shows that a majority of tbe American people
oppo1e tbe Olnton plan and appear to be lookina for a smaller. more phased-In approaeb? ·
Did you milc&leulate?
nn yntJ have mgrctl AbOIIt the plan you put f'orward?
Tom, I think the polls reflect the confusion that a lot of Americans are 1eeliuJi. after
months of very heated. often distorted debate. That's why rm 110 delighted 'With what
you're doing here tonight. 1 h.opo this program will help America focus on wh'lt reolly
matters and what our real choices arc: AS a uation.
I think we have the best che.nce in this century to finally ~uarantee e\'ery American the
~ecurity nflcnnwing that th~y'll always have heaJth coverage no matter what happens in
their lives. My husband is the seventh President who haa tried to do this for the
American people and I believe he will succeed.
I've met literally thousands of people all across this country, who've poured out the heart•
Every one of their stories is difforent, and yet, in the most basic way, they're
really all the same. J think every famiJy wants to know that Jf they get sick, tbcy c;:su
worry about lllm!.to get well, not whether they can afford to. I think they want reJiet' from ·
that fear, that horrible fear, that middle class working families live with everY dav. that
to me.
1hey ftre one illness 9WRY from bMkruptcy, one premiurn increase away from losing their ·
coverage.
I know our policy choices arc complicated, but our goal is so simple. We want to give
everyone in this country the guarantee that they will always, always have health
coverage, no mattctr what.
P 2
�Ann Lewis 6-15-94
I. Principles and strategy
Your role in this program is as an inspirational, national leader and the
voice of real people, especially women- not as a super-legislator or
technician.
The most important people you want to reach are not on stage, but at
home: the television audience that will listen intermittently, tuning in and
out- but more likely to listen to you than anyone else.
The best way to talk to them is in real-life terms, not jargon. Tell the stories
of the people you have met; this is not a political struggle for power, but your
responsibility to those people, to tell their stories, to work on their behalf.
Use words that your television audience identifies with; you are speaking
for and to them. Words like "reallife..middle class... working people...sick
child...elderly parent... meet our responsibilities"
This is not a legislative hearing or a debate. You are not trying to get the
last word or - frustrating as this will be - make up for the deficiencies of any
other speaker.
ll. Define the issue in real life terms. For example:
This is about the real life, health care needs of middle class American
families; working people who make too much money to qualify for public
assistance, but not enough to pay their health care bills. Families who tell me
they are just one serious illness away from bankruptcy - or one more increase
in their insurance premium away from losing coverage.
Let me tell you about somebody I met last year .............. . Now, what I want
to focus on is, how do we solve these problems?
My bottom line is: what will work for the families I met with during the
last year; people who are trying to work hard, to meet their responsibilities, to
take care of sick children or older relatives - and find themselves lying awake
at night terrified of what they're going to do about health insurance.
�How do we fix the system we've got right now to build everyone in? That's
the question we need to answer.
m.
Transition phrases: use eyery q.uestion to make your point. not tbeirs.
- After Harry and Louise:
I hope people thought that was funny. We were trying to use humor to
make a serious point In this debate about health care reform , there has been
so much harsh language and scare tactics that we thought had really gone too
far. So we poked fun at the exaggerations that are out there.
The fact is that what we're trying to do is meet the real life, health care
needs of middle class American families :working people who make too
much money to qualify for public assistance but (are being priced out of
health insurance ) or ( are penalized by the rules and the bureaucracy of the
system that we have now. ) People like Pansy Chaney and Alan Fuller , whose
stories we ju8t saw, or .......
- After talk show hosts
That tells me once again that we have really taken on a difficult issue.
There are billions of dollars at stake in the health economy --and more
important, millions of lives.
So I certainly understand why people would be concerned. ( And
unfortunately, exaggerated charges and scare tactics like those we just heard
can m~ people even more concerned. ) We have to work very hard to
explain to everyone what we're trying to do , to meet the real life health care
needs of middle class Americans ...
This debate is not about Bill and Hillary Clinton, and it's not about
Democrats and Republicans. It's about how do we fix the health care system
so that every American can be sure of getting health care coverage -private
insurance coverage that will not disappear or be priced out of sight or let
them down when they need it most.
- About timing: Are you rushing I going too fast I etc.:
Actually ,Tom, we've been debating this issue in this country for more than
fifty years. Seven Presidents have urged Congress to take action on health
care, and I'm very proud that my husband has shown the leadership and the
determination to get us this far.
But let me put this is real life terms. In the last year I have met with people
all over this country who are being crushed by the faults with our present
health care system.-people like
, whose stories we just saw.
�When you have had someone break down in tears because they can't get
health insurance for one of their children, or because they had to declare
bankruptcy so a husband with cancer or -would get treatment under
Medicaid, or then the question of timing is not just academic it's very real.
( If a child is sick or in pain, you don't tell that child to wait a month or a year
or ten years because the grown ups can't figure out what to do. I think the
grown ups in their country have had enough time to know that we have a
health care problem and we ought to be wise enough to fix it now.)
- About legislative maneuvers or compromises :
I know that members of Congress are going to be working very hard to
write a bill , and they're going to have to make some very difficult decisions
as they do. We want to work with them in every way we can.
But if you're asking me what (is my) (should be the ) bottom line : it's this :
how do we fix the health care system so that every American can be sure of
getting health care coverage - private insurance coverage, etc............... .
-About abortion:
This is about health care, and how we fix the health care system so that
every American can be sure of getting health care coverage for treatment' that
is medically necessary and appropriate. I think those decisions are best made
by women and their doctors and that is in the bill we presented to the
Congress. ( That bill also includes some very important provisions that can
lower the number of abortions, including preventive care, family planning ..
services and education, and I hope all those provisions are included.)
~on~-,~ 'N\\N~c.Mc..,;, ~ou ~~- ~\~.-\~~
C....\a-.c-o. ~~~o,
- - - - - - - - - - - - - - - - - - - - - - - - - - -
"'-OY
-'\~~
~~o...n\- .
------
--------
�Clinton Presidential Records
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�To: Melanne
From: Walter
RE: Notes on Conversation with Margaret Jordan
1.
Edison is now changing its delivery system and options.
Whereas they used to run their own system, they are now
moving to an outsourcing arrangement in which they will be
contracting with point of service and HMO plans.
Thus, Edison is moving away from the very unique system they
used to run. Jordan says they are now able to drop their
own system because there are many good health care delivery
systems --i.e., health plans-- in Southern Calif ••
Edison will be giving its employees a sizable choice of
plans. They have a generous benefits package.
2.
Edison strongly supports the employer mandate. They believe
all employers should contribute. They oppose a "bifurcated"
employer mandate in which small employers are exempted from
the mandate. They are convinced this will lead to more
cost-shifting to those employers insuring their employees
and dependents. They are beginning to fear we are headed in
this direction and Jordan warns that such a move could bring
a great deal of opposition from large employers.
3.
They believe the employer mandate should be coupled with
subsidies to individuals to help those individuals pay their
share.
4.
She believes we cannot get to universal coverage without a
mandate.
5.
She argues that most large businesses support a mandate, but
that business, as a whole, is afraid that government
mandates can only expand to more and more regulation,
requirements, and costs. I.e., it is not the mandate that
business opposes --it is what comes after the mandate.
In short, business can see how a new system, with mandates,
could help them. But they don't trust government.
I.
�Larry English, President of Cigna
FACTS ABOUT ENGLISH:
-- member of the Jackson Hole Group
-- contributed $500 to the Cooper for Senate campaign (Citizen Action)
-- made $1.1 7 million in 1992
FACTS ABOUT CIGNA:
-- member of the Alliance for Managed Competition
-- Operates many large aMOs and other managed care companies
-- made $234 million in profits in 1993; its managed care business continued to be its
strongest performer & is expected to gross $41 0 million in 1994.
ENGLISH'S VIEWS:
MANDATE IS MISTAKE:
"I think the employer mandate is a serious mistake. It is in effect laying yet another payroll
tax on small businesses which they cannot afford."- CNN News, May 18, 1994
CLINTON PLAN OVERLY REGULATORY:
"If this proposal (the Clinton plan] were to become law, there would be new regulatory
bureaucracies at both the state and federal level," said Mr. English, "... the resulting maze of
regulatory requirements and the blizzard of paperwork will keep the vice president's task force
for reinventing government busy through the [)ext millennium." - National Underwriter, Life
and Health/Financial ServiCes Edition, December 20, 1993
"We are concerned about the administration's almost exclusive reliance on central planning
and regulatory control... we believe the new regulatory bureaucracies at both the state and
federal level that would be created are excessive." (Testimony before Subcommitee on Health
and the Environment)
CLINTON ALLIANCES TOO BIG:
"I think what we have in the Clinton plan is a good idea made into a bad idea. I don't think
the idea of a purchasing cooperative for individuals or small employers is a bad idea. I think
it can create efficiencies; it can make the market more competitive, and that makes sense.
What the Clintons have done, though, is to propose to herd everybody, whether you work for
a small employer or a large employer into these regulatory alliances and then cap the price
controls on those organizations." - CNN News, May 18, 1994
PREMIUM CAPS WON'T WORK:
"The proposal, as we know it, would impose rigid, centrally planned budgets that would result
in sweeping price controls for a major sector of the U.S. economy. Our opinion is that such
controls would have highly undesirable consequences on the delivery system of health
services without delivering their goals." (Testimony before Subcommitee on Health and the
Environment)
�SAYS CIGNA SUPPORTS UNIVERSAL COVERAGE THROUGH COMPETITION:
English believes that universal coverage can be achieved thro~gh insurance market reforms .
. competition based on quality and efficiency -- not risk selection, small. competing purchasing
cooperatives, and then government vouchers or tax credits for the remaining uninsured.
Attached is testimony that English gave before a subcomrnitee of the Energy & Commerce
Committee. It is a good overview of where he's coming from.
�Statement of:
Lawrence P. English
President, CIGNA HealthCare
CIGNA Corporation
900 Cottage Grove Road
Bloomfield
Connecticut 06002
Telephone: (203) 726-4235
Representing The Alliance for Managed Competition
before the
Joint Session of the Subcommittee on Commerce, Consumer Protection
and Competitiveness
The Subcommittee on Health and the Environment
Energy A Commerce Committee
of the
U.S. House of Representatives
�.Madam Chairwoman and Mr. Chairman, my name is Lawrence P. English, and I am president of
CIGNA HealthCare. Today, I represent both CIGNA and the *Alliance for Managed Competition .
. which is an informal coalition of five companies that pro\'ide health care and insurance to more
than 60 million Americans.
\1y company. CIGNA HealthCare. is one of the nation's largest pro\'iders of managed medical and
dental care services and group life and health insurance. It operates a nationwide network of
ii health and dental maintenance organizations in the L'nited States and 109 preferred provider
organizations that serve nearly 5 million members across the country. CIGNA HealthCare also
is one of the largest providers of managed mental health and substance abuse programs and a
leading provider of employee disability management and medical cost control services. Currently,
we prO\ide insurance coverage to more than 14 million people.
At the outset of my testimony, l would like to emphasize the fact that the Alliance companies
strongly support the broad goals of health reform described by President Clinton. We welcome
the bipanisan cooperation that undoubtedly will be necessary to produce practical, beneficial
changes.
\lith. that position clearly noted, I would first like to comment on how the Alliance companies
,·iew the administration ·s plan. Second. I would like to put in perspective the type of
fundamental questions the business community is asking about health care reform. Then I would
like to offer some observations on the substantial changes that already are taking place
throughout the industry and on practical effons to initiate immediate additional reform.
First, some general thoughts about the administration's proposal. We are encouraged by the
President's call for a bipartisan approach. Health care represents almost 15 percent of the U.S.
economy. Reforming it will be an extraordinarily complex task that will require the intellect,
diligence and good will of both political panies and of the numerous private sector "for-profit"
and "non-profit" institutions that engage in health care delivery. No one has all of the answers,
and it would be a tragedy to see the debate surrounding this important issue dominated by
partisan or ideological arguments.
There are many specifics in the President's plan we believe should be supponed enthusiastically.
For example, such principles as:
universal coverage;
portability;
the elimination of pre-existing condition limitations and "cream skimming• and
"cherry-picking" underwriting practices;
administrative efficiency through the elimination of paperwork and claim forms,
a standard benefit plan;
community rating;
the implicit emphasis on network-based delivery systems;
the idea of purchasing cooperatives or, if you prefer, health alliances, to make markets more
efficient;
malpractice reform; and
the objective, consistent measurement of quality and outcomes.
*AETNA. ClGNA. MET UFE, TiiE PRUDENTIAL, and TiiE TRAVELERS
�•2•
These concepts are not new to us. We have been advocating them for some time, and they form
the essence of the administration's plan.
So. as I said, there is much that is encouraging. But. at the same time, we have some concerns.
particularly regarding several of the tools this plan would use to achieve its goals. Our concern
is that certain approaches will adversely affect our ability to achieve long term improvements
while producing unintended consequences. This may be a once-in-a-lifetime opportunity for
reform. Therefore, it's important to do the very best we can.
Specifically, we are concerned about the administration's almost exclusive reliance on central
planning and regulatory control, rather than confidence in a reformed market place in which
consumers and providers can respond to positive incentives to make wiser and more efficient
health care choices.
If this proposal were to become law, we believe the new regulatory bureaucracies at both the
state and federal level that would be created are excessive. New regulatory or oversight
responsibility would be given to numerous existing federal agencies, while a new agency - a
National Health Board, with very broad powers ·• also would be created. In addition, each of
the 50 states would have at least one health alliance with powers to regulate all aspects of health
care. which we believe would likely increase administrative costs. (without improving care for
consumers.)
\l'e also are concerned about the proposed use of premium caps as a cost containment measure.
The proposal, as we know it, would impose rigid, centrally planned budgets that would result
in sweeping price controls for a major sector of the U.S. economy. Our opinion is that such
controls would have highly undesirable consequences on the delivery system of health services
without delivering their goals.
From my own personal experience, I know that price controls don't work. Many knowledgeable
individuals from virtually every field and persuasion have spoken to their ineffectiveness of price
controls. I do not believe the government can stop clever people from evading them. Who will
rule on the exceptions? Who will decide how to price a new treatment, a new technology, a new
drug?
Further, it is my opinion that price controls will stifle competition. And they will drive away the
private capital that is needed to continue the restructuring of the health care delivery system
already underway.
Most important perhaps, it is impossible to conceive that national budgets can be met through
the savings the administration envisions as a result of proposed Medicare and Medicaid cuts. Are
there inefficiencies in the system? Yes, of course, there are, and they need to be eliminated.
However, wringing them out will not provide sufficient funds to pay for all of the uninsured,
expanded coverage for most, and add new benefits, such as pharmaceutical and long-term care
for the elderly. The numbers simply aren't realistic, and they don't take into account other
costly implications of the proposed changes. For example, the economic costs associated with
increased coverage for retirees are immense and very difficult to forecast, as are the cost
implications of the graying of America, which will generate increased use of the health care
system.
�-3-
Also difficult to quantify is the deterioration in quality. the delays and the outright unavailability
of technology and medical procedures that are readily available today. In shon. the arbitrary
rationing that is sure to result from this kind of plan.
We also are very concerned with what the plan has done to the concept of purchasing
cooperatives. Health Insurance Purchasing Cooperatives, HIPCs, or Alliances as they have become
to be known, were originally conceived to be cooperatives in which individuals and small
employers could freely select from a wide array of competing health plans at reasonable prices.
In the current proposal, these cc.operatives have emerged as giant regulatory bodies- covering
more than 99 percent of all businesses and more than 80 percent of employees- whose staff
could limit the number of health plans to be offered and would dictate the prices they can
charge. I am convinced that the size of these cooperatives will diminish competition, not
increase it, and it will likely eliminate the incentive private employers currently have to continue
to improve the health of their employees. They also are likely first steps in what eventually
would become a single-payer, government-run system similar to that in Canada.
So, in summary. our view of the administration's plan is mixed. We unabashedly agree with its
goals. but we have concerns about the some of the means it would employ to achieve them
Resolution of these issues is not insurmountable. There are practical solutions which will not
do harm to the 80-90% of our health care system that serves the vast majority of Americans well.
We are committed to working with you to find those solutions.
Beyond our own perspective on reform, I've spoken with many of CIGNA HealthCare's clients
and potential clients. I've heard many of the questions they have voiced about the
administration's proposal. It is clear to me that, over the next several months, each company's
management will be deciding which proposal works best for its respective business. The
conclusions undoubtedly will vary, depending on a firm's size, employee mix and number of
retirees. But the questions all are certain to ask are the following:
o Do we want the state or federal governments or both to establish the level of health care tax
-- disguised as mandated premiums - our company and our employees will pay in the future?
o Do we want to have a direct role in determining the health benefits available to our
employees and the cost of those benefits?
o Do we want rules and benefits to vary from state to state?
o Do we want to transfer the management of fifteen percent of the economy to the government?
o And finally, what will the real cost of change be to our company going forward?
Answers to these questions are essential in judging whether the proposed changes will benefit
or restrict eco'!omic growth in our country.
Now, let me offer some comments on the reform efforts already occurring within the health care
industry.
Large and medium-sized employers already are driving reform. They know full well that
escalating health care costs have impaired their competitiveness. They wield a very big economic
stick, and they are using it to get their medical costs under control and maintain the quality of
care. They are moving their employees into managed care plans at a record rate. As a result,
�-4-
more than 41 million Americans are now enrolled in H~tOs and many more are in Preferred
Provider Plans. Point of Service Plans as well as other plans involving some aspects of managed
care.
The record shows that this spread of managed care techniques is rapidly reducing the rate of
growth in health care expenditures. In other words. responding to consumer demand. It is
changing the very infrastructure of the industry: doctors are joining networks or organizing
themselves, hospitals are merging, new health plans are forming and new capital is being invested
-- all of which has increased competition exponentially.
Funher. increased competition for this business places enormous pressure on us to enhance the
quality of what we do for employers and their employees. Quality programs are proliferating.
Every insurer I know of that wants to be a part of the health care system is focusing on system
improvements that will strengthen service and lower administrative costs. They're moving ahead
with "new world" technologies that use electronic data interchange and electronic funds transfer
that will soon lead to a paperless health care system.
Even more exciting is the fact that competition is leading to innovations in medical care
--innovations that improve treatment while lowering costs. For example, CIGNA HealthCare has
developed more effective medical management procedures for pediatric asthma patients,
improved existing biopsy procedures that aid in the diagnosis of breast cancer and initiated
programs to identify and treat potential high-risk pregnancies.
All of these innovations improve the quality of treatment, from the patient's point of view, and
at the same time, save millions of dollars. And, we .ue not alone in our innovations. Other
managed care providers can cite similar innovations.
Moreover, not all of the improvement is coming from managed care providers. Employers,
recognizing that lower health care cost is a competitive advantage, have initiated wellness
programs aimed at keeping their employees healthy. Nutritional counseling, smoking cessation,
fitness centers and well-baby programs are becoming common in the modem workplace.
The market has begun the process to transform the delivery of health care from the cottage
industry it is now, with lots of inefficiencies, into a truly efficient system focused on quality and
controlling costs.
Without being too presumptuous, I would like to suggest how the government might best
proceed to encourage and move to a more market based system. From my perspective,
government must level the playing fteld so that health plans compete on quality and efficiency
not risk selection. We should put in place incentives so that consumer and employers will fulfill
the public interest through the pursuit of ·their self interests. Government should not scare off
capital - as it surely will - with the specter of price controls. Should not create unnecessary
bureaucracy that will add to administrative costs. Should not limit competition by having huge
bureaucratically laden alliances pick two or three favored plans. Encourage competition. Let it
flourish.
I, also, very much suppon and urge the government to play a pan in enhancing competition and
reforming those portions of the market that are not working well. I believe the federal
�.5.
go\'ernment should create a Standard Benefits Plan. which would enhance competition and
simplify administration. I think it should put in place an apolitical National Health Board to
define the standard benefits plan, accredit accountable health plans (AHPs) and collect outcomes
data.
Perhaps most important of all, I suggest that the government should focus on those having the
most trouble with our current system. The problem, simply stated, is that small employers find
all too frequently that group health insurance is difficult to get or too expensive to provide for
their employees. Under current practices their premium rating can be distorted by a single claim,
pre-existing condition limitations can make changing carriers difficult or impossible, and
administrative and marketing costs can consume a disproportionate amount of their premium
relative to large employers. Individuals face the same problem and, to make matters worse, they
do not get the same tax preference employers get.
Everyone would benefit from the improved security that will result from comprehensive insurance
reform. Surveys clearly show that, while the overwhelming majority is happy with its health care,
people are frightened by the thought that they could lose their job or that their employer will
cancel their plan, and that they will be unable to find affordable health insurance.
To correct these inefficiencies, I think the President and Congress would do well to focus on
insurance reforms that eliminate pre-existing condition limitations, individual risk selection, and
assure portability. I suggest they also should consider the creation of, or encourage the states
to create, purchasing cooperatives designed to assist small employers and individuals gain access
to the market at competitive rates.
These reforms would transform today'~ inefficient market into one that. would be intensely
competitive. All - not just a few •• health plans would have to compete in the purchasing
cooperative. The benefits would be standard. Employees and individuals would have free
choice, and there would be no risk selection .• competition would be based only on price and
quality ·• and it would be fierce.
Competition, based on consumer choice, would decide who would offer service and who would
not. These cooperatives would increase access, bring down cost and improve quality. The
number of uninsureds would decrease. Americans would have the security of knowing that, if
they lose their jobs or change jobs, they could find affordable health insurance - a vinual
guarantee of portability. And, ultimately, the remaining uninsured could be given government
vouchers or tax credits which would enable them to participate in the purchasing cooperative
on an equal footing with other individuals. Eventually, Medicaid and even Medicare benefidaries
also could be brought into the cooperative, and universal coverage could be achieved without
massive government intrusion.
I am convinced that these reforms could be achieved. They would have broad support, including
ours. As a result, the President and Congress would achieve their goal for major reforms of the
health system, capital would continue to be available for the restructuring of the market and
employers would be able to continue the vital and effective progress they have already begun to
make in managing health care costs and maintaining quality. But most important, the American
people would enjoy greatly expanded access to quality care and the best medical system in the
world, delivered through free, effident and competitive markets.
�~
(
,
.6.
~adam Chairwoman, Mr. Chairman, President Clinton and ~rs. Clinton have taken a brave step
forward. Their goals are noble, and we heartily endorse and support them. Let us hope that in
the spirit of building a bipartisan program, we can reconcile the many issues that undoubtedly
will be raised in the coming discussions and bring about reform of the health care market place
which will enhance competition, rationalize incentives, and promote wise decision making by
providers and consumers alike. The American health care system will continue to have the best
trained doctors, the most modem facilities and the best technology, equally available to all
Americans.
Thank you very much.
�HERMAN CAIN
C.E.O. Godfather's Pizza
President National Restaurant Association
Background:
•
During his Kansas City Town meeting in April, the President was questioned by Herman
Cain (via satellite from Omaha). Cain maintained that ''for many, many businesses like
mine the cost ofyour plan will cause us to eliminate jobs".
•
The President responded that "If a// your competitors had to do it and . .. your cost of
doing business went up 1-112 percent, wouldn't that leave you in the same position you
are now? Why wouldn't they all be in the same position? And why wouldn't you all be
able to raise the price ofpizza 2 percent? I'm a satisfied customer. I'd keep buying from
you. " He asked Mr. Cain to send us his figures so we would take a look at them.
•
Cain also appears in the TV ads (attached) that the NRA is running against the President's
approach.
Administration Response:
•
SBA Administrator Erskine Bowles responded to Mr. Cain's letter [attached], which
detailed his calculations and essentially reiterated his points. Erskine's response
[attached] described the obstacles restaurants face trying to buy insurance today and
highlighted the many benefits to businesses under health refonn His two main points
were:
I)
The President's approach would save Godfather's $2 million from what it would
cost to insure their employees under the current system. Current costs would .
consume 14% of their payroll. Under the President's approach, he would be
protected by a 7. 9% payroll cap -- and would pay less than half what it would cost
today.
2)
Godfather's covers only 12% of their employees --leaving almost 3000 without
insurance. Their costs will increase when they cover the remaining 88% of
employees -- whose costs are now being borne by other businesses and taxpayers.
Best Points to Make:
•
Erskine's points remain the strongest two arguments. This emphasis (especially the cost
shifting argument) is better coming from us than the point that "you will only have to
raise prices by x percent" -- a hard argument to make to a private sector businessman.
•
Cain has said that he would like to be able to cover all his employees but that
"employers who do not cover employees do not for one simple reason, and it relates to
cost."
�The President's approach was designed for people like him -- that would really like to
cover their employees but simply cannot in today's system. We address the specific
problems that make it impossible -- and unaffordable -- for him in the current system.
[This argument has the advantage of putting us all on the same terms -- figuring out how
to help him provide rather than arguing about the moral reasons he should want to.]
•
Turnover: Cain has also said that ""Our strategy is, No. 1 keep the ones we get. .. One of
the biggest negatives ofour industry is just high turnover. "
One of the reasons the restaurant industry has such high turnover is that it cannot offer
benefits to attract and keep high quality employees. The President's plan will directly
help solve this problem-- his "#1 priority." [See Starbucks example].
•
Level playing field: On other issues (i.e., banning smoking in restaurants), Cain has
argued that everyone needs to be on a level playing field: "Ifyou outlaw it on a much
broader scale then it doesn't adversely affect one competitor over another." However,
with regards to employer responsibility for health care, he argues the opposite position,
saying that his competitors will not have to raise prices as much.
We can't let him back away from this. Most restaurants find themselves in the
unfortunately position Godfathers does today. Their competitors don't offer, they are
discriminated against by insurance companies, they don't have buying power, and thus
they don't offer. The President's plan finally levels the playing field -- in 2 ways. For the
first time, all businesses will be able to negotiate the rates that America's largest
companies do today. And all of Godfather's competitors will have the same
responsibilities that they will.
A great example:
•
As an example, you may reference Starbucks Coffee Company, whose CEO came in to
meet the President last month. Starbucks --which was named one of the fastest growing
American companies in 1993 by Fortune Magazine -- provides comprehensive health
benefits to all their workers, full-time and part-time.
•
The CEO, Howard Schultz, credits his company's enormous growth and profitability to
the competitive advantage of keeping workers longer by providing them good benefits.
In fact, he maintains that it is cheaper to provide health benefits than to pay hiring,
training and retraining costs. As a result, Starbuck employees stay with the company for
18 months to 2 years on average -- three times the food industry average. "The longer an
employee stays with us, the more we save."
•
USA Today has explored the difference between these two companies (see attached
article)
A«achments; Transcript of Cain exchange with POTUS (4/7/94 ); Cain Letter to POTUS
(4/12/94); Bowles letter to Cain (4/14/94); USA Today article (5/16/94); NRA
Ads
�Transcript of Herman Cain and President Clinton
Kansas City, Town Hall
April 7, 1994
MR. CAROL: Thanks, Wendall. Mr. President, Tuesday in North Carolina, we talked
about the cost of health care refonn for service industries, specifically restaurants. Here
with me now is Hennan Cain, the CEO of Godfather's Pizza. He has some concerns
about that.
HERMAN CAIN (CEO, Godfather's Pizza): Thank you very much. Mr. President,
thank you very much for this opportunity, and I would first like to commend you on
making national-- making health care a national priority. In your State of the Union
speech, you indicated that nine out of 10 Americans currently have health care insurance
primarily through their employers. And tonight you indicated that out of those people
who do not have insurance, eight out of 10 of them work for someone. And your plan
would force employers to pay this insurance for those people that they currently do not
cover. I would contend that employers who do not cover employees do not for one
simple reason, and it relates to cost.
Now, I have gone through the rigors of calculating the ·impact of your plan on my
business, which has about 525 units throughout the country, and we employ in total over
10,000 employees. I have also talked with hundreds of other business people, and they've
also calculated the cost impact on their businesses. I believe that this is something that
we should and can fix, but for many, many businesses like mine the cost of your plan is
simply a cost that will cause us to eliminate jobs. In going through my own calculations,
the number of jobs that we would have to eliminate to try and absorb this cost is a lot
greater than I ever anticipated. Your averages about the impact on smaller businesses -those are well intended, but all of the averages represent a wide spectrum in tenns of the
businesses impacted. On behalf of all of those business owners that are in a situation
similar to mine, my question is quite simply, if I'm forced to do this, what will I tell those
people whose jobs I will have to eliminate?
PRESIDENT CLINTON: Well, wait a minute, let's ask --let's talk a minute about what
you would have to do. Do you have -- are any of your employees in~ured now?
MR. CAIN: Yes, sir. Approximately one-third of my employees are insured now.
PRESIDENT CLINTON: And of the third that are insured now, what percent of payroll
does their insurance cost you?
MR. CAIN: My insurance costs at the present time run approximately 2-112 percent of
payroll.
�PRESIDENT CLINTON: And what do you provide them with? They share the cost
50-50 or something like that?
MR. CAIN: Cost 75 percent paid for by my company, and 80-- and 25 percent paid for
by the employee. Now, two-thirds of my employees are part-time or short-term workers
that fall into the class that you identified earlier.
PRESIDENT CLINTON: Okay. Then, if they're part-time or short- term workers, they
wouldn't add all that much. You wouldn't have to pay the whole 7.9 percent for them,
because they don't work all t!te time. And -- all right. Let me ask you this: On average,
food service businesses, payroll is about one-third of the total cost of doing business. Is
that about it is for you?
MR. CAIN: That's an adequate estimation, yes, sir.
PRESIDENT CLINTON: Okay. So suppose, since you have part-time workers and
some wouldn't have to cover it, so you wouldn't go from 2- 1/2 percent of payroll to 7.9
percent. You might go to something like 6 percent. And if you had 6 percent of payroll,
let's just say, instead of 2-112 -- or let's say 6-112 percent. That's a good even number.
You add 4 percent of payroll, and that's one-third of your total cost. So you would add
about 1-112 percent to the total cost of doing business. Would that really cause you to lay
a lot of people off if all your competitors had to do it, too?
MR. CAIN: If all -PRESIDENT CLINTON: Only if people stopped eating out. If all your competitors
had to do it and you ask 1-112 percent -- and your cost of doing business went up 1-112~
percent, wouldn't that leave you in the same position you are now? Why wouldn't they all
be in the same position? And why w:ouldn't you all be able to raise the price of pizza 2
percent? I'm a satisfied customer. I'd keep buying from you. (Laughter, applause.)
MR. CAIN: Ifl may, Mr. President-PRESIDENT CLINTON: No, I'm serious. This is a serious -- this is a very important - let me say, I don't -- this is a very important question, because a huge number of
Americans are involved in the food industry. Forty percent of the American food dollar is
spent eating out now. Forty percent. So this is not an idle question. This man is raising a
very important question in terms of employment. But what if all your competitors were
just like you? Wouldn't you be able to do it then?
MR. CAIN: Okay, first of all, Mr. President, with all due respect, your calculation on
what the impact would do, quite honestly, is incorrect. Let's take, for example, the fact
that after I went through my calculations, your calculation or your example of the 6
percent or the 7.9 --and in my case it works out to 7.9 percent. Now, let's suppose that 30
percent of my costs are labor costs. 7.9 times that would be the 2 to 2-1/2 percent that
�you're referring to. The problem with that calculation, sir, is the fact that those -- most of
those 30 percent of the people currently have zero. So, when .I calculate in the fact that I
have to go from no coverage on those employees to full coverage at the 7. 9 percent rate, it
actually works out to be approximately 16 percent.
Now, your other point about having to pass it on to my customers in the competitive
marketplace, it simply doesn't that work that way, because the larger competitors have
more staying power before they go bankrupt than a smaller competitor. They have more
staff that they could simply do without until the marketplace reestablishes itself. So what
I'm saying and suggesting is that the assumptions about the impact on a business like
mine are simply not correct because we are very labor intensive, we have a large number
of part-time and short- term employees that we do not cover for one simple reason: We
can't afford it. My bottom-line net profit for the last two years was less than 1-112 percent
of my top-line sales. When we calculate the cost just for my company under your plan, it
equates to three times what my bottom-line profitability is.
PRESIDENT CLINTON: Okay.
MR. CAIN: So what is one of the biggest misconceptions, sir, is the fact that a company
like mine only makes between 1 and 3 percent of top-line sales. And because we have a
large population of employees that we would like to cover, but simply the dynamics of
our business will not allow us to do that under your proposed plan.
PRESIDENT CLINTON: Let me ask you a favor. Would you send to me personally
your calculations, because I know we've got to go on to other questions.
MR. CAIN: I would --
PRESIDENT CLINTON: Let me remind you, if it added 4-1/2 percent to the cost of
doing business and his labor costs are only one-third of his total costs, then all you have
to do is multiply it by three. It would have to be 13-112 percent of payroll. And at
maximum, it's 7.9. So that's-- it's just-- that's not-- we can't get there. We'll-- send it to
me. We'll work on it.
MR. ANSCHUTZ: Thank you, sir, in Omaha.
PRESIDENT CLINTON: Go ahead.
MR. ANSCHUTZ: I'm sure a lot of this health care reform debate is going to be over
numbers.
PRESIDENT CLINTON: That's right.
MR. ANSCHUTZ: And maybe that'll come out in the wash. That's what this is all
about.
�PRESIDENT CLINTON: Let me also say for those that are listening to us that are
part-time employees, you don't pay the full premium, unless the employee works 30 hours
a week or more. Anything less, the employer pays a small percentage of the premium.
[end of CAIN segment]
�U.S. SMALL
BUSINESS AOMINISTRAT!ON
WASHINGTON,
O.C. 20.4 IS
OFF!CE OF THE AOMINSTRA TOR
Mr. Herman Cain
President and Chief Ex~cutive Officer
Godfather's Pizza
9140 West Dodqe Road
omaha, NE 68114
Dear Mr. Cain:
Thank you very much for your quick response to the
request to send us your health care calculations for
Pizza.
The President enjoyed his conversation with
Kansas City Town Hall meetinq last Thursday and he has
respond to your letter.
President's
Godfather's
you at· the.
asked me to
The President has said repeatedly that he l.s committea ~o
<;igninq a health reform proposal that will be beneficial for
America's businesses and families, while improvinq the health ot·
the nation's economy.
American businesses bear a heavy burden
under today's health care system -- with health care costs per
worker almost doubling over tne last eight years. Some insurance
companies, as you know, characterize entire industries as "high
risk'' and refuse to otter them insurance at any price. Restaurant
owners are often sinqled out in this fashion.
The President's reform is designed to solve these problems,
responsibility from everyone -- employers, employees, and.
government -- without imposing an undue burden on any one sector.
a~kin~
•
The President's approach will aggressively control costs by
bringing market forces to bear in the health care system. We
will build on the successful practices employed in the private
sector today to pool purchasing power and enable all
businesses to barqain for the rates that only the very largest
companies get today.
•
The President's approach will streamline the burdensome and
costly requlation that consumes lS cents of every health care
dollar. By replacinq thousands of insurance policies with a
comprehensive benefits packaqe and standard claim forms, more
money will c;o to benefits and less to underwriters and
marketers.
•
The President's plan also includes rock solid guarantees that
increases in business' health care costs will be reasonaDle
and predictable -- not several times the rate of inflation, as
in the past.
1\ printed on recycled paper
�HPR 14 '94 15:16 SEA CONGRESIONAL
AF~.
Godfather's Pizza
April 14, 1994
Paqe 2
•
Under the President's proposal, employers would never pay more
than 7. g percent of their annual payroll for health care.
After carefully ~eviewinq your calculations, it is clear·that
).lnder the Pres icient' s approach you would save nearly $2.
million over what· it would cost to cover all of your employees
under the current system. CUrreDt coats would eoaauae 14% of
your payroll. Under the President's approach, your premiumcosts will be discounted by over 40% to ensure that your
health costs do not exceed 7. 9% of payroll. This is less than
half what you would have to spend today, while provid.inq all
of your employees with the security of comprehensive coverage.
•
Your calculations indicate that, since you only cover 12% of
your employees, your payroll costs will increase when you
provide health security to your entire work force. The 6%
increase in your payroll costs to cover the 88% of your
employees who you do not cover today represents the health
costs for these employees that are now beinq paid by ~axpayers
and employers who currently support our health care systeJil.
Providinq guaranteed private coverage to all your employees
has obvious additional benefits for Godfather's Pizza --·lower
turnover, increased productivity, lower worker's compensation
costs, and a level playing field with all your competitors.
For example, guaranteed private insurance will allow
businesses to recruit ana maintain a stable work force that~will
not he lured away by other companies which otter their employees
"!.ealth secu.:. :.ty.
This will decrease the high turnover that
.:haracterizes the restaurant industry today, which you've said is
of particular concern to you.
Lower turnover will clecrease
employment costs, lower training expense, and improve prod~ctivity.
In your letter, you state that you believe we can achieve the
goal of universal coverage 11 usinq an alternative approach to health
care reform". I am eaqer to hear any ideas you have about how.to
finance guaranteed private insurance for every American.
We
believe that the President's approach -- building on the current
system of employer-based health coveraqe
is the least
disruptive, most equitable and easiest way to achieve the goals we
both aqree on -- universal coverage and affordable insurance.
I must respectfully point out that the cost ot providing
health care to the 2,928 employees you do not insure -- when they
become ill and have to go to the emergency room for expensive last
minute care -- is borne by other business owners, American
taxpayers, and individuals. For example, in 1991, employers who
took responsibility for their employees' insurance paid an
additional $10 billion in premiums to c~ver uncompensated hospital
care -- nearly half of which was provided to workers, or dependents
�~R
14 '94 15:17 3SA
CONGRESION~ ~r.
Godfather's Pizza
April 14, 1994
Paqe 3
of workers, in firms that didn't provide coverage. In addition,
the National Association of Manufacturers further estimates that
employers spent over $25 billion that year to cover dependents who
are employed by firms that did not offer insurance.
By asking all employers to share responsibility, the
President's plan levels the playing field. For the first time, all
businesses will be able to negotiate the rates that America~s
largest companies do today. In addition, all of your competitors
will have the same responsibilities that you will.
Once again, we appreciate the speed with which you responded
to the President's request and your contribution to the health
reform debate.
Sincerely,
B. Bowles
Administrator
�GtdrathZ.s
Pbza.
==============~~~-==---~-~--~--==~--------------~--~--=--~-
¥
HERMAB CAlli
Prestdent
and
Chief Execuuve Officer
April 12, 1994
The President
The White House
1600 Pennsylvania Avenue
Washington, DC 20500
Dear Mr. President:
During your April 7, 1994 town hall telecast from Kansas City, you asked me to send you
my calculations of the impact on our business of your health care proposal. I am happy to
do so in this letter.
As a reminder, the Godfather's Pizza system has 525 restaurants with over 10,000
employees. Two-thirds. of these restaurants are owned and operated by franchisees of our
company, whose operating financials are almost identical to our corporate owned operations
of 141 restaurants. Therefore, in order to be as specific as possible in our calculations, I
will focus on just our corporate-owned operations with 3,418 employees.
Under your proposed health care plan the cost to cover all3,418 employees would be nearly
$2.2 million annually as shown in the attached "Proposed Health Care Cost Worksheet"
(Table A). This amount of $2.2 million is a $1.7 million increase in our insurance which
is approximately 3 lf2 times our prior year insurance cost. Last year we paid $540,000 in
insurance premiums to cover an 80% employer portion for all participating full time
employees.
You mentioned during the teleca~t that restaurants with approximately 30% labor need only
increase prices 2.5%. This price increase appears to be arrived at by taking 7.9% times 30%.
Quite frankly, we cannot .hW. look at a percent of a percent but instead we must look at the
actual dollars involved. A $1.7 million cost increase would directly decrease "bottom line"
profit. In order to produce the same "bottom line" as we are generating today, a 16-20C1o
increase in "top line" sales would be required due to variable costs such as labor, food costs,
operating expenses, marketing and taxes. Thus, it Is incorrect to assume we can just add
$1.7 million to the "top line" and expect it to flow directly to the "bottom line".
·
As a system of small businesses we are concerned about the impact of any price increase for
the following reasons:
Godta.......... lac.
9140 West Dodge Road Omaha. Nebraska 68114 402 • 391 • 1452
�The President
April 12, 1994
Page Two
1.
Large price increases will drive customers away. Over SO% of our customers
use coupons with their pizza purchases because they are very price conscious.
In fact, 25% of all restaurant customers use a discount coupon with their
purchase. (Source: Crest, NPD)
2.
Since it is likely that many of our suppliers of ingredients and materials will
also experience increases in costs due to a mandate, they will likely pass some
or all of those costs on to us and, thus, it becomes an inflationary "snowball".
3.
Although consumers are spending more of their food dollar eating out, it is
due to competitive forces which tend to hold prices down. This .is evidenced
by the cost of eating out rising slower than the cost of eating at home (Source:
Consumer Price Index, Bureau of Labor Statistics - Table 8). I believe price
increases "by all competitors" in our industry would change this trend.
To summarize, Godfather's Pizza, Inc. employs a large percent (67%) of younger,
inexperienced and minimum educated workers with a very high turnover rate of over 100%
annually. This is typical of all quick service restaurants which account for 47% of all eating
place sales. I wish we could cover this group of workers but the incremental cost under
your plan causes a significant negative impact on our "bottom line" which cannot be easily
rectified. We would then be put in a position to eliminate jobs which would impact
productivity and ultimately profitability, ru: to increase prices to the point of being at a
competitive disadvantage.
Mr. President, I believe your objective of coverage for everyone can be achieved without a
mandate using an alternate approach to health care reform ••• but this is what the debate
is all about. I will not impose on the courtesy you have extended to me to personally review
my calculations, but I will be more than happy to share some ideas with you personally on
alternate approaches which are more business friendly and public friendly.
Thank you for your very valuable time and attention; I look forward to your response.
HC/JL
Enclosures
�04/12194
Table A
GODFATHER'S PIZZA, INC.
PROPOSED HEALTH CARE COST
#OF RESTAURANTS
CORP, RFM'S, AND FIELD INCLUDED
141
#OF
EMPLOYEES
FULL-TIME
CURRENT
HOURS
CURRENT
WAGES
ANNUAL HOURS
WORKED
ANNUAL
WAGES
I
975
73,682
673,150
1,915,742
18,671,075
1,570
59,153
308,119
1,537,983
8,011,091
EMPLOYEES WHO WORK LESS
THAN 10 HOURS PER WEEK
720
8,505
42,898
221,125
1,115,347
LEAVE OF ABSENCE/OTHER
153
0
0
0
0
3,418
141,340
1,024,167
3,674,850
27,797,513
TOTAL
PART-TIME
TOTAL
TOTAL EMPLOYEES
7.90%
$2,198,004
..,OTAL HEALTH CARE COST-CLINTON PLAN
SUMMARY OF GODFATHER'S PIZZA, INC. CURRENT PLAN
NUMBER ELIGIBLE
594
NUMBER OF PARTICIPANTS
409
CURRENT COST-GPI PLAN
DIFFERENCE
$540,758
$1,655,246
�Table B
In four out of the past six years the cost of food purchased for
preparation at home has risen faster than food at restaurants. Since
1988 the Consumer Price Index for food away from home rose 17~6%
versus a slightly higher 20.2% for food at home.
Percent Change in Food Prices
1988-1993
Food At Home
Food Away From Home
1988
4.2%
4.1%
1989
6.5%
4.6o/o
1990
6.5%
4.7%
1991
2.6%
3.4%
1992
0.7%
2.0%
1993
2.4%
1.8%
Source: Consumer Price Index, Bureau of Labor Statistics
�MAR
~7
'94
IJ3:23?M 202/479-5129
P.S
NATIONAL RESTAtJRANT ASSOCIATION
"FACES" - z30
VIDEO
AUDIO
Calaa
Still or video head shots of
Nine milllon Americans work in
restaurant workers, one slowly diuolvina
restaurants.
into the next.
Waltressea •••
cooks ...
marsqen ....
Hardworklq people, frequently
sinalo parents, youna people
workin& their first jobs.
Cain talkina to camera, with restaur-.nt
in tw:qround.
SUPER: Herman Cain/Godfather's Pizza
(2nd Line of Super dissolves into
VP, National Restaurant Auociation.)
They Wlftt &ood health c:aze, but
they need a plan chat doeul 't
eliminate anybody's job becausethe costs and bureaucracy are too
hilh·
President Clinton's health plan will
eliminate jobs in restaurants like
mine and many others acmu.
America.
Reprise of 3 head shots.
ORAP!UCS: Call Conpess 202/225-3121.
Disclaimer.
Tell Coqms-people Wallt aood
health care-but they need their jobs.
�; Walking the bottom line
.·
I For b1Binesses,
the debate boils
i down to msts
1
I USATODAY · v/
Judi Hasson
I
By
I
i
·-
Howard Schul1Z and iferman cain bave a lot in common: Both are presidents of
companies that cater to two
of America's biggest food fetishes - colee and pizza.
Bur they're on opposite
sides iD Ule oational debate
over wr.etber employers
should have to pay tbe bulk
Clf their worten' beaith·in·
surance premiums.
Such a requirement. pan
of President Clinton's health·
care proposal. has become
the central issue as eonsress
struggles wtth how to pay for
health reform.
Schultz. president of SW'·
bucks. a colee house chain
with 325 stores, pays 75<ie of
the cost to insure his 6,000
full· and pan-time workers.
Jn exchange. be gers a sraMe "Work fora!. be says. It
costs him $1,500 a year for
each worker; it would cost
$3.000 to train a new one.
"We View this as a compel·
itive advantage," Schultz
says. He supports Cinton's
proposed "employer man·
date" - employen paying at
least 80C:C of a worker's premium. the worker the rest.
Cain. president of Godfa·
ther·s Pizza Inc., wtth 145
company~wned stores and
nearly 400 franchised, is on
Ute odler side olrbe debate.
He pays abOut 80t;i of the
cost of covering 12~ of his
10.000 employees, mostly
managers, at a cost of
5540.000 a year.
Cain opposes making em·
ployers pay for insurance.
Clinton says a busines not
providing insurance now
would have to raise prices
2'< to cover the new cost.
But Cain told Ointon dur·
ing a to,.·n haJJ meetinc iJ
would cost him SU miUion a
year and require him \0 in·
crease his sales up to 20'*.
"lf you mandate a cost. the
business will be forced to recoup the cost from some-
SUPPORTS CLINTON: Howard Schultz. president of Star·
bucks. a coffee-house chain, with President Clinton at an
April29 healltH:are disa ISSion in the White House.
ness because they couldn't
dord to pay.
Labor Secretary Roben
Reich argues that there
would be a "shift of jobs." but
a lass or pin of lea than 1c.«.
CoSIS and jobs are not tbe
only issues.
Many busines people are
philosophically opposed to
tbe government ordering
tbem to do anything.
"It is another tu," says
Frank Nasso. owner of an
auto supply center in Boise,
Idaho.
Although he pays half the
bealth insurance cOSIS for his j
seven employees. he does 1
DOl want to be told to do iL
I
"Costs never go down. especially when the govern·
ment gets involved," Nasso ~·
says.
Other busines executives
say they've been buckling
from the cost of health insur·
ance, until recently rising as
much as ~ a year. And
they'd be happy to have the
relief of capping costs and
creating a level pla)'ing field
- seeing the same insurance
costs they pay hitting their
competiton who don't provide coverage now.
"It's costing me a lot of
money now. and I'm getting
les coverage all the time."
says pharmacist Ken Eply of
Salem. Ore. He coven only
seven of his 20 employees
but says, "I'd like to get all of
them covered."
Whatever the outcome,
most small-busines ownen
would like something that
relief
I·
AGAINST: Herman cain of
Godfather·s Pizza Inc.
pay for most of it- as many
do now voluntarily or under
union· contracts.
• Collect a tax. as Canada
does, so the government can
pay for all health care.
• Combine the two ideas
- require businesses to pay
for insurance, and bave the
government give small Inns
subsidies or have them pay a
1o/c or 2'ii tax instead of 80o/c
of the premiums.
Under ·Cinton's plan. a
business· cast of premiums
would be capped at 7.!tlie of
payroll, but subsidies would
reduce the maximum to
3.~o/c for small . businesses
wttb up to 7~ worken averagi.ag less than 124,000 a year.
Worken not insured now
could cake a double. wham·
my - paying a share of the
premiums. and getting lower
raises if employer! shifted
some of their raise
I
�WILLIAM KISSICK:
Dr. Kissick is currently a professor at the uonard Davis Institute at the University of
Pennsylvania Medical Center. He was one of two physicians in the office of the
Secretary of Health, Education and Welfare who worked on the drafting of Medicare
legislation in 1964 and 1965.
Dr. Kissick, in a 1993 article in the Philadelphia Inquirer, opposed the global caps on
health care expenditures in Senator Wofford's American Health Security Plan He·
called this a "top-down" approach which "won't work because it does not reflect the
incredible variety of health-care insitutions in America." He encourages local
flexibility, building from the bottom up rather than regulating from the top down.
(Attached find the copy of the article and a letter from Senator Wofford)
He is "apprehensive about global budgeting, health care purchasing monopsonies,
health care delivery monopolies and a national benefit structure". He supports
managed care and views capitation as the best way to achieve cost containment.
I will forward additional, more current information as it becomes available.
�SENT BY:
6-15-84 ; 16:48 ;
~
zuz
iUO O~JOi~ ~/ ~
~~~111 II~W~~~'
·-~·-~~~~-~-~-~~~~~h··~~~-,
MEMO FROM THE EDITOR
Ben Franklin.. pracrlptlon ·
AI P'eftn'a medical
~~e.;huol.
tht2 atudenta ore
far Whit 1111 h11Hh Cll'l
laualll that no t.'OJI la too arcat to sa\t'e a human
We mUll all IICIIlfl together, or assuredly we sJrall
Urn.:, students llt The Wharton Sc:hoclleam that
tltl htmf NPQiflfr/y,
rttaources •rc: 1imitr.d, •••d therefore chol~n
One
in
or
llfe or treat 1 dkleoae. he roport1. At Ulc same
-Benjunin Frantlla IJ the &llllllnll of rn\111 be made.
J alkecl ta.lc.:k lur er1lrtteMtsw not only lu &I~
11\1 DlelaraUon ur ladependenc:e
cuss these current lssuca, but also to
learn his Insider's lnal(lhta frgm the last
the earl)' IU&.Iers
limo wa Americans made a major
cbanp In our heallh-c:a181)'1Cem: tho
launching of Medi~ant. He HIVed on
~merlcln
1nedictne
was tsen)llldn Franklin. In
1751, he helped launch
l'ennayiVanla Hospual,
Lyndon John•on·• equivalent of the
HtUuy Roclham CUnto" lask fOR:e and
can caalog Ule evenllthat have result
cd In Medlcara'11 ballooning to a SlSU
............
..,..........
--~···
thl nation's ftllt. In 176&, the c:ount.y'l fblt medleaiiChDOI opened as put o( tho Ul11velllty at
PennJrttyanla lhat hi rounded.
A Wit to lhe Penn campus today oUea striking
historical contnst1. Plaques eomanunt,ratlng
Prauklln'a pioneering elfOitl •nd onJy a stone's
lhraw frorn the medicaiiChool, whlc:h houaa no
fewer than flva MRJs uaed for patient services
and research.
Franklin believed lhat a unlveralty dc1rce
•mould be &11 educ~ttlon for c:lti10JIIhlp .and
should hmd lc mercantile and clvlc IUceeM and
!
usefulnea/ So he would doubU• b~ t.Jieued
hy the stature of Penn's Whartuu School. the
natton•a tl11t bu5ine55 Khoul, and Its Leonard
Davl!&lrwitut~ nf Health kanomics.
One ph)'fliclan who appn:clata this historyand 110me of thr. frnnln.-ia William L Kldick,
profa.uor of public httalth and prc\'CnUve medl·
cin~ In the m..-dic:al Jc:hoot Anti rmfPMOr nt
bUIIon prugram today.
AJ tho nation's first unlveraal-atcess,
tax-supponed. sangi81)1Jer hcaltll proynun, the 27-year Medicare txpf'.tlence
offers important JIIIOM for tJS today.
F'or Instance, it the prir.t tag fur cO¥erlng 35 million elderly ~md diAbled c:utmntlj exceadal133 billion a year, pravldlnR a
llraUar n••ml>er ot uninsured with comparably
PMIOlat benefits is likely 10 coat more than the
uuaual $SO bllUon fil• eatlmated.
KIIRick also believes that tho only -way that
practicing physlclaM are SOing·to IUMYC thCI
coming ella._ In tho health-care l)'llem Is to
follow the famo111 advice Ben Franklin daiYc!red
nn July 4, 177G, Md "RI'OUP up. • Anydme IClMielc
w11nts to commune wlth Penn's spiritual filler
about the dlffleuiLiea or changinll our healtbcare
sya\em. he can. A life-sized .aatuc of Franklin,
sc:ulp&ed by Qwrge W. Lunden, l011ft. . an a
ps.tk IMt\:11 J\llt uff Locust Walk on CIII'IP\JL Ben
t~wurs to be reading a copy of lllln~WSPaocr.
The Pennsylvania Gazelle. but whea you sit
down on the olber hall of tht~ beneh;·you realize
that he's adually peetinl over bls Franklin Na&
lng 11uscs Into tour eyes. And you can alnaoll
hnr P«Jt Richard whlapor: -welpty qua&lons
ltllk for deUbemte aniW'Irs.· •£xDtrlence kcqJe a
dear Rchool, yet roots will learn In no ocher."
•1'lu~
mmt axqul11tc folly ls made of wifldosn
hewtbcartl syatems In lhe buainessldJuol. M he spun too fine:
shultles baelc and fnrth to tll'ac:h his r.lnR."lRA,
KIMl~k e1>nfron1s almost dall)' one of the hand..
mnntal probtam& facing the A1nerlcan health·
care system today.
�SENT BY:
F---'I
'
1
,
What lessons
should we take from
,
Medica~?
One of its architects says the 28-year-old
program can teach us a Jot about howand how not to-reform health care.
T
w~nty·l!ffle
Cl80, CJ
"ec.1et
yenr~
prtJSt·
force liet
out to rEtliltQQe tile
c1elloe1y of health catr ttr 1/1~
d~IIIWf 1n.~
Vnitttd States. On· the task
EciW • • Mur•llllft)
I.......,....WIIM'Itelatklket
the Unlwnilr of PeiiNJMNe.
forrr stuff u:c:..~ a .92·Yf!Clr•Old
giUdUI.lte of the )'(lie llnltllr· ·
iily Scftool of Medteitii!,
WlUiom t.. Ki:,"'Jich.
KiMich Is now a prof(JSS,(W
of flub/ie health artd IJ,.euen·
liur: mftdl~ltJe at tile I Jniuersity ol lifJS been inadcqutJtt:ly !tludie(r: he
Pl!rm$ylmmia School of MtJalclne. c:olls lhfs "Kissl~k ·~ li~l laUJ of med·
clmimlan Cll tile gouemirtJl board of ictnc. • Such wlttlcfrm' hrlp mak.:
the Leoncml JJnuis hJSttlut•~ of his conc:lu~innr mtmcrabfe wiJilc
Hcallh Econo;rtiC:$, tmd a prof5fJI reducins tfleitiJillg.
of trralth-r.are sy~t~m:-; nt Penn's
Rraduare lntsint!~~ school. 'l"he
W11urlot1 School. Hd •~tm osse!is
from a hl'slutic:rtl ittsider'l tJc,lltJge
ooinl til'- current fJif<W'Is of 1/le Clin·
ton admitli.ttttJtlon ro refon11 ht!alth
r.a,-., and what w~·ue l.rlfTte.d i11 ,,,1!
fJr,'t:edinB throo d~es.
ICis.~icl•
willt
tl
is a gilled /)hrosemaker
rlro/1 sense of llumor~ says
Medlcul
l:'c:cmomics f."diltU SlePt?
Medica,, wttft its reiirmr.e on
has· oauuJ.
ly hfiSitned the end ul •the fltJidcm
lee..for-5ell)j~ {)Q)IInent,
agtJ vi Amtrlr.on medicine.· he
sen~.
Yez he shies tlwtJY /rom bmtJd
'"'form. pl'l'fmin(J (I IQOIP.
110/iOfl(l/
localiuci.
JJII~f'H(jtic.
!Jifd ,JumJIJUK:
of hiJ /orth·
flfJPIOCIC h-l11e lfl~tne
c()111inll boo~. "Mr.tficine's Dll•m·
mal~ Infinite Nuffrb; us. Finits
Resoutctt.s. •
MuTata, wlw r1•Cr!nt/v intt'n>ic•"'ed
t1im in PhlladP.I!JIIia. "To many ()(
"'Y medical ~tucicmt~. • Kissick ~ay~
lt1 the ioteriJWW thallolltlW~. $dlt
whether YfltJ ael'ef! wllh Kis.'lir:k 's
anolysjs cmcJ bi.o; Be11 frankli.1t.M/tw.
·a hf'fllll ry /Jt~f!fOII Is !ilntwottl! who
fl"!!ic:rimion fnr thl' futmr..
----·····-·---
�...
~u~
_.....
~vo
1
O~!O•~
•w t v • •
•
~~
• v-.
made certaln lhal WUbur Mills got
credit fur it.
l was not far removed from the
Vale medical school. ~ere I had
atudlcd medicine and public
health and opldomiolof.v, foiJowod
by a year at Montefiore Hospital
oncl Mcdienl Center In th• Bronte
as a resident In social mtsdicine.
Between staff aui&nmenta,l'd find
tnyself slUing there wltb my aye~
wido
opc~n,
wondering. •M7 Ood,
whal'agolng on here?.
Aftor Mc:dic:IU'O wu •18n0\1 ~nlu
law on July 30. 1965, I went on to
holp write the n:giune&l mc:Ui'"al
programs ond was appointed
cJjrector olttratqic.; 11lmmlngln the
Surgeon Cleneral'• uffic.'t. II was~"
eJnraurdlnarUy excltlrtH time In
Washington durtns the New Fron·
11cr and the Oroar Soelety. Wo
thaujlt we had anlved eYf!1Y exist·
In& neatth prot>tem.
a
A
mMrr:C )M211' oplniM of M«Hcme
Q "* tllti)'DIII*11n . . .
eonan-.
l1aUIII of
.labDIDn ....
ated 11om the Oval oma: as thOuflh
tn~ltltdlcoMr
In April 1904, Lyndon ISalnas ha wera aaa m&~ar~tv llldar a1 tha
Johnson esrabllahlld the lftal- U.S. Senate. All neall, lhe ha~
denrs Tuk t'orc• on Health. meauae had 25 le&lslatlve and
Hillary Rodham Cll11&un ha IliON budaet•ry proposals, and every
than 5UO on her t111c fon:e.. L)'ndan one of them wu enacted.
WIIar
A
Johuoft had anothar bfs advanJoh:.aon had tillht plul tbrco
111tafiere. I wu ono of tba three t•: Wilbur Cohen, the 45Sistant
staffers. That small task foree teerel4ry of heal&h for lealalatlon.
wmted in aec:Je~ \0 creflthe health Wilbut head bttn wotkln* for 31
proposals for Johnson'• OJeat Soci- ~ars, cwr since jolnlna the Rooety prosram. Our rtpor\ bulcally ae"ell admlnis&ration, on what
bec.:arnu th~e rust draft of his JanuaJY eventually became Madicara.
1965 pralde.W.I healah meesqe, 1\llhouah many of us helJ>ed,
loday1
Medtc:are was a herculean
pollllc.l achievement requirIng two presidential electionaKennP.dy ill 1960 a•ad Johnton in
1964. But It wu devoid uf tnncwa·
lion, merely utins t1x dollars to
replicate tho open-onded llnanclng
of Blue Cross nnd Blue Shield.
Instead of universol ateess, we
were able to f'rovide complete
cuvcnge for only 10 percent of the
population. Tho
~naequance,
a
quarter Ol fa ~~lllUry hiCt=r, ialhat
we've Invested hundreds of bil·
lions ol doU«te h1 a health-cere
Wilbur Cohon wrote Mcdic:.ara and economy that Is undisciplined by
•Advancins lhe Nadon's Health."
In Novembor 19G4.1.¥ndon John· worked vary closely with the chair- markets, undiaelpllllfld hy ftde·
100 bealBarry Goldwater In a land- man or the HoUle Waya and Meant cauate regul11lion, and uudisci·
slide. In addiUon to enj(Jyiug t~ Ctlnunitlee, Wllb11r Mitis, tu lld th~~t plined by public owner.;hlp and
whelming •najuritle& in. IJuth l~glslatlon pa"•~-eud llltut upcmstlun.
------------------------------------------------------------~~ldlDIC'.AI. f'JX)NOMK:S S
~
�SENT BY:
6-15-94,
We misjudged several things-the size of the older age-group,
the scope of the technological revolution, and patients' rising
expectations.
Dudley White, ersuably the loradinl cudi-
nloglst tn the nation at the lima, flaw
lroan the Harvard Medical School lo
P.isenhowcr'$ bed&ido Lo aupttvlao.the
culllns-edgc therapy oC lhe da~y-bod
at, OI)'I8R, digoxin, antieoqulanta, and
morpt&Jne.
If Prasldent Clinton wre to auUer an
MI. ho'd be Nlhed Into • cardl~uc
unit, continuously mcmttored, given a
thrombolytic drua fuUuw.-d by an
angtoaram, ~nd thtu1 coasLdered for an
ll\lliOPIUty or coronary UICJY byp.....
Cucltac ullrasound, gated blaod-pool
assays, cloctrophyalotoalc:al &Milna, and
other diagnostic ~uctles woulcl be avaJl·
able, as. wall u sophllllcatecl.carcllac
drup, llaart tr&nspluuatlon• and other
thcnlpeuti<: measures that limplY wwnm't
available ire Etseohower'a time.
'lblrd, we mJSiudgcd die publ~'a dalln=
QWPiatdo you tNIIA went wtOnB?
'lbosc of U& who holped wrhe Medicare
Amad• throe amall mlatakn.
the
for these aenices-pallenta' rilln8 upec.
tatlons. When I was a medie&liiUdtnl. I
took care of a 11umber of cldtrly palltnta
who had osteoarthritis olthe hlp. They
~lrst,
we expected to hol>ble alona.wlth uplrln
mll)udged
demoansphic:a-how many and a c;ane. Now these patlents want a
- - - - - - - people would lnln lhc older aai1Jro\IJ). totAl hip ar1hmpluty-end ~her get it. It's
Whell Medi~ was enacted, It eovarod 1he rlslnll Clq)tet&llon that •we can do,
19 ntillion people. 1"oda,y, the numbers lind theteforo we ought to do.~
When Medicare wu pauad, we were
are "'I' La 85 mllllou elderly and disabled.
Soc.:and. we mlallldllf!ld the &cope of spending $42 billion on health care, 8.4
the technological revolutlnn. rrcsident pcrcenc or 1111 BfOII nlttonal produd. Last
Eisenhower's heart attack in 1955 lllut5· year, we epe''' S839 bUBon, more than 14
lr&tes technoloty's impact While visit· percent of yrnas domo1tl~ product.
Ina Culoracto, he suffered a myocardial Medicare has 1one fmm 13.8 bllllcn tn Usinfarction anet WDI hoepitall&cd at the
Fltulrnon11 Army MRdicD.l Center. Paul
cal 1967 (il was implemented July 1,
1966) to Sl33.5 billion in fiscal 1992. and
�we atill clln't take: care of all th~:~ neecb.
PII)'Ooh:lon. and aupportc::d himself
11\iS fac:t led me lo formulate Klssick•a patient a w.k.
10~und lcaw ul .~.edi\;lueo. •No t.CH:ieLyln
the world hll aufflclent reK>Urcts to pro"lde all uf "'" lavaiiJa wrviWII iw .,upula-
tlon II capable of udllzJq.•
We AmeriQRI must team that c:llolea~
In a ~loader
unavoldDble tenalon amon&
tiC:Citll5,
one
"'*'· Marc.us Welby per
$0nlrled lo mo tho autunomy, preroplivu, and au&horl&y of thu ~~i~ ..\. lie
worked ln 1
wiU1 hJlj
f~or-tel'VIce
re:imbur~ment
aolo prActice
baaed on UIUaL
have to be made In health care. Thera'a c:uatamacy, and rouonable
1111
Ol'\
~harga
His
wurld was UIIU\'eluus.
quality, and cost-containment. 1c:all thJa
ltmalun the uuu UIUIII.s of health CIR,
with those three <:hoica at the apues.
You can deliver any one ol lhaac aoalt,
but only by compromising the other two.
QWhy
111
do you suy MediCUtV pur an .nd
llJ
Ahe who pays tho piper cttlls the
tune. c.:osaa rose. Medlcare
When I w•a a kid, I learned tbat Thl Whlrt0n8chaol, .
vm.. Kllltck 11 • •
You can·a deliver all three. No hcallh<are
AM
began 10 8 ,.,._.,, ..,..,_.
sys&em does, or can.
realize that open-ended flmsRcina bad andque-..."'1'.
Nuw, yuu cau uy to achieve greate&l to end. sa HCFA began to demand t1donfromlhe.,
c=ostaefloctlvcmess by attemptlny tu seewad opinions, prlar autbarization, utll· New Yn 8IDakexpand the center ol the triangle. And lzatlon review. and diaanoairrrelatad - - . .
wltbln the b1an&la you can mcwe In ona
dln!ctton or another-but Dnlf DV making
tradHflt. If you g1va nna perr;on a liver
transplant, you deny cataract removaJ lo
&avcnl cldoriJ patients, or lmmunl7.atlons
to a roomful of JddL
how do you judQ• Mlldiea11'•
Q on pttiCiicinB dot/oY$1 end of
Mcdiaue has ushered In the
Ouei'IIU.
iiii(JOCI
A
whal some have caUed •the golden
qe ol American medicine.• or wltat I call
"the Min:• Welby SC~n~rio."
You remember Dr. Welby. In almwt
seven yem of prime-time televlllo11, ht
never missed a d(qnosia, wu elwcsya
eompulfanM•. wu never too ruAhed to
give time to a pauen•. 1nentored a youl\g
'I
I
'\
.I
Americans must learn
choices have to be made in health care. There 1s an un~~voidable
tension among access, quality1 and cost-containment.
�~1::.1\'J 01 • -
- ... --
- ..•••
arUUJ~».
Mora reeenlly, they've lntro·
rr you'n• 35 10 ss, look •round for some
duced the resourcc-bued relative value e.llies intemstect in fom\tna groupa or ioint
venturing wtth you. Consider alllllatlons
!Ieala and praalce SUidcllnes.
In strlvlns for toat·containmt:nt, with hospitals ()r physlcian-besed orpniMedlcare and HCI'A have Ued up ptDcdclnl phyalclina In ao much red tape-so
many cost-cornrolareps-tllal doc&ars
zacluns. Basteally, look :to worklnl coUabo
orallvely.
:
IS you're 2& to ::s:>, thlqk helerodoxlcall)'·
now resemble ship's suqaon Lemuel Oul· Be creative; think ~~~ the &rain. iry eo
llver In Jonalhan Swtll'a "OUJilver's Trav- anuapale ahe tulure, af'd don't bo afraid
els." Therefore, I call HCFA's cost~ntain of new bell"" that ~ from uyiftg to
mant efforts the JJIIIpUDan sccnarto.
nnd waYf of adal)lfns. ;
.
Unfortunately, tee·lor..vlcc pratllce
And If 1011're tired of bclng manqed.
will c:andnue to be •ubject to oven more no matter wh&t your
think 1bout
:aae,
Ullipullan restrtcdons on tt'.e physician's rnanaains. To manaae :or be maftlliCdautonomy and authority. Compelillon's that is the Question Jar. physiclana loday.
"Invisible hand· simply hesn't worked. Solo, lndcpenderu pra~dtloners will «:C)nInstead, It's bacome the Iron fist of ca.~t .tinue \a ba harmed from HCFA's temple
control.
of doc.Jm Jn Baltlmora or the he&clqualteJS
ol Fortune 500 compantes. where bcnefl1s
So whol would )'011 adulse pmi'i"R manaaors ate bually deTfslnl new ways to
ph)Sklanl to do?
ratchel down your reltnbllllti12D.
If you're !55 or older, keep track of
In ~'OilltUl, I think ute orpnlaecl prac:·
Q
Ayour Keogh
~ean.
plan and hold on as beat
tlce of medicine oflemi docto11 •
WI)'
to
break tho bonds of ttl& Ulllpullan sceo
Medicare and HCFA have tied up physicillns in so ~h red
tape that they resemble Jonathan Swift's Gulliver. It's the
Lilliputian sc~nario.
narto. I call t!'tla ;.ltematl"e &he Ban
Pr.lnkUn ~natlo.ln 1776, FtMidin 14id.
•we must lndeec all bang together, or
w•
shall •. U hang ..,_r&&•l)•. •
I'd e.y the same for doctollloday.
IIMUMIIIy
Whal a,., the ktY loc1g of tiM "B•n
·?
QPhil. wa must acknowlqe thai med·
Fmnlllln ICfmario
Aol
lc:al rw~narch has broueht us into tho
era
chronic and desenerative dis·
caso-erthrilis. carcitovaacular dbouo,
�LUl iuO
:StNT l:SY:
JUN
l~-':1~
Ol!Oi~
0/
~
16:36 No.011 P.08
c:ancer. chronic lung disoa::e. 7he tcr·
tiary-carc model lhat we've been follow·
Lna 5ince the FICJCner repor1 in 1910 must
finally lJo repl&eed by the primary-care
rnodel. lntctead of cpociallalt~ providing
tho majority ol care in tho hospital, we
need scanerala a11achla\Q out from their
otficee into the cum mua' il)'.
l)labe&es ls a good t:Mmple of th ia .:shi(L
in thlnkinll. Al the beginning of thl& c:en·
tllry, lt wM a fatal diaeuc. Alth0\18h aciM
cnce hu removed this Immediate threat,
diQbatlc:a now focc the rilk vi ~l!J\IkJYP"
In 1776, Benjamin
Franklin said we must all hang together or we'll all hang
separately. 1'd say the same holds for doctors today.
~.:ular problems, bllndne55, and
other tem. It means doctors getting togeth·
cornplicallona. PhyslciliJlS don'l manaae c:r and practicing medicine in an oraa·
dlabeses. They edu(;lte pali"nt11nd htlp
niud way.
tnem manate their dwease. Show me a
well-conrrollad cUabettc, and 1'1: show
yuu an .ctlve partlc:ipant In the manop
mem of ntt care.
Primary care in the era of c:hrontc di•
case i5 more ot a collaborative rela11onship and Includes many facets of the
nursing model of care. I believe we also
need to add lhe public heahh model tc
thla S)'nlhe.is. Traditional medical care is
passive. Doctors walt for patients to
develop sympcoms and come \O their
<lffieea. If tha costS of too many incredibly
low.Uitth-weight premature babies is teo
a
A
ntsh.
h~r. lh~n
the problem and
can paradoxically transfonn many of the
UWpudu cOII-conuoltaclicalntn tooiB of
instance, docto" hdpln8 to &et the pricuttlttS fm the serviees lheir nrganizalion will dcli\lcr c:ould
replace luloftllnulft C(\ll,flltlanry preautru>
rizadons. Ccrridor consultations that help
~1clan ~elf-control. Jo'CJt
ph~idan.c;
makf' tnMnkgAment decialons
consistent with tho organization's priori-
an\l~lpa&e
"• COUld rt~plnr-. thG mataatory IOCond
out essrtt~ively
opinion. CnnliouoWI quality management
we nlua&
rca~h
How 'un t11ts utrticfpowry strategy
worlc?
Comblncd with lhc duc.1Ur'6 daire 10
maniAC rather than being manoiQIP.d, It
with pranatat care.
initiatlva; c:mald "'PI"''"
pt~L-factn
Such an anticipatory strategy require•
the cooperation of doctors. nurses, other
health-eare providers and patients-all
the "stakeholdersw In om heallh-eare sys-
lion review. Tu <tuote
lyric ftuan Oilb1ut
.
I
•
and Sulllv~tn's "'T'hf.' PirMtau; ol ~el'liSiiuce."
•A paradox. a paradox, 1
mWlt
h •t:enioUfi
parad~·
--------~------~-------
t.....
utillaa·
·-----------...J .....
�..,
SEN!' BY:
r-------------~·-··--------------------
a
But how would the Bfn
FtOnlfftn scanafio se1 the Hno11·
cia/ outer limit$?
w~\lld
'oe
AcapilatJon that pu11 the whole
Tbc beat .atrat•sJ
orsanil&tlon at tlnlmc:ial rl•k, not
jl< the doe&ors. All busint!$1MI and
most famlliu have to live whh
110111e sort of budget Evoryotie real-l&aa there: •re llnan~~;lal liulilll.
Applied to health-care &ystema,
prcparment fur.-~ 111 '111~ ltakcholclerslo aeknowiDCISe thai whUe
there ma7 Ue lnllnlle nocds, tltere
are only Dnlta raources.
the
Ceislr~Stt
Clinic, Health lnsur·
~llnk ~nuch derives fro1n iL
once Plan of On:flter N\:w York,
and Oroup ltealth Alliance of
Wuhtnstuu, D.C.
My wife. Pr1sc:Uia, Ia executive
director of The Wahiclcon Hol-
WM.:h
g~&rn;
Qlor healrh-ca,.
thetr raanlllts do wnen u.e pabenra
d.vlna but blll)l cared ror .. home.
tn 1869, un,.e wens u:ro ha~plc:a~
in the Uatted Sll&es. n~t Yale Unl•
vemty &chooj or NurtlnR. led by
Dean F101e0ce \Vald, had already
brouetn Cec::ll)' Saundem from
llritmn lo lhe United Slates on a
speaklna tour. In 1874, Wald
founded the flrlt U.S. hospice. ln
New Haven. Today, there ara
OOfl
''•• best monel
~Worm?
n,.,_, tli nc boll mtx.lttl. Durtns
Amy 30-ytu career. I've
viailed
uwra thm. 500 heallhotere llllllt\IA
tiona In ~5 atates. and numy overseee. tfo twu are alike. Many are
outstandlna. Nono 1s perfect. Most
ot them are adapung to ttJeir Individual envlronmentA. Southern
plc:t!, and h'• ioterat~ng to ... Che
creative thlnp that patieata and
11.e KUud news tor pJIIIliU)'-Care West Vlr&U\Ia lsD'l suburban
Philadelphia. 1l1ere's more expe~ rou&hly l ,900 hospices across Ull
put tltem In lhl drl"VefS seat. for mentatiOn gotna on In heeltb care CQUnlly.
Instance, the British Nalioual in tba United States than in any
Health service t1U gtven some other caunby, tmd J don't want &o
How doe• hosplte embody
aaneral pracdlloncnl authority to latethtt.
PNISmoUim anti piUTQ/iam1
That's why I'm epl)l'f.henaJva
eontrac:t wllh spedalilltl and hc.p~
Thay'vt dlilaed the nul'llns
tall to obtain servlcea for their about global budptlng. health·
modCJI Into domJaaace;'lbey
ph)'lldans is Uat capkaUon could
Q
pat1Gn11.
cue purchaslna monopsonies,
A
nepaled with the phjsldana.
health-care delivery monopolies,
and a natloul benefit stru('tute. I
believe lhat lndlvkhaal health<are
systems will be able to deliver
more coet-ertactive services. SO comprehensivu heallh IIIVic:aS !leicapltaUoll also prams the Pl'lt ter than a centralized one.
matlam DOd pluralism in American
My experience In Washington
healih care.
Jed me to formulate Klsslck'a third
the oncologist•. to work ln a
r.ollaboralive luhion, enablln1.
patlanta to oot for li.Yina oulthtlr
lives at home In a supportive env~
ronment rather than another
round of chemo or anotbcr round
a
WashiftllOh tlr.elarfRB halplcelto
Within oach organization ur
healtkan tylllom'• budget. however, )'OU'd have auto blanche to
try any strate&Y that could gJve
Jaw: •For every haalth·polley
of radiatiOn.
Thll8 was no nadOIIIl board in
cwy operotinS action, there's a redpraeal overre- be a benefit. llatarted from the
uomples ollhe Bcm Fronlll/11 adlun." If \W'ro tolnt~ tn do some- $lt'8D rnnts. rmm the boltom up. In
anotlo loday~
thing on a grand Jelle. the overre- authorizing hospice as a Medicare
Do you ht~rJe
Henry ford Health SY~tem.~ in action leaves mo apprehll!usive.
usina
So ar~ )011 optlmiltlt: nr pe•timistJc uboul tit~ lu/ul'(l t1l
repreaents the network HMO
model, and Kaiser Foundation Amedetln medidntl?
Health Plep lllultrat• the graup
uwe ean leave lOOn\ for prag.
madam and pluralltm, I'm e.•p&imodel. too. There are dozens of
ADetroit Is an axampht
group practietll. U.S. Healthcart
Q
heMI!t, ConfJft'll raliflad tho c:oR•
ctpt. I racotnt&e thlt you have 10
havt topdown tnltl1tl,.. and c:on·
tinuance between tho nallonal pollt<y and th• servieo1 at the loaal
level. Hospices, however, are a
othar exampltt-the Group Health
A As a soc:icty, we have
miatlc.
vel)' irn~'OrtAnt ilh&Slta,ion of the
need lO provide room for local and
Cooparatlve of Puaet Sound. the
tremanttnus optimism. Even
rc1ional experimenlallon a.nd
Harvard Community Heallh Plan, though II creates some l)lf.tblema. I pragmatism. •
�06/15/94
1a:-cro-
-u
I(&JUUJ
March 5, 1993
\JOhn
Lubell
Letters Editor
Tne Pniiadelpbia Inquirer
400 N. Broad Street
Philadelphia, PA 19101
TO the
Editor:
Wharton SchOol professor William Kissick should have
strolled across Locust Walk to talk with his colleaoues at Penn•s
Leonard Davis Institute of Health Economics before writinq his
March 3 article. Since they have been amonq my key adviRArs and
resources on health care refor.m, they could have cleared-up his
confusion about the American Health Security 'PlRn T introducad
nearly a year aqo and also brought him up-to·date on important
developments since then.
While I know Dr. Kissink'R vi~ws and a~ree with many of
them, r cannot accept without protest his misstatement of my
progosals. His claim t.hat my bill from l.ast year would create a
•top·down approach ..• [that] does not reflect the incredible
variety of hMlt.h c.are institutions in America, n is not merely
wronq, it is exactly what I aim to prevent. In fact, my own
April 19, 1992 Inquirer opinion article about tho plyn stcted:
"T.he [national
hea~th1
board's primary function will be to_
set an overall national budqet for health care spendinq and
a minimum packaqe of covorod aorvices -- much as the Pederal
Reserve Board sets the size of the money supply for the
nation•s private banking system.
Dut our
p~An
relies on
states to establish their own innovative approaches to
providinq oomprehensive covera9e to every person •
... our bill preserves the best features of our private
hoalth CQre system, incl.udinq our ~eaue.tt~blp in medical
technology and the.patients• right to choose their own
doctor. n
Dr. Kissick and I bY~~e that che qoal of nealth care retor.m
rnust·be to qive maximum flexibility to states and local
communities, pu~ k~y decis1on·mak1nq in the hanas ot doctors and
patients and cut·down bureaucracy.
I strongly agree with nr. Kissick that unlike what happened
with Medicare, tlll::o time we must achieve a funaamental
restructuring of the orqanization, financing and delivery of
~~Lvlces.
In6eed, my b1i! ot a year ago, and the
heal.Ul
�UU/'l:)/94
16:-01
-
If! UU4
'Q'
To the Editor
M11rc::h 5,
Paqe TWO
1993
decencra11zed, ~e-bureaucratized structure I am workinq for now
with Hillary Clinton's task force, is desiqned to accomplish just
that. My approach promotes Dr. Kissick's prescriptions of
"health-care systems that use prospective budqets derived from
•capitation' (monthly fees per enrollee) to cover comprehensive
health services.'' And I am proposinq as models for the new
system some of the very examples he cited.
But Dr. Kissick'S analysis is nearly a year out of date.
Since I introduced my bill I have joined with my Senate
colleaques to put aside our individual pieces of leqislation and
work toward a consensus approach that can control costs and
provide universal coveraqe. Now that we have a President who is
committed to comprehensive health care reform instead of one
opposed to it, that process of consensus·buildinq is movinq
rapidly forward with the leadership of the White House task
force. My work with them convinces me that they are equally
concerned about the issues raised by Dr. Kissick.
We all well understand that we nn1st hui 1 ri f'l'"r,m the bottom·
up, notl the top·down and that there is no such thinq as a "quick·
fixa in health care reform. Ant i do not believe that Dr.
Kissick's advice to for.mer President Bush to go slow on
comprehensive reform i
A
any lon(]er
acceptab~a
to the American
people. That, after all, is one of the reasons he is now a
fggner PT'ARi~Ant-.
Sincerely,
cc: David Bol.clt
carrie Rickey
�.
.
senator 1fams W41ffcrd~
plan sukt gldia1 caps ··on
·health exper.diruru and
· beirejits. Bur rOp-do:wn,
apjn-co&h~ moni ~k.
... ~-.
~J !"•e veaet 'lli«UIIto.·KI ·ll.e•l~t~.
·,
an llat:r.n1lllil·lei'Oil 'Ill!' Ulllflli'~
~:i ·, ekar-!11117 ·lroDil •!II ~t. ~
ae
..... ·
··.· ...
lll'o·ae llkllliad.
lfD..It·M; 1· Jiar.
·· .. ··.~-(~~~
·te·
•
•
••
0
•
•
•••
,
••
, ••
·, ·•·. · : · · • - ·:
pll'tiCiiiGrft" :}Dj:
;coiil wtt~ F.e..tllia•h....U'dit·a
•
�THE WHITE HOUSE
WASHINGTON
MBMORAKDUM FOR FIRST LADY HILLARY RODBAM CLINTON
FROM:
John Bart
DATB:
June 15 1 1994
RB:
Panel Participation for the NBC Health care Special -Rationinq and the Employer Mandate in oreqon and Panelist
susan Tolley
Summary of Oregon Health Care Issues -- Rationing and Employer
Mandate: To provide coverage for its poor uninsured residents,
Oregon took a controversial approach that no other state has
imitated. Oregon took a two-fold approach to achieve universal
coverage: First, it established an employer based system for
insuring coverage for workers and adopted a "play-or-pay" plan
that would require all employers to either provide basic coverage
to their workers or pay into a state insurance pool. However,
this portion of its health reform has been overshadowed by a
second part of its plan -- a proposal to expand eligibility for··
Medicaid, bringing in everyone below the poverty line while·
reducing the scope of covered services under Medicaid.
The process has generally been referred to as oregon's
"rationing experiment", although its supporters point out that
the coverage will probably be similar to what is now covered
under Medicaid, while its "rationing" is a matter of injecting
"rationality" into what care is given. In essence, the Oregon
rationing experiment is based on the premise that by cutting
spending on heroic lifesaving services that help only a small
number of people, a substantially greater number of people will
be given access to basic health care, in which preventative
medicine is emphasized.
To decide what would be covered, the state went through a
comprehensive process of community hearings, expert
consultations, and commission meetings to create a ranking for
709 different possible combinations of health conditions and
treatments. Actuaries then estimated what it would cost for each
treatment to be made available. The legislature would then know,
when setting the annual program budget, what services it was
including or excluding.
Panelist susan Tolley (pronounced Toll), is expected to advocate
the element of rationing as a necessary part of responsible
health care reform. An expert on the topic of rationing at the
center for Ethics and Policy at oregon Health Sciences
University, she strongly believes that in the health care reform
discussion, society must blend its social values (what health
�care services it ought to provide) with clinical values (what
services it can afford to provide). Tolley is considered to be
more of an academic than a pragmatist.
I.
HEALTH CARE ISSUES IN OREGON
Rationing -- Prioritized Health Services
Under the Oregon model, the key to controlling health care
costs is to set priorities for health care services at the.
level of particular kinds of interventions. Critics of the
Plan argue that the proposed system -- which prioritizes
health care services according to their cost and benefit -will unfairly ration care to the needy. Advocates of the
Plan argue that prioritizing benefits will allow a
substantially larger population to receive increased
preventative and primary care at a lower per capita cost.
In contrast, our approach seeks to control health care costs
by emphasizing private sector competition creating the right
economic incentives to bring costs in line and encourage
health plans to compete on price and quality. Every doctor,
every nurse, every patient -- everyone who comes into
contact with today's health care system will tell you that
there is an incredible amount of waste and excess and
inefficiency. Dr. Koop, for example, thinks that there is
over $200 billion in waste that we can eliminate by
reforming the system. I would argue that we begin by
attacking some of this waste and inefficiency and creating
the right cost incentives before we begin to discuss
rationing people's health care services.
Employer Mandated Health Insurance
To cover all eligible workers in Phase II, the Plan enacted
a pay-or-play employer mandate. The mandate calls for a
80/20 employer/employee share and 50/50 employer/dependant·
share. The mandate is currently scheduled for
implementation between 1996 and 1998.
II.
SIMILARITIES BETWEEN BSA AHD OREGON PLAN
outside of oregon's approach to rationing, the Oregon Health
~lan shares many similarities with the President's approach.
Both plans strive for universal coverage; utilize managed
care to lower the cost of health care; require employers to
share the cost of coverage; provide subsidies to small
businesses; define a basic benefits package; provide
guaranteed renewal; eliminate preexisting condition
exclusions; develop practice parameters and technology
assessment systems; rely on market forces to limit premium
increases; and impose growth limits on premiums to help
contain costs.
2
�MEMORANDUM
TO:
HILLARY RODHAM CLINTON
FR:
JOHN HART
DT:
RE:
JUNE 15, 1994
OREGON HEALTH CARE
.,!>v.<=.C e -"'.S.
~ran
.t.... \\i
'
FYI, attached is an article
in yesterday's
Statesman-Journal on the human ~~~~!on of Oregon's rationing.
It is the story of a mother who fought to have the Legislature
make an exception for her 5 year old son, whose illness was not
covered.
_]______
-----
--
--
�.
..
MomW1rls
battle over
heahh care
• A \Vdlamina woman tests the
Oregon Health Plan, which denied
payment for her son's hernia repair.
~Diane DIIJtz
Jte Sbl&sn••.IDunll
I
~
=
A dGetar t.Jd her DO. All insuaoce oompany
told her no. The state tala her DO.
E~y tol• Ca~ Ta,·lor a:' Willamina that
the Orecm Heahh Plao was DOt giNDg to p~ fill"
hernia 8W"'erJ lor ber 5-)e.u-.Jd 8CJIIL Hi& aaditioa waa tA:Io low 011 the Ust, b:o far bel- the
rmaJJCed priorities.
·
BliC Taylor epeDt .
TODAY"S TOPIC:
lou IDODths ptUbiJig
until abe 6»1111d ... llfHEAL1H
&c:ial wlao could cle6'W!f' Uae
WIUitecl. She fmally matacted dace.....Stan
Sen
8111111, &Newbug.
'"He made aome pboae C211&, aad bia£D, it. p&
IDO'IEd up a~ve lbe line, 111111 biap, it got paid
ror... .abe said.
The h.y'&IIUJ'IBI)' ia scheduled far Friday.
Tbe 0repn Health Plan wu aciDpt.ed to provide basic beal1b ~fer ~e state'• ,.,...a.
residents by limiting tbe treatmftlla theJ nceivecl to the moat effective. A Jist of' 698 lrealments was nmked.
The 0repu l..epdature decided tlult iL cuuld
pa.)' for the 6nt. fi65 taeatmmata on the list;. Tbat
woRld allow 120.000 additialal On!pniaus toteceive medical~- Eurollment bepa Feb. 1.
BecaUBe t.he plu limited D»>ical caJe 1D tile
poor Lased oo a prioritized li.t. it 'a'Oil iDiemational atter.tioo. The &tlategy appeals te curernmeols overwhelmed by the cost oCbealtb care.
But critics and auppcgten alike haft wondftecl
whethew limitinc health cue for the paor waa po6tically def'e..W,le. ~ Taylor lllld aimilar
.,... 'Raaalli'S.aleslru Journll
eases, the OreBUD plaD f..:e. its firs& tesl&
TREA1'11EN'ft Wilt help ten s1B11t S... Stan Bum. ft.Nawbag. Cal¥ Tll)lor has
Please see~. Page 2A seaMed ir1su{ance or , . b' ~that her son, 'Miam Maley. wll haw Friday.
�06-15-94 04:00PM FROM GOVERNORS OFFICE
..
·· ••·· ···· ·- '-'• .. ,.a.
.
\
..
~"'~'
.
.
Surgery/lllrless
'
P03
" .-a· "'"''"'"'''a;·· · "-'•••..,•....,.... _ _ _.,.._'-
~
.
r
; ..
listed for coveragel: .
~ ...... ~ tA
actecl improperly by~ the
· ·T&l_lor wu batbbia her aon aurpry heea\181 it \\'81 Uatid at
1ut l'ebru.u, wlaa iDe dilcov· lilul 807. .
· . ··
II'ICl that one of hla ttlticlet wu
Tqlor wrote to ~~~. ·
DUfW to twice it:iiiUaalme. Sha ad. callecl politiciaDa. ·KuuS;·.J r.
aw DOt hesitate Gl tab him to a Ealy. a lePalat:tve aicle fot 'ltate' '
pediatriciaB iha neal day.
· ·SeD.. Bmm azul Brady .Adami,
Taylor la a lophladcaacl '&1111' wu' famiUar with the problem ·
of the 8Q!81'1111l8D.t wNdieal .,.. with IDpbW bemtu. ... . .
·. '
tea • hu trte&t. tor two ,... · a. 1atd that Adami neat~, .
to aet dlaab!Uty=YIDIJita tor her lwlped. a Orata Pau eou~lii ...
back pain ancl
IUDI con· cure paJIIl8Dt tor their lOili her·
diticma.
.
·
ma. Bmm called Meclicaia or- :
Miiraine lw1•ebu 8lld c1a- tlclala e the Taylor bot• wa.tr. .
preuiOD. haft qpt her~~. Ealy laid.
.
the boY• fadutr,iov.t of Work for
-na. J18Kt u, the call8cl baiik
· two yean. The ~, liV.. on ancl aaid they wet
to ·their ·
1480
srut.
commiytoza.· azul thav ware ....
· Tba
·-membin apad. to ocmr the 1"_;;-the aaicl. their time tra~ to cloCtor'a
H al•"" ., __:-•··"'.:._.,._ • . ·
appoiatment.a.'::.They p to aa
• .u·~IIID ::c~~a-~-· worry. .'
IIUIDV u 11 In ·•~v 8Q..Ia.. _ _._.
that IDGVIDI
Viclual treat·
"'
~
"V!'Y ~-·
meDtl ill reapoue to polidcal
"'qlor aaid. M8dicaid uHcl to preuu.re cauld jaopal"cliH the
0* the bill; DOW the 0na0D plan pia.' ·
.
.
·
~ylor'a lOll, WtWam ~. -we all 1aunr that it it'a poefti referrecl ta~ wfao aible at all, 101118bodywiib ~
11.
1
~h8raia. . will IIWlipulat.a that U.t.. The .
Pive ~":or
bablea have mare it'a 1118Dipula~ ~ mare
I
t!:
=:::,welfare
~~a ~.Jtt'.~~ ~= !c.::;n:~t!~~·
.ilairlc aU::, at.' ~becber
CJdldnm'1 HOapltal ill PortlaJul.
Tbe hemiu are ca111ed. by a
hol8 ill the abclommal wall
tllroqh which a lo_op of amall ill·
tutmu .Up1. ID abOut ona-tbircl
of ··chilclreD who ·haft ilapjDa1
beruiu, the l!)O_p p11 trapped
outaide.of the abclomiDal wall.
8uch complica~ put chil·
drell at aerloul nak. a~
cua aet tn. IDlect.icm.caD tlo04l the
~Waodatream. E~D~q~ACJ &\1l1817
to nmove part or the afl'ectecl
bowel may be requirtcl.
At the eiDU'pncy atap, the
traatmct of ·Salem l"'lidmta .
who piDed COYVap tbrouP the
Ore~n plan~
.
. But atata oftlclala IW8U' · ~t. ·
the clec!atoD to pay for hii'Dial ·
wu 1llade on the baala of medical
~tion azul not ~~,:~,t' ·
I
·.
•
.,
·. : ·;~ : · :
- ;#.;.:,·,:·.
Patp Sipe~·Metsler~: ~.. -.·;..}:
ecuaft cUnctor of tba~·.: . ·' ... ·:1
Semcil .CommilaiOD, -~·· .• ,.;:,i .
charpd with raaldq -..~~;.:,;
,
menta, laid pecliatric181l.~-P:;·{; 1
bell pruentecl con~~·fil~i':··l .
dance that the IIUI'IIIY'... ·:~ ··.~;.~~'~· :
eft'ective and.n1C88181')'..'~/,1 .:.;t./ .~::
aurp!7 ia covered u llne 6 oza
About the aa11111 ~~
· •.· .,
the prioritized liat UDd.er the Or· · ciaM worlda, under l'l:aJ :JJr-'· •' '
tap plan.
.
· epn chon to~ the·•'ili'Pr- ·
Taylor'a doctor achecluled the lea, evea If it meant the~·. they...
..
wrpry, but a da!later an cdl1oe hacl to abaorbthecoet. · ·.. ·~:..... ·...
&taft' member called to aay the
The Health BerW:ea C~ . · ·
lurpl')' wa1 cuu:eled. The aw- a1on a11o diRovered tbe ··eoat. to·
1
pry wu rankecl at liiU!i 60'7 Oil pravicle the aurpl')' to chtlchil fD' i ••
the prioriti&eclliat. or~.r:c-• Ores= would be 1eaa tban·l per~,.
below the level the
Nre cent of the total COlt of. the Or· .'
Nul apeecl to pay for.
.
tiOD plan. ·The commillioll';:!d
A nurae warned. Taylor ta nub squee18 it onto line 6 .wi· t
her child to a boapital emergiDC)' bumpiq &DOiber line out.qfi.tJ,la.
roam at the tirat lip of pain. covered categozy.
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political preuure.
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�RON ANDERSON - CEO at PARKlAND MEMORIAL HOSPITAL (Dallas, TX)
Parkland is a 1000-bed public hospital that had over $264 million in bad debt and
charity care in 1991. Traditionally a single-payer advocate, Dr. Anderson helped to
draft the National Association of Public Hospital's statement in support of the Ointon
approach to reform. He should be solidly behind the principles of universal coverage,
employer mandate, choice, etc. (Attached find statements from NAPH)
�- ...
For more iDformation ccmiiCt:
HOLD FOR RELEASE
Until 11 !30 am (F.sT)
Tiffany Sknnsky (202) 408-0223
Wednesday, January 26, 1994
~iEW REPORT. SHOWS URBAN SAFETY NET ROSPrrAU IN CRISIS
NAPH CALLS FOR UNIVERSAL COVERAGE
AND ENDORSES PRESIDENT'S PLAN
Washin&ton, D.Cr- Urban safety net hospi!3ls and health syaems are losin& billions of dollan
ayear, and strainin& to near the breakir:J point. as a result of serviq Medicaid patients and cbc
uninsured aftd underinsured, acc:orc!inl to a new 167 pqe Special R.epon issued today by 1M National
Association of Public Hospitals tNAPH).
·untas universal anc1 mandatory heallh cOVerap is ,..,.,ed
soon, many critical community-wide servi=s for all pertons, and not just the poor, wiD soc. ·be
Jeopardizeci, • said NAPH President Larry S. Oage in announcinJlhe rcJaue of the Special lepaft.
.. For this reason, we are also announcinalOday NAPB·s endorsement of the maJor priDciplel and~_
provisioas of President Bill Clinton's Hcaldl Security At:t. •
The NAPH Special Report is based on the most recent data available from a suney of NAP&'a
100 member hospitals,. which includ&: :nost of the major public hospilals ·anct healdl sysrema ua .dac
.nation's SO lArgest metropolitan areas. These hospitals constiruu: a safety net tbat provide~ a subllulill
majority of the uncompensated inpatient and outpatient care in ~or urban areu today. In addllal,
:ney often serve u
the only provider of many COStly, ~iallzed services In their commuaitiea, includaq
trauma care, bum care, neonalll incawve can:, bich risk prepancy services, pcdiOD coauol,
emergency psydliatric services.
The report's principal findings indude:
• Just 67 major urban safety nee h~spitals and health systaris experienced combiDal los.e"'
billion in serving Medicaid patien:s and the uninsured in "1991. If nat for local
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billion and extraordinary Medicaid •disproporrionacc slw1: hospilal• (L
approximately $1.4 billion, these hospitals would haye been bankrupt and many W\
..s
�•
to cbc their doors. Yct bodl of these essential
sources of financina have come under preuure from
federal, state, ancllocalcovernmenu in recent years.
•Measurinl changes ift hospital utiliz.atioo and c:ost, the proportioc of uninsured •seJf pay•
patients increased by
by 16"
~
17~
in urban public: hospitals during the period !rom 1980 to 1990, wbilc dcclilliq
41 ~ in all other catqorics of urban hosp;tal.
*Twenty-four percent of all discharges and 37" of all Cmef~CDCY and owpadent vislu
.
.
w=
uncompensated in urban publlc; hospitals.
-These are just a few of NAPH' s smtistics provided in the Specialltcpon dJa& lad us to conclude
.
,
that enactment of universal and mandatory health c:overqc is t'Ur most urpat domesdc policy prioriC,. •
'
said Larry Ciage. "lt is not that NAPH believes the President's proposed biD is perfect, or that it canaat
be improved.
However, we are prepared to accept the President's invitation to share our~~ an
lhe forthcuming .Congrcs~onal deliberations from a posidon of suppan, not oppolilloa. We do ., .
because we arc penuaded that Presidcau Clinton lw offc:ial Ame.ricaDJ oar bel& oppanDIIilJ Ia ower hLf
a century to
j~ the family of civ~ natioas that .make ~
llellda care a balic:.rip& Gl
citizenship. We simply cannot afford to 1d this opportunity slip away, lib JO many odlen ·iaiM :. .
SO yearJ," concluded Mr. Gqc.
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National AssociatloD ol Public Hospitals OD IINJth Reform
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The National AssocWion ot· Pub1ic HosPital (NAPH) represents CMr 100 of Aau:riQ'a
mmc.,••litan area safety net h~tals and health systems, who pmvidc over 7111 of their.
services to Medicaid and low income uninsured ancl unclerinsurcd patients. 1bcac hospitals
Wcady IC[VC u •nalional bca1th insurance• by default in most urban ueu. From lhil vaaaae .
point Oil the froat 1iDes of our most critical wbaD health battles, NAPB membm believe dill:._
tbe wnent attention bciq paid to hea111l retorm bas never bcca more welcome or UlpiiL~.
&."'*"" of univenal health covcrap must now be our most impo~amt domestic policy··
pdot!ly. We cannot afford to Jet thia opponuDity to llip away, liD 10 llllllJ others iD tbe JuL
30 yean, to JWa dac ramny of civilized aationa that mab adeqUAte bmbh ialunnce a buic-IIP-t
.lp.
of Ol¥1§ISh'
Plnident n;nrnn•~ hill and the WcllstoneiMcDermott sindc Pile' bill uc thC only bills
cum::mly before Coqtess which &uarantce health security to all AJI'1C:I'jQm. 'Ibe President's ·.
plan Is an cu,;ltca~ fouadatioll for achicvins health reform, which 11111111lnolt of the prlDcipla~
. NAPH has adopted in the past u a prerequisite to our support for 8llJ plan. ID pardculu,
NAPS applauds such elements of the President's pllft u: itS comm•anc:nt to UDlVenll.lllll.,..-Aetmy eoverav.; iu mmmituu:nt to prevemiao and primary care m C1Wlt&:lt of a~··
lbl
UDibm beDefit padcacc; its proposal to comiDUility ll1e prembuns for Ill, u wen • 10 . . .~:
.a f&un as
bcalth ucl iDcome atatua; ita wiDiapea ta ....... ..:
IDII'iarns far low i.acome individuals IDCI small buainesses; and its 1pJ81Md wiDinpea 1D11Q,,. •ina to die special acccu and infrasaucture uall ot providln illiDdenened . . . . . . . ·
pus•iQma ., tcOect
acar'-•ic health CIEidtll.
Al
me same dme, NAPS doCI have a number of CODe ems abaut tbe QlntaD .plla;
IKswever, we will nile tbae concenu .in lbe fonbcoming Conpessicml delibemioas fraaa:a .
pncirim of support, DOt opposition. OeGelally, we are CODCaDed thallbe uotested CCJ1ft41·of
•rnaapci COIIIpiCitiaa• CUMt in the fore• lble fun11'e meet all of die laidliDd IOCial aeedl~
of die low income residents of IDIDY urbu communida, or cover die costa of the pabJlc IDd. ·
. pavase safety Get provtden Chat ~ daD. Olhcc specific ·coorau iacludc:
1.
NAPH is Conccmed about the pmvJsiai dd fulldin& of senices far many individalls we
cuaaatly sene wbo may DDt be ellaible - or who may face sip~ burien to cmollmlat..·
- UDder the Prelidcut'l plaD. Two P1"J)ations likdy to be esci!Mied from coveaac ia:-..
ICfixm propoe'a are JllcpllmmlpiDa and priauncra. NAPB lnCIIIben IUid other urt.a pabUc
bmpitaJs serve a very aublaandally clisp&upodionatc number of both popolatiaaa aad wiD..be ..
apocially hard bit if they remaill wboUy outside the syllall. Furdllr, our exper~t~D'!Wia· ·.
Medicaid delllOftiDtel thai there are sipificam burien eo caron..-t CYCD for muy indlvldulla
wbo may ochawi• be eli1ible, wbo often p!elellllbemselves to prvvidal UDable to povJde ...
most baSic lnt'oanadoll about thl:mclvcs ot who citbc:r inadYcrtcmly ar iDtaadaDally lip up lor
multiple plam or ccmceal their pmious earoDmem in order to obCaiD are. It Is impeadve lbal
the eligibility process be bpt u simple u pOssible, ud tiW the lddilicml c:osa of~ ....
c=ollin& certain populatioal be tab:n inlo accnunL
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Health Refonn must not be nn-.1 lbmup elimination or suoSQ1ltJJJ reaucucm in
clispropallionase tbue hospira1 J'l'ymetl'-' uaim Dlher ~tnMeCUons and ~taymems are substitutat
for tbc highest volume pmYiders of c:aJe tD our 1DOit wlnenble populuiou. NAPH's mnv.
~rtaus CDDc:aD in lise an:as of financing bu to do wilh the pzopoealto fuwu:e a subs=tial put
of hclldl mcmn . thmagJl e!iminaaon or I1MlCtmftU of me so-called ·dapmpuniu~ sharchosoi111" (DSH) acljusaumts. The DSH .U••"iMtl have bcm ot &!eat impnma: in belptq .
safety aa ~tals provide rhe brmd n.np tlldditiona! services ncc:ded by low income palients
aDd mba (&ad remote Nml) communitill. ·'1111 Prelidenc'• p1aD tJlOPOiel r.o alter tbe Medime
formula 114 ellmtnate MaJic:aicl DS!l al,..., A Vulactablc I'apuiadaD AdjUSLmenC would .
replace Medicaid DSH. at muell reduced ieweil of l•mdlna. It It e. .dal dla Medlcatd DSH.
paymeau be pbased out cradually. anci . , pcnnalll 'VPA• need~ co adequately nimbune
·pmviderl for COitl whicllam DDt ldequiiiiJ mmt-L.-l Ia ott. an:u of Cbe Plaa.
3.
'lbOulli lldequasely comprdlensiw Ia IIIII& aapcct~, the pai4DJCCI beaciit pacbcc wiD
result in mmy UI1COYel'lli costs for some llba r4:sidena who suffer flvm liedloU~ dru& abUse.
or 'INftal itlneu. OUr- two .;or eonc:ems wi1b tbe coateDIS of the bellefit oacaae Ill widl ---- '
proposed limilalious an mental health mdiUbscance abuse benefit1.
Wi1b sespect co plan ac1mlDlsaillll, NAl'H b espedaiiJ CUIMZnal Lhal SifaJ act:.
hospjg)s tbal meet asaaable criteria be ailklnalicllly *'ignar.ecl es•na• COIIliiiUili1y providaL
In ianplemmtiq •~n~~~~~p~ campetitiml. • die tli&yiq fie1d ll11lll be lllde leva for pmVldm llld.peri"'" To be equillbla, ud to 1_..... for pmnb ia iuer dries lncll'eiiiOie nual.
uas ID rbc biUidat JIII&C of health_
a pllll_. CIISID dw allllll&y ....._.
pgovldas mpYIII u equal o~ 1D develop ad puds:lpulla aaapeli&iw plua.
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5.
ll ilea!ntial thllaay majnr shift Ia 1t1 fnncti•1 of medbl educ:atal take U. ..-::
tbo apec:WDDOIII of .u.ty aecllolpilalllllll.........,.. .,..... NA.Pillllml&ly·~uppona the"~
need ID develap IIIID DllioDal ud b~lf~llid fuadinl mcdwni!IDifor mllliall eclucatioa, milL.;
to lblft our em(ftltis iD ndiCil educallaa (a wen • mpadfat em) •WJ 6um sprdali,•iaa.
and 1DWII'da DrilaarY cue ad JJIVCiltiGL ......., tbilma be accompHsbed With seasillVIlJ ·
to tho impanucc of medical educalioD ia providine palient care in llllllJ Ulldmervecl~~a~6.
In Ql'Cier to UIUl'C adequate ICCQS aod I
cm:{ul U4ullidoo tD a DeW IJSiaD, 1G1110 v.diiiD·.:.:
aad Jml safety lilt providea will~ •••nee in pmina accea fD capbaliO nb1dld ~~
iafllltauc&Ure ud develop ... nelWOrb ud plus. Eaenlia1 urbaD - runl salay
•= .
tmpiP'I uc lilaGly CD , _ a lubtculial Aeed for aaimace UDder bealdl refom in ahtliaiJia.~.
· adeqUIIe caplllliD atJuDd u1 equip our ......, lailll ~. A 1993 NAPB1111dy
nrtnpw till&- tbere- arc at Jaa SIS biJia·ll- Clpilll._. 1m11111 diCIC a•Ual Ulbla.:
pmviden. Yet tbe1e holpillla alJo face llpifkw• blrrim m••;u;. access to capilll, u.well:: .
u ia their abililJ to . , incurred diMI iilliaelr faD P'tirnr Cl&·revtiiDIL
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�MARGARET JORDAN
Vice President, Health, Southern California Edison
Southern California Edison
•
Southern California Edison (SCE) is the second largest electric utility company in the
nation. Health care is a top management concern at SCE. They have historically
provided a rich package of health benefits to 55,000 beneficiaries-- including employees,
retirees and dependents. When costs for their traditional fee-for-service plan began rising
at 18% to 20% per year in the mid 1980s, they redesigned their health benefit program to
aggressively cut costs while maintaining high quality care.
•
On January 1, 1989, SCE's Health Care Department-- now headed by Margaret Jordanimplemented a managed care program that integrates self-insured medical plans with an
in-house claims payment system, utilization management programs, preferred provider
organization, and primary care delivery system. Their program places greater emphasis
on selective provider contracting, management of utilization, increased patient cost
awareness, and preventive measures. (For more details, please see attached articles/fact
sheets).
•
The results? SCE saved $20 million in 1989 alone and health care costs for 1989 and
1990 rose at less than 5% per year.
•
Although their corporate iefonns have brought some respite from the cost escalation,
SCE concluded that the problems in the "health care system were far greater than one
company could manage or control by itself. Systemic reform is necessary." For the past
several years, SCE has worked actively -- on a local, state, and federal level -- to advocate
broad-based health care reform. They have testified repeatedly on the importance of
health reform in Congress.
•
SCE was one of the first companies to aid in the formation of the National Leadership
Coalition for Health Care Reform (Simmons Group) in 1990. The Coalition supports
universal coverage, employer mandates, and cost containment as well as quality and
consistency of care.
Margaret Jordan
•
Margaret Jordan, SCE's Vice President for Health Care, participated in the transition team
Task Group on Health Care Delivery. She joined SCE in 1992 from the Kaiser
Foundation Health Plans. She has extensive knowledge and understanding of the health
care system, having worked both in the provider and public health sectors.
•
She is expected to be very knowledgeable and supportive.
�:U.·l219J
17:00
F.U 818 302
~810.
SCE
Soudlern caDronda EdisoD
Key Strategies for Mana(ling Health Que
•
Prior to 1989, we had a fairly umestricted, traditional indemnity medic:al plan. Since
then, we have be.!n gradually moving toward more tightly managed plans. In 1989,
the HealtbFJ.ex plan was i~lemented with a financial incentive (20~ higher benefit)
to \!SO our large preferred provider network where all pJOViders were individually
credentialed. Health}lex includes comprehensive utiliution review requirements with
a 20" mduction i!• benefit payments for non-compHance. Among the serlir.es subject
to this review are: occupational and physical th-erapy, mental health day treatment
programs and out-patient visits, durable medica! equipment, all substance-abuse
rehabilitation (which must be received at an approv& program and be completed for
benefits to be paid), seledcd out-patient surgeries and all hospital confinements.
•
Cost-sharing by HealthFlex plan members has been incorpora.ted in several ways.
First, tbxee deductible options ($100, $400 and Sl,OOO) are available and require
di.ffcn:nt employee co!ltributions. Second, aftu the annual deductitle is met, patUzts
pay either 1096 (if preferred providers are used) or 30" plus any amount above the
plan's covcn:d amoWlt for non-preferred providers. FiDal.ly, if another medical plan
pays first, HealthFlex maintains the patient cost-sharing aspect and does not reimbmse
the full balance.
e
We an: currently working in a joint process with our two largest labor unions to
develop the :1ext genemdon of managed care for our employees and retirees and their
families. We anticipate this tightly-managed Point of Service plan will include a
much smaller, more selective provider network with a much gieater emphasis on
accountability for health care outcomes.
•
SCE operates eight health care cen~ staffed by physician and medical personnel
employed by the company which are part of our preferred prO\ider network. These
centers provide both primary care and oca1pational medicine; the physicians
coordinate any needed specialty care through external resources. The health care
centers were accredited by th: 1oint Commission on Accreditation for Health Care
Organizations in 1990.
•
An in-house pharmacy di~ medications for both HealthFlex and our retiree
medb2 pJan participants. Approximately 200,000 prescriptions were dispensed in
199'2. These are dispensed at approximately 2596·1ess cost to SCE than if filled in the
retail environment. Usage for maintenance medic:ati.ons by the retir.ed populatlon is
particularly popular.
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SCE
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Prevention has been a focus through several ;n;tiatives:
• The Good Health Rebate which targets cardiovascular disease by measuring five
risk factors (blood pressure, to1al blood cholesterol, blood sugar, body weight and
smoldng). This volun1ary annual screening "rebates• $10 to each employee-and
spouse each month if they "pass" the screening or initiate action to modify a
problem risk factor.
.. Routine and preventive servic.es are covered by the HealthFlex plan, with a $500
annlilllimit fof' employees and spouses and no limit for weD-baby and well-child
CtlTt through age six.
• The Preventive Health Account provides up to $150 for each employee and spouse
emoUed in HealthFJex toward the cost of organized exercise,
smoking-cessation and weight-Joss programs.
•
The Parent Path is for employees and spouses who are eitber expecting babies
now or considering getting pn:gnant in the future. The program is designed to.:
help participants pay careful attention to their health and lifestyle practices as -soon
as, or before, they get pregnant.
BLD/jt
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�SOUTHERN CALIFORNIA EDISON
HEALTH POLICY
At Southern California Edison, we take an active role in the health care of our 55,000 workers, retirees
and dependents, and manage our health care program to provide the highest quality care at the
most affordable cost for the company. We have tried innovative approaches to managing health care
costs, saved $20 million in 1989 and lowered our long-range rate of increase from· 23 to 14 percent.
Not every company can do what we have done to control our costs; and what we have done is not
enough. Edison believes the next step has to come from the Federal Government.
EDISON HAS A UNIQUE HEALTH PROGRAM:
*
We operate our own health services
• 10 primary care clinics plus pharmacy
• 60,000 patient visits in 1989
• 200,000 prescriptions in 1989
*
We manage our own health benefits program including claims processing
THE SIZE OF EDISON'S HEALTH CARE COMMITIMENT MAKE COST CONTROL IMPORTANT
*
*
Annual health care costs were $66 million in 1987
Before 1989, costs were rising at 23% per year
IN 1989, EDISON MODIFIED ITS PROGRAMS AND PHILOSOPHY
*
Our new program is aimed at involving employees more actively in maintaining their own
health and at increasing their awareness of health care costs.
*
Edison's innovations include:
• Employee cost sharing
• ·- Managed care emphasis: utilization review and preferred provider network
• Preventive health focus: Good Health Rebate/Preventive Health Accounts
• Geriatric case management: •Generation.. program for re~rees
• Medicare Insured Group (MIG) project with HCFA
-more-
�Southern California Edison- Health Polley
Pag~"-
"'\ISON'S CHANGES HAVE HELPED SLOW THE INCREASE IN OUR OWN HEALTH CARE COSTS
*
our long-range protected increases have been reduced from 23 to 14%
*
our actual 1989 heaJth care costs were less than our 1988 expenditures
*
our estimated savings for 1989 is $20 million compared to the projected trend
HEALTH! CARE INFLATION NATIONWIDE WILL CONTINUE TO DRIVE UP EDISON'S COSTS
*
National health expenditures are increasing at an accelerating rate -- rising from 4.6%
in 1984 to 6.7% in 1987.
*
Employer costs for health care are rising two to three times·the rate of medical inflation
- up 19% in 1988 -- to an average of $2,354 per employee
EDISON FAVORS A REFORM OF THE HEALTH CARE SYSTEM THAT WOULD:
*
Expand employment-related heaJth benefits
• All employers should be required to provide coverage for workers and
non-covered dependents
*
Control heaJth care costs:
• Equitable provider payment for all payers:
-
The costs of medical care should be distributed fairly - Government
and private payers should pay the same rates.
·
• Cost sharing and utilization controls
-
lndMduals should be more aware of the cost of health care, all
non-indigent indMduals should share in the cost of ·their care.
Resources should be devoted to eliminating inappropriate medical
care and setting priorities for acquisition of new technology.
• Equitable financing mechanisms
-
Financing for subsidies to expand coverage should be broadly
based and should not interfere with tax incentives that encourage
employers to provide heaJth insurance.
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SOUTHERN CALIFORNIA EDISON COMPANY
Health Care Department Fact Sheet
Southern California Edison's Health Care Department implemented a
comprehensive managed care program on January 1 , 1989 that integrates the selfinsured medical plans with the SCE in-house claims payment system, utilization
management programs, preferred provider organization, and primary care delivery
systems. Prior to the introduction of this new program, health care costs for 55,000
employees, retirees, and their families were projected to reach $100 million annually
and were rising an average of 23% per year. Health care costs for 1989 and 1990
rose at less than 5% per year compared with those of 1988.
Corporate Health Care Cost Containment Strategies
• The corporate managed care strategy includes an SCE provider-services
organization of 7,500 physicians and other health care professionals, and
85 hospitals with negotiated discount rates and agreements to participate in
utilization review (accounts for a net $18.7 million savings in 1989 and
1990).
•
The HMO pricing strategy includes reversing the HMO migration of
active employees by developing an SCE plan with aggressive cost
containment provisions resulting in an actuarial cost less than the
HMOs, thus requiring an employee contribution for HMO coverage
(accounts for a net $13.8 million savings in 1989 and 1990).
•
The retiree plan strategy includes a five-year phase-in that adds managed
care provisions to the current plan, cost-sharing components for future
retirees effective in 1991, and eliminates reimbursement for Medicare
"Part B" premiums for future retirees effective in 1993 (accounts for a net
$5.5 million savings in 1989 and 1990).
Preventive Health
• The Good Health Rebate provides active employees and enrolled spouses
with a cash incentive for achieving and/or maintaining good health ($120
annual rebate per person on their health care premium).
•
The Preventive Health Account provides active employees and their
enrolled spouses wjth a credit of $100 to be applied to preventive services
and programs not otherwise covered.
Cost Impact
• In total, for 1989 and 1990, the health care cost containment strategies for
managed care, HMO pricing competition, and retiree plan changes
accounted for $38 million in net savings.
•
For five years (1988-1992) savings will be $120 million, bringing our
health care expenditures from a projected $580 million to an anticipated
$460 million during this period.
3129191
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SUNUAY, SF.I"TI~tm:K Z9,1991
Oli'YIII~If
I" I tntr 11MnMIIIC*IIIAirAN' •II II! ..IPAI;( \
Firms See 'Managed Care'
Remedy to Medical Costs
"ealth: Companies are using a hands-on approach to
ut expenses. Critics say the programs are too complex.
When Steve McMenamin, a syscms manager at Southern Califoria Edison Co., told his supervisors
hal he needed a heart transplant
fE HEALTif CARE CRISIS:
oo Many Needs,
oo Many Costs
One• in an (I('MSional series
artier this year. Paula Nordhoff
prang into action.
Nordhoff, an Edison medical
enefits manager, and her staff
rantlcally pored over prices and
uccess rates at heart-transplant
· cilities throughout the country.
And they negotiated with CedarsSinai Medical Center in Los Angeles for a nat $200.000 fee for the
transplant operation and follow-up
services, including hiring of a special "utilization" nurse to guide
McMenamin through a yearlong
rehabilitation. "They ran the
whole show, and I'm grateful," he
said, recalliniJ his transplant in
February. .
Nordhoff and her crew weren~l
motivated entirely by compassion.
With business outlays for medical
costs skyrocketing-by more than
40% over the last two years
alone-McMenamln's heart transplant easily could have cost Edison
$500,000 or more. Nordhoff's job
was to cut costs any way she could
Please see CARE, Ate
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l.u< .\llfl<'IMTum·•
Healtll Ciu~·~ Cure or Curse
U.S. firms are cutting the cost of medical benefits with "managed care." The syst<'m rcslw:ts lhc way
worker!! use medical service!!. Crit1cs say it ill too ("flllll)lcx ami can rrsult in in•ulrc1imtr. lr<'alm<'nt. Dr. Jacque
J. Sokolow of Southern California Edison, above, says the system will save his firm $100 million by 1993. A1
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0
0
�A
16
SUNDAY. SEPTEMBER 29, 1991
**
CARE:· Doctors Give Discounts to Firms
· ··o:~tinued from A1
·. :-. ie , ' d I ensuring quality care.
! <h•·.H: ,, new program is at the
j,,;-.•fr<.•r::. oi a new, often-conten-
llo:.s r.osr.- containment movement
that is sweepitig corporate America. Following Edison's lead. employers are increasingly trying to
stanch ·health care spending by
imposing a new system called
"managed care," which essentially
restricts the way workers may
utilize medical services.
But the practice has become
highly.controversial because it often requires employees to forsake
their own doctors for those who are
willing to join a network of physicians wb~ contract · to discount
their fees by up to 30% in return
for a guaranteed now of patients.
Critics charge that rather than
simply containing medielll costs,
managed-care programs are too
complex. too often transfer more of
the financial burden to workers
and sometimes even deprive patients of necessary treatmel'lt-occasionally with deadly consequences.
LAKit1' HJ!Si~;L I U.Anaetfl"fillll!ll
W
illie Stewart. assistant busiPaula Nordhoff, a Southern california Edison medical benefits managness manager of Local 47 of
er, negotiated a flat $200,000 fee for a heart transplant operation.
the International Brotherhood of
Electrical Workers, which baa I
5.000 members at EdiroD. com- . ·Custer of the Employee Benefit
$7-milUon "Live for Life" program
plains that under the new 'plan
Research Institute.
that offers free checkups and enworkers often end up PQtng as
Not every major corporation is
courages healthy lifestyles by
much as 30% of their medical
maintaining a gyin for employees
following Edison's example of inbills-up from nothing before the
and stocking the company cafetesUtuUng a sweeping managed-care
program went into effecL He also
ria with "healthy heart" foods..
program. Many are using a more
says that the rules are so complex
Although the program costs
surgical approach, trying to deal
that trying to understand them is
Johnson & Johnson $200 a year for
with specific problema, such as
like "walking through a maze."
each employee, the firm is saving
mushrooming costs of prescription
Many physicians also oppose
$370 per employee and holding
drugs. Goodyear Tire & Rubber Co.
"managed care"-partly ·beeause
increases in its health care spendsaves $500,000 a year by running
of its oversight pracedilres, · which
ita own pharmacy. The Gillette Co.
ing to about 10" a year-after a
call for review of all bW8 and
saves $125,000 a year doing its own
rise of more than 300% during the
procedures by computeri:jn order
last decade.
·
medical X-rays.
to compare them to compaDy man- ·
And when DuPont & Co. realized
evertbeless, most analysts
uals. Physicians "resent" the fact
a. few years ago that employee
agree that whatever ita flaws,
that their decisions are reviewed
back injuries were cosung it $40
the managed-care approach seems
"by' nurses or clerks who know
million a year, the chemical giant
to be the wave of the future, at
nothing about the patient but make
designed an educ:aUon and prevenleast for the momenL And no
decisions based on some recipe,"
tion program that has cut the rate
company bas tackled the problem
of such injuries by 25%, saving
said' ~- C.J. Tupper, a Davis
with more zest or determination
internist who is a past president of
about $10 million in the process.
than Rosemead-based EcUson. the
the American Medical A8lm.
Some firms, such as the Chesacountry's second-largest public
~y physidans' groups-jOined
peake & Potomac Telephone Co. in
uUUty.
by hospitals and other major prothe Washington, D.C.• area. main· Edison's motivation in establishviders-are belatedly lobbying
tain their own medical clinics to
ing the new program was almost
state legislatUres for curbs on
perform free annual checkups in
managed-care programs. But with
entirely economic. During the
hopes of detecting conditions early
many businesses spending an av1980s, the company's spending for
enough to avoid more costly probmedical benefits soared, eventually
era&e 26% of their net income on
lems later.
quadrupling to $88 million near the
meclcal biUs, that effort seems
And Johnson & Johnson, conend of the decade. Dr. Jacque J.
l~ly a rear-guard action.
cluding that up·to 25% of illnesses
"Managed care is here, and it's
among its 35,000 employees were
Sokolov, Edison's medical director
spreading fast," said WWism S.
N
�A 18
SUNDAY. SEPTEMBER 29. 1991
*
LOS ANGELES TIMES
\RE: Firms Seek Out Ways to Cut Rising Health Costs
the first half of 1991. for instance.
26 such cases-incl.uding McMenamm's heart-transplant operationcost the company more than S23
million.
In McMenamin's case. the previously fit 36- year-old systems manager first noticed a shortness of
breath in early January. By the
end of the month, his condition had
deteriorated sharply. "I could walk
or talk-but not both," he recalled.
In distress at home one Sunday in
late January, he went to the emergency room at a nearby hospital. A
day later, he learned that he was
suffering from a serious viral heart
infection. Short of a heart transplant, his chances of survival were
practically zero.
Continued from A18
and vice president. says worried
company executives decided "to
throw out all the old paradigms"
and design an enurely new medical
msurance program. "Health care
costs are Edison's fourth-largest
budget item," he said. "If I don't
control them. there's not as much
money left for our core businessgenerating electricity."
The payoff has been impresstve.
Sokolov says the cost of providing
medtcal benefits ts still t•istng, but
at il 5c;o annual rate instead of 23%.
as before. Hr. figures that by the
end of 1992. Edison will have saved
more than SlOO million-a staggerin~ a!"'ount even for a large Cllrpo·
rallnn.
B
estde~ it.~
own network of physictans under contract, Edison
mamtains 10 in-house climes
staff~d b~· l:i full-ttme physicians
and 100 part- time workers, treatmg everything from hypertension
to pmk eye and rcgtstermg 100.000
patirnt vastL~ a year. It also has its
own pharmacy, which dispenses S7
mathon a vcar tn medications. makin<• •ltc utility one of the largest
11e buyers of drugs in CaliAnd it of:<-rs employees
s.. ..d HMO opuons if they choose
not to use the managed-care progrant.
·
When Edison instituted HealthFlex. as the new program is called,
it also stopped paying full medical
expenses for its t•mployees. For
workers who choose physicians
and hospttals that are members of
us network. the company pays
90% of the doctors' bills and the
co11t of prescription drugs. Employees are free to go to outsiders, but if
they do. the company pays only
70C:O of reasonable and customary
charges-which could be less than
70% of the actual bill. In the case of
life-threatening emergencies. the
company pays 90% of reasonable
and customary charges, no matter
where the employee is treated.
No employee pays more than
S2.000 a year~ or $3,000 per family,
for treatment given by providers in
the Edison network.
Monthly premiums typically
range from SlO for a single employee to S&O for a family of four.
Workers also may select the
amount of their deductible. ranging
from SlOO to Sl.OOO. The higher the
deductible, the lower the monthly
P'"
''!1.
>yees and spouses may
G
for an annual S120 rebate
on premiums if they meet five
standards for a "healthy life-
pany would only authorize four
more days; her physician did not
appeal or protest. Later. the woman developed· complications that
required amputation of her right
leg.
In a 1987 decision. the California
Court of Appeal ruled that the
doctor could be sued. adding: "The
physician who complies wtthout
protest with the limitations imposed by a third-party payer. when
his medical judgment dictates oth·
erwtse. cannot avOid his ultimate
responsibility for- his patient's
care. . . . It is essential that costlimitation programs not. be permitted to corrupt medical judgment."
ordqoff and her staff w~nt to
work immediately and .by the
next day, they had reached an
agreement with Cedars-Sinai Medical Center. Less than three weeks
later. McMenamin got a new heart.
"When we went to Health Flex. a
lot of people were concerned." he
said. "But if my experience ts
indicative, any concerns I might
have had were misplaced."
Edison takes a similar hands-on
afJproach in all but the most routine cases. Nordhoff says. "Somebody may not need to be in a clinic
for three weeks," she said. "Maybe
day visits to Alcoholics Anonymous would do. We try to hit the
right. level of care."
But Custer, research director of
the Employee Benefit Research
Institute. warns that strikinl( the
appropriate level of care is far from
easy, especially given the dearth of
definitive studies on the effecttveness of specific treatments and
procedures. ''There's no good consensus yet on what. proper. good
medical care is," Custer said. "The
tools are very blunt and primitive."
Just this month. for example,
Harvard University researchers
reported that ho$1)ital treatment
for problem drinkers may be costeffective after aU-this at a time
when such hospitalizations are a
major target of corporate healthcost cutters. The central question
is: "What is good medicine. and
who determineR it?" Custer said.
"It's a very murky area."
To the chagrin of some corporalions, t.he answer increasingly is
being supplied by the courts. In one
landmark case. a Los Angeles
woman who had vascular surgery
to correct a circulation problem
was told by her doctor that she
needed eight more days of hospttalizaoon. but her insurance com-
c~
n a more recent California case.
I another the family of a deadjudg •
panel appellate
granted
L•>$
of
N
Steve McMenamin's employer
oversaw the costs and quality of
his heart transplant operation.
style" -control of obesity. blood
prej;.'lure. blood sugar and cholesterol levels. as well as not smoking.
Those who don't meet the standard.'! receive a rebate just by enrolling in behavior modification
programs. And each Edison employee and spouse receives another
SlOO a year in a "preventive
health" account. which can be used
for other programs that reduce
health risks.
Bell
is anSouthwesternannualCorp.pioneer
other "managed-care"
that has kept
health care
costs from rising no more than
10%. From 1979 through 1985. its
health care costs increased 217%.
Under its 4-year-old CustomCare
program. employees who join may
ptck an approved internist or some
other primary-care doctor, who
then serves as that wor~er's gatekeeper, controlling medical access.
Each visit. to a network physician costs a worker a flat SlO. with
the plan picking up Virtually everything else. 'The plan. which
includes home health care and
well-child care, is administered by
the Prudential Insurance Co. of
America. which also screens network doctors for competence.
Under Edison's program. the focus is on high-cost cases because
85% of its total health care expenditures are generated by just 15%
of the employees, Sokolov says. ln.
1
Angeles man the right to sue Blue
Cross of Southern California. in
that case. the relatives allege that
Blue Cross' cost-control reviewer
had improperly denied the man a
three- to four-week hospitalization
for depression. anorexia and drug
dependency. forcing his dischargt'
after only 10 daya. Soon afterward.
the man ,killed himself. The case is
set for trial in November in Los
Angeles Superior Coun.
Despite such risks. many Edison
employees say they prefer the nr.w
system-now that they are over
the trauma of making the switch.
"Before. there wasn't. much of a
medical system-whatever you
needed or wanted.-You just go out
and get it.," ~id Davtd M. Black. a
steam-generation worker. "At
first, HealthFlex aroused a lot of
animosity, hostility. People didn't
understand it and felt something
was taken away from them."
Still. for all the attention that the
manage-a :Care "approach is receiving in the workplace, experts say
cost-cutting efforts by indiv"dual
companies are Ukely to have relatively little impact on the nation's
worsening health care crisis without some broader naUonal framework.
''These programs are useful, nice
and good," said Harvard Universi·
ty health care economiSt Rashi
Fein. "At best. they provide individual companies something that is
more efficient and therefore presumably somewhat . cheaper. But
there will continue to be 35 million
people who are left. out. (because
they have no medlcallnsuranceJ."
Sokolov. agrees. lh.: likens his job
to piling sandbags on the banks of a
raging, ratn-swollen river. "Wbat
we need is flood-control reform."
he said.
1
�RKETPLACE
TUESDAY. Jt"NE 12.
Time for a Fresh Look
At Company Doctors?
ISING !\IEDICAL cos~ are
forcing some compames to
reconsider an old form of
employee benefit: the company
doctor.
Over the past decade. Good·
vear Tire & Rubber Co .• Tenneco
inc. and America \\'est Airlines
Inc. all ha\·e begun sponsoring
their own clinics. In July, Quad.'
Graphics Inc.. a closely held
priming company, will open a
clinic in Pewaukee. Wis.; it plans
e\'entuallv to pro\'ide medical
care for ·all its nearly 5,000 em·
ployees. The Stouffer Corp. unit of
Xestle S.A. also expects to open a
clinic for -1.000 Cle\·eland·area em·
ployees this year.
__,___ Company-run clinks fell out of
fashion decades ago, but busi·
nesses that continued to offer on·
site care-including Southern Cal·
lfornia EdJson Co.. Gillette Co.
and Gates Corp.-say it helps
check unnecessary diagnostic
tests and eliminates costly, incon·
renient paper work. The clinics
also avoid the cost-shifting that
occurs when doctors boost
R
1?~0
charges to company·insurea pa·
tients to offset lower paymentS for
!\tedicare and ~Iedicaid patients.
Southern Califc,rnia Edison es·
t!mates that its clinics. which
date back to 1903, keep costs
about zoe-, below what they'd be
on the open market.
--+--.....
Some consulting firms see
business for themseh·es in equip·
ping clinics and contracting with
doctors when companies don't
want to do that work indepen·
dentiy. L'sing a middleman may
also guard against ri0lations of
confidentiality. "If a manager
asks whether Joe was in the
clinic. we s;w, 'That's none of
your busine-ss:· .. says C. \·lctor
Williams. president of MedlCenter
Inc., which has opened three
clinics for Goodyear.
Still, this type of venture is a
big step for most companies.
Since opening a dental center last
year. Fort Howard Corp. has
gi\·en some thought to taking on
the greater complexities of a
medical clinic. But "the idea
scares us a lot more than this
[dental center I does.·· says Ml·
chael Riordan. a personnel execu·
ti\'e at the company.
l,___ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
�Calif. utility cites health care cost savings
Union accuses company of inflating
results, forcing workers into one plan
ISy l1atrick Mullen
of Edison's 55.111111 employee.,.
retirees and their families say the
company inflates the program's
suvings to p1111h employees who
rullli &hili one."" 5aid Willie Slewart. senior assistant business
manager of Local47 of the Inter·
national Brotherhood of Elcclri·
ranging from n:viewing hospital
admissions to setting up di5countcd provider networks.
ROS..
:MEAD. Calif.-Southem
Edison's 10 health clinics and
California Edison Co., the
rirsl·aid Slalions
nation "s second·
handle IS pcn:cnt of
largest electric ··----- ··-- -· ... -·-··-····---$187
employees' primaryutility, say11 it
care visill. 11lc comha.' dramatically
Edison's Cost Containment lin mdlionll
$151 ............
pany, &he thinl·larJCSI
slowed the in·
1987·1989aclllalcoall
buyer or wholesale
crease in what it
• • •
Projecled coala without Heallhflex.
$123_. .........
drup in California.
spend.' on health
••••••• 1990·1992 projaGiad coala wilh Heallhflex
also reviews all
can: at a time
claima in-house.
when doubles1no_..,..........
•·········•
s121
••••••
$82
"They · monitor
digit increases
• ••••••••
$104
•••••••$90
when: every nickel
an: the rule at
sao
they spend goes and
111011t large comwhat- it buys;· said
panic.,.
1991
1992
1987
1988
1989
1990
Thomas Collillli. IICII·
EcJi!itlll spent
--CollanoiaE-c:.. ior vice president of
$20 millim1 lc!i.'
Memorial Medical
last year on
Center in Long Beach.
health can: than
belong to liMOs into the com· cal Workers in Diamond Oar. Calif.. the firal hoapital 10 join
it would have under its old plan.
Edilion"s PPO.
Calif.
p;my plun.
said Dr. Jacque J. Sukolov. the
"We track over 700.000 pa·
What is undisputed is that
ll1al plan. dubbed llcalthFicx.
company's vice pn:!iidcnl and
Edi11011 has taken direct control of tient cncounlclla yar," Sokolov
includes a I'P0of70 hospitals and
medical director. ·n,c 19119 in·
1he delivery of health can: to its said. 111is- is the largest corpcn:a.w wa.' 5 pen:cnt. compared 7.500 doctors.
"You can·, run a health plan as workers. M0111 employers have orate managed care program in
with 2.1 pcrccm in 19K7.
Clllllillrllrl t111 fltllf" ZO
Out unions representing K,OOO cheaply a.~ the company say5 it adopted cost-control strategies
..........
• ... .._,......____11111141'·······
........
····•
·--=·=--=-=-=-:.::-=-=-=-=-=-=-:.....:==::!:::==========,..--· ... - ---- ·---------"""-'--=-==:.....====================--
EDISON
Cnt~tinurrl /,.,., (ltJt:r
/0
America."
But according to the union's Stewan.
llealthAcx CO!iiS exc:ccd pn:mium n:venuc
by 20 percent, ba.wd on ligures the comp.1ny files with the U.S. Labor Dcpanmenl.
The company undcr.llatc.\ plan costs be·
cause those expenses dctenninc whal
Edi1011 will contribute to HMO premium."
for the 11.000 employees not in
llealthAex. he said.
"Ac:cording to the company. Kaiser
(Pennancntc"sf group-model HMO costs
S9R a month mon: than Edi1011"s indemnity
plan."' he said. "You don't have 10 know
much about health in5urancc to know that
that is cra:r.y:·
Sokolov countered &hal it wouldn 'l he in
Edi1011"s best interest &o !ICI premiums
lower than costs. lie speculated thai the
aged HcalthCan: •
union is Up!iCI beeau!IC its mcmbera no
longer n:ccive free health can:.
The company pays 90 percent of what it
calls "reasonable payment amoonts"'ba.wd nn the claims hi111ory of Edison employees-for each proc:cdun: dcliven:d in
the lleallhFlex PPO and 70 percent oflhosc
amounts for can: outside the PPO.
Union oflicials concede that for·mutinc
c;1n: provided by pn:fcrrcd providcf!i, the
system work5 well. llowcvcr, cxpen.~ive
prc.wnt problem.~.
ca.-
'Arbitrary' payments
Said Steve Veverka. a 25-ycar Edison
employee: ''Tiley pay 70 percent of what
they arbitrarily think the bill mould be. In
my case. the average payment ha.' been 42
percent or the bill."
Veverka"" wife ha.\ been a patient in a
psychiatric hospital for mon: than a year.
"Under lhe old plan. the comp.1ny provided a Sl million lifetime psychiatric
benefit." he said. "'The new plan pays
April9, 1990
Southern California
Edison Co. said it spent $20
million less last year on health
care than it would have under
its old plan.
$35.000 total lifetime benefit. inpatient and
outpatient. ll1a1'5 a joke. The hospital my
wife is in costs $24.000 a month."'
Sokolov said the company works to
cnsun: that beneficiaries n:ccive can: in the
appropriate selling, and that some provid·
Cfli of psychiatric can: an: mon: intercstcd in
exhausting available benefits than helping
their patients.
Twenty-five of the Fonunc 100 compa·
nics have asked Edison about its plan.
which proves its suc:cas, he said.
Meanwhile. the Elec:lric:al Workef!i and
the Utility WnrkCfli Union of America say
they an: considering legal aclion to force
mon: complete disclosure of what they say
an: the program "s hidden C05II.
•
�SUNDAY, FEBRUARY 18,1990
CO"RICIIT 19901111£ TIMES MIRROR COMPANY lctl/11• PAGES
Firms Making Deals to Cut Rising Health Costs
• Medical care: Doctors and hospitals negotiate prk-e breaks. Workers say the burden is shifted to them.
Oy RODERT A.ltOSENBLAIT
TIMES $TAFF WRifEI
WASUINGTON-Major corpo·
rations across the country, stag·
gering under the burden of soaring
health expenses, are expenmenling
With new ways of tnmrrung the
costa of the bcnefiLS they proVIde
to their workers.
After years of absorbing runaway medical bills. some compames have scrapped their tradi1i11Da1.
1nsurance programs and begun ne·
goliatiq clirecliy wtth hospilals
and doctors for prtce breaks.
Workers may go out:adc the company -approved list of phystclans
and hosp11als-buL they must pay
more for the pn vilege.
Many workers are concerned
and angry. Health bcnefiLS have
eclipsed salanlls as the key issue tn
many contract negotiations. Cutbacks in health benefits Jay behind
two btller stnkes last year involvmg coal mtners for PitLSton Coal
Group in Appalachia and telephone
wor'
• Nyncx Corp. in New
Yor
,
..y people. health -cost
tnc:reliiM:II ate up their wage in·
creases,'' said Sharon VanMeter
Bailey, a member or the staLe board
of clirectors of the Ohio Civil Ser·
vtce Assn., which recently ratified
a contract with the sl:lte govern·
menL
Companies began to act more
"ggressively Lo control costa after
corporate spending for employee
health care. JUSt 9% of pretax
profiLS in 1965. rocketed to 50% in
l!l87. Businesses inilially had trted
to slow this trend early tn the '80s
by requtnng such things as second
optmons before surgery and ad·
vance approval for non-emergency
hospJLal slays. But health-care in·
!lalion conunuccl at double-digit
rates and now managers are trytng
to use companies' economtc power
to negouate direct sa v1ngs with
doctors and hospitals.
Southern Califon1ia Edison Co.
established a system that has be·
cQIIII. a prototype for other em·
pioyers. After a 10-monLh collcc·
Live-bargaining 1mpasse. il
110poaed a net work of 7.500 doctors
•md 140 hospitals that have agreed
to care for tts workers at discount
r:ILCS.
~~ison employees. who formerly
paid nor hinr for their health care.
now pay IU'lo 01 tne cost of aoctors
and hosp1lals in the company's
network. The company pays the
othe• (V\"'"'.
r
1rs outside the network.
he
~c company pays only
70 ·.
• fcc that a doctor in the
netwu111. would charge. If an em·
pioyee's personal doctor charges
more than that. the employee pays
all of the clifference.
The program. which took effect
on Jan. 1. IDSll, paid quick clivi·
dends for Edison. Its mcclical costa
dipped by S2 million last year to a
tolal of $80 rrullion. Under the old
regvu.. .lf.dlson figured ita expenses
would have dimbed to $100 rml·
lion.
Company ofllclala said they were
forcccl to act because health costa
had been going up nearly 20% ~
year and they felL those increases
might eventually Lhrcaten their
ability to offer heaiLh benefits.
Union officials at Edison don't
buy Lbat ralionale.
"Edison saya it is controiUng
heallh-care costa,'' complained
Willie Stewart, senior assistant
business manager for Local 47 of
the lnLemalional Brothrhood of
Electrical Workers. "All that
means is they went out and stuck
· employees wiLh the coaL"
outhern California Edison's
system. like most others al·
ready in effect. placcs an upper
imiL on out-of-pocket ouliays by
workers to forestall financial disas·
rcr if a scrioUB illness strikes.
AL Eclison, workers pay no more
Lltan 12.000 of their own money
toward Lreallnent provided by doc·
tors and hospitals in the company's
network. Eclison says only 23 of iLS
55.000 workers reached the ceiling
last year.
But for doctors ouLSide Lhe network. only the employee's 30%
share of the company-approved
rate counts toward the ceiliq. If
the doctor charges more than the
company-approved rate, the em·
pioyee mUlL pay Lbat cost but
cannot count it toward the ceiling.
Consequently, out-of-pocket costa
Cor employees can far exceed
S
$2,000.
One employee, whose daughter
has been hospitalized for menl:li
illness. has already patd
and
•he cash regiaLCr is still ringing.
Under the old company health
plan. the employee, who askccl not
to be iclentificcl. would have paid no
more Lhan S1.500. regardless of the
total bilL according to union offi·
Ctals.
"Not many people have that
kind or money, $8.000. lying
around," Stewart said. "We hear a
lot of complainll like that, with
people paying a lot of money out of
their own pockets."
For many workers. the aiLema·
Live to those kinds of costa is to
switch to a doctor who 18 part of
the company's network. That is
sometimes an unpalal:lble course.
"People With the greatest ncccl
for care already have rclalionships
wiLh doctors, and they don'L want
to give up these relationships,'' said
Dale Grant. a bcnefiLS consultant
with the New York firm of Martin
E. Segal Co.
So Car, workers parlicipaling in
company-imposed health-care
networks have few complaints
about the qUBiiLY of the care they
recetve from doctors and hospitals
in the networks.
Southern California Eclison i1
now so deeply into the hcaiLh
business that ita medical depart·
ment has appliccl illr a~crcdil:IUon
sa.ooo.
rrom the same nauonal agcncy•he JninL Commission on Accredit·
aLi(ln-thaL cerufics hospil:lls. Or.
Jacque Sokolov. Edison's mcclical
director, said the company went so
far as to negoliaLe a package deal
with Cedars-Sinal Mcclical Center
when an employee nccclcd a heart
LransplanL
First Interstate Bancorp has a
similar network of health-care
provtders who were assembled by
Metropoiil:ln Life Insurance Co.
Workers in California. Arizona.
Colorado and Oregon pay 20% for
doctors m the network but30% for
ouLSiders. The system. just a year
old. will be expanded to Washing·
ton, Oklahoma. Utah and New
MeXico this year.
Sun Oil. a third company Lo go
this route, switched to iLS network
of health-care providers on Nov. I.
1989. Allied-Signal Inc. and South·
western Bell Corp. are two more
companies in this camp.
ajor wr:10rauons are able to
negotiate cliSCOunt rates from
doctors and hospitals because they
can offer the prospect of a big flow
of patients. A doctor treating a
patient WiLh a particular ailment is
expected to order no more Lhan the
typical number of office visita. teaLS
and proccclures.
Doctors who exceed Lhe average
will be paid. BuL the strategy is a
risky one.
"First we pay him, then we
throw him out." said Philip Briggs.
vice chairman of Metropolitan Life.
"Our biggest weapon is the ability
to say he is no longer in the
network."
For corporate managers. "there
is one item on the balance sheet
they seem to have no control of,
and that Is healLh care," said Car·
son Beadle. managing director of
Merr.er 'o'leiclinger I< Hansen Inc.. a
New Yvrk employec-benefiLS firm.
"At110mc point the chief excculive
officer says. 'Whoa. wait a minute.
this is all I am willing to pav. and
you figure out how to deliver iL'"
Grant, also a New York benefits
conaultanL said. "EiLher companies
will pay more or employees will
pay more. This will become a big
qucslion in health care. How much
of the tolal coaL can be placed on
employees. and what is the break·
ingpoinL?"
Strikers at Pittston Coal and
Nynex Corp. believed that their
employers had gone too far. M
Pittston. the company withdrew ita
threat to cancel healLh bcnefiLS for
relirces; Nynex backccl away from
iLS pian to force workers to pay a
share of their health-insurance
costa. Strikes against three other
regional phone companies-Bell
Atianlic Corp., Amentcch and Pacific Telesis-had similar causes
and similar outcomes.
"For every Nyncx siLualion. you
have hunclreds of others going
throiJih the same crisis.'' said John
Sweeney, prcstdenL of the Service
Employees International Union.
M
If bllliness cannot force costa
down by barpining Cor cliscuunt
rates from networks of doctors and
hospitals, they may abandon their
usual disdain Cor governmental in·
volvement and call on the federal
government to step in.
"If we keep goiq at this raLC.
and no one intervenes to control
things. in 10 years we will have
every big company asking for national health insurance," said John
Bauer. manager of legialalive services Cor Armco Inc.
Chrysler Corp., which spends
S700 on employee hePith costa for
every c:1r tl m:~kcs. nas :~lrc:~dy
cmbr-o~ccd Lhc idc:1 of Lough gov~rnmcnt acuon.
•
"We support any program that
brings costa under control.'' said
Walter B. Maher. Chrysler's former director of employee bcnefiLS.
Chrysler dispatched Maher to
Washington to lobby full lime on
this issue.
Chrysler. engagccl in a tough
international competition with
Japanese car makers. finds iLSelf
parlicularly squcczccl by a large
number or relirecs who are drawing health benefits.
The company backs Cccleral leg·
islatlon Lhat would require all em·
ployers to offer healLh insurance.
Two other big companies who
share. Chrysl~r·s position are
Amertcan Atrhnes. whtch must
compete wtth non-union airlines
that pay lower w:~gcs, and Baxter
Travenol Laboratories, a dru(l
nanufacturcr.
Such lcg~sialion. these companics believe. would mdircclly re·
duce thetr own health-care ex·
pcnsl'~
About 37 million
Americans. two-thirds of them
workers and their dependenta. now
lack insurance and frequently
leave their mcclicaiiJills unpaid. To
offset that, doctors and hospitals
increase their fees for those who
carry insurance. That. in turn. adds
to the cost burden of such compa·
nics as Chrysler.
But most big companies sull
hope they can curb thC!lr own
health-care costa by shtfling more
or the burden to employees and by
using their economic muscle to
demand discounLS tram doctors and
hospitals.
The Times Mirror Cl)., whose
propcrlies include such newspa·
pers as the Los Angeles Times and
Newsday, will begin ustng a net·
work of providers next month for
menlal·health problems and drugand alcohol-abuse LreaLtnenL
The union representing editorial
employees at Ncwsday says the
network plan violates iLS contract
with management: the union is
pressing to keep the current bene·
fits system.
Alberto lbarguen. a vice presi •
denL of Newsday, denied that Lhe
company is vioialing the contracL
In New England. it is a umon
that is taking the inilialive in
seeking to push health costa down.
The Laborers Union NaLiona.
Health and SafeLy Fund is trying tc
negoliatc a 40'llo to soc;r, price
discount Cor giving a New Englanc
hospital its referrals for alcoholisrr
treatmenL For surgeries, the unior
fund wants to pick a Cew aclccte<
centers.
Unionized construction firm:
pay $1.75 an hour for each worke:
into the industrywlde health fund
Knut Ringen, the fund's clircctor
warned that unless something t:
done. the cost will explode to S3.0:
in three years-enough to driv•
contractors to break with the un
ions.
"If construction is going to sl:l:
unionized. we have to limit some o
the healLh coaLS." Ringen said
Small buainessa will find i
particularly difficult to contrc
healLh cosLS. analysts say, becaus.
they lack the economic dout c
corporate gianLS such as SouLhcr:
California Eclison.
NoL only Will they have cll(flcut
Ly ncgouaUq the sort of cliscoutl
rates Lbat. big companies can get
but they stand to feel a backlasi
rromthosecliscountrata.
Doctors and hospi&a1a Lbat oCfe·
discounts to employees or larg•
companies Will try to lllaka up th•
lost revenue elsewhere. Worker:
whosefirmabavenotbargainedfo
lower rates arc likclytargeta.
Thatcouldforceaomebusincssc
to drop healLh insurance altogeth
cr.
"Everyone has a vested intere!
in saving money and shifling cost
to someone else," said Mitchc
Anderman. manager of benefit
planning and design for Sun Oi
"You reacL to Lhe environmer
with self-defensive measures. BL
you can only pass the baU arour.
so much."
Southern California Ediso1
which cxpec:LS iLS network pian t
save $150 million by 1992, is one t
the lucky ones-so far.
"But there will come a poir
when even Eclison can no Ionge
live in isolalion,'' said Sokolov, Lt.
utility's mcclical clircctor.
Ultimately, he prcclid.ccl, ani
the federal government will t
able to assure that all lndlvtdua
"have a right to a certain level ,
health bcmefits."
�..V.RCH 19·2.5, 1990
THE WASHINGTON POST NATIONAL WEEKLY EDITION
PAGE
THE ECONOMIC PULSE
BOEF"S~-------------------------------------------------------------------------
T1__ New Pay-As-You Smoke Medical Plans
~laking
employees pick up the tab
for the health ri:;ks they take
1y Albert B. Crenshaw
"""-"- Pool Stall Wrilw
n jan. I, the price of tobacco for about 37,000 workers
at Baker tlul(hes Inc. went up: Any tobacco user at the
lluustnn·b.1Sed firm now has to pay $10 a month more
"' hc;tlth insurance.
:\t U-Jiaul International, the big truck and trailer rental
trm, employees and spouses who are uverwei1d1t or under·
''"'llhl wtll find their paychecks lightened by $5 every other
,.,~,.k fnr health insurance, be11inmngm April. The same goes
,., smnker~. Those who don't smoke and are the corrPrt
,.,.,~:ht l(t'l tht• msunmt·c altut t'Ost.
l'nmte l<esorts. operator of three large resort hotels 111 Phoe·
•x. pa)·s VII pt!rcent ul the hralth insurance premium for exec·
.11\'t'~ whn don'! smokt• and wctgh what they should wetl(h. Fur
;nuitt'rs ,,ml thP obese. the company wdl pay only half.
·\llo·r ,.,.,.,, uf t••unthn~:.,noloM·turs ami hus(lltals tut·ulo'usts
'"I e•h.,rton~: wnrkt•rs tu ;nlu(tt llt'altlucr hfcstylcs. a sm01ll but
llumlter nf t'mployers arc turning to "wcllue>~S" pro. r .tms. l'n·sscd by the hi~th cost of medil'al care. these em·
;,,·t·rs hupe that puttin11 a monetary premtum on better
.t·.olth woll suc.-ccd whert' uther rust...:ontamment strategtes
'""''laded.
:\nd wht·thcr they arc called incenttves, as they are by most
·mployers. or penalties, as some employees see them, the
Heo:t i• •~e same: Employees who live healthier lives, who
0
'''"'"'!!
'""'
1\,•k•·r llu.:hl"s ulhc.allcrm~
"illnt·~''""
ui
.-~..,;,..,;
>ay i
.hose who do not.
Sm.
.nd exces.~ pounds are the most common targets.
•ut some companies extend their programs to such risk fac·
,,rs as blood pressure. cholesterol levels. use of car seat belts
.nd others.
Southern California Edison. for example, offers a five-point
.:reenin11 process that checks not only smoking and weight,
·ut also blood sugar. blood pressure and cholesterol. Employ·
cs who p.lss the test. which is voluntary, or who can obtain a
nctor's certtficallon that they are tn a program to improve
II)' deficienctes. get $10 a month from the company. That
120 a year is enou11h to offset the employee's requared con·
cthutton to the company's medical care program.
The compames as well as benefits experts around the coun·
cy agree that the growing costs of medical care are behind
'•ese new programs.
"Compames are pulling their hair out trying to figure out
•hat to do" about the costs. says Michael Carter of Hay Hug·
·ms benefits consultants. "Most companies have already tried
all a dozen or a dozen ways to cut, and they have run out of
hin11s to try."
Carter and other experts say that the number of companies
~lkin11 about these steps is far greater than the number ac·
'Jatly taking them, and they expect rapid growth in the next
ew years.
"There is a great emergence right now in lifestyle aware.ess." leading employers to refocus their cost control efforts,
ays Tim Borchert, a group benefits expert with Hewitt Asociates. Wellness and employee assistance prolflms, which
.eal with personal problems including alcohol and drug abuse,
.e says, "have taken off like a shot recently."
Adds Carter: "When yoo think about it, the best way to control
osts is to be healthy and not use the [medical! services to begin
••th. Skeptical people say wellness programs don't affect that
1any people, that those who participate are those who would
artie;
~yway. But when you add rmancial incentives, a
one
~ who were on the fence are motivated. •
Tt,
tal savings for the companies are enormous.
A stu.. , done by Control Data Corp. found that medical
osts are 18 percent higher for smokers than nonsmokers, 11
ercent higher for non-exercisers than exercisers, 13 percent
1ore for those who don't wear seat belts and 11 percent high·
r for t.bose overweight or with high blood pressure, according
o David R. Anderson of StayWel1 Health Management Sys-
IIY lt10 IICft-THI! W.U...OION lOST
tems Inc .. which was once part of Control Data but has since
been spun off•
"With those kinds of numbers, employers began looking at
the whole issue" of lifestyle-related ailments, Anderson says.
U·Haul, for example, discovered that health care costs for its
13.000 employees totaled $17 million last year but that a mere
400 of those 13,000 workers accounted for S8 million of the
costs. And of the 400. two-thirds could be tnced to smokinR or
dietary problems. says Carol Bodnar. U·llaul's benefits mana11er.
Under U-Haul's new plan. "the most an employee could pay
would be $260 a year." l!odnar says. "That doesn't even touch
the premium [cost to the company f-it's just a little nud11e to
say we would like for you to come to a point where you don't
smoke and don't have a weight problem."
Similarly at Baker Hutthes. a giant drilling~uipment and tool
company, an internal study traced more than half the company's
$40 million annual medical bill to lifestyle-related illnesses.
About 12,000 of Baker Hu11hes' employees-n10re than a
third of the total-confessed to using tobacco in some form
and will have to pay an additional premium. The result will be
a $418,000 savings for the company this year "just off that one
step,• says Joe Vinson. director of compensation and benefits•
The company expects a total of S1 million to $2 million in sav·
ings in the first year from all its measures. groWUig to $4 mil·
lion in three to five yean, he says.
Neither Baker Hu~ehes nor most other employers who are
trying the stratell}' know whether it will really save money •
however. Most of the pro~erams have been in place less than a
year-most only a few months-so it is too early to tell.
S
o far, employers who have tried the penalties/incentives
approach say they have been well received by employ·
ees. But others remember an ill-fated effort by Circle K
Corp. to limit health care coverage for employees with alcohol- or drug-relaLed ailments or acquired immune deficiency
syndrome. That proposal produced a storm of protest and was
withdrawn.
Still, the question of limits remains. "It •s a complex issue
with many sides." says Anderson.
He notes that tt flies in the face of the traditional "notiot
insurance fwhich I is to pool the risk across everybody with
only rating variables [bein11l age and sex and maybe iml~
and geography. But ... if people through their own acll·
are costing themselves and their employer more money ••,
it fair that they bear a l(reater portion of the costs? Heai
people start saying, 'Why should I be paying for that ot
person's care?' •
Several experts say they think that uncertainties over how
to go and how to police such a ptol(nm have deterred many •
ployPrs from trying the idea, despite their obvious interest.
"Employers are oeginning to wonder what they can .
can't do." says Dave Garratt of A. Foster Hiuins & Co.
Is an employer willing to deny medical coverall! to a per.
inJured in a car accident while drunk? How does the enaplo·
detect closet smokers? How far can the employer go in look
,,, hahit~ and 3t"ll~tltes of dependents,)
S.11ne potential target groups, such as AIDS sufferers :
older workers. have legal protections, but some experts f
that a prol(ram that cuts benefit,; ha.o;cd on personal hai
could become rather subjecttve, perha!lll even discriminat
in applic;~ttun.
In ,uldiltun, tl is '"""'ibk• tlt3l sume em11lnye" will ahusc
idea by decmml( all sorts of atlmenta as lilcstylc·relatcd aa a •
to force employct"s to bear a greater share of the cost burdea
"When. dest!(ning a pro11ram, (an employer! should foL
nuc sim1tle rule: Avoid anythinK the person can't control." l'
Carter. ''If ;m unhealthy person is 111 a wellneSII prol(ram·
deal wnh a problem, he says, "you shouldn't penalize thena.
a company sucks to factors that the worker can change,
says, "it's pretty hard to be criticized by employees becat
the employee has it under their coalrol to chan&e. There·
lui of lug1c In llliJI .1pprwch."
On the questton of policing such programs, employers .
divided. Most rely on the honor system, simply asking empl·
ees to fill out a form and sign it.
Pete Lumianski. human resources vice president of Poi:
Resorts. says his firm's program extends to spouses as wei!
executives and relies entirely on the hanor system. "We clk
want to be Nazi·like about it," he says.
Likewise. the state of Kansas, which gives a $10 permo'
discount on health insurance to IIOIHIIIOkers. takes the t
ployee's word.
Susan lrza, Kansas's director of personnel services, s
that 29,500 state workers have qualifaed for the discoc
compared with 6,900 who do not.
Kansas combines the discount with free stoposmok
classes and other health-improvement information and fa
ities. includin11 a free health·risk appraisal each year.
"We have had interest from so many other states." I
says, adding that "we are very proud of our program.·
At the other extreme is Southern California Edison, which
quires employees and spouses to go thnlugh a formal mech
screening to qualify for what it calls its Good Health Rebate.
"We felt that it was to our advantage to have aU the scrft
be objective measures." says Mary Schmitz. manager of c
porate health services for the big utility company.
To ensure that, the company requires employees to h<
the screening done by company clinica or contractors, not
their own physicians.
"We have an integrated data base, which allows us to tr.
claims cost for categories of risk." Sc:bmiu says, so atandao
ized data is crucial.
So far. the company has screened 11,000 people, about
percent of those eligible. Of those. 78 percent got the reba
About 58 percent qualified by paasina all the screens, the n
by enrolling in smoking-cessation classes or other programs
combat their problems.
Schmitz acknowledges that because .the screening is volt
tary it is possible that those taking it were disproportional•
healthy. But she says that was only true for "visible risk
such as smoking and obesity. For invisible risks. such as blo
pressure and blood sugar, "we don't feel they were undem
resented that much.·
"We have very much taken the 1taace that this is an ina
tive for good health," Schmitz says. "You don't even have to
heathy to get it: you just have to be wwlciag on it."
�~l}t NtUr Dork ~imc~
Business
Sunday, September 24, 1989
Four Health Care
Vigilantes
Radical cuts in
corporate medical
bills are possible.
Dy GLENN KR.\MON
EDICAL costs mntmuc to run
wild despite wtdcsprcad efforts
by the n::tuon·s Clllflloycrs to
<"Oillain them. TI1e cost ol the lYfltcal
company mrchcal plan as proJected to
M
nsc by 20 1u 2.1 JlCrcctll 1111s vr.nr, tUTnnJ·
IUJ,t lU lhc )aleSI SIII'Vt'VS, a(tf..'l' 111t:rt~:.:;; ..
Dr.Jacque Sokolov, with a patient, Michael Karlin, at a clinic
run by Southern California Edison.
llljl by 15 IU 20 fiCrl·c•nt' last VC<II".
llut a !l!w large cumpamcs have suc·
c·esslully r"stramcd mrlltcal mllauon.
Employers like the Southern Calilornaa
Edison Company, Catcrtllllar Inc. and
the ,\dolph Coors Comttltny arc rrcurll·
11111 increases nl less 1han 10 pcrccm a
year. ancJ 111 some cases. of closer to the
a percent of the consumer prtcc tncJcx.
Rather than laktnll isolated stabs at
cutung their costs, these comp:mtcs
have developed more comprehensive
st r:ucgacs to Ci~:ht inflation 011 several
fronts. TI1c Olllproachcs cauJd tiCrvc as
models lor othrr employers and dramat·
ically change how health scmccs arc
dehvcrc:d. benefits spccialiala aay.
To rcdu~c the cost and usc of m(:clical
SCrVIt:l'S, they arr. IIC!WllllllRR klWCr
lll"itc5 !rom ccmnn cluctura and hospi·
talK m return fur a ptvmille to nudj~e
employi'Cs m thctr llit"Kllon. They are
rcvtcwinJ: the nlllit.ation of services 1n
an allcmpl to clnmnate unncccssary
ICSIS. lli>CraiiOIIS and days In the hospi•
tal. Ltkc most employers, some have
also slnllc:d more of the bunlcn to em·
fllnyccs h\' nu·rcas11111 annual llrdur"l·
thll!S, <"UIIIMII":&Ill:l' flaYinCIIIS :mil payroll
wntnlmliuns 10 the health plans.
The~" 1mssthlc 1rend scuers have also
token murc r.:adtcal measures. CalC11ltl·
lar has iakcn on murc than 100 doctors
in cuun tu chilllcnJ:c the price of lhctr
srrv1ccs ami m m:my l'asc5. has won.
Titc John Urcuncr Cumpnny. ::tnothcr
aggressive cost culler, refuses to pay
the mc:dac:tl lnlls or cmploycc5 who clo
nut JOIII a health matntenance organt7.11·
CunltRULod on l'a,;c ~
�THB NBW YORK TIMBS, SUNDAY, SEPTEMBER 24, 1989
lVledical Cost Cutters
r
~~ntmu,•d
11un. ;
~d
(rum
Pa~:e
I
a lew employers have taken eenain
I". a II h lll~urance sc:rvtces like the proc:esatng
"' ~launs tnto thetr own hands. Soutbem Call·
!unua lldison even runa ata own plaarmacy.
llc:lallh care. at seema. il commg to be
•, II'Wc:IJ 1111 a product tO be purchaled pruclcnl•
1.. tusl like the steel m Ca&arpillar's heavy
,
rquapmenL "The idea ia to manage heahb
care like a busuacsa and do your bell to Ret
)'IJUr employees to understand the prolllem,"
'"'d David E. Scherb, dltcctor of benefits at
1'eps1co Inc.. whose medical costa Will nse by
•Jnly about 8 perccntthia year. "We can't keep
'h11lona costs to employees."
1ndced. employees do not always welc:ome
111e alldc:d bunlen. Proposala to make workers
! "'"r n1orc of their mediCal costs were at thO
rum of the stnkes by untonazed workers that
1\C~an tn early AURUSl at two of the rcgaonal
llcll compames. Nynex and Bell Allanuc, ancl
<UIIIInuc:d at Nyncx last week.
What is more. the mc:dical commun11y fears
'hat 11 and tta paucnts wtll bear the bnmt of
1he htgher costs. They further worry that
ruhn~:s a11atnst doctors tn billing disputes in
.·nurt could sca a precedent for Insurers to
Joct:ue medical lees and influence care.
Still others complatn that other people
··oulll be forced to absorb the COlli. "Aller
, "mp.,nocs nr.~:ouate discounts. the mediC<~I
nunmunuv stmloly shills costs to others - to
lhl' small company or lndivtlluals that can't
nc~:otlllle a discount." said Franeas M. Miller,
t>rcs.. •···· ~r the Colorado Bustness Coalition
fur ·
Ocnvcr·based employers RI'IJUI).
lhe most aqrcss1vc companaes
ma\
able to sustam smllic-llign cost
rncrno:.u. The rc::~Hn: Acconlmg to a survey
hv Nnbk' Lownlles. a benefits consulung firm
rn "ast Oran~tC. N.J .• costs ShOuld conunue to
climb because or increases tn \he use of high·
1cchnni011Y tre11tmenta like organ transplants
.1nll CAT !!Cans nse and &n the casas or cata·
.<ll'llllhlc cases hke AIDS and cancer. sub''ancc-abuse treatment anll psyeh111tne care.
.rnd or subs1dizim1 the un&nsured and those
~overed bY Mc:dicare and Medlca&d.
51111. the lollowm11 compan&es m1ght be &n a
hcncr fMJSUion U1an most.
Southern California
Edison
Whtlc mcrcasm11 at an avera~:e annual rate
ul zz percent through mucll or the 1980's, the
mt'dical costs or the nauon·s second-largest
uuhay should rise by only 5 to 10 percent thiS
vcar and by 14 percent aMualiY over the lll!lll
hvc:. The proJected sav&ngs over that ume:
SI05 molllon on a total medical bill of 1815
rnllhon. Over the nellt ZO ye11rs, the company
hnpcs to save SS.G b&llion. or 70 percent of Its
cu~t5 had it Iiane notl11n11.
"' the: ~x-ttsnnon11 of this year, Ed~ OYC!r•
haulc:d ita health plan lor tho first time tn 37
vcnrs. The Rosemead. CaiU.-bascd COmiNUIY
on1antzell a large network of hospitals that
ajlree to orrer lliscounaed pnccs on rooms and
a panel or doctors who ndherc to a fee schedo
ulr. lor many procedures.
r::dison also s&opped paytng the enure medl·
,·;ol htlls or its employees and of most of ita
!ulure rcurc:es. It now pays 90 percent ol the
lull lor those who usc the network and 70
f'l"rcent lor Ihose whO do noL But employees
who 110 outSide Ihe net work often pay more
1h;•
~rccnt or thetr bills. The company
rr
cent or the amount accepted by the
<J,
liS panel.
..ny employees are now requtred to
,.
rnn1r1muc up to SIOO a month toward thetr
rnNJocal plans. Under the "llex&ble" arrant~e·
mr.nt, en1111oyccs can lower lhetr monthly
cnar11C and pay a higher dcducUllle. And
wurkc:rs •hu ~'""" to loa aaaled lor amol&ina.
we•Rhl, chnlcsterol. blood pressure and blood
•u11ar - and to pan1capate tn remedial pro-
grams al ncc:ded - can rcdut·c their monthly
contnbutiuns by a lotal or SIO. As a resull,
some employees pay no·monthly charge and a
lew even receive a small credit.
Finally, the company rc:ducc:d by about
pen:entlhc amount It pays ata IIC!alth maantcnance organazauona. The company's previOUS
paymenta had been basell on the medical
costa or workers tn Ita non-H.M.O. plans.
. . _ 911eft1D -re mucll higher than those
of H.M.O. enrollees.
Now, it pays H.M.O.'s baled on what it
c:sumatos care actually costs. Employees
~g H.M.O.'a that cllarge more than
what the comiNUIY will pay must make up the
difference. The company argues lhat it can
fairly assess !be cost of care because. unlike
most companies. It is sell·lnsured. processes
its own claima and even rev1cws claims lor
potenual excesses itaelf rather than hiring an
outsade utilization rcvtew firm.
Edison even hires Its own doctors and buys
»
Southern California Edison's Cost Cuts
How much will health
care costs be reduced
Where do the cost uvlnp
come from?
In coming yean?
8.1
In billions ot dollars.
Coats
::& Savings
8
.51
5.6
Costs if no changes
w.,.macle.
•
J
offer lo-r
prlcea.
38%
~
tJ~
•·r
.82
1988-1992
~
Use of network
doctors, who
11188o1997
1988-2007
eas&cr lor Dreuncr than 11 mtllhl be lor others.
Most or 11s employi'CS arc 1n Califorma. where
H.M.O.'s arc Wtllcsprcad .
The company has tned tu 111vr. every rm·
ploycc a choacc or atlcall two lt.M.O. 's anll an
rn~cn11ve to 10111: ~;,nplovt'e!O pay only a smnll
(ntnllllrancc toavment anli a monthiV payroll
ueducuun ol S:ZS lo SIJ7. Dental anll vastan
cavera.:c was also tmprovt'd.
Even so. to ~onunuc tu •·ccc:tvc ~ovcraKc.
some employr.cs hall In ~:ave up donors thcv
had uscd lor decades. Anlllhc H.M.O. linctors
were not always as conveniCIIL
Still. seven emplo)'CCIIontervacwcllat three
store~ 111 the San Francasm nrcu wc:o"C JICncr·
ally pleasc:d. Rut nne cmplo~ worried thnt
she would suller hnancaallv because H.:'ri.O.'s
do nol alwnvs covt'r ~r11ni11 procl'durl'S pmd
lor by olhcr lll!illrera.like m-vnro lc:rtah7.allon.
its own pharmac:euucals. Ita 10 clinics and
first-aid stationS. managed by salanccl physl·
caans on its stall. handle 15 percent of the
pnmary-carc v&sus or thO company's 57.000
employees. reurccs and dependents. The: doc·
Lars pi'OYIIIe care at a lower cost. enabhn!ILhe
company and employees to save about 20
cents on the dollar, satd Dr. Jacque J. Sokolov.
v1ce prcsadenl and medical dorcctor al tha
company. By buytng liruRS at below wholesale
pnces. Edison's pharmacy. wh1ch fills 85 per·
cent of all prescriptions. saves about 40 cents
on the dollar.
But some EdiSOn employees arc not pleased
wolh the Changes. Employees whO once paid
almost nothtnR for health care now shell out
up 10 $3,000 annually. Elii!lllll unposc:d the
provas10ns unilaterally alter reaching an 1m·
p - in bal'!llllniRll woth Ita unionazc:cl work·
en. who objected to tho plan.
·
Rae Sanborn, a hustness manaar.r or a unu
nl t::..u-·s largest un-. the lnlenla&Wl1lll
Brolllerhood ol Electrical Workers. saad the
chaqc~ have caused "a big drop an morale
and producuvuy." And by rcducmg payments
10 H.M.O.'s to unrealistically low levels. ha
alidl!d, the company has forced those prov1d·
crs 10 cut bac:ll on &heir servtccs.
Some atRue that the company's role In
health care is a conflict or Interest. "Yuu have
the same people· who arc payinll the boll
evaluauna the treatment rcce!vc:d." satd Wil·
lie Stewan. another I.B.E.W. ollic1111.
inll lor their mcclicnl c:are other than lor the
vtslta to Lhc doctor's ullicc:.
Catcrpallar saves in a number or ways. It
contracts wilh the hospatals usc:d by 115 em·
ployc:cs lor concesstons on Ices anll plans In
rcqusrc employees whO 110 10 olher hospolals
to pay lor pan of the btll.
II also nellct&alcs w11h many doctors on
cenain fees. II pays only the: prtce on a holl
that 11 consKiers laor. Calcrpallar allen reprc·
sen&s 111111ents who hnvc been succi by docwn
lor the rcmatndc:r of thetr balls m cuurt and
pays those playSicaans Lhc balance tl 11 loses
cases. It has won most of its 100 battles so far,
said Dr. Raben D. Her1enste1n. medlcalllircc·
tor for group msurancc at Caterpillar.
Catcrpallar saves on dru115 by contr<~Cllllll
wuh pharmacacs and payan11 them &he whole·
sale prtcc: or druiCI plus a d1spens1ng Icc.
When 1he prcscrtbang phySICian dues nul
speedy a prnprtetary liruR, Calcrpallar en·
cnuraaes ahe pharmacies to scll11et1Crtc llrullS
by sharana the prtcc d&llcrcncc wnh them.
Like Edison. Caterpillar also admanasLcrs
cla1ms usclf. "That g1vcs us a savangs or
probably Ito l percenl JUSt an admanosU"allve
costs.'' Dr. Hencnstetn sa1d.
"Over all, I would say the company has
done a very 110011 Job," saad Tonv Green. the
president ol the Umted Automobalc Workers'
Peoria unu. C<llerpillar's boqest unoon local.
Caterpillar Inc.
The John Breuner
Company
When it comes to health care. Lhas heavy·
cqu&pment manufacturer nmvcs lasLcr lhan
111 name tmplics. The Pcorta. lll.·bnliCII com·
pany has matlllllc:d 10 hold tiS mcreascs to an
average of well below 10 percent a year lor
live years. after they rosa by I&Lo 2.$ percenL a
year an lhCI lato 1070'a 11nll early lliBO's. Yol
Caterpillar's almost 200.000 c:mplovccs. de·
pcnclenta and rcurccs sull pay vortually noth·
:'t1ost employers gtvc the&r workers Lhc
ChUtCe of a health maontenancc orjtilnt7.llUOn.
Out stncc 1987, Urcuner has requarcllols ncar·
ly 1.~00 employee~. retirees aml theor uepcn·
<Ients 10 SIKn Ull Wllh an H.l'oi.O. The San
Ramon. Calif.. fumnurc·s&ore chaan. whach is
owned by Oawa Inc., haa ••nco CUllll mlllilclll•
cost snllauon rnle Stlln•licanlly. Makon11 the
change to an H.M.O.-unly hcallh plan wns
Adolph Coors Company
The Adnl11h Coors Company prov•lles trou·
bling cvodence that even a rompany lh:u
works hard to control mcclical cos1s c.:m be
humbled by !actors heyonll us control.
In recent yeus the Guklcn. Culu.·bascll
brewt'r has managCII to limn 111 pcr·c:apua
111creascs in health costs to abuut 5 llCt'cent ,,
year. But lhas year. the lt~urc wtll probahlv
cllmh to alluut 15 percent.,\ lrw nrcan·lrans·
1>l11n1 t·ascs thai woll total almost S2 nulhon
arc the: snnon ~ulpnts..\ncl Cours n1anlljlers
hope the th1s yrar's an~rca~<e as only a blip.
l.1kc Cnacrptllar, the company, whacll cov·
ers about JZ.OOO people, has tnc:d 10 save
n1nncv hy admsnostcrsn~:us own claoma. Conrs
also i.:mitr:u·ts wuh hosauuals. durlon and
<lcnllsls lor a·educc:d ratcs.ll ;111Ko hlsndlcs rls
own rcvtew of mc:dical and mental·hcallh
cases. As a result, cxpcn!ll!s for meoual health
anll substance abW<C fell S percent last vc:ar.
allc:r nsan11 20 perccnl a year an tliC two years
hclorc at be11an to mallllllf! the cases. saall
Mark w. Wri~thl, director of health servaccs.
Out ill COSI-tUillng PnJRl'llm also cmplaaSilU!S
good health. For c:a(lhl years, it has run a
wellness center. wh1ch now haa a I!Ym and
tnlioor track anll ullcrs pro11ram!1 on smokanll.
alcohol abuse. nutnuon anll weagtu loss. "
separate mc:Utcal center handles all of the
company's workers' compensauon cases helpang rchabtlitate employees wnh sue11 atl·
ments as back 1n1uncs.
To show employees 11 means biasmcss.
Coors pays 90 percent Of the hcallh COSta of
employees and thcar s(ICIUSCS who undc1'1!,o
hcallh appratsals and are JudllCII healthy or
smve to omprovc tbclr heallh 11 they are not.
llut ot pays only ~ percent or the claims or
cmplovee• who do nul cooperate or try to
unprove their health 1f they arc llt(lhcr•nsk.
Oavod Lall(lluon. a rc:prescntauvc of the
Teamators Union. which faik!cl sn an auomna
10 Ol'!lan•zc Coors workers lasa year, sa1d he
heard no complaants about tho plan.
•
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�UNINSURED AND MORTAUTY RATES
•
Whether you have insurance does make a difference in your health. People
without insurance are up to 3 times as likely to die as people with insurance.
They•re more likely to be admitted to the hospital for a condition that has a
higher expected risk of death and appear in more urgent need of care.
Sources: Hadley et al, .. Comparison of Uninsured and Privately Insured
Hospital Patients:' JAMA, January 16, 1991 and Franks, Peter et al, .. Health
Insurance and Mortality .. , JAMA, August 11, 1993.
�WHERE DO AMERICANS GET HEALTH INSURANCE?
(1992)
Millions
220.8
Private Health Insurance (Total)
• Employer Coverage
• Other Private Coverage
Public Health Insurance (Total)
• Medicare
• Medicaid
• MilitaryNeterans
No Insurance
Percent
100.0%
156.6
70.9%
138.0
18.8
62.5%
8.5%
33.4
15.1%
4.0
25.6
5.7
1.8%
11.6%
2.6%
38.5
17.4%
Source:
Represents non-elderly (under 65 population); Employee Benefit Research Institue Analysis
of March 1992 Current Population Service
•
From this study, we get our statistic that "Nine out of ten people
with private insurance get it through the employer-based system."
[62.5/70.9 = 88.2]
�BACKUP FACT SHEET
People 'Without Insurance Each Year
58 Million
THE FACT:
"The Bureau of the Census calculated that 50 million Americans
lacked health insurance for at least 1 month during 1987.
Lewin!VHI updated the census estimate, calculating that 58 ·
million people were uninsured for at least 1 month in 1992."
THE SOURCE:
"Dynamics of People Without Health Insurance: Don't Let the
Numbers Fool You," Journal of the American Medical Association
(JA.l\{A), January 5, 1994
People 'With Pre-Existing Conditions
81 Million
THE FACT:
An estimated 81 million Americans under age 65 have medical
problems for which insurance companies .can charge higher
pJ>emiums, exclude coverage or deny coverage altogether.
THE SOURCE:
"Health Insurance at Risk - The Seven Warning Signs", Citizens
Fund, June 1991 [with data from National Center for Health Statistics
"Health Interview Survey•, further data from the Health Insurance Association
of America "Source Book •, and the latest Department of the Census "Current
P~~nSwro~s1
·
People 'With Lifetime Limits on Coverage
133 Million
THE FACT:
The Bureau of Labor Statistics 1991 Survey of Medium and Large
Private Establishments reports that only 1 out of 4 people have
insurance policies without lifetime limits.
THE SOURCE:
Table 45 -- Medical Care Benefits: "Employee Benefits in Medium
and Large Private Establishments", Bureau of Labor Statistics,
1991
CALCULATION: In 1992, 177.5 million Americans had private insurance, according
to the Employee Benefit Research Institute analysis of the March
1993 CPS. Seventy-five percent of 177.5 million is 133 million.
�HHS STUDY TO BE RELEASED NEXT WEEK ON 'IJNl:NStJRED
This study shows that the number of Americans under 65 who had no
health insurance grew from 25.2 million in 1980 to 38.3 million
in 1992. That represents a growth from 12.5 percent of the under65 population to 17.2 percent. (Health, United States, 1993)
I
_I_
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�SOCIALIZED MEDICINE: THE SAME OLD SCARE TACTIC
TODAY:
Senator Robert Dole (R-KS): "The President's idea is to put a mountain of
bureaucrats between you and your doctor." [Wall Street Journal, 1/26/94; N.a:
Yorlc Ijmes, 2/1/94]
Senator Phil Gramm (R-TX): ". . . good old-fashioned socialized medicine
with the government running the health system . .. "[Reuters, 10/13/93]
Representative Newt Gingrich (R-GA): " ... it has got to be the most
destructively big government plan ever proposed .. . "["Meet the Press", in
WashinKU>n Times. 10/4/93]
SOUND FAMILIAR?
•
If these arguments sound familiar, it is because they are the same, exaggerated,
emotional "big brother" arguments that have been used time and time again to
defeat health reform proposals.
1949
Oggosition to President Truman's Health Reform Progosal:
Do You Want the Government to Come Between You and Your
Doctor?" Full-page ad in 30 national magazines. [Campion, Frank. TheAMA.
and U.S. Health Policy Since 1940, Chicago, IL]
"Who is for Compulsory Insurance?" opponents asked and answered, "All
Who Seriously Believe in a Socialist State." [Campion]
1961
Oggosition to President Kennedy's Medicare grogosal:
American Medical Association: "We fight because the administration's
medical care proposal, if enacted would certainly represent the first
major, irreversible step toward the complete socialization of medical
care." [Campion, p. 256]
1965
·oggosition to President Johnson's Medicare grogosal: Representative
Hall (R-MO) - "Consequently. we cannot stand idly by now, as the
Nation is urged to embark on an ill-conceived adventure in Government
medicine, the end of which no one can see and from which the patient is
certain to be the ultimate sufferer." [Congressional Record, House, 4/8/65]
Senator Cunningham (R-NE) - "This legislation could eventually lead
us to socialized medicine. Make no mistake about that. It takes no more
than a quick glance at a history book, and a little common sense, to come
to this conclusion. " [Congressional Record, Senate, 3/3/65]
�06/15/94
15:26
DI-JC RESEACH/COMMUNICATIONS
~
4566485
HOUSE RESOLUTION 6675
(MEDICARE, 1965)
PARTY VOTE
HOUSE (April 8, 196S)
Total: 313wl1S
Democrars: 248-42
Republicans: 65-73
SENATE (July 28. 1965)
Total: 70-24
Democrats: 57·7
Republi can.r: 13-17
SIGNIFICANT VOTES
1) Rep Bob Dole (R-KS)- NO
2) Rep Bob Michel (R·IL) • NO
(Source: Congressional Quarterly Almanac. VoL XXI. 1965, p. 950, p. 1062)
�06/15/94
15:25
DNC RESEACH/COMMUNICATIONS
~
4566485
NO. 954
P01215/00~
MEDICARE
American Dental Association
''The American Dental Association has long been concerned
with the health problems of the aged. recognizes that the
problems are not yet entirely solved and agrees that the
Federal Oovemmem has a proper role to play in solving
them.
Tbe hospital and medical care plans being
considered here, however. are not the answer. . . .we
believe the underlying assumptions to be mistaken and we
believe the basic principal-extension of care without
regard tO need-to be wrODg 11 (Staii:DIIml of Or. I. Lawrence Kerr,
American Dental Association m die Seaara F'Uiall.C* Commiu= un H.R. 6675, April 29-
May 7. 1965. page 42.5).
American Medical Association
In 1957...
•
In 1957, the AMA opposed and defeated a bill from
Rep. Aime Fourand (D-RI), that was the
predecessor to Medicare (Richard Harris, Annals of
Legislation, Medicare. IT-More Than A Lot of
Statistics, The New Yorker, XLll, July 9, 1966).
.In 1962...
•
In 1962. the AMA opposed and defeated the KingAnderson bill, later know as Medicare (David,
Sheri Iris "To Lift a Heavy Burden: The Story of
the Medicare and Medicaid Lawn Ph.D. diss., City
University of New York, 1982).
In 1965...
•
In 1965, the AMA opposed. for the first time
unsuccessfully, Medicare. H.R. 6675 (Ronald L.
Numbers. Compulsory Health Insurance, Westport.
Connecticut: Greenwood Press. 1982).
Health Insurance Association
Of America
In 196S, HIAA spokesman J. Henry Smith testified against
He stated the
a forerunner of Medicare, HR 1.
organization has " ... been opposed to this type of legislation
on the grounds that it is unnecessary and undesirable in the
light of the existing magnitude and growth of •1olumary
health insurance, coupled with the evolution and potential
or government programs for those who need help" lU.s.
Congress. House. Cll1Mlir:tee on Ways and Means. M1dir.al Q.rt Ft~t Tht .A.g«<, H.R.
l. Exe<oulive Ruiun. february 4, 1965).
�06/15/94
15:25
DNC RESEACH/COM."1UNICATIONS
National Assodation
Of Manufacturers
~
4566485
"The National Association of Manutacrurers. wim a
membership representing 75 percent of the ~ation's
industrial production, recognizes the fateful decision that
confronts Congress in HR 3920 (a forerunner of Medicare).
It presents a choice between a voluntary system of medical
care that has made America the envy of the world, and a
national compulsory program that will change this system
beyond hope of recall'" CStammem of National A~iilliolt cf Mallllfamrers
on HR 3920. submi:ted 10 llouse Cotllmiltll on Wa'/S and M~JS. llrnpilul Cun For 771r
AR«l UNlu SDdiiJ S«<uity, 1966).
NFIB Opposed the
Enactment of Medicare
The NFIB opposed Medicare when it was created in the
mid-1960s. Entering his statement into the record, NFIB's
then~ legislative services vice president. George J. Burger,
explained that for "5 years we have polled our
members ... on measures proposing to finance hospital and
nursing home care for the aged through an expanded social
security tax program. On each and every occasion our
members adamantly opposed these proposals csnurce: Mamrial
11
fnr
U.S. Chamber of Commerce
Cllc
Rcami, U.S. House Commie~= nn Way!. ""' Mnns, l! /63 and I f64).
"There are several reasons the chamber is opposed to HR.
3920. One of these is that social security medicare· is not
needed. In sharp contrast with the situation 10 years ago,
a very large pan of our eJderly population today has
protection against costly illness through one or another of
several programs II (Stall: of Chamner nr Ctlmmerce or u.s.. ~hmitted Ill HcAUC
Cr.mminc:~
1964).
nn Ways and Means, Hnspirtz/. Cim F"r Tht Aged (}n.der Soc.'iaJ S«ufil7,
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�'U202 .101 i:l21
HHS :I.SPE·HP
MEMO!U\..'IHJUM FOR: MELANNE VERWl!lR
FROM:
!~:EN
THOI\PE
1:0!:: ADMINISTRATIVB COSTS
t.'),;;.
DT: JUNE 14, 1994
********************************•*******•************************
several auestions were raised dur.i.u;.~ l.he North CarolinCL bue:ineaa
meetinq concerning administrative costs of runninq the Medicare
program compareci to priva'Ce health im:JuLcUlce. 'l'houqh these cla.t.a an
two years old, projections by BCFA indicate the relationships still
hold. The bottom line is Mee11care':;j a.dmini:strative eoatca are
slightly above 2\ of benefits while private health insurance
averaqes around 17\ ot benefits. At lea~t Lwo factors account for
the hiqher costs; Medicare is a universal system that does require
administrative expenses to underwrite (i.e. c:Lvoicl) a.pplicanta.
Second, it has substantial economies of scale. For instance, some
small groups with private insurance pay up to 40t of btUlefits on
administration (smal~ qroups ~re administratively expensive).
Reform addressess botn issues, universal coverage, 1nsuring lArge
qroups. and ~rohibiting underwriting will reduce administrative
expenses.
�ADMINISTRATIVE COST AS PERCENT OF BENEFITS, 1991
15.0%
10.0%
5.0%
0.0%
Sourl
U.S. TOTAL
ALL PRIVATE INSURANCE
HCFA Office of the Actuary
MEDICARE
MEDICAID
�SOURCE OF HEALTIIINSURANCE AND ESTIMATED ADMINISTRATIVE
EXPENSES, AS PERCENTAGE OF TOTAL SPENDING. 1990
AdministratiVe Costs
Source of Coverage
u Pe::rcent of Spending
Private
Employment-based
5.6%--40%
Individual
Self.fnsured
40%
5%-12%
..
Public
Medicare, total
2.1%
Part A
PartB
1.2%
3.5%
3.2o/o-11 .8%
Medicaid
Total
5.8%
Source: K.E. Thorpe, "Inside the Black Box of Administrative
Costa.., Health Affairs (Summer 1992):41·5b
�ADMINISTRATIVE EXPENSES BY flAM Size
(aa a Percentage of Incurred Claims)
Administrative
Group Size
Individual
Expense%
40.0%
100
Over 10,000
18.0%
o.S%
Source: K.E. T11orpe, ..Inside the Black
Box of Administrative Costs•,
Health Affairs (Summer 1992):41·55
�TO:
FROM:
DATE:
RE:
Hillary Rodham Clinton
Jennifer Klein
6/15/94
Federal Employees Health Benefits Program
The federal government contributes an average of 72% to
health insurance premiums for employees.
The government paid $10.4 billion in 1992 and $11.2 billion
in 1993 in premium payments for federal employees (including
postal service employees).
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�Women's Checklist For Health Care Reform
The Health Care Security Act Meets The Criteria
Universal Coverage
-J
-J
-J
NOT dependent upon health status or health history
NOT dependent upon marital status, employment status or ability to pay
Discounts for low income families
Comprehensive Benefits
-J
v
.-J
No lifetime limits; no pre-existing condition exclusions
Coverage for preventive care and prescription drugs
Expanded sites for care
Preventive Health Care
.-J
-J
.-J
Emphasis on regular check-ups, early diagnosis and treatment
Clinical preventive services for high-risk populations;. age-appropriate
immunizations, tests, and clinical visits
Screening for breast and cervical cancer including routine mammograms, pap smears
and pelvic examinations
Quality/ Choice
.-J
v
Annual "report cards" of health care providers and health care plans including
important consumer information: e.g., percentage of women who receive
mammograms, number of babies delivered by Caesarean Section
Option to change health care plans once a year
Reproductive Health Care
-J
.-J
.-J
Full-range of pregnancy-related services
Family planning services
Screening for sexually transmitted diseases
Medical Research Investments
-J
-J
Increases funding for prevention research at the National Institutes of Health.
Research priorities on women's health care concerns including osteoporosis and breast
cancer
Long Term Care
-J
-J
-J
Home and community-based long-term care initiatives
Expansion of nursing home coverage
Increased quality and affordability of private long-term care insurance
�ABORTION
As you know your remarks in response to a question about abortion at the League of Women
Voters were misrepresented in media reports. It's possible that you will get a question based on
those erroneous reports. The most difficult abortion question is when it is posed as restricting
choice: we deny people who wish to join plans not covering abortion the option to do so. A
suggested answer is below.
Question: Many people think abortion is morally wrong. Why should their tax dol/an go to
pay for covering abortion on demand?
Answer: One of the major goals of our reform is to guarantee people health benefits as good or
better than they have today. Most private health care plans cover the full range of reproductive
services today, and our plan will cover abortion when a doctor determines it is medically
necessary or appropriate.
A conscience clause ensures that doctors and health institutions - such as religious hospitals will not be required to provide any services against their moral or religious beliefs.
The President has always said he feels abortion should be safe, legal, and rare. That is why we
are doing everything we can -- through health care reform, through welfare reform, and through
other school-based prevention initiatives-- to dramatically reduce the number of unintended
pregnancies.
Q: But shouldn't people be given the option to join plans that don't provide a service they have
such personal and moral objection to?
Answer: We think comprehensive benefits should be spelled out in law, and for security,
portability, and simplicity reasons, that every insurance plan should cover the same things. There
will no doubt be plans that are organized by religious hospitals and are staffed by providers who
would not themselves be required to perform services they thought were wrong. But if a plan
didn't provide a service directly, and someone in that planm had a medical need for that service,
the plan would have to arrange for that service outside their plan.
Q: You indicated earlier this week that you would be willing to give up abortion coverage in
order to get health care reform? Is that the case?
Actually what I said was quite the opposite -- I said that now is no time to compromise. I said we
should be focusing all our efforts on fighting for universal coverage. Most women with private
insurance have coverage for abortion services today, it is part of our comprehensive benefits
package, and we will fight for comprehensive benefits.
�~OG~COVERAGE
Women are increasingly at risk for life-threatening illnesses like breast cancer, yet in the past too
little attention has been paid to the research, detection, and treatment of this dread disease.
Today, one in nine women in the U.S. will develop breast cancer in her lifetime. In addition to
the 2.6 million women who have breast cancer in this country, another 182,000 will be diagnosed
with the disease this year, approximately one every three minutes.
·Our health care plan addresses the threat of breast cancer aggressively and comprehensively,
guaranteeing all women coverage, regardless of whether they are healthy or sick, married or
single, working or unemployed. Our approach provides unprecedented coverage of preventive
care, including mammography. It will cover a whole schedule of preventive screens, tests and
check-ups at no cost-- protection available in only a few oftoday's insurance policies.
Coverage for all women:
Women of any aae can receive clinical breast exams and mammograms at any time when the
patient and doctor feel it is medically necessary or appropriate, and will pay a standard copay, (for example, ten dollars) set by the plan.
Extra coverage for women at risk:
Women of any age who are defined to be at risk of breast cancer will receive additional
visits, including clinical breast exams and mammograms, with no cost sharing.
Additional coverage of mammograms:
For certain age groups, at certain intervals, mammograms are free of any cost sharing, so
there is no charge when a woman goes to the doctor for these services.
As part of the preventive services p·ackage, all women age 50 and older would have routine
mammogram screening every other year, free of charge. Again, any woman who needs more
frequent mammograms would be covered, and would pay a co-pay.
Additional coverage of clinician visits:
Clinician visits, including clinical breast exams, are covered for all women, and additional
coverage is available for women in certain age groups. Clinician visits are free once every
three years for women age 20-39, and every other year for women from 40-64.
New investments in combating breast cancer
This year, the National Institute of Health's breast cancer research budget increased by 44
percent, from $208 million to almost $300 million.
Under reform, new research initiatives will concentrate on the prevention of illnesses
affecting women, including breast cancer, mental health, reproductive health and
osteoporosis.
�Clinton Presidential Records
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�GLEASON CHART:
Talking Points
Let me show you what I mean when I say that it's hard to imagine a system that's much more
complicated than today's system.
Dr. Gleason, a doctor in private practice in Iowa, sent us a chart showing what his office has to do to
get paid for a simple office visit. For each patient, there's a different set of rules and procedures that
his office has to go through, for example:
•
Confirm that a patient has insurance;
•
If the patient has insurance, what kind of services does the insurance policy cover? This is
important because there are so many different policies out there today -depending on the
policy, some services are covered but others aren't; sometimes a patient has run up against his
lifetime limit and isn't covered any longer; sometimes the plan won't cover the service unless
preconditions are met; and I could go on and on with this.
•
Then, when it comes to getting paid after the patient leaves, that's when it gets really
complicated. The office has to figure out which insurance company is the primary payer, how
much to bill the insurance company and what codes to use. Today, each insurance carrier can
request whatever information they think they need and the doctor's office has to fmd it, put it
on the claims form in exactly the right spot in exactly the right way, otherwise they may not
get paid right away for the visit.
•
Once all this is done, the office then has to track the status of the claim and may have to have
follow up conversations and give the plan more information about the patient and the visit
before the plan will send a payment.
Dr. Gleason also sent us a chart showing what his office would be like if the President's plan is
implemented.
It's much less complicated.
•
First of all, all Americans will have health insurance. And, there will be a standard,
comprehensive benefits package. The doctor's office won't have to go back and forth with the
plan to figure out which services are covered and which aren't.
•
Their office will only have to fill out one claims form and all the information on it will be
standardized, regardless of the plan. The office staff won't have to spend time figuring out
what kind of information goes in which box on the form. It'll be the same for everyone.
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Dr. Gleason's Office After Presidettt Clinton's Plan
PATIENT
OmCEINTAKE
•
·------·-._.....,._.. _
··---PokyCoon:l
... _.,_.
_ _ _ _ .. _ _ .,...__.._ .......... a-.-
�CLASS OF '94:
Number of Students Applying to Medical Schools at All-time High: The numbers
aren't final yet, but so far, over 45,000 students have applied for 16,100 spots. And,
they are just as qualified if not more qualified than their predecessors.
Year
Number applicants
Comments
1974
42,621
3rd highest level
1988
26,721
lowest level in recent
times
43,808
1993
2nd highest level
)Ource: 1994 ~ \ssoc1atlon of Amencan Medical Colleges
�Clinton Presidential Records
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by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our digitization
capabilities, we are sometimes unable to adequately scan such dividers.
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Page 30
�If we don't pass health care this year••..•
American families will pay more for health care with less secure benefits and diminishing
choices. Many workers will continue to trade wage increases or stay locked in jobs that don't
suit them just to hang on to the health benefits they've got.
•
Health care spending per worker will be over $7,000 in 1994. By the year 2000, health care
spending per worker will rise to $12,3 86, or 25 percent of compensation.
•
Without reform, by the year 2000, American workers will lose almost $600 in wages ~
~just to keep their health benefits [Commerce Department]
American businesses will drop or pare back coverage, or continue to pay more for employee
health benefits.
•
One and a half million fewer full-time workers receive health benefits directly through an
employer today, compared to 1988. [University ofNorth Carolina, 8/92]
•
In the future, 30 percent of small businesses currently providing insurance will drop their
insurance coverage because of the high cost. [Health Affairs. Spring 1992]
Choices will decline for those with insurance, as employers try to stem rising costs by switching
to managed care plans with a small number of "approved" doctors. And as more families fmd
themselves without insurance, those with any history of illness will join the 81 million
Americans labeled as having "pre-existing conditions".
•
In 1988 , 89% of employers offered indemnity (fee-for-service) plans. In 1993, only 65% of
employers offered such plans. ["Health Benefits in 1993", KPMG Peat Marwick]
•
Up to 30% of employees report that they are afraid to leave their job for fear of losing
continuous health insurance coverage.
Doctors will have less and less control over their practices and the care they provide their
patients, as people at insurance companies without medical degrees second-guess medical
decisions and dictate "necessary care".
The federal budget will be overwhelmed by health care spending on Medicare and Medicaid.
This will add to the deficit, raising the pressure to cut back on benefits in those programs. State
budgets will also be increasingly eaten up by Medicaid, paring back on crime-fighting and
education to pay for health services for welfare recipients.
•
Two-thirds of the growth in federal spending between 1993 and 1996 will be accounted for
by health care spending.
�Who Would Incremental Reform Really Hurt? Middle Class Families
Some propose an incremental approach to health reforms aimed not at guaranteed
coverage for everyone, but at trying to increase the number of people with some
insurance reforms and subsidies for the poor. Employers could continue to drop
coverage, and millions of families would continue to go without insurance.
It's hard-working Americans -- the middle class -- who would be hurt by such an
approach. It's middle class families who will continue to lose their coverage when they
change a job; to take out a second mortgage to pay the bills from a child's illness, to
forego career advancement for fear of losing the coverage they have with their current
job.
Besides, all the evidence suggests an incremental approach won't work; in fact, health
reform that falls short of universal coverage could actually make things worse. Millions
would remain uncovered, including some previously insured through their company.
Costs would not be controlled, leading to higher prices for working familes and a
ballooning federal deficit.
Millions of families remain at risk
•
Incremental reform bills will not cover everyone -- not even close. An estimated
24 - 40 million people would remain uninsured without universal coverage.
•
One in six Americans will still lose their health insurance at some point during the
year.
Middle class will take the hardest hit
•
Since the poor and non-working would get free coverage, and since wealthy
Alnericans could afford coverage on their own even if costs continue to rise, those
hardest hit by incremental reform would be middle-class working families.
•
Under a non-universal, managed competition-style reform plan , an estimated 2440 million people, more than twa thirds o.fthem in middle-class. working families.
would remain uninsured. The main reason these families wouldn't be covered is
the cost of insurance.
•
What's worse, many people who now have insurance protection today would find
themselves without coverage under an incremental reform plan. An estimated one
in ten workers with employer-sponsored insurance would be dropped by their
employer.
�The cost shift will continue
•
Under the Band-Aid approach, those who take responsibility for insurance
coverage will continue to pay for those who do not. Senator Chafee, a Republican
from Rhode Island, puts it this way: "If there's no mandate that people have to
belong, then young healthy males who don't ride motorcycles aren't going to join
and so the costs are going to be carried by those who are sick." Alain Enthoven,
the so-called "father" of managed competition, adds that "such a system would be
destroyed by free-riders".
The deficit will increase
•
Without any change to the existing system, two-thirds of the growth in federal
spending between 1993 and 1996 will be accounted for by health care spending.
•
Incremental reform plans aim to extend coverage to low-income families and the
unemployed by providing government subsidies to those Americans. Under a plan
with subsidies for the poor but no universal coverage, CBO says there would be
oyer $300 bmion added to the deficit in financin~ the subsidies for low income
Americans. By contrast, the President's plan is expected to curb expenditures by
$30 billion by the year 2000, and by $150 billion by 2004.
Universal coverage is the only way to guarantee controllable costs, and fair,
equitable f"mancing of health care.
Imagine a diner where everyone in a community goes for lunch. Most people have lunch,
pay, and leave, but every eighth person who walks into the diner sits down, orders
(usually the most expensive thing off the menu because they're famished), and gets up
and walks out without paying. The cost of that patron is spread over the other seven who
did pay. It only makes sense that when that eighth person pays for their lunch like
everybody else, and orders like everybody else, the cost to the other seven paying diners
will go down.
We don't think the solution is to charge working families through the nose for lunch, and
let the poor eat for free by taxing everyone who orders a steak. We think the free lunch
should end.
..
All Americans deserve the security of high quality health care coverage they can't lose,
even if they move or take a better job. The American health care system will be stronger,
better, and less costly if Congress finishes the job they've started and guarantees private
health insurance to all Americans this year.
�James].. Jion{?an
Health Care: Why We
·Failed the Last Time /
I am the doctor who was at the
bedside when the last national health
proposal. put forth by the Carter ad·
ministration. died. The time was May
1980 and the place the Senate Finance
Committee. I was the White House
represeatative for the Carter administratiDD during the committee's bi1J.
drlftin8 lieSSion. The proposal died
quiedy, v.itb little attention from the
media. after a t~ "Wastinl iiJ.
ness• during whic:h it shrank from a
larp, relatively robust proposal to a
small. anemic shadow of its former
self.
The Carter plan bepn. Wider priacil:!es released in July of 1978, u a
proposal for a pbase-in of universal
cavenaeo But the adminisuatiao was
never c:eruiD of support for the increased taxes of employer mandates
necessary to make universal coverage
a reality. So the plan bepn to diminish
evea before it was released in •draft
form• in Jaauary of 1979-to a proo
posal for a pbase-in of coverage, with
eada expiDSiml c:auditional on c:enaiD
ec:oaomic c:irc:anlsWKeL This coaditiaall phase-ill was tben diluted fur.
durilll c:cJillftSSiona coasultatiaaa. to oae CODditioned on further
conpessianal votes for implemenlatioa. each phase.
rlllllly, uni\-ersality was left behind
in March of 1979 when the Carter
admillisUatiDD feD back to an atte~Dpt
to • a pbasHneooaly biD tbat would
have ICbimd some modest expaasioa
of Jow.iDcome covenae. alon1 with a
cti1aled emplorer mandate of muc:b
less eJI)eDSive coveraae. apiost oaly
catasUopbically bigb bealtb costs. The
proposal fiDally apired in May 1980
. . . tbe F"IIIIIICe Committee failed to
reacb agreement even on dis anemic
remnant of the original proposal.
I write aow in the hope tbat we can
leara some lessons from an autopsy of
this case that milht lead to a differeat
outcame for the Clinton proposaL
There ue important similarities betweeD tbe Carter and Clinton pJaas
and their potitical context. Both proposals. at least at the outset, have
beellquile broad in scope, calling for a
pba&e-ia of UDiversal coverage, aDd a
broad set of benefits. financed in good
part through an employer mandate,
witb appropriate subsidies. There are
also some similarities in the political
~with. in both instances. a Democratic president working willa a Congress coauolled by Democrats.
These ue also, of course. important
differentes. Substantively, the CJintaa
u..
'··
name but two competing i:isues. Secoadly, there appears to be somewhat
more cohesion among Democrats than
there was in 1979 and 1980, when
health insurance became an important
battlqround in the suuale between
President Carter aad Sen. Edward M.
Kennedy prior to the primary election
fi(lbts in 1980.
Wbat lessaas can be learaed. then,
from the story of the iJI.Iated Carter
proposal? First we must establish the
cause of death. 1be Carter proposal
wasted away a little at a lime. gradually growinc smaller and smaller.
Why? Uncloubtedly, dMsioa amang the
Democracs was a major fac:cor: it pve
the admiaistlatiao little cboice but to
attempt to build a more coa&e~Yative
coalition around a muda lllllller propaaal in the F'IIIIIICe Committee.
EqaaUy important \VII the subordina·
tioD of the goal of universal coverage
to other goals-amaas them aWJidinl
tax incrases and empluja maadates..
wbicb uoaaed tbe aqer of the small-
business COIIliDIIIIitJ.
The first lessaa, tbea. is to mnem-.
18 the importaace of party c:obesioD.
A health insaraDce biD CIIIDDt be
paged by Democrats alaDe. It surely
canaat be passed witb a baci1J frac.
tuRd majoaity parlJ.
Democrats wbo
WDt healtb iusa&au&:e to pas must not
aJJow the best to became tbe enemy of
the load and bol dowa the debate in
repeated teses of ideoloP:al purity.
Having said tbat. the teCDDil Jesson
is tbat duriDI the paD IDii lui of
c:aapessioaal ac:tioa. the manl CiCIID"
pas to pile us tbrougb the bea1tb
insurance debate IDii lead to a successful c:andllsion 111111t not be lost or
set aside. That mca1 CICIIIIIIID is the
attainment. by a date cenaiD. of ani~ coverqe. Once this debate begins to slide dowa the slippely slope
away
from
universal
coverage,
tbrougb contingent UDivenal
cover-
aae. on down to im:remeDral expansions of coveraae. it wiD suffer the
same death by degrees as tbe Carter
proposaL
Although just about evayone in
Congress, of botb parties, is osteosibly
in faVIH' of the c:cacept of universal
coverage. there is stiD a notable queasiaess about the employer mandates
and taxes nee essary to make uaiversal
coverage real.
In the quest to pin the broad bipartisan support that will be DeCeSSiUY to
pass legislatjnn, then is the daager
that the goals of avoiding tases and
mmdates will apiD take~
the
of adlieving uaiversal
~~
w-
�L'ommunity-Rated Health Plans Prqve Popular,
But Success May Depend on Universal Coverage
By HIL.ut\' STOt:T
u,. THE v• ..u. STREET J•ll'R:-<AL
--'!".:.._.._.. tile~~
. . . . . ~,
I
~-~··~
S;a:' R•·P•·'''''
WASHI:'\GTO:X - It's the health·care
proposal ~veryone loves: the notion that
msurance compames shouldn't be allowed
to )ack up rates for sick people or others at
risk or pilin~ up big medical bills.
So attracuve is the concept. known as
"commumty ratmg, .. that even many Re·
publicans and conservau•;e Democrats say
Congress should go ahead and enact it.
along with a set of other insurance-market
revisions. and forget about umversal
Gop
health coverage ror now. A new
television advertising campaign pushes
for bipartisan insurance-market reforms
to "fix health care."
There·s 1 one problem with the idea.
·ust
experts insist and real·life evidence shows.
It probably won't work without umversal
covera~e. Indeed. several of the insurance
changes that reformers are clamoring for
may depend for their success on bringmg
nearly e\'erybody into the insurance pool.
For the past )'ear .:-lew York state has
tried community rating without a law
requiring everyone to have health insur·
dnce. The result has been a rise in insur·
ance premiums for younger. healthier
people and a drop in rates for older. sicker
individuals. Consequently, young people
have bailed out of the system. filnJJ'ing
they either won't need coverage or they'll
be able to get it at a reasonable price when
they do.
Older. Sicker People
:-;ow. msurers are raising prices again
in order to cover the medical needs of those
0lder. s1cker peopiP. left in the pool. State
msurance department figures show that as
l)f Jan. 1. nine months after the new law
took effect. 25.~i7. fewer people had health
insurance tndlvtduallv or m small·
employer groups. That'·s a 1.:!": decline.
The onl\' wa\' to avo1d this chain reac·
tion. man~: experts say. is to set up a
svstem wnere people can·t drop out. Uwe
Reinhardt. a Princeton University health
economist. sa vs that when he heard Republican cans· to enact insurance market
reforms alone as a way to vastty improve
the current svstem he reacted with "total
disbelief.·· Community rating without uni·
versal coverage "wiU trigger the worst
kind of behavior among insurers and pa·
tients." he says.
"If you can go in and out of a system at
will. then the only people who witt buy
insurance are those who need it." says
Barbara Ragle. legal counsel at Central
Reserve Life Insurance Co.
:'\or is community rating the only popu·
lar insurance reform that would be nearly
impossible without universal coverage.
The same thing is true of proposals to
outlaw the common industry practice of
refusing to cover people with known medl·
cal problems. so-called pre-existing condi·
. lions Most healllt bills that stoD short of
"'OW
me ma;or nea1tn-retorm o1ar.s aea1
·:11!~
- ' ... ·.
.•
, •. o~c.,.
:"e ·ssut ct c:;~mur.1t'l ·at:"g
• CLINTON: No ;Jrem:um .:ar;at1ons
allowea tor age. !'r.eOtcal sratus. geog·
raony or lifestyle Separate pools
accoramg to tam11y s;ze
• SENATE WOR AND HUMAN RESOURCES
·
, (-_....... J 91 s
c'"t
une : ame as 1 on Dut
_
pnased '" over tour years.
I
I ..,...........
I • CHAFEE: Health olans must offer a
·
n ~our separate OCO!S r:: ·. ::wl.S
emo,oyers wttn 2·250 emo oyees.
employers w1tn more t~an 250 ,·;or(ers.
assoc1at1on plans ana t'eJitr. aiharces
• SENATE FINANCE (currently under can·
slderation): P~em1um var.at;ons
accoramg to fam1iy SIZe. geography ana
age. Htgnest age·adtustea prem1um
may be no more tnan tw1ce tne lowest
age·aatustea prem1um.
modified commun1ty rate prem1um tor
people ana bus messes of unaer 100
• COOPER·BREAUX: No adtustments
workers wno buy 1nsurance througn a
allowea tor med1ca1 status or numoer o+
purcnasmg coooerauve.
oast med1ca1 c1a1ms: prem1ums can oe
• HOUSE WAYS AND MEANS (currently
vaned according to geography ana. to
under consideration,: Commumty ratmg
some degree. age.
._1-------------~------------Some supponers of community rating
at a deathly ill patient. seein~e a SlOO.ooo
are pushing to allow some adjustments. 1 bill. and cheerfull)' enroll that person for
such as for age and habits that affect
S2.000.1t goes against human nature. So in
health, like smoking. And for all the rhetoorder to overcome normal human nature.
ric embracing community rating, most
you need some coercion ...
of the actual bills under consideration in
That means that while everyone pays
Congress wouJd adopt only a modified
the same amount into a communitv·rated
version of the concept.
~ystem. a mechanism muse be sei up so
"Nobody is proposing pure community msurance companies receive varying
rating;• says Henry Aaron, an economist amounts. depending on tile rist levels or
at the Brookings Institution in Wuhing· their beneficiary pools. Otherwise, a plan
ton. Even the sweeping Clinton proposal
would aJlow four different types of regional t~at for some reason wu chosen by a
risk pools. based on family type - for tndi· ~tsproponionate number of, say, HIV·posi·
viduals. for single parents with children. ttve people. would be in bad finanCial
for couples and for two-parent families shape. Ultimately. heaJth plans overloaded
with bad risks who pay low premtums
with children.
The House ways and Means Commit· could collapse. Risk·adjusting basicatly
tee, under pressure from the insurance requires plans with better risk pools to
industry, is considering a biU with five
subsidiZe those with worse risk pools.
1 different market sectors. based largely on
The administration proposed health at·
a person's employer. Each sector would be
community rated. but insurers wouldn't liances to accomplish that task. However.
have to sell policies in every sector. The most of the people pushing insurance reforms are balking at alliances. Conse1 adi s t R bli
b'll writte b
.J~hn n~h~: ~f g~ec~at!d: allows" i;. quently, large mandatory alliances are
surers to adjust for age and geography in all but dead in Congress.
some markets.
Alliances aren't the only entities that
In fact, many people .argue that the only could perform such functions. "It could be
legislation that guarantees a true commu· done througb state insurance regulation.··
nity·rated approach are bills establishing a says Mr. Aaron. The Vinue of alliances.
"single-payer" health system. where the Prof. Reinhardt points ouL is that they also
government pays people's medical bills wouJd collect the heaJth-insurance pre·
with tax revenues.
miums. and could then tum around and
Other things that make community pay money out to plans in the form of a
ratings work are also opposed by sup· "risk-adjusted premium." He says.
porters of the concept. A successful com· ·'That's a lot different than having to go in
munity·rated system requires a bureau· there and fight with their lawyers."
cratic structure to oversee it. Yet many of
the people calling for insurance-market
reforms are the same ones decrying the
large regional health alliances that Presi·
dent Clinton has proposed.
The alliances. which would be set up by
the states. would include employees of all
1 businesses with fewer than 5.000 workers .
r
II
The WhitA UnncA C"VC thAV wero N\nreivAri
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative marker
by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our digitization
capabilities, we are sometimes unable to adequately scan such dividers.
The title from the original document is indicated below.
Divider Title:
Scanning Technician Manual
Clinton Library Digitlzatlon Pilot Project
11/10/2014
Page 30
�...
.
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IDSIORY OF TilE FEDERAL :MINIMUM WAGE SINCE 1965
Year
Wage
Amount of Increase
1964
1967
1968
1974
1975
1976
1978
1979
1980
1981
1990
1991
$1.25
$1.40
$1.60
$200
$210
$230
$265
$290
$3.10
$3.35
$3.80
$4.25
*
.15
.20
.40
.10
.20
.35
.25
.20
.25
.45
.45
·
. . . . .·.
-·'-
,; ...... .
�SENT BY:OffiCE Of SECRETARY
; 6-16-94 ; 9:22AM ;
U.S. Depw-lmenL of Labor (June 16, 1994)
The Minimum Wage and EmplOJDY!IU
While the potential employment effects of a minimum wage increase surely Med
to be c:omldered, the wet~t of lhe empirical evidence suggests that the effects of a
moderate raise from its current level ue Ukely to be negliglole in either direction. This
conclusion is based on a variety of recent studies employing different methodologies;
the studies examined thP. P.ffeets of raises mthe federal minimum wage both ac:roaa the
nation and in pardcular states, as well as the effects of raising state minimum wages
above the federal level.
Richard Freeman of Harvard University •• long considered one of the nation's
preeminent labor economists - juRt r.ompleted a review of the studies of the
employment effects of the minimum wage. He concluded:
"At the level of the minimum wage in the late 1980s, moderate legislated
increases did not reduce employment and were, if anything, associated with
higher employment in some lo~al...,;.
Studies bused on employment act·~»~t ~unumic unitS such as states and counties
yield. more disparate results. Most studies, however, reject the notion that the
late 19805-early 1990s increases had adverse employment effects, and the studies
that find adverse effects prior to those increa~P.S obtain small elastidties
[meaning small employment effects] that confinn the eff«ti\leness of the
minimum In rediBtrlbuting wage inc:ome.
...That moderate increases in the minimum transferred income to the lower paid
without any apparent adverse effect on employmP.nt In the U.S. at the turn of the
1990s is no mean achievement for a policy tool in an era when the real earnings
of the l•s skWed feU slwrpl;y."1
The studies that Freeman reviewed examined fairly large i.naases in the
minimum wage. One of the state stUdies estimated the eft'P.dR of New Jersey recendy
ndsing its state minimum wage by 80 cents. from $4.25 an hour to $5.05 an hour;2
annther enmined the effeets of Calilomia increasing its nunlmum wage 90 cents from
$3.35 an hour in 1987 to $4.25 an hour in 1988 (which would equal $5.20 iD 1993
dollars),, Studies of the federal minimum wage examined the effects of a 90 cent
1
Richard Freeman. "Minnmum Wages - Agajn,• prepared for the Conference on Beonomic Analysb
of Base Salaries and B.ffec:u of Minhnum Wages. Am en Provanco:•. Reptember 30 • Od:obef 1, 1993.
Davicl Cant. and Alan Krueger, ~um Wages and Rmplo~ A Case Study of the Put
Foocl Inchutzy in New Jersey and Pennsylvania,• Jnduatrial Jlelationa Section, PrincetGn Univmlty,
2
AuJUJt 1993.
3
David Card, "Do Minimum Wacea ltH'hltt Employment? A Cue Stucly of California, 1987-89;
Industrial anct tabor Relations B.eyiew, October 1992.
�u1ct:ease 1n two lncremt:nlti uver a two-year period." All of these srudles found that the
. minimum Wage increases did DQ1 reduee emplo)'llleDt opportUnities.
Some recP.nt studies of raises in die minimum wage have found that it had a
negative effect on employment. These other studies, however, include methodological
~ m~l widely dted of these studies was
conducted by David Neumark and William Wascher.' Their study, however, mistakenly
assumes no teenagers are simultaneously attending school and workins, when this is in
fact a common occurrence. They also U5f! a mP.aS\1re of the minimum wage that skews
their findings. When David Card, Lmy Katz and Alan Krueger corrected for these two
ftaws that bias their Ie&Ults. F01· example,
errors, and reanalyzed Neumark and Wuc:hea.Js data, tbe 1a-ulL» apia show that the
mJnimum wage does not negatively aft'ec:t employment.6
These studies do not suuest or prove that au incna.a.w. in the minimum wage no matter how large -· would have only desirable effects. But the outcomes of the
studies suggests that the low·wage market does not fully conform to the slmple labor
market model described in most introduc:tory economics textbooks. In the textbook
model. firms can immediately and costlessly fill all vacancies and worken are not
modvated by concerns about equity. In actuaUty, workers have to search for openings.
firms expend resources in recruitina, and both are c:onc:emed with equity, fairness, and
motivation. More realisdc lobor INU'kct modcls that emphasize theJe elements have
been developed by distinguished economists such as George Akerlof of the University of
CalitomJa at Berkeley, Robert SOlow of the Massachusetts Institute of Technology, and
Joe Stiglitz. In suc:h models. modest increases in the minimum wage can potentially
lead to expansions in employment because they decrease turnover, reduce vacancies,
and increase commitment and hence productivity.
lD c:onc:lusfon. when the mfnlmum wage is at especially low levels, as it is today.
the employment effects of a moderate increase in the minimum wage are likely to be
negligible.
4
David card, Lawrence F. Katz ancl Alao B. Krueger, 'Comment on David Neumark and William
Wucher, "Employment Bfl'ec:ta of Minimum and Subminimum Wages: Panel Data on Stare Minimum
Wage ~.oaw~•, Workina Paper #316, Prineeton lnduaaial Relations Section, April1993, forthcoming In the
Industrial and ~ R.eladons R4yjew; David Card, ttt.Jsina R.egioMl Variation in Wages to Measure the
Hffeera oC the Federal Minimum Wqe,• lndwqial i Labor RelatioN RevJew. October 1992: and
Lawrence Kat& and Alan Krueaer. ~ Efflff ol the Minimum Wap on the Put·PoocllndJUtry.•
lnc:lustrial and Labor ReJatiPQI R.eylew, October 1992.
'
David Neumark and WilUam Wascher, -&nployment BffectJ of Minimum and Subminimum
Waaea: Plftel Data on State Minimum Wage Laws', Industrial & Labor. Relations lteview. October 1992.
6
David Card, Lawreuce P. katz and Alan B. knle.ter, "Comment on. David Newnalk and WUliam
Wucher, "EEIIplo:yment Bffe$.ofMinimum and SUbminimum Wages: Panel Data on State Mimmum
Wqe Laws', Worldns Paper #316. Princeton lndUitrial Relations Section. April1993: fmthcomins in
the Indumlal and Labor klatlon! lteyiew.
2
�WHAT IS THE MINIMUM WAGE EFFECT OF HEALTH
CARE REFORM?
SUMMARY:
Some critics of the Health Security Act have tried to assert
that health care reform is equivalent to an increase in the
minimum wage, which they claim will cost jobs in small
business. In fact, an increase in health care costs for
currently insured low-wage workers in small firms is
equivalent to only a very modest minimum wage increase
of $.15 to $.35 per hour. An increase of this magnitude
will still leave the real compensation cost for minimum
wage workers below its aL·erage level in the 1980's, when
adjusted for inflation. 1.'1Jany studies indicate that recent
increases in the minimum wage have had minimal -- or
even positive -- effects on employment.
POLICY:
Minimum wage workers will see different effects of the reform, depending on
where they work. The minimum wage is currently $4.25. For frrms with the
following caps, the increase in the effective minimum wage is:
Firm
3.5% cap
7.9% cap
Increase
$ .15
$ .34
EVIDENCE THAT MINIMUM WAGE INCREASE WON'T COST JOBS:
Richard Freeman, Harvard University
This preeminent labor economist found that "moderate legislated increases
did not reduce employment and were, if anything, associated with higher
employment in some locales ... Most studies ... reject the notion that the late
1980's-early 1990's increases had adverse employment effects". [Richard
Freeman, "Minimum Wages -- Again". prepared for the Conference on Economic Analysis of
Base Salaries and Effects of Minimum Wages, Ai.'C en Provence, September 30-0ctober 1,
1993]
Lawrence Katz, US Department of Labor
David Card and Alan Krueger, Princeton University
These economists found that when the total labor pool. including part-time
workers, is analyzed, minimum wage increases do not negatively effect
employment. In fact, the increases studied by these economists were much
larger ($.90 over two years) than those projected under health care reform.
[Industrial and Labor Relations Review, October 1992: Industrial and Labor Relations
Review, October 1992]
�DISTRIBUTION OF WORKERS WITH/WITHOUT EMPLOYERPROVIDED INSURANCE BY WAGE LEVEL
•
The following table breaks down the total number of workers (11i million)
by their wages (over $4.30 per hour and under $4.30 per hour) and
whether or not these workers work for firms that currently offer
msurance.
•
For example, the "Currently Covered by Own Employer" section
illustrates that there are 1 million workers who make less than $4.30 per
hour and are currently covered by their own employer.
·· Eleven percent of these individuals work for firms that will be
capped at 3.5 percent of payroll under reform.
·· Thirty-three percent work for firms that will not be capped.
-- Twenty one percent work for firms that will belong to corporate
alliances.
Regional.'-\lliance
Firm Cap
Workers
Num 3.5
(millions)
4.4
5.3
6.2
i.1
7.9
No.
Cap
Corn. Allian..
Total
117
3%
3%
4%
4%
15%
46%
19%
5%
Currentlv Covered bv Own Emplover
Total
<$4.30
70
1
2%
11%
1%
4%
2%
3%
2%
2%
2%
3%
15%
24%
52% 23%
33% 21%
Currently Not Covered bv Own Emplover
Total
<$4.30
47
4
13%
25%
5%
6%
4%
3%
5%
3%
9
5%
2%
18%
18%
37%
26%
14%
16%
�EMPLOYER MANDATE VS. BUSH MINIMUM WAGE INCREASE
For most employers with less than 75 workers, the hourly cost of health care
under the Health Security Act will be less than the $.90 increase in the
minimum wage signed into law in 1989 by President George Bush -- an increase
that had no negligible effect on jobs.
See attached chart for a comparison.
I
I
.
�~.
A Burden on Small Business?
IL
.\
(The BUSH Minimum Wage Increase v. the CliNTON Mandate)
$1
-------------------1
$0.8
$0.6-
$0.4
. i..
!
I
-----------·-------------1
------------------- ----4
$0.2
CUNTON Employer M~~ate
~
r
,
•
~
· · .
:
1. , ;
~
;
1: ~
r· .1
•
�HAWAll: DOES IT HAVE UNIVERSAL COVERAGE?
RHETORIC:
•
''After 20 years of operation, Hawaii's employer mandate has produced coverage levels
(92 percent to 93 percent) no higher than in Connecticut, Minnesota, or elsewhere." [Jack
Ferris, NFm, Washin$Jt Post. 6/13/94]
IS THIS TRUE?
•
The statistic: The Hawaiian Department of Health estimates that 4.3% of their
population, at the most, still lacks insurance. Other estimates -- such as 6.0 from the
1992 Current Population Survey -- include people with employer coverage, Medicaid and
Medicare but leave out those under the new state government supplemental program
(estimated at about 2% of the population).
•
Hawaiian officials are the first to agree that there is only so far they can go on their own.
They argue that an employer mandate cannot get all the way to universal coverage by
itself. You must have a system of shared responsibility -- such as the President's
proposal. Employers contribute, employees contribute, and the government helps those
who have lost their jobs or who are unemployed.
•
There are people that are left out of Hawaii's employer mandate. The unemployed, of
course, are not included. It also does not cover people who work less than 20 hours a
week or dependents. Because Hawaii is not able to change their mandate [per the
conditions of their ERISA exemption], they established a supplemental program to
include these groups. This program -- the State Health Insurance Program -- has been
very successful and 22,000 people are now included. Hawaiian officials welcome a
federal solution that will bring more people in under the mandate.
WHAT WE COULD SAY:
•
The experience ofHawaii demonstrates that an employer mandate works: both business
and employees prosper. Since Hawaii began asking all employers to provide insurance
for their employees in 1974, the unemployment rate has dropped to one of the lowest in
the nation and small business creation rates have remained high. But no one argues that
an employer mandate can bring a state -- or the country -- all the way to universal
coverage by itself. There are people who are not covered by an employer mandate people between jobs for example. The President's proposal ofshared responsibility-employers, employees, and the government -- will give every American private insurance.
•
A positive conclusjon: And, since Hawaii has come very close to universal coverage,
health costs are about 30 percent lower. Hawaii's experience proves that the more
people are in the health care system, the lower costs can be.
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative marker
by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a tabbed divider. Given our digitization
capabilities, we are sometimes unable to adequately scan such dividers.
The title from the original document is indicated below.
Divider Title:
Scanning Technician Manual
Clinton Library Digitlzation Pilot Project
i
,_
11/10/2014
Page30
-----------
�DELffiERATE MISINFORMATION
Message:
•
The Brokaw program is the ideal opportunity to warn everyday Americans
that many ofthe things they hear about the President's approach are just
plain wrong -- deliberate distortions by opponents ofreform intended to
scare them.
Title of Wall Street Journal Exgose: "Truth Lands in Intensive Care Unit as
New Ads Seek to Demonize Clintons' Health-Reform Plan. •• " [4/29/94]
"The only problem with the radio spot produced by a Washington based
group called American for Tax Reform, is that it isn't true. Neither the
Clinton health-care bill nor any of the alternatives on Capitol Hill would force
people to call for government approval before visiting a doctor or rushing to the
hospital." [The Wall Street Journal, 4/29/94]
•
Note that the advertisement features a woman with a screaming child,
desperate for help, calling 1-800-Government and reaching a recording
that says: ''All health care representatives are busy, please hold . .. "
•
"Fear mongering is rampant as Congress moves forward on compromise health
care legislation. The complexity of the Clinton proposal and the fact that the issue
affects every American have resulted in a flood of alarmist propaganda that
makes Harry and Louise, the health insurance industry's fictitious Clinton critic,
look like Ozzie and Harriet." [The Wall Street Journal, 4/29/94]
•
"Some groups have taken the terrifying images to a dift'erent level, serving
up wh~lly fictional accounts of people denied the most basic care by a
heartless bureaucracy." [The Wall Street Journal, 4/29/94]
•
"The health care debate has brought out a feeding frenzy of fear mongers whose
primary goal is to fleece older Americans. The sad part is not just the money
being scammed from poor people on fixed incomes, but that older Americans are
being used as a catspaw to cripple a health care plan that would give most of them
what they want and need." [NCSC Press Release, 5/26/94]
•
"In the current debate, fear has unfortunately become a growth industry."
[NCSC Press Release, 5/26/94]
•
, I
"The information groups are mailing to seniors across the nation is misleading
and irresponsible. Debate on health care reform issues is healthy, but it is
unconscionable to prey on senior's fears just to raise funds for a lobbying group
that doesn't have any visible lobby." [ AARP Press Release, 5/26/94]
�Truth Lantis in-Intensive Care Unit as New Ads
Seek to Demonize Clintons' Health-Reform Plan
By RICK
W.UTZ:'tiA.~
Sta.rr· Reporter o,f THE W 4LI. STREET JUL'RS.\L
WASHIXGTO:'l - The baby's scream is
anguished. Ihe motner·s voice desperate.
··Please.·· she pleads into the phone. as she
seeks help for her sick cbild.
"We're sorry. the government health·
care center is now closed... says the recording at the other end of the line.
"However. if this is an emergency, you
may cau l·Soo-Government." Her baby
still wailing. she tries it. only to be greeted
by another recording: "We're sorry, all
health·care representatives are busy now.
Please stay on the line and our first
available ... "
"Why did they let the government take
over?" she asks plamtively. "I need my
family doctor back ...
The only problem with the radio spot.
produced by a WashmgtOn·based group
called Amencans for Tax Reform. is that it
1sn·t true. Xeither the Clinton health-care
bill nor any of the alternatives on Capitol
Hill would force people to caU for govern·
ment approval before visiting a doctor or
rushing to the hospital. "It scares people.
and that irritates the dickens out of
me... says Democratic Rep. Jim Slattery, a
critical vote on the House Energy and
Commerce Committee whose eastern
Kansas district was a target of the ad.
Battle Heattng Up
Such fear-mongering is rampant as
Congress moves forward on compromise
health·care legislation. The complexity of
the Clinton proposal and the fact that the
issue affects every American have resulted
in a flood of alarmist propaganda that
makes Harry and Louise. the health·insur·
ance mdustry's fictitious Clinton critics,
look like Ozzie and Harriet.
Some of the horror stories stem from
Ideological differences. ~fany of the groups
twisting the facts are hard·llne conserva·
tives. bent on stopping any government
presence m health care. But clearly there
are other motives as well. Some groups. in
issumg direct·mail waminp about healtb·
care reform. are solldunr money to help
their cause.
Americans for Tu Reform. which
claims 60.000 memben. malres no apol~
g~.es for the 1·8110-Govemment ad. "Is it
frightening? Yes. Do I thint we overstate
the case? :'lo... insists Grover NorqUist. the
president of the group. which is perhaps
best known for asking lawmakers to sign a
pledge opposing all income-taX increases.
Yet even some of the toughest critics of
the Clinton health-care proposal. upon
hearing the ad. condemn iL "I think it's
unnecessary to use scare tactics." says the
Manhattan
Institute's
Ellzabetb
McCaughey, whose own attact on the
Clinton plan in The New Republic map·
zine was denounced by the White House
and its allies.
''g J'sCn"qbs" PubS defend' b•"
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Amlfi&an Councillor Hlllth Cart RtiDrm 'I diflct m•illiltfiiUfl
"You will not see Dr. !\lurray," the
"government gatekeeper" replies. "Dr.
Johnson wtll see your son next week....
l'nder health reform all Americans. and
that includes you and your son. will have to
go through government health alllances
With gatekeepers like me. We Will decide
who. when. or even if you need to see a
doctor."
Brent Babler of Cltlzens for a Sound
Economy claims that "what we're present·
ing is a likely outcome" if legislation like
the Clinton bill is passed. But that's impos·
sible. None of the health-care proposals on
the table. includinr the president's. has a
"government gatekeeper.··
Some opponents of the Clinton bill
worry that such spurious claims could
backfire. "It becomes all too easy to fault
anyone who has legitimate criticism,"
says Pam 8ailey, president of the Health·
care Leadership Counc11. a coalition of
medical Industry representatives that Is
lobbytnr against the Clinton plan.
Sometimes. the fabrications are born of
real concerns. Many experts worry that
the Clinton bill, With its regional insur·
ance-buying pools and a National Health
Board to oversee the system. would give
too much power to the government.
Moreover. many believe the Clinton
plan would hasten the already fast·rrow·
ing trend of' "managed care," where a
person's choice of doctors is limited and
physician "gatekeepers" often dectde
whether a cenain treatment is appropri·
ate. Some analysts caution that because of
strict healtb-care spendinr caps in the
Clinton biD. ratlontnr is possible.
The groups ta1c1nr the hardest line
against the Clinton plan tend to oppose the
president's goal of guaranteeinr coml)rehensive health coverare for every Ameri·
C'D
Y•nv favn-
instead a
marp
llmth¥1
United Seniors was founded by conser·
vative direct·mail pioneer -Ricbard Vl·
guerie. though he is no longer associated
with it. The organiZation is uod=:l
investigation by tbe Palell.
n
Service and the FedenUiuna oiiDvesti·
gatton. ac:c:ordlllr to pos&lllnspeclllr Larry
Fryer. The associatioa, .wldcll says it
hasn't heard from any federlllnvesttra·
tors since October. comptalal it's tbe Victim of a political witcb blllll.~'lt'l frustrat·
inr." says United Senion ....,.an Steven Allen. a former senate aide.
Another of the bil calllldl about the
Clinton plan is that people face "5·year's
in jail if you buy exaa-can." as. the
American Council for Healtll Cln Refonn.
an ArlingtOn. VL. group. PUll it in a
direct·mail pac:kap it hal sent out to
millions of pec»~Jle. Tht"'COUIIcil. which
according to tax records hid revenue of
5302.259 in 1993. was fouaded 11 years ago
to get the government out of llealth care.
"We aren't beinr alal'llltlt.;" says the
group's Christopher Maaioa. "We think
the Cllnton bW Is aJarmilll."
But in fact. while there il an antibrib·
ery provisioll in tbe C1IDtaD prapasal. the
bW expUdUy says that people are free to
purchase "any healtb care serVices" they
want out of their own poclalll.
"I don't see anybody IOinr to jail on a
liver-transplant rap,'' says JobD Sheils. a
Vice president at healtb-cue consulting
finn LeWin·VHI Inc. "Tbey're trying tc
scare litUe old ladies."
�CDALIIlON FOR HEAL1H INSURANCE CHOICES ADVERI1SEMENTS
Television advertisement #1
Woman:
"This was covered under our old plan."
Man:
"Oh yeah, that was a good one, wasn't it?"
Announcer: "Things are changing, and not all for the better. The government may
force is to pick from a few health plans designed by government
bureaucrats."
Woman:
"Having choices we don't like is no choice at all."
Man:
"Yeah. niEY choose."
She:
"We lose."
Announcer: "For reforms that protect what we have, call toll- free. Know the facts.
If we let the government choose, we lose. Call today."
'IV ad #2.
Harry:
"rm glad the President's doing something about health
care reform."
Louise:
"He's right We need il"
Harry:
"Some of these details."
Louise:
"Like a national limit on health care?"
Harry:
"Really."
Louise:
"The government caps how much the country can spend health care and
says, 'that's it'".
Harry:
"So what if the health plan runs out of money?"
Louise:
"There's got to be a better way."
'IV ad #3
Harry:
"Find more you like in the President's plan?"
Louise:
"Yeah."
�Harry:
"And?"
Louise:
"Well, it just doesn't have the choice we want ...Look at this: the
government picks health plans, then we have to pick a plan from their
list That's the choice we gel"
Harry:
"What if we don't like their choices?"
Louise:
"If it's not on their list . . ."
Harry:
"Well, ~re's got to be a better way."
Announcer: "There's a better way to reform. Call this toll-free number for the facts.
Call today."
1Vad #4
(In the car)
Harry:
"On Saturday?"
Louise:
"O.K."
Harry:
"Have a great day."
Louise:
"Bye."
Harry:
"Bye, Honey."
(In Louise's office)
Libby:
"Louise, can we talk for a moment?"
Louise:
"rm with the President on health care for everyone ... but these details...
Uke the national health care budget? The government sets a ceiling on
spending and says 'that's it'"
Libby:
"Bu~
Louise:
"There gQt to be a better way, Libby.''
what if there's not enough money... ? I mean what happens then?"
1Vad #5
Libby:
"I want Congress to pass health care reform. .. "
Louise:
"Make sure everyone is covered..."
�Ubby:
"But not force us to buy our insurance form these mandatory
government 'health alliances.'"
Louise:
"So we couldn't choose a plan that's not on their list even if we think it's
better for our employees and their families?"
Ubby:
"Not according to this."
Louise:
"But Congress can fix that .. cover everyone and let us pick the plan we
want"
Ubby:
"And they will, if we send them that message."
1Vad #6
(Matt is the teenage son of Louise and Harry)
Louise:
"Good game?"
Matt
"Oh, well, I let him win."
Harry:
"Time to hit the books, bud."
Matt
"rm going."
Harry:
"Health care reform again, huh?"
Louise:
"This plan forces us to buy our insurance through these new, mandatory
government health alliances."
Harry:
"Run by tens of thousands of new bureaucrats."
Louise:
"Another billion dollar bureaucracy."
Harry:
"You know, we just don't need government monopolies to get health
coverage to everyone."
Louise:
"Congress can fix that"
Harry:
"And they will, if we send them that message."
1V ad #7
(Hospital setting)
Nurse:
"Dr. Abrams. Code Blue. ICU." (on intercom)
�Nurse:
"He's in ventricular fibrillation.
Doctor:
"One milligram Adrenalin IV push. Shock with 200 jules."
Technician: "Cear."
Nurse:
"I have a pulse."
Announcer: "Necessary medical care and the coverage to pay for it. We want that
guaranteed for every American. Congress is considering half a dozen
health care reform proposals with much to like, and a few problems to
fix, like mandatory government health alliances. Nearly everyone
forced to buy health insurance through untested government agencies
run by tens of thousands of new bureaucrats. A new billion dollar
bureaucracy. We don't have to settle for that. Congress can make sure
every American is covered without mandatory government monopolies.
Doctor:
"He's fine. He's going to make it"
lVad #8
(Office setting)
Woman 1:
"Our small business is like a family. We care about each other, and we
provide health coverage everyone here likes. But all that may change
soon."
Woman 2:
"Here's that book you wanted."
Woman 1:
"Oh, thanks.... Congress is considering legislation that will force us to
buy coverage through untested, mandatory government health alliances.
We may have to give up our current plan for one bought through our
government. Even if we like another plan better, the only ones we can
choose are those on the government list. We don't have to settle for
that. We can cover every American without government monopolies.
Announcer: "Congress can pass the health care reform we want, and they will if we
tell them to cover everyone without these untested mandatory health
alliances."
1Vad#9
(Thanksgiving dinner with Arthur and Dorothy, Louise's parents.)
Dorothy:
"rm just thankful we're all healthy."
�Arthur:
"And we'll all stay healthy if Congress does right by reform."
Dorothy:
"Dad called that 800 number on 'IV."
Louise:
"And?"
Arthur:
"And I got ideas about coverage you keep even if you get sick, or
change jobs or lose your job."
Harry:
"Everyone covered?"
Arthur:
"Everyone."
Louise:
"Like the President wants."
Arthur:
"And this plan is backed by thousands of Americans like your mother
and me ...and our insurance company."
Dorothy:
"Sounds like there is a better way."
Harry:
"Sounds like I am going to call that 800 number."
Radio ad #1
Woman:
"The President's right America wants health care coverage that
everyone can keep."
Announcer: "But let's be sure health care reform gives us security we want There's
a book in the stores with all the details of the President's proposal.
There's a lot to like but also much to worry about Page 65 says
everyone in America would choose from only those plans approved by
the government"
Woman:
"Wail We can only choose one of those plans on their list?"
Announcer: "Page 102 says that the government will set a limit on what everyone
can spend for health care."
Woman:
"So if my health care plan runs out of money, I'm out of luck?"
Announcer: "There's a better way to reform. Insurance everyone can get, everyone
can afford and everyone can keep. Even if they change or lose their job.
For a better way to health care reform alll-800-285-HEALTH."
5
�N()... ho ~
tl
J 22.-1,3
American.s Are Calling:
For Health Care Reform.
Each day thousands of
Americans call our 800 number
looking for a better way to reform
the health care system. They
are getting a sweeping proposal developed by
America's best insurance companies.
It will provide cradle to grave coverage for
all Americans. Coverage you are sure to get
even if you have an existing illness. Coverage
you can afford and coverage you can keep even
if you change jobs or lose your job. Best of all,
you can choose to keep your present plan. This
is the reform America wants.
Ov'""
A Better Way To Reform
We are committed to the health ~are
reform America wants. Call toll free for information on the visionary proposal developed by
the Health Insurance Association. of America
(HIAA) and endorsed by thousands of farmers,
seniors, businesses and individual consumers.
Read the plan that will help make the President's
plan better.
For A Better Way To Reform
1-800-285-HEALTH
•
Coalition for Health
Insurance Choices
Sponsored by a coalition of thousands of businesses. individuals, conswneiS. farmen, sc:nion and insuren. Major funding by Health Insurance Assoc. of America.
�SEP
9'92
!~:55
F~
(Nt~
SFECIAL
RSSI~~M~N
02
5~5
2929
~0
~45E5425
Here's Where America's Best
Insurance Companies
Stand on Health Care Reform
~Q one has thought more about health care reform than the people of America's best
;nsurance companies. More than two years ago we began meeting with thousands of Americans.
We list~ned tc their views and called on our experience to develop a comprehensive reform
proposal. To the $Urprise of those who want to make us their scapegoat. here's where we stand:
Wllat V\i'e Are For
What We Are ApiDSt
• •Cmcile 10 grave• co,·erage for all Americans.
• 1\o ex::lusioos for existing or previous illness.
• Co"erage ~a.-:not be canceled if you get s;~k.
•
Exc:lu.:;ive health alliances. monopl)!ies or cartels.
Aat community rating.
• · Artificial COI)trOIS on rmce.
+
• If you change jobs or lose your jcb, CO\·eragt goes
Wlttl VOl!.
•
•
•
•
•
+
•
•
E~loyc:r~ and er.tployees both pay toward
cO\'\!rage.
Subiidies for ttl~ woo can:lOt aiford premiums.
CoutroJ maJpractict lawsuits and 1..t.nneeeSsary testS.
Ptiblilih price and quality data.
Single ciaim form t0 COOifOI paperwork.
lncen:ives for beaJtll) lii~tyl.a. Empha.~s on
wellness and prevention.
S~o;;> shifting cosrs of Medicaid and Medicare
t-.' those with pri\-are insurance.
L~li!n~ managea.:are to comrol costs.
America's IDsurers Are For
The Refonn America Wants
.Vr1W i.sn 't that a nic" surpriss?
Amtrica';; best insurance companies are backing a positive propow r.o provide bealt!l care refonn. To
that ga.l. we ve helped fund and organize The Coalition for ltealtb lasu.tanu Choices. a broad based
coalition of teo!l Qf thou..qnds Qf individuals. small bu~inesse4. ma.ior c:~rporarion.o;, ano many other orgAni~stions.
call tbt: toll ftee nwnber below. We'll send you U1formation on health care reform that ~ill work. ana on me.maJl) people and comp&:liea working tc make it a reality.
acr.i.~'<e
For Facts on Tbe Reforms Amtrica Wuu
Calll•800•28S HEALTH
�C< > \LlTf<)\"
FOR HE.-\L.TH
hsL R.--\.,CE CHoiCES
Dear Concerned Americans:
Thank you for calling the Coalition for Health Insurance Choices.
The Coalition is dedicated to s~curinl! h~alth care reform whkh would !Zuarantee l:uvera!Ze
everyone can get. keep and afford. At the same time. the Coalition's ref~nns would prote-ct
choice and limit the role of government to policing. but not running. our health care system.
~any of the Coalition's refonn principles. which are outlined in the enclosed brochure. are
similar to those contained in the Administration's health care reform proposal. However.
other areas in the Administration's plan raise great concerns.
For example. the Administration's plan Nould establish mandatory ··health alliances:· Under
this provision. the government would tell you where you had to go to purchase your health
coverage and from which few plans you could choose.
If we allow the untested and mandatory health alliance requirements of the Administration's
plan to move forward. you could be forced to give up your current health care coverage and
could be required to pick a health care plan selected by government bureaucrats.
It won't make any difference if you are currently very satisfied and secure with the health
care plan you have. Your only choice will be to pick one of the few plans and insurers
the bureaucrats have already selected for you.
The Administration's plan would also set a so-called ··global budget"' spending limit on what
can be spent on health care in each health alliance. While we must control costs. global
budgeting raises serious concerns. It could mean rationing of care. long lines and limits on
procedures that are covered. It could also reduce the quality of care we receive.
What America wants in health care reform is covt:ragt: I!Vt:ry one can gt:t. coverag~ everyone
can afford. and coverage everyone can keep. We can achieve these reforms without being
forced to accept a government run health care monopoly or so-called global budget limits on
health care.
We don't have to settle for less competition and innovation. We don't have to force
Americans to exchange their current health plans for an unproven government experiment.
That's why we've organized the Coalition for Health Insurance Choices. The Coalition.
representing tens of thousands of Americans. including business owners and employees.
consumers. seniors. farmers. health care workers and insurers. has a plan that provides for the
refonn America wants without setting up a government monopoly and global spending limits
which will severely restrict your health care choices.
<oven
102~ (,llm.:~·ti..:Ut
.-\1-:nu.:. \.\\' .. Suit.: 111!4
D.C. 200.'o
\\'J~hingllm.
21 )~/X:!X-7 ~ 7:-<
�I urge you to take a few minute~ to read the
pwpo,al. here·' how ~ ou can help:
cndo~eu
material. If you agree with our
Join the Coalition today and add your ,·oice and support to thousands of
others. ~lembership costs you nothing and ~·our participation will help
us delh·er a strong message to the decision makers in Washington. D.C.
and in the states. that we can get the reform we need without sacrificing
the choices we now ha,·e.
Immediately call or write your U.S. Representative and V.S. Senators.
Let them know that you want reforms that guarantee coverage without
forcing you into so-called mandatory health alliances that take away
choice. Tell them you are ,·ery concerned about the affects of a global
budget on the quality and nailability of your health care.
To join the Coalition. just complete and mail the postage-paid membership form. We'll keep
you up-to-date on the health care reform debate and add your voice to the hundreds of
thousands of Americans supporting our responsible and reasonable health care reform
proposal.
Thank vou for vour interest in the Coalition for Health Insurance Choices and for takimz time
to consider our. proposal. You gm make a difference. Please join the Coalition today. -
Sincerely.
Bill Gradison. President
Health Insurance Association of America
�1"1/E COAI.JT/ON FlJR
HEAI.~TIIINSURAN'cl~
("110/CES SUPPORJ:~ A
RIU:ORM 1'/.~AN AMERICA
ll'I1NTS.
\\"r alrr:ul~ ha~t· a o;iiiJIJh· o;olulion to he;Jith l'are
nl'nrm. II pnl\ itlr' what Amcrira \\ants within Ihe
II;IIJU'\\111"~ 11! om puhlir-pri\:llt' iiNII:IIIl.T 'Yslcm. It is
'"l'l"''lnl hy hu,inc"t'~- roll\lllllt'r'. \l'nior\. lan11n'.
health r:nc \\lllll'l"' ami in,lnt•r,.
It dnc,n·r n·quirr a hul!t' new 1-!un·rnmL'Ill hmcaurrary.
II tint''".' ma~e ~ llll)!iH' up the health in,uram.:c phm
\IIU.It'llll\\ romlorlahlt· :nul 'il'l'llll' with. llndds to
~·uur 'il'l'Uril~·. II is simJJit•. II worb. II is whal
·\nlt'l ira \\ ;ml\.
WHO WEARE.
Ne:uly two year~ al!o an amhiliou~ study was l:mnrhetllo
nplore whal t\merica \\anll'tl in health rare rdnrm.
Input hom lhoJI\;uul\ of intli,·idua". indudin!! workers.
l;nllll'l\. \l'nioi·, anti hollll'llla~t'r' wa~ snlirill:,r.
Sll)!)!l''lion' \\l'll' '"ll)!hl homtlnll'll' 111' !!roup'
ll'l"'~''rnlin)! apiruhm'l'. i1N1rann•. heallh ra1r providers.
h11,ine"r' and many othrr'. t\ rtnnprdll'no;iw pmposal
\\a~ tlr,·doprtl amllht• ( 'o:1lition lor lleallh Insurance
( 'hoin·, "·a, "'l!anilt'd 111 s11ppor1 lht• snuml ami sensihlc
Jeln1111pla11 that l'llll'l)!l'lllmm lhi' in-dl'lllh prnces~.
I k1r j, \\hal 11111 plan inrhult''·
Hl~AI.~T/1 (~ARE RI~FORM
AME/l/CA WANTS.
HEALTH INSURANCE EVERYONE CAN GET.
hn~ American i' enlitll'd In ht·ahh rare. Wt· \Upporl
··rradk In !'I an··· rmcra!'t'lnr l'\'l'IVonc. with no
nchl,illn,·llll Jill' ni,li;,~ mcdica!"rondition'.
HEALTH INSURANCE NO ONE CAN TAKE AWAY FROM
YOU.
Wilh 11111 p11opmal ~~~~~ h·rp yom health iiNirann·en·n if
'"" rhall~l' or lt"l' \'IIIII joh. ln,mancl' will 11111 he
ra11rrlnlll •
··,·t ~ir~.
HEALTH INSURANCE EVERYONE CAN AFFORD.
t\mt•rir:m' hdinL' in an l'lllplo~l'l. hasl·tl hL·allh r:1rc
~ys1cn1. Both L'lllployn' :uull'lllployct·, ,IJoultl 'hall'
in Ihe n "' ol l'IIH'I':Il!l'. Tlwn· musl :JI\oh: ~Uh\idics
h• hdp pay pn·miums In•· low inwnw indi,·iduah ami
small hu~im·ssl'\ Ihal ran ·r allortllhe lullroslol
l'IIH'I"a)!l'.
PROTECT FREEDOM OF CONSUMER CHOICE.
Emllloycrs amlru1isumns musl he free lo rhoost• lhl'
heallh rare ddivcry syslemlhal works l11.·st lor Ihem
ami must he free In keep the W\'l'l'al!l' lhl'Y have or
d11H1se cmw:1ge outside a so-ralkd health alliance.
( 'onsmnt·rs ami husincsses musl nnl he limited In a
few gm·ernllll'lll appmved insurance lllllinns or
forced lomnvc fmmlheir cunenl plan inlit a
gmnnmenl IIIIIIIIIJ1llly heallh alliance.
COMPETI110N, NOT MONOPOUES.
Thl· Atlmini'>lralinn 's proposal woultllc•rri: almnsl
L'wryone In purdlil'il' rm·t·mge lhmugh 1!•,1\'emmenlwnlrolkd. mandatory hl·allh alliann·~-
llmlcr this type nf unlesletl ~nvernmcnl experiment
lens nf millinns nf Americans wnuld he li•rrnlln
switch from I heir current insurance nunp:my l\1nnc
of Ihe m:umnnlh antlmnnnpnlislir insurance plans
\clerll'd hy hugL' new gmcnunL'nl hureaurrarics.
Americans ruuld ht· fnrccd lu gi\'C up Ihe health
insumnce plan they nnw find cnmli•rtahle and secure.
Thl' gmwnmenl w11uld rhtiiiSl' :nul Americans wnuld
lnse.
,...... .
..,
Thl·se mandatnry alli:mrcs wnuld also eliminate lhl'
runsumcr services pmvidcd hy health insurance
agents. lntkpcmlcnl agcnls would no longer ht· ahk
lo sdlur st•rvire mnsl health insurance p11liric".
CONTROL COSTS AND DEUVER QUAUTY CARE.
Wl· must and ran runlrul hl·allh can· rnsls.
l.lnlortunaldy. lhl' Admini\lralinn "s pl:llll!lii:S ahoul
this lhr wrung way. II would sri a Yl'arly limil nn
whal Wl' ruuld spend 1111 hrallh rare. railed a "glnh:1l
hllllgt ,_ .. This provision would t'si:Jhlish arhilrary
caps 1111 hl·alth rare C:<fll'lldilurrs within each
monopoly alli:mrc.
j
�ll"l"' I hi'
llh',IIIJaiiPIIIII~
ol carr ;Jfllllimil' Oil
I'''~ colu11·, Ihal ;n,· ,·o\l:lnl' Will ~·lohal hntl~,.,,
"·ol11t"1' 1111· q11ali11 ol cur 1\l' nTri\l· and ,,.,ull in
1"11~· 11 all'' I hn l"lllll'lll h,·allh r;nr ''''''Ill r:111 h,·
""1~11•\l·ol 11 ilhPIII ll''ollill).' flo a ).'loh;il hutl).!l'l
t"\ ,.,., illll'lll.
!\Lm:l).!rd r;nr ha' hn·nplo\l'nlo hrlp hold tl111111
, '"":nul ~·ll;nanlrr quali11. 1\lillion .. ol :\mrriran'
;nr l:n11ili;n and rPIIJiorlahk 11 ilh llt;llla~nl rarl'
ho·allh pi all'. 11 hid1 arr llnihlr antlmn:l i111li1 idual
rh·rol, I kallh r:nr rdonu 'lu11rld huild 1111 lhl'
,ll,·n·"''' "' n~;mal-'r•l r:ur 11 • pro1 itlr 'lualil~
llll'oliral o·a,,· '"' \lltcrir;m' ;md In ronlrol ro'''
CONTROL COSTLY MALPRACTICE lAWSUITS, WHILE
PROTECTING CONSUMERS.
Wr ncrtl k~·i,blion lo rrlunu lhr 1111'tliral
llt;tlpradir,: ''''''"'and runlrullhr 1"11\ll•f 1:1\\,llit~.
\\"c alw nrrol h•rrd11rr 111111\'n'"'"' tr,lin~ and
ptun·dllll'' I hal arr dour pt im:u ih ·II, a11oi;l
llt;tlprarlirr l;m 'llil ..... h''" Ihal arr had li•rlht·
rnn'"'"''' '· l'"tlclhon~' and "•ntrlillll'' lor thl'ir
hc:thh
REFORM INSURANCE PRACTICES.
I kahh iu,tnt·r' 'houlol .,fin hrallh irl\lnanrr lo
1·1 r11 1111r \\"ilhin '" irl limih. prrmium' 'houhl
trlk~·lllll· hi!!hrr ti'~' ol n11hrallh1 lilt''(\·lt~ rh11in·'·
l'l·opk 11 ho ~i11n·1 '"'11~1·. l11r ill,laitn'. ,h;oultl ht•
,,.,, atolrol 11 ilh I"''~'' prrrnitllll'.
LIMITED GOVERNMENT ROLE.
I im l'llllll\'111 'lll•llld hrlp ,.,lahli'h a rompl'lilin:
lwallh, :nr oldill'l\ '' ''''"'- :mol lhrn 'Ia\· on I of lht•
ol:11 lo ol:11 :ulntilli~ILilion ol lhal '"'''Ill:
I;,,, l'lllll!rlll '"""lol ,·,lahli'h :nulcnlotn· rufr, lo
!'ll:n :nii\T n l'l\ nne in"n a111,. ,.,, rr a~1·. 1kfinl' lhr
io:"i' to·quitl'lll~'llh nl plan'. and roonl;.lll l"ll'''·
lin 0111d lh,·,r ''l'f"· .\nwt ira tlnr'n ., lll'l'tl
~.,.;,.,llllll'llllllllllin!' llw IJ,·allh <:Ill''~''''"'·
ENACT AN EQUITABLE TAX POLICY.
Ia\ l;m' ,Jt,nlol lor aflh'lldrd lnptolillr fair Ia\
ltrallltl'lll n·!';flollr" nl 11hr1hr1 ro1rra~r i'
l'llll'ha,rtl h~ all inoli1 iol11al "' a ~"""'P";'~.
lnoli111111:11, and lho,..,· ''"":Ill' ,rff ,·mplon·tl ,Jtoultl
rnjo1 lho· ':IIIII.' Ia\ ad1 alii a~~~-, a' a lar~·r rnrpntalinn
'"' li11· o'"" ol lwahh il,..lll:llh'l' rnlrta!'r
A MESSAGE FROM
TilE CoAI.JTitJ!V
plan and tell us
FOR
what you think. If
llEAI. TH
INSURANCE
CIIOICES.
lh1· ( '11ali1ion for lkallh lnsuntnl'e
( 'hoin·~ ~upporls many of the relimns in
lhl' t\1lmini~tmtion's plan. including
"nadir to ~raw" rovcral,!l'. ruvera!!e you
Gill ~l'l'P if yourh<ml!e or lose your joh
ami ~.,,,na!!l' fur all prt·vious health
romlitions. There are some provisions in
lht• 1\dmini~tmtion 's 11lan. however. that
rai't' 'l'riou' 4uestions. like mandatnry
hl'alth alliances whil'h would severely limit
ht·aflh ran· rhoil'cs. huge new l!nvemment
re)!ulalnrv :t)!enl'ies re4uirrd hy the plan
lhal \mnidpul government hurcaucrats in
rhaiJ!l' nf 11111 health care system. and
).!l11hallimit' 1111 health rare spending.
"Please read our
you agree that
health care reform
Is essential and
that these
~_principles
represent the plan
that America
wants, please join
the Coalition for
Health Insurance
Choices today.
Till' C1•aliti11n hclieves that real choice
fromt'lllllfll'litinn-<:ompctitinn
amon)! comp;mies, prnviders. :md health
plan'. amlrolllpl'lition whirh puts health
rail' ronsumers in the driver's scat. We're
lakin!! that message tot he derision makers
in Wa,hin)!llln. D.C. and the states.
opportunity to
HERE'S HOW YOU CAN HELP:
speak out on this
emt'l')!l'~
JoiN
lm ( 'o.\I.ITIUN,
We'll keep you
you the
issue, which is so
nation's future."
Ju,l romplt'll' ami mail the allarhrd
pnsla~l' paid memhership fnrm. II cost'i
~·ou nolhin~ and ran san• you a lot.
Bill Gradison
('ollll \1'1 \'OIIR 1-:t.trn:ll ()n·tc'IAI.'i.
(·all 111 1ni1t· your Memher nf Cnngress
and ~our II.S. St•nator' today. Lt•t them
knm1 Ihal Y"""f'llllSl' gl11hal hudgets and
mnnnpnli~lir ma111lalory h1·alth allianres
:tlltf lhal yon don'l wanll,!overnmenl
hml'aunah ll'llin!! you where vnu must gn
for hraflh l'fi\'L'r:t)!l'.
)
informed and give
Wl' 'II h'l'fl you informed 1111 health rare
and h1·lp mah· o;ure your vnil'c is
hl':nd.
1don11
K.D.
critical for our
Presidentj Health
Insurance
Association of
America
l
�//1~·,\I~TII (,''JRi!· ... , ....
lli~'/;OilA·t MAIJE SIM/•jj~
WHAT WE ARE FOR.
Src nun
• "( ·1adk lo !!ran-" ron·ragc for all Americans.
• <·.,H·ra;.!l' of allnisling or previous health conditions.
• ( ·o, rra)!C yonnncr lo~c m•mallcr if ynu're sick or
hrallhy.
• <·on·raj!r thalj!lll'S with yonl'\'l'll if you change or lose
yom joh.
• Suhsidirs for those whorannol afford premiums.
lV!I\T lLHLRICA
/)0/:·s.v 'r lVLVT
To Los!:'.
,\11ll'liL'~I II ~1111.' lil·~tltli L'dl\' 1\'[llllll.
J>llt Ill' d\11(1 1\~111\ \II '~ll'llfill' Iilii
llfrd-L'~IIIIL'd
'l'l'lllil}
tlll'\l'iLitl~l·
[ill ~Ill llllll''ll'li. liiiJlllill'll.
~~llll'IIIIIIL'Iil-llllllllilllllf1ilf}. lli~ll·,
~- l'\~llctll II kit a-1(1[ ill f11lliTtl't~tth ~i~d
Jlillil: 11\~l~l'i' \\~till ll' lil dll.
TilL' . II ,ttl\ .
I.
!.:ill l'IIIIIIL'IIl hllt\'dlll'l~tt'
\II 'l'kL·t ~IILitldfLtl 11[ lii.'lildllc'l'
nunc r
• lhr 1i!!hl of roiNimcrs to kccplhc wverage they have
o1 rhome n"·naj!l' ontsitlc a so-ralkd health alliance.
lhl'r
llu t i 11
SwrNc;s
k l. II I l'l ~I~ l'
11ill hall' a rhoirl'.
1 illtt 1111 h ,1 H 1i ·, l' 11 i II
l.illll[ 1d till'' t I I I 1I I I I ll
sa~ ~ou
t
~ tc· t .
hl' ltll\11 tilL' lttllilL'LII1I~ttl, ~ttid
• ( ·ont1ol nl rusts and dl'lin·ry of quality rare thmugh
mana)!l'd r:ur Jllll)!rams.
111.'111\'1' till' hlltl\lllll~lt' ILl\ l'
• Lnd fraud :uulronlrol waslt' in I he health care system.
:tlt\'dlh 'l·kcll'd !111 .
11111 .. ~ttld :1
.
l'hilll'l' tiLl\ dill''ll.t !.:Ill' Iilli II l1~1t
• Bolh cmplo\'crs antll·mployl'l'S paying toward coverage.
lilllll~ttll j, IIIILIIL'il·l· ~tt all.
• l'uhliralion ol prilT ami qualily data.
,\tlll'lil·d Lflil''il.( h;tl l' (il 'L'ltfL' [111
• J:rcclronir rlaim' prorrssing and a single claim form lo
ronlrol papl'l"\\or~ ;uul rut administrative costs. ·
~I) I l' 1111\ll' IIt Iii I ) Ill 'fl\ ,[ IL'' ; till I \ l' ~II I \
• lnn•nlin·s for hcallhy likstylcs and emphasis on
v.cllncs' ami prt·n·nlion pn•j!rams.
hL·~tlili l';ttl' \\l• dill\.\ h;ill' (II 'l'itk
• An end lo pri\alr insura111:C making up for what
1\ktliraitl anti Mctlicut· Jail to pay.
L' ~Ill' '\ 't l' Ill.
• ( ·onl1olmc1 rosrl~· malprartin·l:lwsuits and
lllllll'U'"arv ll''" autl pnli.Ttlurcs.
lttlltl' 1111 I\ ~~~It I'.L' l'~lll 'Jll'tllf 1111 illll
II\ I ~I ~I I\ l'llll I I •,' I I I -ll II I \II
'l'lik [ill
k"
\\
l'
ll \'I i I
!I k tl
fl; I I l'
l'ill\\fll'(l\lilll ~\tilf
i I I Ill I I ~ill\ ) I I. \\ l' l ; ! II ~ l' t t hl'
L:tt\' ll'filllll .\llll'IIL'd \\;\tli,
WHAT WE ARE AGAINST.
• 1\l:nulal"" hrahh alliann·s. )!Ovemmcntmnnnpnlies and
,·;ulrh.
•J·Ial n•111111nnily ralin)! t!'vnyonc pays the same
1rganllc" ollikslyll' ''' hcalrh hahils).
•! ;"' 1'1111111'111
I'' irr ~'"""""-
lUE COAl'·'.._.._, FOR HEALTH INSURANCE CHOICES
SUPPOR
UFORMS AMERICA WANTS.
ill' d Iii I
(I I
li l\ tl t II
..,
l
�)·c,. l'~i ;;c:c· L ... l ·:~~ ..4' .t "\.:~r·
Health ln~u-ran.:e Ch\11.:.:'.
r· .:~
·~.;,: ~
--------------.- - - - · - - - - - ----------- -------
Hllme
Phlln.:tOfti.:~
-------
Phone:
Fax :"umb.:r
Signatur~
I can also help the Coalition in the following ways:
= Display materials 'in my place of business
= Write a "letter to the editor"
=Call a radio or TV talk show
= Distribute materials to friends and neighbors
= Write letters to the President. Members of Congress
and other elected officials
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Page 30
�ur·<C PESEACH. ·'COt·1t·1UN I CATIONS .,;. 4566485
BOB DOLE AND HEALTH CARE HISTORY
Dole Voted Against Medicare
Dole Supported Nixon
Health Insurance Plan
Dole Supponed Catastropbi~
Care Ad of 1988
Bob Dole (R·KS) voted against HR 6675, the bill '·'·hich
later became known as Medicare (Source: Congressional
Quarterly Almanac. Vol. XXI, 1965, p. 950)
"( intend to cosponsor that administration health care bills
that will be sent to Congress in response to [President
Nixon's health care] message. in addition to the proposal
cf the Senator from Wyoming [Sen. Hansen's
Medicredit), because I feel each makes valuable
suggestions for combatting the currem health crisi5 ill
America'' (Statement of Bob Dole, Congressional Record,
92d Congress. 1st Session, page 454 7, Match 2. 1971.
Emphasis added).
Bob Dole voted for 1988 Catastrophic Care Act (HR
2470) (Source: Congressional Quarterly Almanac, Vol.
XLIV. 1988, p. 29·S).
Dole Flip-Flops Oa
Individual Mandates
"Well, under our plan. we have an individual mandate ...
But one of the problems we have now in health c~ is
that if nobody pays, you're not responsible for anything,
you don•t care what it costs, and that's what drives up
the cost of the programs and all your costs in states and
everything else. So we shift to an individual mandate in
ours.. (Remarks by Senator Bob Dole (R·KS) to the
National Governors' Association. Federal News Service,
February t, 1994 ).
Senator Dole is a co·sponsor of S. 1743, sponsored by
Senator Don Nickles (R·OK), and S. 1770, sponsored by
Senator John Chafee (R-Rl). Both of these bills contain
an individual mandate.
"I don't think either individual or employer mandates will
work" (The Washington Post. May 11, 1994).
�;2)6/15/94
19:01
DNC RESEACH/C0t·1~U~ I CAT I m~S ..:. 4566485
t-10.971
Fc.J~,·'008
WHERE'S BoB?
Like the elusive character in the children's book, ''Where's Waldo."
Senator Bob Dole (R-KS) has been hard to locate on the issue of heahb
care. The Senate Minori1y Leader has routinely staked out positions,
only to take the opposite side a shan time later. Now. a.~ House and
Senate Democrats search for a bii)anisan agreement to provide every
American with guaranteed private health insurance, Senator Dole has
disappeared once again~ choosing to blend in with the "Just Say No"
Republican crowd.
Senator Dole's com:radic:tory Hatements include flip-flops on;
Individual
~tandates
"\1/ell, under our plan, we have an individual mandate ... But one of
the problems we nave now in health care is that if nobody pays. you're
not respons1ble for anything. you don't C3re what it costa;, and that's
wllat drives up the cost of the programs and all your tosts in states and
e'/erything else. So we shift to an indi\lidual mandate in ours"
(Remarks by Senator Bob Dole (R-KS) to the National Governors'
AliSOCiation, Fcdel'al Ne'W.'-'" Sentcc. February ! . 1994 ).
Senuor Dole is a eo-sponsor of S. 1743, !ipan.!lnred by SenatOr Don
Nickles (R·OK), and S. 1770. sponsored by SenlltOr John Chafee (R·
RI). Both of these bills contain an individulll mandate.
"1 don't think either i'ldividual or employer mandate$ will work" (The
Wtuhington Ptm, May II. 1994).
Universal Co\·erage
"Senator Chafcc and others who worked long and hard - we both want
universal coverage· l think. that's one thing we have in mmd ... We had
hoped to reach universal CO\'erage by the year 2.000 in our plan."
(CNN Transcripts, The L()u Dobbs Show, September 16. 1993).
"We said it would be a goal. Universal coverage is a goal."
Washington Times. February 27, 1994).
(The
By resc:inding his suppon of individual or employer mandates, Senator
Dole bas made universal coverage an impossibility.
The Health Care Crisis
1971
"Mr. President, yesterday, President Nixon !lent to Congress a
comprehensive health mc::ssasc:. Dljs me$sa&s: n:cginiu;s the preient
health care r:rjsis in our Nation ... :· (Statement of Bob Dole:.
Congrasiorrt~l R~cord,
92d Congress. Ist Session, page 3310. February
19. l9i1. Emphasis added).
�r.NC RESEACH, 'C0~1MUN I CAT I Ot~S -+ 4566485
1991
''Mr. i>resident, yesterday the Majority Leader join~d by tour
nfhis colleques announced their solution to cemin aspeCTS of
the bgalth care cri:ii!ll cqnfrnnting this nation. They are to be
commended for helping to begin and shape a long o~erdue
debate on access to health care'' (Remarks by Bob Dole on S.
1227 and two other measures. Cong,essioMI Record, June 6,
1991. Emph3Sis added.).
1994
"0( course there are many Americans wilh a sick child or a sick panmt
in real need-both in rural and urban America. Our country has health
care problems, but not a health can; crisjs" (Statement of Bob Dole.
R.::publican Response. January 2,. 1994. Emphasis addtd).
Sin Taxes
·•wen, I'm not interested in taxes, but it seems to me w~ can't say. well,
never you're going to touch the so·called sin r.a.'es, and I think we ought
to go into it IJn the ba.llii!i of cost containment. That's what me President
said during the campaign, he sa1d earlier this year. Our members would
rather do it through cost containment. They may lind those voles are
tougher than voting for a tittle increase in sin taxes'' (New~maUI'
Sunday. August 29. 1993).
Republicans • even those who agree on Clinton's seneraJ healdl-care
goals • differ with the president on major issues such as so-called sin
taxes and employer mandates. Dole said (The Chicago Trib.,ne.
September 24. 1993).
�REPUBLICAN COJOIDlTS OR MEDICARE
By 1965, it was clear some type of health care legislation was
going to pass. Recognizing the futility of opposing a health
care proposal entirely, the Republicans changed tactics and
endorsed an 11 eldercare" proposal that was a voluntary
participation plan. The majority of the negative comments
occurred in the years preceding 1965 and during the Truman
administration in particular.
COMMENTS FROM THE 50 '8
Representative Henry
c. Dworshak (ID)
3/28/50
•
"The Fair Dealers advocate socialized medicine mainly as a
means of providing them more. control over the people. They
are concerned only with obtaining control of the people by
means of socialized medicine, and to me, such deceit and
intent are not a new deal or a fair deal, but a raw deal."
•
"Both Socialists and Communists conceal their real purposes
by talking in terms of 'public welfare', 'planned economy',
and 'social security'. These words do not have the
unpleasant meanings that are attached to socialism and
communism. But no one need be deceived about any scheme
which looks to Federal ownership or Federal control of the
resources, industries, farms, homes, and lives of the people
in any state of our Union. Such a scheme inevitably
involves either socialism or communism."
•
"There is an old saying that the human hunger for power is
like a cannibal whose appetite is never satisfied. It is a
sober fact that our bureaucrats in Washington are always
reaching-·-for more and more power over the industry, the
business, the agriculture, the resources, and the people of
the United States."
•
"I am most anxious that you decide whether you want a free
system of medicine, such as we now have, or socialized
medicine with its_destroyed freedoms and its medical
monopoly in the hands of the Federal bureaucrats • • • • This
is the American way, and I am anxious that we continue this
American way. It is what has made our National great and
strong. Let's continue it so.
Representative Edward Martin (PA)
•
7/14/50
The Association of American Physicians and surgeons held a
national essay contest on the subject, "Why the Private
Practice of Medicine Furnishes This country with the Finest
Medical care." Rep. Martin submitted the winning essay.
�Representative Edgar A. Jonas (IL)
2/20/50
•
"Compulsory insurance - this opening wedge of statism, with
the same promises of welfare and security which duped the
people of Britain should be militantly opposed. Why?
Because it would abrogate not only the responsibility of the
individual -- but do great and irrevocable harm to the
inhabitants of the community and the state as well."
•
"Laws which are venal and obnoxious of their very nature
have always been frowned upon and treated as incompatible
with the fundamental principles of liberty and justice.
Therefore, it may be assumed that the medical
profession, and any or all activities that are kindred orincidental thereto, will not readily lend themselves to the
enactment of any legislation which inherently destructive in
character, and objectively despotic, and is obviously
partial to a socialistic philosophy."
Harry Truman (year unknown) -- taken from Jonas statement
•
"I depend upon our peculiar genius for combining
governmental and voluntary activity to expand and maintain
our hospital system."
COMMENTS XH 19 65
Representative Dorn 2/23/65 (Upon introduction of the Herlongcurtis bill - the AMA alternative "Eldercare" bill)
•
"Nationalized medicine, with its political pull and
overcrowded hospitals would only be a cruel hoax on our
aging and disabled citizens who are really in need."
•
"The very fact that the United States has an increasing need
for more medical aid to the elderly is a tribute to
thesuperiority of our private enterprise medical standards.
In 1900 the span of life in the United States was only 47
years -- today it is 70 years."
senator Cunningham (Nebraska)
3/3/65
•
"It [medicare) is an old issue. Its supporters have
introduced it in one form or another year after year, and
they will not admit that its continued defeat means that it
lacks general support in the country. • • • This could well
be the first step toward socialized medicine."
•
"Assistance to the elderly is presently available in every
State for those aged who are without adequate financial
resources. It includes payment for medical care."
�•
"Such a program of benefiting the rich at the expense of the
poor is a demonstration of the Robin Hood episode in
reserve."
•
"This legislation could eventually lead us to socialized
medicine. Make no mistake about that. It takes no more
than a quick glance at a history book, and a little
commonsense, to come to this conclusion."
•
"Many supporters of socialized medicine candidly admit that
their goal is universal medical care under control -socializ~d medicine."
John Tower (TX)
•
1965
"Medicare can destroy Social Security as we know it."
Senator Jacob Javits (NY)
Medicare bill)
7/7/65
(During Senate debate on the
•
"The developments since that time [1949] went through the
hotly contested 1960 postconvention session of the senate
when our tragically departed and highly revered President,
John F. Kennedy, was here as a Senator, and almost as his
final act in the Senate fought to put through a bill which
contained half of what is contained in the pending bill,
namely, essentially the hospital care plan with social
secuirty financing. In my judgment, he failed because of
the failure to include a complete health care program, which
required the addition of the second half, the voluntary
supplementary insurance plan."
•
"It is a--great tribute to the American system, that, after
this monumental effort, so deeply involving the passions and
ideas of individuals, we should be back here with a bill
which has remarkable areas of agreement and shows every
indication of sweeping through the Senate with not too much
opposition. I am sure there will be a number of votes
against it, but on the whole it is taken for granted that
this is the year in which medical care for the aging will
become a reality."
Senator Mundt (NO)
•
7/9/65
(Senate debate)
"In good conscience I cannot support legislation, for
example, which would force the poor to pay the hospital
bills and other medical bills o the wealthy. This type of a
result, which could be referred to as Robin Hood in reverse,
flows from legislation which would derive its financing from
a compulsory tax on first dollars of wages earned by the
Nation's working men and women with no exemptions allowable.
surely the pretense that this is a great humanitarian effort
�to care for those in need is severely damaged by sacrificing
our methods upon an altar of expediency as we would do if we
enacted this bill."
•
"It is unconscionable. It is unjustifiable. It violates~
every cannon of a conscionable concept of legitimate
taxation."
•
"As we vote on this bill, however, my fears are not so much
for htese two groups of our society or the collateral
private economic enterprises and acitivites certain to be in
the forthcoming target circles, as they are for society
itself, for we will be taking another step toward destroying
the independence and self-reliance in America which is the
last best hope of individual freedom for all mankind."
Senator strom Thurmond
•
7/9/65
(Senate debate)
(Senate debate)
"It would do it by requiring the wel-to-do and the wealthythose who are better off-to pay all or part of their own
medical bills." Curtis - leader of opposition on Sen.
Floorjjcrux of argument against medicare and for eldercare
Senator McClellan 7/9/65
•
7/9/65
"The medical care part of this bill is not directed at the
need which exists. It attempts to provide services for
those who are not in need, and it seeks to finance this
expansive program with a heavy tax on those who can least
afford to pay it."
Senator Curtis (NE)
•
(SC)
(Senate debate)
"One of the objections that I have to the proposed
legislation, although I shall vote for it, is that I do not
believe we ought to support people who are able to support
themselves, or that we should pay their taxes." "This
program should be given a trial and an opportunity to get on
a sound basis before we are asked to pay the doctors' bills
of people who are able to support themselves and to pay
their owii bills."
�To:
War Room Staff
From: Alice Dunscomb
Date: June 14, 1994
Chafee/Dole on Record for Universal Coverage
Chafee
"I personally feel you have to go the
coverage ... " -Capital Gang, March 5, 1994
route
of
universal
"So under our program, we require that everybody be covered." MacNeil/Lehrer NewsHour, May 12, 1994
" ... I believe that we're going to be able to come out of that
committee with a very good bipartisan bill that is going to have
universal coverage ... " -MacNeil Lehrer NewsHour, May 12, 1994
Dole
" ... we believe in the goal of universal coverage."
Nation, August 22, 1993
- Face the
"Well, first, our goal is universal coverage. I think that's the
goal of everybody." - CNN Newsmaker ·Sunday, Augus·t 29, 1993
"I think one thing we're going to have is probably universal
coverage." - C-SPAN, September 7, 1993
"Senator Chafee and others who worked long and hard - we both want
universal coverage - I think that's one thing we have in mind." CNN, September 16, 1993
"So I would say the areas of agreement I think are fairly broad,
particularly the universal coverage." - Remarks to the Atlantic
Information· Services Corporation, September 28, 1993
"I think everybody ought to be covered," Dole told the National
Governors' Association on Tuesday. "So the goal will be coverage."
- USA Today, February 2, 1994
�-
1 -
THE WHITE HOUSE
Office of the Press Secretary
Internal Transcript
June 14, 1994
REMARKS BY SENATOR MOYNIHAN AND SENATOR PACKWOOD
AT STAKEOUT
Stakeout Position
Q
Good morning
SENATOR MOYNIHAN:
Q
Good morning.
Senator Moynihan, what did you tell the President?
SENATOR MOYNIHAN: Anybody might want to have a Panama
hat on, on a day like this.
(Laughter.)
Senator Packwood and I met with the President for the
better part of an hour. A good meeting, as you would know. We
agreed -- and I want to just read from notes, if you don't mind -that we would say -- and Senator Packwood will say it in his own
words -- that there is not now a majority for any health care reform
plan in the senate Finance committee, that we will continue to work
on a bipartisan basis to provide legislation that covers everybody.
Univ~rsal coverage is hugely important to the President, important to
us. And we have specific plans, which we needn't go into. We've got
a very intensive work period ahead and we're ready to go, and,
indeed, off we go.
Senator Packwood.
SENATOR PACKWOOD: Well, one, the President asked that
we take no votes in the Committee at the moment, also. The term
"universal coverage" is amorphous.
If you were to say, does
everybody have access, is that universal coverage, it's hard to tell.
It is very clear that we are all wanting to go in the same direction.
But there's a strong lard-feeding(?) on the Republican side against
any compulsion that absolutely forces people to do things they don't
want to do. That is sort of where we are.
MORE
/
�- 2 -
Q
Senator, what do you think you need to do to come
to an agreement, to break this logjam?
SENATOR MOYNIHAN: We're going back to put together
combinations. There are many forms of triggers that will be
considered. The President was open to any suggestions we had. He
made no commitments; we didn't ask for any. We had a good meeting,
and we have a lot to do, and it's already hot. And there is a vote
on in the Senate, and -- (inaudible) -- do our work.
Q
senator Moynihan, is the President's plan --
SENATOR MOYNIHAN: Now, this gentleman asked for one
more question, and you can do the same.
(Laughter.)
Q
Is the President's plan dead as he presented it?
SENATOR MOYNIHAN: Not at all. This is a large piece of
legislation, and some principles are absolutely essential, others are
negotiable, and he knows that.
SENATOR PACKWOOD: I think I would answer it slightly
differently. At the moment, all plans are dead. If you mean, if we
put up anybody's plan, Senator Chafee's plan, Senator Breaux's plan,
the -- (inaudible) -- plan, as a plan and vote on it, there's not a
majority for any single plan.
So the question is, can we accommodate ourselves to
different parts of different plans and reach a majority, and the
issue is going to be -- the defining issue is going to be coverage.
Q
What's your time frame?
SENATOR MOYNIHAN:
Q
Now.
can you get a health care bill this year?
SENATOR MOYNIHAN:
We had better.
Q
Do you think the Finance Committee can report
something -- July 4th?
SENATOR MOYNIHAN:
I hope.
Q
Mr. Chairman, the figures -- the thing that people
talk about triggering is the employer mandate. Can you get universal
coverage as you understand it without an employer mandate of some
sort?
MORE
�-
3 -
SENATOR MOYNIHAN: We don't yet know. We're going to be
asking CBO to help us on some numbers, and, really, we do have to get
back.
I'm trying to keep --
Q
The President has been said to have been above all
this, not commenting on daily developments in various committees.
Has he gotten down to the horse-trading level yet? Are you dealing
with specifics and detailsm that he's offering to trade one thing or
another?
SENATOR MOYNIHAN:
details, and at great length.
He made no offers, but we talked
Would you not agree?
SENATOR PACKWOOD:
Yes.
Q
What does the President need to do to get a bill
this year, senator?
SENATOR MOYNIHAN:
-- need to let us get back to the
capitol Hill.
questions.
SENATOR PACKWOOD:
Any others?
Go ahead -- answer a couple more
Q
senator, is your position on the mandate adjusted
by what you heard today?
SENATOR PACKWOOD: Adjusted?
(Laughter.) Let's take
them in order. one, is there the vote for a universal, immediate
mandate bill? Is there the vote for a hard trigger? In three years
you will have compulsory coverage.
No, there is not. Are there the
votes for a soft trigger?
Ye~, but a soft trLgger doesn't force
anything.
So we talked about fast track.
Is there some kind of a
procedure we could work out that would say, okay, we won't have a
mandate today, but in three years the President should mix something
and the congress will have to vote on it one way or the other. That
was kind of agreeable to a lot of people until the issue came -- if
we have something submitted by the President and don't vote, does it
automatically go into effect, or do we have to vote for it to go into
effect? Would it be like a base-closing; if we do nothing it
automatically happens? And that, again, was kind of a dividing
point, but I sense interest in the concept of fast track.
Q
finance, what do you mean by universal coverage,
MORE
�- 4 -
what do you think is acceptable to
SENATOR PACKWOOD: We make more mistakes in haste, and
we lose opportunities in delay. This nation is going to come to
universal coverage one day.
It's going to come to 95 percent or 96
percent coverage. The question is, when youive got a determined
group of people who -- restauranteurs, small business, retailers
who are passionate in their objection, who feel that this is going to
drive them out of business, is the country served by jamming this
down their throat now? We will come to it in three, four, five
years.
Is that a long time in the history of the Republic?
Q
trigger.
there --
What was the President's reaction--
SENATOR PACKWOOD: Well, he doesn't like the soft
The soft trigger is no trigger. Secretary Bentsen was
Q
What about the fast track?
SENATOR PACKWOOD: Well, the issue would come down to,
if we have a fast track and if we have to vote -- now, here's where a
Majority Leader could guarantee a vote -- let's say in three years
the President will say you haven't achieved the level of coverage
that I wanted, whatever the percentage is -- I am submitting today a
bill that will get us to 96 percent or 97 percent coverage, and we
had already put in place legislation that we had to vote on that
within three months or six months, whatever time, if you had a
majority leader that wanted to bring that bill up, we would have to
vote on it. No way we could get out of the vote.
So in that sense, you would certainly get a vote.
It
doesn't guarantee the vote passes; it doesn't guarantee that the
coverage goes into effect, but it does guarantee that we have to vote
on it.
Q
And what did the President say about that?
Q
And do you think that senator Dole would go along
with that?
Congress?
SENATOR PACKWOOD:
(Laughter.)
As Majority Leader in the next
Q
What did the President
Q
-- in '94 or '95.
Q
No, I'm
ser~ous,
MORE
senator.
�- s -
SENATOR PACKWOOD: My guess is, if the bill said fast
track legislation said, "And the congress shall have six months to
vote on it," you'd be hard-pressed as a majority leader, Republican
or Democrat, to say, "I don't care what the bill says, I'm not
bringing it up for a vote."
Q
Do you think all of this .can be accomplished this
year?
SENATOR PACKWOOD:
Q
Yes,
I do.
What was the President's reaction?
SENATOR PACKWOOD: Well, it's interesting. There was
interest in the fast track concept.
But I think the question is,
should it be like base-closing; if we do nothing, does the mandate
automatically go into effect, or would you be willing to say, I'm
willing to live with a vote in three years, as long as I'm guaranteed
a vote? And I think a majority leader would almost feel morally
bound if the legisltaion said you had to vote to bring it up.
Q
Did the President have a preference to either one?
SENATOR PACKWOOD: Well, the idea was just -- just
flowed.
And Al Gore was magnificent in this meeting.
He really one,
two, three, four, cut through and sa~d if we had Social Security
today, it would have passed the Congress -- to which I said, if you
were to say to employers today have we got a deal for you, a new
entitlement that's going to cost you seven percent payroll, would it
pass today? Probably not.
Q
Did the President seem amenable to the fast track
issue, though?
SENATOR PACKWOOD:
He listened. And he wants a
bipartisan bill. And he would just as soon we not vote on anything
now, and he obviously doesn't want any vote that causes his plan to
be defeated.
I suppose we could do what the Democrats used to do to
the Reagan budget each time in the House of Representatives when they
put the budget up for a vote.
Q
When you say he doesn't want to vote now, how long
-- does that mean he doesn't want you to get something out of
Committee before the July 4th recess?
SENATOR PACKWOOD:
No, no.
I don't think anyone who has
a plan wants their plan put up and have it defeated right out of the
box; that's what he means.
He doesn't mean wait.
But there's no
MORE
�QUOI'ES ABOUf ~L SECURIIY
*"(Social Security will facilitate) ultimate socialist control of life and industry."
(National Association of Manufacturers]
*"(Social Security will undermine the country by) destroying initiative, discouraging
thrift, and stifling individual responsibility.'" Uames J. Donnely; Dlinois
Manufacturing Association]
* "(Social Security) sooner or later will bring about the inevitable abandonment of
private capitalism." [Charles Denby, Jr.; ABA]
*"(Social Security) ... invites in power so vast, so powerful as to threaten the integrity
of our institution and to pull the pillars of the temple down upon the heads of our
descendants." Uames W. Wadsworth]
[All cites: The Age of Roosevelt Coming of a New Deal, 1958]
�Talking Points for Roundtable with the Vice President
Monday, June 13, 1994
Points to be made:
* There has been talk about whether the Administration will back
away from universal coverage. Let me repeat what the President
said in the State of the Union Address: If you send him
legislation that does not guarantee every American private health
insurance that can never be taken away, you will force him to
take his pen and veto the legislation.
* The Administration stands by this as strongly as we did when
the President said it in January. If you don't achieve universal
coverage, you hurt millions of American families. Eight out of
ten Americans without insurance are members of working families.
* There is momentum on the Hill for health care reform this year.
We have come further along than any other Administration since
the fight first began over 60 years ago.
But what does universal coverage mean?
* It means guaranteed private insurance to EVERY American that
can never be taken away. It means that every American has a
guarantee in law that they will always have health security.
w.bat about a phase-in?
* We phase in coverage in our bill (January 1, 1998).
is debating this issue right now.
Congress
The w.hi te House seemed to signal that it would be open to an
extended phase-in.
How long?
* That's an issue that Congress is debating. We have said all
along that we would be flexible, but we mean every American needs
to be covered within a reasonable period of time.
w.bat about percentage - 91%, 98%?
* I'm not going to engage in a percentage debate. The
President's bottom line is to guarantee every American health
coverage that can never be taken away. I will say that doing
incremental reform and leaving over 25 million hard-working
Americans without health coverage is NOT acceptable. Millions of
families would remain at risk and the middle class would take the
hardest hit.
�...
\
....
..,
T.be Administration also seemed to indicate that it would be
willing to accept a trigger. Is this a signal being sent from
the White House?
* What the Administration has been saying all along is that the
bottom line is universal coverage and we are flexible on how you
get there. We remain flexible on how you get to universal
coverage, but not whether you get to universal coverage.
Everyone knows that the Administration feels that health benefits
guaranteed at work is the simplest, least disruptive means to
achieve universal coverage. We feel that work should be
rewarded.
* There are a number of proposals being floated on the Hill. We
cannot make a judgement on any one element without seeing the
entire package.
Representative Gephardt indicated on Friday that Committees may
not get the work done by the July 4 recess. Will that kill
chances of getting legislation done this year.
* First, Congressman Gephardt said that he believes we will get
legislation done this year.
* There is obviously a lot of work to be done. But there is
momentum on the Hill to get it done this year. We think that
virtually all of the Committees will have completed action by
July 4th. And, if not, they will move quickly afterwards.
* What the American people do not want to hear is talk of
inaction and gridlock. Congress has been talking about reform
for over 60 years. The time is not for further delay the time
has come for action.
Senator Dole seemed to indicate over the weekend that health care
should be presented to the voters?
* We already had a referendum on health care reform. It was
called the 1992 elections. Health care reform and universal
coverage was a key issue that the President and I ran on. And
it's what the American people want and deserve.
Senator Dole also stated that there may be a filibuster i f
mandates are in the legislation.
What's your reaction?
* The American people want action on health care. They don't
want gridlock. I think it would be in the best interest of the
American people to work in a bipartisan fashion to achieve
reform.
Do you think you will get Republican support.
without Republicans?
Can you do it
�HRC TALKING POINTS FOR BROKAW
1) This is the best opportunity in a generation. It's got to be this year.
Although seven Presidents have proposed national health care reform before, this bill
has come further than any other. There has been historic progress in the Congressional
committees. We must seize this moment.
2) We want this to be bipartisan.
This is no time to be playing politics. This is an issue that affects all of us -Democrats and Republicans -- and we must come together to get this right and do it
now.
3) Universal coverage is a middle-class issue. If we don't do universal, we leave out the
middle-class.
Half-measures and quick fixes would leave out millions of hard-working, middle-class
Americans like Jim Bryant and his family, who the President talked about in his radio
address last week. Jim Bryant told the Boston Globe that he works 70 hours a week,
but has no health insurance for his family. He wonders if it's fair that he misses his
son's soccer games on Saturdays to go to his second job while people who are on
welfare have health benefits he and his family don't have. In a moment of frustration
he pointed out to his wife that if they broke up she and their two sons could get
benefits that working families like theirs can't afford.
4) We must have universal coverage in order to reward work.
Think of the message that non-universal reform would send to literally millions and
millions of working Americans. It would say, much as we do today, "If you are lucky
enough to work for someone who will help you with your insurance, or if you are
poor enough and down on your luck enough to qualify for government assistance, then
you'll have health security. But, if you're in the middle and you get up every day and
work for a living and you cannot afford health insurance yourself, you're out of luck."
5) No solution or partial solutions fail eyecy American.
Those who urge Band-Aid solutions say they're reforming the health care system. But
they fail to provide every American with the ironclad guarantee that they'll have
private health insurance that can never be taken away.
6) Now is the time to answer the call of history.
Together, we confront a historic moment. It is a moment when we ask ourselves: are
we going to join every other industrialized country and guarantee health coverage to
all our citizens? The President's answer is "Yes, we must," and I believe that we will.
�L
TO:
FR:
RE:
DT:
Hillary, Maggie, Mandy, Melanne
Lisa
NBC Health Care Special
June 14, 1994
You are scheduled to participate in the live taping of NBC's
2 hour prime time special on health care which will air Tuesday,
June 21. The taping will take place on Thursday, June 16.
The special is meant to be an educational program on
the health care issue. It will be comprised of taped segments,
panel discussions and audience participation. I have attached a
list of the taped segments, panel participants and audience
composition. The taped segments will include real people
stories. The people featured in those segments will be in the
audience. The panels will be evolving panels that will change
for each different segment of the show~ The audience will
consist of about 120 people, each of whom have a stake in the
health care issue.
Your role in the program will be three-fold: an openingL
discussion wit
·
ions to ou from the
~u 1ence, an audience participant for the body of the show where
Brokaw or one of the NBC correspondents will throw to you for
reaction no more than 4 times during the show, and a closing
summary discussion with Tom Brokaw.
The format of the show will basically consist of 5 parts
which are still being worked out -- here is the rough cut:
Opening -- Opening with 2-3 minute video production piece to give
overview of the basic segments of the show: What do we want from
the health care system? How is it broken? How do we fix it? Who
delivers it? How do we decide on a solution?
After the taped piece, Brokaw will discuss the results
of a recent health care poll conducted by NBC. The poll results
generally indicate that there is anxiety, puzzlement and
confusion over the health care issue. In addition, the poll
finds that most people are satisfied with their own health care
but recognize that something probably needs to be done overall.
The show will then move to about a 4 minute discussion
between you and Brokaw on the topic of either what do we want
from the system or how is it broken? The intention of this
discussion is to paint a broad brush on the issue of health care
that will set the tone for the show.
Brokaw will then throw to the audience where you will
take 4 questions from members of the audience. You can expect
the questions to be both sympathetic and adversarial.
After your response to the last question, you will be
seated in the front row of the audience. Seated on one side of
you will be Dr. Betty Lowe of the Arkansas Children's Hospital
and on the other side will be probably be Julie Carr (an acute
care nurse from Oklahoma whose husband lost his health insurance
�TAPED STORIES TO APPEAR IN NBC HEALTH CARE SPECIAL
1. PRE-EXISTING CONDITIONS
Alan Fuller -- Owner of a Georgetown bookstore who has lung
cancer. He is in debt because there was a 30 day waiting period
before his insurance would cover his illness. He has $30,000 in
medical bills.
2.COST SHIFTING
Long Beach Memorial Hospital Emergency Room -- Interview with a
doctor about how everyone comes to the emergency room to find
doctors but most have no means to pay. Doctor talks about there
is a need for public education on how people should not rely on
getting their health care in the emergency room.
3. PAPER AND BUREAUCRACY
Hospital in Norfolk, VA -- Discussion with doctor or hospital
employee about the nightmare of bureaucracy. This will be
illustrated by showing what the hospital must go though in terms
of paper work for a doctor to perform cardiac surgery.
4. CLASS OF '94
New doctors -- Various interviews with graduating doctors from
UCLA Medical School. Discussion of the debate between becoming a
specialist or a generalist. Point is made by the class of '94
that there is a need to put trust back in our health care system.
Less focus on money and more focus on quality of health care
delivery.
5. LONG TERM CARE
Pansy Chaney -- A woman who lives in Los Angeles and cares for
her 81-year-old mother. Discussion of the difficulties in how to
provide care for one's parents as they get older. Chaney talks
about how she has gone broke caring for her mother and had to put
her in a convalescent home.
6. RADIO TALK SHOWS
Discussion of how conservative talk show hosts talk to
conservative audiences and continually hit home the theme of
government run health care, a theme that is not accurate.
7. LACK OF SECURITY
Cathy and Perry Thorsell -- A couple who live in Connecticut who
have 2 children ages 2 and 7 and fear that they will not have any
insurance in order to cover their children. A discussion of the
difficult choices they must make without insurance.
8. PROFILE OF THE HAWAII HEALTH CARE SYSTEM
9. PROFILE OF A MINNESOTA HMO
10. LOBBYING ON HEALTH CARE
�Discussion of the forces lobbying for and against health care
reform and the different methods used (ie. telemarketing, direct
mail). Will show the POTUS/FLOTUS spoof of "Harry and Louise."
NOTE: The people in these taped seqments will be in the audience.
�don't propose and start off with a compromise that you
ultimately have to compromise again. You could end up
compromising your compromise, and that's not the way to
legislate. So I think what he did was to start from a
position of strength, knowing that we're going to have to
move towards the center. But we're going to need the
Republicans to also move towards the center. We can't do
it by ourselves. And I think the American people
understand that.
MR. RUSSERT: If the Democrats insist, however, in
reporting out a bill, and Senator Dole filibusters
one,
do you think he will filibuster?
SEN. BREAUX: You'd have to ask Senator Dole, but he
has indicated that he is willing to stop it if it has
employer mandates. And I think that's saying, "Look, we're
not going to move." And I think that's not what the
American people want. They know it's going to be
compromised. You can't draw a line in the sand and say,
"If it's not my way 100 percent, I'm not going to play
ball." That's not the way we should legislate in this
country.
MR. RUSSERT: Senator, will we have a health care
reform bill this year?
SEN. BREAUX: I think we will. I think the chances are
better than 50-50. I think things are improving. We're
like moving now into the end of the process. The
beginning is over. The posturing is over. Now we're
going to have to start actually voting. So I think that,
you know, the light of the tunnel is there. We can see it.
MR. RUSSERT: Senator Breaux, we thank you for joining
us on Meet the Press.
SEN. BREAUX:
Thank you, Tim.
INTERVIEW WITH:
HAROLD ICKES, WHITE HOUSE DEPUTY CHIEF OF STAFF
MR. RUSSERT:
MR. ICKES:
Mr. Ickes, welcome to Meet the Press.
Thank you.
MR. RUSSERT: Health care. In January, the president
threatened to veto any bill that did not
provide health insurance to every American. Senator
Breaux just said, "Well, you know, maybe we could phase
�that in over the next 10, 15 years."
Acceptable?
MR. ICKES: I think the important thing that Senator
Breaux said was that he was for universal coverage.
That's the touchstone of the president's program. That's
what we're working for. We think there will be a bill put
on the president's desk this year that he will sign that
will have universal coverage.
MR. RUSSERT:
years?
So incremental, over the next 10, 15
MR. ICKES: Well, no, I don't think over the next 10 or
15 years, Mr. Russert. I think that we have to wait to
see the bills as they come off the floor. But the
critical point is universal coverage, so that in law every
American has the right to health care, has health care
coverage for life that cannot be taken away. That's the
touchstone. The details will be worked out. We're not
prepared at this point to comment on the details.
As you know, Senator Breaux has been a pivotal member
of a very important committee. The committee chairman,
Senator Moynihan, has just put in his mark, his proposal.
They will be working on that over the next several weeks.
And he is a very adroit, sophisticated legislator. He
understands he's for universal coverage. He understands
the president's for universal coverage. We are confident
that he will have the wherewithal to work a bill that will
come out that will provide universal coverage.
MR. RUSSERT: Well, part of his sophistication and
adroitness this morning was that the Moynihan plan does
not have the votes in the finance committee, that the plan
that is now being put forward by the
administration does not have the votes. And he says
that the problem is the Democrats have been looking after
the 15 percent that don't have health insurance and
forgetting the 85 percent who do, who want some reform.
Will the plan that is put forward be modest and
incremental enough to win Republican support?
MR. ICKES: We hope that there will be Republican
support and we think that at the end of this process there
will be Republican support. What is important, though, is
that the universal coverage is the critical aspect of it.
As you know, there's going to be a lot of changes as this
works through the Senate Finance Committee. And what
comes out of that, we don't know at this point. However,
we are convinced that Senator Moynihan will be able to
produce a bill that has universal coverage. And at tha·t
point they will create bills that will go to the floor
that will be debated in both the Senate and the House of
Representatives.
�What we don't want to do is to leave behind and leave
out people like Jim Bryant, who the president talked about
in his radio address yesterday; works 70 hours a week, has
a wife and several children, has no health insurance.
That's unacceptable. Work should be rewarded. And the
president is very strongly in favor of that. And as I
said, his touchstone is universal coverage so that the Jim
Bryants of the world don't get left out.
MR. RUSSERT: But they could be left out in the near
future as long as they got it within the next five or 10
years.
MR. ICKES: Again, those details will be worked out in
the legislative process. But as long as universal
coverage within a reasonable time is provided, I think the
president will sign that bill.
MR. RUSSERT: How seriously do you take Senator Bob
Dole's threat of a filibuster?
MR. ICKES: Well, Senator Dole is sort of -- he seems
to have different positions at different times of the week
or month. What the American people want are solutions.
That's what they elected the president for. He is trying
to provide a solution. We think we've provided a very
reasonable proposal to deal with health care. We think
it's much too early. The American people are not
interested, I think, in hearing the talk of filibuster.
What they want is for the president and the Congress to
provide solutions. That's what they're looking for.
That's the leadership they're looking for.
MR. RUSSERT: Do you think you can pass a health care
reform bill without the support of Bob Dole?
MR. ICKES: We would like the support of Bob Dole. The
president is working very hard over these past weeks and
will continue to do so, reaching out towards Republicans.
As you know, he's meeting with Senator Moynihan and
Senator Packwood this Tuesday. He has been in
touch and will be increasingly in touch with
Republicans, as well as with Democrats, as this process
goes down the line. We think that most members of
Congress understand that the American people want action
this year on universal coverage.
MR. RUSSERT:
Dole?
But could you pass a bill without Bob
MR. ICKES: Is it possible? I think it certainly is
possible. Do we want Republican support? Yes. Do we
expect Republican support? Yes.
�MR. RUSSERT:
David.
MR. BRODER: You heard Senator Breaux say it's the
fourth quarter and it's time that all the players be on
the field. Is he right about that?
MR. ICKES: Well, I'm not sure what he meant by that.
I think all players are, in fact, on the field. The
president and the first lady and top members of the
administration have been fully engaged in this process.
The president is meeting and phoning on a consistent basis
with the relevant members of Congress, meeting with them,
as is the first lady, as are other members of the
administration. This administration is fully engaged.
On the other hand, we are not micromanaging this
legislative process. That is not the president's job to
micromanage. This is a congressional process. We are
providing information. We are providing help. And we are
making -- the president is making his case.
MR. BRODER: The senator's point is that unless the
president begins to get in there and actually say, "Yes, I
will accept this compromise; no, I will not accept that
one," those deals can't be made.
MR. ICKES: Again, I think that time is too early, Mr.
Broder. And I also heard the senator say that the
president and top members of the administration were
becoming increasingly involved. I know as a fact, because
I'm involved in it every day, that they -- the president,
the first lady and others -- have been very, very much
involved and will become increasingly so. But again, this
is a matter
of timing. And Senator Moynihan has just initiated his
proposal in his committee.
MR. BRODER: I'd like to get your reaction specifically
to the plan that Senator Breaux has put forward with the
so-called triggers; that legislation would be passed this
year that said if, by 1998 or 1999, a specific percentage
of the uninsured have not been covered, then the mandates
would come into effect. Is that approach acceptable to
the administration?
MR. ICKES: We're not prepared at this point to comment
on various different proposals. The only way that we can
start to look at this is look at a bill in a totality. It
is impossible at this point to start discussing individual
aspects of individual proposals. There are going to be
many, many proposals going through, as there have been, in
the various committees. I suspect that there will be a
�number of different proposals before this process in
the Senate Finance Committee has ended.
And what counts at the end of the process is what does
the bill look like as a totality. Does it, first and
foremost, provide universal coverage? And does it provide
an adequate basis for financing it, and does it provide
for cost control and other elements? But to now comment on
specific proposals this early in the process, the Senate
Finance Committee, I think, is not at this point relevant.
MR. BROWNSTEIN: Mr. Ickes, let me ask you about
another one of your responsibilities at the White House,
which is the midterm congressional elections coming up.
The Democrats just lost a congressional seat in Kentucky
that they held for over 100 years. They lost a special
election in Oklahoma. Last year they lost governors'
races in Virginia and New Jersey, as well as mayoral cities
in the overwhelmingly Democratic cities of New York and
LA. Is there a pattern developing here the Democrats have
to be worried about as they look forward to this November?
MR. ICKES: I don't think there's a pattern developing
yet. I think it's first much too early to start making
predictions about 1994. These midterm elections are not
going to be national referendums. They're going to be
referendums, district by district, legislator by
legislator, governor by governor. I think the legislators
are going to go home, stand for election based on their
record.
The record of this administration is the most
productive record in the last 30 years, according to some
authorities. An enormous amount of legislation has come
out and will continue to come out. We have health care
up. We have a crime bill that's coming through. Welfare
reform is going to be introduced at least this year. We
have campaign finance reform on the Hill, et cetera. It's
going to be that legislative agenda -- and then there was
the legislative agenda of last year, lowering deficits, et
cetera. It's going to be that agenda that individual
legislators will go home and run on. That is a Clinton
agenda, to a great extent, helped greatly by the Congress.
MR. BROWNSTEIN: So are you then -- are you saying that
you want to encourage Democrats to make this midterm
election a referendum on the first two years and the
accomplishments of the Clinton presidency?
MR. ICKES: No, I'm not saying that. I'm saying just
the opposite, that this is not -- I would not look at the
�midterm elections as a referendum, a national referendum.
It is district by district, and each district has its own
peculiarities. But what I am
saying is that the legislators will go home and run on
their record. That record has been laid out last year and
is being continued to be laid out this year, and that is
primarily a Clinton agenda and a Clinton record.
MR. BROWNSTEIN: The political director of the
Democratic National Committee said this week that there
are clearly some areas of the country where it is not
going to benefit a candidate to associate himself with
Bill Clinton, "and if you want us to stay away, we'll stay
away." Now, after that, his boss, David Wilhelm, and
people at the White House, came down on him with both
feet. But wasn't he just saying the obvious, that there
are parts of this country where Bill Clinton isn't popular
and it would be to a candidate's advantage to emphasize
his differences with him?
MR. ICKES:
retracted.
Well, I think that those statements were
MR. BROWNSTEIN:
his statements?
Which statements, the criticisms or
MR. ICKES: No, no, his statements.
(ph) statements were retracted.
Mr. Schweitzer's
MR. BROWNSTEIN: Do you think he's wrong, that there
are going to be candidates around this country in areas of
the country, Democratic candidates, who are not going to
find it to their advantage to tie themselves closer to the
White House?
MR. ICKES: I think the candidates are going to tie
themselves to the record that they have accumulated in
the Congress, and that is essentially a very broad record,
a record of change and progress, and that is basically a
record that has been initiated, supported and pushed by
this president.
MR. RUSSERT: Mr. Ickes, our next guest, Bob Woodward,
wrote this book, "The Agenda," which I know has been
well-read at the White House. It's a chronicle of the
first year of the administration. What has the White House
learned from this book?
MR. ICKES: I think what the White House and the
country has -- I think what the country has learned, Mr.
Russert, is what the White House has known, is that we
have a very engaged president who has come in, tackled
very tough problems and has made very tough choices, and
as a result of an economic program that is the subject of
�this book, has resulted in lowering interest rates, 3
million new jobs since he took office; has dealt, I think,
very well with lowering trade barriers, has taken on some
tough issues like NAFTA, has moved GATT forward.
\
I think that what that book really shows is the
internal workings of a White House making very difficult
policy. And what is refreshing about the book and what,
in my mind, is heartening about the book is that you have
a chief executive who is very engaged, very knowledgeable,
and is willing to step up to the plate and make very tough
decisions. That's what that book shows, and I think that's
a good thing for the country to read.
MR. RUSSERT: So you're pleased that many members of
the White House staff spent so much time talking to Mr.
Woodward?
MR. ICKES: I think that, you know, people have talked
to Mr. Woodward, obviously. But I think the lesson to be
drawn from this book, as I said, is the fact that this
president has taken on very tough issues and is very
engaged.
MR. RUSSERT: But what about some of the criticisms of
the conduct of the White House staff? Chaos is a word
that's used frequently; the president labeling his own
middle-class tax cut a "turkey," the deputy director of
the OMB saying, "You're well aware of the size of the
deficit, but try to fake it." Some of the criticisms, are
they being taken in a constructive way?
MR. ICKES: Tim, if everything that you said or I said
or David said in offhand comments were printed -- I mean,
I don't think it has any relevance. I think what is
relevant is what has resulted. And what has resulted is a
serious economic program. He came in early in his
administration, decided to tackle a very large deficit that
was left by his predecessors, and has dealt with that
successfully -- deficit reduction over three years, the
first time in 50 years that that's occurred.
MR. RUSSERT: Mr. Ickes, we thank you for joining us
this morning on Meet the Press.
MR. ICKES:
Thank you.
END
Distribution:
TO:
TO:
Jeffrey L. Eller
George Stephanopoulos
�HEALTH REFORM:
THE PRESIDENT'S APPROACH
Here's how the President's health reform works:
•
Guaranteed private insurance. We want to guarantee private insurance
coverage to every American. Comprehensive coverage that can never be
taken away.
•
Choice. We want everyone to have the right to choose their own doctor and
their own health plan. We want to make sure you get high-quality care by
giving you the choice, not your boss or insurance company.
•
Outlaw unfair insurance practices. We want to make it illegal for
insurance companies to: drop coverage or cut benefits; jack up your rates if
you get sick; use lifetime limits to cut off your benefits; or charge older
people more than younger. That's how you'll get affordable insurance you
can depend on.
•
Preserve Medicare. We will protect and strengthen Medicare. Older
Americans have a right to count on Medicare and choose their doctor. We
also want to cover prescription drugs under Medicare, and give new options
for long- term care in the home and community.
•
Health benefits guaranteed at work. Every job should come with health
benefits. Most jobs do today. And yet 8 out of 10 Americans who have no
insurance are in working families. We want everyone to have health benefits
guaranteed at work. The government will provide discounts for small
businesses and help cover the unemployed.
�QUESTIONS AND ANSWERS
1) Doesn't the Clinton plan add more layers of government
bureaucracy?
No. The President specifically rejected a government-run system in favor
of guaranteed private insurance. America basically faces 3 choices:
• government insurance for everybody
• guaranteed private insurance (the President's approach)
• leaving people without insurance
The President's approach is guaranteed private insurance. Everyone will
have comprehensive coverage that can never be taken away.
2) But what about these so-called "alliances"?
The purpose of them is very simple -- to give choice back to the people
and take it away from the insurance companies.
Now, Congress will figure out exactly how they should be structured, but
this is an idea that has bipartisan support. The insurance companies don't
like it because it means they have less power, but that's what alliances are
intended to do. And that's why the insurance industry is spending millions
to weaken or destroy the idea.
3) One of those TV ads says that the President's plan will limit my
choice of doctor. Is that true?
No, it's not. You'll be able to choose your own doctor and health plan.
In fact, to make sure that you get the high-quality care you deserve, the
President's approach actually increases the choices most consumers will
have. Because you will choose your doctor and health plan -- your boss
won't and the insurance company won't. So you can choose any doctor
and health plan in your community. Remember who's paying for these
ads: the insurance companies-- who are trying to scare you and preserve
their profits.
�4) Won't this plan mean that I'll pay more and get less?
No. In fact, the independent Congressional Budget Office (CBO) analysis
that the Republicans praised said that the President's plan would cost
Americans less money and give them more health benefits. Young,
healthy people may pay a little more -- but that's because we're
prohibiting the insurance companies from charging older people more than
younger people.
Under the President's approach, you'll be guaranteed affordable insurance
you can depend on. We'll make it illegal for insurance companies to jack
up your rates or drop you if you get sick, use lifetime limits to cut off
your benefits, or take away your benefits. The insurance companies won't
be allowed to bleed you dry.
And the President's proposal calls for comprehensive benefits, including
preventive care and prescription drugs. Under the President's approach, no
one -- not your boss, not your insurance company -- can take those
benefits away.
5) Won't your emplo_yer mandate cause massive job loss and cause
thousands of small businesses to go bankrupt?
There is no credible evidence to support that claim. The independent
Congressional Budget Office (CBO) analysis that the Republicans praised
said that the Clinton plan would not result in the loss of jobs, and would
benefit all small businesses.
Studies predict that there will, in fact, be job gains as a result of the plan.
The Economic Policy Institute predicts 258,000 manufacturing jobs
created over the next decade, Lewin-VHI, a widely-respected, bipartisan
firm, predicts over one million jobs created by providing long-term care,
and the Employee Benefit Research Institute predicts that the President's
proposal could produce as many as 660,000 jobs.
The President specifically designed his proposal to help small businesses - the biggest victims of today's health care crisis. Small business owners
will be able to get rock-solid, comprehensive coverage for their families
and employees. And no longer will they be subject to insurers jacking up
�their rates or dropping their coverage when one employee gets sick.
Because those insurance company abuses will be illegal.
6) Why do we need an employer mandate anyway?
If we want to guarantee every American health insurance, we've got to
figure out how to achieve that goal. The President believes every job
should come with health benefits. Most jobs do today because most
employers accept this responsibility to provide worker health benefits.
And yet 8 out of 10 Americans who have no insurance are in working
families. We want everyone to have health benefits guaranteed at work.
And under the President's approach, the government will provide discounts
for small businesses, help cover the unemployed, and continue Medicare
for older Americans. That's how we'll cover everybody.
7) When you try to cut costs and limit the amount premiums can
rise, won't that just lead to rationing?
Absolutely not. The key to this is insurance company premiums can't
continue to rise unchecked. Your money will go to buying you the highest
quality of care and service, not padding the insurance company red tape.
That's why there's a limit on how much insurance companies can raise
your rates. In fact, it will be illegal for insurance companies to drop your
coverage or take away your benefits. You'll be guaranteed affordable
insurance you can depend on.
The President's approach is all about keeping you healthy. You'll have the
right to choose your own doctor and health plan. We want to make sure
you get high-quality care by giving you the choice, not your boss or
msurance company.
8) I've got good insurance. What's in this plan for me?
First -- and most important -- you'll get something that no amount of
money can buy in today's insurance market: guaranteed private insurance.
Comprehensive coverage that can never be taken away. Second, you, not
your boss or insurance company, have the choice of doctor and health
plan to make sure you get the high-quality care you deserve.
�Third, unfair insurance company practices will be outlawed. 3 out of 4
insurance policies -- that's 133 million people -- have these lifetime limits
which mean that your coverage could be cut out just when someone in
your family is sickest. No more. No more jacking up prices when you get
sick. You'll have affordable insurance you can depend on. Fourth, we
protect Medicare. We'll cover prescription drugs under Medicare, and give
new options for long-term care in the home and community. And fifth,
everyone will have health benefits guaranteed at work, with the
government providing discounts to small businesses and the unemployed.
Even if you lose your job, you will never have to worry about losing
benefits or being forced to change doctors.
9) Is it true that my doctor can be fined $10,000 for treating me
outside the system?
A: No, that's not true. You can see any doctor you want and pay for any
procedure or treatment. The $10,000 fine refers to the President's
crackdown on insurance company fraud. Fly-by-night insurance companies
will be fined if they try to dupe you by selling you "supplemental"
benefits that you're already guaranteed by law.
[Note: By law, you'll be guaranteed the right to p;:ty to see any doctor in
the country, even if you are in an HMO.]
10) What's going to happen to my Medicare benefits?
A: Older Americans who receive Medicare will continue to receive all the
benefits you do today. And you'll keep the doctor you now have. In
addition, we'll strengthen Medicare by adding prescription drug coverage.
Older Americans will also benefit from new long-term care options in
their homes and communities, where they want to receive care.
�.IUit
.....
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...... ·- ....
Faot &be NldaD CCII Ntwt) • Suadq, .lUM12, ltM
.,
WbtA wo come '*k, we'll talk to David Oeraen abouc healda care and a lot of othor tbqa. David
Oeraon, Wblco HO\IIe couneoJor.
(AnnoUDC«neDll)
SCHIBfFBR: And wtth ua uow, David Gersen, cowelor 10 President Cllnlon, a fo.rmor pest on tbla
broadcaa' from dine to thne as a ~mmentator; now, here u-as a aovernmem official, fOmethlnf chat
you'vo dOAt over the years in varioUI capacltlel.
Mr.
J:?AVID OBJtOSN (CounsoJor to tho Pmldem); Too ofttn.
SCHIEFFER: Let's talk a Utt.le bit aboul. healdl caro flnt and that you beard what Chall'QWl
Roateakowaki aald. Doea the White House welcome Cbalnnan RostenJcowa1d'a hdp on thl1 or do you
feel that could--could hun tbls whole effort?
Mr. OBR.OBN: Oh. no. Of course. I thbJk be =\&Jcl c:cmtln\&C to be-·he '• been avery strooa and 1taunch
ally of healch cue, and I Chink he'll continue co be t!W. He•u have an important volce up thote, but J
have to tell you tbat, aa be said, the new chairman of the committee it Sam Olbboua, 8lld Sam Gibbons
is tatlna tO ao. Bob. Ho wu··he Wl6 over at tho Normandy for the 50th reunion. He went in u a
pr.ratrooptr. And I toll you. thf man bu cot 11 much Jlqticn and a•·up-aM•Jo today u he did 50
yeua aao when hi went Into Nonn&Ddy aa-on-m Jump m.
SCHISPPER: Wtll, Ia th1a solug to complicate tb!Dga? I mean, bocaule, u I hear Mr.l\olu:nkowald
today 1 he Sift M 11 soma to take 1ft actiVe fOit, Do )'0\A tblDk )'OU may haVer lOme lituttfOft where yO\&
bave two people vylq for the chalrmwhip?
Mr. GBROBN: I don't dUnk ao. I dUnk lt'l very clear the chairman ia Sam Olbbom. He'a the maD
wbo's1olq to beleadlnJ the dJarJt, but, )'OU know, the president needs eY8I)' VOte he can aet up there,
and Dan loateukowlkl will be a ll1'0DI all)'.
SCHIBFPBR.: Let's talk about a vote you ~pp~nmtly don't have riPt now, and that Ia dte Ropubllwl
leader in the Senate, Bob Dole, who said fia&l)' yesterday It tbe presldtnt la~is&l OD tmployer m&Ddatesand what he mea:J& by thai, haviDJ emplo)'OQ pay 80 perGtnt of tho cost of health care-If 1M president
iDsista on that, Ser.ator Dole 11Sd yesterday, flatly, all deals are off. Tbere'a tOlD& to 'bono btalth-cart
refonn leaislatlon this yoar. Ho'll bloek all of lt aDd 10 to che votm tD November, ancl use the
coqreulon&l elections u a referendwn on health care. How do you feel abou.c It?
Mr. GERGEN: Well, Bob, I think thelmportanc thina now Ia not tO talk about the 'P4 elections, b\lt Jet's
talk about how do we 1ct hoaJth ~ done thiS )'M We bave tbe bolt cbaDce In I Jentr&tloD to sat
serlOUJ health·caro reform dono in thla Consreaa. If che-ar.d lhe teat II really now of the Conareu to
move on thfe. We've had-Bill Clinton it &he seventh proaident who's tried to move bulth oare duoup
che Coqress. We have come fanblr wdtr th11 presldem than e.ny other prevloUI prNldem in hlatory,
gom, all the WI)' back to PranJcliD Roosevelt. We've act ftn commlttna now cbtt are workin, on bOla
thaC would provide wvar&al coveraae and would have ahared ro&poMlbllltY, with 6mployers and
employeu both pitldq up pan of the tab.
Now lt'l obvioualy sot to work throup the proctts in the conunitteea and OD the floor. Bu,, )'OU know.
it'e-thit-we'vo-thla counuy baa beeD U)'iDa 10 climb wbac ia the MO\Int Ever11t ol American politica,
health-care reform, for 60 yean. Wc'v• come futhtr up tho moWltl.ln tbu anytime we've evor dane
�. . ..,
........
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.....
·-
•••
·-·.
6
FICll dae Nadoa (CBS NIWI) • 8'&1Dday, I IIIII 12, 1tN
7
In lho past. Tbll It the wroq Clmc to be ta1klna abOUt IOiq back down die mounWP and sta.rtlnJ all
over again. Now's the timo to ao all tbe way to th1 top. We've ao& that charJce th1l year. We ought
to 10 ahead and MOlt we can set it done. I hope wo can do it. The prealdent ·wants to do lt Ia a
blpartllian way. And Bob Dole-let't aay this: Job Dole has bad a sorlous lntert~t In health care in the
put, and I trust that be··)'OU bow, beN aiDID who wu wounded..you know, aavaaely wounded ln the
Italian campa1p of World War U. He's bad alona·term lntert$t in health*' elnce thtD. I &run that,
In the oDd, Bob Dole &Dd the Republic:aP&-R.epubUc:ans·~23 of lhem in the Senate bave come ouc for
universal coverage-cov-you know. bave joined the Chafee bUl, and JU'Uit that tn cho end, they wiU wpt
to be conttrucdve lo tr)1D.a to get thlt done.
SCHIBPFBR: All rip. One possible compromife, as you know, that Ia belq talked about 11 the aocalltd Ulger, the OODCept beina pushed by LouiJlana Senator John Breaux. I will now attempt to explain
what the Jat&Oil U'lJJII' means. As I undencud lt...
Mr. GBRGBN: Better-better you than mo.
SCHlBPPER: Al-u-u I understand lt, instead ot inakioa it mandatory that employers pick up 80
percent of the COitl of btalth cart now, you pick out aomc way, aome year dowu the road wlwe you say
Jf. at that point tu time, chat we don't hf.ve unlve:•al healch cue or 90-plus percent, maybe SJ5 percent
of people coverecl with health care Ww:~·if, at t!w time, you don't have unlvtraal coverqt-•theo
tbe employer mandate WW ki~k ln and employon will have to pay mmdatol'1-manthtorUy will havt ~
pay for that 80 percent coat ol health care. That's what they call the-the hard trias•• u 1 understand
it. The aoft utaaer, J undotstand it, it another ooocopt, tbat 1&)'1 if )'0\1 don't bavo unlveml health care
several yean down tht road, then COJJ8fell wUl mlslt dle luue and 4edde wbl1 to do about Jt. DC\
either of tb.ote concepts appeal to the aclmlni.etration?
Mr. OBR.GEN: Woll, the notion beze, obvioualy, is-lt to, In effOQt, ao down ono road and aeo if that
wll1 work tO brtna ua to univenal, as soma people claim it wllJ, relyina boavlly on the private
marketplace: or tfchat doesn't work, lben to 10 to eomothbJB like JJWidatory comrlbudons by emp1oyera.
ADd-and the uurh II, you know, the pt\':lidem has Mid all alOIJ& be II opG to An)' mechlniun-any
medwltsm that Jltl ua ro unlveratl coverqe. Tho bottom Une for hlm, and I thiDk for many, many
people In this CO\WI')'. Ia-la at the end of the day, wltblD a few yean, will every American have a
auu~: Will every American be able to c:oum on havlq hWch in&uranoo?
Now the mecbani&m-the WIJ we set there is 1181 Important tbaq maldna lUre we &et the unlvenal. So,
yeah, tlW'e are people 01l tbe Hill now who tre lookt.Da at dle Ui&Ser question, to II)', II that a--Is that
a basis for formlna a coallclon-hopef\llly, a bipartisan c:oalldon.·tbat will voce for health~? We'll ban
to walt and aoe. That's-that's sometb!nB they're workina out on the HUI today. But the president laid
the bottom line it \IDivmal c~erqe.
SCHIEFFBR: So-eo what you're aaylnl ro me, It we pu& all tbia tecbnical Jaraon aside, which I dld n01
explain very well··Wbat you're slflnl to me, that the White House woulcl CODiider this concept of trlaaer•
if tbaf wu a way to reach uldveraal health cart aomewhore down the line.
Mr. GBROEN: But--but, Bob, 1want tO go back co Ualf, undet5e:oro the point that what'l jmponant here
is-the pretldent's aatd all alana any mechanism which guaranteea-lt hu to auarantN that there will be
unlveml coverage down the road-It-you mow, phased In over time. That'a what tht president's bill
bas done. 1be president saJ4 all alona that be th1nb h1s bUlla the beat way ro aet there, but if there are
odlar way• to aet thero, u loq as they pc to untve.raal-thore are ~ road& u. Roane in fhll airuatlon.
IUit~taU'• INI'OifiiATIOII IMYICES I f'JOII71Uif0 I (IDOJ"I-ItP'F
�'
& ., •
.
.
Face tile NadOil (C118 Newt) • luDday, JUAI 11, 1H4
8
Ho waa wDllua-eertalnly, open to any tOld thai ••" us dlere. ADd if th" •• me trluer, if that' • what
aachen the 18 voce.-cbe-tlw ts .-.rta.inly a mcdw\lsm he can be open to, u Jona .,...bUt 1ec me 1t1ess
thfs, bec&we tbts is the critical ilsue. The ita~ la not the utaser. The issue !1 nOt one mec.banlsm va.
IUJOlhtt mechanism. The 1saue is not even the employer tnandatc. The fsaue Ia. 11 there a-whal'l the belt
way and can we ftnd a way ~ sec co unlvenal covera,e so that every American hu a auuantoe1 That's
what Amorlcan people want. We ue clo11 co chat now, and we ouJbt to so ahead 8Dd move a.nc1 aet lt
done~· year.
SCHIBPPER: AD4·-aad you are saylq, conceivably, tba& Ia a way to so& wre.
Mr. OBROEN: I'm uylq tbe pre&ldent
coveraae.
u open to 111)' mechanism tbat-that bringa us unlveraal
SCHIEFFER: AU rlpt. Let's talk a little b1t about Bob Woodward's book, which caused quite a
&eaaatlon bore, arad I fou.od out lo a lrip o\UIIde Waahi.natOn this week, is causina a swatloll in other
pw or me eountry u well. Hie book pictures a Wblte House ln chaos~ a pre~ldenc who is prone to
lhrowlftl au!oleacent tCIDlper tantrums; a plate where people are wllllnJ to abare the molt intimate
oonveraatioaa that they have bad with tho prealdent himself. And porhapt the most damnln, put of lt Ja
11 is a book lbaC pwpotta to say all of ebll cornea from tho pmident's friends and auppottetS, not from
hll onemlcs. II the White House Ub lc't pletured in lhfa book?
Mr. OBRGSN: ltaeemod JiD-..1 wu sometimes Jooklfta at tbe dlaptera of this eort of like a funhoule,
not 1 Whito House. It wullU looklnl iD a mirror lD a iUMOUJe. Bob, I've been··Whirb II to say that
I foun4 th1a to be often a dlltoned view of convoraatlont. 'lbat'a what-l'm DOt tryfnl to pick fights with
Bob Woodward, but I
"'im to say tbla: I've been In duet previoua Whitt Houeea, u you know.
In every ODO there were ~adom abour confusion, iDdecliiveness, chaos, lnftahtlna. coo many leaks,
people lalklna too amch at die eenior level, u well u th• junior levels, to the pross. 'nlat'1 whallhey
used to ay about Prulkltn RooaeveU roplarl)'. That wu tbt a~ loa the)' made of him. So alona
COD'IC$ a book IDd aays lt'a happenloa, lo and behold, In the Clinton White HoUJe. Life Is ever thua.
You knOw, I dca't find much that'• new.
am-I
What I do lhlnk we have sometfmea iD Wuhln,ton and. co a grov.ina de1rn, 1$ we have an obsession
with prO*&, wids k)ina to fl&ute out wbo taid what to whom, u opposed to whal'a importmt co the
American people, and tbat's reaulta. Wlw Ia the performance level? Ana 1-I would hope chat u dle
clouds olear, chat people w!ll jlldSI a prealdont by hb porto~. Pic! he deUvor on job1? He's JOt
lbree mWion jobt ao far s~ be's beco.rDe presidem. Dld he dtllver on deficit reduction? We have the
blQea\ deficit ndUGtion in biatoey. Did ho deliver on trade? He'a so& the NAFTA aa~f puled.
He'saoc tbe GATr qreanent in process. We're abouc to pasa a crime biD, I hope, this summ&r. This
comlq week he's soma co deltver OP his welfare promlao, deliver a major weltaro-reform bW. He's--we
have oorne tbil far-fanher than lillY other prealdent 1D tho hiscory on health care. We've done family
leave. Wo've done edUQtion.
SCHI8PPBR: Let me...
Mr. OBROBN: Now aet··you know,ID my ...
SCHIBPPBR: I'll let you llat chose •••
Mr. OBROBN: A lot•-& lot of carerwauUna here.
�JU'1 J.'f
...
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u.~•
r.. ·.M
'I
....
. -
race tb NatiOA (CBS NtWI). 8U~Mf,q, Junt12, 1tP4
•
•
•-u.J '~...w •• ,.,. •· -
0
9
SCIIlBPPSR: I ftl\111 uk you one qu11tlon.
Mr. OBI.OBN: OK.
SCHIBPPBlt: There'• ono tcene In the book where it apparently aay1 that )'OU are vory ahocbd tO aee
Che president's temper. It aoUDda ulf it's-it'a been rell)'ocl to Woodward by ,you. Is tba& acoowu tNe?
Mr. OBRGBN: Well, th6o·I lbiDk U111 ~ tlrst appeared ln The Wall SU'Mt Jouraal. J don't know
who told them tba&. lt~t true I wu 1urprlsed once. I was-J \ft'U very eurpriHci at what-you know, what
he had··he wuted to see the Cbiea,o mt)'or ud hla-aocl he wa.s to14-hls advance people said ho could.n't
do it. ][ UDderltan4 wby he got q.ry. Buc I'll tell you-let me just say this one ocher ching. Tbil wu
an acoount of the tint yeu. When I ftnt aoc to tbc Wbftt House a Uttle mort than • year a,o, th11
prealdent wu ftustrated, and there were timet that ho w just-you know, he just wanted to do sood so
..
much aDd ho .,, .o upeec about it. But I th1D1c Cbat-1 have seen very. very few In tbe socond yev-vCU)'
few~ eruptiona. I--wbat I do see lA a man wbo'l very commltccd and detonuined to do beUer by
12111 COWltq.
SCHIBPPBR! We muac atop there. I'm very aorry. Thank& for being with us Ulia UlOl'Dlna. We've run
ouc of time. All tho DeWS today on the "CBS Svealng News." And. we•u see you next Sunday. Thank
)'OU.
SCHIBPPBR: And one Prosrammlna note: Watch Dana King with tho "CBS Bvenlai Newt'' tonJabt.
8C/IItlf&u'S INRNHIAfiON SMVICftl (101JrB3oSif0 I (NOJ45S.II7'1
�Who Would Incremental Reform Really Hurt? Middle Class Families
Some propose an incremental approach to health reforms aimed not at guaranteed
coverage for everyone, but at trying to increase the number of people with some
insurance reforms and subsidies for the poor. Employers could continue to drop
coverage, and millions of families would continue to go without insurance.
It's hard-working Americans -- the middle class -- who would be hurt by such an
approach. It's middle class families who will continue to lose their coverage when they
change a job; to take out a second mortgage to pay the bills from a child's illness, to
forego career advancement for fear of losing the coverage they have with their current
job.
Besides, all the evidence suggests an incremental approach won't work; in fact, health
reform that falls short of universal coverage could actually make things worse. Millions
would remain uncovered, including some previously insured through their company.
Costs would not be controlled, leading to higher prices for working familes and a
ballooning federal deficit.
Millions of families remain at risk
•
Incremental reform bills will not cover everyone -- not even close. An estimated
24 - 40 million people would remain uninsured without universal coverage.
•
One in six Americans will still lose their health insurance at some point during ·the
year.
Middle class will take the hardist hit
•
Since the poor and non-working would get free coverage, and since wealthy
Americans could afford coverage on their own even if costs continue to rise, those
hardest hit by incremental reform would be middle-class working families.
•
Under a non-universal, managed competition-style reform plan, an estimated 2440 million people, more than two thirds Q.fthem jn middle-class. workin.gfamilies.
would remain uninsured. The main reason these families wouldn't be covered is
the cost of insurance.
•
What's worse, many people who now have insurance protection today would find
themselves without coverage under an incremental reform plan. An estimated one
in ten workers with employer-sponsored insurance would be dropped by their
employer.
�The cost shift will continue
•
Under the Band-Aid approach, thpse who take responsibility for insurance
coverage will continue to pay for those who do not. Senator Chafee, a Republican
from Rhode Island, puts it this way: "If there's no mandate that people have to
belong, then young healthy males who don't ride motorcycles aren't going to join
and so the costs are going to be carried by those who are sick." Alain Enthoven,
the so-called "father" of managed competition, adds that "such a system would be
destroyed by free-riders".
The deficit will increase
•
•
Without any change to the existing system, two-thirds of the growth in federal
spending between 1993 and 1996 will be accounted for by health care spending.
Incremental reform plans aim to extend coverage to low-income families and the
unemployed by providing government subsidies to those Americans. Under a plan
with subsidies for the poor but no universal coverage, CBO says there would be
over $300 billion added to the deficit in financing the subsidies for low income
Americans. By contrast, the President's plan is expected to curb expenditures by
$30 billion by the year 2000, and by $150 billion by 2004.
Universal coverage is the only way to guarantee controllable costs, and fair,
equitable financing of health care.
Imagine a diner where everyone in a community goes for lunch. Most people have lunch,
pay, and leave, but every eighth person who walks into the diner sits down, orders
(usually the most expensive thing off the menu because they're famished), and gets up
and walks out without paying. The cost of that patron is spread over the other seven who
did pay. It only makes sense that when that eighth person pays for their lunch like
everybody else, and orders like everybody else, the cost to the other seven paying diners
will go down.
We don't think the solution is to charge working families through the nose for lunch, and
let the poor eat for free by taxing everyone who orders a steak. We think the free lunch
should end.
All Americans deserve the security of high quality health care coverage they can't lose,
even if they move or take a better job. The American health care system will be stronger,
better, and less costly if Congress finishes the job they've started and guarantees private
health insurance to all Americans this year.
�
Dublin Core
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Title
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Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
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White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
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1993
Identifier
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2006-0223-F
Description
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This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
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72 files in 6 boxes
Provenance
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Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
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William J. Clinton Presidential Library & Museum
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
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Paper
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Title
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[Background on Health Reform] [2]
Creator
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First Lady's Office
Melanne Verveer
Identifier
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2006-0223-F
Is Part Of
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Box 3
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2068127" target="_blank">National Archives Catalog Description</a>
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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William J. Clinton Presidential Library & Museum
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Adobe Acrobat Document
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1/8/2015
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42-t-2068127-20060223F-003-004-2015
2068127
-
https://clinton.presidentiallibraries.us/files/original/a46308c92dc464600006b0a4b674563f.pdf
7d0aff424aac560b3cda0d0217caa754
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
MAR~~~R
'
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Subgroup/Office of Origin:
I
First Lady's Office
Series/Staff Member:
I
Clinton Presidential Records
Melanne Verveer
Subseries:
Misc. Subject Files
OA/ID Number:
17607
Folci~riD:
Folder Title:
[Background on Healthcare Reform]
Stack:
Row:
Section:
Shelf:
Position:
s
59
7
10
2
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
SUBJECTffiTLE
DATE
Retrospectives on Health Reform: Update (5 pages)
04/17/1995
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
First Lady's Office
Melanne Verveer
ONBox Number: 17607
FOLDER TITLE:
[Background on Healthcare Reform] [I]
2006-0223-F
ab858
RESTRICTION CODES
Presidential Records Aet - (44 U.S.C. 1204(a))
Freedom of Information Aet -(5 U.S.C. SSl(b))
PI National Security Oassified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office ((a)(l) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
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���---
·~:
--
ABANDONED SURGERY
BUSINESS AND THE FAILURE OF HEALTH CARE REFORM
BY }OHN
B. }UDIS
I
n the ·Progressive Era, business leaders and organizations
played an indispensable role in developing and promoting the
. social legislation that first blunted the sharp edges of laissezfaire capitalism. Key business groups backed the Meat Inspection
and the Pure Food-and Drug Act, the creation of the Federal Trade
Commission, and the passage of child labor and workers' compensation laws. Without significant business support, most of this legislation would not have been adopted until the Great Depression, when
a national crisis neutralized potential opponents to change and invited a host of radical measures.
As Bill Clinton took office, it looked as though business would play
a similar role in the formulation and passage of his major social initiative, universal health insurance. At Clinton's December 1992 economic summit in Little Rock, Ford CEO Harold Polling made the
case for national health insurance. During Clinton's first months, the
three main business lobbies in Washington-the Business
Roundtable, the U.S. Chamber of Commerce, and the National
Association of Manufacturers (NAM)-and business-dominated
health coalitions such as the Washington Business Group on Health,
the National Leadership Coalition for Health Care Reform, and the
Jackson Hole Group were all on record supporting universal coverage and cost containment-the twin goals of the president's health
care reform. The only sharp dissenters were the National Federation
of Independent Business .(NFIB) and the Health Insurance
Association of America (HIAA), which represents smaller insurance
compames.
Yet barely 13 months after Clinton had taken office, most of the
prominent business groups turned abruptly against his plan for universal health insurance. In the space of three days, the Chamber of
Commerce dramatically reversed its stand in favor of employer-funded
reform; the Business Roundtable declared itself in favor of the rival
'
For subscriptions and bulk repn'nts ca//1-800-872..()162
... ·
NUMBER 21
ABANDONED SURGERY 6S
I
f
I
�Commission on Health
plan advanced by
convened a blue-ribbon
Representative
Jim
panel of business leadCooper; and the NAM
Conservative politicians
ers, labor officials, and
announced that it could
successfully lobbied inajor
health experts who
not support the Clinton
issued a report recomplan. The defection by
business lobbyists, who were
met:~ding
universal
these business organizain fact supposed to be
reform. In 1990, Henry
tions helped to doom the
Simmons, a member of
Clinton plan-and any
lobbying the politicians.
the commission, transother comprehensive
formed it into the
reform effort-by reNational Leadership Coalition for Health Care
moving the most important outside pressure for
Reform, which included major auto, steel, electronbipartisan support.
ics, and retail companies. In 1991 the coalition
How did these business organizations first come
came out in favor of a "pay or play" reform that
to support health care reform? And why did they
would have mandated employers to buy insurance
suddenly bail out? In the answer to these questions
for their employees or to pay a tax that would have
lies the answer to the larger question of
created a federal insurance system for the uninwhether-and if so, under what conditions-any
kind of significant social reform is now possible in
sured. Even groups that had historically opposed
any national plan began to advance reforms of their
American politics.
own. Insurance companies worked with Stanford
To THE CENTER AND BACK AGAIN
Business School Professor Alain Enthoven's
Jackson Hole Group to develop a plan for manWhile many business organizations traditionally
aged competition.
have supported labor and welfare legislation, they
Small businesses, whose premiums began rising
have shied away from national health insurance.
rapidly in the late '80s and averaged about 30 per·During the Progressive Era, the American
cent more than those of big businesses, got into the
Association for Labor Legislation, funded by John
D. Rockefeller and U.S. Steel's Elbert Gary, sponact. At the Chamber of Commerce, 96 percent of
sored a health insurance plan, but it was actively
whose members have less than 100 employees,
opposed by the most important big business lobby,
Robert Patricelli, the CEO of a health benefits
management company, convened a subgroup of the
the National Civic Federation, by the major insurChamber's Health Committee that was entirely
ance companies, and by the American Federation
of Labor, which saw government health insurance
composed of purchasers. Insurance and pharmaas an assault upon its prerogatives. The main busiceutical companies were not invited. By the time
ness lobbies also opposed Harry Truman's health
Clinton took office, Patricelli's committee had concluded that to control costs, the government had to
care initiative and the passage of Medicare.
But the rise of health care costs over the last
create a univers~ system and in order to fund it, an
three decades, and particularly during the late '80s,
employer mandate was necessary. With labor and
public interest groups also backing health reform,
spurred business to reconsider its opposition to or
indifference toward national health insurance. As
and with the recession still feeding public insecuripolitical scientist Cathie Jo Martin has argued, the
ty about access to health care, some kind of legislation seemed inevitable.
benefits managers, consultants, and insurance
administrators who were hired in the last decades
Over the next 18 months, many groups backed
away from the initial consensus in favor of reform,
to oversee corporate insurance policies played an
important role in this reconsideration. During the
but the two most important defectors were the
early '80s, the Washington Business Group on
Chamber of Commerce and the Business
Health, which was created by the Business
Roundtable. The Chamber, founded in 1912, has
Roundtable, and in which corporations are often
about 200,000 members. Unlike today's typical
represented by their benefit managers, opposed
Washington organization, it is not entirely staff driReagan administration attempts to deregulate
ven but organized through local and state
health care. In 1986, the National Leadership
Chambers and a national board of directors. Over
66 THE AMERICAN PROSPECT
SPRING !995
�.
.
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ely
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the years, it became known as a tenacious and
effective foe of any measure that threatened small
business-from increases in the minimum wage to
affirmative action. In 1991, in response to a recent
loss of influence and members, Chamber President
Richard Lesher tacked toward the middle. He elevated William T. Archey, known as a "pragmatist,"
to vice president. When Clinton took office,
Archey steered the Chamber to a more conciliatory
stance toward the administration. The Chamber
backed the administration's stimulus and budget
packages and did not join the opposition to the
Family and Medical Leave Act.
The Chamber's position on health care was dictated in part by the same conciliatory political
strategy but also by the realities of small-business
economics. By 1993, 67 percent of Chamber members provided health insurance for their employees
and were being hurt by rising premiums and· by
competition from other small businesses that didn't
provide insurance. In March 1993, the Chamber's
board of directors voted unanimously to back
Patricelli's recommendations, and the organization
published a position paper drafted by Patricelli
and his staff supporting universal health insurance
financed by mandated employer contributions for
50 percent of the premiums.
ver the next six months, as the administration's task force was drafting its
health plan, Clinton aide Ira
Magaziner and other officials met once or twice a
month with Chamber representatives to discuss
how the plan should be framed. In the discussions,
Patricelli, Archey, and Lesher voiced concern
O
about how the mandate would work and the size of
firms that would be required to join the insurance
purchasing cooperatives {later called "alliances")
that the administration was proposing. The administration did not satisfy the Chamber on the
alliances-the Chamber wanted them voluntary for
firms over 100 employees, and the administration
finally settled on an upper limit of 5,000 employees. But the White House went at least halfway in
meeting Chamber concerns about the mandate.
The Chamber objected to a predetermined payroll tax rather than a premium, and it wanted some
subsidies for small business. In response, the
administration incorporated a Chamber suggestion
that it combine a premium with an upper limit on
the percentage of its payroll that small businesses
could devote to health care. The administration
still insisted on employers being responsible for 80
percent of their employees' premiums rather than
50 percent, as the Chamber had advocated, but it
held open the door for compromise. In October,
when Patricelli testified before the Senate on the
administration's bill, he was positive about its use
of mandates. "We accept the proposition that all
employers should provide and help pay for insurance on a phased-in basis," he told Senator
Edward Kennedy's Labor and Human Resources
Committee. Archey and Patricelli found fault with
much of the bill, particularly the huge regional
alliances, but they expected that they could significantly modify these features of the bill during the
m,
tri:la:ed
'·m,
he
!SS
tas
:al
.n, tte
rer
i 95
NUMBER 21
ABA N D 0 NED SURGERY 67
�congressional debate.
Since the first months of the Clinton administration, conservatives had been complaining bitterly
about Lesher's and Archey's conciliatory posture.
They were pilloried by Wail Street Journal columnist Paul Gigot, columnists Rowland Evans and
Robert Novak, and Human Events, and by the 75member House Conservative Opportunity Society,
chaired by Representative John Boehner of Ohio.
In one meeting, Boehner and the House
Republicans in the Conservative Opportunity
Society informed Archey and Lesher, according to
one participant, that it was "the Chamber's duty to
categorically oppose everything that Clinton was in
favor of." Republicans refused to attend an awards
banquet sponsored by the Chamber. Boehner,
Representative Richard Armey of Texas, and
Representative Chris Cox of Ohio contacted local
and state Chambers to organize opposition to
Archey and Patricelli, even urging that local ·
Chambers leave the national organization. A
Washington group, the Small Business Survival
Committee, sent a letter to the Chamber board of
directors signed by former board members protesting the organization's support of employer mandates. Like other Chamber critics, they equated
support of mandates with. support of the Clinton
plan. Conservatives also mobilized talk shows. And
House Republicans, determined to undermine the
Clinton administration, threatened that if the
Chamber persisted in supporting mandates, they
would ignore Chamber lobbying on other issues.
t the same time, the Chamber began to
suffer defections among its rank and file,
as its chief rival, the NFIB, began to raid
the Chamber's members. The 600,000-strong NFIB,
founded in San Mateo in 1943, has recendy become
more of a Washington activist organization, driven
by its staff rather than by a hierarchy of organizations and chapters. Unlike the Chamber; it does not
include publicly traded businesses. The group's typical business employs six or seven people; it grosses
under $300,000 and is much less likely to provide
health insurance to its employees than a Chamber
member. Like the Chamber, it is closdy linked to the
Republican party, but unlike the Chamber under
Archey, it didn't loosen those links after Clinton's
election. When the NFIB brought its members to
Washington, it recruited House Republicans to brief
them on health care.
A
68 THE AMERICAN PROSPECT
As the debate over health care began, the NFIB
unequivocally rejected the employer mandate that
was at the center of the Clinton plan's financing.
The NFIB even refused to testify at task force
meetings. And over the next eighteen months, it
devoted its resources to killing the Clinton plan
through lobbying Congress. By the fall, its strident
campaign was also beginning to win converts
among businesses that the Chamber was Jcying to
reach. The Chamber, which had lost members iii
the late '80s, began once more to suffer defections.
Says Kristin Bass, who worked for Patricelli at the
Chamber, "We were getting creamed in the fidd by
NFIB. It was as much a market share, competitive
issue as anything else."
The NFIB's message found a particularly warm
reception among Chamber members that didn't
provide health insurance, including large corporations like Pepsico, General Mills, and Woolworth
that had growing numbers of workers who received
few or no benefits. The National American
Wholesale Grocers' Association resigned from the
Chamber itself. The National Retailers Federation
urged each of its members to pressure the
Chamber. "It was the 30 percent that didn't provide
insurance that were the most vocal," one staff member recalled. By February, Lesher, who had initially
encouraged the Chamber's conciliatory line, was
ready to reverse his stand. Then an event brought
matters to a head.
THE STAMPEDE BEGINS
With the Business Roundtable scheduled to
announce its position on February 2, the Clinton
administration urged the House Ways and Means
Committee to move up Chamber testimony from
Patricelli to February 3 so that if the Roundtable
went against the administration, Patricelli's testimony might counteract the negative publicity. As
was customary, Patricelli submitted a copy of hi's
testimony prior to the hearing, in which he reaffirmed the Chamber's support for an employer
mandate. "We accept the proposition that all
employers should provide and help pay for insurance on a phased-in basis," Patricelli's testimony
read. When Boehner learned what Patricelli
planned to say, he and other House Republicans
contacted the Chamber and Chamber members in
their district urging them to protest the organization's stand. Under intense pressure, Chamber
President Lesher backed down. He ordered
·sPRING 199S
�:IB
Patricelli to change his testimony, and on the date
Retirement Security Act of 1974 (ERISA), which
of the hearing, a chastened Patricelli told the Ways
preempted states from micro-regulating employer
and Means Committee that the Chamber "cannot
health plans. More broadly, they wanted to be able
support any of the mandate proposals that have
to buy insurance for their employees nationally on
been advanced in legislation by President Clinton
terms that their managers negotiated.
or members of Congress." It was, in effect, comAnother group of companies was directly
plete repudiation of the Chamber's and Patricelli's
involved in selling health care to companies and
earlier position.
individuals. It included large insurance companies
Later that month, the Chamber made it official.
like Prudential and CIGNA, drug companies like
On February 28, the Chamber's board of directors
Abbott and Eli Lilly, -an(lhealt-h care conglomervoted to oppose not only employer mandates but
ates like Humana. Many of these companies
also universal coverage. On April 5, Lesher fired
favored a managed care model of health reform
Archey, and soon afterward Patricelli resigned his
that did not include employer mandates, price conposition as the head of the Chamber's
trois, or premium caps. Explained
Health committee. And for the next five rr=========iJ one consultant who worked with
these businesses, "Their big conmonths, the Chamber used its considerable
resources to kill any chance of universal
emocrats cern was that, as far as they could
health insurance.
tell, being i~ favor of an employer
in Congress mandate also meant being in favor
The Business Roundtable, which is comwanted to use of price controls. If you get one,
posed of the CEOs of Fortune 500 companies, ended up playing an equally important
you were going to get the other."
compromise They were most comfortable with
role in defeating Clinton's plan. Founded in
to win votes the health plan advanced by
1973, the Roundtable quickly demonstrated
its clout by helping block a new consumer
for a final
Representative Jim Cooper and
protection agency and labor law reform
supported by Enthoven's Jackson
during the Carter administration. It took
plan.
Hole Group. This plan eschewed
employer mandates and premium
positions on health care issues from the
beginning, largely through the Washington
caps and tried to hold down costs
Business Group on Health, which it established in
and subsidize the uninsured by taxing the more
1974. In 1985, however, it set up its own Health,
expensive health plans.
Welfare, and Retirement Task Force, which
A third group of companies insured many of
became the focal point for debate over health care
their employees but had diversified into businesses
reform.
where they employed many part-time and lowWithin the Roundtable, there were four distinct
wage workers for whom they provided partial or
kinds of businesses and CEOs, each of whom had a
no health care benefits. These included General
Mills, Pepsico, Sears, J.C. Penney, and the Marriott
different vantage on health care reform: Some of
the large manufacturing companies, including the
Corporation. Many of them were opposed -to comBig Three automakers, Xerox, and the major steel
prehensive health reform. Explained Alan Richey,
producers, were members of the National
General Mills's vice president for compensation
Leadership Coalition for Health Care Reform and
and benefits, "From our standpoint, there was a
had backed its "pay or play" program for reform.
growing need to provide some stability for people
Others, like IBM and Kodak, did not support "pay
on health care issues and we believed right from
or play" but nonetheless supported the use of an
the .beginning that this could be achieved through a
employer mandate to fund universal access. These
relatively small amount ofchange that would focus
companies already insur~d their workers. Their
on universal access and some minor underwriting
CEOs saw national health care reform as a way to
reforms. Beyond that, we felt that the health care
end the cost-shifting from the uninsured to the
market, which has been in rapid change anyway,
would develop reasonable alternatives for people."
insured and, in the case of the auto companies, to
defray the costs of their early retirees. They were
A fourth group of CEOs headed companies that
not upset by price or premium controls. If they ·had
insured their employees and .had a direct stake in
a concern, it was about preserving the Employment
health care reform but were nonetheless opposed
hat
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NUMBER 21
ew;:;;aS•
.ac .
tkOU414WZ&
A B A N 0 0 N E 0 S U R G E R Y 69
a. aa:sscs a: csaa sa
14:
�on ideological grounds to government intervention.
Winters, an active participant in the Jackson Hole
These included Drew Lewis of Union Pacific and
Group and backer of the Cooper plan.
The White House began meeting with the
Jack Welch of General Electric. It didn't matter
that health care reform could save their businesses
Roundtable's Health Task Force almost immediatemoney. They saw reform as the opening wedge for
ly after taking office. According to the White
a more interventionist government that would
House, Winters and the other CEOs initially
expressed concern about price controls, about
eventually threaten their prerogatives in other
areas. According to a senior White House aide,
whether large businesses could opt out of the
Lewis said that he was opposing the Clinton plan -=--allian_ces, and about whether the health plan would
even though his company had "costed it out" and
undermine ERISA. One senior official said, "I got
the impression that Winters thought we were movfound that it would save millions annually.
The first kind of company, which strongly
ing in the right direction."
favored mandates and accepted the idea of price
ut by October, when the administration
controls or premium caps, was in a minority within
released its plan, negotiations between the
the Roundtable. These companies were at an even
White House and the Roundtable's task
greater disadvantage in the Roundtable's Health,
Welfare, and Retirement Income Task Force, which
force had begun to break down. The meetings, one
official recalled, became more "strident." Winters
was chaired by Prudential CEO Robert C. Wmters.
At least 18 of the 35 companies on the task force
and the CEOs from other health-related industries
took special umbrage at the premium caps in the
were either in the health business or did not insure
Clinton plan. "The insurance and pharmaceutical
all their workers. A similar situation prevailed in the
Roundtable's Washington Business Group on
companies were going bananas over price controls,"
recalled Ford official Susan Schackson. They were
Health, whose president, Mary Jane England, was a
joined by General Mills, Pepsico, and Marriott, who
former vice president of Prudential and, like
B
Congratulations to
THE AMERICAN PROSPECT
. I
on its fifth year of publication! .
c!JVI. E. Sharpe /
publisher of books &
periodicals
-including Challenge, the Magazine of Economic Affairs,
Problems of Post-Communism,
and American Foreign Policy Interests
.... to name just a few.
70 T H E A 1\1 E R I C A ~ P R 0 S P E C T
SPRING
1995
�•
•
I
Iole
the
atelite
ally
out
the
1uld
got
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the
.ask
one
ters
nes
the
ical
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•ere
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95
rejected the employer mandates. Together, they set
funding and cost control. It was as if they had
endorsed the plan but not its provisions. Winters
out to stop the Clinton plan. Explained Roundtable
had, in effect, gotten them to back Cooper simply
official Johanna Schneider, "There was a feeling that
as a way of rejecting Clinton.
the Clinton plan was moving forward unless somebody stood up and said this is not going to work."
Afterward, some Roundtable officials insisted
Of course, not all the firms in the Roundtable
the organization had not tried to kill the Clinton
were ready to abandon the Clinton plan. But even
plan and blamed the Clinton administration for the
furor that surrounded thl! organization's vote. Mary
firms like IBM and Kodak that supported the
thrust of the Clinton plan objected very strongly to
Jane England explained, "My feeling was that, by
having a knee-jerk reaction to the Business
provisions regulating self-insured'plans and allowing states to establish single-payer plans that could
Roundtable, the administration polarized the issue.
include large corporations. They also feared that
All the Business Roundtable said was that the
Cooper plan ought to· be considered as well." But
the regional alliances would gain so much clout in
the market that corporations would no longer have
General Mills's Richey knew better. He later boastmuch bargaining leverage with health care
ed of the vote for Cooper and against Clinton,
providers.
"The Roundtable became one of the first groups
The White House desperately attempted to
that stepped out and said this is bad for America."
Indeed, the Roundtable's vote was decisive in
keep the Roundtable in the fold. It insisted that it
could compromise on premium caps, mandates,
shifting overall business sentiment. While it did litand ERISA but explained that rr============;J de to help Cooper, it opened the
Democratic committee heads in
door for other business groups to
Congress wanted to use the
·
reject the Clinton plan. NAM, which
process of compromise to win
ithout the sup- had been hedging its bets, followed
port of key business suit three days later, declaring that
votes for a fmal plan. They set up
meetings for the Roundtable
h
uld "NAM is unable to support the
CEOs with Ways and Means groups, W at WO
administration's health care reform
Chairman Dan Rostenkowski and
have been difficult plan in its present form.·" Combined
pleaded with them not to reject
became impossible. with the Chamber's opposition, the
their plan. They also held separate
rejection by the Roundtable and
meetings with Kodak, IBM, and
Health care reform NAM created a united front against
other companies in the
was doomed.
the Clinton plan. Clinton could still
Roundtable that were more symclaim the support of some individual
pathetic to their aims. But they
companies and of smaller organizacouldn't satisfy these companies' worries about
tions like the National Leadership Coalition, but
he had lost the support of the business groups that
ERISA and about the freedom of action that correally mattered in Washington.
porate self-insurers would have under the Clinton
plan.
White House officials insist that even after the
With even the administration's supporters
business organizations' defection, Clinton could
have still gotten a bill through Congress. Perhaps
wavering, Winters moved quickly to get the
under ideal conditions he could have, but as
Roundtable on record against the Clinton plan. His
Congress began to debate health reform that
task force endorsed the Cooper plan, and in
February, when the Roundtable's policy group conspring, the conditions were not right for a bill to
pass. Conservative attacks on Clinton's character
vened, he got it to back Cooper. To make the outand probity had begun to erode his authority, and
come all but certain, Winters framed the issue as a
Republicans in Congress, sensing the possibility of
choice between endorsing the Clinton plan and
an electoral killing in the fall, had become deterusing the Cooper plan as a "starting point."
mined to block any bill from pa~sing. The recesNaturally, the CEOs, most of whom were uncomfortable with Clinton's plan but somewhat unfamilsion's end reduced the sense of urgency about passiar with Cooper's, chose Cooper over Clinton. But
ing even a modest bill. And the forces in favor of
comprehensive reform-unions and public interest
in their endorsement of Cooper, they rejected the
organizations-were not sufficiently powerful to
tax fmancing that was central to the Cooper plan's
w·
NUMBER 21
ABANDONED SURGERY 71
I
�sway Congress. Without the support of the
Chamber, Roundtable, and NAM, what would
have been difficult became impossible. Health care
reform was doomed.
WHY BUSINESS BACKED OUT
Why then, in retrospect, did the business organizations fail to support the Clinton plan? One
answer won't pass muster: that bus~ess was simply
actrnf1n its best· interest. On the contrary, something very close to the Clinton plan could have
held down costs for both large and small business.
Some businesses would have been hurt-the small
insurance firms that the HIAA represents, for
instance, or some of the NFIB's mom-and-pop
operations that didn't insure their workers-but
most would have benefited. The "slippery slope"
argument advanced by CEOs like Drew Lewis was
also without merit. Business opposed reform in
spite of its being in its long-term interest.
On a very basic level, business support for reform
was a victim of the inescapable conflicts among
businesses themselves that often prevent any kind of
cooperation for long-term ends. Those businesses
that sold health care or that didn't provide health
insurance to their workers were able to outgun those
like Ford or Bethlehem Steel that saw their interest
in a universal health plan. "It was a classic example
of the divisiveness of an issue in which the business
community devoured its own," one veteran of the
Chamber battle declared. In addition, reform was
stymied by businessmen's-and Americans'-historic fixation with a Lockean liberal model of society
in which government is at best a necessary evil. This
vision remains barely below the surface in public
debate and is ready to emerge when the specter of
governmental activism looms.
American business leaders have periodically
overcome their internal disunion and Lockean liberalism, but only under extraordinary circumstances. These have consisted of recessions or
depressions that appear to threaten the viability of
industry itself and to raise the specter of insurgency
from below. During the Progressive Era and the
Great Depression, business leaders were worried
both about the system's survival and their own.
During the Progressive Era, repeated financial panics lay the groundwork for unity between the powerful Wall Street and the smaller midwestern and
southern banks, and led to the creation of the new
Federal Reserve System. During both eras, the
72 T H E A M E R I C A N P R 0 S P E C T
threat of labor unrest and socialism underlay business support for labor reforms and collective bargaining. These kinds of conditions did not exist
during the first two years of the Clinton administration. Whatever sense of urgency business felt
about rising health costs abated as the recession
abated; and labor js simply too weak today to scare
business into attempting to co-opt its program of
social reform.
American business also lacks today the kind of
farseeing leaders who have the intelligence, objectivity, and authority to unite it around its long-term
interests. In the Business Roundtable, Chamber of
Commerce, and NAM, business leaders deferred in
the end to CEOs who were acting primarily in their
narrow, immediate self-interest without regard to
the larger effects that health care reform could
have on American industry. In addition, the men
and women who lead the lobbies in Washington
see their organizations as businesses. They compete
for members and influence the same way that a
company competes for profits and market share.
The contest between the NFIB and the Chamber
was over members and influence, not over the wisdom of their recommendations. In the health care
debate, there was even the ultimate irony of conservative politicians-representing a narrow partisan interest-successfully lobbying major business
lobbyists, who were in fact supposed to be lobbying the politicians.
f course, Clinton must bear some
blame for business's defection. He
made a significant strategic error during his first months in office. Clinton took
Roosevelt's New Deal and his Hundred Days as his
model. He thought he could get a comprehensive
program through a Democrat-dominated
Congress. But Clinton didn't possess Roosevelt's
majority, nor, needless to say, his political powers,
and he governed at a time when extremely powerful forces were arrayed against change. At best, his
situation was similar to that of Woodrow Wilson
who won office because of a third-party challenge
and who had to· rely on support from Republicans
and Progressives to adopt his programs. To pass
national health insurance, Clinton would have been
well advised to delegate a bipartisan commission to
devise a health care plan-one that later could
have avoided the pitfalls of partisan combat.
Clinton's critics have faulted the plan itself for
O
SPRING !995
�Speech to American Political Science Association
�·'
IRA C. MAGAZINER
REMARKS TO THE AMERICAN POLITICAL SCIENCE ASSOCIATION
NEW YORK CITY
SEPTEMBER 1, 1994
..
Today we find ourselves in a great -- yet still unfinished
chapter of American political and social history! Great
because for the first time in decades we are addressing one of
the most intractable social and economic problems of our time
a health care system that is out of reach for millions of
Americans and too costly for our nation. Unfinished because
Congress has not yet written the final words of the text.
As you know, the daily accounts we read on issues like
health care reform are merely first drafts of history. Over
time, those interpretations are revisited by scholars like you,
who bring their own theoretical and historical perspectives to
bear.
Analyzing health care reform is all the more difficult right
now because the process is far from over. So my perspective,
like the perspectives of other insiders and journalists and
political commentators, is based on current and fluid events that
can change from day to day and month to month. But hopefully I
can offer· some useful insights into the health care reform
process that has engaged the Clinton Administration and Congress
for much of the last year.
President Clinton continues to press for health care reform
for the same two reasons he outlined when he ran for the
Presidency: First, because the health of tens of millions of
Americans -- both uninsured and insured -- was at risk and is at
risk in the current system. And second, because there is no way
to fully restore our economy over the long term without doing
·
something about rising health care costs.
Every day, the health care picture gets worse. On any given
day, close to 40 million Americans -- most of them working people
-- lack insurance. Millions are locked in jobs they couldn't
leave for fear of losing their insurance. Families can't get
coverage because of "pre-existing conditions" and·other forms of
insurance discrimination. Small businesses face health care
premiums 35 percent higher than those of large corporations -and those premiums are projected to grow at double-digit rates.
And there is little hope of further reducing the deficit
when health care expenditures consume 14 percent of our national
income, and a decade from now, the figure will be closer to 20
percent. Month after month, year after year, health care costs
1
�--
~-
are further eroding our savings, our investment capital, our
public treasury, our ability to create new jobs in the private
sector. And we cannot take full advantage of the progress this
President is making in restoring the economy if we attempt to
reduce health care costs simply by chipping away at Medicare and
Medicaid.
So the question President Clinton faced upon his
inauguration 20 months ago was this: How do you solve a problem
of this magnitude, of this complexity, of this urgency, when no
President, Republican or Democrat, has managed to do it in 60
years?
Many people advised President Clinton that it was too
politically risky to tackle health care reform. It couldn't be
done, they said, because of the array of special interests
positioned to stop it -- special interests that had spent
millions and millions of dollars to stymie the efforts of
Presidents Truman and Kennedy and.Nixon and Carter before him.
But health care reform was ·simply the right thing to do
socially, economically, and morally. That's why the President
took on this mammoth challenge, and set in motion this historic
process, regardless of the political risk. That's why he is
sticking to it, and why he will keep fighting for reform until it
is achieved.
Throughout the process the President's goal has been
twofold: to achieve universal coverage and to control health
care costs while still preserving quality. Universal coverage
and cost containment sometimes are viewed as contradictory, when
in fact they go hand-in-hand. Counter-intuitive as it may seem,
you can't reduce the burdens on business and government and
individual families until everyone is insured.
The reality is that people who don't have insurance can't
pay but still get health care. They just get it when it's too
late, too expensive, and often from the most expensive source of
all, the emergency room. The result is that the rest of us end
up footing the bill through higher hospital bills and higher
insurance premiums.
The President beat the historical odds by putting health
care reform on the national agenda and presenting a plan last
year. Furthermore, virtually all Democrats and moderate
Republicans supported the goal of universal coverage. And
virtually all the comprehensive health care bills subsequently
submitted by Democrats and moderate Republicans included cost
containment.
2
�·'
There are only three ways to achieve universal coverage, all
of which have been debated by politicians, economists, and policy
experts for years. One is a single payer approach that would
replace today's· employer-based system with a broad-based income,
payroll or value-added tax. It would require about three to four
hundred billion dollars of new federal taxes each year, a
political implausibility.
A second approach is to require all individuals to buy
health insurance, the same method many states use with aute~
insurance today. The down side of that method is that employersmight be inclined to stop covering their workers, that more and
more individuals would need government subsidies to help pay for
their premiums, and new taxes and a ·new administrative
bureaucracy would result. More important, the public opposes it.
The third option -- the approach the President chose -- is
to extend the system that 90 percent of insured Americans already
use. The employer mandate is the' least disruptive, most
conservative option available. .It was an option embraced by
groups across the political spec.trum: the American Medical
Association, the Health Insurance Association of America, many
labor unions, the Jackson Hole group, the Chamber of Commerce and
other business groups, and the National Coalition on Health Care
Reform co-chaired by former Presidents Carter and Ford.
In fact, the President's proposal for achieving universal
coverage through an employer mandate was first proposed by
President Nixon more than two decades ago in a bill introduced by
Senator Packwood, the ranking Republican member of the Senate
Finance Committee.
Cost containment is an equally important part of the
President's equation. Cost containment is essential if you want
families and businesses to be able to afford health care, and if
you want to control federal spending.
But as with universal coverage, there are only a few ways to
get costs under control.
One option is to have the government directly set the price
for goods and services delivered in the health care sector, or
set ceilings on the total amount the nation would spend on health ·
care. But having the government involved in every health care
transaction is way too bureaucratic.
Some advocates support the idea of "tax caps" to contain
health care spending -- limits on the tax deductibility of health
spending by companies. The President rejected that approach
because it would raise taxes on middle-class families.
3
�·'
The President's plan relied on creating a more competitive
market and a more cost-conscious consumer to control costs. As a
back-up, the President proposed premium caps to limit the amount
insurance premiums could be raised if market forces did not
succeed in keeping prices down. This approach was borrowed
directly from a bill put forth by Republican Senators Danforth
and Kassebaum and moderate Democratic Representatives McCurdy and
Glickman.
As you examine the main elements of the~resident's plan you
will find that the bulk of ideas he proposed were gleaned from
members of both parties, from liberals and conservatives and
moderates alike. And in many cases, the proposals already had
been tested successfully at the state level. Employer mandates
are working effectively in Hawaii, Washington, and Oregon;
premiums caps in Washington and Minnesota.
Perhaps no idea occasioned as much debate initially as
mandatory alliances. The first barrage of negative ads came from
the insurance industry, which misrepresented alliances as
government take-overs of health plans that would reduce consumer
choice, when in fact the opposite was true.
The idea behind alliances was to give people more choice of
plans and to reduce the administrative burdens that now exist for
businesses.
As someone who ran a successful small business, I can tell
you that today, cost and complexity make it nearly impossible for
small businesses to offer their employees a choice of plans.
Alliances would have made this choice possible.
The idea for mandatory alliances came from the Jackson Hole
group and from legislation sponsored in 1992 by Representatives
Cooper and Andrews and Senators Boren and Breaux.
Other provisions such as the long-term care benefit, a focus
on primary care, funding for academic health centers,
improvements in rural and urban health care infrastructures, and
some public health initiatives were also included in Republican
health reform proposals.
So if you compare the President's approach to some of the
.options at hand, you will see that -- in case after case -- his
plan was fundamentally reasonable, moderate, and in line with
what most Americans wanted then and still want now.
Yet while the bill's provisions reflected the conventional
solution, the size and detail of the document generated criticism
from opponents that it was a bureaucratic form 9f social
engineering and an example of "big government."
4
I
I·
�Health care reform is a very complex subject. A bill to
reform the health care system is never going to make for light
beach reading. Our goal in writing the legislation was to offer
the American people a realistic description of how the proposed
changes would work.
It's worth noting that many pieces of major legislation are
as long or longer than our bill. Health care reform measures
circulating on Capitol Hill range from 650 to 1,400- pages. The
crime bill that passed last month was almost as long as health
care legislation, and NAFTA was literally thousands of pages.
Yet the length of the President's health care reform bill
became a metaphor for the complexity people would supposedly face
under a reformed system. The number of pages became a symbol of
the amount of government involvement people would see in their
health care.
How did we arrive at the provisions of the bill?
To meet an aggressive timetable, we established a process
for making policy that was unconventional for Washington,
borrowed from private sector models for conducting big projects
in a short time frame. We cast a wide net for participants.
To have a credible health care bill, one must address dozens
of specific issues such as long-term care, mental health,
malpractice, and insurance reform. ·so we brought together
experts and practitioners in each of these areas -- both from
Washington and from around the country.
We held daily meetings with members of Congress, and
involved more than 120 Congressional staffers in the working
groups. The First Lady also held public hearings and town
meetings across the country.
By May of 1993, review groups composed of health care
providers, consumers, auditors, actuaries, hospital and insurance
administrators, and lawyers responded to ideas that had been
proposed by different working groups.
The whole process resulted in an amazing amount of work
completed in a very short amount of time. We succeeded in
meeting a very tight deadline.
Has it been a flawless operation? Of course not. And while
some of the problems we encountered were avoidable, others were
not.
One that we couldn't avoid was the legislative calendar. We
were ready to move forward at the end of May of 1993, just .as the
5
�President had pledged we would do. During April and May of last
year, the task force met 21 times to finalize decisions, a number
of times with the President. But after the defeat of the
economic stimulus package, it became clear to everyone that the
introduction of health care reform should·be delayed until
passage of the economic package was assured. There. was concern
that introducing health care might compromise support for the
economic package. For example, when word leaked out -erroneously-- apout a Treasury Department analysis-of health
care financing that included a tax on wine and beer, the
California delegation immediately sent a letter of complaint to
the White House and some members privately threatened to withhold
support for the economic package.
With the economic package stalled, the introduction of
health care was delayed from early June, to late June, to mid
July, to late July, and finally to late September. The
legislation finally was submitted in late October instead of in
late May. Attention was further diverted from health care
because of the debate over NAFTA and the crisis in Somalia, both
of which dominated the White House and Congress during the weeks
after the President's bill was introduced.
There wasn't much we could do about the calendar. But we
could have done things differently in terms of the press. From
the outset, we should have done a better job of informing the
press about the process. That way we could have avoided
perceptions that the deliberations were cloaked in secrecy, and
we could have helped the news media develop a better
understanding· of reform as the debate evolved.
These problems notwithstanding, when the plan was introduced
in the fall it was greeted very enthusiastically, and in fact, it
became a baseline for other approaches. Representative Cooper
termed his plan "Clinton Lite," a "close cousin" of the Clinton
plan. Senator Chafee spoke on Sunday talk shows about "the
similarities in our approaches" and voiced optimism about
achieving a consensus. The ~resident, meanwhile, was applauded
for offering a clear and persuasive enunciation of his goals to
Congress and the nation. Polls showed broad support for his
plan. The New York Times went as far as to term the President's
bill "alive on arrival."
As the President's plan generated excitement and support for
reform, interest groups who benefited from the status quo
mobilized their attacks.
Powerful special interests are perhaps the biggest single
obstacle we faced then and still face today as we try to move
forward with reform. Several recent studies have documented the
amount of money spent on advertising and lobbying to influence
6
�..
the outcome of the health care debate. Every major legislative
battle -- from the New Deal to Social Security to Civil Rights -has met with opposition. But never in the history of this
country have modern technology and scare tactics combined to
produce the degree and tone of misinformation that was spewed out
so quickly about health care reform. And never has there been
such an extraordinary amount of money spent on disseminating that
misinformation.
-- The Annenberg Public Policy Center studied this phenomenon
and concluded that the health care debate has generated "the
largest, most sustained advertising campaign to shape a public
policy decision in the history of the Republic."
Over $100 million has been spent overall to influence the
outcome. One study found that $50 million was spent largely to
influence reporters and legislators rather than the public as a
whole. And these figures don't capture direct mail and phone
bank efforts financed.by opponents.
Whatever your view of health care reform, if you've seen or
heard the now famous -- or infamous -- ads you know that they are
not only negative, they'~e downright scary.
In fact, they were so distorted that the Wall Street Journal
ran a story about the misinformation campaign under the headline
"Truth Lands In Intensive Care Unit."
The article began:
The baby's scream is anguished, the mother's voice
desperate. "Please," she pleads into the phone as she seeks help
for her sick child.
"We're sorry, the government health center is closed now,"
says the recording on the other end of the line. "However, if
this is an emergency, you may call 1-800-GOVERNMENT." Her baby
still wailing, she tries it, only to be greeted by another
recording: "We're sorry, all health care representatives are
busy now. Please stay on the line and our first available . . .
II
"Why did they let the government take over?" she asks
plaintively. "I need my family doctor back."
The story goes on to say: The only problem with the radio
spot, produced by a Washington-based group called Americans for
Tax Reform, is that it isn't true. (WSJ, 4/29/94)
Misconceptions about the President's plan were continually
fueled by this type of fearmongering. At town hall meetings I
7
�.
.
attended, angry people would shout their opposition to the
Clinton plan. I'd ask why they were against it. They would talk
about the government taking over and running all the hospitals.
Or they would talk about how people wouldn't be allowed to see
their own doctor outside the health plan approved by the
government and that, if they did, the doctors could go to jail.
I'd explain that this just .wasn't true. But the questioner
invariably would shout back that I was lying and wave a mailing
he had received from some group asserting one or another of these
points as fact.
The Wall Street Journal said that "another of the big
canards about the Clinton plan is that people face '5 years in
jail if you buy extra health care.'" The story alluded to a
direct mail package sent to millions of Americans by the American
Council for Health Reform. The story explained that this penalty
referred to an anti-bribery provision in the Clinton proposal
and, in fact, the President's bill explicitly stated that people
were free to purchase any health care serVices they wanted.
But these ads proved that it's always easier to make the
negative case rather than the positive, more complicated case.
I point out the degree of misinformation because these
advertising campaigns distorted the President's plan into some
radical, wild-eyed attempt to revamp our health system. In fact,
as I mentioned ear~ier, the main elements he proposed were drawn
from Republicans and Democrats alike -- most of whom could be
described as political moderates. Universal coverage, employer
mandates, and premium caps, while opposed by powerful interest
groups, are heavily favored by most Americans -- even though, as
a Wall Street Journal headline noted, "Many Don't Realize It's
the Clinton Plan They Like."
In spite of the barrage trom special interests, the American
people have said what they want -- and they have said how they
want to pay for it. And they've been very consistent in their
views.
A recent Washington Post/ABC poll showed that 77 percent
favor universal coverage, 72 percent favor an employer mandate,
and 75 percent favor government cost controls. Even more, 80
percent, support a tobacco tax.
With that kind of support, these ideas and proposals are not
going to disappear and be forgotten by the public;::.. ·
.Another thing worth remembering about this process is that
the President never expected his plan to be the final version
adopted by Congress. He has always stated very clearly that his
bottom line was universal coverage but he knew his plan would be
8
�rewritten. In fact, two House committees and one Senate committee
wrote their own bills, which were similar to the President's.
This was all part of the legislative process the President
envisioned.
So where are we today, nearly 20 months after the process
began?
We are on the path to restoring the economy and fulfilling
the President's broader agenda. And ultimately history will show
that this was a time of great ferment and energy when a
courageous President didn't dodge a difficult issue, but instead
launched a process to solve the health care problem once and for
all.
We have made extraordinary progress in the fight for the
health security of the American p~ople and the fight goes on.
The Congressional Leadership has made certain that health care
will be first on the agenda when they return to Washington. As
was proven with passage of the Crime Bill, special interests do
not always succeed in undermining. the interest of the American
people. And we must continue to make sure that the voices of
reason are heard over the shouts of fear and confusion. That's
why we will not walk away from the fight to provide security for
the American people.
Thank you.
###
9
�MAIN ELEMENTS OF HEALTH SECURITY ACT
BIPARTISAN PRESIDENTIAL AND
CONGRESSIONAL PRECEDENTS
UNIVERSAL
COVERAGE
PRESIDENTS
CARTER/FORD/NIXON/TRUMAN/ROOSEVELT
SENATE REPUBLICAN TASK FORCE
SENATE AND HOUSE DEMOCRATIC
LEADERSHIP
EMPLOYER
OR
INDMDUAL
MANDATE
PRESIDENTS CARTER/FORD/NIXON
SENATE REPUBLICAN TASK FORCE
SENATE AND HOUSE DEMOCRATIC
LEADERSHIP
PREMIUM
CAPS
SENATORS DANFORTH/KASSEBAUM
CONGRESSMEN MCCURDY/GLICKMAN
MANDATORY
ALLIANCES
CONGRESSMAN COOPER
SENATORS BREAUX/BOREN
�-·
,.,..-...
lr
(/<.
••••••••••
ROBERT H.
SCHULLER:
When I was in college, one of the professors said to us, his students, "The secret
of a successful marriage is this: Marriage is not a 5o/5o proposition. A 5o/5o
proposition is one where nobody is giving anything.
"Rather, the secret of a happy marriage is 6o/4o. The husband gives in 6o
percent of the time and expects his
wife to give in 40 percent of the time.
The wife gives in 6o percent of the
time and expects her husband to give
in 40 percent of the time. In a 6o/4o
proposition, you don't clash in the middle and say, 'Now it's your tum.' Instead,
you intersect and overlap, because you're
each giving 6o percent."
-Ht "" f:xt,.,ortlin.,ry Ptrson ;,. "" OrdiMry K&rltl
(Fleming Revell)
MALCOLM S. FORBES, JR.:
The words pnuzlty, restrict and vioappeared more times in President
Clinton's health care bill than in his
crime bill.
--Forb<s
lat~
JACOB NEEDLEMAN:
I was an observer at the launch of
Apollo 17 in •975· It was a night launch,
and there were hundreds of cynical
reporters all over the lawn, drinking
beer, wisecracking and waiting for this
35-story-high rocket.
The countdown came, and then the
launch. The first thing you sec is this
extraordinary orange light, which is just
at the limit of what you can bear to
• •••••••••••••••
look at. Everything is
illuminated with this
light. Then comes this
thing slowly rising up
in total $ilcnce, because it takes a few
seconds for the sound to come across.
You hear a "WHOOOOOSH! HHHHMMMM!" It enters right into you. You
can practically hear jaws dropping. The
sense of wonder fills everyone in the
whole place, as this thing goes up and
up. The first stage ignites this beautiful blue flame. It becomes like a star,
but you realize there are humans on it.
And then there's total silence.
People just get up quietly, helping
each other up. They're kind. They
open doors. They look at one another,
speaking quicdy and interestedly. These
were suddenly moral people because
the sense of wonder, the experience
of wonder, had made them moral.
-Quoted by Bill Moyers. A Worltlofldt•s II
(Doubleday)
CHARLES TAYLOR:
Will corporal punishment help restrain
criminal behavior? Some wellintentioned experts say no. But one
group that disagrees with these experts
is the criminals themselves.
Criminals know that punishment
works, and they usc it every day all
over America. Criminals demand
absolute obedience, and if corporal punishment doesn"t work, then they will
usc capital punishment, for they know
that the fear of death is the best deterrent for disobedience. .
Even the experts tell us that when
15
I
i
'\
___/
�...
.•
.
.,
REGULATORY LANGUAGE IN THE HEALTH SECURITY ACT
I am not familiar enough with the crime bill to know whether as Malcolm S. Forbes,
Jr. contends, the '!\'Ords "penalty," "restrict" and "violate" appears m,ore often in the health
bill than in the crime bill.
- -·
The health care policy book produced in early-September of 1993 was about 250
·pages long. The drafting lawyers turned it into a 1,340 page bill. Both Paul Starr and I
questioned how regulatory the initial bill sections sounded, but were told by our legislative ·
drafters that this was necessary to produce a bill that would stand up legally.
The main body of the bill which described the new health system was actually about
650 pages long. This included about 60 pages defining the benefits package, 110 pages
describing how cost containment would work and 90 pages on financing, all of which were
required for CBO scoring. The other 390 pages described the insurance reforms, employer
mandates, alliances, health plans, quality system and federal and state responsibilities.
The Chafee bill, the Mainstream bill, the Dole bill and others were comparable or
longer in these areas even though they did not have scoreable cost containment nor a defmed
benefits package.
Most of the rest of our bill is made up of sections drafted mainly by HHS and by
Sara Rosenbaum which cover public health initiatives (about 150 pages), long-term care and
the Medicare drug benefit (about 185 pages), Medicare and Medicaid changes (about 170
pages) and remedies, enforcement and anti-fraud and abuse sections (about 100 pages).
These parts of the bill contain about 80 percent of the boxes on the famous Specter charts on
how bureaucratic our bill is and most of the regulatory language which is often cited in
comments like the Forbes one you sent me.
The mandatory alliances and the CBO scoreable premium caps became symbols of our
"bureaucratic" bill, but they did not contribute most of the regulatory language.
I was horrified at how many boards, regulations and legal remedies were defmed into
the package by HHS and by Sara and her drafters and said so. I initially rejected including
most of this when we first received drafts from Sara and HHS during July. Sara then
requested a meeting which we held with you in early-August when you returned from your
trip to Japan, Hawaii and California. She argued that tough enforcement was necessary in
the bill to protect various classes of consumers in a variety of ways and that argument
prevailed, though I was not comfortable with it. At that meeting, it was also decided to
allow HHS to design their programs as. they wished as long as they did not deviate
fundamentally from the definitions in the June policy book. This was done to buy peace with
Donna who was arguing that these sections were solely within the purview of HHS.
�EDITORIALS
firms lashed everybody's pet projects together into
something resembling a strategic plan.
The winners of the EZ/ EC competition were chosen
in large measure on the basis of their ability to snag nonfederal cash to help pay for their plans. EZ/ECrspromoters, in fact, said much of the initiative's value rested
in its capacity to leverage additional financial backing.
Not surprisingly, communities' applications were chock
full of IOUs from businesses and state and local governments. In Detroit, the commitments seem real, though
enforcing them will be an interesting exercise. In other
cases, existing financial resources that had nothing to do
with empowerment zones were included in applications, and some commitments were as firm as tapioca.
Above all, the Administration should resist
the impulse to make this a new urban
entitlement before the first round of grants
can be evaluated.
Now that the awards have been made, both federal
benefactors and local beneficiaries-not to mention the
state and local governments that will have to exercise fiscal oversight-must come to grips with the fact that
roughly $2.5 billion in federal resources have been committed to a crazy-quilt pattern of ideas and organizations
held together by little more than the pursuit of money.
If EZ/EC is to avoid a steady descent into boondoggledom, the Administration must immediately do now
what it should have done earlier: insist that the winners
of the EZ/ EC sweepstakes demonstrate a real and continuing responsiveness to residents' wishes .and needs,
and a real and continuing adherence to some kind of coherent plan of action.
Above all, the Administration should resist the impulse to make this a new urban entitlement before the
first round of grants can be evaluated. By the same
token, congressional Republicans should resist the temptation to kill the initiative and take back the money that
has already been committed. After all, the GOP helped
design EZ I EC, and must share credit or blame for the
high expectations it has aroused.
At best, EZ/EC may yield new evidence of the validity of old ideas about reviving poor urban and rural
areas. At worst, it may so clearly demonstrate the poverTHE \ E\\' DDl 0 CR.\ T
/-1o1,rch - ApnV,
199.~-
ty of traditional liberal and conservative prescriptions
that more radical efforts at empowering the urban and
rural poor will take root in the newly scorched earth.
Ghost Story
Ira's Tale, as Told by James Fallows
n article by James Fallows in the January issue of
The Atlantic Montltly drew a lot of attention-and
fire-as the authorized Ira Magaziner apologia for
the Clinton Administration's handling of health care reform. Its most interesting argument, however, may have
been missed by critics absorbed with its blame-shifting
tone and its specific revisionist claims.
Magaziner and his ghost writer rationalize the whole
"left-in" strategy for reform and the demand for a universal entitlement, which destroyed any potential middle
ground, as tactical necessities. "Left-in" was chosen over
"center-out," Fallows writes, because it was necessarv to
bring along the single-payer faction among House De~oc
rats, especially key members on key committees. The universal entitlement was chosen over more cost-conscious,
market-driven alternatives because White House pollster
Stan Greenberg convinced the President that voters simply
did not believe the government could do anything efficiently, so why not kick out the jams and appeal to their
craving for security? Efforts to achieve a ·last-minute compromise failed not because the Administration was unwilling to abandon the fundamental principles of the Health
Security Act, but because the Republicans were determined to torpedo any compromise.
That's comforting. All the forces Fallows cites as mo\·ing the President to the left and keeping him there are
gone. Single-payer advocates now have as much power
in Congress as Lyndon Larouche. Greenberg now believes the President's re-election depends on his ability
to reclaim his New Democrat mantle. And even·
Republican in Congress other than Sen. Phil Gramm of
Texas seems to recognize the public's desire for reforms
that ensure fairness and stem costs.
Through the inspired medium of James Fallows, we
now know what went wrong with health care reform: It
was bad tactics, bad advice, bad timing-in short, bad
luck-but not any attachment to bad ideology. If that's
so, then President Clinton-and the countrv-should
have better luck the next time health care ref~rm comes
along. •
A
�ill Clinton should have known his health re-
To111111y B
Boggs ana
the Death of
Health Care
Reform
How Washington's best lobbyist
put a stake through the heart
of Clinton's prized
legislation
BY DANIEL FRANKLIN
form plan was in trouble the day he introduced it in September 1992 at the New Jersey
headquarters of the Merck pharmaceutical company.
As the candidate made his trademark post-speech
plunge into the crowd, a mother handed her infant
son to him. The baby vomited on Clinton's lapel.
"That's what babies do;· Clinton said.
Clinton's speech was one of the most important
moments of his campaign. Health care reform had
become a vital issue for voters, second only to the
economy. Bush had already drafted a health reform
plan, and although Clinton had alluded to his own
package, he had never before laid out in detail what
it might look like. Now, the line in the sand was
drawn. After Clinton's speech, two things se.emed
clear regardless of who won the election: The nation's trillion-dollar health care industry was in for
drastic changes, and the Capitol would see its most
profound legislative battle since the tax reform fight
of the mid-eighties.
It's hard to remember the hope and optimism with
which the Clinton health care plan was greeted.
Democrat and Republican alike agreed th;n the nation's health care system was in crisis and needed
some kind of reform. Clinton's victory gave the sense
that the moment for health reform had finally arrived.
Only four days after his inauguration, Clinton appointed his wife and Ira Magaziner to lead the task
force charged with designing the President's health
care plan. The details would be left to the task force,
but the broad principles had been known since Clinton's Merck speech: All Americans would be insured
by large, regional purchasing cooperatives run by insurance companies. The costs would be picked up by
the nation's employers. Also, the nation's malpractice
system would be reformed to limit the possibility of
frivolous lawsuits. In the end, the plan would achieve
universal coverage and help stem the persistent
growth of health care costs. In the first few months of
the Clinton presidency, his health program enjoyed
the support of over 60 percent of the country.
But then Washington's lobbyists began doing what
they do, to much the same effect as that prophetic little boy in New Jersey. Along Washington's K Street,
which is to lobbying what Times Square is to prostitution, the capital's biggest law finns geared up for
April 1995 I The Wa~hington Monthly
31
�...
the coming fight. Health-care experts were wooed
and staffs were bolstered, all in hopes of landing the
industry's major players who, seeing their very existence-atstake, promised to devote as many resources
as possible to ensure that the debate fell their way.
By any estimation, it was a seller's market. At
the time, .there were more than 800 different registered associations in the field of medicine, and
nearly 300 representing businesses, each needing
its own lobbyist to guide it through the jungle of
Washington. Everyone had a stake in health care
reform, and no one wanted to take chances.
Few finns were better positioned than Patton,
Boggs & Blow, home to Thomas Hale ''Tommy"
Boggs, Jr. Over the years, no other Washington
finn had linked itself so closely to the Democratic
party. The biggest Democratic policy initiative
since the days of Roosevelt was sure to be a windfall for the city's most prestigious Democratic
firm. Shortly after the election, Boggs was pic,-··
tured on the cover of the National Journal above
(
the headline: "Ready to Cash in on Clinton."
It couldn't have been more correct. Patton
Boggs did very well in the grab for clients. In addition to its longtime client the Association of
Trial Lawyers of America, the firm landed some
of the biggest players in the health reform debate,
including the National Association of Life
Underwriters (NALU) and the National Association of Health Underwriters (NAHU).
Patton Boggs found itself in the middle of two
crucial aspects of the health reform debate. NALU
and NAHU loathed the idea of mandatory alliances. "Underwriter" is actually a
misnomer-the organizations represent agents
and brokers who recruit clients and find an insurance company's policy that meets their clients'
needs. Under Clinton's plan, consumers would negotiate directly with the purchasing alliances, re.moving the need for the go-between function the
agents serve and, as a result, eliminating many of
their jobs. For the Association of Trial Lawyers of
America, the health care debate meant renewing
its 20-year fight against any and all attempts to reform the malpractice system by putting limits on
the amount a victim could collect from a lawsuit.
Malpractice reform had been a long time
( . ing, but now the pressure for change seemedcomirre\.
.........__....'
sistible. A 1991 Harvard study estimated that malpractice insurance added about $9 billion to health
32
The Washington Monthly I April 1995
care costs each year. Worse still, the study found,
was the ever-present threat of lawsuits, which
prompted doctors to protect themselves by prescribing unnecessary tests, or referring to a specialist patients whom they could just as well treat themselves. The cost of defensive medicine, though
difficult to pinpoint, is estimated at approximately
$25 billion per year. Reforms such as capping the
size of awards for "pain and suffering" have proven
effective. In California, which passed reforms 20
years ago, malpractice premiums are 33 percent
less than those of other large states. With polls
showing Americans squarely in favor of reform, it
came as no surprise when Clinton said he would include malpractice in his health package.
But the Trial Lawyers had traveled this road
before with unblemished success, in no small part
thanks to Boggs. In his 20-year association with
the Trial Lawyers, not one attempt at malpractice
reform has succeeded. Boggs, says Fred Graefe, a
lobbyist for malpractice reform, "has singlehandedly stopped malpractice reform for 20 years."
Son of former House Majority Leader Hale
Boggs and Congresswoman Lindy Boggs-and
brother to ABC political correspondent Cokie
Roberts-the 54-year-old Boggs is widely con. sidered to be the most effective lobbyist in Washington. His network of powerful friends and his
stable of influential clients have elevated him in
some eyes beyond the status of a· mere lobbyist.
William Fay, former director of the Product Liability Coordinating Committee, remembers seeing Boggs in the Senate cloakroom after a vote on
a product liability bill. "Senators were nodding
and waving to .him, coming up and chatting with
him," Fay told Vicki Kemper of Common Cause
magazine. "Senators consider him a peer."
It's a natural enough impression. Boggs has
been at the center of Washington's circles of power
virtually since birth, and he has studied the game
of politics at the feet of Washington's giants.
"[T]hey grew up with politics in their blood," his
mother wrote of the young Tommy and Cokie in
her memoir. "That's what they knew, and it was
served at the dinner table with the likes of Mr. Sam
[Rayburn], Lyndon Johnson, and John Kennedy."
In his professional life as well, Boggs has had
a knack for finding friends in the highest echelons of the Washington power circuit. Former
House Judiciary Committee Chairman Jack
Bro
rnitl
timt
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ecr
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ough
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g the
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•lS 20
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polls
rrn, it
ld inroad
I part
with
ICtice
efe, a
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lding
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was
Sam
ly."
. had
:chcrmer
lack
Brooks and former Education and Labor Com- gy was to try to get the White House to remove
mittee Chaimtan William D. Ford arc both long- malpractice reform from the omnibus bill. Boggs
time friends who frcyucntly visit Boggs' hunting met with Ira Magazincr several times and argued
cabin on the Eastern shore of Maryland. Back that the malpractice issue would hurt the bill's
when Boggs was lobbying heavily on .behalf of overall chances. Malpractice isn't a health issue.
banking interests, he held a surprise birthday par- Boggs said, and it doesn't belong on a health care
ty for his friend and Senate Banking Committee bill. This is a fight the administration doesn't
Chairman William Proxmire.
Many consider Boggs' effectiveness to be a function
solely of his contacts, but this
view vastly underestimates
what makes Boggs unique
among lobbyists. Boggs is a
listener; he uses meetings with
congressmen and senators
more as an opportunity to obtain information than to give it.
"Members like to talk,'' says
Tom Korologos, who for 17
years work~d alongside Boggs
representing the Association of
Trial Lawyers of America.
"Don't stop the presses on that,
but they do have a tendency to ..____._
talk and a good listener will at- Tommy Boggs: the cat that ate the canary
ways succeed in this town."
need, he argued. It would be better to get the Trial
Boggs· listening is strategic. Regardless of the Lawyers-who have advocated universal covercause he is pushing. Boggs always knows the age for years-and their formidable legislative
reasons behind his opponent's position. From ·muscle on board, or at least out of the opposition
there. he can calculate the point beyond which he to the administration's plan. Then, if you must.
can·t push. But above all else, Boggs tries to de- take care of malpractice reform when the big battermine what can be done. When he was a boy, tle has been won.
he remembers, Sam Rayburn told him that "PoliIt was sound advice. but Magaziner didn't
tics is the art of the possible." He considers it the budge. The substance of the proposals could be
best political advice he ever received.
negotiated, Magaziner said, but Clinton needed
Boggs says he knew from the beginning that the malpractice provisions in the bill to placate
the current debate would be more difficult to win terrified doctors and insurance companies. Still,
than his past victories, but that it would not be the White House avoided a full frontal assault on
impossible. The sweeping nature of the Clinton the Trial Lawyers. Acceding to the lawyers' rebill. in which malpractice reform was but one quests, the administration did not limit "pain and
small part. posed a problem for Boggs and the suffering" damages, but it would keep a 33 1/3
Trial Lawyers. Malpractice was always so sim- percent cap on lawyers· fees, and would allow
ple: doctors versus lawyers. The omnibus bill states to adopt even lower limits. Still more
brought more contestants into the ring. Who alarming to the lawyers. Clinton's bill required ~
knew what coalitions could form to gang up on an affidavit from a medical specialist stating that ~
the Trial Lawyers? ··Malpractice refomt as part of the accused doctor had departed from standard 8
a major health bill is different.'' says Boggs. '·Few practices before a suit could proceed.
~
people aren't going to vote for a health care bill
On September 22. 1993. Clinton outlined his ~
because of malpractice reform."
·
health reform plan before a joint session of g
u
In the tirst months of the de hate. Boggs· strate,\pnl I"'') I The \\.asllln~l"ll \llllllhl~
l_)
''
�(~)
(~·---,
.
(j
Congress. "Tonight," he said, "we come together
to write a new chapter in the American story.
This health care system is badly broken and we
need to fix it." It seemed to some as though the
bill would race through. Public support for the
bill had bounced above 70 percent in some polls.
Even Senate Minority Leader Bob Dole offered
an outstretched hand of bipartisanship.
But Boggs was confident. Yes, malpractice
was still in the omnibus bill, but now the bill was
in Congress, where he and the Trial Lawyers had
yet to lose a single battle. Perhaps the most crucial element in Boggs' string ·of successes with .
Congress is money. Boggs himself gave over
$100,000 to candidates between 1987 and 1992,
and his wife, Barbara, gave another $35,000. But
the real root of his influence is his ability to get
others to pony up. It is said that he has raised
more money for Democratic Congressmen than
any other lobbyist. "He has the ability to convince clients and his friends of their need to contribute," said Robert McCandless, a former member of the Democratic National Committee's
finance council. "You've got to be able to tell
your clients that if they are going to do business
in this town, they'd better make certain contributions to the party in power and to key people on
the Hill."
The Trial Lawyers have heeded this advice
well. Between 1989 and 1994, ATLA's political
action committee contributed more than $5.5 million to candidates for Congress. Democratic
members of the House Judiciary Committee received an average of $7,000 per election cycle
from ATLA's political action committee. But
even this figure understates the amount of money
the group and their constituency can shepherd.
According to the Product Liability Coordinating
Committee, the group's 60,000 members made
individual contributions totaling nearly $72 million during that time. Lawyers overall contributed
nearly $120 million, making them the biggest
givers of any single occupational group, both
overall and per capita, in the country. The depth
of their financial power and the fact that the Trial
Lawyers are politically active in every congressional district in the country, have made them an
almost unstoppable force.
The Trial Lawyers have also benefited from an
alliance with various consumer protection groups,
most notably, Ralph Nader's Public Citizen. Pub34
The Washington Monthly I April 1995
lie Citizen argues that malpractice reforms are
aimed soleiy at making it more difficult for injured patients to sue their doctors. They have a
point. Doctors, like lawyers, are just trying to
protect their practices. And they have never
shown any great concern for the rising costs of
health care before. But it doesn;t take a doctor to
see that many malpractice suits are frivolous, and
that the threat of lawsuits does contribute to the
cost of health care.
Still, Boggs was troubled by the sweeping nature of the Clinton bill-and by the number of·
committees with jurisdiction over it. Could he be
as certain of his influence on the House Ways and
Means Committee as with Judiciary? Not likely.
If he could isolate the issue, get sole jurisdiction
for the malpractice provisions transferred to Judiciary, the ball would be back in his home court,
under the watchful eye of his close friend and
duck-hunting buddy, Jack Brooks.
Dan Rostenkowski, chairman of Ways and
Means, was famously territorial, but also a longtime friend of the Trial Lawyers. With an indictment on fraud charges imminent, he knew he
might lose his chair, and with it the chance to
guide the malpractice provisions through his
committee. Mter prodding from Brooks and Boggs, he agreed to hand malpractice over to Judiciary, under Brooks' watchful eye.
For four months, Brooks sat on the bill, refusing to assign it to a subcommittee for discussion
in hopes that it would die of neglect. Only at the
urging of eight of the Committee's Republicans,
led by Congressman Hamilton Fish, Jr., did
Brooks start moving in late May. Committee
hearings were held on June 22, and an open
markup session on August 2-a full six months
after Rostenkowski transferred jurisdiction.
Nowhere was Boggs' influence more apparent
than at the markup session. Amid the bustling Judiciary hearing room, crowded with lobbyists
from both sides of the malpractice debate, Tommy Boggs walked in, and took a front-row seat
reserved for him. "A nice catbird seat," says lobbyist Elizabeth Richardson. Lobbyists for reform
just shook their heads. It was clear where the sessian was headed.
Early in the hearing, Democratic Representative Mike Synar, along with colleagues Jerrold
Nadler and Robert Scott, introduced an amendment. It dropped the specialist affidavit require-
mer
per
pen
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is
ment, but kept the cap on compensation at 33 1/3
percent for awards below $150,000, and at 25
percent for above.
One surprise, seemingly innocuous, was
tucked into the amendment.
It would. make this provision
supersede all other malpractice laws-nullifying states'
existing reforms, many of
which, such as those in California, placed strong limits
When Boggs sat
down in his
reserved front·
on lawyers' compensation row' seat, every·
and damage awards. "It was a
little time bomb," Richardson
one in the
says, "designed to detonate
later and destroy all state tort Judiciary hearing
reform." Only one committee
k
h
member, George Sensenbren- rOOm
neW W ere
ner of Wisconsin, recognized th
the implications of the line,
e mark up s .,but by that p~i~t -the Trial
SiOn WaS going.
Lawyers' pos1t1on was too
strong, and it was too late.
The line stayed. For the Trial Lawyers, says Fred
Graefe, "it was a straightforward slam dunk."
Unholy Alliances
5,
d
e
n
s
s
the cooperatives' size would enhance consumer
buying leverage, bringing the costs down even
further. Making participation mandatory would
prevent insurance companies from "skimming"-seeking out the
healthy and shunning the
sick. The plan seemed a sensible marriage of public and
private sectors. Yes, it was
complicated, but as James
Fallows wrote recently in7he
. Atlantic Monthly, that's "like
saying the blueprints to an
airplane are complicated."
It wasn't the complica•
tions, though, that bothered
two Patton Boggs clients. The
National Association of
Health Underwriters and the
eii~:!!!
National Association of.Life
Underwriters saw their very
existences at stake. With all
Americans buying their insurance directly through the alliances, the role of the
so-called underwriters would be eliminated and
many would lose their jobs. Early on, Scully and
Jonas agreed that the mandatory alliances would
be number one on their clients' hit list.
Scully and Jonas belong to a newer breed of
lobbyist-specialists and policy experts-that
are gaining influence. Jonas came to Patton
Boggs from the staff of the House Ways and
Means committee, where he engineered efforts
toward insurance reform for California Democrat Pete Stark. Since he left in 1986, he has
been one of the leading insurance lobbyists in
Washington. There is nothing flashy about
Jonas. Unlike Boggs, who is given to episodes
of self-promotion, Jonas plays his cards close to
the vest. Even his office is a portrait of utility:
The only decoration in his small and impeccably
neat office are three model sailing ships and his
diploma from Cornell Law School.
Scully is among the top health care authorities
in Washington and a fast-rising star in the Republican party. As a top aide in OMB, Scully was the
driving force behind the .Bush health care plan.
Fast-talking with a whirlwind's energy, Scully's
knowledge of his chosen subject can be dazzling.
"Tom is without question the most technically expert lobbyist-consultant you would find in Wash-
Boggs had sunk a popular initiative with classic influence-peddling. John Jonas and Tom Scully, the partners at Patton Boggs charged with the
task of tackling Clinton's health purchasing cooperatives, faced quite a different battle, and fought
it in a different way. But it was no easier. "This
may sound crazy now," Scully says, "but if two
years ago someone asked me are we gonna get
mandatory alliances, I would have said, 'Of
course."'
Large mandatory health alliances were the
brainchild of Princeton sociologist Paul Starr,
who detailed his plan in the 1992 book, The Logic of Health Care Reform. To be sure, the plan
was not perfect, but within a managed competition system, the alliances would be crucial. The
government would create regional health insurance alliances run by large insurance companies.
Everyone would be required to buy their insurance through these alliances, choosing the plan
that best suited their needs. Competition between
the insurance companies would produce the free
market benefits of lower health care costs, while
April 1995/ Til~ Washington Monthly
35
:I
�ington," says Barbara Daye of Blue Cross of California. "I've seen a lot of lobbyists, I've yet to
meet someone with his breadth and scope of the
technical delivery of health care systems."
Jonas and Scully's command of their field is
their chief commodity. "You can't get access
without knowledge," says Jonas. "I can go in to
see John Dingell, but if I have nothing to offer or
nothing to say, he's not going to want to see me."
When Jonas and Scully served in government,
congressmen grew .accustomed to tapping them
for information, and the relationship stuck. "I always looked upon Scully as someone who was a
good mind on health care, not necessarily a wellheeled lobbyist for a special interest," says former
Iowa Congressman Fred Grandy. "Of course,
. maybe that's just good lobbying."
It is good lobbying, but only if done carefully.
"If you wandered in on a member who's trying to
...--,. write a bill, and they want you to help them tech(1·.
·, nically, and you go in there and act like you don't
·have an agenda . . . and tried to sneak in your
clients' stuff," Scully says, "I think you should be
shot." There may be no better way to lose the
member's trust, he says. Still, the line between a
lobbyist's opinions and those of his client is
murky, if it exists at all. "You certainly tend to
take on to some extent your client's views," Jonas
says, "like you would take on your boss' views."
And expertise will only get you so far. Congressmen care about two things: votes and money. The money was there. The insurance industry
had given nearly $15 million to congressional
candidates in the 1991-1992 election cycle. Together, Scully and Jonas represented four of the
top ten donors from the industry, including the
most generous, NALU, which shelled out nearly
$1.4 million. And with members in virtually every district-many knew their Congressmen or
their staff; some had even . sold them
insurance-the insurance underwriterS had wide
influence. What's more, they were impeccably
organized. The National Association of Health
Underwriters, which represented 13,000 agents,
had arranged fax trees so they could get the word
out to their members. "We could talk to our mem{
i bership one evening," says Jay Grant, the group's
\.,_)president, "and have 2,000 people faxing
Congress by the next morning."
Scully and Jonas decided in the spring of 1993
that to be as effective as possible, they would
36
The Washington Monthly I April 1995
have to expand their base of support by building a
coalition of associations in opposition to the
mandatory alliances. The rise of coalition lobbying is one of the most compellihg ·new developments in lobbying in the last I 0 years. As legislation has become more complex and interest
groups more dispersed, lobbyists have sought to
combine their resources to enhance their influence. This practice reached its apex in the health
care reform debate. Small businesses united with
the American Medical Association to oppose the
employer· mandate. Medical specialist organizations teamed up against general practitioners.
And a broad coalition of groups in support of the
President's program, called the Health Care Reform Project, included groups like the AFL-CIO,
the .American Academy of Pediatrics, the
Catholic Health Association, and the American
Association of Retired Persons.
For their own coalition, reasoned Scully and
. Jonas, the broader the better, and they soon began
contacting small business groups, who felt that
the administration's plan would limit their choice
of health care plans. Before long, 200 groups
signed on, including the National Association of
Wholesale Distributors, the National Wholesale
Grocers Association, and the National Lumber
and Building Material Dealers Association.
The coalition's motto, Jonas says, was "focused like a laser." Limiting its focus to the
mandatory alliance issue-and avoiding more
controversial topics like the employer mandate-took great care and effort to maintain. The
group's statement of purpose, only a single typed
page, took nearly two months to produce.
It wasn't enough to be merely opposed to the
mandatory alliances, Jonas and Scully thought;
they must have an· alternative. And so Scully
crafted a system of purchasing coalitions in which
participation was voluntary. Employers and individuals, he argued, ought to be able to choose to
buy insurance from one of the cooperatives, or
from an individual insurer. The free market force
of competition between insurers would be the key
to keeping health care costs down, not government involvement. Clinton's mandatory alliances,
was big government run amok, they said, and
would undermine the forces of the free market.
To be sure, voluntary alliances sound a whole
lot nicer than mandatory ones. But these voluntary
alliances failed to solve the very problems that
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started the health debate: cost and the growing the fence was Kansas Democrat Jim Slattery. It
number of uninsured. Without the government's could not have worked out better for Jonas, Scul. mandate, insurers could choose to cover only good ly, and the coalition. The previous February,
health risks. The people who most needed insur- Jonas had accompanied several members of
ance, the poor and those with pre-existing condi- NALU and NAHU to a meeting with Slattery at
tions, would be left out in the cold. What's more, which they presented the coalition's voluntary
without the purchasing leverage of the large purchasing option. The Congressman was a natumaridatory alliances, the voluntary alliances would ral ally. NALU was Slattery's single biggest conbe less able to keep health care prices down.
tributor, giving him $10,000, the legal limit, beBut as with most aspects of the health care de- tween 1991 and 1992. Perhaps more importantly,
bate, the coalition's assertions went uncorrect~- one of Slattery's oldest and dearest friends is an
by the press, which, much to its advantage, fo:"-agent for. Aetna Life Insurance, and through him,
cused more on the politics rather than the sub- the Congressman knew a number of other insurstance of health care. The Washington Post was ance agents. So Slattery was acutely aware of the
one of the worst offenders. Not surprisingly, ·underwriters' fear that purchasing alliances
Scully thinks it did an excellent job.
would throw them out of work.
As early as February it was clear that mandatory
Nonetheless, the meeting was tense. A few
alliances wouldn't make it out of Ways and Means. weeks earlier, Jonas had come to Slattery reprePete Stark, the Health Subcommittee chairman and senting New York Life. Jonas' positions, accordJonas' old boss, said he couldn't count a single ing to Karen Hallows, Slattery's aide in charge of
vote for the alliances in his committee.
health care, were not directly contradictory, but
With that, the focus shifted to John Dingell's the quickness with which Jonas switched from
Energy and Commerce Committee. If any com- one client to another startled the Congressman. ·
mince could get a bill to the House floor, many Slattery began the meeting by asking Jonas,
thought, it was Dingell's. The Michigan Democrat "Who are you representing today?"
shared ·clinton's zeal for universal coverage; fifty
After the initial discomfort, the meeting got
years earlier, Dingell's father had introduced the . under way, and Slattery and Hallows agreed to
first national health insurance bill in Congress. watch the issue carefully. Knowing how much it
And Dingell, among the Hill's shrewdest horse- meant to the insurance agents, Slattery soon
agreed to support the voluntary cooperatives plan.
traders, had plenty of chips to play:
But his task was still fonnidable. Every one of
So when Dingell came to Slattery asking for
the 44-member committee's 17 Republicans was support, the Kansan gave a tentative yes, so long
opp(>sed. To get the bill to the floor, Dingell need- as the mandatory alliances were dropped and the
ed 23 of the 27 Democrats. About one-third of voluntary aliiances were instituted. Dingell
these Democrats came from rural sections of the agreed-any·thing but the employer mancountry, where support for Clinton's bill was dates-and amended the bill.
weak and the small business lobby strong.
But the underwriters weren't the only lobby
Except for the employer mandate, which he working on Slattery. The National Federation of
thought to be the only politically feasible way to Independent Businesses, fierce opponents of the
finance such a broad program, Dingell was pre- employer mandate, had sent a barrage of mempared to offer just about anything. In late spring, bers to hammer away on Slattery and, in the end,
Michael Weisskopf wrote in The Wa.shington they won. Slattery broke with the majority, and
Post, the chairman began going door to door.
Congresswomen Lynn Schenk and Marjorie Margolies-Mezvinsky objected to price controls on
________ ..___ -·-- ---- - - - - - new drugs-it would stymie research, they
Give a friend a sub:;;cription to the Monthly and
said-so the chairman dropped the idea. Virginireceive an autographed copy of
an Rick Boucher couldn't countenance the
Tilting at Windmills, by Charles Peters.
cigarette taxes, so Dingell offered tax credits to
.Hail S26to Book (?{fer. Th~ lr·ashington Monthly.
tobacco farmers for alternate crops.
1611 CormectU:ut ''""· \'lr: ll;l.<hington. D.C. 20009
Dingell was one vote short, and the last one on
T•l t1ng £OT Free
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l
April 1995 I The Washinglon Monlhly
L)
J7
�opposed the bill. On June 28, Dingell announced
that his committee would not report a bill.
The coalition had held. Lacking the strong, unified leadership that the Democrats had- pmsented
in the tax fight-and with wilting public sup:
port-the administration never even got to dealmaking, and health reform died a slow death. Several bills were drawn up in the frenetic summer
months, but none stuck. Emboldened by their victories in Energy and Commerce and Ways and
Means, interest groups, which by this had time
spent over $100 million on the issue, became
more insistent, and the Republican leadership reflexively rejected any reform bill that came down
the pike. In the end, of course, not a single reform
bill was passed, and on September 26, Senate Majority Leader George Mitchell announced that
health care reform was officially dead.
That suited the clients of Patton Boggs just
fine. The Trial Lawyers had beaten the odds,
emerging from another malpractice battle unscathed. And the insurance agents had smashed
the centerpiece of Clinton's reform plan.
It also suits Patton Boggs. Not only did their
victory confirm their reputation, but the total defeat of all health reform also means that the issue
will come around again, and with it, another rush
of clients paying top prices to have Patton Boggs
on their side. Health care reform took good care
of Patton Boggs. The firm's total revenue shot up
25 percent in two years. from $49 million to $61
million. The next round could be even more
fiercely fought, and more profitable for the firm.
Tommy Boggs will be ready.
o
The Washlngton Monthly
(
JoURNALISM
AwARD
January 1995
David A. VIse
The Washington Post
In the midst of Washington, D.C.'s staggering
financial insolvency, Fannie Mae, with yearly
profits of $2 billion, pockets $300 million a year
in local-tax exemptions. "If Fanriie Mae were required to pay taxes," says Vise, "it would wipe out
the District's budget deficit." But when Congress
considered repealing Fannie Mae's privileged tax
status, the company threatened to move elsewhere
with its 3,450 jobs, and prev11iled.
Vise exposes Fannie Mae's use of "wealth and
political muscle to maintain the advantages that
make it a money machine." Fannie Mae, the nation's largest privately owned mortgage company;
asserts that it needs its government-granted advantages in order to offer lenders lower mortgage
rates. But Vise rebuts the claim by reporting that
on a $95,000 mortgage from Fannie Mae, a homeowner only saves $200 a year.
Anonymous
City Paper
"ReaSonably well-raised white people with everything to lose are still getting hooked on crack,
smack, you name it," writes the anonymous author. "One night, I'm compulsively mixing and
fixing speedballs by candlelight in a roach-infested shooting gallery on Avenue C. The next afternoon, I'm gassing away on a panel discussion at
one of Washington's more straight-laced think
tanks."
The author details his frequent journeys into inner city drug war-zones and argues that it is the
demand of middle-class "dope-fiends" that has
turned inner city tenements into crime-ridden drug
bazaars. Inner cities become "bloody Bosnias,"
while the "middle-class screw-ups" escape to suburbia, and the war goes on. After reading this compelling narrati~e. you might give seemingly cleancut co-workers a second glance, and the folly of
our drug policy a second thought.
The Monthly Journalism Award is presented each month to the best newspaper, magazine, television, or radio story (or series of
stories) on our political system. Nominations for any newspaper, magazine, or radio or television station in the country are welcome.
The subject can be government in its federal. state, or municipal manifestation. Please send nominations to Monthly Journalism
Award, 1611 Connecticut Ave. NW. Washington, D.C. 20009. Two copies of the anicle or broadcast text should accompany the nomination. Nominations for stories published or aired in March will close April 15. The winner will be announced in the May issue.
38
The Washington Monthly I April 1995
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December 7, 1994
MEMORANDUM FOR BOB WOODWARD
FROM:
SUBJ:
·-IRA C. MAGAZINER
Your book:
The Agenda
I am writing this memo for your document depository in order to correct inaccuracies
in your book, The Agenda. I have limited myself to parts of the book where you discuss
health care and my role. There are many other instances in the book when I sat through
meetings on economic topics where your reports do not conform to my notes and
recoiiel:tions, but I do not comment on those in this memo. To do so would take more time
than I now have available.
(
Overall, I believe that your work suffers from an incomplete context on health care
issues. Health care and its decision process was not your main focus nor the main focus of
most of those you interviewed. You "sideswipe" the issues and tell anecdotes from particular
points of view, often of people who have "axes to grind." Too much of your recounting of
events is gossip or directed innuendo. The truth suffers as a result.
I fmd it particularly objectionable when you incorrectly attribute state's of mind to
me. How could you or your sources know what was in my mind or how I felt, at various
times. Facial expressions can reflect a poorly settling breakfast or the recalling of a
particularly good joke rather than the matter at hand in a meeting.
I also object to the use of quotes when reporting a conversation purportedly heard
second hand.
You paint a picture of me and of the health care issue which is in many respects
inaccurate. In this memo I try to correct some specific inaccuracies, though I do not correct
the many errors of omission which would tell a truer story.
Below are a number of inaccuracies in your book and some cases where you portray
only one side of a conversation and therefore mislead the reader about the nature of the
discussion
1.
(_)
Putting People First
Your description of the creation of "Putting People First" is in many respects
inco~plete and inaccurate.
�A.
You state that the genesis of the plan was a phone call from George
Stephanopoulos to Gene Sperling in early June of 1992 (page 39) giving Gene
two weeks to put together a plan. In fact, at a meeting in Little Rock in
April, Bob Reich, Derek Shearer and I were given responsibility to put
together a plan. Late in May, a group headed by Ken Brody and including
Bob Rubin, and Roger Altman were also asked to make recommendations for a
budget plan. Rob Shapiro was asked to provide budget numbers for both
efforts.
The final version of "Putting People First" had the same structure and content
as the paper submitted by Reich, Shearer and myself and the deffcit parameters
laid out by the Brody group with these exceptions: Our original paper did not
include a section on health care (which was assumed to be deficit neutral with
savings going to fund universal coverage), and the budget numbers incorrectly
included a defense double count as you described. Gene Sperling joined the
effort when he came to the campaign in early June.
B.
On page 43, you state that on Sunday June 14th, "Sperling took a hard look at
the health care numbers in the plan. They had been compiled by Ira
Magaziner. " I had not compiled any numbers on health care at that point. In
fact, I had not known that health care would be included in the plan until
Saturday evening June 13th. It was not part of the draft which Reich, Shearer
and I had done.
C.
It is not correct to say that "some of (my) ideas were used in a health plan
adopted by the state of Rhode Island" (page 43). I led a team which
developed private sector initiatives for health reform in Rhode Island.
D.
The conversation you report on page 44, with quotes around my comments and
Gene Sperling's comments is nonsense. I resent your attributing to me, with
quotes, comments I never made.
Sperling offered to let Magaziner find his own experts.
"They're all wrong," Magaziner insisted (page 44).
Gene Sperling and I did indeed have a conference call with Henry Aaron about
growth rates in health care costs on Sunday June 14th where Aaron and I
disagreed. Afterwards, I told Sperling that a number of Washington-based
health care experts would agree with Aaron, but that there were many other
experts in the country who would agree with my point of view, that there was
a disconnect between Washington and the experience of many companies and
states in controlling health costs. I gave him a number of names of people to
call including Walter Zelman who had worked on the Garamendi plan in
California, Lois Quam who had worked on the Minnesota plan, Uve Reinhardt
2
�r
.........-..,
"'-'
and Paul Starr at Princeton, Jack Wenberg and C. Everett Koop at Dartmouth,
Jack Lewin from Hawaii and Chuck Buck at General Electric who would
support my view.
'
•I
I never suggested that health reform to provide universal coverage would not
be expensive. The employer mandate was the main financing mechanism we
proposed for universal coverage with Medicare and Medicaid savings used
only for subsidies to help make the mandate more affordable to businesses and
low-income people. The mandate raises a great deal of new money.
The Point that Sperling and later in the week Boorstin made, which I
acknowledged, was that reporters would likely call the Washington-based
experts like Henry Aaron first, and that the more aggressive savings(, ··
·projections to finance subsidies would be challenged, Boorstin's "smtll test."
Based on that, I agreed that we should be less aggressive in our assumptions.
Parenthetically, private sector growth rates in health care for 1993 are already
lower than I projected and far lower than Henry Aaron suggested was
possible. The Medicare and Medicaid growth rates projected in our
legislation, the Chafee legislation and in various deficit reduction proposals in
Congress are all more stringent than I wished to project in "Putting People
First." The newly revised Medicare and Medicaid baseline projections already
show slower growth than I projected just based on actions we took outside of
health reform to cut waste iil these programs.
E.
In putting final health care numbers together on Friday evening June 19th, I
relied on updated savings numbers which had been "scored" by CBO for the
Stark-Gephardt bill, so that there would be a "real world" proposal which
could be used as a reference point for reporters. I checked the numbers over
the phone on Friday with Andy King, Congressman Gephardt's health care
expert.
The campaign rhetoric had stated that universal coverage would be phased-in
and paid for as savings became available. Under the numbers I drew up based
on the Stark-Gephardt bill and under the most common estimates of the cost of
providing universal coverage at the time, $35-50 billion per year, this scenario
achieved universal coverage and deficit reduction by 1997 or 1998 (depending
on whether $35 or $50 billion was the right number).
I left these numbers at 6:00am Saturday on my way to the airport. I do not
know what happened that morning, but I gather that the group remaining in
Little Rock put in a different set of numbers on health care than the ones I
left. I also gather that the campaign did not want to announce a plan which
did not guarantee universal coverage by 1996.
3
�... .
(,
r,,· •
:
I received the conference call at my home in Rhode Island and was confused
because the numbers had changed and I didn't have a point of reference, so I
·
found the call perplexing.
The decision to assume deficit neutrality was fine with me. It was where we
had started in the original version of the plan that Reich, Shearer and I had
constructed in May.
The idea that I almost scuttled the economic plan, after months of effort to
help craft it, is very offensive to me. Large sections of that plan on
investments in lifelong learning, technology and infrastructure were based on
my work. The original health care numbers I presented have thus far been
borne out by events. Agreeing to the need for validation when Sperling and
Boorstin proposed it, I presented a set of numbers which could be validated by
the Stark-Gephardt bill. I only regret that I did not stay that extra day in Little
Rock. I suspect that a lot of unnecessary confusion and panic could have been
avoided if I had been there.
3.
The idea of a $50 billion infrastructure investment program was supported by Bob
Rubin, Ken Brody, Bob Reich and myself. Indeed a much larger one had been
proposed by Barry Wigmore, an associate of Rubin's at the late May meeting in Little
Rock. The notion that I was alone fighting "tooth and nail" for this (page 46) is
inaccurate.
4.
On page 77, you refer to a four-page memo I wrote on deficit reduction. In fact, the
memo was over 70 pages long. I had been asked to head the deficit reduction part of
the transition and had conveyed to the President as well as to others on the economic
transition that deficit reduction, though difficult, was a necessary first step to gain
credibility for future investments
5.
The President had already decided to create a team to look at health care costs in
December, long before the Little Rock meeting you describe on page 86.
6.
On page 122, you indicate that Alice Rivlin spoke up against health care price
controls. That is not correct. Alice and Donna Shalala (who was not at that meeting)
both favored using Medicare-type price controls for the health care system. Alice,
however, did not want to include them in the initial·budget plan because more
analysis was needed to design the controls. Laura Tyson and Alan Blinder spoke
against them.
7.
Your description on page 123 of the Roosevelt Room meeting on February 7th is
inaccurate. I proposed alternatives for price controls but recommended deferring any
decision on whether to use them until there was more time for study. Donna Shalala
(
4
�.... .
( ·-
.
.....
spoke in favor of controls suggesting that the knowledge of how to administer controls
had improved since the Nixon days.
'I
8.
9.
'
Your description of the Rostenkowski meeting on page 147 is inaccurate. I did not
advocate a tax increase other than noting that because we were going to take almost
$60 billion of Medicare and Medicaid cuts for deficit reduction in the budget, we
might need a tobacco tax to.replace those funds for subsidies for universal coverage.
Rostenkowski did not object.
10.
(
On page 124, you portray me as being incensed after the February 7th meeting. I
was not in any way incensed. I had recommended the delay in my presentation,
buying Alice Rivlin's Saturday argument that we could not be ready in time to lay out
a detailed plan of health care cost containment. Nor was Hillary angry. J ~Iked with
her afterwards. We wished we were ready, but there was no way we could have been
and we accepted that. I don't understand how you can attribute feelings to me
without asking me if indeed I felt a certain way. .
To the best of my knowledge, the decision to keep meetings of the task force working
groups secret (page 148) was made by White House communications, not by the First
Lady.
n.
Your perception of my meeting with Bob Reischauer on page 149 is not a fair one.
You present his side of the discussion only. I did think there is more waste in the
health care system than he believed, and indeed, cuts have been made in. system
growth which exceeded my expectations without breaking the social fabric of
America's communities. Medicaid's rapid growth rate, for example, was cut
dramatically from 30 percent to less than 15 percent in one year by tightening up
loopholes whereby states were using Federal Medicaid funds to fund non-health
related projects.
12.
On page 164, you intimate that Bentsen, Panetta and Shalala felt that "Magaziner's
numbers work was unsatisfactory." First of all, health care numbers were being
prepared by staff from OMB, Treasury, HHS, etc., all designated by those
departments, not by me. Second, we all were concerned that these numbers undergo
a proper vetting by OMB and Treasury auditors as well as by private sector auditors
before they would be released. We planned such a process. The Panetta and Bentsen
comments were made to be sure that there would be time for these audits once final
decisions were made and before the plan was released. I concurred completely.
13.
Your statements on pages 167 and 168 about my having a two track strategy for
health care meetings are nonsense. It is typical for the President and almost all
CEO's of companies I have worked with to want a private briefing before they go
into a larger meeting. This is standard procedure for Bob Rubin, Tony Lake and
Carol Rasco on their issues as it was for me on health care. The Boorstin comments
5
�·· .....
...
...
.
were completely out of context. At one of the 21 NEC meetings we held on health
care in April and May, a suggestion was made to introduce a "catastrophic" type
benefits package and phase-in comprehensive benefits later. Boorstin rushed out to
complain to me that this would be disastrous. I indicated that there would be further
meetings and that the sense of this particular meeting in favor of that idea should not
be taken as final. There was a subsequent meeting with all the players present where
this subject was debated in front of the President for a few hours and he made a
decision. Bob Boorstin never made the coriunents to -me-· which are quoted on page
168. At a subsequent time in June, when all health meetings were stopped because of
the White House focus on the economic plan, Boorstin and I and others working on
health care shared concerns about cabinet officials feeling left out, but your whole
portrayal of this is inaccurate. I had those concerns more than anyone else.
(
14.
The set-up you have on pages 197 and 198 for the Roosevelt Room meeting was not
accurate. It was one in a series of meetings, some set up in that debate fonnat which
had begun 10 days earlier to make final health care decisions. You also assign a
~ncre central role to Gene Sperling in that meetingn. ....., 1 r ..,,......,...,-nn
15.
Your description on page 316 mischaracterizes circumstances around the decisions to
be made in August. Everyone was frustrated because we had not been able to meet
on health care. Some wanted to put off health care until January to focus entirely on
NAFTA in the fall. The disagreements were mainly around program size and scope
as you indicate, but there was general support for the structure of the refonn and the
disagreements were modest.
16.
Saying that I did not fathom what would come on page 317 is not accurate. I
understood what we were up against, but often the obstacles were insunnountable.
6
�••
0
.
-~
'•
THE WHITE HOUSE
.WASHINGTON
February 2, 1995
Elizabeth Drew
3000 Woodland Drive, NW
Washington, DC 20008
Dear Elizabeth,
I was at a dinner party a few weeks ago when the subject of your book was raised.
The host said that he had spoken with you and that you had taken the fact that people from
the White House had not called you to comment on your book as an indication that it was
accurate.
Since I believe that your portrayal of health care decision-making in the first year of
the Clinton Administration is unfair and mostly inaccurate, I thought I should write and detail
my concerns.
Overall, your treatment of health care is spotty and you rely on a few unnamed
people with "axes to grind" whose colorful quotes attacking the President, the first Lady or
me are often stated as fact, when they are not true or representative. Below are some
examples from your book which don't convey accurately what really happened.
1.
L·
On page 189, you state: "Bentsen, Panetta, and Stephanopoulos felt that adding
health care to an already large legislative agenda for 1993 wasn't sensible. In the
face of arguments to the contrary of some of his most important advisors, Clinton was
determined to propose a health care plan in 1993 for another reason: now that a
Democrat had won the presidency, other Democrats -- such as Senator Edward
Kennedy of Massachusetts and Harris Wofford of Pennsylvania-- would push health
reform bills, and he wanted to get out ahead of them."
All relevant senior officials in the Administration thought that the President should
propose comprehensive health reform legislation in. 1993. The reasons were clear:
he had promised to do so in· his campaign; the long terin economic and deficit
reduction strategy of the Administration depended on it; health reform was viewed as
a prerequisite for welfare reform; and most importantly, rising health costs and loss
of coverage are a major cause of middle class insecurity and diminishing living
standards.
�Early in 1993, there was debate about the best timing for introducing the health care
plan. Some argued along with the House and Senate Leadership that we ought to try
to pass health care reform as part of budget reconciliation in 1993 or failing that, to
introduce .it in May and work for passage by the end of the year. This group feared
that if health refonn_were put off for too long, we would lose momentum and the
issue would become partisan as the 1994 elections approached.
Others, including those you name, favored introduction upon passage of the budget
package, initially thought to be in May or June and ultimately noraccomplished until
August. This group thought that health care would receive a boost from passage of
the budget and could pass in the first half of 1994 after a fall introduction.
Once the economic package ran into trouble in late-May, all agreed that health care
introduction had to be postponed to the fall, though we were concerned with the
negative impacts this would have on the health care debate.
During the summer of 1993, some argued for introducing a set of detailed principles
and a framework for a bill in the fall and then introducing detailed legislation in
January of 1994 after the passage.of NAFTA. I never heard the President or First
Lady express the concern you raise about other Democrats nor did I ever hear it
raised in their presence by others. Senators Kennedy and Wofford worked with the
President very closely and we were never concerned about their actions in any way.
(
2.
You imply that the "immensely complicated mechanisms" I had designed for drawing
up the proposal were in some way responsible for the delay in its introduction. The
health care working group finished its work on time. A first draft plan was delivered
to the President and First Lady on May 3rd, the 100 day deadline. Six major
decisions remained to be made at that time. They were late in being made because of
the unexpected absence of the First Lady during part of the spring because of the
illness and death of her father .. Meetings were set, Some of which occurred iii May,
to make the final decisions so that a plan could be finished by the end of May. The
final meetings, after May 21st, were cancelled for reasons unrelated to health care.
Subsequent delays were due to Administration focus on the economic package.
The process I established may have been complex, but I am not sure that any process
could have come up with a better thought out proposal, with as much input from
sources all around the country, in a newly forming government, in such a short period
of time.
Given the complexity of the issue, the over I, 100 interest groups that wanted to be
heard, the large number of diverging points of view even among Democrats (each
2
�,·
'•
.
held with great fervor), the President's desire to involve practicing health
professionals, state and local officials and health policy experts from _outside of
Washington, the short time frame, the movement in and out of people which is
characteristic of a newly forming government, the difficulties of getting anything done
quickly in the government, the seven different federal agencies claiming expertise in
health care numbers, the inevitable conflicts among different bureaucracies asserting
their turf, and the number of congressional committees and staffs claiming jurisdiction
on health care, not to mention the enormous complexity of the issues, I question
whether any process would have resulted in praise for simplicity and inclusion.
3.
On page 190, you state: "In January 1993, Clinton in fact became quite angry when
the transitions' health advisors -- an experienced group, who were working apart from
Magaziner -- proposed a version of pay-or-play in a meeting in Little Rock."
The transition health care team did not propose a version of "pay-or-play" and the
President did not become angry at the meeting in Little Rock in January. Though
Judy Feder, the head of the health care transition team had indeed been a supporter of
pay-or-play, she and the others on the transition team understood the President's
desire for a managed competition framework and did their work within that
framework.
The only questions of disagreement at the meeting in January had to do with how
much and how soon the growth of health care costs could be slowed. It was a
productive and harmonious meeting.
4.
Your description on page 190 and elsewhere about how I came to have the role I
played in the Administration is not accurate, but I consider those discussions to be
personal and will not get specific about them.
5.
Your description of managed competition on pages 190 and 191 including the historic
position held by the "Jackson Hole Group" is inaccurate. For example, you state that
"the Jackson Hole proposal didn't specify benefits, nor did it have the government
role, or the mandatory requirements that companies insure employees, and that people
join alliances, or the price controls on premiums, that the ultimate Clinton plan did,"
The Jackson Hole position for many years, including the period during which we
wrote our plan, included employer mandates, mandatory health alliances, a specified
benefit package and the creation of a national board to set the guidelines for managed
competition. The major place we differed from the historic Jackson Hole position
was with our proposal for premium caps instead of a tax cap.
3
�(
'
·.-."
~
Jackson Hole proponents subsequently modified some of their longstanding proposals
in the face of political pressures from their sponsors, much as they are again doing
today, but their historic positions were much closer to ours than you indicate.
6.
Your statement on page 192, "Everyone thought Ira's process paper was a joke
because nobody's ever seen anything like it in their whole career, and everybody
.suddenly realized that Clinton had never seen a first-rate policy process," is
outrageous.
I have no doubt that someone said that to you and also little doubt about who it was.
I do think it is unfair and inaccurate to use it as a summary statement about
perceptions of the work plan and process we established. The work plan draft was
widely circulated. The feedback on it was very positive from almost all circles.
The comment that the President and by implication the First Lady had never seen a
· first-rate policy process says more about the state of mind of your source than
objective truth. Given all of his years as chair of NGA committees, political
organizations like the DLC and as governor and all her years as a member of the
boards of directors of some of America's most successful companies and public
organizations, do you really think that neither the President nor First Lady had seen a
first-rate policy process?
7.
On page 192, you state: "Some advisors tried to talk Mrs. Clinton out of keeping the
taskforce meetings secret -- saying it would be a big issue with the press, that it was
easy enough to at least provide briefings, that the papers would be released ... " An
official said later, "they answered, 'we're going to be secret' because they --the
President, Hillary, Ira -- were amateurs. The health care working groups had a
bunch of wacky ideas that they never would have gotten away with if they'd been
public. You had five hundred people with every wacky idea that had ever been
suggested in health care. The people now rewriting the plan never read the working
group papers."
To my knowledge, the decision to keep the taskforce meetings secret was made by
White House Communications, not the First Lady. In a February 1993 memo, I
advocated opening the review meetings of the working groups and having multiple
press briefings every week, but was overruled by communications.
All of the tollgate books and briefing books of the working groups have been made
public. They are serious materials. While nobody would agree with all of the
options presented, I doubt whether.the ideas presented would be considered "wacky"
by serious students of health policy.
(_)
4
�-
\.
~-
-.
I supervised the writing of the final health plan. I can assure you that I and most of
the others working on the final plan were very familiar with the content of the
working group papers and that they provided the basis for much of the legislation .
.Those papers were also used during the congressional process to help prepare
modifications of the original plan· as congressional committees sought· technical
assistance from us.
Again, I don't doubt that someone gave you this quote, but it is not an accurate
representation of what occurred.
8.
On page 192, you state: "The health care taskforce was disbanded at the end of May,
leaving behind over 30 large three-ring binders. Even Mrs. Clinton was alarmed."
Mrs. Clinton asked for the briefing books contained in the three-ring binders. She
was happy with them and used them to prepare in the fall for her congressional
testimony and speeches. I believe that she would confirm that these briefing books
were of great use to her and helped her become the expert on health care which all
have acknowledged her to be.
(
9.
Your descriptions of the decision-making meetings on health care in April and May
are misleading and unfair. On page 193, you note that some found me to be
"secretive, distrustful and dismissive."
While some may have felt this way, you might, to be balanced, also note that some,
including the President, the First Lady, the Vice President and Mrs. Gore who are the .
principles in the Administration as well as many others, had a more favorable view of
my work .
. You further state on page 193 that "to preserve secrecy, Magaziner ordinarily didn't
distribute papers even to members of the policy-making group .... questions about the
basic assumptions were ruled out of place, on the grounds that, Magaziner would say
'the President has already decided that.' One participant said, "Ira had two answers
to everything." "The President has already decided that, or it hasn't been decided
yet.""
This is a nonsensical description of those meetings. First of all, it had become
commonplace, unfortunately, for paper not to be passed out at meetings of the NEC,
the NSC or of the health care taskforce. This was not my decision. In fact, I started
the meetings in April handing out detailed decision papers and when they began
showing up in newspaper articles was asked by a number of participants not to hand
out paper again.
5
�The group who put together the slides for those meetings included designated
representatives from Treasury, HHS, CEA, NEC, OMB, Labor and other relevant
agencies who briefed their principles before the meetings so that they would be
prepared.
The topic of health care was new to virtually all the cabinet participants with the
exception of Secretary Bentsen and Deputy OMB Director Rivlin and the managed
competition approach was new to both of them. Health care is a complex topic.
Most were preoccupied with the budget. This sometimes caused confusion. By and
large, however, those meetings proceeded in a positive fashion. There were some in
the room who were disgruntled because they felt that they should be leading the
health care effort and some who would have preferred either a single-payer approach
or who were afraid that health care would displace other issues of greater concern to
them, but the discussions were fruitful.
The cartoon you paint of me at these meetings is very unfair. While I occasionally
gave the answers you quote, they were usually in response to questions by those who
had missed meetings or who were first learning about an issue. For example, when
some raised a VAT tax as a funding source in April, it was appropriate for me to say
that the President had already considered and rejected that approach months earlier.
10.
I.L/
On page 193, you state: "The economic officials believed that Magaziner was coming
up with far too complex a proposal, with insufficient attention to the costs of the
benefits proposed. The group --which included Bentsen, Panetta, Rubin, Rivlin,
Tyson, Altman and a couple of others -- felt that the President should proceed much
more slowly, dealing with the most immediate problems. Try things out, and then
build on the progress." ·
You confuse a number of things in this statement. The economic officials did not
complain about complexity. In fact, they supported certain measures which helped
create the complexity in the bill. For example, nothing created more complexity than
the decision to go with a premium system rather than a payroll tax. I initially favored
the payroll tax for its simplicity and progressivity. The economic officials, led by
Secretary Bentsen, argued strongly for a premium approach. This necessitated the
creation of elaborate subsidy schemes, a system of caps on employer contributions,
dual contribution rules and a whole series of other measures which took up hundreds
of pages in the bill. They argued correctly, that a premium system was a more
market-oriented approach which was less redistributive and therefore, less disruptive
of current practices, but it did create complexity. The President agreed with them.
Similarly, Treasury concerns about building in enforcement safeguards for the
mandate added enormous complexity as did proposed new regulations for private
'
.
6
�long-term care insurance submitted from Treasury. Had the President gone along
with CEA and Treasury tax cap proposals, complexity would have been increased
even further.
In general, and Bob Rubin has confirmed this publicly, the e-conomic team supported
the structure of employer mandates, managed competition with premium caps and
mandatory alliances which .formed the basis of the proposal.
You are incorrect in saying that anyone proposed "dealing with the most immediate
problems, try things out, then build on the progress." There was never sentiment
expressed for an incremental rather than comprehensive approach. All knew and
accepted that the President had promised comprehensive reform. Many proposed and
I agreed, that there should be a transition period with sufficient flexibility to learn
from mistakes and reverse bad policies. The state-by-state implementation of the
program over four years was designed for this purpose as was the cap on the
entitlements.
The main disagreements had to do with the size of the benefits, the length of the
phase-in period and how quickly costs should be brought under control. Most of the
economic advisors, as you correctly state, wanted less benefits, phased in more
slowly. HHS, Labor and political advisors and many of the health advisors wanted
the bolder approach.
(
The discussions on issues were generally productive and resulted in modifications of
peoples' positions, my own included, as people persuaded each other.
11.
On page 193, you state that someone who attended these meetings said: "Originally,
Ira tried to push through all sorts of decisions without numbers. That was stopped by
Rubin, Panetta, Altman, Bentsen, Rivlin and Cutter."
This is one of the most annoying false statements in your book. From the beginning
of the process in late-January, we carried out an enormously intensive effort to
produce good numbers, because we understood that health care numbers were
complicated and historically suspect.
Although health care numbers are always hard to estimate accurately, we did a
thorough job of backing our proposals with numbers and those numbers stood the test
of time, being validated ultimately by the final OMB and Treasury vetting in
September and October of 1993, by the Lewin-VHI analysis in December of 1993,
and with some modification by CBO in February and March of 1994.
7
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(:
!
Even CBO's analysis which differed most from ours, had almost identical estimates to
ours on the effect of our program on national health care spending. They projected
more private sector and state and local government savings and more federal
government cost than we did. But even this difference was proportionally less than
the difference of their estimate versus OMH!s on_the economic plan.
The team producing our numbers was primarily from HCFA and AHCPR at HHS,
OMB, Treasury, CEA, NEC, and DOL, backed tip by the best private sector analysts
available at the Urban Institute and the Actuarial Research Corporation and audited by
representatives from major actuarial and accounting firms.
The concerns about numbers expressed in April and May, which I was the first to
agree with, were that there be enough time -- 4 weeks -- for a proper OMB and
Treasury vetting of final numbers after all decisions were made and before the bill
was released.
Because final decisions weren't made until early-September, this vetting could not
take place until mid-September and early-October.
{
Though health care numbers are always hard to estimate precisely, a fact which I
reiterated at almost every meeting, we conducted a more thorough and rigorous
numbers analysis than has ever been attempted in health care.
I
Dozens of people worked virtually around the clock for months to produce serious
numbers. For you to say that I tried to "push through all sorts of decisions without
numbers" is inaccurate and is a terrible insult to all of those people as well as to me.
12.
On page 194, you state: "Clinton himself had been loose-lipped on the subject (of a
VAT tax).
We considered a VAT tax briefly in the working groups mainly because Secretary
Shalala and Deputy OMB Director Rivlin were interested in it along with some
senators and labor and industry officials. The President allowed us to research it, but
never , to my knowledge, commented on it as a serious option.
13.
On page 194, you state: "A showdown meeting between the economic camp and the
Magaziner camp, which inCluded Hillary Clinton, took place in late-May. Before the
group were two health care proposals, one (Magaziner's plan) far more generous than
the other, at least at first . . . . . A senior economic official said later, 'the process was
horrible. There were fifty-some people in the room, a very high proportion of them
not above kindergarten age. All of them were for a larger package. There were
8
�.
.
_r--· ..
I.
cheers and groans and hissing. When you have that many people in the room·, the
senior people are not going to conduct a real debate in front of the junior people .....
there was no way for .the President to know the extent to which people really
disagreed.' "
·-
Once again you take the words of a disgruntled person and present them as a
summary description of the meeting. First of all, this was not a showdown meeting.
It was one in a series of decision-making meetings, each with a specified topic and
pre-briefing papers prepared by designees from each department and the health care
team. Second, the debate format for the prqcess was suggested by Bob Rubin and
was discussed by the broader NEC group and agreed by all. Third, the number of
people present was also agreed by everyone and reflects the number of interested
parties. Each secretary or principle wanted to bring at least two aides, a deputy and a
health care advisor -- in the case of Treasury, this meant Roger Altman and Marina
Weiss and Randy Hardock for example. When we had tried to limit to one additional
person at an earlier meeting, the Secretaries all balked. With Treasury, HHS, OMB,
Commerce, Labor, Education, Veterans Affairs, CEA, NEC, and DPC all
participating, this meant 32 people. Added to this were senior White House officials
who wished to attend including the Chief of Staffs office, Public Liaison, Political
Affairs, Communications, Intergovernmental Affairs, the Vice President's office, the
First Lady's office and Tipper Gore's office which added 12 more people. The health
care staff who actually prepared the materials and served as information resources
added another eight people and everyone agreed they should be there. Finally, the
four principles of course attended.
While there were some young "staffers" present, most participants were senior
officials. The young staffers who you unfairly deride as "kindergarteners" were
divided on which approach to take. A number of the youngest participants argued for
the slower phase-in.
I think that most people left that meeting feeling that it had been a good one, though
the leaks which came in part from the person I believe to be the source of your quote,
did put a damper on the meeting afterwards.
Senior Administration officials like Secretary Bentsen or Bob Rubin always had the
ability to give private advice to the President and often availed themselves of that
opportunity.
The richer benefits plan was not "Ira Magaziner's" plan. I did not take sides in that
panicular discussion. I leaned towards the comprehensive package but I thought there
was merit to the slower phase-in, though it added significant complexity. HHS,
9
�...
political advisors and Gene Sperling from NEC, among others, argued for the bigger
plan.
14.
On page 195, you state: "His project was being leaked, mocked and opposed from
-within the Administration. He felt that "The Beltway" or the "Washington
Establishment" was trying to kill his program." ... (one member of the First Lady's
staff privately referred to him as Rasputin) ... White House staff members, aware that
it was Mrs. Clinton's project, lay low. A White House aide said later, most people
in the White House felt that they were over in the OEOB secretly hatching a health
care plan -- that second and third tier aides were working with Ira, the mad scientist
concocting this socialist theme (sp). Treasury and NEC sensed the health care project
was a black box. But because it was Hillary's project, everyone was nervous about
criticizing it. "
I never considered this "my project." I, like everyone else in the Administration
work for the President. It was his project. The President and First Lady are very
smart, knowledgeable people who are quite expert on health care and who have talked
to hundreds, if not thousands of people on the subject over the past few years. The
idea that I was talking them into something is silly.
Do you really think that "most people in the White House" thought we were hatching
a socialist plan? Again, I don't doubt that someone may have said this to you, but
surely you don't believe it is an accurate representation of what most people thought.
The aides working on health care were designated by the cabinet secretaries and
White House department heads. These aides were responsible for briefuig their
principles on the progress of the health care effort. Staff from Treasury, NEC and
other departments were preparing the option papers. This was not a "black box" to
their principles; though there was a period from late-May to August when we were
not permitted to hold meetings or distribute health care draft plans for fear that leaks
would hurt the economic plan. This was a source of great frustration to those of us
working on health care. I appealed this decision on a number of occasions, but my
appeals were rejected.
To say that debate on health care was stifled because of Hillary is not fair. There
was significant debate on health care. There were far·more health care meetings and
memos from all departments on health care than any other issue by far and people did
make disagreements known.
15.
(
On page 305, you state: "Both Clintons indulged Magaziner in his tendency toward
complexity, his insistence that the only way to deliver broader health care insurance
J
""-"
10
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was through an overhaul of the entire health care system . . . his taste for big projects
... and his mind which understood systems better than it did human nature. The
result was that they came up with a plan that few, even in their own Administration,
comprehended or could explain. "
Health care policy is complex, because our current health care system is complex.
The complexity of our plan did not spring from any love of complexity on my part.
It came because we wished to build on the current private system, maximize choices
for consumers, make health care affordable for all types of businesses and families,
crack down on fraud and abuse in the current system and give states and large
corporations flexibility.
I doubt whether many people, including many cosponsors and their staffs understood'
in detail the Cooper/Breaux bill or the Chafee bill or the Ways & Means bill or the
Mitchell bill or the Gephardt bill or any of the other major pieces of health care
legislation. The Mitchell, Mainstream and Gephardt bills were all virtually as long or
longer than ours.
For that matter, I doubt whether many people understood the details of the Crime bill
or NAFTA or GATT or the budget package, all of which were as long or longer and
as complex or more complex than our health bill.
(
What made health care difficult to explain versus these other proposals is the fact that
virtually all Americans have personal experience with the health care system and their
questions are very specific and personal. Cabinet officials or congressional members
can give a general speech on crime or the budget or GATT and deal with the few
general questions they will likely get after the speech. All could deliver a general
speech on health care, but it was difficult for most to master the details of any bill
sufficiently to answer the specific personal questions which followed.
Nobody has yet produced a proposal which achieves substantial expansions of health
care coverage without an overhaul of the entire system of financing health care. This
was not some particular invention of mine. In fact, part of the complexity of our bill
came from a desire to build on the current system rather than wholly recreate it as a
single payer system would have done.
16.
On page 305, you state: "The question was why the Clintons didn't see the danger of
coming up with such a complex program. The answer probably lay, beyond their
indulgence of an FOB, in their sense that they were smarter than anyone else ... they
misjudged probable public reaction in this case and failed to see the material they
were handing opponents."
11
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I
{&,0.' .
,
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·~
We were all aware that any serious health reform plan would be complex and that this
would make it easier for opponents to scare and mislead the public about what was in
the plan. My original taskforce work plan in 1993 laid out these concerns. We were
fa.r from arrogant. Believe me, we were very humbled by the odds against success on
health reform, having studied the failures of six previous presidents to enact
comprehensive reform.
We also knew that we had been unsuccessful in preventing misrepresentations of the
economic plan from turning the public against it and we were being unsuccessful in
bringing the public with us on NAFTA. And, we knew that the forces arrayed
againSt health care reform were more powerful, had more money to spend and would
have a longer time to mislead and scare people than in these other debates.
We could have proposed only principles and not a detailed bill. We discussed this
alternative frequently. We will never know whether this would have worked better.
Based on ·congressional leadership views and a concern that we would be accused of
"trying to remake 117 of the economy without explaining the details" or asking people
to buy a "pig in a poke," etc.; we decided to go with a detailed bill but to say that all
details were open for discussion and modification as long as the President's principles
were met.
17.
On pages 305 and 306, you state: "Another high official said later, what the public
doesn't realize is that this was a rogue policy process. There's no central policy
development mechanism in the White House. Everyone is suspicious of the
numbers."
These statements make little sense. There was a well established health care policy
team in the White House. We all work for the President. He was the one elected by
the American people. None of us, no matter how important we may at times think
we are, was elected _by anyone. We serve at the pleasure of the President in the ways
in which he determines. He set up the health care process, had numerous meetings
with us, gave direction frequently and made the ultimate decisions. How can that be
a rogue process?
As to the numbers, once again, they were produced by a team with designated
representatives from each department. When they were finally vetted in September
and October, they were judged to be reasonably accurate by OMB and Treasury
vetters.
18.
L)
Your descriptions of the August meetings on pages 306 and 307 lack context and are
in large part, inaccurate.
12
�Because of leaks, but mainly because of the need to focus on passage of the economic
program, health care meetings were suspended on May 21st. The health care team
tried desperately to have further decision-making meetings in June and July, but we
were told by the Chief of Staff and senior economic officials that this was impossible
until after the economic package passed.
We. were committed to a late-September release and therefore, needed decisions as
soon as possible. Many cabinet secretaries and senior White House officials were
understandably concerned about whether they would have sufficient time to have input
since the President and many 9f them had planned vacations for 2-3 weeks in August.
The health team was concerned because we needed a certain amount of time between
final decisions and the final drafting of a bill.
As it turned out, there was only a few days of time between passage of the economic
package and the President's departure. Everyone was exhausted from the push on the
economic package, and therefore natural anxieties were heightened.
Most of the discussion centered around how much savings could be realized both in
the private health care system and in the public system, how fast the phase-in of the
program should be and how rich the benefits package should be.
Your presentation of these discussions is far too dramatic. "Everyone looked at it and
went bonkers." "Magaziner ran right over him (Rubin)." One doesn't run over Bob
Rubin and I certainly didn't try. Very few senior administration officials would go
"bonkers." We all agreed on five savings sc~narios for the Presidents' consideration,
and on the numbers backing them. There was disagreement on which scenario to
pursue. There was spirited discussion and the President expressed his views. We
later produced a compromise between different positions which became the final
proposal.
It is accurate that I and most of the health care advisors favored a more significant
slowdown in the growth of health costs and that many economic advisors and the
HHS secretary favored less of a slowdown, particularly in Medicare and Medicaid. It
is also accurate that the President wanted more stringent cost containment than even I
had suggested.
Parenthetically, health care costs, both for Medicare and Medicaid and in the private
sector have already slowed to rates beyond those which I called for without the dire
consequences predicted by some. Health plans subsequently developed by Senator
Chafee, the House Ways & Means Committee and Senator Mitchell also called for
rates of growth in Medicare and Medicaid which were comparable to those we
13
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proposed.
Also, as you do point out, subsequent studies by CEA, Lewin-VHI and CBO showed
that the health team was justified in claiming that there would be minimal job impact
__
from the proposal.
Your presentation of the arguments at these meetings is inaccurate in a few other
respects. First, you claim that Medicare and Medicaid cuts were specified only after
some at the meeting insisted. In fact, we did specify Medicare and Medicaid cuts
long before these August meetings, though HHS wanted to produce their own list,
which they did in September and October.
The paragraph where you claim that "Shalala and Panetta challenged Magaziner to
explain who would be for his program, etc." and that "Magaziner assured the group
that as a result of his negotiations, a large number of interest groups would back the
program, etc." do not conform to my notes or recollections.
I did have a separate meeting in my office with Leon Panetta and Nancy Ann Min
where he expressed concerns about the level of Medicare cuts we were proposing and
whether the AARP would stick with us over the long run and I described the
conversations I had with them which led me to believe they would be with us.
Donna Shalala did of course argue for lower Medicare cuts as she had done on the
budget and as one might expect from an HHS secretary and she does often use
extreme language, though I do not recollect nor have notes of the particular comments
you attribute to her.
I shared the concerns you accurately express as being voiced by Roger Altman and
Bob Rubin about phase-in and the size of the program. I expressed to them that this
was only a starting place and that the package was likely to be whittled down and
slowed down in the congressional process. I told Rubin that if I were writing a law
instead of a bill, I would be closer to his vision than to the one we initially were
presenting on phase-in and scope of benefits.
We were all concerned about the complexity of the plan and realized it would be
painted as "Rube Goldberg" etc. This would be true of any comprehensive plan.
Just as opponents branded the economic program as "tax and spend big government,"
the crime bill as "pork and big brother," it was inevitable that they would brand any
health bill we prepared which guaranteed health security and controlled costs as
"Rube Goldberg." · Ultimately, they did the same thing with the Ways & Means,
Mitchell and Mainstream bills.
(
"-·
)
14
�19.
On page 308, you make a number of statements which are unfair and inaccurate.
First, you state Among the questionable numbers in the leaked draft was that the
program would reduce the deficit by $91 billion by the year 2000 (not $90 billion,
not $92 billion) when obviously this was unknowable. __
II
11
Of course, as with any budget estimate, exact figures are not knowable, but one uses
the best methodologies possible and projects potential costs and savings. The budget
every year contains an exact projection of the deficit five years out even though it is .
clear that such certainty is not possible.
You state erroneously, that "The proposal was going to cost a large number of people
more than they paid for their existing plan. According to estimates by OMB, HHS,
l.ewin-VHI and CBO, this was not true. A relatively small percentage of people paid
more for the same or less benefits than they would in the absence of health reform.
· You also incorrectly state that "One thing that had held up the bill was that Panetta
was dubious about the numbers, and insisted that they be reviewed by OMB -- which
led to several changes.
It had been planned from day one of the taskforce in my original work plan to have
·
normal OMB and Treasury vetting of numbers as well as outside private sector
reviews. Those began in mid-September after we received final decisions from the
President shortly after Labor Day. Both the Treasury and OMB reviews resulted in
very little change (less than 1 112 percent). The only major numbers change resulted
from a policy decision change in how to deal with Medicare recipients who were
working.
You also incorrectly state that the Clinton plan "Did reduce peoples' choices. As
many experts have since testified, this is absolutely untrue -- our proposal would have
increased choices for most Aritericans, not dimirush choice. The status quo is limiting
people's choices and causing people to have to pay more to see their own doctor, not
our plan.
II
20.
I certainly plead guilty to a degree of naivete about how Washington works.
However, we never assumed as you indicate on pages 308 and 309 that we could
close deals with most interest groups. Our production of a plan was only the first step
in a long process where interest groups would have many congressional avenues to
pursue their interests. It would have been foolhardy for groups to completely sign on
with our plah and diminish their chances of improving their positions in Congress.
15
�'·
We sought general support from groups but could not negotiate final deals so early in
the process. In fact, the congressional leadership did not want us to try. They
believed that they were in a better position to negotiate final deals with groups than
we would be and to secure congressional votes in the process.
21.
On page 309, you state: "She (Mrs. Clinton) had come some distance fromher view
that Congress should simply endorse what the Administration wanted -- but she still
had a way to go."
She never had that view and we all expressed a willingness to compromise from the
very beginning.
22.
On page 310, you state: "The three weeks that were to be devoted. to the rollout of
the health care program never materialized. It just fizzled out. There was no real
plan for the third week, and then the President was overtaken by other matters.
There was a six-week plan for health care rollout which was halted because of events
in Somalia, Haiti and by the difficult battle for NAFTA and then the Brady bill.
(
23.
On page 396, you claim that: "Magaziner, who had riled a number of members of
Congress, was kept out of sight."
This is an overstatement. Certainly, as a result of being on the hot seat for so long, I
had developed poor relations with some members and staffs, particularly in the
House, and I stayed away from meetings with those officials.
However, I worked actively with Senators Mitchell; Kennedy, Daschle and a host of
others in the Senate and with Congressman Gephardt and others in the House. I
made dozens of appearances around the country for Senators ranging from aaucus to
Boren to Wofford to Jeffords and for many House members. I did dozens of media
events as well as speaking to a wide variety of groups and briefed the press
frequently.
Limitations on my time due to the need to provide technical assistance to Hill
committees was the major factor in limiting my public appearances.
I was disappointed by your book. I have always regarded you as a serious journalist.
I know that neither the President nor Hillary nor I were very forthcoming to you. I also
know that it is difficult to write an accurate history of events when you have limited access
to principle decision-makers and to documents.
16
�I would have thought that these limitations would have humbled you in characterizing
· people and events. Instead, you have taken the most extreme "sound bites," and without
presenting the other side, have 'portrayed the President, the First Lady and me in very harsh
ways.
Writers usually-justify such attacks by asserting the importance of an accurate
historical record so that people can learn and not repeat mistakes. This is fair enough, but it
places a great burden on an author to be thorough and accurate. In this case, on health care,
you have been neither.
There were many people who were discontented about the health care process and
plan. There were reasons, in most cases justifiable ones, as to why decisions were made
which caused that discontent. In some cases their concerns were legitimate .. In some cases,
those who were discontented acted out of pettiness or jealousy. Your book lacks accuracy
and balance because it primarily presents their stories. That we made mistakes is
indisputable. But you grossly overstate and misrepresent those without presenting a fuller
context of how difficult a task we faced and how many good decisions we also made.
If you are interested in correcting inaccuracies or presenting a more balanced view in
subsequent editions of your book, I would be willing to talk with you. Otherwise, I suggest
that this letter be held for release when presidential papers are eventually made public.
Regards,
Ira C. Magaziner
Senior Advisor to the President
for Policy Development
ICM:dpr
(
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17
�2
Abstract
PoHtical Advertising and Health Care Reform
Political advertising by interest groups attempting to influence public policy has proliferated in
recent years. Fonnerly the preserve of election-campaigns, advertising has spread to non-electoral arenas,
sudt as abortion, trade, and health. care. This paper examines group lobbying on President Clinton's health
care refonn. Using a study o_f ads, a content analysis of news coverage, interviews with leading figures in
the debate, and an analysis of three national public opinion surveys designed to gauge the public response
to health care ads, we investigate the media campaign on health care. We find that anti-Clinton ads played
a crucial role in attaching negative cormotations to key elements of the president's plan, but that these ads
influenced elite opinion more than the views of the general public. Grassroots campaigns can work either
by mobilizing public opinion or by persuading political leaders that there is grassroots opposition to a
particular program.
(
I
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�Political Advertising and Health Care Reform*
by
Darrell M. West, Diane Heith, and Chris Goodwin
Dept. ofPolitical Science
Brown University
Providence, RI 02912
(401) 863-1163
*Support for this research was provided by the Jolm Hazen White, Sr. Public Opinion Laboratory and the
A. Alfred Taubman Center for Public Policy and American Iilstitutions at Brown University. Data used in
(
this analysis were provided by the Roper Center for Public Opinion Research at the University of
Connecticut and the Vanderbilt University Television News Archive.
Prepared for presentation at the annual meeting of the Midwest Political Science Association, April 6-8,
1995, Palmer House, Chicago, nliriois.
�•
.
3
The unraveling of the Clinton health care package in 1993 and 1994 provided one of
i'-
the most dramatic stories of recent public policy. After decades of piecemeal reform in America, a newlyelected president made Wliversal health. care coverage the centerpiece of his domestic agenda, only to see
his effort fail decisively. The explanations for this failure have been varied: concern over the goverrunent
role in health care, fears about the quality of medical care, opposition to loss of choice in health care
providers, and worries about the cost of Wliversal coverage, among other things (Toner, 1994b). But
where did these fears come from? How did foes so effectively mobilize opposition to the Clinton package?
This paper examines the interest group lobbying surroWlding the Clinton health care package. We
argue that interest groups, and the attendant ads and news coverage which emanated from group activities,
were instrumental in creating the negative perceptions of the president's program. Many observers have
emphasized presidential bWlgling, institutional fragmentation in government, or cultural conservatism for
the failure of health care reform. But each of these explanations ignores the ftmction groups played in
highlighting particular impressions of health care reform. Beeause of the large amount of money spent by
opposition groups; the one-sided nature of the ad expenditures between competing forces (especially early
in the debate); and the prominent and non-critical coverage of commercials by the news media, anti-Clinton
ads and news coverage played a crucial role in attaching negative connotations to key elements of the
president's plan. Advertising is a key element in the traditional "outside" strategy of a public policy
campaign; persuade the American public to accept the group's viewpoint and elites will respond.
However, the health care ads influenced elite opinion more than the general public.
Avenues of Group Inftuence
Politics has been defined as conflict over the mobilization of bias (Schattschneider, 1960;
Kingdon, 1984; Hershey, 1992). In many respects, politicai battles are fights over the terms of debate.
The argwnent over abortion, for example, long has centered on the competing symbolism of "choice"
versus "life." Opinion polls have revealed sharp fluctuations in public support for abortion depending on
which symbolic frame is most central at the time.
Health care reform is an obvious example of a struggle over competing constructions of political
reality. National polls show that the public desires several conflicting goals in health care reform: the
preservation of quality care, choice of health care providers, reasonable cost of coverage, security from lost
�.
•
4
coverage, and a system free of excessive bureaucracy (Blendon. 1994). Whether it be a single
payer system, managed competition, or hybrids based on an employer or individual mandate, no plan
secures every principle. These compet.irig conceptions of health care have led to vigorous conflict over the
framing of this policy debate.
T_!aditionally, groups seeking to influence the course of public policy have emphasized either direct
appeals to legislators or outsider strategies based on public relations and news coverage (Walker, 1983;
Cigler and Loomis, 1995). Public cynicism toward Washington has made outsider strategies the preferred
group option. The chief virtue of this approach is that groups which generate favorable news stories are
able to frame policy battles in ways that advantage themselves. However, reliance on the news to fight
symbolic policy battles is risky because reporters are professional skeptics who can not be counted on to
convey a group's perspective. In addition. news coverage does not always occur at the time necessary to
further group objectives.
For these reasons, many groups have turned to political advertising to communicate particular
/
policy frames. The major strength of advertising is that the content and timing of ads is group-controlled.
This gives ad-based strategies substantial advantages over other forms of political communications, such as
interview shows and the news, because the latter are journalist-controlled.
Learning from political
candidates, interest groups now understand that ads are the most reliable means of conveying political
messages. Presidential candidates devote almost two-thirds of their overall budget to political advertising
precisely because these expenditures allow the presentation of direct and unmediated messages to viewers
(West, 1993a). Ads deliver the candidate's message and attract favorable news coverage, which amplifies
· the campaign message.
There are several ways in which public relations campaigns based on ads and the news can be
successful. The classic way is to influence citizens at the grassroots level. If ordinary folks accept key
points in the group message and act on those beliefs, grassroots mobilization allows groups to convey their
viewpoint to elected officials via citizens. Traditional discussions of outsider campaigns indeed emphasize
citizens as the key target of group influence.
But increasingly, there are two other audiences for grassroots cam,Jaigns. One is Washington
officials, who develop impressions about citizen beliefs. Even if citizens themselves are not swayed by
I
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I
•.
,,
·:
s
grassroot appeals, elites can perceive that there is a groWldswell of support or opposition in
regard to particular proposals. For example, congressional adoption of Reagan's economic program of tax
e-.
cuts
and spending restrictions in 1981 arose because elites believed ordinary citizens supported
Reaganomics, despite empirical evidence to the contrary (West, 1988). Elite actions which carry the force
of law have a powerful impact even if they are based on misperceptions.
In addition, grassroots campaigns can be powerful if they influence media reporters.
Public
policymaking depends heavily on the way options are framed and particular praposals are covered.
Although there has been little attention to the influential role of the media in constructing policy frames,
media coverage is very important to how the debate gets defined. Through coverage which invokes potent
symbols, impressions of policy alternatives can be shifted substantially.
Interest group media campaigns have become common (Kolbert, 1993; 1995). For example, rightto-life organizations ran ads beginning in 1992 emphasizing the sanctity of life and non-abortion
alternatives to Wlwanted presnancies. The acrimonious 1993 debate over the ratification of the North
America Free Trade Agreement (NAFTA) also generated extensive advertising campaigns from competing
forces. More recently, proponents of tort reform and a balanced budget amendment have utilized the
airwaves to publicize their point of view.
But these policy ad campaigns generally are not seen as being very successful because the amount
of money spent was not sufficient to guarantee much visibility. In the abortion and NAFTA ads, the news
coverage that ensued was neither extensive nor favorable to the groups running the ads. The general
ineffectiveness of past advocacy advertising has led some observers to conclude that these types of ads
never will be influential. Interest groups which fW1 ads have clear partisan objectives and therefore are not
seen as credible by reporters, legislators, or the public. Furthermore, policy advertising is tricky because of
its multiple audiences - opinion leaders, elected officials, grassroots activists, and the general public, each
of whom may be affected differently by the same ad.
Finally, advocacy advertising is limited because few
interest groups have sufficient financial resources to be taken seriously. In general, the amount of money
spent on most policy advertising pales in comparison to the $30 million per candidate spent on ads in recent
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presidential general elections (Sexton and Loomis, 1994; Kurtz, 1994a).
!
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The health care area, though, differed in two key respects from other policy arenas.
.,---..
The financial stakes of the Clinton reform package were so enormous that major interest groups felt
compelled to spend unprecedented amoWlts of money for advertising.
Former HEW Secretary Joseph
Califano characterized health care reform as a "trillion-dollar pot of gold• with enormous stakes for
hospitals ($409 billion}, doctors ($195 billion), nursing homes and home health care ($108 billion},
pharmaceutical companies ($100 billion), insurers ($62 billion), and others such as dentists, podiatrists,
optometrists, physical therapists, and pharmacists (more than $100 billion) (quoted in Broder, 1994b).
Groups representing the drug and insurance companies, for example, felt that the very survival of their
industries was at stake. Drug companies feared the Clinton cost controls would erode profits and eliminate
their ability to bring new medical treatments to the marketplace, while insurers worried that mandatory
purchasing alliances would put them out of business.
The other major feature in the health care debate was the extraordinary amoWlt of news coverage,
a factor which also raised the public salience of the reform issue. Few policy debates have generated such
a massive amoWlt of coverage. The large scale nature of the changes, the fact that a president made the
issue the centerpiece of his domestic agenda, and the enormous nwnber of lobbying dollars pushed health
care, normally a peripheral public concern, to the center of the national political debate. Ironically, the
very visibility of this debate should have reduced group influence. According to Lowi (1969) and Hayes
(1981), the more visible the policy arena, the less able groups are to exercise influence over the general
public. Yet in the case of health care, the media coverage amplified the messages of certain groups, giving
them a large amoWlt of influence in shaping the ensuing debate.
The Political Environment
President Clinton began his term promising to bring health care before Congress during the first
100 days of his administration. His timetable soon slipped to May, JW1e, and then the Fall as other issues,
such as deficit reduction, NAFTA, and defending the president against character charges, took priority.
The delay in the initial timetable and the sequence of ensuing events had enormous consequences for the
health care reform effort.
Initially in 1993, important interest groups annoWlced support for parts of what became the
Clinton program. For example, the Health Insurance Association of America (HIAA), which represented
�7
small to medium-sized insurance companies and eventually became a sta\Ulch critic of the
·-
president, testified in March, 1993 before the only public hearing of the President's Taskforce on Health
Care that it supported Wliversal
coverage~
an employer mandate to pay for it, and a federally defined
benefit package. Their main concerns centered on federally-defined premium limits and federally defined
spending limits (interview, William Gradison, President of mAA, March 13, 1995). According to
·-
Gradison, "our initial hope was to sit down and try and work something out with the administration but
they wouldn't do it. I never did get a chance to meet with the first lady" (although he did meet with other·
top administration officials a number of times, who conveyed his concerns to the First Lady).
Other
groups, such as the National Federation of Independent Businessmen (NFIB), annoWlced their opposition
as soon as it became clear the ret"orm was going to have a mandate. which would require employers to pay
80 percent of employee health premiums.
The inaction throughout the Spring and Summer of 1993 turned out to be a blessing for HIAA.
•we had lots of time to get geared up. It gave us a lot more time to refine our message, raise our money,
do internal staffing changes, and have training sessions with members of our association as to what they
could do with their hometowns and their editorial boards," said Gradison. EventuaUy, the group put
together a sophisticated campaign based on paid ads, phone banks, direct mail, and letters and calls to
members ofCongress.
The delay \.Ultil the Fall further complicated health care reform by pushing the issue directly into
the middle of the contentious national debate over NAFT A. Since NAFTA was opposed by many labor
Wlions and liberal organizations, Clinton's support for the treaty strained relations with the very constituent
groups who should have been the bedrock of support for health reform. According to an administration
official, •Lane Kirkland [of the AFL-CIO] came to see us in August, 1993 and basically said, 'we have $5
million to spend. We can either spend it supporting health care or fighting NAFTA.' The president wanted
to support NAFTA. As a result the AFL-CIO spent their time and money that fall fighting NAFTA. Some
of the consumer groups that were going to support us on health care did the same thing" (interview). As
shown below, these decisions had devastating consequences for the president's ability to sell his proSram to
Congress and the American public.
�8
ne Media Environment
Against this contentious political backdrop, the president Wlveiled his program for health care
refonn to Congress and a national television audience on September 22, 1993. His elaborate 1,364 page
plan, called the American Health Security Ad., was one of the most comprehensive domestic policy
proposals put forth by an American president. Among the key features of his program were a guarantee of
mtiversal health care coverage by 1998 for all Americans, the establishment of regional insurance
purchasing alliances from which people would be required to obtain coverage, an employer mandate
requiring employers to pay about 80 percent of the costs of the average health insurance plan for a single
person, subsidies for companies with 75 or fewer employees or individuals with average annual wages of
less than. $24,000, the creation of a national health board which would establish national and regional
spending limits and would limit increases in insurance premiums, and health insurance reforms which
would prohibit benefit terminations, including people with pre-existing conditions (Borkowski, 1994).
/
The scale of the proposal was stunning. It included a basic benefits package covering prescription
d~,
rehabilitation services, mental health and drug/alcohol abuse treatment, hospice, home health and
extended nursing care services, and abortion services. Under the plan, almost every aspect of the health
care system would change. For a president charged with ending gridlock in Washington, it was a bold
move (Woodward, 1994). The program was so dramatic that it unleashed tmprecedented coverage by the
news media and extensive spending by concerned interest groups .
. The sheer volume ofhealth care news coverage was extraordinary. Between September 1 and
November 30, 1993 alone, 2,000 newspaper, magazine, and television stories about health care were
I
published or broadcast (Rosenstiel, 1994). Part of this Wlusual media interest came from the massive stakes
of the refonn. But monetary grants from leading foWtdations for news coverage, focuS groups, public
opinion polls, and academic studies also guaranteed a nmning story on health care. For example, the Kaiser
Family FoWldation gave millions of dollars to news organizations for health care coverage as well as to
academics for studies of this coverage. The Robert Wood Johnson FoWldation devoted several million
dollars for research on health care as well as an NBC prime-time special on the issue.
/
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10
But the biggest single share of total lobbying expenditures came in the area of
,.
political advertising. An estimated $60 million, or more than half of the overall spending, was devoted to
I
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advertising (1). Through a combination of news reports and personal interviews with officials in relevant
groups, we developed estimates of the spending by top organizations on health care ads. Table 1 lists the
figures for the largest spenders. By far the biggest advertisers on health care were the Phannaceutical
-
~-
.
Research and Manufacturers of America (PRMA), which represented leading drug companies,
~d
the
Health Insurance Association of America (HIAA), which represented sinall and medium-sized insurance
companies.
The PRMA spent approximately $20 million, while the HIAA spent roughly $14 million,
much of it on the famous "Harry and Louise" series of ads.
Most of this spending by these groups was devoted to targeted ad buys in Washington or New
York, although some of it was spent for ads aired either on the Cable News Network (CNN) or the home
states of crucial members of Congress. Ben Goddard, president of Goddard*Claussen/First Tuesday and
developer of the Harry and Louise ads for HI.AA, said "Our media buys were targeted on involved
Americans, people who were registered to vote, wrote letters to editors or public officials, attended
meetings, and made political contributions. We bought time on CNN and Headline News, CNBC, Rush
Limbaugh, and in New York, Washington, and Los Angeles. We wanted to get on the agenda of the
national media. Those areas are where editors and reporters who decide the news li.ve" (interview, March
20, 1995). In advertising, groups opposed to the Clinton program outspent supporters by a 2.2-to-1 ratio,
although the president did have the advantage of being able to generate free publicity through his and the
First Lady's statements and trips (2).
Initially, the White House did not anticipate the scale of the paid advertising campaign. Clinton
Domestic Policy ColDlcil analyst Christine Heenan claims that, "In the Fall of 1993, it was not clear this
was going to be a paid ad battle as opposed to one based on field organization. Our initial plan was to
create teams of validators in local comm\Dlities, such as doctors, pediatricians, and small business leaders.
They would disseminate infonnation at the local level .... The outside campaign would be in specific
districts ofneeded members" (interview, February 9, 1995).
A month passed before the scope of the HIAA campaign hit home at the White House. HIAA
President William Gradison described the highly targeted nature of his group's ad campaign. and its
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Ironically, the close media attention to health care was not positively evaluated by
citizens. An October, 1993 national public opinion survey at Brown University {West, 1993b) fom1d that
.;-.
while 57 perCent of citizens gave the news media excellent or good ratings on coverage of foreign affairs
and 55 percent gave them excellent or good ratings on general government and public affairs, only 42
percent gave the media excellent or good ratings for coverage of health care reform. Forty-eight percent
said news coverage of health care was only fair or poor. An August, 1994 national poll m1dertaken for the
· Robert Wood JohnSon Fom1dation revealed even worse numbers: 32 percent said the media had done an
excellent or good job and 64 percent felt the coverage had been only fair or poor (Kagay, 1994).
Part of the problem was the complex nature of. health care. Wrth press emphasis on personalities
and the political game, many readers and viewers felt reporters had not told them how health care reform
would affect their personal lives. A news monitoring project by the Kaiser Family Fom1dation, the Times
Mirror Center for the People and the Press, and the Columbia Journalism Review revealed that citizens
believed 31 percent of the stories focused on the political impact of health care, 21 percent dealt with the
/
!
impact of reform on the health care system, and only 17 percent concerned the effect of reform on
individuals and families (Rosenstiel, 1994). The latter, of course, was the topic of prime interest to
ordinary Americans.
The health care debate also unleashed a tidal wave of interest group spending.
A nonprofit
Washington researdt organization called the Center for Public Integrity (1994, p. 83) estimated that at
least $100 million was spent overall in 1993 and 1994 by 650 organizations to influence the health policy
debate. Some of the money was devoted to traditional lobbying tactics, such as hiring a law firm or public
relations agency. For example, it was estimated that at least 97 such firms were hired for lobbying
purposes by interested parties. A second common tactic was campaign contributions. From 1993 to early
1994, over $25 million was given to members of Congress by health-care interests, with top contributors
including Wlions, trial lawyers, life m1derwriters, and health-related concerns. A third tactic was free trips
for members of Congress. These trips totaled over 355 from organizations with health care interests, many
from the American Medical Association, the .American Cyanamid Company, and the Pharmaceutical
-...
__
Research and Manufacturers of America, among others. Some groups, sudt as the NFIB, put their
resources into grassroots mobilization via direct mail and phone banks.
�~·
12
our plan and polling its members ~d of being out there with its $5 million. They didn't
spend their money until March or April which was too late. •
The net result of all this was that in the crucial period October to December, 1993, opposition
groups had the advertising field virtually to themselves. In Fall, 1993, IDAA and PRMA spent a total of
_ ~pproximately $17.5 million ($10.5 million by HIAA for television spots and $7 million by PRMA on print.
ads). During this same period, the DNC devoted about $150,000 to ads. According to an administration
official, this imbalance "was true not jusf in the airwaves but in the newspapers too. Two-thirds of the
~eadlines
were negative towards us and Robert Pear [of the New York Times] was writing stories with
virtually every headline being negative." Continuing, the official said "From October 1 to mid-December,
instead of having four weeks to define our message, we had one presidential day. We didn't have the
president out there the way we expected defining what we were trying to do. International events like
Somalia and Haiti occurred. We had the opposition spending a ton of money."
When questioned about these expenditures, HIAA officials cited fear about the long-term survival
of their industry as the primary reason for their spending (see Hilts, 1993 and Weisskopf, 1993b for
discussion ofHIAA). Bill Gradison, the president of the HIAA, felt that th~ Clinton Administration singled
out a few groups for political demonization: "In the first meeting [with White House health care advisor Ira
Magaziner] he said to me, 'Bill, rm not a politician but our pollsters at the White House tell us that it will
help us sell our plan if we identify as enemies the pharmaceuti_cal industry, the physicians, and the health
insurers' .... It became clear that this was part of a plan on their part to demonize the industry'' (quoted in
Center for Public Integrity, 1994, p. 49; also see Woodward, 1994, p. 147). Ira Magaziner, Special
Advisor .to the president for policy and one of the leading architects of health care reform, disputes this
accolDlt of the meeting, saying that White House polls were indicating that attacking the insurance
companies would be very popular with the public, but that he also made clear to Gradison that "this is not
what we want nor intend to do."
To counteract the message coming from the White House, one group of ads sponsored by the
PRMA emphasized the positive contributions of pharmaceutical research to health care (Kurtz, 1994b). In
some of these ads, the PRMA utilized· a female announcer, which is atypical for political advertisements ..
'-..... ..
�11
integration into a sophisticated phone bank and direct mail operation: "We moved our ads
arowtd focused on the districts where key committee members were and also on key geographical areas.
We felt the battlegrowtd would be the border states and Southern ones.
lbat's where there were
conservative Democratic members of Congress who we thought would be sympathetic to our message. We
didn't focus on Republicans because there weren't enough of them to do anything with."
Each ad included a toll-free 800 number where people could call for more information or to
register comments. According to Gradison, almost half a million people called the 800 number with
comments and personal stories about health care. This information became a vital resource in dealing with
members of Congress and the media. Gradison said, "They all were filed by zip code and activated. We
tried to get them to write letters or patch through phone calls to congressional offices. It was a highly
integrated program," Gradison said. Out of the people who called the 800 number, Goddard said HIAA got
"45,000 performing members of the coalition, people who wrote letters or made calls on this issue.
According to our rf;'Search, those 45,000 people made over a quarter of a million contacts with the media
and members of Congress.
They were interested in public policy and wtderstood the value of
communicating with Congress."
At the same time, groups such as the NFIB were devoting several million dollars mobilizing their
members to contact elected officials. According to NFIB health lobbyist Mark Isakowitz, his group used
direct mail and phone banks "to create a dynamic where when key decision-makers on this issue went
home, someone always would be coming up to them saying the employer mandate would be bad for their
business and when they came back to Washington, their staff would tell them 'we're getting hundreds of
phone calls and letters against the employer mandate' .... We tried to create a blanket effect .... If you get
200 or 300 members to call representatives, that creates a remarkable shock wave in congressional offices.
That can tie up the phones for a couple of days" (interview, March 24, 1995).
Other organizations, such as the Democratic National Committee (DNC) and Republican National
Committee (RNC), lagged far behind in their expenditures. Interest groups supportive of the president's
position on health care also were far outspent. An administration official attributed this to the NAFT A
.. ·
debate: "We were hoping some sympathetic groups would have a counter-media campaign, but it didn't
happen because ofNAFTA. ... We had senior citizen groups like the AARP focusing on the final details of
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13
But as Heenan pointed out, this made sense since polls were showing that •it was female
I ··
decision-makers who had to be targeted. Females make two-thirds of the health care decisions. •
One PRMA ad typified the positive approach by having a person named Mike Quinlan saying,
•My dad has Alzheimer's. They have to continue the research they're doing.• The ad went on to note: "To
Mike Quinlan, and to all of America, we hear you.
And we share your urgency.
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Right now,
.
pharmaceutical companies have 19 medicines in development to fight Alzheimer's. The fact is, more than
90% of all drug discoveries come from our research. So for the millions who are waiting, keep the hope."
Similar ads were run on AIDS (featuring IDV-positive patient Dan Gtmnells), breast cancer (citing
Claudia), cystic fibrosis (with Ashley), ulcers (using Mike), asthma (citing Katie), and ~okes (with quotes
from Phyllis).
Unlike the PRMA ads, the HIAA spots direc:tly challenged specific elements of the Clinton
proposal.
The "Harry and Louise"
commercials developed by the advertising firm
of
Goddard*Claussen!First Tuesday started running in September, 1993. These ads were modeled on a very
effective campaign HIAA had run against a 1992 California health reform initiative called Proposition 166.
According to Gradison: •when this [opposition] effort began it looked like- based on polling data- that
the initiative would prevail by a vote of about 2-1. It was defeated by 2-1 and the [Goddard*Claussen] ads
were really important" (quoted in Center for Public Integrity, 1994, p. 48). In an interview, Gradison
recalled that during the Proposition 166 campaign, "Goddard*Claussen had a gangbusters television
commercial which showed a black female entrepreneur talking about how [health care reform] would
damage if not destroy her small business. h was a powerful piece."
Goddard described the Proposition 166 campaign as "a real-live laboratory test of how you
communicate. It taught us how to talk with people .... What HIAA learned is that you could win these
issues in a public debate. Wmning a state campaign gave the health lobby confidence to fight on a broader
scale." The California initiative battle also taught HIAA how to present their position:
"The two
significant things we learned were that you can't be against reform and the need to personalize issues so
· that people understood their personal stakes. Scare tactics with big global messages don't work. You need
to bring it down to a level people understand and can relate to." This proposition campaign thereby
became the off-Broadway test for the subsequent Harry and Louise campaign.
�..
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In one early HIAA health care ad, a yuppie couple named Harry and Louise (played
,...--...,
I
by Los Angeles actors Harry Johnson and Louise Clark) are sitting over breakfast (see description by
Kolbert, 1993). He is scanning a newspaper, while she is reading a printed version of the president's health
care plan. Harry says, "rm glad the President's doing something about health care refonn. 11 Louise: "He's
right. We need it." Harry: •some of these details. 11 Louise: "Like a national limit on health care?"
Harry: •Really." Louise: The Government caps how much the country c:an spend on aU health care and
says, 'That's it!'" Harry: "So, what if our health plan nms out of money?" Louise: •There's got to be a
better way. • Later ads by HIAA emphasized problems related to government bureaucracy, medical costs,
and choice of doctors in the Clinton program.
Goddard described how these and other Harry and Louise ads were developed through 26 focus
groups and two public opinion surveys: . "The key thing in advertising is finding the right message and
messenger. In putting together the materials, we tested as spokespersons high profile celebrities, doctors,
and academic experts. Bill Gradison then gave a speech and said, 'this issue is going to be decided around
people's kitchen tables.' My first reaction was skepticism, but we tried it with a couple around a kitchen
table and it was a huge success over other formats. People respond to a familiar environment. The kitchen
is a symbol for family decisions. Our research told us that people would respond to the message and that
they would like the messenger."
The "Harry and Louise" spots generated extensive coverage from the news media (Benet and
Stambler, 1994; Carlson, 1994). Between January 15 and July 12, 324 seconds of network evening news
time was devoted to HIAA ads, compared to 122 seconds for those of the DNC (Jamieson, 1994a, p. 18).
Almost every leading newspaper and television network in the country ran stories about the ads, including a .
front page story in the New York Times on October 21, 1993 (Kolbert, 1993). According to Goddard, the
environment was ripe for news coverage of Harry and Louise: "Health care was the definitive program of
the Clinton administration. The delay in introducing the bill heightened press interest in the issue. We
worked the press corps very hard. We had a press conference every time a new ad was released. We had
an editorial board program, we wrote op-ed pieces, we hit the talk shows all across the country. It was a
combination which built press interest."
�15
This set of ads became so prominent that on November 1, First Lady Hillary Rodharn
Clinton lashed out at the health insurance industry, saying: "They have the gall to run TV ads that there is
a better way, the very industry that has brought us to the brink of bankruptcy because of the way that they
have financed health care" (quoted in Clymer, 1993). This brought front-page headlines in the New York
Tunes ("Hillary Clinton Accuses Insurer~ of Lying About Health Proposal: Says Industry Ads Mislead
Public to Guard Profits 0 ) (Clymer, 1993) and Washington Post ("First Lady Lambastes Health Insurers:
Methods Have 'Brought Us to the Brink of Bankruptcy,' Clinton Says") (Priest, 1993). President Clinton
joined his wife in these
~ticisms
on November 3, blaming health insurers for 0 0ver-complicated,
bureaucratic, burdensome, bureaucratic" requirements (quoted in Jehl, 1993). That same day, Richard
Celeste, chairman of the DNC's National Health Care Campaign, crashed a IDAA news conference in
Washington. According to a Washington Post account, this had the effect of "turning a dry, technical
session into a newsworthy event11 (Weisskopf, 1993a). According to Goddard, these attacks backfired:
"when the White House attacked us, it helped us because the press loves a dogfight. That's what they like
/
to cover."
In spite of media attentiveness to the accuracy of ads in the 1992 presidential campaign, there were
almost no Ad Watches assessing the accuracy of health care spots. In the period from Fall, 1993 to
Summer, 1994, only four Ad Watches on health care appeared in the New York Times (on October 21,
1993, February 1, 1994, and two on July 17, 1994). This was well below the 44 Ad Watches run by the
New York Times during the 1992 presidential campaign (West, 1993a, p. 69). Few formal Ad Watches
appeared in the Washington Post, Los Angeles Times, or Wall Street Journal during this time period.
There were just two Ad Watches or Reality Checks on the ABC, NBC, and CBS evening news. Aside
from Ad Watches, there were a number of general news stories about health care ads. Figure 1 reports the
number of national newspaper and network television stories about health care ads. It shows that peak
coverage of health care commercials occurred in October/November, 1993, February, 1994, and
July/August, 1994 (3).
The weakness of media ad oversight led University of Pennsylvania communications scholar
Kathleen Hall Jamieson to complain to Washington Post columnist David Broder.
He thm wrote a
February 23, 1994 column (Broder, 1994a) conceding that the news media had failed seriously to challenge
�16
the accuracy of health care advertisements. But despite the public admonition, little changed
after his colunm. By the end of July, 1994, a University of Permsylvania study reported that 28 percent of
the print ads and 59 percent of the broadcast ads were "unfair, misleading, or false" (Jamieson, 1994b, p.
2).
The Public Response
Early polls showed strong support for the Clinton health care initiative.
For example, a
Washington Post-ABC News poll of adults nationwide conducted shortly after the Clinton program was
anno\Dlced in September, 1993 revealed that 67 percent approved of the president's program and only 20
percent disapproved. By late February, 1994, the same survey organization wing an identical question
found approval of Clinton's plan had declined 23 percentage points to 44 percent.
Similar results were
obtained in other national surveys. USA Today/CNN/Gallup national polls from September 26, 1993 to
April 18, 1994 fo\Dld·an 18 percentage point drop in public support for the Clinton health care program-from 57 to 39 percent (Center for Public Integrity, 1994, p. 28). Other polls showed the percentage of
people who believed they would be better off if the plan were enacted dropping sharply from 77 to 52
percent in the space of a few months (Priest, 1994; Broder and Morin, 1994).
According to an administration official, White House polls right after the president's speech
showed support of 58 to 23 percent in favor of the plan. By the end of December, though, this lead had
dropped to 17 percentage points. The HIAA conducted a nightly national tracking poll following the
president's speech on September 22. HIAA President Gradison said nsupport for the president's plan took
off with that outstanding speech, but it went down 10 days later. The tum occurred arom1d October 2 and
3. I can't explain why, but it was measurable. Public support consistently drifted down thereafter.•
These results were suggestive of the problems faced by the Clinton program. But given the range
of events taking place between the Fall and Spring, one must m1dertake a much more detailed analysis of
public opinion surveys to determine why public support dropped down. In reviewing publicly available
national polls, we fom1d three national surveys which included questions both about health care ads and
sentiments on health care reform (4). This included surveys conducted by the Harvard School of Public
Health/Kaiser Foundation from September 30 to October 5, 1993 with 1,200 adults; by the Washington
I
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Post/ABC News from February 24 to 27, 1994 with 1,531 adults; and with New York
Times/CBS News on March 8 to 11, 1994 with 1,107 adults (which asked specifically about the Harry and
Louise ads).
The surveys cover the crucial Fall, 1993 and Spring, 1994 time period when overall support for the
Clinton program deteriorated, and therefore can be used to examine attitudes on health care at different
·-
time points. They furthermore can determine whether people who said they saw health care ads had
different views from those who did not. One must be cautious in comparing the surveys because while
some of the items were similar across polls, each survey asked a different range of questions. However,
even when particular questions were not identical, each survey did ask items concerning prominent aspects
of the policy controversy (5).
The Harvard poll is useful to examine early thinking on the Clinton program because the survey
started a week after Clinton anno\Ulced his plan to a joint session of Congress and after the IDAA and
PRMA started running some of their Fall ads. In looking at the results of this survey, the most notable
/
point which come through is that few people felt they knew much about health care reform. Forty-two
percent said they knew nothing or only a little, 49 percent felt they knew a fair amount, and only 9 percent
indicated they knew a great deal about the subject. In regard to the Clinton proposal in particular, 44
percent indicated that they did not \Ulderstand the Clinton plan either very well or at all.
There was widespread ignorance about crucial features of the debate. For example, only 22
percent said they knew the meaning of consumer purchasing alliances, which was one of the cornerstones of
the Clinton program. Only 20 percent were familiar with the idea of managed competition. However, 79
percent were aware that Clinton's plan would require employers to contribute to the cost of health insurance
for their workers, 63 percent knew the Clinton plan guaranteed health coverage to all Americans, and 52
percent realized the president's program guaranteed that workers would not lose their benefits if they lost or
quit their jobs. When asked what they were most interested in learning about health care proposals, 79
percent indicated it was the amount they would have to pay out of their own pocket for a doctor or hospital
visit, 77 percent said it was the cost of their family's health insurance premiums, and 73 percent named the
amo\Ult of taxes they paid. Seventy-two percent said that Wlder the president's proposal, they would
I
'
i
I
l\
. personally pay either a great deal more or somewhat more in taxes. Forty-three percent worried that the
�18
Clinton plan would lead to rationing of health care. Thirty-nine percent believed that Wlder
the president's refonn, the health care system would be r\D1 mainly by the government.
The general absence of infonnation about the Clinton proposal and the substantial concern over the
cost of reform and the impression that government was taking over the health care system created a climate ·
~~reby opponents could attach potent negative syritbols to the president's program. This was ironic given
the fact that in 1991 Clinton had explicitly rejected a single-payer system advocated by Yale Professor Ted
Marmor because the "proposition of Big Government and increased taxes was simply W13cceptable"
(quoted in Center for Public Integrity, 1994, p. 18).
Yet within days of Clinton's proposal being
anno\Dlced, these very criticisms had already emerged in the public's mind.
The early stage of issue consideration is often when political communications are most influential.
People are still searching for information and generally have not made up their minds how they feel. It was
no accident that Bush's effective advertising campaign in 1988 came on the heels of the nomination of
Dukakis. The Massachusetts governor was the least well-known major party nominee in recent years, and
the absence of prior beliefs gave Bush the opportunity through the media to shape public opinion (West,
1993a, p. 86). According to the Harvard survey of the health care issue, 65 percent indicated that in the
past week they had seen a TV progi-am, heard a radio program, or read a newspaper or magazine article
having to do with health care reform.
Forty percent said they had watched, heard, or read about
advertisements having to do with proposed changes in the health care system.
Table 2 presents the results of a series of regression analyses of seeing ads or the news and beliefs
on health care reform (6). The results show several interesting relationships. The strongest impact of ads
and news came in regard to knowledge about health care. People who said they had seen ads or heard the
news also reported feeling more knowledgeable about health care. They were more likely to Wlderstand
the meaning of managed competition and health purchasing alliances and to say they were familiar with the
Clinton reform plan. There were weaker ties in terms of knowing the Clinton plan guaranteed coverage and
had an employer mandate .
.Jn
addition, there was a differential impact between ads and the news in views about the tax
consequences of Clinton's plan. There·was no association between seeing ads and feeling there would be a
big tax increase Wlder the Clinton program, but a significant relationship between that impression and
�19
seeing the news. Those who relied on the news for information about health care reform also
were likely to think there would be a tax increase and to report they were interested in the tax and cost
dimensions of reform. This shows that the tie between tax increases and the president's plan came more
from news than ads.
As the debate moved from the Fall to the Spring, important changes started to take place in public
opinion. The February, 1994 Washington Post/ABC News poll showed that 58 percent of Americans said
they had seen or heard advertisements either for or against the Clinton health care plan, up from 40 percent
reported in the Harvard October, 1993 survey. This is comparable to the 58 percent of Americans who say
they saw Clinton ads during the 1992 presidential nominating process, but far lower than the 82 percent of
Americans who reported seeing Clinton ads in the presidential general election (West, 1993a, p. 26). By 39
to 32 percent, people seeing the ads claimed the spots made them less likely to support health care reform
(Broder and Morin, 1994).
Many individuals still felt they knew almost nothing (14 percent) or a little (62 percent) about
(
Clinton's health care program. Twenty-four percent felt they knew a lot about it, up from 9 percent in
October. Seventy-three percent said they supported a federal law requiring all employers to provide health
insurance for their full-time employees. Forty-seven percent worried than the Clinton plan created too
much government involvement in the nation's health care system.
Table 3 reports regression results between seeing health care ads and various opinions about health
care reform in February (7). Seeing ads still had a strong relationship with feeling more knowledgeable
about Clinton's program. Ad exposure was linked to questions gauging beliefs that Clinton's reform
created too much government and fear that employers would eliminate existing jobs as a result of the plan,
but there was no relationship between seeing ads and support for an employer mandate. There also was no
significant relationship between seeing ads and feeling the Clinton program would increase taxes, create
another large and inefficient government bureaucracy, cost too much, limit choice of doctors or_ hospitals,
or pay for legal abortions. These nil relations are noteworthy in light of the fact that many of the antiClinton advertisements emphasized these very themes.
L __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
�20
The Case of Barry and Louise
,.,...--,
Both the Harvard and Washington Post/ABC News surveys are limited by the fact that they
{ .
inquired about exposure to ads in general. The March, 1994 New York Times/CBS News survey asked
specifically whether people had seen television ads showing a couple called Harry and Louise sitting in
their living room criticizing the Clinton health care plan. In this close-ended question, 19 percent reported
that they had seen the "Harry and Louise" ads. This compares to the 6 percent in late October, 1988 who
named Bush's "Revolving Door'' spot in an open-ended question asking them to say the ad which had the
greatest impact on them in the fall presidential campaign and the 10 percent in March, 1992 who cited Pat
Buchanan's "Read My Lips" ad as the spot having the greatest impact on them during the nominating
process (West, 1993a, pp. 98, 111) (8).
Yet a majority of viewers did not find these commercials very accurate. Of those seeing the "Harry
and Louise" spots, 32 percent believed the ad criticisms were completely accurate or more right than wrong
and 52 percent felt their criticisms were either completely Wltrue or more wrong than right. This lack of
~-
credibility was significant given the general importance of source credibility in models of political
persuasion. Information sources which are not viewed as credible are much less likely to be persuasive
with the general public.
h also is important to point out that few people ·were able correctly to identify the source of the
Harry and Louise ads. Of those seeing the ad, 38 percent correctly identified the source of the ads as the
insurance industry, 50 percent had no idea who sponsored the spots, and 12 percent incorrectly attributed
sponsorship to some other organization. Nearly two-thirds of respondents were WlSure who was criticizing
the Clinton program.
Taken together, these findings help to explain the weak results between seeing the "Harry and
Louise" ads and views about the Clinton plan. For example, at the bivariate level with no controls,
exposure t~ "Harry and Louise" ads was associated with reporting a good Wlderstanding of the Clinton
program, but was not related to other impressions about the plan. For example, 64 percent of those seeing
the ads believed the Clinton proposal would increase their health costs, while 60 percent of those not seeing
the spots felt costs would increase, a difference that was not statistically significant. There were equally
small differences in regard to beliefs about the importance of universal coverage (a difference of only 1
(
�21
percentage point), worry about the adequacy of medical care (a difference of 2 percentage
points), and evaluations ofthe employer mandate (a difference of just 3 percentage points).
Table 4 reports the multivariate regression results for these items with controls for political and
background characteristics.
Seeing "Harry and Louise" ads were associated with reports of a good
understanding of Clinton's plan. Ad viewers furthermore were likely to believe the president's program
would increase the costs of their health coverage. But there were no links between ad exposure and
impressions of an employer mandate or the plan increasing paperwork, lowering the quality of care, or
guaranteeing universal coverage.
The absence of strong relationships between seeing "Harry and Louise" ads and views about health
care reform is noteworthy in light of the fact that these items were central to the advertising campaign
against Clinton. Many of the HIAA spots specifically criticized Clinton's program for being costly, overly
bureaucratic, and limiting patient choice. Contrary to the conventional wisdom, exposure to the "Harry and
Louise" ads in the public's mind was not associated with negative impressions of the Clinton program.
Elite views could have been altered by a public relations campaign, but there is little evidence docwnenting
a significant impact on the public at large beyond increased knowledge about the president's program, at
least among a national sample.
Our survey evidence on the weak impact of Harry and Louise is consistent with focus group
research reported by Jamieson (1994c, p. 2). In her research, Jamieson found that the "Harry and Louise"
ads "had a negligible impact on the public. • The problem, according to her analysis, was that the ads
evoked little short-term recall of central themes and were considerably less memorable than other health
care reform ads. Despite the large amount of money spent by HIAA, most of the ads aired in Washington
and New Yorlc or on CNN, where legislators would be sure to see them (9). There simply weren't enough
broadcast repetitions over the 12 month campaign to be persuasive with the American public.
In addition, the Jamieson research demonstrates that most focus group viewers had no idea who
Harry and Louise were because the actors rarely were identified as such in HIAA ads.
Journalists
identified the ads as Harry and Louise because scripts which were delivered to reporters identified the
actors by their real names. Therefore, all the White House criticisms about Harry and Louise (or Thelma
and Louise as President Clinton once called them) did not resonate with the American public.
--------------------
---------------~
�22
Elite Responses
The analyses to this point suggest that the "Harry and Louise" ads did not have a decisive impact
on citizen conceptions of health care refonn (10). Contrary to conventional interpretations alleging a major
link, this research shows that the public impact was in regard to knowledge about the plan. not evaluation
of its merits. But this does not mean the anti-Clinton public relations campaign failed:-c-As suggested at the ·
begjnning of this paper, public relations
camp~gns
can target audiences other than the general public,
namely news reporters and Washington elites. Effective grassroots campaigns can influence citizens
directly or lead elites to conclude that a gro\Uldswell of support or opposition to specific policy proposals
exists, even if that conclusion is based on misperception,
The misperception is created by targeting key decision-makers and by having highly visible events.
The impression of a nationwide movement can be projected by tightly focusing the public policy campaign.
As described by Goddard, his group's theory was "you go to the people and they go to Congress. Everett
Dirksen said when they feel the heat, they see the light." In this campaign, the heat was very selectively
applied. Isakowitz put it quite bluntly, "You don't have to tum aroWld public opinion as long as
congressional offices are getting flooded with hWldreds of calls."
We have no survey evidence on the attitudes ofjoumalists, legislators, or White House officials at
various points during the health care debate. But a search of the public record as well as interviews with
leading figures reveals evidence that reporters, key members of Congress, and White House officials took
the "Harry and Louise• commercials seriously and believed these.ads were decisive in altering the national
political debate on health care. In fact, the yuppie couple achieved enough prominence in Washington to
. reach the status of inside-the-Beltway cultural icons, a notable achievement in and of itself.
IDAA
President Gradison described his group's ads as "like a soap opera. We started getting questions like what
are their names, where do they work, do they have any children. [and] what kind of car do they drive?"
The Harry and Louise ads became a virtual mini-series that spawned numerous headlines, cowtterresponses, spoofs, and cartoons. One national news organization (the New York Times/CBS News) even
conducted a survey specifically to gauge the impact of Harry and Louise. Clinton friend Harry Thomason
produced a spoof ad which began in a graveyard with church bells ringing in the backgro\Uld. The actor in
the ad says: •You've probably seen a young yuppie couple named Harry and Louise on television recently,
�23
questioning the President's health care plan. I thought fd bring you up to date. Harry lost his
~·
·
job and also his insurance. Louise owned a small and struggling company that could not afford group
insurance, so she had always depended upon Harry's policy.
Unfortunately; she had a pre-existing
condition that prevented her from obtaining new coverage." Eventually, according to the ad, Louise died,
Harry moved to another state where !t~ g~ a job making coffee commercials, and his new company did not
have an insurance plan. The ad closed with the actor saying, "Oh, by the way, if you see Harry, tell him to
hang in there. The President's plan is just arolDld the comer" (cited in Kolbert, 1994).
This was followed by a spoof ad at the Gridirons Club in March featuring Bill and Hillary Clinton
as Harry and Louise, sponsored by the "Coalition to Scare Your Pants Off''.
The befuddled first couple
sat on a couch in their living room expressing bewilderment at their own health care plan, all designed to
poke fun at their critics. [Hillary] "Some of these details sure scare the heck out of me." [Bill] "Like
what?" [Hillary] "Like for example, it says here on page 3,764 that lDlder the Clinton Health Security plan,
we could get sick." [Bill) "That's terrible." ... [Hillary] "h gets worse ... Eventually, we all are going to die."
I
I
[Bill] "Under the Clinton health plan?
Yo~
mean after Bill and Hillary put all those new bureaucrats and
taxes on us, we're still all going to die?" ... "fve never been so frightened in all my life." [Bill and Hillary in
lDlison at end) "There's got to be a better way." News reports indicated the Clintons got a standing ovation
from the crowd of journalists after the showing of this ad.
Even cartoonists and other groups joined in the Harry and Louise spin-off's. A Don Wright ( 1994)
cartoon showed a couple watching television while the wife said to her husband, "All we know is that Harry
and Louise, the insurance couple, have been shot and the cops are chasing Clinton rolDld and rolDld the
beltway!". Supporters of a Canadian style, single-payer system ran an ad in May featuring the comedy
team
of Jerry Stiller and Anne Meara declaring: "Harry and Louise, there is a better way" (Toner, 1994a).
The ads achieved an lDlusually high degree of visibility. Numerous officials connected with health
care reform blamed the HIAA spots for turning public opinion against the Clinton proposal, and bemoaned
their inability to counter the opposition message. White House health care advisor Magaziner said the
HIAA ads "scared a lot of people by putting out misinformation. It was akin to a presidential campaign
where one candidate has tens of million to spend on ads and the other candidate can't spend any money on
advertising" (Magaziner, 1994).
�24
The fact thatmAA ads, phone banks, and direct mail were integrated gave the group
\Dlusual flexibility in targeting members of Congress.
. l
Gradison said "we moved aro\Dld our focus
depending on what conunittee or subcommittee was considering a bill at a particular time. In that sense, it
was highly focused. We tried to reach the swing members of those committees on a serial basis depending
on when they would be taking things up.~
.~
Magaziner pointed out that the combination of ads, phone banks, and direct mail "were effective at
creating the impression of a grassroots catnpmgn." Continuing, he said "Every place I would go to a town
hall meeting, a lot of people would have received letters or calls from these groups. They would ask
questions like why are you taking over all the hospitals, which was not true. The same thing would happen
on talk shows." He said the ads were particularly important in Washington. "They were all over the air
waves. I used to have a 20 minute drive to work and they were frequently on the radio."
Reporters were affected too, regularly crediting the Harry and Louise spots "with undermining
public confidence• in the Clinton plan and doing "more than any single lobbying tactic to hobble Clinton's
plan" (see Weisskopf, 1994a and 1994b, and Colford, 1994 for examples). A J\Dle 20, 1994 network story
by John Cochran of ABC News credited Harry and Louise with "creating real doubts" about the Clinton
program among the general public.
A study of national newspaper stories in the New York Times, Washington Post, Los Angeles
Times, and Wall Street Journal folDld 55 articles about health care ads. Ofthese, 51 percent had headlines
mentioning television ads, 9 percent had headlines specifically mentioning Harry and Louise, and 13
percent had pictures of Harry and Louise. In terms of the news content of these stories, 36 percent had
comments emphasizing the importance of ads to the health care debate and 22 percent had comments
emphasizing the importance of the Harry and Louise ads to the discussion of health care.
A parallel study
of the television network evening news revealed 11 broadcast stories. Of these, 8 mentioned the Harry and
Louise ads and most showed video fr()Jll the mAA spots. For a single set of advocacy ads, this was a large
degree of exposure.
As a sign of the potency of the advertisements, the summer featured the Wlprecedented spectacle of
House Ways and Means Committee chair Dan Rostenkowski reaching an agreement with mAA in which
Rostenkowski agreed to changes in health care legislation in exchange for an agreement that the mAA
.....--.
(
�25
would not nm ads in particular states (New York Times, 1994). HIAA President Gradison
recalled that "Rostenkowski referred to the [Harry and Louise] ads as the Wlllie Horton ads and said it was
time to stop shouting at each other.... We just agreed to stop the ads during the markup after Rostenkowski
agreed to a couple of substantive changes we had asked for." Later, Gradison said, "nothing came of it so
we went back on the air.• In regard to the agreement, an administration official said "the idea was you let
up on my committee members and we'll help you out on the legislation. • Gradison conceded that this
agreement was "an \Dlusual arrangement. • Never in recent memory had an interest group managed to cow a
leading congressional committee through a series of television ads. Within weeks, though, this pact came
\Dlglued when a felony indictment forced Rostenkowski to relinquish his committee leader~hip.
Gradison also indicated that the Rostenkowski negotiations were not the first time such a deal had
been offered by lllAA. The day of Clinton's national speech on September 22, 1993 Gradison indicated he
had "called [Dick] Celeste [who was managing the field operation on health care] and said 'We know you
guys are sore about the ads. I don't want them to stand in the way of our working together. We
Wlilaterally and with no preconditions stopped the ads. We are going to watch very carefully tonight to see
if you guys stop beating up on us.' I also told him we had a couple of new ads in the can which were being
tested in focus groups." But the offer bore no fruit. Gradison said," A couple weeks went by and they hit
Us again, and that was our signal to start our ads again. Once it became very clear that things had not
changed at their end, we went back on the air aro\Dld October 10."
By Summer, 1994, it had become clear that the anti-Clinton campaign was defining the policy
debate. The Democratic National Committee began airing a new spot on July 10 called "Harry Takes a
Fall." In the ad, "Harry and Louise are in bed. Harry is in a full body cast; his head is bandaged. Louise's
arm is in a sling.
She chides Harry for having been skeptical about proposals for Wliversal health
insurance coverage. Harry, it seems, has lost his job, his health insurance and most of his financial assets"
(quoted in Pear, 1994). This was a tacit admission that the HIAA ads were major players in the national
debate.
Rolling the Elites: A New Means of Group Inftuenc:e
The anti-Clinton health reform effort will go down in history as one of the most successful
advertising campaigns of all time (Scarlett, 1994). A newly-elected president who made health care reform
�26
the centerpiece of his domestic agenda was defeated without a definitive vote being taken on
the floor of the House or Senate. By attaching negative symbols of high cost and big government to the
president's proposal, opponents effectively derailed Clinton's initiative. This lobbying success was all the
more impressive in light of evidence that Washington elites were swayed by "Harry and Louise" ads while
-'-_jte general _public was not.
Our case study demonstrates the need to rethink key elements in interest group theory. There is
little doubt that big financial resources make a difference in lobbying. HIAA spent $20 million overall,
with $14 million devoted to producing and broadcasting ads. The heavenly chorus of interest group
influence is important. Unlike the arguments of Lowi (1969) and Hayes (1981), group influence is not
necessarily constrained by highly visible policy debates. By framing political disputes in favorable ways .
through the media, interest groups can persuade legislators to reject a president's proposal.
This research also suggests a new way for interest groups to be effective. Traditionally, group
campaigns have been successful either through direct lobbying (the inside strategy) or by mobilizing the
public, who then commtmicated group objections to Washington (the outside strategy). The health care
experience demonstrates that outside strategies can work not just by targeting the public, but by altering the
impressions of news reporters and Washington elites.
As an administration official explained, "the
lobbying effort scared the heck out of legislative members .... The effectiveness was all money-induced." If
elites can be persuaded that the public does not approve of a particular proposal, that campaign is
successful even if it turns out elite views are based on misperceptions.
Indeed, history is strewn with cases of elites who took actions based on erroneous views of public
opinion. The 1981 congressional adoption of Reagan's economic program is one recent example (West,
1988). Contrary to the conventional interpretation of the key role of elites in democratic representation, the
health care case suggests that elite evaluations can be manufactured and manipulated through sophisticated
public relations campaigns. The big early spending by a few prominent interests alerted reporters and
officials to a major new dynamic in the policy debate. The subsequent failure of the media critically to
evaluate group claims regarding ad effectiveness led to a widespread Washington view crediting a grassroots uprising against Clinton's program, as opposed to a savvy media campaign by a few interest groups.
----.
�27
What is less clear at this j\Ulcture is what this experience tells us about the future of
{
public policymaking. Some scholars have argued that America is at a turning point. and that high-profile
advocacy campaigns will become the new norm in policy disputes (Jamieson, 1994b). Based on her
experience in the health care debate, Heenan concluded that "interest groups are going to be using ads more
frequently and they are going to be using all the new and varied forms of comm\Ulications." If this is the
case, the danger to representative democracy will be serious. High-profile media campaigns a>st large
amounts of money, and groups with financial resources will be the clear beneficiaries of this system. In
addition, if public relations campaigns can be persuasive with elites but not the public, it suggests a
ftmdamental breakdown in democratic representation.
While there is no question other organizations will attempt to replicate the success of Harry and
Louise, there is reason to believe the success of the health care ads was exceptional. There were several
elements in this debate which made it possible for health care concerns to make a case via the media that
are not likely to repeat themselves in other policy arenas. What made the health ads against the Clinton
program effective was the large amount of money which was spent, the one-sided nature of the advertising
expenditures, and the relatively uncritical media coverage of group ads.
These elements may not be replicable in other policy areas.
Few groups have the financial
resources to run the type of campaign waged by the insurance and drug companies. Those that do, do not
necessarily have the incentive to spend their money on public lobbying. It was the large-scale nature of the
Clinton reform which mobilized major opponents. Presidents are not likely to \Uldertake this type of battle
on very many issues.
In addition, group advertising on health care was aided by the complex nature of health care reform
and its salience to the American public. Although surveys indicated more people felt knowledgeable as the
debate \Ulfolded, most Americans did not have a good sense of what the president was attempting. This
allowed opponents to fill the void through advertising that was deceptive or misleading. For example, one
group called the American Council for Health Care Reform sent direct mailings accusing the Clinton
administration of advocating prison time for people who bought "extra care", a charge that was blatantly
false (Wartzman, 1994). An administration official pointed out that the attacks on Clinton's personal
character in 1993 and 1994 hurt the health care effort: "The R Square on public health care attitudes
�...
28
tracks very closely with presidential popularity." Heenan added that •Greenberg's early polls
found that people's view of reform indicated a certain nervousness and lack of full understanding. It was
going to come down to people's trust in the reformers." As she pointed out, the combined emergence of
Whitewater and the Arkansas trooper situation hurt Clinton on this crucial trust dimension.· Quoting Russ
Limbaugh, she said "Whitewater [was] about health care."
Finally, the health care experiEnce was idiosyncratic because of the particular way advertisements
were reported. The lack of media oversight was glaring. Unlike the 1992 presidential campaign, where
reporters actively cllallenged the accuracy and fairness of political advertising, there was little effective
oversight in the health care debate. News accounts amplified the self-interested claims in group ads and
accorded them much greater legitimacy than was warranted. Over half of the television ads had claims that
were either outright false or clearly misleading. Assuming reporters learn from their past mistakes, the next
policy battle should feature more detailed oversight by the mass media. We can hope, too, that decisionmakers will not be as easily misled by interest groups using public relations tactics.
.
'
�.
29
Notes
l
1. It is difficult to get precise spending figures because of the \Dlwillingness of all groups to disclose their
exact spending and the fact that various organizations cowrt different types of production expenditures in
their ad totals.
Figures released to news reporters are not entirely reliable- beca'::JSe several groups
announced million dollar ad campaigns only to fail in their fundraising efforts. News reports also varied
substantially even for major groups (Times Mirror Center, 1994; Jamieson, 1994c).
2. This ratio was determined by adding the expenditures of groups opposed to the president's program
(approximately $41.5 million) versus those in favor ($18.8 million).
Opponents included the
Pharmaceutical Research and Manufacturers Association, the Health Insurance Association of America,
American Medical Association, American Dental Association, Christian Coalition, Republican National
Committee, and Single Payer Across the Nation, among others.
Proponents were the Kaiser
Foundation/League of Women Voters, Health Care Reform Project, AFL-CIO, American Conference for
Health Care Workers, AARP, Democratic National Committee, and Group Health Association, among
others. There were a number of other organizations who spent less than one million each on health care
advertisements. In addition, there was variation in how aggressively various groups opposed the Clinton
program. The Health Insurance Association, for example, ran ads criticizing specifics in the Clinton
program, while pharmaceutical interests used ads emphasizing their concern that support for basic research
to improve drug treatment and medical care be maintained in the Clinton reform.
3. This is the number of stories about health care ads, not health care in general.
4. One limitation of these surveys is that the health care ad exposure questions measured ad viewership as
yes or no, not the frequency of exposure such as the number of days in the last week health care ads were
seen. This makes it impossible to test hypotheses concerning the link between frequency of ad exposure
and views about health care reform.
S. After reviewing an earlier draft of this research, Health Insurance Association executive vice president
Charles N. Kahn ill wrote to us that these publicly available data "make it difficult, if not impossible, to
evaluate the Harry and Louise series• because the New York Times survey "attempted to captUre recall at a
time when the ads weren't even on the air." (personal commlDlication, September 13, 1994). He pointed out
�..
30
that ad "recall diminishes quickly after ads are taken down." The lllAA conducted over 25
..---,
focus groups and 11 national public opinion studies of health care reform (see Mcinturff personal
comnumication, 1994), but were lDlWilling to make their data available to us.
6. Since it is likely that other factors beyond media exposure influence views about health care, we included
controls for several other factors in each eq~tion. For example, partisanship and ideology are important to
how people respond to policy controversies, so they were included as control variables in the analysis of the
Washington Post/ABC News and New York Times/CBS News polls. Ideology was not asked in the
Harvard study. In addition, people have differential views about health care and different exposures to ads
and news based on their educational attainment, race, age, and sex (see West, 1993a). As an illustration,
well-educated people are more likely than others to recall seeing ads. Therefore, it is crucial to include
these items as control factors in the regression analyses.
7. Questions about news exposure was not asked in the Washington Post/ABC News or New York
Times/CBS News polls, so it is impossible to test whether news or the ads influenced citizen impressions.
8. One must be cautious in comparing these items, though, because an open-ended question obviously is
much tougher than a closEHnded item. With the former, you have to recall a specific ad from memory
without haVing a question to prompt your answer. That fact notwithstanding, there is little doubt that the
Hany and Louise ads achieved a high degree of visibility for a policy advocacy campaign.
9. In response to inquiries from the authors, lllAA released the geographic breakdowns for airing the
"Hany and Louise" ads (see Kahn, 1994). Their figures show that overall just 11.4 percent of the ad were
broadcast in Washington, D.C. and 88.6 percent were broadcast in other parts of the colDltry. But this
does not address Jamieson's aitique that the most of the ads were targeted on the major media markets of
Washington, New York, and Los Angeles and in the home states of crucial members of Congress.
10. Public opinion pollster Bill Mcinturff (1994) wrote to us on August 18, 1994 after seeing an earlier
draft of our research that his studies on behalf of the Health Insurance Association showed "the Harry and
Louise spots were effective" with the general public. The specific evidence he cited came from a February,
1994 survey in which 1) "People who had seen the Harry and Louise spots were 8% to 15% more likely to
be familiar with the mandatory alliances and other elements of the lllAA sponsored advertising", and 2)
that "People who recall seeing the Harry and Louise spots are consistently less supportive of specific
\ ...
_.
�,.•
31
elements of the Clinton plan (mandatory alliances for example) and overall provided the
Clinton health care plan with less favorable ratings." My:~t-tilts based on the New York Times/CBS News
!'':·.~:~~;:/ ,:
survey in March, 1994 support the first point of increased· familiarity based on ad exposure, but not the
change in evaluations of mandatory alliances. Mcinturff did not cite any other specific instances of ad
impact in his three page response to our paper, and HIAA would not release their survey or focus group
-
data.
.......
~-
.
�..,
32
References
Benet, Lorenzo and Lyndon Starnbler. 1994. •spin Doctors."~. April II. pp. 105-107.
Blendon, Bob. 1994. •The Gridlock Is Us.• New York Times. May 22. p. 15.
_ _Borkowski, Monica. 1994. "How the House and Senate Bills Stack Up Against the President's Original
Proposal.• New York Times. August 3. p. Al8.
Broder, David. 1994a. "Junk Jounl.alism." Washington Post. February 23. p. Al7 .
. Broder, David. 1994b. "As Predicted, This is OneHeckuva Battle." Providence Journal. July 26. p. A9.
Broder, David and Richard Morin. 1994. •clinton's Health Plan: A Tum for the Worse." Washington Post
National Weekly Edition. March 7-13. p. 15.
Carlson, Margaret. 1994. "Harry and Louise.• Time. March 7. p. 41.
Center for Public Integrity. 1994. "Well-Heeled: Inside Lobbying for Health Care Reform." Washington,
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Cigler, Allan and Burdett Loomis, editors. 1995. Interest Gro\m Politics. Fourth edition. Washington,
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Clymer, Adam. 1993. "Hillary Clinton Accuses Insurers of Lying About Health Proposal." New York
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University of Pennsylvania press release. July 18.
Jamieson, Kathleen Hall. 1994b. "The Role of Advertising in the Health Care Reform Debate: Part Two."
University of Pennsylvania press release. July 25.
"--------------------------
-
.---....
~-
�33
Jamieson, Kathleen Hall. 1994c. "The Role of Advertising in the Health Care Refonn Debate:
/
Part Three. • University of Pennsylvania press release. August 1.
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�34
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... ·.
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�..
35
West, Darrell M. 1993b. 11 Public Gives News Media Mixed Evaluations." Brown University
... J
press release. November.
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Wright, Don. 1994. "Cartoon." New York Times. July 3.
�.
'
Table 1 Organizations Spending Largest Amounts on Health Care Ads, 1993-1994
Organization
Pharmaceutical Research and Manufac:ters Association
Health Insurance Association of America
Kaiser Foundation/League of Women Voters
Health Care Refonn Project (consumer groups)
AFL-CIO
American Conference for Health Care Workers (unions)
AARP
American Medical Association
American Dental Association
Christian Coalition
Democratic National Committee
Republican National Committee
Group Health Association
Single Payer Across the Nation
Source: Personal interviews with organizations, 1994
News accounts, 1993-1994
Amowrt
$20,000,000
14~000,000
4,100,000
4,000,000
3,000,000
3,000,000
2,434,000
2,000,000
2,000,000
1,400,000
1,300,000
1,100,000
1,000,000
1,000,000
�Flgurel National News Coverage. 1993·94
10
9
I!
- • • - Newspaper
'8 5
I
•
3
--o-- Television
•••••••••••
2
1
oo-~-o~~._~~~~~~~-+~r-+-~~
U! ~~I B ~ ~ ~ ~~ i
Month
Sources: The newspaper stories come from the New York Times,
Washington Post, Los Angeles Times, and Wall Street Journal.
The television stories include those airinR on ABC, CBS, and
NBC as reported in the Vanderbilt University Television News
Archive.
�Table 2 Ad Viewing and Health Care Opinions, October, 1993
Saw Ads
Familiar with managed competition ·
.12(.03)•••
Familiar with health alliances
.11(.03)•••
Knowledgeable about health reform
.21(.03)•••
.24(.03)•••
Understand Clinton Plan
Believe Clinton plan has employer mandate .02(.01)*
·~03(.02)
Believe Clinton plan guarantees coverage
See big tax increase with Clinton plan
-.02(.03)
Strong interest in tax implications
-.04(.03)
-.06(.03)•
Strong interest in cost implications
SawNews
N
.24(.03)••• 2410
.32(.03)••• 2415
.31(.03)••• 2429
.18(.04)••• 2411
.01(.01)
2031
.00(.02)
1818
.10(.04)•• 2034
.14(.03)••• 2430
.13(.03)••• 2422
Adjusted
RSguare
.20
.13
.15
.06
.01
.05
.04
.02
.02
•••p < .001
••p < .01
•p < .05
Source: National survey by Harvard School of Public Health/Kaiser Fo\Dldation, September 30 to
October 5, 1993 (N=1,200 adults)
Note: The numbers are ordinary least squares regression coefficients with standard errors in
parentheses. The significance of the coefficients is marked with asterisks. The results for control
variables (party, education, age, sex, and race) are not shown.
\
�""'·
.
/"'"-· ... ,
_:·
Table 4 Hany and Louise Ad Viewing and Health Care Opinions, March, 1994
Saw Ads
Understand Clinton plan
.12(.04)•••
Believe Clinton plan increases costs
.1 0(.05)•
B~eve Clinton plan increases paperwork
-.07(.06)
Support employer mandate
-.01(.04)
Believe Clinton plan improves quality of care -.01(.05)
Guaranteed coverage is very important
.02(.04)
N
953 .
930
914
848
941
968
Adjusted
I, Square
.01
.02
.05
.02
.. 11
.06
•••p < .001
••p < .01
•p < .05
Source: National survey by the New York Times/CBS News, March 8 to 11, 1994 (N= 1107
adults)
Note: The numbers are ordinary least squares regression coefficients with standard errors in
parentheses. The significance of the coefficients is marked with asterisks. The results for control
variables (party, ideology, education, age, sex, and race) are not shown.
/
.\
�I
,
Table 3 Ad Viewing and Health Care Opinions, February, 1994
Saw Ads
Knowledgeable about Clinton plan
.16(.03)•••
Believe Clinton plan had inadequate coverage -.05(.06)
Believe Clinton plan creates too much govt
.08(.03)••
Worry employers would eliminate jobs_
-.16(.06)**
Support employer mandate
-.02(.02)
.08(.06)
Believe Clinton plan costs too much
Believe Clinton plan creates large bureaucracy .02(.06)
Believe Clinton plan pays for abortion
-.10(.08)
Believe Clinton plan limits choice
.02(.05)
Believe Clinton plan increases taxes
-.08(.06)
N
1671
552
1621
553
1666
557
552
529
585
535
Adjusted
R Sguare
.08
.10
.17
.05
.15
.05
.06
.04
.02
.04
•••p < .001
••p < .01
•p < .05
Source: National survey by the Washington Post/ABC News, February 24 to 27, 1994 (N=1531
adults)
Note: The numbers are ordinary least squares regression coefficients with standard errors in
parentheses. The significance of the coefficients is marked with asterisks. The results for control
variables (party, ideology, education, age, sex, and race) are not shown.
·
�Withdrawal/Redaction Marker
Clinton Library
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001. memo
DATE
SUBJECT/TITLE
Retrospectives on Health Reform: Update (5 pages)
04/17/1995
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
First Lady's Office
Melanne Verveer
ONBox Number: 17607
FOLDER TITLE:
[Background on Healthcare Reform] [1]
2006-0223-F
ab858
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�
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)
September 22, 1993
MEMORANDUM FOR Hn.IARY RODHAM aJNTON
FROM:
SUB]ECf:
Kim Tilley, Amy Nemko
Briefings for Thursday, September 23rd
Briefing for Morning Show Tapings
CNN Briefing
Meet &: Greet with CEOs
(To be provided by Public Liaison.)
Health Care Rally Briefing
- Talking Pointsfor HRC
- Talking Points for the President
(NOTE: The order of introduction at the rally after you welcome everyone to the
White House is: Mrs. Gore introduces the Vice President, the Vice President
introduces you, and you introduce the President Lissa crafted the talking points so
·
that your remarks are complimentary with the President's.)
Senator Breaux and Con&J'eSSman Cooper Briefing
- Member Profiles
-------------
- - - - - -
�TO:
FR:
RE:
DT:
Hillary
Lisa
Morning Show Interviews
September 22, 1993
-------------------------------------------------------------
You are scheduled to do 3 20 minute pre-taped interviews
with each of the network morning shows which will air in Friday's
broadcasts. All of these interviews will be on health care.
Each interview will probably wrap up with 1 or 2 soft questions
about living in the White House and how you are feeling after 8
months in Washington.
Your first interview with be at 11:00 am with Paula Zahn of
CBS News This Morning. You were last interviewed by Paula during
the campaign when you and Tipper did a joint interview from
Chautauqua. You should know that Paula is due to have a baby in
October.
Your second interview will be at 11:45 am with Joan Lunden
of ABC's Good Morning America. Joan has never met you. She is
the weakest of the morning show anchors and is likely to ask more
general questions.
Your final interview will be at 12:30 pm with Katie Couric
of the NBC Today Show. You will recall that Katie did the hour
long prime times special on you in June. Many see Katie as the
savior of the Today Show, making it the top rated morning show
currently. Katie is now breaking into prime time by co-anchoring
.with Tom Brokaw the new NBC Now show which airs Wednesday
evenings.
All of these interviews should be fairly straight forward.
You should remember to stay general, stick to the 6 principles
and tell stories to illustrate the principles.
�TO:
FR:
RE:
DT:
Hillary
Lisa
Interview with Judy Woodruff, CNN
September 22, 1993
---------------------------------------------------------------
You are scheduled to do a 15 minute taped interview with
Judy Woodruff of CNN at 1:15 pm. This is a one on one interview
that will run after 6 pm.
This interview will be similar to the other one on one
interviews you have done on health care.
Judy Woodruff is the newest anchor addition to CNN. She was
formerly at MacNeil-Lehrer and joined CNN about 2 months ago.
�THE WHITE HOUSE
WASHINGTON
September 22. 1993
HEAL111 CARE GROUP SUPPORT EVENT
DATE:
September 23. 1993
2:00PM
11l\1E:
LOCATION: South Lam1
FROM:
Alexis Hennan
Mike Lux
I.
PURPQ)E
To build political momennun for health care retorm by having a broad range of groups
and businesses join you at the White House for an event in support of health care
reform.
II.
BACKGROUND
In order to demonstrate the incredible depth and breadth of political support for your
overall vision of health care refo~ we decided to have a support event at the White
House the day after your speech to Congress. Those who will be there are there under
the following ground rules:
•
That they support the overall direction of your health care plan. although we
have explicitly told them they don't need to have endorsed the entire bill or
agree with every detail of it.
•
That they are committed to work constructively with us to get comprehensive
health retorm legislation passed in this Congressional session.
•
That they support our six basic principles (security, simplicity, savings,
responsibility, quality, choice).
•
That any negative things they do say in statements to the press be couched in
constructive, moderate language in stead of using highly politicized phrases
(such as "big government." "vast new programs," etc.)
Under that set of ground rules. we have been able to attract a wide cross-section of
people to stand behind you, ranging in perspective from single payer advocates to Blue
Cross Blue Shield and the American Medical Association
�IlL.
PARDCIPANIS
The. President ·
The First Lady
The Vice President
Mrs. Gore
There are several hundred organizations and businesses represented. as \Veil as all of
the Working Group members \vho worked on health care policy development.
Attached is a list of the 84 individuals who will be standing with you on stage.
IV.
SEQUENCE OF
EVENTS
•
You \\'ill meet the Vice President Mrs. Clinton, and Mrs. Gore in the Red
Room.
•
The four of . \Vill be announced and will walk out together onto the South
vou
Lawn.
•
You will proceed down the center aisle of the tent and onto the stage. Eighty
four heads of organizations, CEOs, and labor leaders will be standing behind
you.
•
It is suggested that the four of your take a minute to stand together away from
the podium and acknowledge the crowd with a wave or something similar
betore you begin the speaking program.
•
The program begins:
~
Mrs. Clinton welcomes
Mrs. Gore· speaks
The Vice President speaks
Mrs. Clinton speaks and introduces you
You deliver remarks
•
V.
When the program is finished, you and Mrs. Clinton will depart stage left and
the Gores will depart stage right in order to work separate rope lines.
PRFSS
This event is open press. All supporters on stage will have an opportunity to speak to
the press.
VI.
REMARI<S
Attached.
�HEAL11-I CARE GROUP SUPPORT EVENT
LIST OF SUPPORTERS ON STAGE Willi 11-IE PRESIDENT
September 23, 1993
NAME
GROUP
COY/STAlE
Families USA
Ron Pollack, Executive
Director
Washingon D.C.
National Council on Aging
Daniel Thursz, President and
CEO
Washington D.C.
American Nurses
Association
Virginia Trotter Betts,
President
Washington D.C.
Blue Cross Blue Shield
Barney Tresnowski,
President
AARP
Horace Deets, President
Washington D.C.
Vitas Corporation
Hugh Westbrook, CEO
Miami, Florida
National Council of the
Churches of Christ in the
USA
Joan Campbell, General
Secretary
New York, NY
National Fanners Union
Lee Swenson, President
Denver, Colorado
AFL-CIO
Lane Kirkland, President
Washington, D.C.
AFL-CIO
Tom Donahue, SecretarY
Treasurer
Washington, D.C.
AFSCrvffi
Gerald McEntee, President
Washington, D.C..
SEIU
John Sweeney, President
Washington, D.C.
Building Trades COlmcil
Bob Georgine, President
Washington, D.C.
United Auto Workers
Owen Bieber, President
Detroit,. MI
Citizen Action
Ira Arlook, Executive
Washington, D.C.
Director
National Education
Association
Keith Geiger, President
Washington, D.C.
American Health Care
Association
Bruce Yarwood, President
Washington, D.C.
�Catholic Health Association
John E. Curley. Jr.: President
and CEO
St. Louis. MO
American Hospital
Association
Richard Davidson. President
Washington. D.C.
National Association of
Retail Druggists
Charlie West, Executive
Director
Washington, D.C.
National Association of
Chain Drug Stores
Ronald Ziegler. President
Washington. D.C.
Conswner Federation of
America
Eugene Irvin Kimmelman,
Legislative Director
Washington, D.C.
National Association of
Social Workers
Ann Abbott President
Villanova, Pennsylvania
American Medical
Association
Joseph Painter, MD;
President
Houston. TX
American Academy of
Fan1ily Physicians
William Coleman. PhD;
President-Elect
Scottsboro, AL
American Academy of
Pediatrics
Howard Pearson. President
(pediatrician at Yale New
Haven Hospital)
New Haven, CT
American College of
Obstetricians and
Gynecologists
Dr. Richard Hollis, President
Amery, MS
American College of
Emergency Physicians
Dr. John McCabe; PresidentElect
Syracuse, NY
League of Women Voters
Gracia Hillman, Executive
Director
Washington. D.C.
National Black Nurses
Association
Linda Bums Bolton.
President
Washington. OC
Consumers Union
Linda Lipsen, Legislative
Director
Washington. D.C.
American Academy of
Physicians Assistants
Ann Elderkin, PA; President
Alexandria, Virginia
National Association of
Childrens Hospitals and
Related Institutes
Lawrence McAndrews,
President
Alexandria, Vrrginia
�AMVETS
Donald Hearon. National
Commander
Lanham. MD
Paralyzed Veterans of
America
Richard S. Johnson, National
President
Washington. D.C.
Disabled American Veterans
Richard Marbes.
Commander
Vietnam Veterans of
America
James L. Brazee. President
Lafayette, LA
The Anlerican Legion
Bruce Thiesen. National
Commander
Washington, D.C.
Veterans of Foreign War
Larry Rivers, Executive
Director
Fairfax, VA
N~ional
Group Health Cooperative of Phil Nude~ President
Puget Sound
and CEO
Washington. D.C.
Seattle, WA
Robert Wood Johnson
Foundation
Stephen Schroeder, MD;
President
Princeton, NJ
Johns Hopkins Health
System
James Block, MD; President
and CEO
Baltimore, MD
Johns Hopkins University
School of Medicine
Michael ME. Johns, MD;
VP for Medicine and Dean
of the Medical Faculty
Baltimore, MD
University of Pennsylvania
School of Medicine
William Kelley, MD;
Executive VP for the
Medical Center and Dean
Philadelphia, PA
Memorial Sloan-Kettering
Cancer Center
Paul A Marks, MD;
President and CEO
Ne\V York, NY
National Leadership for
Health Care Refonn
Henry Simmons, MD;
President
Washington DC
Blue Cross Blue Shield of
Iowa
Robert D. Ray, President and
CEO
Des Moines, IA
Purdue University
Steven Beering, MD;
President
West Lafayette, IN
Association of Academic
Health Centers
Roger Bulger, MD; President
Washington DC
Scripps Clinic & Research
Foundation
Dr. Charles Edwards,
Presdient
LaJolla, CA
�Harvard School of Public
Health
Harvev V. Fineber2, NID.
.
...
PhD: Dean
Boston. M£\
University of Notre Dame
Rev. Theodore Hesburgh,
C.S.C.: President Emeritus
South Bend. IN
Duke University School of
Medicine
Dr. Ralph Snydennan;
Chancellor for Health Affairs
Durham NC
Brandeis University
Dr. Samuel 0. Thier;
President
Waltham, MA
National Council of Senior
Citizens
Larry Smedley, Executive
Director
Washington, D.C.
Consortium for Citizens
with Disabilities
Paul Marchand. Executive
Director
Washington. D.C.
National Council of
Independent Living
Denise Figueroa, President
New York
National Medical
Association
Dr. Tracy Walton, PresidentElect
Washington, D.C.
American College of
Physicians
Paul Griner, MD; President
Rochester, NY
Businesses for Social
Responsibility
Michael Levett, President
Washington, D.C.
American Iron and Steel
Andrew Sharkey,
American Forest and Paper
Red Cavaney,
Amtrak
W. Graham Claytor. Jr..
CEO
Washington, D.C.
Archer Daniels Midland
Dwayne Andreas. CEO
Decatur, IL
Bethlehem Steel
Curtis "Hank" Barnette, CEO
Bethleh~
Blue Cross of Western PA
Eugene Barrone, CEO
Chrysler
Robert "Bob" Eaton, CEO
Highland Park, Ml
Columbia Cellular
Corporation
Mark Warner, CEO
Virginia
Ford
Harold "Red" Poling, CEO
Dearbol1\ .MI
Invacare
'Mal Mixon, CEO
Cleveland, OH
The Dnunmond Companies
Gary Drummond. CEO
Binnin~AL
PA
�Electronic Data Systems
Alice Lusk, CEO
Dallas. TX
Hechinger Company
John Hechinger,Sr., CEO
Maryland
John Alden Insurance
Bill Mauk, CEO
Miami. FL
Ralph's Grocery
George Allwnbaugh, CEO
Compton. CA
Food 4 Less Supennarkets
Ronald Burkle, CEO
Yucaipa CA
Autwnn Harp
Kevin Harper, CEO
Bristol. VT
Fidelity Investments
Peter Lynch, CEO
Boston. rvtA
The ADS Group
Alan
Vennont Teddy Bear
Company
John Sortino, CEO
Shelburne, VT
Rite Aid
Alex Grass, CEO
Harrisburg, PA
Soapbox Trading Company
and the Mills Group
Helen Mills, CEO
Virginia
Circuit City Stores, Inc.
Alan Wurtzel, CEO
Richmond, VA
James River Corporation
Robert Williams, CEO
Richmond, VA
Solomon~
CEO
Boston. rvtA
�.__ ,,- -·-·i"":
'
' .. -,
""""''
-
•C.
-
.:..·_.;::,:..;.-:·"': ..;..-: .• -:
FIRST LADY HILLARY ROnBAK CLINTON
INTRODUCTION OP THE PRESIDENT AT BBALTR CARE KICK·OFP
THII: WHITE HOUSB
SEPTEMBER 23, 1993
Dlal..l'
T~:an:-<:
?..:i.-~.:.eve
yo·:.;. all fc:l:::- j
hea~th
:::ar~
The precess leading
"!"housands of
o~n:.r:q
us in this historic effort co
refc!.:m.
~p
to today has been
extraordi~ary.
have been inv·o::. ved in shaping the
~~~siden:'~ plan -- doctors, n~rses, and health care
professional~. Ordinary citize~s. Businesses, large and small.
~oliticians of ~very stripe f=om every state.
American~
this c0un~ry never before hae witnessed this kind of
ooen, .:a:J.did, i:1te•1sivs disr:ussion about health care. You have
s~oken up. Your friends ~~d rela~ives have spoken up. Yc~r cc·...-orkers have spoken '-'P. And we ha,re t:t·ied to listen t_o each and
every one of you.
~ruly,
Those of you here c.r;,day should be especially proud ::>f your
role. Over the past eight mont.hs, your unique perspectives h~lped
educate •.:s about the complexities of O\lr health care sys:em. ·::our
energ:z· and com:ni t:nent w-ere constant reminders of the need to
press forward wit~ ~his ambitious goal. And your willingness to
shara your ideas enablsd ue to arrive at a plan that is fair,
:cmpassicnate and r@a!is:ic.
So, on behalf of thosa working on health care reform at. the
White House, !'d like to thank all of you for your co~~ributions
to making this nation healthier and happier. It is bscause cf the
spiri~ and dedication of your organizations and the many people
you ~sprasent that I'm sure we will suc~eed in achieving ~eal,
:aating refor~ th~~ will be good for all Amerieans.
[Introduction of tt.e President}
�--=----=-
PRESIDENT WILLIAM JEFFERSON CLINTON
REMA!UtS AT HEALTH CARE REFORM KICK-OFF
THE WBITB BOUSE
SEPTEMBER 23, 1993
DRAFT
Today is a moraento,Js day in the history of Ame:=i::a. 'r:1day is
jay we b~gi~ in earn~st our journey to real health car~
:::-e:forr.1 -- ar:d real ~e:altr~ se:::urit.y for ;veri· A.meric~-n.
=~~
This lS a journey that has been discussed for decades,
d.;:Cated for dec:e'.des, ar:d delayed for far too long. And tl1at is
why this day is so important.
':'hose .:>f you gathered here represent Anericans from every
se31nent of society -- Americans whose diverse ideas and opinions
nelpea :rame the Heal~~ se~urity Act r introaucea to ~ongress
last night.
Ne?er bef.:>re :.n our nation's history have so many ordinary
citizens and sc manr diff~rent groups joined together to sound
:h~ alarm fo1: health care reform. Never before have so manv
~~ericans put aside selfist concer~s and partisan differences to
f'-t.lfi:.l a commo:1 vision of good health for every .kmerican.
Standing with r.-te today are doctors, nurses, physicians
ass:..stants, hospi :al adtrc:.nistrators, psychologists, soc:_al
workers, and medical school deans; Fortune 500 executives; small
business owners; labor l~aders; senior citizens; veterans;
stude::t.s; and consumer advocates.
Yo~ represent hundreds of thousands of citizens across this
-:c:.mt.ry, many of i-:hom have written letters to ue at the White
House an:i talked c.o us about the need for health care reform.
Today, finally, we can honestly say to every American that
we are on ':.he road r.o change. We are moving forward. And we will
reach our destination.
Now it • e sa"!:e to say that we probably won't agree on eve::y
detail; every technicality as we work toward reform. Our health
care system is so complex, so vexing, ~hat it wou:d be a miracle
if we could all agree 0:1 .axactly how to fix it.
What's i~portant is that we share a common set of goals -protecting the economic security of our nation, and protecting
th~ health security of our families.
To t:nose of you who are single-payer advocates,
I salute
yO\.l
for your long devotion tc healch care reform. And •nhile you and I
1
�J•--
may noc agree en cne precise prescr1pt1on for curing our health
care system, your innovative ideas have influenced key elements
:Jf
O'..<r
:;;lan.
To 6ther s~~ups who disasree with one aspect or the other of
I'va proposed. I salute you too -- for your courage tc
~:;:;:-t:pl·omi s::. .::.n te:·.al f cf che nat:.on a. a a whole. The Americar~
De en :i.e h~·"·o; :.:-escl•:.;d that health care reform must co f or'N"a:::-d, and
- c~ac ~ill o~ly happe~ if we are willing to work together
. . if
we are willing to honor and respect our differences as we build
::l:'om a ;::ommon ground.
~hat
~
~e~ me ~ss~re yo~ t~~t, in the months ahead, we will
cont:in'.le to nee.:! your ex~·ertise and ideas to help refine our plan
so that we ·:an a·:h:i.cve the American dream of cornprehensi~re hea::..:h
~are
for avery citi=an.
One thing we ha·.fe learned from cur discussions o·.·er the past
eight months is ·c!'lat we are '..mit.ed around certain principles that
must be the bedrock of =iny l:'eform effort.
SECtzRITY: Reform must ens".J.re tl:at every American is
-:or.:prehensive health k;)enefits -- ev~n if you lose yout'
job, switch jobs, get sick1 or move to a new town or city.
~::ruaranc.;ed
SIMPLICITY: ,:.:(_eform must simplify the way America11s sive and
r.:,:::eive health care. !t must k;)e simpler for patients, and simpler
for doctors, nurses. ether medical professionals who delive~
care.
O!JALITY: Reform :nust buil~ on and expand the good things: in
system -- like quality. we r.mst make surs that:
.::ur.su~ers get more information so that they can make informed
JUdgments about tt.e quality of their health care.
o•..n:
cu~ren.t
CBOICii Reform must allow Americans to choose their own
health plan and their cwn doctor. Instead of handing that choice
over to your employer, ou= plan will enable every American to
choose from a range of high-quality plans in their region. You
can stay ~ith your current doctor, join a network of doctors and
hospicals, or an Healch Maintenance Organization.
SAVINCSs Reform must control skyrocketing health care cos:s
-- and make the sys~em cheaper and more efficient for all of us
by getting rid of waste, cracking do•,.;n on fraud and abuse, and
gncouraging the use of preventive and primary care that is
healthier for all of us a=-td saves money.
RESPQNSIBILITX; Reform must make every American a
r<!Sp;:)nsible, active parcner in his or her own health care. No one
should g~t a fre~ ride.
2
�-
-
-, "''
..:.•_..:..-_-:.:.. __. .
Alchough the :uajority ·.:·f Americans want health care reform
although grcups as diverse as these gathered here want heal~h
:are ~efor~
the kns~-Jerk cynics already are ou: in fcrc~
~r;i~g :c s:op thi~ hist~ric effort.
:-- .... -"' ... "' · "...,,...:.,, ......... ,_rl'"1u ... s are spenalng millions of dollars en
ads that create fear and grossly
dis~~rt this p:a~.
.:. '=" . - - ·-·.:.. - ·- -· --· ) - ·' ' :j ::J ._} J:i
)~~~Y st~~:.2a ~~ct :e~evisicn
-::-:-.e3e a..:~ tl1.o: sa:':'lt:: paroc~1ial i~t.erests who, in years past,
st::or.S. i.:l :::::e :,.;ay of Fra:-~k2. in .Rcosevel t.' s dream of a health
s~c'.:~·i::.y act. These ar@ rhe sarr:e pa:::·::Jchial i~terest.s TJrho stood
tt.e ~..·::1.y .)~ Hart·y T:::"'..it.lar:' s ~lan to provi:ie universal co?erage.
The/ ~u:e t::-.. e same :..nte-:-9s:.s ;.;he stood in the way· of John F.
t:s:lnedy, Ly~"ld=:t J c:..hr:so::-1. f' :!..~l-...ar--! N.i,xon and J:.rtlr.ti· C.3rte :::-.
t~e:l,
_~·re' re r.ct: going
t(~
let them stand in our way
,'
.....
,~
a:1ymor~.
?~~ 60 ye~rs, we have le~ the~ win the batcle. For 6C years,
·...·e l:a·.·e mar·:=hed ~o -:he edge of heal ch care reform, only to shriz:k
:.r~ the fa::e of oppcs:.tio:1 -::~.:1d '.lalk a•:1ay. For 60 years, ·,.,e ha·re
h~:d meetings, dsbated options, and then thrown up our l1ands i:u.
frustration and walked away.
Now is our t~rre tc bea.t b-::~.ck the naysayers who insist that
good deeds can ne•1er be dGne. !low is our time to meet the test of
hist.o:-y aiJ..j -.;~t cc-r-Lt~o:::. c: cur health care system once and for
all.
T1:anks t.o :,c..:, we already have come a long, long way on this
j c.1rney. Wi tl: your continued help, we car.. go !1\uch
~xtl·ao-;:-1inary
further.
T!'lis ::: ime, l.:!t • s
l10t
l.ilalk away. This time,
way.
T~"lanK
you ve r;:y much .
###
3
let's lead the
�. AD:\1I~ISTRATIVE
MARKI:\G Per E.O. 12958 as amended, Sec. 3.3 (c)
Initials: Ac ~
Date: OL-/ IIn j Itt ·
PRIYILEGED AND OONFmEN'fiAL
TO:
FR:
RE:
CC:
Hillary Rodham Clinton
September 22, 1993
Chris Jennings
Meeting with Congressman Cooper and Senator Breaux
Melanne, Steve, Distribution
Tomorrow you are scheduled to meet with Congressman Cooper and Senator
Breaux. As you know, this is the meeting that we have tried to schedule for a
number of weeks and both Members are pleased that we were able to set it before
the President introduces the legislation.
BACKGROUND
The latest update we have received on the likelihood that Cooper will be
introducing his managed competition bill is that it appears he wants to. introduce
it next week or the week after., Congressman Michael Andrews' staff (his chief
cosponsor) indicated that they would be sending up a letter today or tomorrow
indicating their intention to introduce the bill. Based on the conversation, it
appeared as though the letter would be very strongly written and quite critical of
the Health Secu_rity Plan·. I asked Andrews' staff to do all they could to tone down
any unnecessarily confrontational rhetoric. I said I thought it would be
counterproductive for all parties. Dave Kendall seemed to agree. As of this
writing, we have yet to receive any such communication.
Senator Breaux's office continues to appear to be wavering as to whether to
introduce the companion bill in the Senate. However, he believes that it may
prove beneficial to introduce an initiative to serve as a marker for the upcoming
negotiations. Interestingly, we have just learned that Senator Boren will not
introduce the Senate companion bill; it appears he does not want to again
antagonize the White House.
·
Senator Breaux's office indicates that he is more likely than not to introduce
the bill. His primary concerns are that (1) he believes the alliance structures are
too regulatory, (2) he believes that the premium caps are too close to price
controls, and (3) he believes in general that our package may be too complex and
controversial to get through the Congress. He is of the opinion that we may want
to downsize our goals and pass those provisions for which there is consensus.
�GOALS OF MEETING
•
To placate Breaux's and in particular Cooper's desire to have more input on
the development of the President's proposal.
•
To offer additional consultative opportunities in the next two weeks at the
staff level (Ira, et al).
•
To urge both Members to not be overly negative in public in criticizing the
President's plan and to offer the same in return from the White House as it
relates to their plan.
•
To succeed in convincing Breaux to not introduce the Senate companion
legislation by illustrating our sincere willingness and desire to work with
them (in the absence of that achievement, to at least ensure that he
downplays the introduction of his legislation and highlights his desire to
work with the Administration in crafting an acceptable compromise).
�SENATOR JOHN BREAUX (D=IA) - While Senator Breaux's budget differences with
the White House are well known, he is a moderate to conservative who is known
more as a pragmatists than a idealogue. In the area of health care, Breaux is another
of the Finance Committee members who cares deeply about small business and rural
health care. He introduced the Conservative Democratic Forum's managed
competition bill but is very concerned about its limitations. he opposes price caps
and freeze to control costs.
Beginning in late spring, Breaux has made very positive public comments about the
prospects for health care reform and praised the consultative process with both
Democrats and Republicans. He believes people want health care reform but it will
be important to sell the benefits first (and sell people on what they are getting). He
thinks it should contain malpractice reform.
RECENT PRESS QUOIE!S "In order to achieve those goals (of health care reform),
Cinton has crafted what Senator John B. Breaux, D-L~ calls a 'gumbo:' a blend of
sweeping new government powers to regulate the delivery of medical services and
incentives designed to cut costs by encouraging greater competition." AP Wire 9/23
CONGRESSMAN Jll\1 CCXJPER (D.TENNl
RECENT PRESS QUOIE9 On September 3, Cooper told USA Today that months of
hearings would be needed on health care reform. Since then, Cooper has been
publicly critical of the administration plan, noting in particular his opposition to
employer mandates and global budgets. He told the Wall Street Journal on
September 12 that the plan "makes both conservatives and liberals unhappy. . . You
can't have a sausage product when it comes to health care."
•
"While single payer sounds good on the surface and has some pluses, it is a
terribly expensive system."
(Cooper on "Newsmaker Saturday" CNN, 9/18)
•
"The key thing to realize in our plan is that half of it is in the Cinton bill.
We're just worried about the other half of the CUnton approach. We feel that
we have the only bipartisan health care reform plan." (Cooper quote in
Healthline 9/20)
•
"Some moderate Democrats, led by Rep. Jim Cooper (D-TN) and Sen. John
Breaux (D-LA), complain Cinton's plan creates an elaborate government health
bureaucracy with too much power; they say they will introduce their own
managed-competition plan." (Newsday 9/19/93)
�draft 11/2 8:30 p.m.
~/1-~··
Let us be clear: without refonn, 100 percent of AmericBDS can expect to pay higher
insurance premimns and higher health care bills nearly every year, forever, with no guarantee
of security, no guarantee of benefits, and no guarantee that their insurance will be there when
I\
-~~
·
.
'
~o--1?.( ~.-..-l.dw
~.
With the President's health secmity plan, a majority of Americlans •• nearly 70 percent
•• will pay the same or less for benefits that are the same or better, iacluding out-of-pocket
costs, saving osf avem~mO'nth. If you are older, have~amilY-,_Q[ if someol!.e in your
household has been sick, you are probably among this 70 percent.
•' ···5';' ... -....
So,.e people will pay a little more, on avemge abo.i.S~a month::, but they11 receive
benefits that can never be taken away and many will receive~.
Yes, under the President's health secmity plan, health care refonn will cost some
people a little more and even more people less, but for a health care system that will be there
when you need it. .Dt.bel:-pFepesals..are..likel~ise..co~~faMire-nm,tffi'ilY'OrAmetlcans:-"
witbmJt ptau.iGi~-reakeeurity~or"co"VeffiigeveryOn'~
I
A~~ .{_~,.{ ·< ((.. c~C-·::.. f£.t.•tt.e·t..1
~C,t.-vLcvL0·t(, Uvl '( ,.~'"""~" ·· .
.tp rw' / f ,J,wl:- ~ ~ /'
·
·
.
/1
~ 11.-·<.· o.t.. 0'-''-"{T~!_..
k.-...1/J...,
...
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t..rf. L /L., .•,;.I )L,-c .."f:
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-
�draft 8:30p 11/2
PRESIDENT CLINTON'S HEALTH SECURITY ACT
Our national goal is health secmity •• comprehemive health benefits guaranteed for evel)'
American that can never be taken away. No limit on benefits over your lifetime. No refusal
of insurance if you have a pre-existing condition. No losing your insurance if you get sick or
lose your job. And no indiscriminate rate increases. This principle is non-negotiable.
Our principles are clear and clistiugulsh our approach: SecuritY •• comprehensive benefits that
. can never be taken away. Simplicity •• eliminating paperwork and bureaucracy and creating a
single form. ~ •• controlling health care costs. .Q1Win: - making the world's best care
better.~·· preserving your right to choose your doctor and expanding choice of plans.
Responsibility -- every American assumes responsibility to bring an out-of-control system
under control and put funding on a fair and responsible basis.
w
Real refonn and real savings are possible
If health care benefits are guaranteed to evel)'
American. Without universal coverage, there's no guarantee we will be able to control costs
and provide comprehensive benefits. For example, today, everyone of us pays a part of the
$25 billion bill for health care for the uninsured; a single claims form doesn't work unless
everyone is in the system and following the same rules.
Comprehensive benefits include preventive care, doctor's visits, hospital seiVices, prescription
drugs, mental health care, dental care for children and eventually, for adults, home health
care, hospice care, emergency care and ambulance seiVlces, vision and hearing care.
For seniors, the protection of Medicare remains with improvements •• new prescription drug
benefits and new long tenn care benefits. Our health security plan will achieve real savings in
Medicare and re-invest that savings to improve benefits.
For small businesses, our plan provides imunmce discounts to help them afford
comprehemive benefits for their employees. Most small businesses •• 62 percent •• already
provide health insurance to their employees but they're forced to pay 30 to 35 percent more
than larger companies. Our plan helps them compete for the best price and the best benefits,
controlling costs and expanding coverage.
For the majority of Americans •• nearly 70 pen:ent •• our plan will mean you will pay the
same or kn for health care benefits that are the same or better .. on avemge. savi"' $61 a
JIWI1h.
Some people will pay slightly more, on avemge about $24 per month, but theyU receive
benefits that can never be taken away and for many, they,l be better benefits.
�If we fail to act:
> Every American •• 100 percent •• can expect to pay higher imiDBDce premilDIIS
nearly every year, with no guarantee of security, no guarantee of benefits, and no guarantee
that imurance will be there when they need it.
> One of every folD" Americans will lose their imiDBDce at some point in the next two
years.
> Almost $1 of every $5 Americans spend could go to -health care.
> By the end of the decade, just to keep their health benefits, American workers will
sacrifice almost $600 in wages every year.
> Milliom of Americans will find that rising costs will force their finns to cut back on
benefits and limit choices of doctors and health plans.
Our plan for health security is the most comprehemive and respomible, building on what
works in our cummt system and fixing what doesn't. We rejected switching to a big,
government-run program, instead favoring an essentially private system, streamlined and less
bureaucratic than what we face today. And, we're demonstrating how that system will work-from details on the benefit package and premiums to a firm explanation of the most
responsible financing possible. It is a standard by which other proposals ought to be judged.
�The Health Security Act- the Plan that Makes the Most Sense fbr America
President Clinton's Health Security Act is the only proposal before Congress that
is a detailed, thorough plan of action for providing every American comprehensive
coverage that can never be taken away. It extends coverage to all Americans without
turning health care over to the government or placing an undue burden on American
families. It does it by building on what works; private sector health coverage paid for by
employers and individuals.
The other plans don't meet the most important requirement of health reform,
universal coverage, or because they achieve universal coverage in a way that would cause
major disruption to the way most people receive and pay for health care.
The Single-Payer Plans (McDermott/Wellstone, Stark)
•
The single-payer approach replaces our existing private-sector health system with a
government-run, government-financed system requiring major tax increases.
•
This approach would dismantle the private-sector employer-based system that works
and covers 9 out of 10 people with private insurance.
•
Single-payer plans impose a federal "one size fits all" solution on every part of the
United States, a country with unique differences among states and vastly different
approaches to health care.
•
The problems with the current health system can be fixed and everyone can be
covered without turning health care over to the government or raising new broadbased taxes.
The "Managed Competition" plans (Cooper and Breaux)
•
These plans call themselves "Clinton light". They are light: light on coverage, light
on benefits, short on specifics, and weak on financing.
•
They call for benefit cut backs in the name of "cost consciousness" and treat
consumer choice as a taxable luxury rather than an individual right.
•
In addition to minimizing choice, the Cooper/Breaux bills fail to guarantee universal
coverage to all Americans and risk leaving millions of Americans uncovered.
•
According to the CBO, the Cooper proposal actually encourages companies now
providing insurance to drop coverage for their employees.
�•
The Cooper and Breaux proposals do not protect Americans from exorbitant out-ofpocket costs and cannot assure you that you and your family will be covered next
year.
•
It calls for an increased role for the IRS in monitoring company spending on health
care, and puts a government board and insurance companies in charge of deciding
what benefits people will get.
•
The administrative complexity oftoday's system will remain in tact; frustrating
providers, confusing consumers with mind-boggling forms, and wasting money on
red tape.
•
The Cooper plan doesn't even pay for itself-- it increases the deficit by $70 billion.
The "Individual Mandate" proposal (Chafee)
•
This proposal is noteworthy for recognizing that universal coverage is a must, but too
much is uncertain. The American people need security. They need to know what will
and will not be covered, and how much they will be asked to pay. This plan leaves
those decisions to a government board after the plan is passed.
•
The proposal promises, but does not guarantee, comprehensive benefits and help for
low-income people. Universal coverage comes only when and if the plan achieves
forecasted savings. A government board will provide benefits, but how
comprehensive they are will depend on whether or not they are affordable.
•
Universal coverage comes through an individual mandate -- every family would be
required to seek out and pay for health insurance on their own.
•
It includes no requirement on companies, only on their workers.
•
Small businesses and individuals cannot count on increased leveraging power in
negotiating with health plans, because purchasing alliances are small and voluntary.
•
Widely different health care systems in different states could significantly disrupt
businesses and workers by encouraging relocation.
�The "Medi-save" plans (Gramm-McCain, Michei/Lott)
•
These plans are anti-consumer and pro-insurance company.
•
They call for leaving in place everything that's wrong with insurance companies-- preexisting condition exclusions, lifetime limits, skyrocketing rates, dropped coverage-and putting at risk the one thing people like-- comprehensive benefits.
•
It does nothing to cover the millions of Americans who go without insurance today,
so millions will remain uninsured, and the rest of us will pay their bills.
•
These plans would pare back the insurance most people have to bare-bones coverage,
covering only catastrophic costs. The day-to-day health care most people need would
not be covered by insurance, it would be paid for out of people's savings. This
discourages preventive care like regular check-ups and immunizations.
•
It does nothing to protect quality, and nothing to preserve choice of doctor.
Employers who do provide insurance could continue to limit their employees'
choices, and lock them out of plans where their doctors practice.
•
This plan also ignores the significant savings which could be made available through
simplifying the system: it leaves all the bureaucratic complexity choking today's
system in place.
�PRESIDENT CLINTON'S HEALTH
SECURITY ACT
OIUERPLANS
COVERAGE FOR EVERY AMERICAN
MILLIONS REMAIN UNCOVERED
COMPREHENSIVE BENEFITS
SPELLED OUT AND GUARANTEED
NO GUARANTEE OF SPECIFIC
BENEFITS
ELIMINATES "PRE-EXISTING
CONDITION" EXCLUSIONS
DOES NOT ELIMINATE "PREEXISTING CONDITION"
EXCLUSIONS
ELIMINATES LIFETIME LIMITS ON
COVERAGE
DOES NOT ELIMINATE LIFETIME
LIMITS
GUARANTEED CHOICE OF DOCTOR
NO GUARANTEE YOU CAN SEE ·
YOUR DOCTOR
PRESCRIPTION DRUG COVERAGE
FOR SENIORS, NEW LONG-TERM
CARE PROGRAM
NO NEW BENEFITS FOR SENIORS
DOES NOT TAX EMPLOYERS WHO
PROVIDE BETTER COVERAGE
TAXES EMPLOYER BENEFITS
ABOVE LOWEST COST PLAN
STREAMLINES AND SIMPLIFIES
EXISTING INSURANCE SYSTEM
LEAVES EXISTING INSURANCE
SYSTEM IN PLACE
DISCOUNTS FOR SMALL
BUSINESSES
NO DISCOUNTS FOR SMALL
BUSINESSES
�1HE REAL EFFECfS OF 1HE PRESIDENT'S HEAL1H SECURI'IY ACf
I. The real issue for the insurance companies:
The HIAA says that one of their main problems with the President's plan is that it sets
"artificial controls on price." What they mean is that they don't like the fact that the
President's Health Security plan takes away their ability to indiscriminately raise premiums
30% a year. The President's plan cracks down on the insurance companies and limits the
amount they can raise rates each year. And it makes it illegal for insurers to refuse to cover
people with pre-existing conditions, drop people when they get sick, and use "lifetime limits"
to deny people coverage when they need it most.
II The truth on the President's plan:
Increases choice. Under the Health Security Act, every American wiU have a choice of health
plan-- something that few people have today. Today, just one in three employers with less
than 500 employees offer any choice of plan, separating many people from their doctor.
Under the President's plan, the consumer -- not the employer or insurance company -- will
decide which health plan to join and which doctor to go to.
Puts consumers and small businesses in the drivel's seat The Health Security Act will release
the chokehold that in today's system, insurance companies have on all of us -- consumers,
nurses, doctors, and businesses. Refonn will encourage competition -- forcing costs down as
health plans compete by offering high-quality care at an affordable price. Giving small
businesses and consumers buying clout will level the playing field, give employers and
employees leverage over insurers, and give smaU businesses and consumers the same
bargaining strength as big businesses.
Guanmtees comprehensive benefits that can never be taken away. AU Americans wiU be
guaranteed a benefits package as comprehensive as those offered by most Fortune 500
companies. The comprehensive benefits package includes prescription drugs and goes beyond
virtuaUy all current insurance plans by covering a wide range of preventive services. It
guarantees that no employer or insurance company can ever take those benefits away.
Limits the rise of premiums. The President's plan puts a limit on the rise of health insurance
premiums. And it's more than justified. Today, insurance companies hike your premiums sometimes at several times the rate of inflation -- if you get sick or if someone in your family
gets sick. The President's plan prevents insurance companies from raising premiums at
outrageous rates that today send families into debt and businesses into bankruptcy.
Prohibits insurance company practices that burt consumers. Under the President's plan,
insurers will no longer be able to drop people -- for any reason. The Health Security Act also
makes it illegal for insurers to raise your premiums or drop you because you get sick. AU
health plans will be required to accept anyone who applies -- healthy or sick, young or old.
Insurers will be prohibited from charging sick people more than healthy people or old people
more than young people. And it wiU be illegal for insurers to use "lifetime limits" to deny
people coverage when they need it most.
�Gives small businesses a discount on the price of insurance. Today's insurance market is
stacked against small business owners, their families, and their employees; small businesses
are charged 35% more than large employers. The Health Security Act gives small businesses
discounts, enabling small businesses to provide comprehensive coverage at an affordable
price. Small businesses that currently provide insurance will receive "an unexpected windfall"
from reform, according to the Wall Street Journal.
III The insurance industzy's motives:
Protecting their profits. The current system enables the insurance industry to make outrageous
profits. They make money from insuring only the healthiest people -- refusing to cover old
people or sick people. And they profit from the fact that they have all the power in today's
insurance market. It's no wonder they are so determined to preserve the status quo.
Protecting their ability to drop people. Today, insurance companies make money by
competing to insure only the healthiest people. When people get sick, the insurance company
has to spend more money -- and make less. So rather then cover people, they point to the fine
print and drop them -- when they get sick, when their child gets sick, when their spouse gets
sick. Or they'll use a "lifetime limit" to deny people the benefits they deserve.
Protecting their ability to nlise people's rates. Sometimes insurance companies decide to
continue to cover people -- even when they get sick. But they've got to keep their profits up.
So they raise people's premiums. If you get sick, your illness is just the beginning -- just wait
until the insurance company socks it to you.
IlL Independent parties deczy the insurance jndustzy tactics:
Their ads mislead the American people. CNN said that "most Americans probably have a lot
less to worry about than the couple in the insurance industry's commercial." The St.
Petersburg Times called the ads "dishonest." And the industry has the gall to attack the plan
about problems it has created. "The health care industry has spent the last 15 years trying to
take away our choice and it's ironic that now they run these ads trying to attack on the issue
of choice," said Dr. David Himmelstein of the Harvard School of Public Health.
They're ''flat wrong" about the President's plan. Governor Richard Celeste of the National
Health Care Campaign called one of their ads "flat wrong." The Los Angeles Times said that
their ad's claim that the President's plan would limit choice to plans designed by government
bureaucrats was "not true." USA Today says to one of the characters in the ads: "Hold it right
there, Louise. The Clinton plan doesn't limit health care; it limits premium increases."
They're out to protect their profits. Families USA sees the insurance companies' true motives.
"That's right, the big insurance companies are spending millions to protect their profits and
undermine health-care reform," says the group. The Washington Post says that the "insurance
industry TV ads seem to us to be aimed much more at preserving the industry's own .
revenues." And the St. Petersburg Times said that "(t)he $6.5 million the insurance industry is
paying for its current campaign is just a taste of what the health care system's various special
interests will spend on advertising and lobbying in an effort to protect their profits."
�BC HEALTH-I:NSURANCB lSTLD (SCHEDULED)
HEALTH I:NS'ORBRS :IN DI:SARRAY, BUT ADS TO GO ON
(Eds: new throughout)
By Mike Clancy
HARTFORD, Conn, Hov 2 (Reuter) - Like squabbling players on
a losing sports team, health insurers Tuesday argued among themselves about
whether to continue an advertising campaign the White House and other critics
have called a pack of lies.
Leaders of the Health :Insurance Association of America were adamant that
they will not change their ads just to get a truce with the White House.
But officials of a separate group of companies said they were working
hard to get the ads pulled.
~~The ads are just adding gasoline to the fire,•• said an official of a
major insurer.
~~Between criticism from the White House and dislike from the public, I:
am starting to feel like a fire hydrant at a dog show,•• the official said.
But the bickering will have little effect on public opinion, one critic
believes.
·
~~People say •so what?•,•• said Ron Pollack, executive director of the
Washington-based lobbying group Families USA.
~~When one faction of the insurance industry gets into a pillow fight
with another faction, the public roots for the pillow,•• said Ron Pollack,
executive director of the Washington lobbying group Families u.s.A.
Hillary Clinton Monday accused health insurers of lying about the
president's plan in order to protect profits.
Other critics, like Pollack, said the ads are ~~terribly deceptive -- in
some cases outright lies.••
President Clinton's chief health care adviser, :Ira Magaziner, called it
~'unconscionable•• for the insurance industry to promote the idea in their ads
that the Clinton plan would restrict choice of doctors or health care
coverage.
~~They are raising this choice issue where it is really the health
insurance practices in this country that have limited the choices of millions
of Americans,•• he said in a speech to employees of the Veterans• Affairs
medical system.
But Dave Hurd, chairman of the Health :Insurance Association of America,
which has spent more than $50 million on a television and radio advertising
blitz, was adamant Tuesday that the ads will not be pulled.
'~There isn't any specific consideration to a moratorium on the ads in
response to the statements the White House is making,'' Hurd told Reuters.
But that may not be the majority opinion within the trade group.
Seymour Sternberg of New York Life :Insurance Co, a key player in the
trade group, said he believed the lobbying group should consider a moratorium.
''We really have to re-evaluate how we communicate our strategy,••
sternberg said.
''The really sad thing is there is a lot of common ground between what
the president is proposing and what we would like to see done,•• he said.
~'But time and again the White House has rebuffed our efforts to form a
friendly, cordial working relationship.
'':It may well be that these ads are not accomplishing what we would
like, 1 1 he said.
:In September a two-week moratorium was declared on the advertising
campaign in hopes the White House would be more willing to entertain
suggestions from the health insurers.
''For a time back in September we decided to stop the ads because they
were upsetting people, but that didn't seem to change their attitude and it
was a short-lived moratorium,•• said Charles Kahn, executive vice president of
the Health :Insurance Association of America.
The association represents about 300 health insurance companies.
But five of the largest u.s. health insurers disagreed so thoroughly with
�the association's strateqies that they renounced their membership and formed
their own alliance.
Gary Fender of Aetna Life & Casualty Co, one of the five dissidents, said
his qroup has ''differences of opinion about how to enqaqe .in the health care
reform debate •. • •
For the most part, officials of the dissentinq companies were unwillinq
to be quoted on their differences of opinion with·other companies.
It is that professional courtesy that critics say helps fuel public
disdain for insurance companies.
''Those companies that disaqree with the advertisinq campaiqn are not
beinq very vocal about their opposition,•• Pollack said. ''In fact they are
beinq deafeninqly quiet.••
''The public has such a low esteem of insurers that even members of
Conqress say 'thank God for the insurance industry because they qet even lower
points on popularity polls than we do','' Pollack said.
REUTER
**** filed by:RB--(--)
on 11/02/93 at 16:33EST ****
**** printed by:WHPR(MMIL) on 11/03/93 at 08:35EST ****
�·ac-NEWSCONF-FOLEY-MITCHELL SKED
.THE REUTER TRANSCRIPT REPORT
PRESS CONFERENCE
CONCERNING HEALTH CARE REFORM
PARTICIPANTS:
SENATOR GEORGE MITCHELL (D-ME), SENATE MAJORITY LEADER
REPRESENTATIVE THOMAS FOLEY (D-WA), SPEAKER OF THE HOUSE
REPRESENTATIVE RICHARD GEPHARDT (D-MO), HOUSE MAJORITY LEADER
SENATE RADIO AND TELEVISION GALLERY
WASHINGTON, DC
THURSDAY, SEPTEMBER 9, 1993
.STX
TRANSCRIPT BY: FEDERAL NEWS SERVICE
620 NATIONAL PRESS BUILDING
WASHINGTON, DC 20045
FEDERAL NEWS SERVICE IS A PRIVATE FIRM AND IS NOT AFFILIATED WITH THE
FEDERAL GOVERNMENT.
COPYRIGHT 1993 BY FEDERAL INFORMATION SYSTEMS CORPORATION, WASHINGTON, DC
20045, USA. NO PORTION OF THIS TRANSCRIPT MAY BE COPIED, SOLD, OR
RETRANSMITTED WITHOUT THE WRITTEN AUTHORITY OF FEDERAL INFORMATION SYSTEMS
CORPORATION.
TO RECEIVE STATE, WHITE HOUSE, DEFENSE, BACKGROUND AND OTHER
BRIEFINGS AND SPEECHES BY WIRE SOON AFTER THEY END, PLEASE CALL
CORTES RANDELL AT 202-347-1400.
COPYRIGHT IS NOT CLAIMED AS TO ANY PART OF THE ORIGINAL WORK PREPARED BY A
UNITED STATES GOVERNMENT OFFICER OR EMPLOYEE AS A PART OF THAT PERSON'S
OFFICIAL DUTIES. -SPEAKER FOLEY: As you know, we•ve just concluded a meeting with a number
of members who are responsible for major health-care jurisdiction and Mrs.
Clinton and Secretary Shalala and others. Incidentally, at this meeting it
was agreed that the president will come to the Capitol on the 22nd of
September to address a joint session of the Congress, and I will a write a
formal letter of invitation to the president today which will be delivered at
the White House on my behalf and that of Senator Mitchell and the House and
Senate leadership for inviting the president for that purpose.
Q
Nine p.m. as usual?
SPEAKER FOLEY: I assume so. Nine p.m. has been generally the
those
details are usually confirmed at the more proximate time, but I assume it
will be 9:00 •
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FOLEY,MITCHELL,GEPHARDT
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Q
PAGE 2 09/09/93
So what happened? (Laughter.)
SPEAKER FOLEY: well, we agreed on that. We agreed on a number of other
things, that there will be an enlarged process of consultation with the
�staffs and the members on both the Republican and Democratic side as we move
toward the date of the 22nd. There was an active solicitation of comment and
contribution made by Mrs. Clinton as people examine the details of the
program. The -- she made -- Mrs. Clinton made a very impressive overview -she always does -- of the work that•s been done in preparing this plan, of
the numbers of consultations with people in the private sector, with hundreds
of members of the Congress in the House and the Senate, and the detail with
which the plan has been designed and presents a balanced and comprehensive
program, which she was emphasizing was not one that they did not want to
encourage comment and contribution on from the members, but that it was a
program that had been presented as a coordinated whole, that it had been
developed that way, and that it would provide enormous opportunities for
Americans to receive health care that will be sustainable and, in effect,
guaranteed for the future.
Q Congressman Foley, it sounds so easy, but in reality where•s the money
going to come from? And are you going to be able to convince small businesses
to -- that a mandate -- (inaudible)?
SPEAKER FOLEY: Well, I'm going to let some others comment, but let me
just say that I think the plan will be a positive benefit to innumerable
small business firms and that they will be receiving, under the plan,
assistance in meeting those health-care premium requirements and that many
firms will have that burden eased and that the plan needs to be understood in
that way.
SEN. MITCHELL: If I could just make a comment on that. I don•t think it•s
intended to make it sound easy, because it isn•t an easy problem and it will
not be an easy task to gain enactment of a comprehensive solution to the
problem. But I think, speaking for myself, and I believe for all of the
participants this morning, we•re very much encouraged by the substance of
what we•ve heard so far. We are also encouraged by the obvious willingness of
the administration, it having reached preliminary conclusions to consult with
members of Congress in a genuine give-and-take, and I 1 m quite certain that
the plan which the president presents on September 22nd will not be identical
to that which has been reached in a preliminary fashion now. That is,
there 1 ll be some adjustments made reflecting the concerns and comments and
suggestions of members of Congress, we and many others.
Finally, with respect to small business, I believe you will find that the
overwhelming majority of small businesses will benefit from this plan. Those
who are already providing insurance to their employees will find it
,specifically beneficial in that their costs for health insurance will
probably go down for the most part because of the assistance to small
business offered in the plan, and those who
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FOLEY,MITCHELL,GEPHARDT
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PAGE 3 09/09/93
are not now providing insurance, almost all of whom very much want to do so,
will find that this offers the best opportunity to do so, to meet·what they
want to provide to their employees. So I think you•re going to find a very
gooQ and positive response in that regard.
Q Will one of those adjustments be the Medicare numbers? we•ve heard all
kinds of numbers that are, oh, there may be $200 billion in cuts between
sometime now and sometime in the next century. Is that going to happen? Is
that going to fly?
�SEN. MITCHELL: First, it's important to understand the terms being used.
You used the word ''$200 billion in cuts.'' To the average American, a cut
spending less in the future than is now being spent. That is not being
proposed. What is being proposed is that the rate of increase in Medicare
will be less than would otherwise be the case. Medicare spending will rise
Medicaid spending will rise, reflecting the increase in the population, th~
lengthening of the life span, and the rising costs of health care. The
question is whether those costs can be controlled in a reasonable way, and I
believe they can be.
Secondly, the overall objective of this plan is to bring down the cost of
health care so that the increases that have been occurring will not be as -~
will not be repeated in the future and will be less. As you bring down the
overall costs, you bring down the costs for Medicare and Medicaid, which
represents 40 percent of all health-care costs in the country. You can
actually get the same level of service at a cost that is less than would
otherwise be the case. That's going to be a major part of the savings •.
Third, there are some policy changes
bring those down.
w~ich
ought to be made which will
So the answer to your question is, yes, savings can be made, savings must
be made, and savings will be made in Medicare and Medicaid.
Q Congressman Gephardt, do you think it is politically feasible to
squeeze nearly $240 billion out of Medicare and Medicaid?
REP. GEPHARDT: Again, I think your terms may not be entirely accurate.
There's not an attempt here to squeeze something out
�·sc-NEWSCONF-FOLEY-MITCHELL lSTADD
.THE REUTER TRANSCRIPT REPORT
FOLEY,MITCHELL,GEPHARDT PAGE 4 09/09/93
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X X X
Medicaid.
The effort, as the president said in his budget speech, is for the first
time to be able to hold down on the increases in cost of the entire health
care system so that we can get the same effect in Medicare and Medicaid,
something that everyone wants to do because the truth is nobody, no matter
how wealthy you are, today can afford the kind of increases in health costs
we're seeing across the board. If I -- and this is -Q (Off mike) -- in other words, we -- but if it's politically feasible to
talk about --
REP. GEPHARDT:
Q
Yes.
(Off mike) -- cost control.
REP. GEPHARDT: Well, understand, health care costs in this country have
been going up at 20, and in some areas, 30 percent
a year. so if you can hold them down near the rate of inflation or the rise
in the gross national product, you have a real chance to bring health care
costs back to the real world, which is what this whole plan in part is
designed to do.
Let me add one other thing. There was a lot of enthusiasm in this meeting
among the members, as much as I've ever seen in the time that I've been here,
about the prospects for this plan and about the plan, and about the
attractiveness of the plan. And it's for two reasons: one, people see that
we do have a chance here to begin to hold down the cost, to moderate the c9st
increases so that Americans can afford to have health care. Secondly, there
is a real prospect here of passing a universal health care plan that ensures
every American family the confidence and the peace of mind and the security
that they're going to have health insurance no matter what. And that is a
very attractive thing for people -SEN. MITCHELL: I'd like to make one further comment on that point. The
question deals with only a part of the plan, and that's the problem with
viewing a comprehensive plan by selecting one item out and not looking at the
whole. Let's take specifically the beneficiaries under Medicare about whom
the question is concerned. In this plan, those persons will receive
prescription drug coverage and long-term care coverage, which they do not now
have, in amounts which will exceed the reductions in Medicare and Medicaid as
previously defined. And so when you ask about one part of it and not the
other part, .it creates a misleading impression •
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FOLEY,MITCHELL,GEPHARDT
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PAGE 5 09/09/93
If I take eight dollars out of your left pocket and put ten dollars into
your right pocket, are you better off or worse off than you were before? Your
question is what about this eight dollars, and doesn't take into account the
ten dollars. Look at the overall plan ana don't just look at one part, and
�you will see this will be enormously beneficial to all Americans, including
Medicare and Medicaid beneficiaries specifically.
(Cross talk.)
Q The beneficiaries of Medicare and Medicaid argue that they enjoy a
special medical care status in the United states that they might lose
special status -- under the program. That's one of the objections
(inaudible due to background noise) -- how do you answer that?
this
SEN. MITCHELL: Medicare will continue, so the answer is -- the
implication of the question is erroneous. Medicaid will not continue. I have
never heard a Medicaid recipient make the statement you just made, and I've
met with thousands of them. So the fact of the matter is the problem we have
now is that the Medicaid system is not functioning effectively, does not meet
the needs of persons who would otherwise be eligible for it or should be
eligible for it, and this will replace a system that is not working and
functioning, not meeting the needs of people who should be eligible with a
.comprehensive system that will give them a better, more consistent package
of benefits that will be available to them no matter where they go, no
matter what job they have or don't have.
Q (Off mike) -- follow-up, on Medicare, which is where most of the outcry
is coming, and I suspect that you've heard statements to that effect from
them, what are you going to do to dissuade
SEN. MITCHELL: No, no, we haven't heard that -- we've heard that from a
few members of Congress, that's all.
REP. FOLEY:
I think it's a misnomer to say there's an outcry.
Q senator Mitchell, in putting this package together, do you think the ·
administration has consulted thoroughly enough with the Republicans? And what
are you going to do next to get them on board?
SEN. MITCHELL: I have not been in the Congress for a long time when
measured against many of my colleagues, but in the time that I have been
here, I have never seen a more extensive, thorough process of consultation
with members of Congress of both parties in the preparation of a legislative
plan by an administration.
MORE
�"BC-NEWSCONF-FOLEY-MITCHELL 2NDADD
"THE REUTER TRANSCRIPT REPORT
FOLEY,MITCHELL,GEPHARDT PAGE 6 09/09/93
.STX
x x x administration.
It has truly been extraordinary. There have been hundreds and hundreds of
meetings. Members of congress have been consulted from dawn till dusk, day by
day, and Republican members of Congress have specifically been sought out by
the administration for consultation. It has been extensive, it's been in good
faith, it will continue. And Mrs. Clinton made very clear today, in the
meeting we just had, she intends this to be a good faith, continuing
consultation with Republicans. They're going to be included right from the
start. This is not asking anyone to be on board at the landing without being
on at the takeoff; they're going to be involved right from the takeoff. Many
of the proposals included in the plan have been recommended by Republicans in
the past and in this process. Perhaps others will be included. This is a
good faith effort.
We want, we need, and believe we will have bipartisan support for this
plan.
Q Yes, but Senator Dole has not been quite as magnanimous in his
assessment.
SEN. MITCHELL: I take that to be a statement as opposed to
a question, and I accept your statement. (Laughter.)
Q (Off mike) -- impression floating around here that this plan will
somehow pay for itself -- (inaudible due to background noise) -- what level
of taxation on cigarettes and alcohol and other taxes are going to be
palatable to the House and the Senate that will get this package through?
SEN. MITCHELL': I cannot tell you what level of taxation is or is not
palatable in the Senate. I can tell you from past experience that no level of
taxation is desirable in the Senate, and -- but I think there is a very
strong desire on the part of the members of the Senate to deal with what is
one of the most serious problems confronting every American family, and
·
therefore there will be a willingness to accept some level -- and I cannot
define it in advance -- to adopt a comprehensive plan which deals effectively
with that serious problem.
Q
congressman Gephardt, are you -- (off mike)?
REP. GEPHARDT: I'm not enthusiastic about that, but there -- you know the
discussion that's gone on about so-called other taxes -- sin taxes, some call
them. There obviously is the need for some additional revenue in this plan.
It has not been finally decided how
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FOLEY,MITCHELL,GEPHAR~
PAGE 7 09/09/93
.STX
to achieve that, and I'm sure that even after the administration proposes
the bill, it will get full and active discussion in the Congress •. That's the
way it should be.
�STAFF(?):
Q
We'll take one last question.
Senator, just for a point of clarification
REP. GEPHARDT (?):
table.
Everything's on the table
everything is on the
Q Just a point of clarification -- you said a few minutes ago that
Medicaid, in effect, was going to end. Does that include the portion of
Medicaid that pays for long-term care, nursing home care?
SEN. MITCHELL:
Q
No.
You're just talking about the welfare.
Q Senator, the administration yesterday said it would be difficult to
achieve final passage by Christmas. Is there any time line on passage?
REP. FOLEY: Well, this Congress, we're expecting that it will be passed
in this Congress. My views are perhaps well known to the press. I don't think
it's feasible or desirable to set some artificial date that we'll have
passage. I think it has to be fully considered in the House and the Senate.
There's a consensus that it will not be done finally this year, but a very
strong consensus that it will be done in this Congress.
SEN. MITCHELL:
Thank you all.
Q (Off mike) -- no decision has yet been made, but what are the levels of
additional taxes that you were talking about assuming the necessary -- (off
mike)?
REP. FOLEY: Well, the final numbers are being discussed now, and I think
it would be premature -Q
(Off mike) -- a range or some idea, a ballpark figure?
SEN. MITCHELL:
From zero up. (Laughter.)
Thank you all.
Q Regarding the schedule on NAFTA --
REP. FOLEY: Well, this press conference was called, frankly, for the
purpose of discussing
(Cross talk.)
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FOLEY,MITCHELL,GEPHARDT
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PAGE 8 09/09/93
Q (Off mike) -- schedule health care and NAFTA and reinventing
government? How will all of this be taken care of in --
REP. FOLEY: Well, I mean, there's -- we have an undertaking to proceed
with health, we're going to proceed with the.reinvention of government
proposals of the vice president. These -- we don't stop and do only one
thing.
�Now, you know, we said earlier that we thought the budget process was so
universal an attention of the Congress, in both the House and the senate,
that it would be unwise to bring the health care plan forward while that was
being concluded. But we expect to make progress on all of these issues in the
same period here, but not all of them will be passed this year. Obviously, as
we say -- (we say ?) health care will not.
Q (Off mike) -- what is the likelihood of that not coming up this year -(off mike)?
SEN. MITCHELL:
STAFF:
We expect it to come up and pass this year.
Thank you.
REP. FOLEY: What I stated earlier in my own press conference was that,
you know, it is a possibility -- not a probability, as I said -- a
possibility that NAFTA could in some partial consideration come up next
year, but we have no intention to make that decision. I suggested it would
probably come up this year, and that's the probability that is to me.
STAFF:
TQank you.
SEN. MITCHELL: Yeah, go ahead. The Speaker has got to go. I'll take a
question on another subject. Go ahead.
REP. FOLEY:
Okay.
Q What's your general reaction to the agreement in the Middle East, and
will congress provide the money required to support it?
·
SEN. MITCHELL: There is strong and enthusiastic support for the progress
that's being made in the Middle East. It's premature for me now to speculate
on what amounts of money are necessary and what the reaction will be, but I
do know at the joint congressional leadership meeting with the president
yesterday, he briefed us on the subject, and while there was not extensive
discussion about it, it is my impression that there is good and strong support
-- bipartisan among members of both houses for the process that's now underway.
Q And you're confident, then, that congress will come up with whatever
funds are required?
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PAGE 9 09/09/93
SEN. MITCHELL: Well, I -- (chuckles) -- I don't know whatever funds are
reqUired, so we have to wait and see •. But there is good support for the
process.
Q Do you expect more debate this year, or will it slip over until next
year, like on the legislation itself?
SEN. MITCHELL:
On the
Q on the health care.
~egislation
on --
�THE WHITE H•
Office of the Press
September 17, 1993
For Immediate Release
PRESS BRIEFING ON HEALTH CARE
BY
TIM HILL, JOHN SILVA, RICK KRONICK, AND LYNN MARGHERIO
The Briefing Room
2:55 P.M. EDT
MS. MYERS: The following is an ON-THE-RECORD briefing.
The topic is administrative simplification. No mult? No mult.
Alright, I will continue with this riveting introduction while you
quys fix the technical problems.
Tim Hill, who is health policy analyst at HHS will give
an overview. He's chair of the administrative simplification group
on the task force. John Silva, a practicing physician in DOD
specializing in information technology. Rick Kronick, Senior Health
Analyst, advising the administration; and Lynn Margherio, Senior
Policy Analyst for the Domestic Policy Council will be available for
questions. so without further ado.
MR. HILL: Good afternoon. My name is Tim Hill. I work
for the Health care Financing Administration. We run the Medicare
and Medicaid program. We've been working on the task force for about
the last six months, putting together a proposal for the President to
help us cut through some of the paperwork and administrative burden
that we're faced with here in the health care system.
I want to start off by saying thank you for putting this
on camera. We're all kind of wet; it's nice to have the lights and
dry us o·ff a bit.
Q
We're glad to serve.
MR. HILL: This is -- it's wonderful. We're focusing
here on the administrative simplification part of the President's
health care plan on reducing confusion for consumers, freeing up care
providers -- doctors, nurses, alternative practitioners -- to provide
care, not to be performing administrative tasks, and to reduce some
of the, or most of the confusion and complexity with respect to what
providers have to face to get reimbursed for health care services.
Q
Why don't you do it for Medicare right-now?
MR. HILL: We've taken a long, hard look at where the
government fits in. We recognize that Medicare and Medicaid and the
other government programs are, in effect, part of the problem and
they will be included in the simplification measures we're going to
talk about. As a matter of fact, there's been consideration given to
the fact that Medicare can start things earlier than the rest of the
plan just because it's authorized already.
I want to talk a little bit about how we got to where we
are and the problem that we're trying to solve. What we have now
with respect to reimbursement is the federal government and private
insurers setting up elaborate rules and requirements for providers to
follow in order to get reimbursed for health care services.
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These providers must follow and keep track of all the
various requirements and differences among health care plans in order
to get reimbursed. They have to hire staffs and have clerks to
insure that they know what health plan A and Medicare and Medicaid
all require with respect to information before they can get paid.
What were once small back offices have grown into huge
utilization review offices coding medical records and billing
departments. They spend countless hours determining whether an
individual has health care coverage, which company is the primary
payor, what services are covered, what codes to use, and how much to
charge.
What we've sort of come up with to address this issue
with respect to the health care plan are a number of very broad sort
of initiatives that we hope, taken together, will bring us to a
situation where a lot of the administrative burden is going to go
away. First and foremost, every American is going to get coverage.
Guaranteed universal coverage will virtually eliminate the hassle of
determining and tracking coverage for providers. Providers will no
longer be saddled with the problem of determining whether or not any
individual patient has health care coverage and finding that person.
The introduction of a standard comprehensive benefit
package will eliminate the needs for providers to go back and forth
with health insurance plans and the government trying to understand
whether or not a procedure is covered, and at what level it's
covered, and how it will be paid.
Under reform, covered services do not vary from plan to
plan and standard costs sharing rules will simplify accounting for
providers. A single standard reimbursement form and standardized
reporting requirements will replace the hundreds of different claim
forms and reporting requirements that exist by insurance companies
today. FUrthermore, promotion of the electronic exchange of this
information will further reduce provider hassle and cost.
A national quality program will be developed that
stresses results over process. We're going to get utilization review
firms and the government out of the back offices of doctors, and
allow them to provide care without worrying about punitive responses
to potential quality problems. We'll focus on education and results.
Furthermore, the regulation of clinical lab testing will
be refocused to emphasize quality protection and reduce
administrative burden on providers. A coordinated inspection process
for facilities will replace the multiple inspection processes that
currently exist in hospitals and doctor offices.
And finally, the Medicare program will be simplified and
streamlined with respect to its reimbursement claims and
certification processes. Specific reforms under Medicare and all the
government programs are aimed at rebuilding the trust between
hospitals, doctors, patients, and the federal government.
John Silva will now sort of talk a little more
specifically about some of the things that I've mentioned.
MR. SILVA: Thank you, Tim. I'm John Silva, I'm a
physician in the Department of Defense and specialize in information
technology. And what I thought I'd like to do is give you a brief
synopsis of many of the individuals that we talked to and interviewed
and had come to Washington to present their case to us as we put the
framework together for administration simplification.
This morriing you heard Dr. Beard complain about the
amount of time that she spends in filling out all of the paperwork.
Nurses, consumers, patients -- one hospital vendor told us that it
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cost him $5 million a year just to build the tables and files for all
of the different changes in all of the various forms that go on.
So our administrative simplification program really
looked at articulating standards that would be uniform across the
country. Of all of the vendors, all of the individuals that we
talked with over the last six months, have clearly indicated that
when we asked them, what would you like the government to do for you,
they all said, please establish some standard that we can all build
towards, that we can use, recognizing that that's the beginning of a
long process.
So standardized forms, standardized clinical encounters,
standardized insurance reimbursement forms, that permits the
automation of those insurance transactions and the resultant
reduction in administrative overhead costs. It will also allow us to
simplify coordination of benefits, and you'll see that in our
administrative simplification part of the plan.
Lastly, it will also enable us to work towards building
a unique identification for consumers, for physicians, for plans and
alliances, and for employers so that the 150 or so different places
and different identifiers that make if very difficult today will be
by the board.
I think that the key issue from an information
technology perspective is the standardization of the information
contained within those forms. That's going to permit us to be able
to go across the country and do a lot of the analysis that Tim talked
to you about earlier. And I think we'll be glad to answer your
questions.
computers?
Q
Are you going to be using the Social
Is that the
Securi~y
MR. SILVA: The question is regarding the unique
identification number. The Social security number has been one that
has been proposed. we believe that a public-private forum really
needs to be established to identify all the pluses and the minuses
for using that particular number.
Now, whether it's the Social Security number or yet
another number that's created specifically for that purpose -Q
I don't mean the number, I mean the computers -- a
system that's already set up basically that touches every American.
MR. SILVA:
Yes.
Tim, do you want to --
MR. HILL: I think it's unclear exactly how we're going
to identify all the Americans with respect to getting a unique number
and understanding where folks reside. But clearly the Social
security Administration is one place where that information resides
and where we'll be able to use as a base to understand who are
exactly the folks that need to be covered.
Q
Will alien immigrants get a card?
MR. HILL:
Q
No.
Alien residents?
I mean legal residents, is what I
meant.
MR. SILVA:
Q
Yes.
They will get it.
MR. SILVA:
Yes.
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Q
Is this a reform that you put in place regardless
of what happens with the rest of the President's package?
MR. HILL:
Absolutely.
Q
so, if the Congress wanted to go to more
incremental kind of changes in the health care system, this is one of
.the things they could do--
MR. KRONICK: My name is Rick Kronick. Parts of the
reform, certainly the single claims form could be done without
universal coverage, but some of the savings come from eliminating the
need for wallet biopsies when we walk into provider offices. And
those savings will only come with universal coverage. And that's a
very significant cost for many providers.
Some of the savings come from standardized benefit
package,. not needing to check the policy that each of us have to see
whether a particular service is covered. And that will only come
when all Americans have a guaranteed benefit package.
So some of the streamlined reimbursement single claims
form could come in the absence of broader changes, but significant
parts of the savings are dependent on the rest of the package.
Q
My understanding, the previous administration,
under Secretary Sullivan, launched a project to get the industry -the insurance industry to come together on standardized claim forms
and simplified forms. And the industry seems to think that they're
pretty far along on that. Why do we need to write this into
legislation?
MR. HILL: I don't think we're going to write anything
into legislation that is going to be contrary to what the industry
agrees on, both industry -- public-private partnership, which is what
was started under the previous administration. But I think there is
a need to ensure that what is developed is, in fact, used so that
we're not in a situation in 10 years where we've developed a standard
and nobody's using it. So the progress that's been made to date
won't be thrown aside just for the sake of putting something into
legislation.
Q
These are waste figures. Our administrative
paperwork waste figures seem to run all over the lot from 10 percent
to 20 percent, from $40 billion to $100 billion. Can you clarify
that for us?
MR. KRONICK: Only to some extent. They do run all over
the lot. And one person's administrative waste is another person's
unnecessary information gathering. But I'll try to help you some.
One area where I think the savings figures are clearest
is probably in the administration of insurance policies. Right now
small group and nongroup insuranQe policies are often sold with
administrative overheads of up to 40 percent with averages probably
close to 30 percent. But a large employer -- when a large employer
buys insurance, is often paying in the five to eight percent range
for the administrative costs of processing insurance. And there will
be significant savings as small employers are pooled together and the
costs of insurance for them are closer to the costs for large
employers today.
.
on the administrative costs of providers -- of hospitals
and physicians, you're right; the estimates are all over the lot.
You see some estimates as high as 25 percent of all the costs in
hospitals and physicians' offices are administrative costs and that
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you might have very large reductions in that as the system is
simplified.
our own estimates are, like many others have a broad
range. · And at the low end of the range would probably be at least
$10 billion of savings -- reductions in administrative costs in
physicians• and hospital offices. And, as I say, I think those are
quite conservative. Many other people would estimate much, much
higher savings as possible.
Q
That's for all of the ohanges, not just the single
uniform standard form?
MR. KRONICK:
That's right.
MS. MARGHERIO: I'd like to just point out an example
from Children's Hospital. They actually went through the process of
determining how much could be saved under the reforms that the
administration is talking about implementing. And they estimated
that patient-related administrative costs in their hospital were
about $11 million, and they figured that they could -- they estimated
that they could ~ave about 12 percent just through standardization.
And their estimated costs were $1.2 million.
so these costs vary institution by institution. some of
them depend on how automated the billing processes are, how many.
insurers they work with. So there is a broad range of estimates out
there.
Q
Could you all elaborate on what -- how this would
affect Medicare beneficiaries? Somebody mentioned that it would
affect people more quickly if they were in Medicare.
MR. HILL: Well, to the extent that there's
standardization and a lot of the confusion is eliminated, it will be
a boon to Medicare beneficiaries. We don't anticipate -- and, in
fact, an explicit sort of goal of the plan is not to make things
worse for folks. We're up here trying to make things a little
better. So, as I pointed out before, all the reforms that have are
going to·be part of the total package will apply to Medicare as well.
So I -.
Q
You said -- I thought you said it oould affect them
more quickly or something like that.
MR. HILL: Well, to the extent that Medica.re is a
program that already exists and we don't need a law to create it, to
those things that we could do administratively I think we're going to
try and move to do administratively.
Q
What have you learned from Medicare in addition to
-- is this the bureaucracy and the overweight and the --
MR. HILL: Well, the one thing that we've learned from
Medicare that I think is a good thing is on the standardization and
the automation side. The Medicare program is far and away ahead of
most of the private insurance with respect to submitting claims
electronically and exchanging information in an automated standard
fashion, and have -- save just tremendous amounts of money on their
administrative budget. And, clearly, that's something we want to try
and mirror.
Q
You're talking about computerizing --
MS. MARGHERIO: could I add some things to the Medicare
and what we have learned from the experience in Medicare. What we've
found actually is that Medicare is very efficient at the federal
government level. The problem is that a lot of what happens -MORE
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nurses -- the time that nurses spend filling out forms, the time that
doctors spend filling out forms -- those are a lot of costs that
don't get captured. And what we're going to be doing through
requiring -- through having Medicare go through this same
standardization with the same forms, the same rules as the private
insurers-- we expect that that's going to streamline·things
tremendously.
We are also having -- we're reviewing the cost reporting
process for-- the reconciliation·process that hospitals have to go.
through. They've got to look at how much they billed for inpatients,
how much they billed for outpatients. And it's a very elaborate
process. So we are going through and we're having a group of outside
advisors as well as -- it's an interdepartmental group -- look at how
we can streamline that process.
As far as what the consumers see, today there is a
problem -- I mean, consumers have to figure out and doctors get
involved in sort of the back and forth. Well, who's the primary
payor, who's the secondary payor. And we're going to do all that for
the patients behind the scenes. so they don't have to get involved
in figuring out am I covered under this program? Am I covered under
that program? How much do I have to pay? And it's going to be very
-- they're not going to have as many bills.to look through, to wade
through, and as much fine print as they do today under the current
system.
Q
A lot of the costs, or a lot of the forms that
people have to fill out today are not just from health insurers, per
se, but also from consultants and people like that who are asking
doctors to verify that procedures are necessary and so forth. And
that seems to be like the growth field in terms of document
production these days. What does your plan do to that kind of health
forms, or does it affect it at all? Because those forms are actually
aimed at reducing costs, so don't you lose some control?
MR. HILL: I understand what you're getting at and we
agree that a lot of what providers complain about with respect to the
forms is not the claim, it's what the insurance company or the
utilization review firm requires after the claim has been submitted.
But as an underlying premise, we sort of assert that a lot of the
information that is required could be made standard and that there is
no reason that utilization review firm A and self-pay plan B has to
require two wholly separate sets of things to pay for the same
procedure.
Some plans require that you submit the whole medical
record after a claim. Other plans require that you've just got the
emergency room notes. And so while there is a need -- and that the
use of that information is to control benefit costs, the outlay -- we
think we can still do that, not lose control of how we're controlling
the benefit costs and standardizing information that needs to be
required from providers.
Q
Specifically in Medicare, that's what doctors
complain about -- not that they have to fill out forms,. but they have
to spend hours playing telephone tag with nurses on the -- at the
blue, or whatever the local administrator is, on utilization
review -- pre-certification of conditions. What are you doing to get
that out of the doctor's hair?
MS. MARGHERIO:
Actually, for that, the PRO
Q
Especially if you screw down on. Medicare costs, try
to control volume, and limit fees.
MS. MARGHERIO: What we're doing is we're taking a look
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�- 7 -
driven, very regulatory system. And we're focusing on outcomes and
we're putting together a system -- we're going to be streamlining it
through investments in outcome measures, as well as investments in
effectiveness of different treatments, as well as investments in
practice guidelines and broader dissemination of practice guidelines.
So we believe -- and these will be done in a
standardized way so that insurers, health plans, doctors will have
the same information, so they'll be working off the same kind -they'll have the same information about what the effectiveness of
various treatments are.
We are looking at phasing out the PRO system, which is I
think what you're hearing a lot of the doctors responding to now,
over time. Once the quality system that we're putting in place that
is more consumer-driven -- we're getting consumer surveys, we're
having consumers answer surveys to find out what do they think about
the care that they're receiving7 how long are they waiting in lines7
how quickly are they able to see the doctor that they want to see7
how responsive was the doctor to
or the nurse -- to their
concerns.
And so we're trying to back away from, reevaluate the
processes that we've put in place today and say what can we do to
reduce the administrative burden, the hassle factor for the doctors
and the patients, and put in place a system that both ensures quality
and reduces the administrative burden.
Q
What does PRO stand for?
MS. MARGHERIO:
Peer review organization -- I'm sorry.
MR. KRONICK: Let me add to that, that if you go to the
American Society of Internal Medicine meeting or any ~pecialty
society meeting these days, you'll see usually long presentations on
the hassle factor. And some of the hassle factor is directed at
Medicare, but in many cases, there is as much or more directed at the
private sector -- these myriads of utilization review professionals
looking over the physician's shoulder -- much of which is done at
arm's length in an adversarial kind of fashion, and arguably, much of
which does not do much to improve the quality of care that's
provided.
And in the structure of the reforms we're proposing, we
expect to see a growth of more integrated systems over time in which
the insurers and the providers, while still there are always going to
be some portions of the relationship that are adversarial, but have
more commonality of interests and have more intelligent tools than a
nurse at the other end of a telephone line to try to make sure that
resources are used well.
Q
Briefers earlier this week about the quality system
admitted that it was going to take quite a number of years to phase
in all of the changes. So you're making it sound like you're going
to just walk out the door and we'll have a new form and everything
will get up to speed. How long do you actually anticipate it will
take?
MR. HILL: I think we have to separate out sort of two
sets of issues. On the reimbursement side and the sort of strictly
administrative information that flows between insurance companies and
providers we think we can act fairly quickly to standardize the
information that has to happen. On the quality and sort of retooling
the way we think about how we manage providers and understand
quality, I think that we are looking at something that's a little
more longer-term, but that doesn't mean that we can't begin to
standardize some of what is required. ·
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Q
What does "fairly quickly" mean?
MR. HILL: The quality of information -- I mean, fairly
quickly with respect to the reimbursement? January l, 1995 I think
we can -Q
That's the standardized form?
Q
can you clarify for me -- I got the impression from
what the President said this morning that that single form would
satisfy the needs of Children's Hospital, which he was specifically
talking about it replacing 300 various forms they do. The form looks
to me like a professional's form, not -- it looks more like a 1500
than a uv 92. Could you clarify what he means by single form?
MR. HILL: We need to be real specific. The form that
we saw this morning and I think that most of you have is a prototype
and is used to sort of illustrate how things could look. What will
happen on January 1, 1995, as we currently envision it is that the
two forms for reimbursement that are out there now -- the HCFA 1500
for physicians and the UV 82, soon to be 92, for hospitals -- will be
mandated to be used by all health insurers, and mandated to be used
in a standard way.
·
Q
That's two forms, not one.
MR. HILL:
Q
It is two forms, but it is -- I agree
Vastly different forms.
MR. HILL:
settings as well.
Well, and they're used in vastly different
Q
The President talked about this form, which was
essentially a professional form, in an institutional setting, which
it will never be used in.
MR. HILL: I don't think that that's entirely accurate,
because what -- the plan is, January l, as soon as we can, we
standardize, the National Health Board begins to evaluate and
understand exactly what would be needed on an encounter-by-encounter
basis, and then in an out-year, which I'm not qUite sure of yet, one
standard set of information, whether it be a paper form or an
electronic transaction, will be mandated and in use by all actors.
And what's on the 1500 and what's on the UB 8292, while
it looks different are, in fact, similar sorts of questions.
Q
The goal is
Two forms, right?
MR. HILL:
Initially.
In January l,
1
95, initially.
Q
Ana what about the third form for dentists and the
fourth form for pharmacists?
MR. HILL:
and for pharmacists.
The 1500 we envision being used for dentists
Q
So that's three, and then a fourth form was drawn
up by the pharmaceutical people.
MR. HILL:
That's two.
MR. KRONICK:
types?
Q
That's the 1500
For dentists.
1500 for dentists, this for professionals of other
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MR. HILL: No.
future would evolve once --
That's a prototype what we view in the
Q
And what about the pharmacy form? Is that going to
be a fourth form? The plan draft referred to all four. Now, the
1500's been for a number of years --
·MR. SILVA: I think the issue here is, the President was
referring to clinical .encounter forms, the things that drive docs and
everyone really crazy. Because, although there is just one form, as
Tim described earlier, there are many, many rules depending on who is
your insurer, what plan you're in. The goal was to simplify that to
one form for inpatient institutions and one form for outpatient
encounters.
·
MS. MARGHERIO:That all providers.will .use and all health
pians will accept. That's what he was -Q
one form, okay.
Q
The health plan allows for supplemental
coverages-- correct me if I'm wrong, but both within the HPIC, i.e.,
your health plan can offer you a slightly richer package of benefits
if they want above the standard, or you can buy a supplemental. How
will those be handled in this standardization?
MR. KRONICK: Most of these supplemental coverages are
not coverages that are going to affect the hospital or physician when
the patient comes in and needs treatment, so that the statements that
we've been making that say when you go into a physician's office, the
physician doesn't need to spend, or the nurse at .the front desk
doesn't need to spend time looking through your policy book to see
whether you're covered, is an accurate statement. If there is
supplemental coverage for eyeglasses, for example, that's a kind of
separate issue, really.
Q
If I buy copay coverage? Say I want hospital copay.
I'm not going to be paying that out of my pocket, as I would under
this system? That's another something for the hospital to deal with.
MR. KRONICK: Right. But there will be a
standardization of information on our insurance card as we go through
the door. so that's a very simple piece of information to get.
MS. MARGHERIO:· And there are only two supplemental
insurance policies that will be available, and they'll be
standardized. so it's not like we're talking about hundreds of
different supplements -- all insurance policies that are available.
We're talking about two.
Q
can I ask just a clarification of something that
was said before? The story today that we're doing is on the
paperwork savings. There was a figure in the handout that we got:
"health care administration costs exceed $100 billion each year."
Now, where do you get that statistic? And, also, what do you
estimate would be the savings under the new regime, when you have
your new plan?
MS. HEENAN: We've got asked that question this morning.
We're looking into where Washington Monthly got that figure. That's
where we pulled that from. These are all statistics we've pulled
from other sources. So we'll give you the source if you call the
press office later today on where the $100 billion figure comes from.
There have been a lot of studies that documented as they said, all
over the map. We'll get you the exact source of this study.
Q
Well, when you mention a figure of saving at least
$10 billion, though, then how do you get that?
�- 10 -
MR. KRONICK: That's an estimate, as I say, a quite
conservative estimate that on the hospital side, starts by looking at
the costs in patient accounting and admitting functions, as reported
in survey data that the AHA collects, the annual AHA panel survey.
And making an estimate of the percentage of those costs that would be
reduced with streamline administration and universal coverage. And,
as I say, an estimate that's conservative, many people would argue
that the estimate should be larger.
on the physician side, it comes again from estimating
function by function using data from an AMA socioeconomic survey of
physician offices that's done every year to look at the costs that
.physicians attribute to each function in their office, and making
some estimate of the percentage of the costs that would be reduced in
each functional area. And these estimates are -- a variety of
analysts have tried to make these estimates. We don't know for sure,
as in many other areas of health care, we've tried to err on the
conservative side of estimates from other analysts, such as the
congressional Budget Office, VHI and others.
I should also say that those estimates don't include any
estimates for an area, even though they mentioned earlier, we expect
very large savings, and that's from reduction in the administrative
overhead as we move from the high loads that are paid by small groups
now in the direction of much lower administrative loads that are paid
by large employer groups today.
Q
Could you quickly tell us what the denominator is
that gives you 20 percent, that indicates a $500-billion denominator,
which is a lot less than total health spending?
MR. KRONICK:
on that later.
On the $100 billion, we'll get back to you
Q
Twenty percent of X? I'm sorry, $100 billion is 20
percent of health spending. Health spending is more like -- a
trillion, which would give you 10 percent. Is the 20 percent wrong,
or is the $100 billion wrong, or what's wrong?
MR. HILL:
Q
We'll give you the base.
We'll get the base.
I mean, it's written.
MR. KRONICK: You're certainly right, that $100 billion
is 20 percent of $500 billion.
THE PRESS:
Thank you.
END
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3:25 P.M. EDT
�THE WHITE HOUSE
Office of the Press Secretary
Sept~er
For Immediate Release
21, 1993
PRESS BRIEFING
BY
DIRECTOR OF COMMUNICATIONS MARK GEARAN,
ASSISTANT '1'0 '1'HE PRESIDENT ON ECONOMIC POLICY BOB RUBIN,·
OMB DIRECTOR LEON PANE'l"l'A,
'l'REASURY DEPU'l'Y SECRETARY ROGER AL'l'MAN,
COUNCIL OF '1'HE ECONOMIC ADVISORY CHAIR LAURA TYSON
The Briefing Room
1:16 P.M. ED'l'
MR. GEARAN: Let me start out with giving you a road map
of what we're about to do today •. We have Bob Rubin
Q
Mark, before you do that could we just get a little
reaction to what's happening_in Russia?
MR. GEARAN. I'm going to do that, yes. Yes.
to do road map, then reaction. It's not alphabetical.
I'm going
Bob Rubin, Leon Panetta, Laura Tyson, and Roger Altman,
who will give a briefing on some of the questions that have been
raised in terms of the financing of the health care system. They
have a limited amount of time, so we 1 11 go to them quickly.
Let me give you just a preliminary on events in Russia.
We are just learning of the events unfolding in Russia ourselves at
this time. We're in the process of getting more information and will
be assessing it as the hours progress. We expect to have a statement
later on in more detail and with more information than we're
·
receiving at this point.
Yeltsin?
Q
So we were not informed before the acti~---·
MR. GEARAN: No. Mr. Pickering was called in with some
of the other foreign ministers in advance of it.
Q
In advance of it?
Q
How far in advance?
MR. GEARAN:
Q
Is that correct?
Soon in advance of it.
It was not --
Well, they're saying in Moscow less than an hour.
MR. GEARAN:
I think that's correct.
Q
What were they informed? 'l'he details .of what
Yeltsin would say, or just that Yeltsin would speak?
·
MR. GEARAN: . They were informed of the speech.
leave it at that.
Q
'l'hat•s about all we can provide.
When was the President informed?
MR. GEARAN:
As
the events were .proceeding.
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Let me
�- 2 -
Q
Mark, what form will the statement be?
MR. GEARAN:
Q
I 'm sorry.
What form will his statement --
MR. GEARAN: We're waitinq to see who will best respond
or how we'll do that -- and whether it will be someone from the White
· House or secretary Christopher will -developments?
Q
Do you know who told the President of these
MR. GEARAN:
Q
The national security staff.
Before or after the National Service event?
MR. GEARAN: It was -- I 1 11 have to ·confirm that. My
understandinq -- I think it was afterwards. Let me confirm that for
you in terms of when he was told.
Bob.
MR. ROBIN: Thank you, Mark. I 1 m Bob Rubin, the
Assistant to the President fo~ Economic Policy. We're qoinq to
discuss the financinq of the health care plan, which seems to be a
subject of some interest. And let me start with a few qeneral
comments, and then we'll qet into the specifics of the financinq.
As was true in the economic plan -- and you heard the
President say this in reference to the economic plan-- he'll say the.
same thinq about the health care plan. From the very beqinninq, be
insisted that we take enormous care with the numbers with respect to
accuracy; that we have accurate, conservative, valid numbers, and
that our policy decisions be based on such numbers so that there will
never be a question about our numbers.
With the economic plan and aqain with the health care
plan, his position was that he's happy to have.all the debates people
want to have about policy, but he does not want to have anybody
validly questioninq the validity of his numbers. And it's on that
with that mandate that these numbers were developed.
There obviously will be a debate -- a national debate on
health care policy, and there will be all kinds of issues. But what
there shouldn't be any debate on is the validity of these numbers.
They were developed with enormous care and enormous carefulness with
respect to makinq sure that we··had numbers that would withstand any
kind of challenqe.
I've been involved in my own career with enormous
numbers of number developinq processes. (Lauqhter.) I quess that
fits toqether. And I can tell you, this was an exhaustive process.
HHS, OMB, Treasury, CEA, actuaries, internal within the qovernment
involved with developinq the numbers. And then there were external
-- accountants and actuaries reviewed the models and reviewed the
development of the numbers.
·
·
I can remember early in the process when there would be
disaqreements and there would be debates about the numbers. And
Ira's position throuqhout it was tha~ we had to have accurate numbers
and then we make our policy· decisions and these differences will
eventually narrowed and brouqht down to numbers that everybody could
aqree on.
itself.
Finally, let me make one more comment on the process,
This was an exhaustive process of debate and discussion. We
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had endless meetings amongst ourselves, and then with the President.
Well, the ones with the President weren't endless, but we had endless
meetings amongst ourselves and a goodly number of very lengthy
meetings with the President. We all the ability to state whatever it
is we wanted to state. There were healthy debates, there were
lengthy debates, there were real differences of opinion just as there
were with the economic plan. The groupings would be different over
each issue. We had one grouping on.one issue, another grouping on ·
.another issue. And out of it all came a plan, as was true in the
economic plan, that all of us felt was a good plan and that realized
the purposes that the President started out with, which was to
develop a way of reducing or eliminating the enormous excess
expenditure, which is I think unquestionable in our health care
system, and then utilize those savings to fund the·realization of his
objectives. And that's what this plan is all about.
With that, let me turn it over to Leon Panetta, who will
get much more involved in the specifics of the numbers.
DIRECTOR PANETTA: Let me again, preface these remarks
by trying to compare a little bit of this to the economic plan. I
mean, the fact is with the economic plan, there were models that were
in place over the years. We had very good estimates about various
proposals, either on the tax side or on the cut side, that have all
been estimated before. There are economic consequences that have
pretty well been estimated. .so we basically had models in place that
made us much more comfortable, obviously, with the numbers that we're
dealing with.
In this instance, we're dealing with an unprecedented
effort at reform of the entire health care system in this country.
And the problem we had from the beginning is obviously.to develop
models that could estimate the impact of that kind of broad reform
with regards to health care. What happens when you suddenly pick up
almost 60 million Americans who are uninsured or under-insured, and
bring them into a health care system? What are the costs of that?
What is the impact on the health area? What are the·behavioral
consequences of bringing people into that kind of system? Then
determining the cost impact, not·only on business, but on employees,
individuals as well as the health industry, as well as the Treasury.
so, obviously, those were the. questions that we had to develop
approaches to if we were going to try to develop the most accurate
numbers that we could develop in the reform plan.
over the last six months, we have basically been
involved in trying to develop that kind of modeling system. We've
had representatives from OMB, from Treasuryr economists who have been
part of that, HHS, the various actuaries that are involved with
health care issues generally have participated in that effort. And
so at the conclusion of that, we tried to develop the most credible
and conservative kind of estimates of the impact of health care
reform as we could. You have to look at again, what -- if you
develop a basic benefit plan, what does that looklike? What are its
impacts? What are the characteristics of the people that we•re
dealing with? What are the households that we're going to be
impacting, employers, employees, and obviously just the whole cost
issues.
·
After six months, ·we believe we•ve developed I think the
most sophisticated models in the business of analyzing health care
costs. They are the best in the business. There aren•t·any others,
really, out there. And that WilS our. problem. But I think that as a
result of the work that we•ve done, we•ve got the best in the
business. And so the estimates that we have here, I believe, are
credible and I believe, again, can be defended when we present the
plan itself to the congress.
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Like the economic plan, I think it's important to
understand that people can question the policies, they can question
the politics. And, obviously, that's a process we're going to go
through after we've presented the plan to the congress and to the
country, and that's legitimate. But if, in fact, we can get all of
these elements passed by the congress, then we believe we can hit
these numbers.
Now, let me speak a little bit about the specific
numbers that we're working with in terms of the elements of the
program and the financing for those elements. Let me begin with a
very important promise here that I think a lot of people are losing
sight of. The most important premise that we're operating with is
that most of the money comes from where the money now comes from to
pay for health care, which is the contribution by employers and
individuals into a premium process to pay for their health care
plans. That process is still there. That premium base is still
there. People who are now paying for health care will continue to
pay health care premiums. So that is a base that's there and that is
going to continue to be funded through the premium process.
With regards to the federal side. of it, let me describe
.what those elements are, because that's where legitimate question can
be asked: how is the federal qovernment then qoinq to pay for those
benefits? Aqain, I want to condition all of this to say that it's
subject to continuinq adjustments. We're still lookinq a~ these
numbers and there will be, I think, minor modifications in the final
numbers that appear in the bill. But riqht now, the numbers that I'm
going to present to you are estimates between largely 1995 and the
year 2000. Some of these numbers basically will ratchet-in,
depending on the particular program that you're lookinq at.
On the new benefits, let me describe the new benefits
that will be part of the program. The new b~nefits include .a lonq~
term health care program for the elderly, and that program larqely
tarqets on home health care, community-based health care for seniors.
The estimate on that is about $80 billion.
Q
over?
DIRECTOR PANETTA:· That is between -- it ratchets in
startinq in I believe 1995 -- 1 96, and qoes to the year 2000.
Q
Is that an annual number?
DIRECTOR PANETTA: That's the total number .for that
period of time and it ratchets in.
Q
Four years? ·
DIRECTOR PANETTA:
Q
Five-year numbers.
Does it start low and grow?
I mean, that.'s --
DIRECTOR PANETTA: Essentially, in this area it ratchets
in and it starts to escalate in terms of the costs.
on the Medicare drug benefit, it's the same over that
period of time. That's about $72 billion. That basically provides
for drug benefits to those on Medicare with a deductible, small
deductible. That's $72 billion.
·
The third piece of it is that there are public health
care investments that are part of this, in which there are targeted
increases, particularly for rural clinics and community clinics that
try to serve those at the low income levels. And there will be about
-- in addition to that piece, there are start-up costs for the basic
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system itself that will come to $29 billion over that period of time.
We will be providing a 100 percent self-employed
deduction for those who pay in, those who are self-employed with
regards to their payments. They'll have a 100 percent deduction.
That costs $9 billion.
And then lastly is the largest portion here, which are
the discounts for subsidies, as they've been called, to businesses
and the employees at the low income level who would qualify. And the
price tag on that is $160 billion. And that's the one, very frankly,
that continues to -- we need to continue to scrub that number,
.because we need to analyze just exactly who's going to receive those
subsidies as we work through the plan. But that's -- $160 billion is
the estimate right now. So that the total cost we're looking at of
the new benefits that will be provided by the federal government are
$350 billion.
Bow do we pay for this in terms of trying to make sure
that each of these is covered? The first area, obviously,·deals with
the two principal health care programs that are the costliest at the
federal level: Medicare and Medicaid. And let me preface this by
saying that, again, all of you know that we're dealing with programs
that, in terms of the federal budget, are escalating at double and
triple the costs. We're looking at taking these programs from
roughly three to four times ~e rate of growth in the economy down to
about two times the rate of growth. So we're basically trying to
reduce the very high level of growth that we're seeing in these
programs.
on Medicare, we're looking at about $124 billion in
savings over that same five-year period. These savings will be
specific. We're not talking about a cap. As you know, there's often
times been a discussion in the Congress about setting some kind of
arbitrary cap with regards to these expenditures. We are going to
present specific proposals to achieve these savings. An example of
some of those proposals would be requirements for additional copays, competitive bidding with regards to medical equipment, some lab
co-insurance requirements. These are proposals that have been in the
mix in terms of the discussions on Medicare savings as long as I've
been involved in the budget process. And we are selecting, we think,
they policies that make sense, both from a substantive point of view
as well as a savings point of view.
The same thing is true on Medicaid, which will be $114
billion in savings over that period of time. Most of that will come
from a reduced cost on the disproportionate share, which is basically
what we now pay hospitals that are the targeted hospitals that serve
an excess number of individuals on Medicaid. We think we obviously
will be able to reduce that disproportionate share provision as a
result of the other elements of health care reform.
The second area is the savings that we hope will flow,
and we were confident will flow from the fact that other federal
programs that serve people, people will be moving gradually into the
health care system itself, into the alliances, and we estimate that
we will get savings from veterans programs, from Department of
Defense programs, and also, obviously, from the federal employee
health programs where we now cover all of those costs, federal
employees will be part of the new health care system. we expect
savings there of about $47 billion.
.
The fourth area of savings relates to our ability to
move away from tax-free benefits, which we now provide in large
measure, obviously, through deductions in which we cover health care
payments. our hope is that obviously as we reduce the cost of those
payments, that not only will we reduce the amount of benefits we have
to provide through the tax system, but in addition, we will incur
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some additional revenues from those who receive profits and
additional wages as a consequence of that. And that's a pretty fair
estimate that we generally use. It's a little bit like looking at a
mortgage deduction, and as you reduce interest rates obviously the
consequence of that is to produce more money to the individual which
then becomes subject, hopefully, to additional taxes flowing to the
federal government.
The estimate there is $51 billion, what we estimate in
that area. And this one that we, again, in terms of our own process
we're trying to nail down with Treasury and with OMB looking at these
numbers continually.
The last area is sin taxes. Sin taxes are approximately
$105 billion. The final decision on the exact elements of that have
not been decided, but -Q
You're kidding.
DIRECTOR PANETTA: Whose kidding? (Laughter.) No, I'm
not kidding. They have not been decided. We're looking obviously at
cigarette taxes, and whether we go beyond that, or how much the
cigarette taxes will be is still being discussed.
Q
How can you come up with $105 billion fiqure
without knowing precisely what is involved?
DIRECTOR PANETTA: Well, there are proposals that are on
the table and we estimate that we have to look at somewhere ·between
$100 billion to $105 billion in order to make these numbers work.
And that's what needs to be done.
Q
How big does the· cigarette tax have to be without
some other kind of taxes in order to come up, with that amount of
money?
DIRECTOR PANETTA: Well, if you're just looking at
cigarette taxes you're probably looking at somewhere around $1 a
pack. But if you were doing less on cigarettes then you've got to
make it up elsewhere.
The total number on that from what we estimate in income
is $441 billion from what I've just described, meeting a cost, as I
said, of about $350 billion, and that is what leads us to a hopedfor deficit reduction of around $91 billion over that period of time.
And that's particularly important from my perspective because I think
I've often arqued that if you're going to get the deficit down
further you've got to be able to get this kind of return on health
care.
Now, let me just conclude by saying that as always, you
know, when you're putting numbers like this together based on the
models that we've developed, the numbers fit just as they did in the
economic plan. But just as what we faced in the economic plan,
obviously, there will be political implications of a continuing
consultation process with the Hill, the concerns that are raised on
Capitol Hill as we go through the process, and that will obviously
require some adjustments as we work through the legislative process.
Secondly, there is going to be a continuing assessment
on the numbers themselves. We are currently in the process, between
OMB and Treasury, over these next two weeks, where we are going to be
scrubbing all of the numbers I've just presented to you. And we do
not expect -- I should make clear -- we do not expect any major
changes from that process, but there may indeed be some adjustments
that will have to be made as we again revisit these numbers.
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I think.the President's goal is to begin this process.
And this is the beginning of the process of the debate on health care
reform in this country. He has presented -- and I think it was his
intention and the First Lady's intention to present a bold plan for
health care reform to the country. But like any smart negotiators we
know that there are going to be bargaining that's going to have to be
done with the Congress. We're going to face a number of special
interests who are going to force us to fight this battle. And our
view is that it's much better to start with a bold approach as we
begin.that process.
DEPUTY SECRE~Y ALTMAN: I'm so happy to be here that
I'm compelled to be brief. Secretary Bentson would have been doing
this instead of me, except that he is in New York, on his way to
speak to the Economic Club of New York tonight.
.
As Leon alluded, Treasury has responsibility for
estimating the revenue issues, the revenue impacts of this plan. The
sin taxes, the revenue effects of the mandate, the self-employed
deduction, and the others. I simply want to say that we're using the
same Treasury estimating model and the same methodology that was used
in the economic plan and that is always used to assess possible
changes in tax policy or legislative initiatives.
We are continuing to scrub these numbers.· It will be a
couple of weeks before we fi~ally finish doing so, together with OMB
and others. There may be some moderate changes before the final
details are released. But I'm confident that the numbers we do
release will withstand the scrutiny -- which will be very tough
that, of course, they'll be subject to.
I think we •ve been very cheered so far by the
congressional reaction. A lot of us have been up on the Hill for the
last·couple of days in various workshops, which have been
extraordinarily well attended, I might add. Extraordinary how many
members of Conqress have come for hours on end. And they've all
said, among other things, even some that aren't happy with the plan,
that we've put forth the most-detailed and the best-researched health
care plan that's ever been put on the table by a lot.
As Leon said, the congressional process is just
beginning. It will take quite a few,months, there will be
undoubtedly changes in the proposal that we put forward and we
welcome that process.
The only point I'd add in addition is that in the event
that anyone does point out a true flaw in our numbers -- can prove to
us that they're off, well, then, of course we'll adjust them. And
we'll adjust them on the cost side. In other words, if it turns out
that people convince us that something we've estimated at X will cost
more than that, well, we'll reduce costs in some other area. What we
will not do, beyond the sin tax proposal that will be made shortly,
what we will not do, is to propose any further changes on the revenue
increasing side, on the tax side.
I think Laura's next.
.
MS. TYSON: I will just end by reaffirming or
emphasizing, the comments made by Bob Rubin at the beginning. The
process by which these numbers was developed was a process.which was
exhaustive and inclusive. The CEA and other agencies of·government
were involved in the process from the very beginning. We did not
just rely on internal experts, however. We consulted a wide variety
of external experts on all aspects of the health care system. So it
really was, as the First Lady has correctly said, an unprecedented
process in terms of inclusiveness, exhaustiveness and precision. So
I don't think there really is any question about the numbers.
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Now, it's been reported in a number of places that I
have raised questions about these numbers and that the CEA has raised
questions about the numbers. That, in one sense, is true and in one
sense is misleading. It is true in the sense that it is the role of
the CEA to raise questions. We love to raise questions, that's one
of our jobs -- we raise questions. The reports are misleading
because they seem to indicate often that our questions were not
answered. That is not correct. our questions have been answered.
They have been answered as part of this eXhaustive process. So, for
exampie, if we raised·a question about Medicare and where the
Medicare savings would come from, there are now precise, specific
policy proposals backing up the Medicare savings.
so the process has been unprecedented and exhaustive
and, I believe, has moved the information base on how the current
health care system is functioning and what we heed to do forward by
an order of magnitude relative to anything anyone knew when we
started. so I think one should, at this point, ·welcome debates about
policy and welcome debates about politics. But really, the numbers,
it seems to me at this point, are not really debatable. They came
from a very credible process and a very exhaustive process. And
that's really all I wanted to say.
·
Q
Despite the fact that you insist that there aren't
going to be new taxes, we have a poll out today that says 80 percent
of Americans still b~lieve that that's how it's going to be paid for.
DIRECTOR PANETTA: Well, interestingly enough, we ran
into the same problem with the economic plan. I mean, obviously,
everybody felt that when you debate any kind of revenues or indicate
that even if there's going to be sin taxes, that people automatically
assume that somehow there's going to be some sort.of broad-based tax.
And, as we pointed out in the economic plan, 80 percent of that
affected those of $200,000 and above. I think people are beginning
to understand that now. And as we go through the debate on this, I
think people will also understand that there is no broad-based tax
here.
Now, again, having said that, the premium is here •.
Let's make clear that the premiums that people are paying now, that
most of the money in this process for this health care reform, is
going to come from the same area that it comes from now, which is
businesses and people paying taxes on health care. That needs to be
made clear now, because I think there's a sense that there's these
other taxes. It's based largely on the premium base.
Q
You presumably realize some savings from the
elimination of cost shiftings since everyone is now included. Onder
which number, or numbers, is that included? Where is that number
reflected?
DIRECTOR PANETTAi You're basically in the -- I think
it's going to be in the reductions. While the reductions in federal
programs will probably be part of that, I think the Medicare to the
extent -- I mean, we're going to be doing specific savings on
Medicare, so you -·
Q
I know, but that's going to affect nearly -- that
cost shifting is paid for by all the private consumers of health care
insurance. Presumably there will be a saving to them of some untold
sum of money. What is the sum and where is it reflected.here?
DIRECTOR PANETTA:
Okay 1 we think that when the plan is
fully implemented, that there's about $25 billion in uncompensated
care that's currently embedded in what private insurance and what
private payers pay. That is, everybody gets coverage so that money
will go away over time. · So the dollars are really reflected in the
premiums that we are estimating. So they're ·not specifically shown
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in this line item here that the Director has talked about. But
rather, if you reduce uncompensated care, the premiums that people
will have to pay for health. insurance, those costs will fall.
Q
Do you really think that you're going to see $91
billion in deficit savings at the end of five years? Do you think
that these models clearly estimate people's behaviors?
DIRECTOR PANETTA:
I don't think -- no, itis not a
· problem of the models. I think that if we achieve these kinds of
savings with regards to these kinds of costs, then I think we can
produce that much in savings in terms of deficit reduction. I mean,
that's our goal. our goal was basically to start with making sure
that we achieve deficit reduction over this period.
. Obviously, I have to tell you -- as I think we found out
on the economic plan, where our investments were vulnerable, I think
the deficit reduction number is going to be vulnerable on Capitol
Hill. The large question for Capitol Hill to answer is do you want
to achieve this much in terms of deficit reduction, or do you want to
lessen the amount of deficit reduction and lessen the hit in terms of
some of the other programs. You're going to see some trade-off here. ·
Q.
In terms of trade-offs, it was so difficult to get
to the $57 billion in Medicare savings. What makes you think you're
going to reach $124 billion? .
DIRECTOR PANETTA: As long as I've dealt in the budget
process, every time we've dealt with Medicare and Medicaid savings, I
have heard all of the expressions of fear -- that the hospitals are
going to close, .that the doctors are going to go out of business, et
cetera, et cetera, et cetera. And it hasn't happened. The fact is
that there are tremendous cost increases that are taking place in· the
Medicare and Medicaid program. We know that. We see that in the
budget. And I think as a result of that, we have been able to
outline. a whole series of very specific proposals that from a policy
point of view I think makes sense.
Now, you're asking me really what I think is more a
political question than a substantive question, because sitting in
that room people are always nervous -- do·we want to cut Medicare
this much? can we cut Medicaid this much? But ultimately, if you
can justify the policies based on substance, then I think we can come
very close to these numbers. And that's going to be the test.
Q
Mr. Panetta, can I ask you a question about -- you
started your account by saying that the bulk of the money was, of
course, going to came from where it now comes from -- from the
private sector. And yet, what··all of you have said addresses only
the public portion of this. We need to give the American people a
picture of the whole thing. could you tell us what the private
portion of this is going to look like? And it would be very helpful
if it was year-by-year what the business sector is going to pay, what
the household sector is going to pay, and what you either think
they're going to save or net -- have to pay to make this system work?
DIRECTOR PANETTA:
Oh, Ken?
(Laughter.)
MR. THORPE: We didn 1 t pass that out? (Laughter. ) Of
·Course, we•re -- as we continue to go through this, we focus first in
terms of our -- first step of an estimate is to try to get a handle
on what the federal and state and local piece of this is. And we•re
in the process right now cif ·doing exactly what. you've asked. As
you've seen from your documents, that's -- I'm sure that you've read
through. We do have a table in the back that looks at the change in
national health expenditures under the proposed plan. We will,
during the course of the next several weeks, be developing exactly
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what you're talking about -- a sector-by-sector impact during that
time period.
Expenditures.
Q
That chart at the back is entitled National Health
Is that the chart you're referring to?
MR. THORPE:
Right.
Q
It appears to show that in the first three years of
this· if I understand how to read it, that the private sector in
agqr~gate is going to bear -- one year it's $23 billion in extra
costs, the next year it's $50 billion in extra costs, the next year
it•s $30 billion. And only in the very·end of the five-year period
are you going to see it -- the savings, in effect, be qreater than
the costs. Is that true? In essence, the private sector is going to
bear increased costs during the early years?
MR. THORPE: No, we think ·that due to the fact that
we're covering $37 million under uninsured and we're providing
comprehensive benefits not only to that population but to individuals
that don't have as comprehensive benefits -- that is, you can see
from the chart that for the first two or three years that the amount ·
of spending in the system will rise slightly. But by 1998 -- I don't
have the figures with me. .It's in the back of your -bear --
Q
The point is that the private sector is qoing to
MR. THORPE: No, that's total spending -- public and
private. What we don't have and what you could not infer from that
chart would be the specific public-private impacts which we are still
working on.
Q
Ms. Tyson, could you tell us
proposal will increase --
MR. THORPE:
Q
wheth~r
or not the
I don't have the figures wi'th me.
Mr. Panetta, could you tell us --
DIRECTOR PANETTA: Could I -- Andrea, let me just add
another point that I think is important on the Medicare and Medicaid
aspect of this. Normally, the cuts in Medicare and Medicaid have
usually been done for the sake of deficit reduction in the sense that
you basically are doing it as part of an economic plan. In this
instance, you're doing it as part of comprehensive health care reform
with a long-term health care element as well as a drug benefit
element. And I think that gives us a little better arguing point
with regards to those that are··concerned about who's going to be
impacted by that.
Q
Mr. Panetta, one of the central features of your
plan is cost controls on the qrowth of insurance premiums. How can
you convince the public that their services aren't going to be held
down, constrained, rationed by the doctors and hospitals as they're
livinq under these insurance caps at a time when you're trying to cut
inflation and health care in half?
MR. THORPE: Well, again, we think that if you take -again, you can't just look at the cost containment piece. I think
it's important to look through and look at the plan in its entirety.
Because what we•re proposing in the bealth reform proposal is really
comprehensive change in the delivery system. We believe that there
are substantial administrative savings in hospitals and physicians,
as well as insurance companies that we've talked about. we•ve talked
a little bit about reductions and uncompensated care that's sitting
out there.
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�- ll And one thing I think that will be useful to do is that
if you look at the dollar savings, don't look at the percent changes,
but actually look at the dollar savings in the private sector
associated with what we're proposing. And if you look at what we
think is going to happen in the system in terms of cost conscious
selection of health plans, administrative savings, reductions in
uncompensated care, moving toward a delivery·system that is no longer
an open ended, uncoordinated delivery system. It is really something
to focus on much more effective and we believe, not only cost
effective, but better quality medical care. That any one of those,
individually or serially, will develop and create the types of
underlying cost reductions that the plan is talking about.
Q
But you and Mr. Rubin can stand here today and
assure people there will be no rationing of care under this Clinton
package?
MR. RUBIN: Let me try as a nonprofessional to take a
shot at that. Having sat through, I guess it's six or seven months
now of meetings with enormous numbers of health care professionals
on, as you know, a very complex subject -- when you hear them come
through all this, I think where you come out is it sounds from what
they've said -- let me put it differently. I came away persuaded
having listened to them, that this thing ought to work, that the odd
ought to be very, very high that there is very substantial excess
expenditure in the system. ~d you compare the 14 percent of GDP
that we spent on health care with less than 10 percent in any other
developed country, and I think it sort of validates that notion. And
it ought to be possible to create a plan that does that without
creating untoward effects.
But if there are problems there is a contingency in
these numbers, number one. Number two, as you know, it's going to be
phased in somewhat gradually so the first dates, hopefully, will come
in '95, and they will continue to come in through 1 97. so if you
start to see problems you can correct course.
And thirdly, and I find personally most importantly,
there is tremendous flexibility in this system and there is
tremendous flexibility within each state to adjust the system as it
goes along. So I think you have, in effect, a self-correcting
mechanism if problems develop.
.
Q
Laura, can you comment on the job impact, what your
models have shown in terms of --
DR. TYSON: We're actually going to have a briefing on
that issue on Thursday. We 1 11 talk about the employment effects on
Thursday. secretary Reich will -- we are trying to sort of have a
discussion today of financing, and a discussion on Thursday of -Q
What is the hold up in figuring out how the sin
taxes are going to be apportioned and are there discussions going on
with, for example, representatives from tobacco states as you're
figuring out how these taxes are going to be apportioned?
.
DIRECTOR PANETTA: I think it's -- you know, it's
obviously -- the issues are on the table with regards to the elements
of sin taxes. The one question is this corporate assessment and
whether or not we will look to this corporate assessment for
additional revenues as part of that package. And that -• frankly,
it's that element that's being evaluated right now. We have not come
to any conclusions on that. But depending on whether or not you
include that element, that tells you a lot about what you do then on
the sin tax.
Q
How much might that produce, the one percent
corporate assessment?
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DIRECTOR PANETTA: I mean, again, it depends on how many
corporations are going to be impacted, and that's something we're
analyzing right now. Because it depends to some extent on which ones
are dropping out of the process and. which ones stay in the process.
Q
The.goal was to--
Q
can we just clear up the payroll tax?
DEPUTY SECRETARY ALTMAN: We're not going to give you an
exact number, because we're continuing to refine that. But it's not
a huge number in the context of this plan. You have to make certain
assumptions about which businesses opt into the alliances and which
businesses, s,ooo and over, employees may opt out and so on. But
it's not a gigantic number.
Q
There may be no decision on alcohol tax by tomorrow
night, is that correct?
DEPUTY SECRETARY ALTMAN: I don 1 t know the answer to
that. Someone asked that question earlier about when the sin tax
decision was going to be made.
Q
lobbyists more?
Are you deliberately not deciding to not iqnite the
DEPUTY SECRETARY ALTMAN: I heard somebody say the
President's upstairs having a drink and a cigar and would make that
decision shortly. (Laughter.)
Q
You said the President's goal was to have a
situation where people could arque politics and policy, but not about
the numbers. It hasn't been hard for people here to find economists
and politicians who are arguing about the numbers. What is the
problem? Where is the disconnect?
MR. ROBIN: Let me take one shot at that and let other
people take another shot at it. You know, when you read the reports
and then you speak to some of the people -- and I've done both -- I
think there is a bit of a muddling here. And I think sometimes when
people talk about concerns about the numbers, they're really talking
about the politics or they're talking about the policies. And I
think if you take somebody and you say, okay, you've said you have
concerns about the numbers, what do you really mean?
osually, at least in my experience, it has turned out to
be either they simply need more information, or they're really
raising a question about political feasibility or policy impacts.
And that, I think, is -- to an awful lot of it.
Q
Well, to what extent did you --
MR. ROBIN: can I make just one more comment? These are
very complex calculations. I've heard a lot of it developed, and
I'll tell you -- and I've had a lot of experience in developing
numbers -- these are very comilex numbers developments. And I think
what's qoing to happen over t me is, people who have serious
questions about numbers as opposed to policy or politics, they'll sit
down with the people who developed it, and I think they'·ll come out
satisfied on the numbers.
·
.
Q
To what extent did.you factor in political
feasibility in creating your models?
MR. ROBIN: Well, numbers are one thing and political
feasibility, I think, I would arque, a separate one.
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that.
DIRECTOR PANETTA:
(Laughter.)
There is no model you can develop for
MR. RUBIN: Leon has a perfect model for political
feasibility, and he comes out with -- (laughter) -·
Q
obviously, there are policy assumptions that are
going into the numbers. I mean, you seem much more optimistic than a
lot of independent experts about how quickly waste can be gotten out
of the system, for example. I mean, those assumptions are built in
MR. RUBIN: Those assumptions are in here, as we said.
You•ve got an interactive process with OMB, Treasury, HHS, you•ve had
outside actuaries and outside accountants, and enormous numbers of
them, and they•ve come out and concluded that these kinds of savings
can be achieved in these kinds of time periods.
.
Q
Mr. Altman, you said in your remarks that if you
were convinced your numbers were wrong, you would make adjustments on
the spending fight, not the revenue side. Does that mean if Senator
Moynihan is correct, that it 1 s not political~y possible to achieve
this level of Medicare savings, that would put at risk these
proposals for new long-term and drug benefits for seniors?
DEPUTY SECRETARY. ALTMAN: No, I didn 1 t say that. I
didn't say that at all. I simply said that if anyone can prove to us
that there are flaws in our estimates of the costs of this, I mean,
really prove it, which I doubt, I strongly doubt, as I mentioned
earlier -- we would make adjustments on the cost side. We would -Q
talking about --
You•re talking about a technical thing, you•re not
DEPUTY SECRETARY ALTMAN: Well,. if someone couid prove
to· us that we•ve underestimated the cost of X or the cost of Y, you
·
know, really win the argument -Q
But it•s all based on predictions of future
behavior of all kinds.
Q
Q
it?
You•re saying --- what would you cut, then --
Q
-- which is kind of an interesting standard, isn•t
DEPUTY SECRETARY ALTMAN: -- in some other area the
costs to offset that. All I 1 m trying to say is, we would not turn to
the revenue side of the equation.
Q
then?
But would that affect the core benefit package
DIRECTOR PANETTA: Let me mention -- you 1 ve got -- all
of the pieces are here now. And, obviously, there•s going to be some
adjustment on these pieces as we go through the political process and
as we go through, obviously, the discussions with regards to the
accuracy of the numbers and what have you. But there are key pieces
now that you can work with here.
·
If we decide, for example, that we want to do a phasein, a longer phase-in on this, we have some phase-in already built
into the process. That 1 s something obviously that can be looked at.
It doesn•t mean you•re reducing the benefitsJ you•re reducing the
benefits in the short term for some, but in the long run everyone's
going to get the same benefit.
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But we have the ability now with the plan that we're
working on to give us the flexibility to make those kinds of
adjustments without impacting on the basic principles that the
President wants to present in the health care plan.
Q
Given the record of economic modeling over the last
10 or 12 years, don't you approach the modeling of this entire sector
of the economy with some humility?
DIRECTOR PANETTA:
Humility and trepidation.
Q
can you tell us, is there any reaction from the
President on the Moscow coup?
MR. GEARAN: In terms of events in Russia, we have no
further reaction to that.
Q
The President did not react at all?
MR. GEARAN: We'll just leave it at that.
you posted whether there will be a further statement.
END
We'll keep
1:55
P.M. EDT
�THE WHITE. HOUSE
Office of the Press secretary
september 21, 1993
For Immediate Release
REMARKS BY THE PRESIDENT
IN INTERVIEW WITH RADIO TALK SHOW HOSTS
Room 450 OEOB
3:06 P.M. EDT
.
THE PRESIDENT:
Thank you very much and welcome to the
Executive Office Buildinq and to the White House, and thank you for
cominq today. I --what did you say, nice tie? (Lauqhter.) That's
a Save the Children tie.
Q
THE
siqninq today.
columnists
All right!
PRESIDENT:
I wore it for the National service
It's interesting, we just had a lunch with a number of
Q
Lunch?
Lunch?
(Laughter.)
THE PRESIDENT: Lunch? I'm sorry, I'm sorry. Would it
make you feel better if I said I didn't enjoy it? I mean -(laughter) -- anyway, and they knew you were all here, and we had 700
or 800 people out on the lawn for the National Service siqning, and 4
or 5 of these folks that have been covering Washington for 20 years
said they had never seen the White House so busy. I didn't know if
they were happy or sad about it, but anyway, it's busy.
I thank you for coming today. I hope this will be the
first of a number of opportunities we have to provide people who have
radio talk shows and who communicate with millions of Americans on an
intimate basis, daily, to come to the White House to have these kinds
of briefings. You've already heard all the basic approaches that the
administration is going to take on health care and that will be
hopefully crystallized in a compelling way in my address to the
Congress and to the country tomorrow evening.
So, I thought what I would do is make a general
statement about how this fits into the overall approach the
administration is taking and then answer your questions. I'd rather
spend time just answering your questions.
But let me just make a qeneral comment, that I think you
can -- that runs through the thread of debate that we had on the
economic program, on the health care issue, on NAFTA, on the crime
bill that's coming up, on the welfare reform issue, on all the major
things we're trying to come to grips with.
It is now commonplace to say that we are living through
a time of profound change -- not only in our country, but around the
world. People are trying to come to grips with a rate and nature of
change that comes along less frequently than once a qeneration.
You may know that just since you've been sitting here,
Boris Yeltsin has dissolved the Russian Parliament and called
elections for that Parliament in December, and his major opponent has
apparently declared himself President. I mean, they are going
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through these things, trying to come to grips with what it means to
be a democracy and what it means to try to change the economy.
In our country, if we're going to continue to be the
leading power df the world, ndt just militarily, but economically,
socially, the shining light of the world, this has to be a good place
for most Americans to live. Most people have to know that if they
work hard and play by the rules that they can make the changes that
are sweeping through this country and the world their friends and not
their enemies. They·have to believe that, as citizens they can work
together and trust the major institutions of our society to function
well, to meet these changes, to respond to them.
we confront this bewildering array of challenges: the
size of the deficit, the fact that we have an investment deficit,
too, in many critical areas, the health care crisis. At a time when
most people are quite insecure in their own lives and most Americans
have worked harder for stagnant or lower wages for the last 10 to 20
years, when they're paying more for the basics in life, when they
have lost faith in the fundamental capacity of political institutions
to represent them and to solve problems.
I think you can see that in the 700 1 000 letters we got
on health care. The number of people who would say, you know, what's
wrong with me? I worked hard all my life and I lost my health
insurance. or my child got sick and now I can never change my job.
Or my wife and I spend 60 hours a week running our business and our
health insurance was $200 a month four years ago, and it's over $900
a month today; you know, that things are out of control. I say that
because I believe providing security in the health care area and in
meeting the other objectives we talked about -- quality and choice
and cost control -- is a necessary precondition, .not only to improve
the health care of the American people, but to help root the American
people again in this moment, to make them freer to face the other
challenges that we face.
I see in this debate over NAFTA, which I have wrestled
with in my own mind, that is the whole nature of our trade relations
with Mexico and other countries and where we are going for far more
longer than I've been President. I dealt -- had to deal with it when
I was a governor. I see people, some of them looking ahead with
confidence in the future that we can triumph in the world of the 21st
century, that .we can compete and win, that we can create tomorrow•.s
jobs. And others so uncertain about it, just trying to hold on to
today and to yesterday's jobs.
so, what I am trying to do is to give the American
people a .greater sense.of security over. those things that are basic
to their lives that they can control, and at the same time challenge
our people to assume responsibility for dealing with our problems and
for marching confidently into the future. That's what this National
Service issue is all about that we celebrated today on the White
House Lawn.
And, therefore, the.health car issue is about more than
health care. It is about restoring self-confidence to America's
families and businesses. It's about restoring some discipline to our
budget and investment decisions. Not only in the government, but in
the private sector. It's about giving us the sense that we actually
can move forward and win in the face of all these changes.
I cannot under -- or I guess I cannot overstate how
important I think it is not·only on its own terms, but also for what
it might mean for America over the long run.
Yes.
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3 -
Q
Does anybody really know whether this will work,
from the administration? Is it that fine -- have you parsed the
numbers that fine, that you can say if this is passed in toto, it
will indeed do what you say -- cut costs, maintain quality of care,
cover everybody?
·
THE PRESIDENT: We know it will do that. But that's not
exactly what you asked. That is, we know that if this plan is .
adopted, it will provide universal coverage, that it will achieve
substantial savings in many areas where there is massive waste. ·
Dr. Koop, who was, you know, President Reagan's Surg~on
General, who was with us yesterday, and the doctors that we had -said that in his judgment, there was at least $200 billion of waste,
-- unnecessary procedures, administrative waste, fraudulent churning
of the system at least in our system -- so we know that those things
will achieve those objectives? We do. Do we .know that every last
dollar is accurate, or that there will be no unintended consequences?
Or that the timetable is precisely right? No we don't know that.
Because nobody can know that exactly.
But I would like to make two points. Number one, our
administration has gone further to get good health care numbers than
anyone ever has before. Until I became President I didn't know this,
but the various agencies in the federal government responsible for
various parts of health care financing and regulation had never had
their experts sit down in the same room together and agree on the
same set of numbers and the same methodologies for achieving them.
So that's the first thing we did. No wonder we had so much fight
over what something was going to cost and the deficit was going
crazy. The government had never gotten its own act together.
Then the second thing we did was to go out and solicit
outside actuaries from private sector firms who made a living
evaluating the cost of health care and asked them to review our
numbers. Now, that is very important that you understand that,
because it's -- there is going to be -- there should be a debate over
whether the course I have recommended is the best course to achieve
the goals we want to -- all want to achieve, whether there is a
better course, whether we can achieve the Medicare and Medicaid cuts
that we say we can achieve without hurting the quality of care.
That's fine. But I want you to understand that·we really have killed
ourselves at least to get the arithmetic right -- to give people an
honest starting point, a common ground to start from, so that we can
have the arguments over policy.
Yes, sir.
Q
Do you feel that your plan places undue hardship on
business with the employer mandate versus an individual plan that has
been proposed with other proposals?
THE PRESIDENT: No, and I'll say why. First of all,
let's just look at the employer mandate. Most employers cover their
employees. I like your question in the sense that you -- the
question assumes that we should have universal coverage, and that's a
good assumption. If you don't have universal coverage, you can never
really slow the rate of waste in cost, because you'll always have a
lot of cost shifting in the system. That is, people who aren't
covered will still get health care, but they'll get it when it's too
late, too expensive, somebody else will pay the bill, and it will
have real inefficiencies and distortions, as it does today.
If you want to cover everybody, there are essentially
three ways to do it. You can do it the way canada does. You can
abolish all private health insurance premiums, raise taxes to replace
the health insurance premiums, and have a single-payor system -- just
have the government do it. That's the most administratively
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efficient. That is, the Canadian system has very low administrative
costs, even lower than Germany and Japan. The problem is, it's not
very good for controlling costs in other ways, because the government
makes all the cost decisions.
The citizens know they've already paid for this through
government, so they make real demands on the system, whereas if you
have a mixed system where employers and employees are actually in
there knowing what they're spending on health care and lobbying for
better management and to control costs, like in Germany, you don't
have costs go up as fast. So the canadian system, even though it's
administratively the cheapest, is the second most expensive in the
world. We're spending 14 percent of our income; they're spending 10
percent of theirs. Everybody else is under nine •
. Now, the second system is the individual mandate. It's
never been tried anywhere. The problem with the individual mandate
is that it could -- and, again, I want a debate on this. I think the
Republicans are entitled to their day in court on this and I want
them to have it. Really, I do. I mean, I want an honest, open
discussion on this •. I am so impressed with the spirit that is
pervading this health insurance -- we had 400 members of congress
show up for two days at our health care university just trying to get
everybody to have enough information to be singing out of the same
hymnal when we talk to one another.
The dangers of the individual mandates are that it could
cause the present system we have for most Americans, which is working
well for most Americans, to disintegrate. That is, you have to have
some subsidies with an individual mandate. So will companies that
now cover their employees basically start covering their upper income
employees or their -- not their lower income employees. Will they
dump all their employees and make them go under the individual
mandate system? How are you going to keep up with all these
individuals when you realize who you've got to subsidize or not? In
other words, we believe it has significantly more administrative
burdens and it has the potential to cause the present system to come
undone. But they deserve their day in court on it, and we'll debate
it.
our system -- let me just say this: Our system on small
-- for small businesses -- I'd like to make the following points: we
propose to keep lower the premiums of small businesses with fewer
than so employees, including all those that are just starting up, and
those with -- and they get more if their wages of their employees are
low and low-wage workers also get a subsidy to try to make sure
nobody goes out of business.
But the point I want to make is, most small businesses
who do cover their employees -- and that's the majority of them -are paying too much for their health insurance. They are being
burdened by it. That's one reason 100,000 Americans a month
permanently lose their health insurance as well as at any given time
in a year, as many as one in four may be without it.
So what we propose to do will actually help more small
businesses than it will hurt. And over the long run, they'll all be
better off, because if you put everybody under this system, then the
rate of increase in health care costs will be much lower. And it's
just not fair at some point for anybody who can pay something to get
a free ride. Because, keep in mind, we all get health care in this
country. But if we're not insured, we get it when it's too late, too
expensive. Usually we show up at the emergency room, the most
expensive of all, and then somebody else pays the bill. That's what
is -- one of the things that's driving these costs out of sight.
Yes, sir.
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Q
We've heard a lot about every group today, except
for the doctors. And from the doctors that I'm hearing from, they're
saying that this is going to hit them in their pockets. In my
experience before in being in operating rooms and seeing doctors
after the·diagnostic~elated-groups started setting some prices of
procedures back in the •sos, a lot of doctors that went into business
for themselves were either multi-using single-use items or
resterilizing items that were made for single-use so that they
wouldn't lose any of the money that was going to be coming to them so
they wouldn't take a personal hit out of it. How does your plan
guarantee us an uncompromised medical claim?
THE PRESIDENT: Well, for one thing, the quality
standards that govern medical care today will still be in effect.
That is, most of them are professional standards and they're not
enforced by the government today.
Q
They're talking about doing more procedures to make
up the money. They're saying, well, I'm going to have to see more
patients and spend less time with them.
THE PRESIDENT: Yes, but that's what's happening today.
I mean, the truth is that as we've tried to control the costs of
Medicare and Medicaid, particularly Medicare, by holding down costs,
you see dramatically increased numbers of procedures. What we want
to do is to remove the incentive for having large numbers of
procedures by having big blocks of consumers pay for their annual
health care needs in a block, so that you won't have so much fee for
service.
I would also point out to you that one of the big
problems we've had with doctor costs going up is that doctors are
having to negotiate their way through the mine field of 1,500
separate health insurance companies writing thousands of different
policies, having to keep up with it in ways that no doctors anywhere
in the world but our doctors have to deal with.
So if you look at -- we've already had the American
Academy of Family Practice and a lot of other doctors' groups have
endorsed our plan. The AMA has been quite interestingly supportive
in general terms. They say ~ey want to see all the details. They
believe there ought to be universal coverage. Dr. Koop has agreed to
come in and sort of moderate this discussion. But we had a couple
hundred doctors here yesterday, who were -- most of whom were
extremely supportive. And let me just give you one big reason why.
This is the flip side of the argument you made.
In 1980, the average doctor was taking home 75 percent
of the money generated by a clinic. In 1990, the average doctor was
taking home 52 cents on the dollar, 52 percent o~ the money generated
by a clinic. Twenty-three cents on the dollar increase in the amount
of money the doctor was having to spend on people, basically to do
clerical work in the clinics.
The Children's Hospital at Washington told us last week
that the 200 doctors on staff there spent enough time in non-health
care related paperwork every year because of the administrative cost
of this system -- a dime on the dollar more than any other system in
the world -- to see another 500 patients each a year, 10,000 more
kids a year. So, a lot of doctors are going to feel very liberated
by this because they are going to be freer to practice medicine, and
the incentives to churn the system just to pay for all their
paperwork will be less.
Q
Time for one more question, I guess I have the
opportunity, I'll make it a two-part question because it's a rare
opportunity and I appreciate it. First of all, if you receive
everything that you want, that you're hoping for, and we hear about
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the 37 million uninsured and the many under-insured people, I'm
wondering if there's anybody that will be disappointed with the new
system?
- ·· · ·--THE ·"PRESIDENT: - ·oh . yeah.
Q
-- if you get everything you want, and who those
people might be. And secondly, I hear very little about medical
fraud and medical malpractice problems, as if it isn't a major
problem and we are lead to believe that it is.
THE PRESIDENT: It is a big problem. Maybe I should
answer that question first, because it's a quicker one. Then let me
try to tell you how to sort through the winners and losers. Okay?
First of all, we will have -- in this system if you put
consumers of health care, employers and employees, particularly the
small businesses, in large buying groups where they will have more
market power and more oversight authority, you will inevitably -- we
are going to change the economic incentives as well as the private
sector oversight to reduce fraud and abuse. we are definitely going
to see big savings there.
Secondly, what was the other thing you asked me?
Q
The medical practice--
THE PRESIDENT: The malpractice -- doctors --well-doctors-- one of the things that we don't know is how much extra
excess procedures and tests are done as defensive medicine or to
churn the system to go back to your other question. The economic
incentives to churn the system will be dramatically reduced under
these kind of payment plans.
It will be more like the way the Rochester, New York
system works, the way the Mayo Clinic systems works. More and more
people will be in a system where they pay up front and then they take
what they need. And the doctors are going to get paid out of that.
But, the malpractice issue is a problem. We will
propose some significant ref~rms, including limiting the percentage
of income lawyers can get in contingency fees and lawsuits. But I
think -- I have to tell you, what I think the most significant --and
alternative dispute resolution mechanisms. But I think the most
important one will be: permitting the professional associations to
draw up medical practice guidelines which, when approved, will
protect the doctors to some extent, because if they follow the
guidelines in any given case, it will raise a presumption that they
weren't negligent. And that will be a real protection against just
doing an extra procedure because you're trying to·hedge against a
lawsuit.
The state of Maine pioneered this because they wanted
more general practitioners in rural Maine to do more things for
people like help deliver babies because they didn't have anybody else
to do it. So, the idea of giving people practice guidelines I think
is very good.
lose.
Now, you asked who's going to win and who's going to
Can we talk through that?
Q
Yes sir.
THE PRESIDENT:
You know, there will be some
can -- there's a pretty good
pretty good job of analyzing
I'll tell you who will have to pay more.
people who will have to pay more. You
-- the news magazines this week did a
this.
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If we go to community rating, so that we can allow
people, for example, who have had a sick child not to be bankrupt by
their insurance costs and to move from job to job, and you put
everybody in a broad community, it means young, single, super healthy
people·wilJ:··pay-11\o-re-in the ··first year-·of this than they would have
otherwise. Now, here's why I think that's a good deal for young,
single, super healthy people. Number one, all young, single, super
healthy people will get insured and they aren't now. Number two,
they'll all be middle aged some day, too, and they'll win big.
Number three, their cost will go up less every year. So, even though
they might pay more this year, within five to eight years, if this
plan goes through, everybody will be paying less than they would
have. so, they would pay more.
secondly, there are some businesses who don't insure at
all. They'll have to pay something. There are others who insure,
but only for catastrophic. They will have to pay more, but they'll
get much better benefits and their rates will go up less. So, there
will be some people who will pay more now than they were paying. But
I believe that if we can -- keep in mind, if we can stop the cost of
health care from going up at two and three times the rate of
inflation, if we can get it down where the rate of increase is much
lower, by the end of the decade everybody will be way better off than
they were.
Q
Mr. President -- the Boris Yeltsin announcement
that he's going to dissolve the Parliament, and does the United
States support him and his power struggle with his opponents?
THE PRESIDENT: Well, as you know -- first of all, let
me say I have had only a sketchy briefing about this and I have not
talked to President Yeltsin yet. I would like to reserve the right
to issue a statement after I attempt to talk to President Yeltsin.
In any case, I will issue a statement before the end of the day, but
I think at least I should have a direct briefing.
Yes sir, one more.
Go ahead.
Q
President Clinton, tomorrow you'll be speaking
before a joint session of congress and there are 535 people,
individuals in Congress that will have their own specific plans of
what they --
THE PRESIDENT:
Yes.
Q
-- If you could say that you could put your name on
one or two or three specific parts of this that you want to say,
"This is my health care plan," that you want to see, no matter what
535 other people want to see -- that you feel you want to be part of
your Clinton health care program, what two or three items,
specifically?
THE PRESIDENT: Number one, every American would have
security in their health care system. You would be able to get
health insurance, there would be adequate benefits and you wouldn't
lose them. Number two, the system would impose a far higher level of
responsibility for managing costs than it does now on all the
players, including the consumers. Number three, people would keep
their choice of physicians and medical providers. And, number four,
we would guarantee adequate access to preventive and primary care so
we could stop some of the big things that are happening to us before
they get going. And, five, we would have incentives -- market
incentives to bring costs down. Those are the things that I want to
be the hallmark of our program.
very much.
I wish I could stay all day.
(Applause.)
END
I'm sorry, but thank you
3:25 P.M. EDT
�THE WHITE HOUSE
Office of the Press Secretary
September 21, 1993
For Immediate Release
INTERVIEW OF THE PRESIDENT
BY TABITHA SOREN OF MTV
The Colonnade
12:02 P.M. EDT
Q
obviously, this is· a huge success, getting national
service passed so quickly. one of the goals of national service is
to have kids have a multicultural experience. But, yet, in the pilot
program, Summer of service, within a couple of days, the black kids
were in black caucuses, there were Hispanic caucuses and gang groups.
How are you going to make sure during national service, when it gets
going, that they serve side by side?
THE PRESIDENT: Well, those are the kinds of projects
we'll favor. But I think if you look all across the world today,
there's always going to be some ethnic cohesion. People are going to
pull together, talk together, feel a greater initial comfort level.
That's just true worldwide.
But what we also saw in the summer of Service is that
people really were working together across racial and ethnic groups
to an extent greater than they had before. I think what we have to
do is let people be themselves, but favor those programs that have
multiracial makeup, and we will do that.
Q
Okay. As far as health care is concerned, isn't it
true that because your health care plan is community based that many
young people, because they're young and healthy and they get
discounts on insurance now, may end up paying more with your plan?
THE PRESIDENT: Yes, in the first year, those who have
insurance may pay more, depending on whether they work for small or
big businesses. Very young people who are basically in plans that
have big businesses insuring them may pay some more in the first
year. Even they, however, within five years should be paying less,
because we slow the rate of growth in these premiums.
Young people who work for small businesses probably
won't pay more because they're paying too much already -- all small
businesses. And they'll be in great, big groups. But I would also
point out that an awful lot of young people who don't have health
insurance -- and some young people do have access7 some young people
do get sick7 some young people even have serious illnesses -- so it
will help them. And I would say, also, to all these young people, if
we change it in this way so·that we're all rated as a community, what
it means is, is that some family gets a sick child, it means that
they won't lose their health insurance if they change jobs, or they
won't be locked into the job they're in. And all of the young
people, I can certify because I was one once, will someday be middleaged, will someday be older, and they will then benefit from that.
so the fair thing for
has already done, what a couple of
what other nations do, which is to
people so that we can keep overall
America to do is to do what Hawaii
other states have already done and
have the nation in big pools of
costs down.
MORE
�- 2 -
Q
In terms of the health care plan, last time I spoke
with you, you said you wanted abortion to be covered under the health
care plan. And now I understand the language says, "medically
necessary, pregnancy-related services are covered."
THE PRESIDENT:
That's what it says --
Q
Does that mean that anyone who wants an abortion
can get one and have it covered under the plan?
THE PRESIDENT: It means that it will be just like it is
today in most private plans. Most private plans absolutely cover it.
But no insurance plan specifically mentioned any surgical procedure.
The surest way to eliminate any kind of abortion coverage from this
act would be to mention it specifically. Because no other surgical
procedure -- none -- are mentioned specifically. And all private
insurance plans which cover abortion may cover pregnancy-related
services, and the doctor and the woman make the decision.
So what we propose to do is to put low-income people who
are covered by the government today into these big pools with people
who are privately insured, give everybody a private plan.
Q
I'm sorry, I don't -- is it more than the Hyde
Amendment in terms of --
THE PRESIDENT:
Q
How so?
Oh, yes, absolutely.
I don't --
THE PRESIDENT: Because the Hyde Amendment prohibits any
public funding for abortions, except when the life of the mother is
at risk.
Q
But I thought the Hyde Amendment was selfcertifying now, and you could say, I have a heart condition,
therefore --
THE PRESIDENT: Well, I don't know about that, but you
have to prove that your life is at risk.
Q
or rape and incest.
THE PRESIDENT:
Q
No?
Not in the Hyde Amendment.
Okay.
THE PRESIDENT: No. We tried to expand it and broaden
it, but this would simply put people who get government funds into
big private insurance pools, and they would then be treated like
other people in private insurance pools. It's just what we did for
the public employees this year, we got rid of the Hyde Amendment for
public employees this year.
Q
pregnancy related?
You couldn't have just put abortion instead of
THE PRESIDENT: Absolutely not. And it would have been
wrong to do that. Then people would say, well, why don't you put
brain surgery in there, why don't you put appendectomies in there,
why don't you put other surgeries in there? And that would have
sparked a whole reaction. They would say, why are we giving special
preference to one kind of procedure over all others? This will
guarantee that most plans will cover abortions.
Now, there will be religious exemptions, which there are
today. Catholic churches or other religious groups that have health
plans don•t have to cover it, doctors who have religious -- don't
MORE
�- 3 -
have to do it. But if a doctor and a woman decide that that is an
appropriate pregnancy-related service under this plan, then it can be
provided.
Q
In terms of paying for universal health care, why
are you trying to sugar-coat it? Why not just give us the bitter
medicine of how much it's going to cost us in taxes?
THE PRESIDENT: I'm not trying to sugar-coat it. I have
worked harder to get better cost estimates on this than anybody ever
has. Moynihan -- in all respect to senator Moynihan, he's a very
brilliant man, but he and his committee staff have not done anything
like the work that I've done on this. Now, they may not want to pass
Medicare cuts7 they should say that. It doesn't mean the numbers
aren't right. We have had -Q -- some people say --
THE PRESIDENT: No. We have had four different
government agencies for the first time working together to verify
these numbers. We have had outside actuaries from people who work
for private business, working to verify these numbers. It may be
difficult to pass because the Congress will not want to make the
administrative changes necessary to lower the rate of increase. But
I want to tell -- first of all, there are no Medicaid cuts in this.
We're talking about -- the inflation rate in this country today is
about three percent. Medicaid's going up this year at 16 percent.
We're talking about, over an eight-year period, bringing down the
rate of inflation in health care costs to the rate of inflation in
the economy, plus the number of people who are increased into the
program. That's all we're talking about doing.
For the next five years, health care costs will still go
up more than prices as a whole in this economy. I don't think that
is fantasyland if you have a systematic change. Other countries do
it. The Mayo Clinic, which is normally thought of as having some of
the finest care in the world, is now charging less for many basic
services than an awful lot of ordinary health care plans all across
America today because they manage their business better.
So it is not fa~tasy to say that the numbers are right
and they can be achieved. Will it be politically difficult to do?
You bet. Why? Because there are a lot of people who make a lot of
money out of the inefficiencies of the system today. And because
there are a lot of people who honestly don't believe-you can ever do
more with less. But I do, and I think there's a lot of .evidence of
that.
so, Senator Moynihan is right, it's going ·to be tough to
pass. I don't think that the numbers are wrong. · And let me also say
something nobody else has noticed. There are 85 members of the House
of Representatives who want the government to basically eliminate the
private health insurance companies, get out of it altogether, have a
huge tax increase to pay for health care but eliminate the premiums.
They propose bigger cuts in Medicare and Medicaid than I do.
so I just think that the numbers are entirely
defensible, and I think we'll be able to persuade the Congress.
Q
I forgot to ask you about -- why Soul Asylum?
THE PRESIDENT: They were supportive in the campaign,
and they made that wonderful song about runaway children, which had a
big impact on young people throughout the country. We just thought
they'd be a good group to be here.
Q
Does Chelsea like them?
�- 4 -
THE PRESIDENT: Yes. I do, too. I heard them play last
night, you know. So I sort of got caught up on my music last night,
listening to them practice.
Q
Have people that looked like that ever walked into
your OVal Office before?
THE PRESIDENT: Oh, sure. (Laughter.)
everybody's oval Office. I'm just a tenant here.
Q
This is
I see.
THE PRESIDENT:
Thanks.
Most people here tend to bathe, however.
Thanks.
Q
(Laughter.)
THE PRESIDENT:
Thanks.
END
Bye.
12:10 P.M. EDT
�AMERICAN HEALTH SECURITY ACf
SENATE JURISDICTIONAL CONSIDERATIONS
A...
Standing rules of the Senate
Under Senate Rule 25, both the Labor and Human Resources Committee
and the Finance Committee have broad jurisdiction over health care, and the
Labor and Human Resources Committee has broad jurisdiction over workplace
issues and employment standards:
1.
Labor and Human Resources Committee:
"All proposed legislation ... relating to the following subjects:
1.
Measures relating to education, labor, health and public
welfare.
****
5.
Biomedical research and development.
****
12.
Labor standards and labor statistics.
****
14.
Occupation safety and health.
****
16.
Public health.
****
2.
Finance Committee:
"All proposed legislation ... relating to the following
subjects:
****
5. . Heal~ programs under the Social Security Act
[Medicaid] and health programs fmanced by a specific tax
or trust fund [Medicare].
6.
National social security.
****
, 8.
Revenue measures generally ....
****
�B...
Proposed Committee jurisdiction based on section
in Administration specification book
Provisions/
Chapters C?l
Committee
.Jurisdiction/basis
I. Coverage and benefits
Health Alliances,
including state
responsibilities
Labor & Human
Resources: regulation of
labor standards (employer
mandate) and health
Medicare, including
new and revised
benefits
Finance: health program
financed by a specific tax
or trust fund
Medicaid, including
new and revised
benefits
Finance: health program
under the Social Security
Act
Other health programs:
VA, DoD, Indian Health
Service, FEHB
Relevant Committees(?)
II. Budget, development and enforcement
Alliance' budget
Labor & Human Resources
(see above)
Medicare and Medicaid
budgets
Finance (see above)
Title or Titles <to be
determined)
�III. Health infrastructure (delivery and management issues) including
public health,· quality management and improvement, information and
administrative simplification, protection of privacy, manpower and
training, rural health and health access
Private sector
infrastructure
Labor & Human
Resources: regulation of
labor, health, biomedical
research, labor standards
and public health
Manpower and training
Labor & Human
Resources: Public Health
Service Act programs, and
private sector
infrastructure
Finance: Medicare,
Medicaid payments, tax
incentives for manpower
training and distribution
IV. Long term care
New home and
community based lowincome program
Finance
Reforming Medicaid
long term care
Finance
Tax incentives to expand
long term care insurance
Finance
Home and community
block grant program
Labor & Human Resources
Regulation of private
long term care insurance
Labor 8i Humaij Resources
�V. Malpractice and antitrust reform, fraud and abuse, legal rights of
individuals (anti-discrimination -provisions)
Malpractice, antitrust,
legal rights (anti-.
discrimination)
Judiciary or Labor &
Human Resources
Medicare, Medicaid
fraud and abuse
Finance
VI. Taxes
Cigarette taxes, tax cap
(year 2000), tax
preferences for rural
practioners, other revenue
raisers
Finance
VII. National Health Board, National Administration
Mechanics of establishing
board and administration
divided by function
performed
. r
�11 November, 1993
MEMORANDUM FOR: Ira Magaziner and Melanne Verveer
~~
FROM
Ken Thorpe
RE
Additional Spenders, Savers Analysis
*****************************************************************
We have now completed analyses of total health care spending
(premiums plus out of pocket) for four groups of individuals (see
Table 1) . The analysis now includes information on 170 million
individuals. The analysis does not include the medicaid or medicare
populations. We are currently working on a medicare analysis. With
respect to medicaid, the 20 million cash assistance recipients in
the program should be counted in the 11 pay the same for similar or
better benefits.. category. With the cash assistance medicaid
population included, the analysis includes information on 190
million individuals. Across all the groups, 18.7 million
individuals--nearly 10 percent of the total (that is with the
Medicaid population examined--would pay more for similar benefits.
Approximately 28 percent (54 million) would pay more and receive
more comprehensive benefits. Finally 62 percent--approximately 118
million-- would pay the same or less for similar or better
benefits. I have provided a more detailed breakdown of these
categories (see Table 2).
In addition, we have also examined average savings and expenditures
in these groups. I include this analysis in Table 3. Among those
that save, average yearly savings are $1,390 in 1994 and $1,860 in
the year 2000 (see Table 3).
�I
'\o.b\~
~···:,. ~-
t
Count of Health Insurance Units and Individuals According to Cunent Health Insurance Type
(units.ln.thousands)
.,•••< .......... ••••••••,
· .. · . ·.
1994
2000
Number
HI Units
Total
Number
Persons
Number
HI Units
Number
Persons
85,623
170,742
90,246
179,962
93,691
11,125
36,203
29,723
42,212
6,178
25,910
15,946
98,751
11,726
38,158
31,328
By Current Health Insurance Unit Type
ESI
Non-Group
Uninsured
M;xed Coverage
40,050
5,861
24,583
15,129
SOURCE: The Urban Institute's TRIM2 microsimulation model, benchmat'k8d to the National Health Expenditures Accounts.
Model 1000
·~
D
::;)
::;)
:c
V)
»
I
I
~
10-Nov -1993
02:08PM
�.. .·:· ....... ,.·· :..,.
~\ok
-- -~~'"-~-~-Spendllll
2.
~····
1884 AeeultP-OuNt PacDtEJpeadlturn lllcluded
FGIIIre8' cllncl parmenta1
~'!llbi!IIIJIIIII!IIl'llibm !a 1ctuar1at aauiYaleiJB!
Flnlllatel Mil~ cap (7 .9% -.Jih lo\WI' caps for llllallllmll) I Four-way CDIIIpOJIIe pran:ll.nla 1
For AD Hedh lalu...._ Uda 1D Regional Allllnce
Nnber
sawn
$1~+
~
T01al
85,.,
$5001,000
SP811da18
S25D·
500
$100·
2SO
c$100
No
IK
8%
7"A
7%
8%
ESI
15
84
It
II
5
1
II
IS
MIJIIIId eo-vue
40.050
5,8&1
Z4,583
IS,128
5
5
2
5
12
0
I
12
0
1
4
t5ilO-
$250-
StOO·
250
K
'
$250500
I OJ.
5
0
8
8
9
c$100
IO'lf.
BJ eun-t HM!ttlln!nmlnt!A lllllllDI
l'foii-Gioup
Uo'nlunld
$100·
250
"'
C!lanqe
•
0
18
8
ssoo~
2%
14
0
26
20
13
13
$1~·
18%
0
••ooo
4
0
0
8
0
4
2
17
For Urile willa Head UDder Ap IS
Savel$
Nulnbat
TotaJ
1~
500
14~
7"14
8%
9
13
11
85.950
Itt CIIIMII1 HMtllo lnluranca LbtB lJIIII
ESI
Nan-Gioup
Unlnlcrre:f
Mbald eo.arage
..
14,440
1,773
13.,883
5,844
6
2
5
5
II
0
I
4
$500-
12
S2ii0-
$50).
500
t,cr»
~
12%
21'1to
6%
1%
I.!!!!Q
500
250
2
9
0
15
17
16
0
29
20
3
0
0
2
$tOO•
mo500
1400J,OOO
11,000+
IS'Ito
9'J(,
w.
t1oo-
No
...
!i!!!!S!...
<S100
250
14'1'
9%
18
0
I
5
8
7
0
<i100
1160-
9
7
•·
§J!!!!J!IS
$1,000+
(TixJusan:lt)
0
21
14
II
13
0
5
9
I
For UDila w10t a HHd Cll Age 81 or Gallier
Number
l11=IMI!ds)
TC1181.
49.473
aa...
11~+
2M!.
a
ESI
n
'"
0
:>
::>
:c
,
~
I
I
:..
:::>
z:
Vnlnlured
Nh8d CoMnlge
25,610
4,CI88
10,690
9,286
17
98
IS
18
<!IOO
~
c:lumae
cftOD
""
8'1.
1%
7%
5%
12
0
I
It
0
I
4
0
17
4
0
8
a
12
0
5
ti
5
4
8
ax Currim1 Haaltl ........_ IJDb ImJ
Non-Group
..,
13
2
souRCE: l1i8 Ui&ll Gt~ulll'l TRiiJ2 mkniSIIIIUt8IIO ..... 68113uaalklld so lhli m
8
7
260
K
8
0
tO
10
18
0
21
20
4
0
0
0
13
21
6
3
HeiJdl Ellji8llllllUf8$ Accoults.
1. Coalpo&aepnltlllllnls:$1,54812,12512,47912,479. Alllmoa IICial1ta" plem!UIIIa: St,932r'8,885t3.,89Cti4.38Q. PMirdualtl redUced 2.7 peroBII1 to .IOIOtal.pa.'HIIng.
2. .tacludell WOI'Ir8f share ol ESI and IDciiYidoal nongroup pay1118111S. CWIInl apandfng redoc8d CO matdltiCJ'A clla1rlbulion.
3. Assumes ~ curran11y pa)tng VINI8I' t11sn 80% ot premlullll confllue to do 10 If spending ct:les GOt . - d currant.
~au 8l1lplo)'8ls am1 YIOdla pDI'Cbas8 ~~~~~ COYWap co ll'l&1ch actuarial \Iaiiie ot curnnt ~Coal ot supplemaniiiiM l5har8cf ba1waen ~ and wr1cer r. JIAIPCI1lull10 cwrent pnllld:IID allaret.
20'1.1oa:f on~
4. lncladee ~ wllh CUI'T8fl1 ESI ~aD familY AIQ!b815 aQ year.
mwnes
ModeltOOG
to-Nov ·1998
02:19 Pt.t
..
�..
DllfaNace In Heallh PreiDium SpandiDg
lt!M Results- OuHt Pa clr.IIIEJipenclturea InclUded
To.~'~ 2..
FllllllllM' cflrec:l ~~
Wltti!!!RI!IIftl8llltatlon II ac1Uarfll U!!lvll1enceFltm rM"'Iaubsldy cap (7.9% with loW8I ~ klr small flmas) 1 four-way compo&lle ...,.,...a
For AD Hallb nurance UAha Ia Regional AlllaDce
Number
CThousallds"
Total
85.&2:l
Better
Save
No Change
&B&ttet
28%
19%
8%
'Z1
2
0
19
8
Saw&
Pay&
B&UM
Pg
32%
II%
3
15
17
0
0
0
60
I
42
0
0
18
NoCIIana&
8
1k QJ!li!DI Health 1A1u1ance YDII Imt
ESI
NAI
24,.583
2f
$5
100
0
IS.129
18
15
Save&
Bstt«
Save
&SaUer
No ChaM&
Battar
Pax
35.950
UnlnRnd
MIHd Cowerage
5.881
(Thousands"
N~
24%
15%
12%
2%
37%
11%
:11
5
16
0
E2
19
0
40,0SO
For Utlltl wru.Had under Ap as
Nc.anbel
Total
Pay&
No Change
6! CurnN11 Haallh lnswanca !.!oil !mt
ESI
14,440
26
No!HJtoup
Uninsured
Mixed Cowraee
1.773
13,893
5,.844
NA
17
tOO
4
0
0
21
13
14
13
0
0
I
40
0
19
For Unlll with a Head of Age as or Grealer
Number
~·
Tolal
'-!)
co
49,873
&we&
Bettlf
Sail&
31%
22%
No0haft9e
Pay a
&Be11ar
NoChaaae
EI8Utr
P!r
6%
'"'
2&~
17%
15
0
56
4C
16
0
0
17
ev eummt tJWh 1osurai!O!t umt l)pt
0
Est
25,610
28
S1
2
2
NGn.Qraup
NA
100
:::>
E-
4,088
10,690
26
Mi.lred CaiMrage
9,285
18
0
15
0
17
5
0
0
1
::c
C"f')
CD
I
I
E;
:z:
u.dnand
SOORBE: ttle ULii 11\StltUtesa TRiM2 mJCrOSIImJit1ll rn&l81 mfiQid 1o ihe NatiOMJ A8& Expencl'itures m.
I. Aduarlat value 110t ~ lm,pnlwment can aot be de1etmlned.
Model JOOG
10-N<Pt ·1993
�..
.... _..
~~ln.~ PraduiiiSpeadlng
. .·:.;.·.
2G4IO Rwuh8- Oft.oloPocllill Expncfttllf•IIICIUdu
co
F111111fa' ct11wct pavmanl8'
0
Mhaall-•tallaniRaatualtai!IID!IUJIDK
Flm IMIIIIUbsldycap (7.9Wo wDiowar caps lilrii!UD 6ftiiS) I Folr""ay ccnposl18 prarnlulns 1
For Allllealt1I........_Unbfn RegloNIAIII-.
sa..-.
250
<1100
Z4%
8%
7%
7%
.....
t't'.
6%
,.
,
12
0
7
0
I
4
6
I
18
9
4
0
8
$500•
$1 1000
CTIIousancrs)
Total
IQ,248
B! CummJifaabh .,..__, una r.r.
ESI
42,213
~
&.178
15,810
15,848
llnlasulwd
Mlx8cl Cov8lag8
For unn. with Helllt under •
24
88
14
16
a
'
·'Ttl0usallcf8l
8
6
5
$250-
I1CO•
$1,000 •
500
250
I,GOO.
18%
8%
81ft
19
88
31.,892
t3
4
II
BJ eurr-t Utlllb h-•a UnliT,_
E8J
Unlnsunlcl
t.tbracJ CcMrage
0
I
1600·
Eawrs
ftcn.~p
No
chana&
<$100
$250·
$500·
600
I~
§1,000+
17%
SUIO·
2fiO
7%
2%
n
7
7
13
4
0
12
12
0
(I
·J
0
28
8
18
5
3
$1CO•
0
wso-
·~·
110CO
11,000+
S%
11fo
0
0
18
35
'hlr'Db8f
Total
S»88ldooa
I~
$2SO·
500
SHIO·
t-
Numllet
16,219
1,.888
14.844
e,1ao
II
4
II
6
0
2
6
II
0
1
5
SDeadeJ8
~§100
No
<$10)
250
13%
'""
II%
t1%
9
7
10
0
3:.
0
5
I'
10
7
0
14
18
3
0
5
0
10
15
0
0
4
19
10
f500·
4"J(,
clllno8
50:)
3
I
For Uab wllb • fiNd of Age~ orGraat•
SaWI8
Humber
fThouaan:lsl
TotaJ
62,35$
~·~·
29%
•·
1,000
-mo:500
SD8rldBr5
$100·
2SO
_s!IOO
E81
co
co
0
:::>
::c
E-
('\')
-
0)
I
I
:>
0
::z:
28,993
4,309
11,267
9,788
UnlnlluJIId
Mlmd Cov8nlgll
28
99
t7
19
500
I~
11,000+
""'
'""
4%
8%
14%
8%
zr.
8
II
4
0
12
0
0
22
17
~
10%
7%
8Y.
15
0
11
12
5
0
2
5
0
I
5
0
4
0
3
0
t
17
6
0
8
3
6
8
9
BJ CLmlll1 lml1li lnsurRr.!!G !.Ill II bJit
Non-Group
1100250
l2t10.
<i100
No
5
6
0
.7
20
soOkE! & uaan rm 'TFiithra.Gmr nn m r roltl8m H8aii&ezp8Adltll83 m,..
I. Colnpo6lte pnlllltullls: I 1,64912, 12512,47etl,479. Alllano8 8dUal1al p-e.1liUrllt: fi,9321S,86&0.118S'4,380. Pr8111kna r8Ciucecl 2.7 perc&n~IO align to IOial 8J)8IIdlno.
2.. h1clud8lo WGrla Ulr8 of ESI and lndlwlcalal 110118ftlUP Jll&l'I1IM1S. CUtnln1IJplllldlng ~ 10 nudch HCFA ~
3. AlsUIIIe& ~ Cl.r1l8fiUV pa)trg grvAN lltan SOY. of pr8DIIulna CM1IIWe to do 10 i18p811111nf doe$ n:IIIIICBad cwt&nl
AssVA'I8S 11 ~am wata~ra purdl8le supp~a~en~a~ ~to naa~e~a actuarlad Yalu8 or curHIL'II CIIR8IIIg8.
Cos1 ot IA!ppiB-Itdcneharad biiiWeiiD eroplora' and 11011car In P"'PP''Ion to c:urren1 preiiiiUnllhanla. AssurnBs 20% ba on auppllm8nla.
4. fndudes workr8 ani\ cum11J1 ES1 OO'IIIIfng all f&IIIO, 11181Rbcn Ill pm.
Mod&IICOG
1o-No¥ -1993
02:24PM
�Dlflarenc.fh Heal1h Ptenalum s,endlng
2000 Raaura.F.......- drrectOUt-of Pocket ExpellciJIUI'M InClUded
p8JI'ftentl'
:«<ib !!!l!lttmmlJJIR!l !2actuad!IHYI!!I!IIi!et
firm MIIUbalcJy cap (7.1'.4 with lower caps lor smaQ fllvM) 1 Four-'61ly OCiftiFOIIte ~ •
For AU HNith Insurance llnlllln Regional AIBanoe
Nabet
Saw&
Sattar
Saw
&Battw
NoChar!Qe
Better
Pay
30%
21'Jo
8%
1%
30%
Ul%
29
NA'
38
2
8.178
25.910
15,948
t2
18
D
17
D
19
a
100
0
0
"
0
58
8
1
40
14
D
0
16
(lhQuaanda'
Total
90,246
Noelwlp
Pay&
§.1 Current Heallb lnsuta1J.211.1!!111We
Est
42.213
Non-Group
~
MbGicl Cawlag&
For ..... with Head VAder Age 3S
Number
!Thousaftds'
Total
Pay&
~
Save
a Better
lfoChallae
Belter.
~
25%
17'%
11"'-
2%
311"'-
9%
15,219
Z8
1,869
14,644
8.160
35
too
0
3
tiA
17
15
14
0
~
4
0
0
t6
13
1
62
38
18
D
D
18
Sav&&
Bett8r
&we
No Change
a. 8eftet
No Change
Belter
Pal/
33%
2AY.
~
1'1(,
2801{,
10%
26,9113
30
2
0
13
14
NA
40
100
2
4.309
0
11,287
~
0
17
0
0
56
0
0
9,786
20
18
5
1
4f
15
37/192
~ Qumml tl!dh
No Change
S.W&
!IJ!Y!ance Um :rmt
ESI
Hon-Group
UnlnsunMI
Nixed Coverage
0
For UI1Us wJ1h aHead ot AgeSS or Grealar
NU'I1bel
fl'housallda'
Total
-
co
co
0
:::::»
::c
E-
(Y)
C)
I
I
::::>
0
:z:
52.355
Pty&
~ QyiD!J! Heallh JAsurance !b!!l Tvoe
Est
~
Uninsured
Mixed Cowlage
souRCE: The O&n in8ti£Ut8i8 tAIM2 miC(oslmUiatloiilnOdeC b8maiii8d to lll8 NiiiOMI Health $fldlhltes Accovras:
t. Atttlarial VIWe not availallle-Coveraoe iarpovemant can no1 1» cleter'mMed.
Modei100G
1D-Nov ·1993
�•;
...........
Average Dlfter.nce In HeaSth Plerium Spending-··· ,· ·.
1994 Raulta- OUI-OI-Pocket Expendllurea lnctuded
FamDIH' direct~
With aui!Jtltmtntat!on h! acJuarJal agulyalence'
Arm level subsidy~ (7.9%wllh tower C8p8 for smaD tlfms)/ Four-way COIIIpOSJte premiums'
For All Health ln8111'81l04 Units In A41glonal AD lance
Number
(!housands)
85.623
Total
or Those Who save:
AvgAnnuel Savings
$1~90
01 Those Who Spend:
Avg Anr.aal spendlna
$370
By Current Heaflh lnsutaOC! Unit Tvpe
ESI
Non-Group
Un'nancl
Mlxecl Oovetap
24,583
$740
4350
1340
15,129
1230
40,1)50
6,861
8290
:J30
4!0
410
For Units wJth Head Under Age 35
Number
(Thousands)
Total
35,950
or Those Who save: 01 Those Who Spend:
Ava Annual &wings
81,090
Avg At1nual Spending
i31o
By CWrtnt Heal!b Insurance UnftlyP.t
14,440
$680
:rooo
~
1,773
13,893
1240
S.844
840
340
310
280
For Units with a Heed of Age 3S or Greater
or Those Who save:
Avg Annual Savin1JS
$1.550
Tolal
Of Those Who spend:
Avg Annva1 SpendkiQ
$420
By Current Heal!b !nwanct Unit Type
ESI
Non-Group
J)
$770
4930
$300
Uninsured
Mixed CcMrage
I')
25,610
10,690
9,285
1410
510
1430
470
4,oaa
360
SOOR6e: 11l9 ulb8n inStitU18's TRiM2 mtamr model, m m to ihe Aat01181 H8&liii EXPi@itUre9 Accoun1L
I
.....
.....
I
>
E
Modal 1000
1o-NGv -1993
�Av.rap-DIIf«eace In Health Pnmdwn Spending .
2GOO RMUI._ Out-of-Pclckel Expendllurea lnofuded
Families' direct payments'
WBb svpplt!YHtn1allgn to actuarial eaulyalmce1
Firm level subsidy cap (7.9% wilh Iowa caps lor small firms) 1Four-way composite prlllftiUm!l•
For AU Heahh tnsurano. Unit• In Regional Alliance
Number
(Thousands)
Total
90,246
or Those Who Save:
Avg Annual Sar!ngs
Of 1hose Ylho Spend:
Avo Arwlal Spenrllns
$1,860
$410
$1,080
$320
6050
1560
320
1640
450
Bv CUrren1 HtaJt1l!nauraoce Unit bot
ESJ
42,212
6,178
Non-Gruup
Uninsured
Mixed Coverage
25,.910
15,948
460
For Unite with HHd Uncter Age ,5
Numbet
(Thousands~
37,892
Total
§! Current Health
For Units with a Head of
$970
6.160
Age,,
ot Those Who Spend:
AliA 1&mual s,encona
S360
$320
4190
80
\460
380
1060
350
or Greater
~
Total
or ThGee Who Save: or Those Wflo Spend:
Ava Annuat Sa!lng8
$2,090
Avg Annual Sperldlrv
$460
Haalth lntnJrance Unit J)a
Est
:0
Non-Gn)up
Uninsured
Mixed Cov«age
=>
=>
::c
:--
$1,440
15.2t9
1,869
14,644
Number
~ Current
Ava Annual Sa\'lnJp
mranoe Uri! Imt
ESI
Noft.Gfoup
Uninsured
Mbced Co'Y8f8198
:0
Of Those Who Saw:
26,993
$1,140
4,309
6860
1640
11,287
9,786
1780
$330
430
670
520
SOURCE: The ulban 111Sti1U1e's iRIM2 mlcrOSJmUiatiOD moaec m r 10 ihe m
;"f')
:::n
Heaiih Expenditures Accounts.
I
I
e;
z:
Modai100D
'
•
10-Nov -1993
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
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White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
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1993
Identifier
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2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
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72 files in 6 boxes
Provenance
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Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
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William J. Clinton Presidential Library & Museum
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<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
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Title
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Background on Health Reform [6]
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First Lady's Office
Melanne Verveer
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2006-0223-F
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Box 3
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2068127" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
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William J. Clinton Presidential Library & Museum
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1/8/2015
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42-t-2068127-20060223F-003-002-2015
2068127
-
https://clinton.presidentiallibraries.us/files/original/529babc234fa06b908daea1e3cc2475d.pdf
fbebefc885c6fac0c52098178ca0b3f6
PDF Text
Text
'I
MEMORANDUM
DATE:
12/6/93
TO:
The First Lady
FROM:
RFC
SUBJECT:
Paid Media Strategy
On Friday, we spent nearly two hours discussing how we should allocate resources and
responsibility for paid media on behalf of the President's Health Security Act. We reached the
following conclusions:
1.
We should continue to do all that we can to steer resources toward the DNC's Health
Care Campaign, where we have a both a clear commitment to the President's interest and
control of message and timing.
2.
We should work to achieve maximum coordination with other efforts, especially the
Health Care Reform Project, Families USA, and the National Leadership Coalition.
3.
We see four stages to the campaign, which can be described roughly as:
Now to Dec. 31: GRASSROOTS CQNTACI. Targeted CO's. No paid media.
Jan. 1 to STATE OF TilE UNION(SOUl: REPOSmQNING ISSUE. Run up to the
SOU. Suggested paid media: Opinion Leader Ads Comparing Plans (Lead: Health Care
Campaign- $1M).
SOU to May: DISTRICT FOCUSSED. Follow-up with targeted Committee Members.
Paid media: Lead: DNC - $2M. Our goal is to have at least $30,000 per district and
leverage it to at least $50,000.
.June to Aue./Oct.: ENPGAME. Funded by those who have a stake in the victory.
430 Sourn CAPITOL STREET, S.E.
WASHINGfON, D.C. 20003
To VoWNTEER AND CoNTRIBIJI'E 1· 800 • 923 • 1993
202 863-7174
�4.
Response ads are essential to respond to potential attack ads. Suggested action by
Families USA to take a lead on this task with resources of at least $500,000.
5.
Develop several models of a national positive media effort based on a budget of $5
million. This is highly speculative, but the NHCC would like to mount this in the
January/February time frame. I will make an effort to find outside sources of funding
specifically earmarked for this purpose. We will consider producing a spot or series of
spots using the Madison Avenue team that Mandy has assembled, so that we have a
finished product around which we can raise money.
6.
We agreed that this issue requires much more than a 30/60 second media strategy. The
key resource is the use of the President's and the First Lady's time and travel. This is
essential in the period immediately following the State of the Union. It is also a critical
resource in countering any large scale negative paid media campaigns. We should develop
a strategy for the use of this time before the end of December.
7.
We need to determine how best to engage friendly members of the business community.
Some of them will give to the National Health Care Campaign, others to the Health Care
Reform Project. For those who want to stay distant, they can use the National
Leadership Coalition.
cc:
Williams
Verveer
Boorstin
Lux
Grunwald
Greenberg
Wilhelm
Moore
�·~
..
REMARKS OP SENATOR JOHN D. R.0CKBPPJ..LER. IV
Nadonal Health Coundl
Washiugtou, DC
December 8, 1993
Thank you. It is good to see that we are proving that Washington does JlQI
come to a screeching halt when Congress adjoums. I even had to resort to asking
my scheduler to block out t1me for Christmas shopping ... you might think about
doing the same th1ng, or else ....
r am very glad to be here again, a guest of the National Health Polley Council
which so many of you support for all the right reasons. Responsible poliey-maldng
absolutely depends on honest dialogue, constant education, and even heated debate.
The Council has understood this for decades. rd also Hke to note the special role of
the Paralyzed Veterans of America in todays gathering. Given that r just finished
my 1irst year of chairing the Senate Veterans" Affairs Committee, I am reaching d1e
conclusion that the PVA's assistance is a sign that we have made a good start
together.
·
We also are finishing the first year of a new Presidency and a new
Administration, with much to be thankful for. More to the point of today, I hope
we are entering the final stretch of one last all-out effort to enact comprehensive
health care reform.
Par stalwarts like Senator Ted Kennedy, and for historians, we are on the
brink of achieving something that has eluded Presidents and Congresses for ahnost
sixty years.
But perhaps it's less stressful to measure this point as the last and most
difficult part of a campaign that picked up steam in the past three yean; roared onto
the political track with the Wofford election; and is now on a train stoked with fuel
that includes cvcrythina from Presidential leadership, to serious politic:al pressure on
Republicans and Democrats to deHver.
Thus, I hope this is the last year when I come before the Council to say the
train is about to get to our destination.
At the same time, I am 112! here to allege that the ride from here on is going
to be a piece of cake. Instead, [ want to share some thoughts about how r honestly
think we are doing, and what has to happen to make it.
Pirst, an observation: right now, when pubUc discussion turnS to health care,
a strange phenomenon occurs. Finally, when most politicians and so~ealled
opinionmakers talk about health ~are, they spell out the same concerns and agree on
the same parameters. And yet, many of these same people think that means they
�have to go off and cook up their own special recipe for the actual soludon. I keep
hearing a clarion call for the principles of President Clinton's Health Security Ac.t ••
security, savings, simplicity, choice, quality, and responsibWty •• but for some
reason. often with ng intendon of supporting the plan itself.
It .il tremendous progress that just about everyone discussing health care
reform agrees the problem is dire enough to wan-ant action.
We all know the burden our present health care system is placing on America.
Here we are, spending $1 trillion on health care ··fast approaching $2 aillion ··yet
despite that investment, two million Americans lose their health insurance each
month. Not poor Americans, not Americans living in depressed communities, not
minimum-wage earners. The vast majority of those two million Americans being
robbed of their peace of mind are middle class, taxpaying Americans who play by
the rules and still come up on the losing end.
Beyond the personal toll, we agree that health care costs are an anchor
around the neck of the American economy. Twenty percent of our economy now
goes to health care costs, leaving us with few resources to invest in srowth,
technology, modernization, and competitiveness. We've had some heartening
economic news lately ~· unemployment is down. consumer confidence is up,
American exports are growing •• but if we don't fix this bloated, inefficient,
voracious health care system, and fix it soon, that news will be history before we
know it. We have a chance to give the American economy another boost and speed
up what appears to be an encouraging recovery if we just can rein·in this runaway
system and stop health care hyperinflation.
So it seems we should all agree ~- lers refonn health care and administer a
long-term cure to the American economy. Why then are we still seeing so many
roadblocks thrown in the way? One suggestion is that health care has its own
Tower of Babel.
As I see it, there are now two distinct conversatior.s going on about health
care. They may use the same vocabulary, but the meaning and intent behind the
words are very, very differenr. OnP. cnnvP.rsarlon, here in Washington~ is about
details, special interests, factions, and politics. The other conversation, across
America, on front porches and around kitchen tables, is about real life worries and
practical remedies, from people looking for an answer they can trust.
The President and the First Lady staned bulldmg L'lu:ir plan by listening to the
American people. They put together a plan to respond to the needs of parents,
workers, sm.all business people, with A la~P.r-like aim on what famllies call their
bottom line •• peace of mind. A plan based on the fundamental principles that rn
list again •• security, savings, simplicity, quality, choice, and responsibility. These
2
�are more than titles for each secdon of a bill ·• a lot more. They describe a
proposed contract between the American government and the American people to
deUver a health care reform package that is defined by real world needs, not
political expediency in Washington.
President Clinton's plan, exhaustively researched and audited, will give every
American health care coverage they can never lose and can never be taken away.
Other plans pass other tests -~ ideological, political, the demands of certain special
interests. Only the President's plan passes the toughest test •• answering the
demands ot worldng famflles.
People wnnt to know they'll have insurance and they'll never have to fear
losing it. Parents want to know their families are safe and their coverage can never
be taken from them. Seniors want to know they'll get the care they need where
they want it, at home, and they'll never have to fear being shunted off to a home
somewhere. Families want to know they'll never have to choose between one child's
college education and another's medicine. Thars real life, folks. And that's what
the debate on health care should be about.
You see, we .smWi build a health care plan that starts with the poUtical details
and mechanisms. and then try to squeeze that plan to fit the conc:ems most
Americans have.
But to do so would be to allow political means to define practical ends, and
that's a sure redpe for disaster. That might leave a lot of folks in Washington
satisfied, but it won't soothe the worries of the rest of America.
Yes, both sides rely on same language, but what do they really mean? When
terms like savings, security, quality, and choice come up, what are we talking about?
o Around a lunch counter, security means universal coverage- no loopholes,
no lifetime limits, no redlining or fine print. Coverage that can never be lost
or taken away. It does not mean universal access. Let's be honest, we aU
hut access to most anything -- say a Mercedes Benz, if we sell our house to
pay for it.
Acr.e~~
i.s the ;wn the same as coverage. security, protection.
o Around the kitchen table, savings means real limits on insurance premiums.
Savings is not just a word in real life, so it won't fly to settle for new promise
from the insurance companies.
o Across a backyard fence, simplicity is about fewer fonns and fine print. It's
not a new, big, complicated gnvP.mmP.nt bureaucracy. and I agree we should
avoid exac:dy that.
3
�\
.,_
o On the front porch, choice means the freedom to stay with the doctors you
now know and trust. Choice does not deciding to focus solely on how to
protect physicians' incomes.
o For famWes, quality is about a ba5ie set of clear, comprehensive benefits
that include some long-term care, help with prescription drugs, and an
emphasi~ on prP.vP.ntion. Quality is not a promise that someone else will
define the benefits after the bill is passed.
President Clinton's Health Security Act meets the tests of peopleJ not the
lobbyists assigned to obsess on one detail or one deal. It guarantees every single
Amedcan health c~ that can never be lost -- without raising $500 bilUon in
new taxes. [t defines a comprehensive set of benefits, guarantees extensive
coverage. ends lifetime limits, bans discrimination for pre-existing conditions, and
guarantees prescription drugs fur senior citizens. And it achieves universal coverage
by building on the existing of insurance through the workplace, rather than radically
altering the way most Americans get their coverage.
And by the way, the Health Security Act also paves the way to giving
America's veterans better care, without substantial additional costs to the Federal
government or taxpay;ng non-veterans. With VA medical facilities currently involved
in training approximately half our nation's doctors and in crucial medical research,
supporting veterans also pays dividends for every American.
I know there are other plans our there backed by a Capitol Hill Who's Who.
Phil Gramm, Jolm McCain, Dan CuHUi, Jim Cooper, Pred Grandy, Bob Michel and a
host of others have been in the kitchen, stirring up a range of other health care
plans. They all have .!Qmg merit, and some have a lnt of merit. But none deliver
everything that the President's plan does. And, by the way again, Ill these proposals
ignore the ctUTent VA health care system. And most ignore long-term eare,
prescription drugs, and the list goes on.
Then, we have the much·advenised speciW offered to us by the Health
Insurance Association of Ameriea, the new declared advoeate for health reform, the
crusader for the Uttle person. Talk about a giant sucking sound.
In dead seriousness, HlAA •. and others -- have made a dent. They even
figured out that it made sense to air a lot of those ads right here in Washington.
Because it's here where the point of health care refonn can get so easily lost, so
quickly off track. They want to scare Americans away from the CUnton plan, and
maintain the status quo •• and they can see that the cheapest way to do it is by
spooking the politicians ancl the p\.\n4its.
Supporters of real health reform •• with real security ·• have to do a better job
4
�exposing the motives of HIM and other relentless critics. We have to help everyone
understand that the words might be the same, but their meaning, their goals, are
not even remotely related to the needs of Americans.
The legislative process will take time and may reshape the President's plan,
but again, l argue the debate on health care reform must be built on the Clinton
plan. Because the Clinton plan is built on real-life needs.
And among you, members of the National Health Council, you possess the
clout, the dedication, and the credibility to help produce a final product that meets
these needs. l note members like the American Red Cross. The American Lung
Association. ~. The United Way. Collectively you have constituencies and
members who belong in the fight for health care reform that delivers.
You must be proactive. You must seize the high ground and make clear to the
American people that what is at stake here is whether or not they get the kind of
comprehensive, universal, reliable, and secure coverage they want. You have to
invest in education, in outreach~ In confidence building to show that the Health
Security Act is the only refonn plan defined by the American people, not by factions
and special interests looking for ways to conquer by dividing-- or who mistakenly
think it's their way or no way at all.
The challenge is before us. Congress will return to session in late January and
begin to take up President Clinton•s health care plan. There will be hearings,
testimony, and reports galore. What I will tell every one of my colleagues over and
over at every hearing and con:unittee meeting, until they can finish the sentence for
me, is that this is a once-in-a-lifetime opportunity. The Health Security Act isn't
tinkering or pretending. It doesn't just gloss over the threatening menace of an out-
of-control health care system. This is a chance for us to do something real and
make the lives of every American easier, safer, and more secure. It is a chance for
us to make our country more prosperous and more competitive. In shon, it's a
chance for us to leave a legislative legacy that will far outlive us all. With a charge
like that, we have the sacred duty to work tirelessly to pass a plan that deserves the
word security in its title. I am eager to continue working with you, and to make
next year .tlK year of health refonn. Thank you.
s
·
�.
Remarks of Senator John 0. Rockefeller IV
Sloan-Kettering cancer Center
New York, Hew York
December 16, 1993
Thank you.
I begin by showering praise on Dr. Paul
Sloan~~At.t.Aring for arranging my visit.
My family has a rather long, philanthropic history with SloanKetterinq, but I know that your hospitality has absolutely
nothing to do with that. I have always succeeded on charm and
good looks, and nothing else.
Marks -- and thanking
As some of you suspect, I qrew up 1n this city. While I
have now lived 1n, and represented, a rural state -- west
Virqinia -- for more than half my life, I cherish my roots and
my family here in New York. I hope that enables me to have a
real appreciation for tha importance of your work. I
certainly know something about tho expectations and
obligations that fall on your shoulders -- in trying to
perform some of the best medical research and treatment in the
world, while respondinq to the health care needs of the ve~
poor, the very old, and the very sick.
.
I have tried not to be intimidated about speakinq to you,
and instead, to think about my obligations and expectations -and what thouqhts to sharA with you. We are on the eve of an
historic year when our country may finally commit itself to a
specific path of health care reform. As a Senator totally
dedicated to thia goal, I find this visit a chance to reflect
on the iseues of reform that pertain to you and your
institutions -- to academic health centers and-the workforce
of health professionals.
This is also an opportunity to express my intent to work
with you every step of the way in the stretch that awaits us - an intense period of tan months in which we ~ produce a
final legLslative produot, paee it in both houses, and get it
signed into law.
I start with a basic premise that most congressional
leaders in health care and most key officials in the Clinton
Administration want your institutions to function and thrive
in a reformed health care system -- so that you can continue
your critically important missions in education, research, and
patient care. But, before gQtt~ng into the details of what I
mean by that, I ahould say something about the bigger picture
to set tbe context.
I am a proud, original cosponsor of the President's Health
Security Act. I sincerely believe this legislation, formally
introduced just before Thanksqivinq, is our beat hope for
comprehensive reform. It provides the framework needed to
achieve our overarchingo mut:u~l goals and Bhould be the basis
�for the remaining legislative process .
•
Por most of the year, larqely due to the First Lady's
extraordinary leadership, the Administration and its health
eara alliea dominated tho public stage. We built excitement
for the President's plan. We showed the pundits and the press
that health refor.m is qood politics, b9cause the demand for
action was coming directly from the public -- from the middleclass, from small business owners and workers, from
physicians, hospitals, and institutions like yours.
But ~n the past few months, while the Administration was
immersed in the oritty work of translating the President's
plan into a bill, the guardians of the status quo stepped
riqht into the breach. They didn't need legislative language
~o
oppoeo tho
P~oaident'•
plan.
They didn't feel any
obligation, whatsoever, to give the plan a fair hearinq before
taking out ads and airing commercials -- all designed to
strike terror in the heartM of Ame•icans over the plan.
Thanks to the deep pockets of the Health Insurance
Association, and other nay-sayers, washington 1s once again
full of questions about whether serious reform can really be
passed. I.ines are beinq fed riqht from the forces that would
like to keep things just as they ara1 Universal coverage
should be dropped, they say. Cost containment is too
controversial. Why should ~overnment dictate any chango• in
health care? Let the private market, the insurance companies,
continue to dictate whether or not our fellow Americana -- and
your patients -- can get insurance and have peace of mind
about their health care.
You know the responses to these questions. While reform
or change will not be easy, sticking with the status quo is
what we all should fear and tremble over.
Moreoever, in the recent months, health care history has
started to repeat itself. Once aqain, we have seen Senator
after Congressman eook up their own special recipe for health
reform -- so now we have an entire cookbook of plans, sure to
confuse the beat of us.
Most of the plana have m9rit. Some havs a lot of merit.
But I say this about all of them• every reform proposal
should be measured by the same rigorous standards that have
been applied tc the President's.
Every plan should be judged
on whether it meets the fundamental tests of refor.m ~
universal coverage and cost containment. And the test of
meeting the need for a responsive health care workforce and a
recognition of the unique role of academic health centers.
Only throuqh fair comparisons, can the public possibly judge
whet is in their interests.
2
�Another observation on the repent months may answer your
own concerns about relying on Medicare and Medicaid to partly
finance health care refor.m. My friends, it has been made
abundantly clear that the choice is not between health reform
and busineaa-as-uau4l. All oYer Congress, troops a~o
organizing to captu~e the very same money for a very different
mission -w and it is called deficit reduction. To me, the
choice now is between devoting health care resources to health
care, or to a reckless course if Congress gets conned into
passing something called a Constitutional amendment to balance
the budget. You need to help your representatives make the
riqht choice.
The President's plan restructures the way health care is
provided, including the way our health care workforce is
trained. A aerious health reform proposal muat deal with
these issues. A fundamental point of reform is to ensure that
those who are on the front lines providing the full range of
health care services to our communities are able to continue
doing so. Fundamental to that qoal is taking the riqht steps
so that we are ablexo delive~ the kind of health care that
all Americans deserve to have.
In helpinq to lead the fight in Conqress for health
refor.m, I am putting special emphasis on workforce reform and
the promotion of primary care. Not because I don't think the
kind of specialty care ~hat institutions like Sloan- Kettering
provide ia terribly important. It is. It should be fostered.
It is because I think it's time to recoqnize the direct
relationship between the mix and distribution of our health
care workforce, and its ability to provide the care that
people need, when and where they need it. Unless we
intervene, and change that mix, we simply will not live up to
the promise of true access for all Americans.
As I began by notinq, while I was born in this city, with
access to the best health care facilities, for the last 30
years of my life I have lived in the beautiful mountain state
of West Virginia. I originally went as a VISTA worker to a
town called Emmons. Then, and ever since, I have seen and
struqqled over the ravages of inadequate and inaccessible
health care.
As a Governor, I grappled with how a state can
improve access to care for its citizens without the help of
health reform on a national level.
West Virginia has three medical schools that do a
tremendous job of training and caring for patients in need.
Even with those resources, there is still a lot of unmet need.
As you can imagine, it takes considerable commitment, from the
stnte end ita health care p~ofessLonals, to support and
cultivate three medical schools in a state our size. But we
3
�have supported these institutions,throuqh some very lean and
maan economic years. We do i t because we feel it's our
obligation, and because we want to invest in the lonq-term
benefits of the training, the research, and the care provided
through these echoola.
I want reform to assist my own state's centers in meeting
their mission to improve the health status of ita community,
just as I want it to bolster your good efforts -- and for the
same reasons.
After thinking a long time about the role of workforce in
health
~aform,
anc the special issuQs connectec to academic
health centers, I decided to develop my own legislation on
just this set of issues. Working with Conqressman Henry
Waxman, another health cur~ leAuer, I have tried to apell out
our view of what it will take to produce the necessary
workforce.
Therefore, as I finish by discussing these issues and the
my bill. While
doing so, I ask you to focus on the basic question of whether
or not these ideas will be good for the country and our
President's plan, I will mRntf.on idAas in
overall health
c~re
system, alonq with what they will mean
fo~
your institutions. And if you still object, think about
whether or not you can suggest other viable alternatives or
approaches that will help us achieve our mutual qoals.
To start, I would say the ideas in the President's bill
that aim directly at improving support for academic health
centers are not where the fierce debate will take place -the~e
is acceptance for tho 1doas of continuinq support for
your research efforts' transitional relief for the changes
that will come from regulating the physician workforce, and
issues having to do with which specialized services merit
guaranteed contract rights.
We all want to make sure that patients in need are
provided access to the excellent health care that your centers
have been counted on for. How much money is needed to
preserve, protect, and fairly compensate academic health
centers for this unique role will be something to sort out. I
think we all want to accomplish thfl saa!le thl.nq -- practical
constraints will be our bigqest problem.
The sharper debate is over workforce reform, as you well
know. And it is on this front where I hope to persuade you to
be less resistant to ohange, and as constructive as you can
possibly be in this essential part of refor.m.
Now, we all know that in a refor.med health care aystem,
demand for primary care providers will increase, as will
4
�demand for other well-trained
pri~ry
care professionals.
But, hare we face the major dilemmas demand for primary
care practitioners is qoinq up, but fewer students, especially
physicians, are choosing this career path.
And even though
many of you are specialists, whose contribution will always be
essential, I think you understand that primary care providers
have been undervalued and underused in our current $yetem.
Simply put, the workforce provisions in the President's
bill are designed to change the incentives in our current
system so we produce more of the kinds of providers that for
years have been neqlected -- and who, clearly, will be needed
in much greater numbers in future years if we are to succeed
in building a more rational, stable system of care for all
Ame~iccna.
This shift must affect how you run your training programs,
and in some instances, the structure that you currently use to
provide that care.
The President's proposal, and my own leqislation,
recoqnizes this and attempts to ease you through the
transition to a reformed syatam where uncompensated care is a
remnant of the past. Both bills draw heavily from the
recommendations of the Physician Payment Review commission on
how we can best achieve workforce reform. Aa you well know,
workforce reform is intrinsically tied to the provisions that
deal with academic health centers.
Now,
I
want to make a
polnt-by~point
case for the chanqes
embodied in the President's plan and what T believe wa must
pursue•
Qnea I share the belief Lh4t an all-payer fund should
support the costs of graduate medical education and buttress
the work of acadamic health centers is common sense.
Medicare should not bear the sole explicit burden for services
that benefit everyone who uses the health care system.
On a related subject, while we're talking about funds to
promote the common good, like training of our nation's health
ca:e
workfo~ce,
I understand that you support SenAtor Harkin's
idea of a dedicated trust fund for biomedical research. I
will take a serious look at it. The financing of that fund,
of course, will be key 1n determ1n1nq its political v1ab111ty.
Another reminder to help kill the balanced budget amendment.
~~
I think consensus is forming around the threshold
decision that we need to ensure some control over the number
of roeidQnoioe in this country, and that those approved
residencies should be properly allocated.
5
Just how a
�National Council on Graduate Medi~al Education will do that
will be an issue of much debate. As a representative of a
small state, I want to see small, quality residency programs
able to continue producinq residents that practice in their
stAtes -- in unde~aerv~d areas, to be more p~ecise. Candidly,
I am nervous about the hopes, or designs, of some who want to
end up with regional training centers that are supposedly
going to farm out their residents to smaller states like West
Virginia. I fear this may be an effort to allow some centers
to continue to churn out specialists in the numbers that they
do today, without regard to the need for these positions in
our workforce. I don't think that is a road we want to take,
or an approach that should be encou~aged, taeitly or
explicitly.
Tbi;d pointa The President's legislation recognizes
that our current system trains professionals in all the wrong
proportions. , The bill says that we should have at least a 55
percent ~x of generalists to specialists -- I think that's a
goal that we all basically share.
Specifically, the idea is
to ensure that we are no longer paying to train health care
professionals that we do not need. This raises the concern
that we may be forcinq this chanqe too fast. I confess to you
that l am the ringleader here.
I think we absolutely need to
commit to a touqh timeline, and say when to b9gin trainina in
tha riqht mix. 1998 is five years from now. With proper
planning, I think we can make the necessary adjustments. I am
open to your views on this. By I feel emphatically that to
produce real change in the real world, we have to agree on a
time~tabla with some ambition.
Fourth•
one of my main concerns w:f.th the Prssident'a
proposal is that there is no cap on the overall number of
residents trained. That decision is left to the new Council.
Without a cap on the number of residencies, the goal of at
least 55 percent of all residencies being primary care
providers can be subverted. Let's be honest, some of your
institutions may find it easier to do just that. More primary
care providers could be trained solely to offset the number of
specialists. That scenario would mean we've done nothinq to
control the imbalance that currently exists, which could lead
to serious problems as a result of increased volume of
Gervices.
A cap is
~oeontial
to inauring that
care emphasis improves our current system.
ou~
new primary
Fifth, l1ke you, I share tne concern about just how the
allocation process will work. Congress, and all those
involved in the traininq of our workforce, deserve to know how
those allocations will be made. Specifically, as I have said,
I am concerned that there will not be sufficient protections
for quality residency p~o9~ams in small and rural states. Wa
should know how approved residency programs will be divvied
6
�up. Criteria should guard agains-t: the "big guys" overpowering
the ." 11 ttle guys" and therefore thwarting our attempts to
improve the distribution of providers.
Sixth point, I support changing the current formula for
determining payments for graduate medical eduoation training
to eliminate the huge variation that currently exists for
paying to train residents.
The last point I will make on this subject is there is a
great deal of controversy over who controls the dollars that
are used for training. There is debate about what the
President's legislative language actually calls for. No
doubt, this will be one of the issues causing the loudest hue
and cry. Por my part, I have a simple philosophy1 whoever,
or whatever entity, incurs the costs of training health care
professionals should be reimbursed for that service, directly.
That means if a training program inoura the costa, they should
g·et the dollars.
'l'h&t doean' t
m~an
that t.he money necessarily
has to go directly to the program. Medical schools could pool
the reimbursement for their individual proqrams. If community
hospitals are doing the training, they should get the money.
I know this is not a simple task, but I think we can figure
out a way to do it. I also know this will upset some
traditional relationships, but I think it is a fair principle
and is common sense. It also reflects the direction that
medicine
reform.
i~
moving already, even
absen~ na~ional
health oaro
I recognize that workforce reform is about altering
existing relationships and funding pipelines. aut unless we
succeed in makinq these chanqes, it is more than likely that
we will allow health reform to become a hollow promise -proclaiming universal coverage for care from professionals who
ara nowhere in sight.
I want to conclude by laying all my cards on the table.
~he end of
this process. But I readily admit to you that all the
President's and the First Lady's efforts to overhaul our
nation's health care system -- to give the promise of health
care security to the American people -- will be much more
difficult if we do not have the active support of our nation's
132 academic health centers. You are the health care
"elite" -- the Titans in this debate.
We may not agree on every detail, now, or even at
Your voices count, and that is precisely why I am here to
make my case to you. What you think and say about health care
reform, particularly its effects on academic health centers
and workforce refor.m, reverberates in the halls of Conqress.
And I want our voices to reinforce one another -- rather than
add to a clatter of dissenting views and demands.
7
�My hope is that you will do everythinq you can to work·
through the details of this legislation with me and my
colleaquea, ond consider care!ully the conaequences for your
institutions and the people that you serve. If we blow this
historic opportunity to achieve comprehensive reform, we will
share the blame.
Americans recognize that academic health centers are the
jewel in the crown of our health care system. They may not
know the jargon, but they do know where they want to be cared
for if they get cdnce~, or any numbor of serious illnes&Q&.
They turn to you. They put their faith in you. They rely on
your unmatched expertise, in their fight for life.
Today, we are talking about the fight for a decent,
stable, compassionate health care system. This patient is
also very sick. A few aspirin or a simple treatment will not
do the job. In order to make the system whole, we have to
administer a bold, serious ~eqimen of ohanqes in policy and
behavior.
If we can work out the steps toqether, we will all be
winners. Your institutions will retain their special role in
health care. But you will also look around, here in New York,
in the reet of the ~egion, and across the country -- and you
will see patients, neiqhbors, and family members who can gat
qood health care, wherever they live. Whether they have a
great job, or are in between jobs. Whether they are healthy,
or have somethinq called a pre-existing condition.
Please help, today and in the weeks and months to come.
Commit your support to the framework and the goals of the
President's proposal, and then help streng~hen the pillar that
will hold up the future of our academic health centers and our
health care workforce. We'll have to be very courageous and
very creative. As physicians or part of health care, that is
not new to you. The challenge now before you and me is to
~iva all we can to build a health care fQture that our great
nation deserves.
8
�SENT BY!Xerox Telecopier 7021 ;u-
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JOR ULIASB UPON tiiLIVIRY
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STA'l'BMIN'l' OJ
JUDITH. I • I'BDBR I Ph.D.
PRINCIPAL DIPUTY ASSIST.lNT SICRBTARY
FOR .PLANNING
»m
BVALtnLTION
DBPAR'l'MBm' OP HEALTH AHD .HOMAN SIRVICIS
BBPOU 'l'HB
HBALTH SUBCOMMI'rrll
COMMITTBI ON INPGY JUm COMMBRCB
·.·.
BOOSB 01' :UPRBSDTATIVIS
necember 9, 1993
�5ENI sy:xerox Ielacopler 1021 i12-
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• l
Mr. Chairman
and
Members of the SUbcommittee:
Today, cur health insurance and health care deliver,r
ayat~
sutter from major flaws that threaten our health security.
Tbe
'
taaafc needs of millions pf bard wozoking Amezoicana azoe ·not !)eing
The quality of care is often ccm;>romised by fragmented and
mat.
uncoordinated delivery of services and by a lack of useful and
widely available clinical information to guide providers.
And
the coat of health care consumes zoesources we cannot attoZ'd to
.
.
waate.
The causes of these problems are well understood tay this
subcommfttee1
•
market.
Today, insurers are free to price the aick out of the
Pre-existing condition waiting periods in moat health
insurance policies force people who need care to ;o without
coverage for months or years.
rear of losing medical coverage ia
keeping people in unproductive jobs or on welfare.
Insurance
companies compete to enroll healthy people, pouring vast
resources into identifying those least likely to need medical
care, not into providing care to those who need it moat.
*
Decisions about which health plana are available for
enrollment, and what benefits are offered, often are not made
the families whose health care will be affected, but
euwloyers.
~
by
their
This arransrement compramiaaa not only choice, but
also continuity of care, when peopie are forced to chan;e their
health plan becauae they change ~ oba or because theizo employer
switches carriers.
1
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�SENT
tsr:xerox rerecupur
·rul·J , •~
·r vii ,
····...vr ....
I, •
•
Por the moat part, health plans today are not held
accountable for the quality of care their providers
~r,
the
efficiency of their.cuatomer •ervice, nor their ability to
organice hospitals, doct~ra, and ether providers to aChieve these
ends within a budget.
Nor could they be, under today'a health
ayatem.
*
our ayatem of quality manitoring and aasuranoe also
needs significant a~rengthening, beth .. to protect patients and to
assist health care practitioners in their jabs.
Today, data on
What works and· what constitutes quality care ia fragmented and
hard to access.
For too long health care data have been
collected with an eye toward what we are spending, not whether we
are producing satisfactory outcomes.
inf~rmation.about
practitioners
i~
And for too long,
_what works and why has not been available to
a convenient, useful, and timely manner.
Mr. Chairman, the demand for reform is a rational rew.ponse
to an irrational system.
To address this demand the President
has outlined six principles on which health reform must be
founded: security, simplicity, savings, quality, choice, and
responsibility.
The Firat Lady and the Secretary of Health and
Human Services, in their respective teatimany before this
Committee, explained how the President'• plan fixes what is
broken and builds en what wcrka.
In the rest of my testimony
today, I will describe the role of ·health plana in accomplishing
theae goals, the role of the States
in
overseeing health plans,
and the role of corporate alliances.
j' I
�..
-- - -sENT sv:xerox Telecoprer 70l1 i12- 7-93 :12:44PM :
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202 385 8148:1 8
•
UDder the Act, the Federal government eatabliahea What il
guaranteed to all citizens and what is expected of our health
care system.
and
However, because health care ia a local indu.tl'Y
a personal service, the federal gover.nment is not beat auited
.
'
to anticipate and respond to the particular circumstances and
needs of consumers and providers in each community in thi•
country.
best
ror this
provided~
~eason,
oversight of health plan operations is
the atates.
Health plana will provide health insurance coverage, muCh as
insurance
c~aniea
and HMOs provide such coverage today.
A
health plan-can baa fee-for·•ervice plan like today'& indemnity
plans, an HMO, a PPO or other type of network, or any other
arrangement .that Meta the federal and State requirements.
There
must be at least one fee-for-•ervice plan available in each
alliance.
Health plans (other than faa-for-service plans) will have
flexibility in structuring their relatianahipa with providers,
Providers themselves will be encouraged to form new health plana.
Health plans will be required to contract with Baaantial
Community Providers during a transition period and pay them ao
less than rates paid to other providers in the community, or pay
them based on Medicare reimbursement principles.
Bvery person will choose his or her own health plan.
No
employer, no government, no bureaucrat will make these decision•
for us.
3
.. ...,
�Th•
Federal lramawp;k for Health Plan Operatigpa
Health plans will operate within the following federally
mandated parametara : :
VDivuaal
c~ara.·
Through shared responsibility,
employers, individuals,, and governments all contribute to
premiums.
Guar&Dtee4
oamp~aheDaive
requires eaeh
~ealth
beDelita.
Tbe President's plan
plan to offer the nationally guaranteed
benefita package .... 'l'ha: ..suaranteed benefits eatablishec!
initially will be comprehensive enaugh to cover people'•
health c.are needs • The National Beare! will update the
guaranteed benefits ever time to reflect changes in health
care practices, technology, and training.
Because one size
· does not fit ·all, health plans may also offer aupplemantal
polie~ies
•. ·'
lr&auralice z-eto:na.
All plana must accept applicants on a
first come-first served basis (unleaa the plan ia a closed
panel plan which is full) .
Pre-existing condition clauses,
waiting-period&, and 0 &kimming" (selection of low riak
applicants) are not permitte4.
Community rating is
required.
ree-ro:~r•Service
Opt:l.cm.
All health plane that rely on a
network of participating providers muat alao offer an •outof-network" option, enabling enrollees to seek care from
nonparticipating providers.
The
option can be offered as
part of the plan arrangement or as a separate option.
4
., .
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Staadazdi•e4 for.m. 8D4
'I'
~aiatrative •~lifiaatiOD.
uniform reporting requirements and at&Dd&r4izec! forma will
dramatically
l~ghtan
COUumu pnt.ect.icm.-.
alliance information
health plana' paperwork burden.
Bach health plan provi4ea. to .the
concern~ng
.
ita coats, the qualifica-
tiona of ita providers, its utilization management and
quality assurance procedures, and ita consumer grievance
procedures,
i~
accordance with Pederal rules.
The
alliance
will make this. information.available to consumers in a
standardized format, to facilitate comparison.
consumers
will be guaranteed grievance and appeals procedures that
aaet Pederal requirements.
Quality St&Ddarda.
The National Board also will establish
atandarda of access and quality for health plana.
It will
develop the cora quality and performance measures for a
health plan_performance report,
10
easily compared and evaluated and
country.
tbat quality can be
i~roved
acroaa the
Bxamplaa of these measures include consumer
satisfaction, ensuring adequate access to care (including
waiting times for primary care appointments), appropriate
use of medical care (such as immunisation and mammogram
rates) and success of medical care (such as survival rates
of heart attack patients) • Quality measures will be updated
over time.
Aa a reault of theae federal reform.,
for
~he
heal~h
plan• will
first time -- compete head-to-head for enrollees.
5
�·~~NTISY;xero)(
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Telecoprer
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7021 ;rz- 7-n i12=45PM;
. 202 385 814li# 8
Today, each plan offera different coverage, making coat and
quality comparison virtually impossible.
Manipulation of
benefits pacJcages is' also one way insurera try to &elect low riak
enrollees.
With
atanda~
mance report information
benefits and the comparative
a~ilable
~rfor
from their alliances,
consumers can meaningfully compare plaD quality and goats, and
choose the type of plan, providers and premium atructure whiCh
beat meet their needs.
These competitive pressures will create
new incentives.for provider& to d.evelop innovative approaches to
management of acute and chronic conditions.
Competi~ion
~nd
will
~e
further-enhanced by expanding the number
type of· coverage options available to conaum.ra.
Today, many
people must choose from the one or two plans offered by their
employer.
consumer
The President's plan will dramatically increase
choic~,~
by
making every Health Plan operating in a
community available to everyone in that community, thrOI.lgb the
regional alliance.
State Oversight of Health Plane
States are responsible for oversight of health plan
operations.
States have a great deal of experience in many of
the nuts-and-bolts aspects of health syatem oversight, such as
licensure of health care providers and regulation of the health
insurance industry.
The Act builds on what works today at the
State level, by assigning states
raeponai~ility
eor certification
of health plane, for establishing solvency standards and ensuring
that these atanc!arda are met, [quality], and eor establishing an
6
�202 385 8148il10
SENT BY:Xerox Telecopier 7021 i12- 7-83 i12:48PM ;
acSministrative a.Ppeala office tor complaints· againat health
plans.
Cazoti!iaat:I.OA. ·. Qnly health plans that have been. certifiec!
by the State as meeting Jaderal and State requirements can
contract with an alliance and Obtain enrollees.
certifica-
tion standards include compliance with the federal insurance
reforms listed above, as well as stata•eatabliahed standards
in areas such
as
Qua1:lty ~ .· Quality
State.
~e:raight
·i• the responsibility of each
Plan quality is one of the core criteria for state
certification of Health Plans.
·.·.
Stataa will hava broad
flexibility in how they measure and evaluate plan quality.
Today there_. are aa many different performance tools as there
.
.
are health plans.
under the Health Security Act the quality
measures developed by the National Board (describec! above)
will be available to States.
In this way, quality will
become one of the crucial measures which States will use to
certify regional alliance health plans.
so1'9'aay.
State have the primary responsibility for
assuring the financial solvency of health
~lana.
States
must certify the financial stability of each plan, and each
plan's capacity to deliver the comprehensive benefits
package.
Statea establish capital standards, reporting anc!
auditing requirements, anc! reaerva r.quirementa for health
plans.
States muat monitor health plans, to aaaure that
they continua to meet aertifiaatian
7
requi~ements.
Health
�plana can purchase reinsurance for unexpected and cata·
I
trophic medical expenses .
States may make such zoein1urance
.. ' ' '
mandatory.
l'z'otect:lcma iA tile
•1a ra:llve.
BY~t o~
States must
deaignate·an agency of state gover.ament to aupervise (or
take control of) plan operation in the evant of plan
failure.
Stat$& must ens.ure that there ia a guarantee fund
that meet• federal.requ~retnenta,· to protect providers and
others in the case of plan failure.
the
Sta~e
If a health plan fails,
is authorized to impose a surcharge on other
health-plana to cover claims against the failed plan.
Providers' claims against the tailed plan are paid first,
before ·claims for administrative expenses and other claims.
Providers _may not seek payment from consumers.
Appeals.
A .consumer or a provider who disagrees with a
Health Plan decision has 60 days to request reconsideration
from the plan.
Bach State must establish a Complaint Review
Office, to handle appeals from regional alliance and
corporate alliance health plana.
Tbe procedural rules
governing these state administrative appeals will be
established by the Department of La)x)r.
l'or appeals from
Regional Alliance Health Plana, the Complaint Review Otfice
will offer claimants the option of an adminiltrativa
hearing, alternative dispute resolution, or proceeding to
any court of competent juriac!iction.
ror appeals from
8
f
...
, ... I
�Corporate Alliance Health »lana, the Complaint Review Office
will offer claimant a choice between alternative dispute
resolution and. an· ac!II\:Lnistrative hearing.
'!'here azoe
expedited procac!ure.s for emergenciea (the Act' 1 expeditec!
procedures are NOT intended to ·superaede or in any way
undercut the existing
anti-du~in;
rules).
Tbe Role gt AlliiQgea in Baalth Plan QgtratiQna
Alliances are
~esponaible
for (among other things) enauring
that everyone is enrolled.in, a health· plan and for assuring that
health plana provide access for all eligible individual, for
conducting the premium negotiatiana and enforcing the ceilings on
the rate of· growth in plan premiums, for oversight of plan
marketing, and for premium risk adjustment.
Bu-ol~t
'U4 A.aoeaa.
Any
health plan that wants to
operate in an area must do ao through the health alliance;
the
allianc~
members.
then makes all such plana available to its
Alliances will be responsible for enrolling all
individuals in their area into health plans.
Alliances have
authority to use financial incentives to encourage health
plana to expand into underaerved areas, and may assist
providers in creating new plans in underservad areas.
:k.aiua Regot:Lat.ios.a ad Bw:tget bfora...at.
In order to
obtain the best premiums for their members, alliances will
solicit competitive bids from· insurers aDd make sure that
premium do not exceed the overall budget.
Competitive
preasures and incentives will induce plana to offer high
9
�~
g~11r
gy
•Alfru;,;
rlfllJ~up:~.·er
·tull
;-u- -,-..,
i
u••nt"lll
.
i
quality service at affordable
p~em1uma
.
zn
n:~
lln411 il
in order to get and
. .
retain membership.
%f the weighted ·average premium bid. exceeds budget targets,
the alliance reduces the premiuma of each Health tlan whose
premium bid exceeds
in
p~cportion
th~
average.
Premium bids are nduced
to the amount by which the Plan's bid exceeds
the target, and by an amount sufficient to bring the
weighted average of all Plans' bidl within the target.
JOAresain; Riek Selegtign . . .. .
. .
:
•/:' .~
Risk selection -- particula~ly the intentional exclusion by
health
inau~rs
of people with serious
o~
chronic health problems
-- is· one of the most significant obstacles to health aecurity in
our current health care. system.
The Health Security Act
add%esses ~isk selection through a serious of integrated ataps,
including: assuring universal coverage and comprehensive
benefits; enrollment and marketing
~eforms;
insurance underwrit-
ing and rating reforms; mandatory reinsurance of high coat cases
and conditions; and
~isk
adjustment of premiums paid to health
plans for demographic and health status variations in plan
enrollment.
Risk selection
occu~s
distribution of health
when a health plan attracts a skewed
~isk
in its enrolled population.
Tbe
problem of risk selection is important becauae it affect• the
p~amiuma c~arged by
health plana.
If risk &election occurs,
health plans that attract relatively healthier enrolleea will
10
�QCI11 IH•
have r•lativaly fewer claims and can charge
~owez-
premiums.' On
the other hand, health plana that attract relatively sicker or
higbar·riak enrollees 9enerally will have .o~e claims than plans
with average enrollment mixes,
and
will be raquire4 to.
~harge
higher than average premi\IIQ to cover their higher costa • lf the
premiums ot competing health plana refiect riak aelection rather
than the efficiency and quality of the plana, the benefits ot
competition -· promoting efficiency and quality -- are diminiahe4.
The Health Security Act emplcra a number of •trategiaa to
address the problem of risk selection:
•
Dniveraal coverage.
In the currant system, insurers
worry that people with or at high-risk for health
problema are more likely to seek coverage.
lnsurers
use medical underwriting, preexisting condition
exclusions and other mechanisms to protect themselves
from adverse selection.
1.
Health insurers can generally manage the risks associated
with random occurrences of illness and injury in a large pool of
enrollees. However, competition in a health insurance market can
fail if the enrollment choices of consumers are ayatamatieally
biased in a war that particular health plana attract a markedly
healthier or a ckar than average mix of enrollees.
11
•
I
'
I
'(
�under the Health Security Act,.ever,rane will hava
health insurance
ooverag~.
No one will wait until they
..
have
•
prOblems to Obtain coverage.
healt~
uniform comprehensive benefit package.
In the current
system, insurers worry that leas healthy people tend to
choose richer benefits.
Insurers often design their
banafit packages to attract··younger, healthier
enrollees.
Under the Health Security Act, everyone will have the
same comprehensive
~enefita
package.
Bealtb plana will
be unable to influence enrollment decisions through the
design of their benefit packages.
In addition, because
all piana will offer comprehensive benefits, there will
be less reason for people to change health plana if
their health status changes.
•
Bnrollment through alliances.
under the current
system, health plana can influence the composition of
their enrollment through their marketing activities.
Marketing effort• can be focused away !rom areaa with
higher-risk populations and agents cau discourage
applications from higher risk individuals.
12
.
, ..
f
'•
I
�under the Health security Act, enrollment will occur
.
'
through health alliances, providing all applicants with
an equal
~olea
of all health plans.
information ahou.t costa, quality
be provided
direc~ly
aDd
ccmaumer
plan design will
to individuala through alliances
and employers, so the opportunity for selective
marketing by inaurera will be eliminated.
The Health
Security ,.ct also requires ~hat cSi::r:ect marketing be
made to the
•
served by a health plan.
sa;ia!action and diaenrollmant aurvaya.
~ana
·.·.
en~ire ·-~~ea
of risk selection
~Y
one potential
health plana in a reformed
system is to discourage higher-risk •nrollees from
continuing with the health plan by giving them poor
service or failing to contract with providers that can
address special needs.
Onder the Health Secu.:r:ity Act, enrollees can be
periodically surveyed to detect problema with health
plan service.
People who switch plans can be su.rveyed
to determine if they left their former plan because of
poor service or inadequate access to
~ecialista.
Problema uncovered can be addressed through the state
certification prodaas.
13
�e
Guaranteect ,acceptance !or coverage.
!n
the current
market, insurers use medical underwriting and
other atrategieJ
~o
a host of
discourage enrollment by higher-
risk people.
Onder tha Health Sequrity Act, all health plana will
.
~
.
required.to·accept.any·enrollee who appliea for
coverage.
Plana will not be able to discourage
enrollment based on health status.
•
C!ammunity rating and guaranteed renewability.
In the
current market, insurers can directly affect enrollment
of
h~gher·risk
individuals by raising premiums or
eerminaeing coverage for groupa with high claims coats.
under the Heath security Act, health atatus cannot be
conaidered in establishing premiums.
Coverage cannot
be canceled by a health plan for any reason.
•
Contracts with academic health ceneera.
Bven with
enrollment, marketing and insurance refoZ'INI, one
14
�.
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202 395 814Bi#18
potential source o! riak aeleation by health plana is
their decisions about which health' care proVider• to
contract with. C:Oncerna have been raised that health
plans will avo'id contracting with leading tr"tment
centers
and
specialiata in order to avoid patienta with
serious health conditions.
Tbe Health security Act alao re;uirea health plans to
cont:ract. ·.With ..acad.emic health centers for the treatment
of health conditions that require the apeaialized
treatment expertise of these aentera. This requirement
will aasure that enrollees who need apecial aerviaes
will
~
able to select
and
stay in any plan serving
their area.
The Health Security Act requires the National Health Board
to develop a risk adjustment and reinsurance methodology to
be uaed by regional alliances.
The methodology will assure
that payments to. health plana reflect expected utilization
of services and protect health plana that enroll a disproportionate share o!
higher-ri~k
people.
The Act directs the Board to consider a number of
~actors
developing the methodology, inaluding
Character-
15
demog~aphic
�iatica, health atatus, geographic
~esidence,
socio•econamic
status and the proportion of cash-assistance recipients
enrolled by a plan.
•
Adjustment for demographic characteristics an4
residence.
The Health security Act provides for
community rating by health plans.
plans from
adv~rse
To protect health
selection if they Clispraportioaately
attract; ~n~oll!J~~"~o are ·older or who reside in highel"
cost areas in an alliance, the premium payments by
regional alliances to.health plans will be adjusted to
reflect the demographic characteristics and areas of
residence of each plan's enrollees.
•
Adjustments for socio-economic 1tatus and proportion of
cash assistance recipients.
The Health Security Act
requires the Board to consider the need for
adjustments to reflect any additional
plans may face
~
p~um
that health
~isk
enrolling a disproportionate ahara of
lower-income or cash assistance recipients.
Concerna
have been raiaed about the willingness of health plans
to serve traditionally underserved peqple and about the
potentially higher administrative and·other costa of
providing services in underaerved araaa.
%f necessary,
premiums pai4 by alliances to health plans that aerve
underaerved areas to reflect any higher costs incurred.
16
'\
t
,·.,
.. -·-·.. .. . .
~
'
.
�.
•·
•
Health status adjustments.
The Health Security Act
requires the Board to conaider enroll health 1tatus in
developing the ri•k adjuatment and reinsurance •ystem.
Bven in a refoJ:'IMd •ystem, there is concern that· some
health plans may face -ratematic adverse selection
'
which could affect their competitive poaition in the
market.
The Health Security :....
..... :....... Act proVides for several methods of
:.
'•
protecting health plans from advarae selection by
higher-cost enrollees. The Act anticipates a short-term
and a long-term strategy.
In the •hort-tem, we expect.
the Board to rely on a combination of mandatory
reinsurance and health status adjustments baaed on
aelf-~eported
of
pla~
health status collected through surveys
enrollees.
over the
lo~ger-term,
we expect the
Board to develop and implement 'II'LOre sophisticated
adjusters for health status, basad on diagnosis of plan
enrollees.
In the short-term, reinsurance will be used to protect
health plans that attract a disproportionate ahara of
enrollees with
high~co•t
Reinsurance systems are
or chronic illnesses.
~eing
used 1D a DUmber ot
states today a1 part of insurance reform effort•.
1'7
�.
under a reinsurance approach, health plana share the
costa of treating higher-colt or cbronically ill
enrollees pn ··either a manc!atoxy or voluntary basis. If
a health·plan
~·•
a high-coat claim or enrollee, the
reinsurance 1yatam reimburses a portion of a health
plan's payments for these caaea.
Thi• reimbur1ement
can be baaed on a percentage of a plan'• actual co1t1,
or can be .a specific amount .baaed an diagnoaia or
coziditio:a.. ·.
~·
hlllaltb plm·paya a premium to the
reinsurance fund for tbia protection.
The Board also could adjust for perceived health status
or the presence of chronic conditions in the short-term
through the use of health status surveys.
Tbis
appro$ch relies in health status data collecte4 from
health plan enrollees, either at time of enrollment or
through surveys of random S&mFles of plan enrollees.
Premiums would be adjusted to reflect the differences
in health status across plan enrollment.
In the near future, mare sophisticated risk adjusters
should be available that are baaed on the diagnoses of
:l.ncUv:l.c!ual anrollaaa.
Initial n1aarch indicatea that
these adjusters should be more accurate than other
approaches, but no system has been fully develo.ped and
18
�202385 8148il22
implemente4 that reliaa an these potentially more
accurate measures of riak.
OVer the laat few yeara, the Department of Health and
Buman Services has apanaare4 and caQducted a substantial amount of research looking at the davela.pment of
~iak
a4juaters for health atatua, primarily related to
the Medicare population.
To accele~ate
ri~k.adjuatmaZ1t.~thodolosies
development of
for the unc!er-65
population, the Department 11 currently developing a
work plan that encourage ·research efforts in thia area.
The work plan will call for internal research efforts
·.·.
and for sponsoring research and demonstrations by
outside·experts.
<:OI!QM'Dj ALL!.IlmljS
Bmployars of sufficient size (as well as Taft-Hartley plans
and rural electric cooperatives) will continue to have the option
of salt-insuring their employaea' health benefits, by formin; a
corporate alliance.
Any
private employer with over !5000 full
time employees nationwide may elect to form a corporate alliance.
These large employers may also choose to participate in the
regional alliance.
A corporate alliance will aarva the aama functiOD8 •• a
regional alliece, under aimilar requirement a.
accordingly.)
(II.! D.
is amended
Corporate alliances must offer health plans that
provide the nationally guaranteed comprehensive benefits.
19
Bach
�.
-
,_
., SENT sv:xeroxtelecopier 7021 ;12- 7-83 i12:51PM
202 885 8148il23
corporate alliance must hold. an annual open enrollment, ami
provide comparative information about health plans.
~e;uirements
procedures and reporting
G~ievance
applicable to reJional
alliances also apply to cor.porate alliances, as do.a6mini8trativ.
SiftPlification mandates.
BaCh corporate alliance must offer at least one fee-for-·
service plan and at least two other plans Cwaivers will be
available for areas -where such plana are not availakJle) •
Corporate alliance plans must accept all eligible enrollees on a
;
•
~
•
·•
,,
"
~'·
-
""'•• I '
••-•·•,:. ' ........
'•" •
'
•
first-come first-served basis and may not terminate enrollees or
limit coverage for the nationally guaranteed comprehensive
benefit package.
waiting periods
Bxcluaions for pre-existing conditions and
~~
Plan
prohibited.
p~emiums
in the corporate
alliances must stay within the nationally establiahad target.
A co%porat~
alliance makes premium payment• directly to
health plans, using any type of insurance rating arrangement.
In
addition, corporate alliances will be required to pay a aurcharge
to help support the financing the cost of medical training and
research in academic health centers, that will
supported
by
~e
otherwiae
premiums in the health alliance.
In some cases, one spouse may work for an employer that has
formed a corporate alliance while the other works for an employer
in the regional alliance.
Bare, the couple must enroll in the
same health plan, and ia free to chose a health plan th2:ough
either the regional or the corporate alliance.
20
i· •. ·
II
l .
Whichever
�---
--~-
·---·- --·--- --·-·r·--·
.-.. . -·
• ••
• •• • ·--•-• "'' '
alliance the couple chooaea, both emplO¥ars would be required to
make a premium contribution to the chosen plan.
The
Health
Guarantee I'Unc1.
Secur~ty
Act establishes a Corporate Alliance
'l'hia PuDcS helps assure univaraal a overage by
w~en
paying for health benefit•
a
co~orate
allianoe health plan
is unable to provide the guaranteed benefits package.
tions to the Pund
ar~
Contribu-
made when receipts are needed to maintain
the solvency of the .PuncS1 it ia DOt an· automatic a1aesamant
imposed regardless Qf need.·. . .Aaaeaamezita will be required only if
.
.
.
.
'
an unusual n~er of insolvencies occur.
Bmployer~
have.
that form a corporate alliance will periodically
the.apportunity to switch to the health alliance.
Once in
the regional alliance, there is no opportunity to return to
corporate alliance status.
employers
whi~·join
Jor corporate alliance eligible
the regional alliances, community rating and
discounts will be.phased in over eight years.
Mr. Chairman, there ia room for debate about the 4etaila of
this plan.
But the basic principles are not open to compromise:
• All Americana muat have health coverage.
• Bveryone must make a contribution.
• Baalth care quality
~•t
ba preserved and improved.
• Consumers' choice and access to care must be enhanced.
*
Tbe rate of inflation must be slowed.
*
Administrative requirements and costa must streamlined.
21
�.__ ....... --.-- ............ " ••••••r·••• rv•• ., 16- ··-vg r-r&:'WI"rJQ
• {...
!
t
.
202 195
8148~#25
..
Bealth plana are a crucial component to making traDalating
principles into reality.
Thank you for tbe opportunity to
discusses theae aap•ct8 of.the Health Security Act1 at thi• time,
% woulc!
:be happy to ana"'r any questions l'0\1 maY have.
22
�THE
CATHOLIC HEALTH
ASSOCIATION
OF THE UNITEO STATES
November 5, 1993
TO:
Melanne Verveer
The First Lady's Office
FROM:
Jack Bresch
Catholic Health Association
SUBJ:
CHA CONGRESSIONAL TESTIMONY
CHA's enclosed testimony on the issue of cost containment in
healthcare reform strives to accomplish two purposes:
•
to clearly enunciate our position in support of cost
containment achieved through delivery system reform backed up by
a national global budget (a somewhat unique point of view in the
hospital community with which many do not agree); and
WASHINGTON OFFICE
1776 K Street, NW
Suite 204
Washington OC 20006
Phone 202-296-3993
Fax 202-296-3997
•
to offer recommendations based on own proposal for
systemic healthcare reform that build on and strengthen the cost
containment provisions in the President's bill.
As I hope our testimony demonstrates, CHA is determined to keep
a positive tone with regard to the President's legislation, even as we
communicate, on behalf of our members, recommended changes to
Congress. Be assured that we will keep the White House advised of these
recommendations in advance.
�JACK EBRESCH
Government Services
THE CATHOLIC HEALTH ASSOCIATION
OF THE UNITED STATES
WASHINGTON OFFICE
1776 KStrBBI, NW Suite 204
Washington, DC 20006
Phone 202·296·3993 FAX 202·296-3997
�'
.
.ThSTIMONY
. OF THE CATIIOIJC HEALTII ASSOCIATION OF THE UNITED STATES
HEALTHCARE REFORM
AND.
COST CONTAINMENT
Presented to .
HOUSE ENERGY AND COMMERCE SUBCOMMITTEE ON
HEALTH AND THE ENVIRONMENT
Henry Waxman, Chair
Presented by
. William L. Dowling, PhD
Vice President, Planning and Policy Development
Sisters of Providence Corporations
Seattle, W-A
and
Member; Task Force on National Health Policy Reform
. The Catholic· Health Association of the u·.s.
IHA.·
November 8, 1993
THE CATHOLIC HEALTH ASSOCIATION
OF THE UNITED STATES
WASHINGTON OFFICE: 1776.K Street, NW, Suite 204, Washington. DC 20001).,2304
Phone: 202-291).,3993
Fax: 202-291).,3997 ·
�Good afternoon, Mr. Chairman and members of the Health and Environment
subcommittee. I am honored to appear before you today to discuss how to ensure
cost control in a reformed healthcare system.
My name is William L. Dowling. I am Vice President for Planning and Policy
Development at the Sisters of Providence Health System in Seattle, Washington. The
Sisters of Providence serve the healthcare needs of people through 22 institutions and
facilities and through sponsored managed care plans. The System operates 3,462
licensed acute care beds and 1,015 long term care beds with 16,382 full time
equivalent employees in the states of Alaska, Washington, Oregon and California.
Subscribers of managed care plans totalled 420,684 in 1992.
I am here today in my capacity as a member of the Catholic Health
Association's (CHA) Leadership Task Force on National Health Policy Reform. CHA
represents more than 1,200 healthcare facilities and organizations that make up the
largest group of not-for-profit healthcare institutions under a single sponsor.
Mr. Chairman, CHA testified before your subcommittee last month on our
overall evaluation of President Clinton's healthcare reform proposal. At that time, we
praised the President for his leadership on healthcare reform; identified eight
components of the Clinton plan with which we are in basic agreement; and
recommended five ways to strengthen the proposal.
It is our view that the
President's bill is headed in essentially the right direction.
One key component of the Clinton bill which CHA believes needs to be
improved is the focus of today's hearing -- cost containment. This afternoon I will
1
�discuss our views on this subject by first describing CHA's position in support of cost
containment in healthcare reform, and then by enumerating our recommendations for
strengthening the cost containment provisions in the President's reform legislation.
I. CHA's POSITION IN SUPPORT OF COST CONTAINMENT
The Catholic Health Association developed its own proposal for systemic
healthcare reform two years ago. This proposal is anchored in six core values, one
of which is the following:
responsible stewardship requires that our healthcare
system must be reorganized so that it can better manage healthcare resources and
better control the growth in healthcare spending.
In the process of developing and refining the CHA reform proposal, we
systematically examined various approaches that could be taken to slow the rate of
growth in healthcare expenditures. We drew six major conclusions from that work:
1)
reliable and fair cost containment has become a moral and practical
necessity;
2)
true cost containment can occur only through healthcare delivery reform;
3)
cost control is dependent on universal coverage;
4)
reform must include a national budget "backstop;"
5)
overall expenditure control is best achieved by linking a national budget
to capitated payments; and
6)
cost control will be undermined unless healthcare financing for lower
income populations is linked to financing for the middle class.
I would like to spend a few moments on each of these conclusions.
2
�1.
Reliable and fair cost containment is essential.
As a nation we can no longer allow unpredictable and uncontrolled health
spending increases to arbitrarily squeeze out other important social needs, like
education and the environment; to enlarge the Federal deficit and weaken the
economic competitiveness of many U.S. companies; and to burden families with
unmanageable healthcare costs and lost wages.
It is generally recognized that the rate of increase in healthcare spending is
unsustainable. The key question is not whether health spending will abate -- annual
surges at two to three times the rate of inflation cannot continue indefinitely. The key
question is whether we will slow the rate of growth through systemic, orderly reform
or let it happen through haphazard, ad hoc market forces that result in constricted
access and uneven results for employers, patients, and communities. Our concern is
that market forces in an unreformed healthcare system will only exacerbate the risk
segmentation, cost shifting, and deteriorating insurance coverage that have prompted
the call for reform in the first place.
Let me offer an example of what I mean by this. There have been a number of
recent press reports about the success of some large employers in reducing their
premium increases through selective contracting and other "managed care"
techniques. This is certainly encouraging news as far as it goes. But is healthcare
really being provided more efficiently, or are costs simply being shifted to small
employers and individuals in the community who lack the same purchasing clout as
the large employers? To the extent it is the latter, many employers will find insurance
3
�even less affordable, and the insurance companies that serve them will escalate their
efforts to avoid risky populations and decrease coverage.
CHA believes market forces can be harnessed to help bring costs under control,
but only in the context of fundamental, even-handed reform.
2.
True cost containment can occur only through healthcare delivery
reform.
The current healthcare delivery system is characterized by costly fragmentation
and duplication. Skewed financial incentives encourage inefficient behaviors by both
providers and consumers. Specifically:
•
acute care and rescue medicine are emphasized at the expense of
ongoing primary and preventive care;
•
reimbursement policies encourage the use of institutional care in cases
where home care is often more effective and less costly;
•
episodic emergency room care is too often a substitute for an ongoing
relationship with a physician;
•
consumers are given few incentives for healthy life-styles;
•
the system allows for the inefficient duplication of high technology
equipment and services, as well as provider overcapacity; and
•
providers often function in isolation from one another with little
integration among primary, acute, and long-term care settings. Patients-especially the elderly and persons with chronic conditions-- often find
themselves shuffled among a bewildering array of providers, each
maintaining separate medical records and each generating a new and
confusing set of healthcare bills.
CHA has concluded that healthcare reform must address these problems in the
delivery system if there is to be any hope of containing costs while enhancing clinical
effectiveness for patients. Limits on expenditures without delivery reform are doomed
4
�to fail. They would only build on the fragmentation, duplication, and uneven access
of the current system. As a nation, we must find a way to "turn down the heat"
rather than just force a lid on the pot of boiling water.
CHA's approach to delivery system reform is embodied in a person-centered,
community-based Integrated Delivery Network (ION). An ION is a set of providers
organized to assume financial risk for a coordinated continuum of healthcare services.
Providers are linked together through a series of contractual or ownership
arrangements. These networks receive a risk-adjusted, capitated payment and are
held accountable for improving and maintaining the health status of their enrolled
populations. In the CHA vision, consumers participate in network decision-making and
choose among competing networks based on quality and service.
The IDN is designed to improve the coordination and efficiency of care by
creating new relationships among providers. This occurs not through an arbitrary,
burdensome, and external regulatory structure, but rather through a re-alignment of
financial incentives. Operating under a capitated payment, the ION must emphasize
primary and preventive care, less unnecessary care, better coordinated care, services
in less costly settings, more appropriate capacity levels, and a more rational use of
high technology services.
And because consumers can choose from among
competing IONs, the networks must ensure they are providing responsive, clinically
effective services.
5
�3.
Cost control is dependent on universal coverage.
The reason for this conclusion is the inextricable relationship between universal
coverage and health system efficiency. Anything less than universal coverage creates
a vicious circle whereby the uninsured are more likely to receive care in costly settings
like the emergency room, and for conditions that have grown more severe with time.
The resulting high cost of this care is then shifted to employers who in turn find
insurance coverage for their workers increasingly unaffordable. We must break this
vicious circle if there is to be any hope of controlling healthcare costs in this nation.
4.
Reform must include a national budget "backstop."
An explicit national spending amount is needed for two reasons. First, we have
no guarantee that managed competition alone will restrain costs. While it and other
purely market-based approaches to reform certainly may contain costs, the
consequences of failure will simply be too severe: i.e., employers who could no
longer afford double digit inflation in their healthcare costs; individuals and families
who would be burdened with high out-of-pocket costs and loss of benefits; and
continuing upward pressure on the Federal budget deficit.
Second, a national budget is necessary because of the dynamic in the
healthcare market known as "moral hazard."
This situation is created by the
insurance function (private or public) which allows beneficiaries and the practitioners
that serve them to consume healthcare resources without regard to cost.
The
problem is mitigated to the extent that insurance coverage includes cost sharing, as
6
�does the CHA proposal, but over 70 percent of all healthcare expenditures in today's
system are by persons who have exceeded all cost sharing requirements.
Thus
persons with the largest expense to the system are receiving care for which they are
no longer personally "paying."
Under these circumstances, ill persons and their families quite naturally demand
all potentially beneficial services, and their physicians have no financial reason to
constrain the use of resources.
This dynamic, combined with the increasing
availability and expense of new technologies, will likely place upward pressures on
national health spending even in the context of a reformed delivery system.
CHA concluded that the only way to address this problem with certainty is to
constrain demand through a broader political consensus in the form of a national
budget. As a nation, we may decide to provide all potentially beneficial services to
all persons, but effective stewardship demands that we should do so only in the
context of an explicit budget aligned with other social needs. This cannot now be
accomplished.
The CHA proposal determines a national annual budget through a "bottom
up/top down" process. An independent, politically insulated National Health Board
recommends an annual rate of increase in national healthcare spending based on
uniform data on the relative efficiency of IONs, changes in healthcare needs, local
system capacities, and expectations about new technologies and procedures.
Congress approves the budget amount based on an "up or down" vote. If the budget
is rejected, the National Health Board reduces the scope of the uniform benefit
7
�package and resubmits a budget recommendation accordingly.
This approach is designed to involve the American people in a very direct and
explicit set of choices, and to make everyone aware of the tradeoffs involved in
healthcare spending decisions. If Congress funds less than the recommended amount,
it does so in the form of a visible negative vote that affects all persons. This may be
the "right" decision, but it can only be made with consent of the people who receive
the healthcare.
On the other hand, the American public may argue to their
;
representatives that the "right" decision is to raise the revenues needed to keep the
benefit package intact. In either case the process is explicit and entails neither an
arbitrary formula (one-size-fits-all) approach to cost control nor the current
unpredictable and uncontrollable nature of public and private spending.
5.
Overall expenditure control is best achieved by linking a national budget
to capitated payments in a reformed delivery system.
Capitation payment to IONs is the best way to achieve true cost control under
a national healthcare budget.
Capitation realigns financial incentives toward
"seamless care" and greater efficiency. It allows providers to participate with society
in controlling healthcare costs and does so by relying primarily on incentives rather
than regulation.
Capitation also allows for provider accountability to people and
communities based on improved health status.
Rate setting, by contrast, does none of these. Unlike capitation, rate setting
freezes into place the fragmentation and duplication in the current system.
Rate
setting forfeits the opportunity to produce efficiencies across providers through better
8
�patient management and alternative treatment settings.
Rate setting also diverts
attention away from improved health status and responsiveness to community need.
Finally, rate setting requires external volume controls and the continuous recalibration
of provider payments required when incentives for "doing more" remain strong.
6.
Cost control will be undermined unless healthcare financing for lower
income· populations is linked to financing for the middle class.
We mean two things by this statement. First, per capita funding on behalf of
low wage workers and poor populations for the uniform benefit package must not be
allowed to deteriorate compared to per capita funding for higher income populations.
CHA believes this would be best accomplished by pooling all funding in a single trust
fund before it is allocated to Regional Alliances on a per capita basis. There are,
however, other means of accomplishing the same result.
Second, the uniform benefit package must be comprehensive enough that most
people find it acceptable and do not feel compelled to purchase supplemental
insurance. There will always, of course, be a group of well-to-do persons who will
"buy above" the uniform benefit package. But if this group becomes too large it is our
view that the uniform package is, by definition, inadequate.
As with many of our positions, there are both moral and pragmatic reasons for
keeping all persons under the same financing umbrella, regardless of income. Morally,
we should avoid crafting a "basic" package that becomes a floor for the middle class
and a ceiling for the poor.
Pragmatically, a pared down uniform benefit package
would only perpetuate the cost shifting and insurance risk segmentation that
9
�undermine current efforts to contain costs. Similarly, if lower income populations are
perceived to be financed from a "separate" pool of funds, arbitrary budget cutting
becomes all-too-easy, exacerbating the cost shift from the public to the private sector.
II.
RECOMMENDATIONS FOR IMPROVING COST CONTAINMENT IN THE
PRESIDENT'S LEGISLATION
CHA supports many components of President Clinton's healthcare reform bill.
We are especially pleased that he is calling for universal coverage, a uniform
comprehensive benefit package, and a number of important protections for low
income populations. With regard to cost containment, we commend the President for
including in his proposal:
•
A framework for delivery reform with incentives for health plans to
organize themselves to operate within annual premium limits and to
stress primary and preventive care.
•
Universal coverage achieved relatively quickly, an absolute necessity for
effective cost control because of the "vicious circle" of cost shifting
described earlier.
•
Reliance on a uniform, comprehensive benefit package for all persons
regardless of income or health status--a feature that is essential if we are
to put an end to the cost shifting and risk segmentation that plague our
current system.
•
Overall expenditure control for much of the plan based on premiums or
capitation rather than rate setting. The President does rely on some rate
setting for fee-for-service plans operating in the alliances, but we are
pleased to see that the dominant mode of expenditure control is through
premiums.
•
Consolidation of acute Medicaid financing into the Regional Alliances
which helps to prevent financial discrimination against the poor and a
destabilizing cost shift from the public sector to the private sector.
10
�Based on our extensive analysis of the cost containment issue, CHA urges
Congress to strengthen the President's bill by 1) creating a sharper focus on delivery
reform, and 2) developing a more realistic process for overall expenditure control in
the form of a national budget.
1.
Sharper Focus on Delivery Reform
The bill needs a much sharper focus on reform of the healthcare delivery
system. CHA believes that the Integrated Delivery Network concept is essential for
true, long term cost control in a reformed system. Without delivery reform, insurers
will be encouraged to rely on a Ia carte discounting, rate setting, externally imposed
utilization controls, and micro-management of providers in order to get the "quick"
savings they need to live within premium caps. Some of these devices may, in fact,
be appropriate. But to rely on them solely is a mistake. We believe that the insurance
function should be merged with the delivery function in the form of integrated
networks and that the focus should be on more efficient methods of organizing care,
not simply clamping down arbitrarily on payments and utilization.
Several elements of the Clinton bill need to be changed to ensure effective
delivery reform:
•
First, there needs to be greater emphasis on clinical and financial
integration of care in the form of community-based, person-centered
networks. The proposal assumes and even encourages significant
reliance on insurance companies to form and administer plans. This, in
itself, is not a problem as long as the insurers act as partners with
providers to create truly integrated locally-based networks. It does
become a problem, however, if insurers act as distant regulators. This
kind of arrangement may bring "quick" savings to the system and
substantial profits for insurers, but it will not result in better coordinated
11
�or more efficient care. Nor will it ensure long-term accountability to local
communities.
•
Second, Medicare should be incorporated into the overall reform. The
Clinton legislation leaves Medicare out of the new financing
arrangements.
While the Health Alliances may encourage more
integrated systems of care through annual per person payments,
Medicare will perpetuate the opposite incentive by paying providers on
a procedure-by-procedure basis. Thus providers will continue to face the
mixed and counterproductive financial incentives that plague our current
system. We can understand why Medicare may not be immediately
folded into the Health Alliances, but we urge you to consider a fixed
schedule and transition plan for bringing in Medicare to ensure
consistent, stable incentives.
•
Third, long term care needs to be fully integrated with acute care. We
support the President in his expansion of long term care services to the
disabled and elderly, but once again, sustainable cost savings will occur
only if integrated networks can manage the full continuum of healthcare
services, thereby allowing them to make patient-specific decisions about
the most appropriate, most humane, and least costly patient care
settings. Admittedly, local healthcare systems are not yet prepared to
accept capitated payments for the full array of acute and long term care
services, but reform should move the system in that direction through a
target date and transition plan. Otherwise, we will perpetuate an
artificial and costly bifurcation in what should be a seamless continuum
of care for people in all stages of life.
•
Fourth, the financing schedule for the Clinton bill needs to be restructured to ensure effective delivery reform. Expenditures in the
Clinton legislation are compressed unevenly and unrealistically fast. CHA
fully supports the need to bring both private and public healthcare costs
under control through a national healthcare budget. But the President's
proposal calls for a faster compression for the two major public
programs: Medicare and Medicaid. This will result in greater cost
shifting between the public and the private sector, and could ultimately
lead to severe access problems for the elderly. More importantly, total
spending is brought down at an implausibly rapid rate that may well
encourage "quick and easy" payment and utilization controls, but
certainly will not allow time for the development of efficient, communitybased healthcare networks. The reduction in spending increases
envisioned in the Clinton plan may not be too much, but it is certainly
too fast for effective delivery reform.
12
�•
Finally, financing for low income populations needs to be directly linked
to financing for the middle class. The President's "caps" on subsidies
for low wage workers violates this principle and could severely hinder
delivery reform. If these caps result in further underfunding of the
system, the President's bill will have further postponed the day when
integrated delivery networks can bring true efficiencies to healthcare. If
the caps result in inadequate access for low wage workers and the poor,
we will once again be facing the vicious circle of cost shifting in
healthcare, not to mention a failure to meet the needs of all Americans.
In short, effective cost control can only be built on a foundation of delivery
reform. Without meaningful delivery reform, we are deprived of the tools we need to
achieve the President's goal of effective cost control.
2.
Process for Setting the National Budget
Our second recommendation for strengthening the President's legislation is to
employ a more informed and realistic process for establishing a national budget.
CHA's reform proposal calls for a "bottom up/top down" national budget-setting
process that would incorporate critical information on population needs and local
system efficiencies over time.
Our plan likewise outlines a series of "checks and
balances" that would help ensure direct and explicit accountability to voters for each
year's national budget. As described earlier, for example, the National Health Board
in our proposal uses data from local Health Alliances to recommend an explicit and
visible national budget amount to Congress which must then act on it with an "up or
down" vote.
In contrast, the President's bill calls for a "top down only" approach to a
national budget as defined by a formula-driven rate of increase. In CHA's view, this
approach misses an important opportunity to make healthcare expenditures not only
13
�more predictable and reasonable, but also more consistent with changing health
needs, system capacity, and the public's own view with regard to the tradeoffs
between healthcare and other important social goals.
The President's legislation is also weakened in this regard because the National
Health Board is structured not as an independent body, but as an agency under the
President.
This undermines the independence of the National Health Board and
precludes the process we are describing whereby Congress is held accountable for a
"yes or no" decision on an expertly determined budget amount for the year.
Mr. Chairman and members of this subcommittee, CHA strongly urges you to
retain a national budget "backstop," but to use an informed process to determine the
annual allowable increase in national healthcare expenditures. We also urge you to
structure the National Health Board as an independent agency.
Ill.
CONCLUSION
Let me conclude by offering a personal observation from my two-year tenure
on the CHA Leadership Task Force on National Health Policy Reform. In one of our
early two-day meetings with that group, we conducted an exercise whereby we
designed an "ideal" local healthcare system for people and the community.
For
purposes of the exercise, we did not consider cost containment or financing issues--all
of our attention went to the question: "What would make the best sense from the
point of view of the patient?" The design we produced on that day back in 1991 was
the initial version of the Integrated Delivery Network, a seamless continuum of care
14
�oriented toward the needs of individuals, families, and communities.
What I found instructive were the next steps in our deliberations as a Task
Force. The more we developed the financing approach to our reform proposal, the
more we realized that, when linked with capitation, our "ideal" delivery system
simultaneously addressed both the quality and the cost issue. An integrated delivery
network is a way to simultaneously meet the need for clinically effective, coordinated
care and more cost-effective care. My hope is that this is a combination you too can
encourage and support over the next several months as you work on Americans'
behalf for a more secure healthcare future.
Thank you.
15
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The Bealtb CatllefonD Project (BCRP) I
the broadeat-buetJ orpuization tD emcr the bea1tJi'care debala, rapre1J811tiaa
mom tb8ll SS milJioa Amerkua, lllid today It would utp leaden iD Coupaa
to mab 1:tJe Cllmaa plaD dul "SIIu:dJII pola&" for dlo Jeslsladye dlttate•
BCBP, a coalltlcm tbat iAGh.., provlclen, coasumers~ busiaea•, Jabolo, older
AmadcaDa aDd old1daal'a advoaatu. paUed Prelldlat CliDtoa'a bealth can=
%Ibm bDlaa.yiiJ It iDc1uded lltlJe ..alai bUildlaJ blocb for compmlleu.tve
mbm, • &Dd ci111n.g it •ra foaadadoa tor acdaualllllt1a ntcm.J.ai•latin."
BCRP sakt ita coa.cluslou' VfCI&'e baaed Olllb owa preUmJaaty
enhwtfnn eoqmlagleVIIII. IIIIJar health pmpoaala widl pliaciploa tho
coalilloa COdliclen eaSOGI:ial to comptebeDSlve hea1tb Xlform.'. Tbe MJuatkm .
ftWIIll tbat tbe'Omion bill ud the atap paya proposal spoason=cl by
ICiplOSOIUadVtl Jtm WCDotJDoct (Jl-WA) 81ld 1ollll COnyers (D-Ml) aad
Saaafor Paul WIDimaa C:C:.MN), lllllt the cxwJilkm'B plillcip• of ·
oompzebeasiYD ~ 1be OCJI.Iitioa said that two otiier prO,o.la. ·
· apoiiiCad by Seaatot Cbat8a (&oR1) aad lllpreleld:advea.Cooper (D-TN) aDd
GlaDdy (Il-IA), deliervo rocollddon u serbia effotta, but dud both pmpoaals
fall abort ol tho JIUilk u cmnady draftld primarily because tboy don't . .. .· .
parantcc secazily of 1lea1dl coverqe 'for all AnleJJcaDI Ucl fit1 to IP,!IId ·
··
!aaa1tll c:o1t1 fairly III10ll8 an emplOyers.
..
RDD Pollack, Bucutive Director of PamtUes tJsA. said: "1'118 Cltaton
p1aG atvea the Colqplea a bhtepriDt for~. wmtalblo an4
atfoldab1o health care zetotm. CoDpea may mocUfy ita demlls, but~
IIIOUld aot tamper widt 1bD ....w 1Dpe11eNa ror retWm. mcludillg bealth
secmity. cost contahtmeat, ad CXJmpmlasivc C0Yel'8.1fl·" .
Walter Maher, Dlreclor ot Pedtal ReJatloDa for Cmysl8r Co!poradm,
said: "The ClhlDl plau is aood newa for all tbl Dlii1Y businesses who bave
beoll car.rylag a t.vy cost 8biftill burden. It speadl costs fairly amana au
employen Ud tbrOUfhout tbc economy• 8lld COIIUVII ovaralliiDIIldJ iptllldiua.
'!'Ilia wm be scocl for OW' ecaaomyf tot bltanatioaal DOIIIpditivaeaa, aacl for
jobs."
IJada Sllilm, IDteJim eucutlve diroctof of tbe Amedcal\ Nursos
Association said: •ne CIIDton plan assures quality health caro CXMmiP for
202 296 45Q1
10-28-93 02:05PM
POOl 127
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all ArDciricalla &1,\d provldol tbo prlmuJ llld provoodvo bealtb eam ICI\IiGcs
tbat are Che basis for a bellthior AmorlcaG populatlaa ill the tutum. •
1o1m SWecllCY. PM.dealt of the Scrvico lbployeaa Ullion Cd.ed the
CUatoa plan: "Tbo best Malth cam propotal for Amcdcaa wotken llld their
fimlmes to COIIll fi'Om 1:11e While Bouse u 1ea1t 30 yean.· He~ •tp
mobJUze tbe tUU force of cqaolzrd labor bebbacl the Clintoa plan. ad Dat 1D
. . . . special ...... or their~ m
..,.....,.. U&atmwuar
down zeal ~ve reform. •
m
...,_of an
IDvola B1lqoal,
tbe ADierla8li' A""''iltioD ofBertmd
Penoaa (AAIP) ..ul: •A...au Qf qes bave a plat stab ill the debate
that il taldJls plaao .Ia our at~oa•a Capitol. But, we have come too tarwarbd too bald - to 111& beallll care mtoaa juJ& bo a debate allo'bd by
pat'tisall blcDrlq. Tile time far actkm bas come. We now call upoa tho
Conpu to Jet it dpt bJ coverhlc avaycme, maintalttlac qaalty, m•Jdnl
bea1tll care coata affordable IUld lucludlaa vital pn:a:dJtloa drug mlloq-term
care pmteC:daDI. •
'9/ldJe prat.tas the C!llntm plan,
the Reabh Cue l8fotm Pftdect
coadn11ed Ita practice ~ Mal]fqiq ._... tbat !lave heeD critical of
com,.aastve refoaD plaua. Ira Adoak, ._.,. DiRctor ot Cldzeu At.tlcm
IBid: ."Tbe Bll!da l'lllu:raace .Apm;auon of A "'MMca QUAA) IDd lbo Nldomd
Federation of~ Ballnel• (NPl'B) both baw 01lO tldDg in COJOJJJOII:
thoJ waat to piOieCt tJaelr lll.1rOW' epeala1 Jatmeata at . . apeue of
campmlleDaive Nfcmu dlat beafll: 1lle overwulmt"' ~orlty ot Americall
=-umen. '1'b8ae amupa PBJ Ill .W. to reform bat they'm oaly :iat.mesttd
1D mlonDI tim pi¥ off tor .....
II
Jldt Brad. CJavcmmcnt UaJaon far . . Cdlollo Boalth Aasocriatloa
of tho umted suaa (CBA), said ''By SIJbndtdna a detailed aud
~dve ptu In Jealiladve fonD, PICIIidoDt Cllut.oD bu lit the comw
tar IIJ8temic boaltbcue Nfoma~ It CNODdaJ\J the riJbt coune. It is. ot aU
diD pmpoaala =-tly beJDJ dliCUIIId, tbe mOat compadble wllh out stated
pdDcjp1el Ud objectlvoa fOr 1'1folm., prJ;IDa:ry IIDOBI wllicb ia me JU8l'llllCO ot
wdvona1 CCMI'Ip lor a compmblm.tw baeflt pacbao. •
u
BCBP lmoDd8 to fmlmllfy iCa GBIDpBlp for blalth nfom1 beJlaldDg
tbls week. The collitiDD II oollectln1 DJedpa fmm Membem of Coupeas in
IIUPPOit ot comprelaeulve beaJtb Momt~ n will be IDIIliDJita 8D8lysta of tbe
ap bealtll ca pJ1D1 to mllUcms of i1111181Dben over 1be aext m011th aad is
1IOW ftmni'QJ local COIIIJtions ad pJanDiQa local pMS evtllltll iD by atatel aBd
toy distrk:ta to support ita labbylasstaDJy.
..3()..
202 298 4501
10-28-93 02:06PM
P002
~27
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101.&8/98
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Iii 0031007
CKLOPAI, LBON.utD,
OVERVIEW or BBAL1B CARE REI'OBM P&OPOSALS
HEALTH CARl
UJOII PIOICT
YRIYGICIG\1
..-a
.......
CIWIII, lOW.
..._.,DLam
a DOD-plldsaD coa1.it:km of COIU1IIDOt8.
buaiaeu, labor, bealth rAre providers, cld1dlen'a advocate~ ad older
AmerJcaua who11 memban are committed to com.pl'lbeaalvo mform Of 'Cbe.
The B•bh Cam Bafann Project Ia
u.s. lll!8ltb cam ayetem. without c1e1a,.
co 111t tlallly aactmeat Of D&UOnal ~ t11at
aad affordablo coverap. eatabHah system-wido coat
11le Project ia dedlealed
wUl: 111111m u:alveaal
......"'DNNtl illlpftm llea1th . . fl111lk1, J4'C*Ct C0111111B8111 eiiC01II8p
bmovadon. p!OYide equD:able fiDanciq, toater blaldt promotioD IDd. welhlell,
uul iDinasc candattloD ol patleat
ICI'OII tbe full CXHitiaum of cate,
·.w.
inc1udiDa preveatlve, acam ad chmJdc CCJVedl8·
Tbcl
f'ollawJDs tour kDJ Cli1ma lnmmtzf• our health AXO lllbm pliDolpJel
ud are the atandatcla by wldcJl we wll1 evaluate all llfoma JDOPCI8I)s
~ iD
the CoDpss&. Tile attae'bad charta 8UIIIJDil'iz8 our apeclftc
evaJn•dclla far CIICb. of tile ggumt pJw Wlder coasideratlon.
UXPOINTS
Sesnl'IJ gt CQYID. for AU AmerJMQt - 'l'l:ID Pmject be1lavca that health care
dorm mat establab permaaent bealtll secudty tor an AmericaDI.
'Dirtcf5tJ PMlraM • ne Ploject believe& bealth cam retarm
muat iDc1u4o a compreheaslve beaefits pacbp tot people of all qea. The
benefits must cover pteVODtive aod acute CI1'D services u Will u bDDCfitS for
Comptohemdye
tboae .... ohroaic Ot lOllS taml ha1th ueda.
· BmlltiJlla 1md Ad. . ••MIDI - Tbe Pm,tect be&vea tbat au
employer~
lll1llt COidlibuto to the MlpJJUA of tllo bealth 01.1e ayetem. Adequll&D aad
equitable flDaadDI~ wJth lltnJq quality UIUI'IACI8, also m1Jit be provided to
meet 1hc health cam DIICis of
Coli:
Cnntatnmn
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wicJt, rato of iDcmule in overall bealtb. costs I1ICl provkll admiaiatrative savings
and aimpll&atkm.
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202 296 4501
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Dec. 13 19S3
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HEALTH
.'
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CARE
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REF:ORM
..
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President Clinton's
..
plan· will shift
i
control back to
physicians
' !
• By Jeffrey B. Morris, MD
In April and Mayo( this year, I had
the unique opportunity to work wlth
a grnup or physicians and other health
professionals to "audit" the optlons of
the White House Task Force on Health
., .
.. .
Care Reform. I wanl to share with you
a few of the l~eas and concepts we
;.
supported. Universal coverage, com·
prehenslve benefits, community rat·
ing. and elimlnallng Lht dlscrtml·
nation against pattcnts with pre-exl~t·
tns lllness are all key to PN&ldeat
Cllutoa'• plan and now have wide
pubtlc and bipartisan suppurt. I doubt
these concepts are at serious risk o(
being lost ln the lcglsliaive process.
.•
.., ..
:
~} ·~· •. ;: .. ,· ..
,.
..
�r· -.
,.r0111 : JEFFREY E. ~IS, M. ~.
pt.0E No.
: 619 753 S.i.50
Dec.1J 1993
11:~1
PB2
.I
~
,,,
·J
Jeffrey B. Morris, MD
...
What h Ukely lo be attacked as the to weaken the influence of the aUla nee
plan moves t.ha·ough Congress ls lhc by allowins employcn to opt. out and
concept or \he health purc:haslng •alli- purchase "insurance" on thelr own.
ance." The atllhuu:e1 are regional He argues thal t·hc traditional insur·
•
t
-
Ilt;. '
::·:·
/.
.
health purchulng cooperatives that
will serve as l'natke~places where con·
sumen c:an purchase Lhetr health c:are
directly from physicians. Consumer&
ancc company/employer relationship
has created a group o( very sophisli·
c:ated buyers who have leveraged
down prlce&.
·'
and thelr employen wlll pay a pre·
mtum tu the itlliance and will then
choose one o{ sevenal .. vaHable
"Accountable l·lealth Plansn (AHPs)
· .from a menu ofCered by the alllcmce.
What's important about thi~ new
arrangement ls that ~~atlent/consum
cra will directly choose lheir own phy·
slctan networks and hospitals. Thts ls
decidedly diffctent from the current
arrangement, wherein employers
choose an Insurance company that has
pre-arranged an exclusive re1attonshlp
wllh a phystclan/hosplta1 network
without patient/consumer input. In
thls new arrangement, the alliance will
be a conduit to lhe provider networks
wtth a mlnlmal ~h i(tlng of re5ources to
middlemen. Addltlonally, employers
wtll benefit since the alliance wlll
replace the extsttng employer he11lth
benefits bureaucracy.
We In California know .too well the
result of thot relationship: lm.utanc:e·
run managed care. Many of us do not
oppoR the concepl of "managed care"
bul we are alarmed to see insurance
companies selllns HMO producl$ to
The atuance Is now being auackcd as
empluyers and lhen escaping from
lhelr tradtdonal role: a:. rbk underwrit·
ers by shifting the rl~k lo physician
providers.
In dab siluallon, phyalc:lans have
•more layers o£ bureaucracy," been sulpped o£ control bul ere still
"Increased governmenlal control, • or blamed for medlcal cost increases.
•soctallted medicine." There are lndl· Meanwhile, bonuses and dividends
vlduals such as Paal Ellwood.. MD, are paid 11 0ff the top" to CEOs and
of the Jackson Hole Group, who want shareholders and a srowing ~rccn t.-
. -·---··~··--··-·····
····--~
...
··········-..-~····- ..
·------............
~
..................... .......
~
~·
�FrO!" : JEFF'RE'l" B. MJRRIS, H. D.
--...--..······
.""r
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"'
M·l·}·
- 1.. .
~;:-1, ...!~·.···.:,.: . . ·
-
ase o{ the health care dollar,, shlt'led
away from direct patient carelnto corporate profits and expensive marketIng plans. Physicians are left with the
risk for care and a growing morass of
quallty of care Issues.
l submit tn ynu that the alii·
ance/AHP concept proposed under
President Clinton's plan will fundamentally shlft control back to the physicians. The bargainln& for health c:are
services wlll take place not between
Insurance companies and employers,
but between consumers and providers.
Not only will the insurance company
no longer be able tn contrac:t wlth an
employer and "deliver"' groups a(
patlents to one provider network over
anothC'r, emrloyf.lu will no longer
have the acllnlnlstratlve chnr~ nf
selecttns an insurance plan for their
employees. Through the alltance
mechanism tbat responsibility, and
the rlsht to choose his or her own
doctor, will revert back to each c:lUzen.
E.ach provider network wlll have an
equal opportunity to compete, both
on. cost and quality, tor patients who
directly choo~ lhclr nclWOlk.
This provide• ph)'llclans wllh a his·
todcal opportunlly to unite as an AUP.
Each physic:lan network wUI probably
toln wlth a hospital, an Insurance
company, or wlth other buslneu orga·
nizatlons to vertically lntepate Jnto
SH Dr. Mol'l'la, nt~t page
I
I ,
"
.i
Dec. 13 1993 11! 26AM
pe3
�. ...
~·
an AHP, but the insurance eompanies
wlll be compettns to hecoma •partners• and will have to offot competl..
ttve pd~~~ for 'he services they brlng
to the table, auc)l as admlnlstratlop,
management and markettns. Those of'•
us on the .Whlte House physletan
audhtna t~am argued that tf the pby.
slc:lan ~mmunlt)' is to accept respon·
slblllty for contalnlng coat, then there
must be appropriate controls on the
"middlemen. • Aho, physlctans destrvo a degree or autonomy to an
along with tho rcsponslbUlty of tNe
cost containment. President Cllnton
has responded to these stated con-
cerns.
The aiUance/AHP concept represents a profound oppnrtunlty to
achieve thtH results. The ball is tn our
court. Please pause and think ~refully
when this lestsla do~ Ia debated and ,
dissected. We cannot turn back the
clock to a time of unlimited health
expenditures; managed care fts a realtty, sweeping the country even with·
out health c:are n=fonn. The !act that
thls reality places physicians In roles
subservient to the insurance indU$try
ts somethlns President· Cllnton'5
Am.:rlcan Health Security Act It
attempting to change. We can leam
new ways t.o prac:tlce medldne In a.
budgeled environment, u Ions as we
collectlvely have leverage to negodatQ
and thannel most of our ll'eSOurees
into dlreet padcnt cace service$. Those
who eilher unwittinsly or knowingly
auempt to undermine this lesis1atlon
could destroy a. solden opportunity
(or phystetans and other health profeuionals tO repln the stowardshlp of
health care ln thls country.
Dr. Morril u • m..,.,.,. oftla. Whlto
House H••dtll Pro(f11lmt1 R•vi•w
Group '""' pr•et~.ca uplttludtnolog
In the SiJn Dieg-o arf41,
..............________________________
'
·..
·:
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'l~/2~83
14:01
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202 296 '&01
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!IOO'I/00'7
I0-28-83 02:05PM
�c.c : M Et-if?U IC.J
EDWARD M. ICIEHHIO'I, MASSACHUSETTS, CHAIRMAN
ClAIBORNE PELL RHODE ISLAND
ORRIN G. HATCH, UTAH
HOWARD M. METZENBAUM, OHIO
NANCY LANDON KASSEBAUM. KANSAS
CHRISTOPHER J. OODD, CONNECTICUT
JAMES M. JEFFORDS, VERMONT
PAUL SIMON, ILUNOIS
DAN COATS, INDIANA
TOt.l HARKIN, IOWA
STROM THURMOND, SOUTH CAROUNA
BROCK ADAMS, WASHINGTON
DAVE DUREHBERGER. MINNESOTA
BARBARA A. MIKULSKI, MARYLAND
THAD COCHRAN, MISSISSIPPI
JEFF BINGAMAN, NEW MEXICO
PAUL D. WELLSTONE. MINNESOTA
NICK UTTLEFIELD, STAFF DIRECTOR AND CHIEP COUNSEL
KRimNI A. IVERSON, MINORilY STAFF DIRECTOR
srEVe
tinittd
'""'
~tatt.s ~matt
COMMITTEE ON LABOR AND
HUMAN RESOURCES
WASHINGTON, DC 20510-8300
October 22, 1993
Mrs. Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500
.'
·., . !i~~?.'J, :v ~J
Dear Hillary:
I understand that a new option has come under serious consideration
in the last few days for funding expanded public health service activities
and possibly academic health centers as well. This option would create a
separate "receipt" account for this purpose, which would be financed by a
premium surcharge or some other dedicated funding source. Because it is
a receipt account, it would be outside the discretionary caps.
You asked me to let you know if there were any aspects of the
President's program that would distort normal jurisdiction. For many
years, all Public Health Service Act programs, including community and
migrant health centers, nurse training programs, Centers for Disease
Control programs, and the National Institutes of Health, among others,
have been the exclusive responsibility of the Labor and Human Resources
Committee.
Standing alone, the new public health funding would unquestionably
be within the jurisdiction of the Committee on Labor and Human
Resources. But the receipt account option would shift it to the Finance
Committee. The Senate Parliamentarian has informed us that the account
would be considered a trust fund for jurisdictional purposes, and the
Finance Committee has clear jurisdiction over trust funds used for health
care.
I also understand that the receipt account option would create a
sixty vote point of order for the legislation under the Budget Act, because
�r
'
it would be viewed as an attempt to circumvent the discretionary
spending caps.
I would like to propose an alternative approach to achieve the
Administration's goals without creating jurisdictional problems or
violating the Budget Act. Under this approach, Public Health Service
funding would be treated as capped, mandatory spending. Such spending is
outside the discretionary caps but is carefully controlled and limited by
the authorization amounts. There are- already ten such programs in
existence (list attached).
As I understand it, the rationale for the receipt account option is the
importance of avoiding the appearance of creating any new open-ended
entitlements. But that objective can just as easily be achieved under the
approach I have proposed.
Because the amount of capped, mandatory spending is specified in
the law itself, it cannot be higher than the law allows. It does not change
with the economy, number of beneficiaries, or any other factor. Thus, it
has nothing in common with the open-ended entitlements. None of the
concerns involving entitlements has ever been raised, to my knowledge,
about the existing capped mandatory spending programs. Indeed, the only
major difference between a capped mandatory program and a regular
appropriated program is that the authorizing committees, rather than the
appropriations committees, control the funding level.
I hope you will give serious consideration to the alternative I have
proposed, which is of great importance to me. Many thanks for considering
this request, and I look forward to next week's unveiling.
Sincerely,
Edward M. Kennedy
L....__ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
-
�List of Capped Entitlements/Mandatory Spending Authorities
1. OBRA 81: Social Services Block Grant (Title XX of the Social
Security Act)
2. OBRA 86: Section 9414: Medicaid Respite Demonstration
3. OBRA 89: Section 6407: (Medicaid) Demonstration Projects
OBRA 90:
4. Section 4711: Home and Communiey Care for Functionally
Disabled Elderly Individuals (Section 1905(a)(23) of the Social
Security Act)
5. Section 4712: Community Supported Living Arrangements Services
(Section 1905(a)(24) of the Social Security Act)
6. Section 4745: Demonstration Program to Study the Effect of
Allowing States to Extend Medicaid Coverage to Certain Low-Income
Families ...
7. Section 4747: Demonstration Project to Provide Medicaid
Coverage for HIV-Positive Individuals
8. Section 5081: Grants to States for Child Care (Section 402(i)
of the Social Security Act)
Newly Enacted in OBRA 93:
9. Section 13761: Social Services in Empowerment Zones and
Enterprise Communities
10. Section 13711: Family Preservation and Support Services
�P.2
.''
GOLDEN RULE INSURANCE COMPANY
:
:
Home Omce, Lawrenceville, IL
· Jolm M. Whelan
J. Patrlek Rooney
CHIEF EXECUTIVE OFFICER:
CHAIRMAN OF THE BOARD:
THE COMPANY
•
Golden Rule has over 80,000 agents nationwide.
•
The company has 15 regional offices, one
executive office in Indianapolis and one ·home
office in Lawrenceville, IL.
•
The company has been in business for over 50
year~
•
•
•
Patrick Rooney is a member of the Jackson Hole
Group (Hospitals, Journal of the American
Hospital Association, Feb. S, 1993)
· Jack Whelan is a member of the board of
directors of the Council for Affordable Health
Insurance . The Council represents 18 companies
in the individual, medium and small group
markets (National Underwriter- Life & Health.
October 12, 1992).
Golden Rule dropped out of HIAA (National
Underwriter· Life & Health. October 12, 1992 ).
•
Golden Rule is a member of the National
Association of Life Companies (NALC). NALC
supports guaranteed access to health interest
coverage through state interest pools and
portability once an individual has been in the
system for a year (National Underwriter· Life &
Health. May 4, 1992).
•
Golden Rule is also a member of the Council for
Affordable Health InSurance whose main purpose
is to support refonn of the health insurance market
/
DNC/NA'nONAL JDA.LTH CAl\B CAMPAIGN RESEARCH UNIT
+t
�- OcT 04- '93
02:22PM DNCC wASHINGTON, DC-202 479 5129
- - -·
--
- - --
- -"I'""'.-,.::,-
5.
for small businesses (The National Journal, April
25, 1992).
=LARGEST WRITER or MAJOR .
MEDICAL INSURANCE
•
The company is the largest writer of individual
maJor medical insurance in the country (National
Business Journal, March 15, t 993)
THE WTS
GOLDEN RULE PULLS BUSINESS OUT
or VERMONT IN RESPONSE TO NEW
LAWS TO PREVENT CHERRY PICKING
1
Golden Rule Insurance company decided that the
new laws in Vermont, (now also being proposed
in New York) "forcing companies to charge all
individual and small-group customers the same
rate" and requiring community rating and force
insurers to accept all applicants who can afford
coverage, would hurt business enough to wammt
pulling out of that market completely (Health
Line, July 7, 1992).
1
Pat Rooney Stated that: "We think the real
consequence of all this will be fewer people who
are insured" (Health Line• .July 7, 1992).
1
The Jaw was enacted to stop cherry picking in the
health insurance industry and ensure that the risk
in the industry was equally spread "by pooling
people of all ages, occupations and states of
health." (Health Line, July 7, 1992).
/
DNCINAnONAL HEALTH CARE CAMPAIGN USIA&CH 'UNIT
t2
�FLORIDA INSURANCE COMMISSIONER
CALLS GOLDEN RULE A "BAIT-AND
SWITCH INSURANCE COMPANY" AND
A "RIP-OFF ARTIST"
•
Tom Gallagher. Florida state insurance
commissioner, accused Golden Rule insurance of·
being a "bait-and..switch" insurance company and
a "rip-off artist" in a TV ad durin& his re-election
campaign (Orlando Sentinel Tribune, January 31, ·
1992). Galla&her's accusations came after Golden
Rule had publicly criticised him for attempting to
force the company to raise their Medigap
(medicare Supplement) policies (Orlan4~-"~!ltinel .
Tribune, January 31, 1992).
· · · -····
•
Gallagher has said the company wanted to lure
customers with low-priced Medigap policies and
later increase rates dramatically - a practice he
called bait and switch (Orlando Sentinel Tribune,
January 31, 1992).
·
Golden Rule subsequently sued Gallagher for
defaming the company and as of January, 1992, a
circuit court judge in Florida refused to dismiss
the suit (Orlando Sentinel Tribune, January 31,
1992).
GOLDEN RULE REDLINED
LAWYERS IN 1984
•
•
/
In 1984, golden rule insurance ceased extending
heilth insurance to lawyers, concluding that "such
coverage was more trouble than it was worth"
(The National Law Journal, May, 14, 1984).
Darrell Richey, the company's general coUDSel at
the time, stated that lawyers file, "a significantly
higher percentage of suits"· against the company ..
than the general population (The National Law
Journal, May. 14, 1984).
DNC/NA.110NAL HEAL'IH CAIUl: CAMPAIGN B.ESIA&CH 1JNIT • J
�WASHINGTONI DC 21212-479-5129
REPRESENTATIVE STARK
CRITICIZES GOLDEN RULE
•
In 1989, Congressman Pete Stark (D·CA) noted
that Golden Rule rejects 20 percent to 30 percent
of Medigap policy applicants and said its
"coverase targets only the rich and the healthy"
(The Washington Post. November S, 1989).
•
Since Medicare catastrophic covers the poor and
ill as well as the rich and healthy, Stark wondered
aloud if Golden Rule wasn't trying to deprive the
poor of coverage in order to preserv~ .its. -n.arket
among the rich (The Washington Post, November
s, 1989).
MISSOURITIIREATENED TO REVOKE
GOLDEN RULE'S LICENSE
•
In 1989, the Missouri Division of Insurance
threatened to revoke Golden Rule Insurance Co.'s
license to operate in the state because the insurer
wanted to keep its health insurance underwriting
manual proprietary. The company appealed in
court and the outcome is unknown (St. Louis
Business Journal, 1989).
IN 1989, GOLDEN RULE HAD ATTEMPTED
TO INCREASE PREMIUM RATES BY 86%
•
The Ohio Department of Insurance had to restrain
Golden Rule from implementing an 86% premium
rate increase in 1989. After long deliberations
between the state and insurer, both agreed to a
compromise of increases ranging from 68.9% to .
78o/o on varying individual major medical
·insurance policies (Indianapolis Business Journal,1989 UMI/Data Courier).
DNC/NATIONAL HEALTH CAD CAMPAIGN RESEAR.CH 'UNIT • 4
�--
P~6-
----- -----
GOLDEN RULE DRAFTED BILL IN
TENNESSEE TO SET OWN PREMIUMS
•
Golden Rllle Insurance Company drafted a blll in
Tennessee to allow inSUl'IDCe oompanies to set
their own premiums on individual health
policies--but restriots how much profit they can
make (Nashville Business Journal, March 15,
1993).
It won approval by a S·to-1 vote of the House's
Insurance Subcommittee last week, despite
vehement opposition from state Insurance .
Commissioner Elaine McReynolds (N)1sl.lville
Business Journal, March 15, 1993). · _._, , .- --
GOLDEN RULE FORCED BY COURT
TO COVER AIDS PATIENT
•
A jury in U.S. District Judge Sidney Fitzwater's
court found April 3 that Indianapolis-based
Golden Rule Insurance Co. oould not deny
coverage to David Smith, despite the fact that
Smith did not disclose on his application that he
had tested positive for the Human
Immunodeficiency Virus, which causes AIDS.
Judge Fitzwater entered the judament the day of
the verdict, ruling that Smith's $1 million major
medical policy was in force from the original date
·of issue (Texas Lawyer, February 8, 1993).
On May 26, Judge Fitzwater entered an order
denying Golden Rule's motion for a new trial and
awarding about $29,000 in attomcys' fees and
oosts to Smith(Texas Lawyer, February 8, 1993).
•
On Golden Rule's notice of appeal of the case, the
jury found that Smith had not intended to deceive
the insurer and, th~fore,-was guilty-of-nothing-, -- ---- ----- ---and should be oovered by his plan (Texas Lawyer,
February 8, 1993). .
DNC/NA110NAL HEALTH CAlli!. CAMPAIGN I\ESIW\CH UNIT • 5
�P.T
--- ;f
Goldeu Rule•• stand on aaother eontrovenlal AIDS policy
•
In 1990, Golden Rule supported a bill proposed in '
Wisconsin, which prohibited insurance companies
from requiring AIDS tests for health policies
·
(United Press International, January 24. 1990).
•
The bill, whleh also would have given lnsuren ~
the right to deny eovera1e to patients who
manifest the disease within the fint year of
holdlns a policy, was strongly contested by the ~
rest of the state's insurance industry and the state
itself (United Press International, January 24,
1990).
- '"£." ·-- .-~
•
John Siefert, of Golden Rule Insurance Co. of
Milwaukee, defended the policy as one that would
protect individual rights. He al1o said requiring
AIDS teat would cost hll company Sll mlWon a
year and that the money would be better spent .
paying the medical expenses of persons with th~
disease. "Testing is a waste of money." he said.
"All we've succeeded in doing is enriching testing
labs" (United Press International, January 24.). DEAD MAN 1S WIFE SUES GOLDEN
RULE FOR WRONGFUL DEAm
•
In March of 1991, a woman sued Golden Rule for
the wrongful death of her husband. The victim
died from a heart attack one week after Golden
Rule cancelled his health insurance (BNA, Inc.,
United States Law Week, March 19, 1991).
c
The wife's complaint alleged, 11As a direct result
of the defendants' tenninatlon of insurance ...
decedent ... became severely emotionally
distressed . . .was caused to suffer [a heart
attack]." The insurer flied a motion-m--dismiss;·
arguing that the Employee Retirement Income.
Security Act pre-empts the state law claim. The
case's outcome is unknown (BNA, Inc., United
DNCINAnONAL HIALTH CAllE CAMPAIGN USIWlCH UNl'l'
t .,
�P.8
States Law Week. March )9, 1991).
THREE RATE INCREASES IN ONE YEAR
•
While most insU1'111Ce companies aaree to ask for
. only one rate increase a year, Oolden Rule ask~
for three increases in one year in North Carolina
(Indianapolis Business Journal 1989 UMIIData
Courier).
GOLDEN RULE TRIED TO BLOCK NEW
INDIANA RULES ON LONG mRM CARE
., .• :.i
·~-
- ..
•
Golden Rule went to court in March of 1993,
hoping to block new state rules on lOJli·term care
insurance policies. The company said the rUles
would harm its sales with a warning to consumers,
just because its policies do not tit the state's mold
for policies designed .t0und health insurance.
•
The lawsuit sought a temporary restraining order
that would have delayed the start of a program
designed by the In~ Department of Insurance
and the state's Family ~d Social SetVices
Administration. The program was designed to
cure a common complaint that nursing home
residents often must drain nearly all their
resources down to their last $1,500 before
Medicaid begins payina their bills.
Thus, Golden Rule tried to block a
provision that would make it
possible for seniors to reoeive .
long·term care insurance without
"spending-down" all of their
I
:./
I
resources. The reason being that
Golden Rule wouldn't be able to
compete in ~ch a system '~ust
because its policies do not fit the
state's mold for policies designed
around health insurance" (United
DNC/NAnoNAL H!At'IH CAllB CAMPAIGN I.ISLUCH tJNlT
+ '1
�Press International, March 30,
1993).
WHELAN MAKES CLAIMS OF
INFLATION 01' 'VNINSURED
"ESTIMATE'
"The 37 million [people uninsured in the U.S.]
figure is a distortion," said Jack Whelan, president
of the Golden Rule Insurance Co. of
Lawrenceville, Dl. "It's a large number, but for
various reasons they are transitory people."
(Newsday, May 16, 1993).
. _....
•
ROONEY'S PROPOSED HEALTH PLAN
ROONEY ENDORSES "PERSONAL
HEALTH ACCOUNT" AKA
MEDICAL SAVINGS ACCOUNTS
•
/
Rooney proposed having an employer put twothirds of the annual cost of a workers health care
plan Into a special account out of which that
worker would pay his own medical cost and the
remaining third of the employer's contribution
would buy an umbrella policy to cover doctor and
hospital bills in excess of $3,000.
"Say your employer has been
contributing $4,500/year for your
own health coverage - about
average for a medium sized city.
Under Rooney's scheme, $1,500 of
that amount would buy protection
against ~or illnes~ ~r ~~· But
the remaining $3,000 would go into
your medical care account out of
which you weuld pay your own
medical bills. Anything left in the
DNC/NAnONAL HEALTH CAD. CAMPAIGN RESEAI.CH UNIT • I
�M DNCC WASHINGTON,. DC. 202 479 5129 ..
.
P.10·
~·
account at the end of the year
would be yours to keep."
.... (Chicago Tribune, March
1S,l993)
•
Rooney estimates that this approach to health care
refonn would cost the government 514.3 bUiioD
annually, considerably less than Clinton envisions
spending (The Hartford Co\11'11lt, May 24, 1993).
•
When Rooney appeared before the Senate Finance
Committee last year, Lloyd M. Bentsen, then a
Democratic senator from Texas and the_ committee
chairman, said he did not trust Rooney's figures.
(The Hartford Courant, May 24, 1993).
•
While Bentsen has reservations, many
congressional Republicans like the plan because
they think it is easy to understand and would
make a dent in the nation's health care problems
without establishing a large bureaucracy. At least
a half-dozen Senate Republicans have endorsed
the plan, and it has 11tremendous support" among
House Republicans, said Connecticut Rep. Nancy
L. Johnson, R-6th District. · "It does give
consumers a whole different incentive to think
about overuse.. of health services, Johnson said.
"It's a powerful idea'' (The Hartford Courant, May 24,
1993).
ROONEY HAS LOBBIED HARD FOR
PASSAGE OF THE MEDICAL COST
CONTAINMENT ACT OF 1992, B.R. 5250
•
/
In 1992, Rooney frequently traveled to Capitol
Hill to lobby more than 100 meDlberS of the house
and senate, particularly the House Ways and
Means Committee and the Senate Finance
Committee members (National Underwriter,
August 10, 1992). ·
DNC/NAnONAL HEALTH CAD CAMPAIGN RBSIAB.CH UNIT • 9
�TOr:
Melanne and Chris
FROM:
Tamera
DATE:
29 Settembre 93
Buon Giorno. Yes, I actually returned
barred out of Italy, but qave in.
~-
had to be crow-
First, bravo for the events of the past two weeks. When I
turned on the news on Sunday night, it was not only proof of
being in a new time zone -- it was like entering a new planet.
What a transfor.mation, at least for now.
My immediate reason for sending this is to pass on two
issues -- relayed from our Social security staffer -~ that
Moynihan continued to focus on in today's Finance hearing on
the propose~ Commisaionert
1. His intense distress over the action taken to lift the
wage cap for contributions into the Medicare HI Fund, proposed
by the Administration for the budget and enacted in
reconciliation. Moynihan detested what in his eyes was a
violation of the principle that there ehould always he a link
between the level of contributions and the level of the earned
benefits in Social Security, Medicare, etc. Would think it's
less likely that this would come up tomorrow, Dut important
for HRC to know his views and how strongly he feels about
this.
2. His continued discourse and focus on issues connected
with the Social Security oard and the Medioald eard under the
health reform proposal. Would think this WILL came up, and a
chance to hit a home run. Moynihan has history in pushing for
a "real" card (as opposed to a flimsy paper one) for Social
Security, and now sees the President promoting a "real" card
for health covera~e. Has soma interest in the Social Security
number being the IO for the Medical card.
We don't know much more than this, but if you want us to
do any back-door prowling, we will. Otherwise, I wanted to be
sure your worker bees put background and suqgested answers on
these two special issues for the Chair.man. Social Security,
in genaral 1 continues to serve as a lens for him. Assume HRC
will be given some capsule summary of the Committee's history
on enacting Social Security and Medicare 1 and the links in the
issues involved.
·
Best to both of you.
�COVERAGE
•
All citizens and legal residents entitled to national
guaranteed benefit package
•
Guaranteed benefits include:
Typical employee benefits: inpatient and outpatient
hospital services, services of physicians and other
licensed professionals, outpatient prescription drugs,
laboratory and diagnostic services, pregnancy-related
services, post hospital nursing home, home health, and
rehabilitation services
Additional benefits: preventive services
(immunizations, mammogram); mental health and substance
abuse services; some dental care
Benefit changes over time: A national board
reviews coverage periodically to reflect changes
in medical practice.
•
Out-of-pocket costs:
Fee-for-service plan:
Deductible:
Coinsurance:
Limit:
$200 per person; $400 per family
20%
$3000 - $4000 per family
No out-of-pocket costs for clinical
preventive services. Separate deductible and
co-payment for prescription drugs and mental
health services.
·
HMOs and other organized delivery systems
available with lower cost sharing, e.g. $10
per visit.
Benefits beyond the guaranteed package: Employers can
supplement cost-sharing for employees and
purchase extra benefits for employees, but only with
after-tax dollars. Individuals may purchase services
beyond the guaranteed package with their own, after-tax
dollars.
�SOURCES OF COVERAGE
•
Coverage for all workers financed through mandated
contributions from all employers and employees.
Employers pay 80% of alliance average premium up
to a fixed percent of wages. (Employers who now
pay more than 80% may continue to do so.) For
small employers who employ low-wage workers,
employers will pay a lower percentage of wages.
Employees pay 20% of alliance average premium, up to a
fixed percent of wages. For employees reaching the
payroll cap, unearned income is applied toward the
premium.
Self-employed and those with unearned income pay
premium up to a fixed percent of income.
•
Medicare: Initially remains a distinct program,
modified to include coverage for prescription drugs.
When state systems for the population under
age 65 are in full operation, states can seek
federal approval for integration of Medicare
program.
•
Medicaid: Medicaid beneficiaries have choice of plans.
Premiums are financed by continuing current Medicaid
expenditures (maintenance-of effort requirements), and
used to contract with alliance plans. All plans are
required to cover Medicaid beneficiaries.
States also continue to provide to current
eligibles, working or not working, Medicaid
services (for example, extended
rehabilitation services) beyond the
guaranteed benefit package, under current
rules.
•
Other federal programs:
Department of Veterans Affairs: All veterans
receive choice of VA health plan or other
plans offered to general public. Current
beneficiaries are guaranteed protection of
current benefit levels. Management
flexibility is allowed to enable VA system to
compete successfully with other p·lans.
2
�Department of Defense: Department reports on
integration with broader system one year following
enactment. Objective is to promote development of DOD
health plans as option for DOD beneficiaries, subject
to commitment to military readiness requirements.
Current beneficiaries are guaranteed protection of
current benefit levels.
Indian Health Service: Resources enhanced consistent
with providing native Americans guaranteed benefit
package. Tribes receive funds directly from Indian
Health Service. Individual Indians may choose to
enroll either in IHS plan or in plans available to
general public.
Federal Employees: Federal employee program fully
integrated into program established for the general
public.
•
Workers Compensation and Auto Insurance: Individuals
-injured at work and covered by workers' compensation or
injured in auto accidents receive health benefits
through their health plans with payments made (under a
fee schedule) by workers compensation and auto
insurers.
NATIONAL HEALTH BOARD
•
President appoints (with advice and consent of Senate)
7-member board to set national policy and oversee
overall health system. Members will be selected based
on experience and expertise in health care finance and
delivery, consumer protection, business, state
government and service to vulnerable populations.
•
Board has responsibility to review and update the
guaranteed benefit package, to implement and enforce
constraints on health plan premiums (the national
budget) and develop and oversee quality management and
improvement program.
HEALTH ALLIANCES
•
States must establish one or more alliances (purchasing
groups). Non-compliance leads to financial penalties
(subsidies, tax preferences) and federal enforcement.
•
Alliance areas are defined by the state but may not
segregate populations by race, income, or health
status. Only one alliance serves each area.
3
�•
Alliances may be state agencies or non-profit
organizations, directed by boards representing
employers, employees and other consumers.
•
Alliances are responsible for ensuring that all
citizens and legal residents enroll in plans: that
plans provide guaranteed benefit package, provide
consumer information, meet quality standards, offer
dispute resolution mechanisms, serve underserved and
low-income populations.
•
Alliances must offer consumers a choice of at least one
plan which is fee-for-service.
•
A state could require an alliance to offer only one
plan, contracting directly with providers -- in other
words, a single-payer system.
•
Alliances are purchasers, not regulatory agencies •
Their primary responsibility is to negotiate premiums
with health plans and to provide consumers information
to evaluate and choose among plans.
•
All except the largest employers (up to 5000 employees)
are required to make their premium contributions
towards coverage in a regional alliance.
•
Large employers and Taft-Hartley plans with more than
5000 employees are not required to participate in the
regional alliances but they may participate in regional
alliances if they purchase coverage at an experience
rate. Those not participating in the regional
alliances must offer employees a choice of plans and
ensure compliance with rules governing the regional
alliances, as above.
·
HEALTH PLANS
•
Plans contract with alliance to provide guaranteed
benefits within negotiated per person payment. Feefor-service plans, like other plans, must operate
within per capita constraint.
•
Plans must charge same premium for all enrollees, must
accept all applicants and may not terminate coverage.
•
Plans whose enrollees are disproportionately old or
receive extra payments (risk adjustments).
high-~isk
•
Plans must·participate in federally established quality
management and improvement program.
4
�•
Plans must meet solvency requirements, enforced by the
state. State-established guaranty funds protect in the
event of bankruptcy.
•
Plans must provide consumer
procedures.
•
Plans may be required to contract with essential
community providers, serving low-income people in their
communities.
•
Plans may be made up of (owned by) providers or may
contract with selected providers for services. Terms
of provider payment will range from fee-for-service to
salary arrangements~
g~ievance
and appeals
COST CONTAINMENT
•
Open issue: short-term controls under discussion.
•
When new system is fully implemented, health plan
premiums are constrained as follows:
Federal law establishes per capita spending limit
nationally for guaranteed benefit package.
A national board determines state premium targets
by adjusting national average premium to reflect
each states' population characteristics (age,
gender, health status) and historical costs,
relative to the national average.
The targets are increased annually based on a
national formula to reflect inflation (e.g. CPI +
a fixed percentage).
State health plan premiums, on average, cannot
exceed state premium target, as described below.
•
Initial enforcement of premium targets is the
responsibility of the federal government. If targets
are not achieved, the federal government sets premiums
directly and may set provider payment rates.
•
States assume responsibility for enforcing premium
targets after initial implementation. If alliance
fails in negotiation, state achieves target by freezing
enrollment, surcharging high-cost plans to encourage
enrollment in"low-cost plans, regulating provider rates
directly, or regulating premiums.
5
�QUALITY MANAGEMENT AND IMPROVEMENT
•
National Board establishes and implements
quality management and improvement program
with uniform annual performance reports on:
selected measures of outcome, consumer
satisfaction and access to care. The federal
government provides funding for, and a
clearinghouse for, outcomes research and
practice guideline development.
•
Clinical Laboratory Improvement Act reform under
discussion for improvement and streamlining.
ADMINISTRATIVE SIMPLIFICATION
•
Develop single, standard insurance claim form
for all insurers, establish standard rules
for reimbursement and standardize insurance
transactions, including billing.
•
Streamline coordination of benefits among
plans, providers and patients.
•
Require states to coordinate licensing and
certification visits to hospitals and other
health care institutions from government
agencies and outside organizations.
•
Establish standard and unique provider
numbers for providers, patients and
institutions.
PROTECTING UNDERSERVED POPULATIONS
•
Federal government supports health services
for high-risk populations and invests in
health care system in underserved rural and
urban areas.
•
Federal support continues for services such
as transportation and translation that ensure
access for vulnerable and underserved
populations.
•
Health alliances assure participation in new
system by contracting with essential
community providers -- also called "safety.
net" providers -- or requ:f,.ring health plans
to do so.
6
�)
MALPRACTICE REFORM
•
Health plans required to establish
alternative dispute-resolution mechanisms.
•
Limits on contingency fees and on noneconomic damages are under consideration.
•
States have option to pursue enterprise liability.
FRAUD AND ABUSE
•
Federal law establishes criminal penalties
for health care fraud.
•
Civil monetary penalties established for
submitting false or fraudulent medical
claims, routinely waiving co-payments,
unbundling charges, failing to report
required information, submitting false or
fraudulent statements, denying care to
eligible individuals.
•
Extends prohibitions against kickbacks and
self-referrals to all health plans but allows
"safe harbor" exceptions.
BANKRUPTCY AND ANTITRUST
•
McCarran-Ferguson exemption is amended for
health insurers to assure that anti-trust law
applies.
•
Physicians and other providers who hold an equity stake
in a non-fee-for-service plan can negotiate or set
prices collectively for services in the plan.
•
Institutional providers may -enter into
cooperative arrangements to share services if
a state actively supervises their activities
under a state policy intended to replace
competition with regulation.
7
�HEALTH CARE WORKFORCE DEVELOPMENT
•
Total number of first-year residency
positions limited to 110% of graduates of
u.s. medical and osteopathic schools, with
total limited to produce 50-50 distribution
between specialists and generalist
practitioners.
•
New process developed to involve public and
private sector in distributing residency
slots among geographic regions based on
population.
•
Expands training settings eligible for
Graduate Medical Education funding to include
community-based sites outside hospital.
•
Expands National Health Service Corps to
16,000 professionals, provides 4,000
scholarships each year and expands loanforgiveness program to include health
professions other than doctors.
•
States are prohibited from enacting scope of
practice laws that restrict practice of
health professionals for reasons other than
skill or training.
•
Increases funding and loans for training of
non-physician health professionals.
PUBLIC HEALTH AND PREVENTION
•
States required to maintain current level of
support for public health and prevention.
•
Federal block grants to states to support
core public health activities, including
health status surveillance and monitoring,
disease prevention and control.
•
Grants support prevention objectives in
Healthy People 2000, with funds allocated to
states by formula based on needs and per
capita. Activities targeted to prevention of
chronic and infectious disease.
·a
�ACADEMIC HEALTH CENTERS AND MEDICAL RESEARCH INITIATIVES
•
Unique costs of Academic Health Centers are spread
across all health plans in the community.
•
National Institutes of Health supports
prevention research in priority areas,
including child health, reproductive health,
chronic illness, mental health and substance
abuse, AIDS and HIV infection, tuberculosis
and infectious disease.
LONG-TERM CARE
•
Home and community-based care: New federally-financed,
state administered program established for home and
community-based care. Program has following
characteristics:
-- Array of services defined by the state (to
include at least personal care services)
available to severely disabled persons of all
ages.
-- State establishes mechanisms to determine
eligibility, develop care plans, coordinate services
and assure quality.
-- Federal funding capped for each state based on
estimated numbers of eligible patients and per capita
spending. Funding increases annually with consumer
price index plus a fixed amount.
-- Eligible individuals entitled to $500 per month in
services; additional benefits may be provided on a
funds-available basis.
-- Individuals with incomes above 150% of
poverty pay 20% of service costs.
•
Improvements in Medicaid nursing home benefits:
-- All states required to establish medically
needy programs, allowing individuals with
incomes exceeding eligibility levels to
"spend down" to become eligible for Medicaid.
-- Nursing home residents allowed to retain $12,000 (up
from the current $2·, 000) in assets and $100 per month
(up from the current $30) in income.
9
�•
Private long-term care insurance
-- Preferred tax treatment now accorded
health insurance medical spending is extended
to cover long-term care insurance premiums
and expenses.
·
--States required to establish a plan for regulating
the content and sale of long-term care insurance
policies.
•
Tax incentives for working-age persons with
disabilities
-- Disabled individuals are entitled to tax credits for
work-related personal assistance services.
10
�Participants include:
Kathryn Bemmann, M.D.:
President of the American
Medical Women's
Association
William (Bill) Coleman, M.-D.:
President of the American
Academy of Family
Physicians
Paul Griner, M.D.:
President of the American
College of Physicians
Richards. Hollis, M.D.:
President of the American
College of
Obstetricians and
Gynecologists
Betty Lowe, M.D.:
President of the American
Academy of Pediatrics
Alan Nelson, M.D.:
Executive Vice President of
of
the American Society
Internal Medicine
Clifton Peay, M.D.:
Trustee of the National
Medical Association (also
Professor at Medical College of Virginia and
private practice ophthalmologist)
Jimmie T. Sylvester, M.D.:
President of the American
Thoracic Society and
Director of Pulmonary & Critical Care Medicine
at
Johns Hopkins University School of Medicine
Elena Rios, M.D.:
President of the
Chicana/Latino Medical
Association of California
Hugh Tilson, M.D.:
President-Elect of the
American College of
Preventive Medicine
-30-30-30December 16, 1993
�r \
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Telephone:
II. . ~
2021408-1080
Fax:
; Wa.<ID~ DC 20002
.
J ::'
F'AX MESSAGE COVER SHEET
CENTQ ON BUDGET AND POLICY PRIORITIES
. 711 NortJt Capitol Street, NE, Suite 705
.
2021408-1056
'~
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sep1:ember 39, 1993
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If thare are any pTnblems with the transmission of this docum.eDt, ·
please call 202/408-1080.
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..: :I
l Uope you can lnnk at this memo as soon as possible. It is about an urgent matter- tl1 ~
'!! ' ; ~
GrUilm ~enchnent to slash the discretionary caps to reflect the saviDgs total listed in the
·.
i; : .i
Nadeualihrfo..·.maace Review. This amcncbnent will be on the Senate floor l4ter'this week.
.:
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The memo discusses arguments the White House could make to help combat it
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�OCT 04 '93
a2:-26PM -oNce WASHINGTON; DC 202 479 5129
&laney has been attempting to persuade
congressmen to support Rep. Andrew Jaeobs'
Medical Cost Containment acrt of 1992, H.R.
S2SO, which is based on Rooney's ideas for
Medical Savings Accounts/Personal Health
Accounts (National Underwriter, August 10,
1992). The bill was reintroduced in 1993 as H.R.
3065. (Jacobs' Hill ofBce).
Rooney paybag for media out of pocket
•
Rooney had spent $88,000 as of Aug., 1992 on
T.V. and Roll Call ads promoting b9th H.R. S2SO
and a similar Senate bill, S. 2873 (intrQ4u~e.d by
Sen. John Breaux) and was expected'io sj;end a
total of $100,000 (National Underwriter, August
10, 1992).
•
The ads state that passage of these bills would:
.,. Reduce health care spending, (without
raising taxes) •
.., Help 25 million uninsured Americans
stay insured (without ralsini taxes).
... Help small businesses afford health
insurance (without raising taxes) .
.., Help American working people increase
their personal savings (without raising
taxes).
--National Underwriter, August 10. 1992
•
/
The Washington based National Association of
Life Companies endorsed these proposals at its
annual meetings in Toronto (National Underwriter, .
August 10, 1992).
DNC/NA.nONAL HEALTH CAKE CAMPAIGN USEAllCH UNIT
t tO
�Another of RooDey's advertilments played •• follows:
Visual: Pat Rooney, chairman of Golden Rule Insurance
company, speaking in a library. Text: "If Congress passes the
'Medical Cost Containment Act of 1992,' the one with medical
IRAs, one of the benefits for American workers is if you'd lose
your job, you'd have a tax-free fund that you can use to stay
insured until you get a new job. Now, according to a recent
study published by Blue Cross, 70 percent of all uninsured
Americans are without health insurance for one year or less.
Now, if these people bad medical IRAs, they would not have to
be uninsured during that time. ·That means by passing this law,
Congress could help 25 million more Americans stay insured
without raising taxes. Now that is doing somethiniJ ~for. ::: __
American workers instead of promisina them something.
Medical IRAs, Congress should pass them now.'' The end of the
ad reads: "Congress: We need action, not promises. Support
S.2873-H.R.5250. Paid for by Pat Rooney" (CNN. 8/S) (Health
Line Auaust 6, 1992).
GOLDEN RULE ESTABLISHED
POLICY GROUP "HEALTH
CARE SOLUTIONS"
•
In November, 1991, Golden Rule and the A.M.
Rooney Foundation (founded by Rooney's family)
tlnanced the formation of "Health Care Solutions"
in New York, which is reported to have· a
$100,000/year budget (The National Journal,
January 18, 1992).
The group's first report, produced in January.
1992. called for extending tax exclusions for
workers with employer-sponsored health plans to
all Americans who buy health insurance. The
l!fOUtt is also nush for tax.. free savings accounts to
~c&u6&&a&
/
"""_£....&, ,_,.._, .. "• ",,_,,
Health Care Solutions ~o_w .b.as an office in
Washington, D.C.
DNC/NA'nONAL HJ!AL1H CARE CAMPAIGN USJWlCH UNI'I'
t
11
�MARKETING
•
In July, 1993, Golden Rule Insurance began
widespread marketing of medical savings accounts
in 19 states. Patrick Rooney "the nation's leading
advocate of the accounts" said that, "the results of
a test marketing campaign were so favorable that
he believes the accounts could be successful"
(Indianapolis Business Joumal, July 26, 1993).
•
"Since November of last year, Golden Rule has
been test-marketing the accounts among employers
with three to 30 people in parts of Indiana, Ohio;
Louisiana and Michigan. Several tho~~ people
are now using the accounts, company ·ol!Ciils
said" (Indianapolis Business Journal, July 26,
1993).
"This month, the testing ended, and Golden Rule
expanded the program throughout the four states
and into 1S additional states. The company
expects to soon begin offering the program to
employers with 30 to 2SO employees."
(Indianapolis Business Journal, July 26, 1993)
"Companies that decide to use the accounts
p1lrchase what amounts to a high-deductible
insurance policy from Golden Rule" (Indianapolis
Business Journal, July 26, 1993).
THEY SUPPORT MEDICAL SAVINGS
PLANS BECAUSE THEY BELIEVE THAT••••
•
/
The genius of the medical savings plans,
according to its supporters, is that employees
would become more cost-conscious. Because they
would be spendini their own money, they would
ask what services cost and shop around tor fair
prices" (IndianaJ'Olis Business Journal, July 26.
1993).
•
"With Personal Health Accounts, escalating
increases in insurance premiums for employers
.
DNC/NATIONAL HEALTH CAR! CAMPAIGN RESEAR.CH tJNl'I' •
12
�would stop. The higher the deductible, the more
stable the price from year to year.
•
Deductible& and co-payments would no lonaer
exist. Personal Health Accounts would cover
them. And the money saved from not using them
stays with the employee.
•
Government spendina would be slowed, but it
would slow down even more if people on
medicare and medicaid received a refundable tax
credit that would give them the same financial
incentive as people covered by personal health
plans.
:· ----'li·:::: --...
•
Good health habits would be encouraged because
the price of too much booze, too many cigarettes,
and too little exercise would be paid ftom their
own money from their personal health account.
•
There would be a lot less paperwork for insurance
companies and doctors alike, because most •
nearly 70% - of health care spending happens in
the first $3,000. All the medical procedures that
cost less than that would suddenly become over
the transactlons.
•
The plethora of tests and procedures being
conducted by doctors to safeguard them from
malpractice suits would drop,because people
would think twice about a frivolous test if they,
rather than their insurance company, were paying
for it.
•
Even the working poor who don't qualify for
medicaid would be helped." (The Seattle Times,
October 25, 1992)
./
DNC/NAnqNAL HEALTH CARE CAMPAIGN R.ESEAR.CH
tJN1T. 13.
�P.15
;:c
GOLDEN RULE'S POLmCAL
CONTRIBUTIONS, 1985-1992
GoldeD Rule Financial Corporation • PAC
Contributions to:
Democrats..
594,700
R.epublicaos- $86,826
J. Patrick Rooney
Contributions to: ·
.... - .: ··- -
~
Democrats·
$19,750 to candidates
$1,000 to DSCC
$1,000 to DCCC
Total• 521,750
Republicans$26,445 to candidates
$20,250 to Republican Party Committees
Total= $46,695
Golden Rule Financial Corporation-
$15,000
John M. Whelan
Contributions to:
Democrats-
S3.500 to candidates
Republicans-
DNC/NAnONAL H!AL'IH CARE CAMPAIGN RESI!..UCH UNI'I' • 14
�_....
._....,, 1 1 ""' 1""''""'
nn...,•
1J:1 ,".
o• '' oc
c:t~z::
,. r :;~~ :>It:o:;,
,,
P.16
;·
.~
::
• <
.-
DNC/NATIQNAL HIAL1H CARE CAMPAIGN IWIAR.CH lJNI'l'
t
15
�ATTENTION a
THE FOLLOWING IS FYI
ROONEY SAT ON A PANEL WITH
CHRISTIAN COALITION:
•
On September 10, 1993, Rooney was on some sort
of radio or TV show discussing the topic of the
Christian Coalition's Political Conference with
Ralph Reed, (Christian Coalition's Executive
Director), Senator Jesse Helms, SenatQr Bob Dole,
Bill Crystal of the Christian Coalition),
Senator Don Nickles. (C-SPAN Daily Schedule,
September 10, 1993)
and
.
EDUCATION VOUCHERS
•
Recently, Golden Rule Insurance Company
committed about $1.2 million to Two Valley,
Arizona to help low income families send their
children to private schools. (The Phoenix Gazette,
September 8, 1993) In essence, Golden Rule
Insurance provides tuition vouchers to low-income
families.
•·
Specifically, Golden Rule supports the education
vouchers so that minorities can receive a better
education.·
GOLDEN RULE PROVIDES REDUCED
RATES FOR STUDENTS
•
Golden Rule was reported in the Wall Street
Journal as one of a few insurers providing low
cost, short term insurance to· students tor as little -- ·
as $120/month (Wall Street Journal, Aug. 18,.
1993).
DNC/NATIONAL HEALTH CARE CAMPAIGN BESI!Al\CH UNIT • 16
�,
'
STANDARD AND POORS RATES
GOLDEN RlJ4;
•
On Aug. 19, 1993, Standard and Poon 1ave
Golden Rule IDsurance Co. an AA- u a
Claims-paying Abnlty IJ'Bde (Reuters Aug.
1~,
1~93).
NATIONAL MEDICAL ENTERPRISES
•
Golden Rule was one of 19 major insurance
companies (lncludina Aetna, Met Life, Travelers,
Prudential and CIONA) sued by a subsidiary of
National Medical Enterprises (NMB),.NME··
Psychiatric Properties, for conspiracy, consumer
fraud and defamation (Regulatory News Service,
Aug. 24, 1993).
..,. .,.
However, NME was raided by the FBI on August
27, 1993 in a broad orhnlnal investigation on
fraudulent billing and criminal misconduct (PR
Newswire Sept. 7, 1993).
•
Golden Rule Insurance Co. spoke out against
genetic testing defying the insurance industry's
position that such tests should remain legal. The
company believes it is the only insurer in the
country that has taken the position publicly that no
genetic testing should be allowed of applicants for
health insurance or life insurance (Indianapolis
BWliness Journal, March 29, 1993).
•
Patrick Rooney, Golden Rule' s 64-year-old
chairman, sent a letter to all Ohio legislators
several months ago arguinj that "even if it
becomes cost-effective, genetic testing will be
rejected by the public. The reason is simple.
Genetic testing simply intrudes too excessively
GOLDEN RULE SPEAKS OUT
AGAINST GENETIC TESTING
/
DNC/NA'I10NAL HIALnl CARB CAMPAIGN USI.Al\CH UNI'I'
t J7
�---:y-~
U"-' c=.:1rl'l
.IJNCc wRSRINGTON~ --oc
202
479 s129
P.19
,,
into individual privacy." (Indianapolis Business
Journal, March 29, 1993)
WW.WA.MW....., ..v avv•11 ........, -•••J•·-~
-
g•-·•·
(Indianapolis Business Journal, March 29. 1993).
DNC/NA1lONAL HIALTH CARE CAMPAIGN RESEAR.CH tJNI1' •
I.
r
'JI
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
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Original Format
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Background on Health Reform [5]
Creator
An entity primarily responsible for making the resource
First Lady's Office
Melanne Verveer
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
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Box 3
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2068127" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Reproduction-Reference
Date Created
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1/8/2015
Source
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42-t-2068127-20060223F-003-001-2015
2068127
-
https://clinton.presidentiallibraries.us/files/original/bca0fc0ee5d98cb265c729c899174a54.pdf
b3aff84805b55b7dcbe009449349e676
PDF Text
Text
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. list
SUBJECTffiTLE
DATE
National Health Policy Council Meet and Greet Reception at Brown
Universty. Guest List. [partial] (4 pages)
10/08/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Melanne Verveer
OA/Box Number: 17607
FOLDER TITLE:
Background on Healthcare Reform [4]
2006-0223-F
ab616
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)J
Freedom of Information Act- [5 U.S.C. 552(b)J
PI National Security Classified Information [(a)(l) of the PRAJ
P2 Relating to the appointment to Federal office [(a)(2) of the PRAJ
P3 Release would violate a Federal statute [(a)(3) of the PRAI
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRAJ
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRAJ
b(l) National security classified information ((b)(l) of the FOIAJ
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIAI
b(3) Release would violate a Federal statute ((b)(3) of the FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIAJ
·
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIAJ
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Foster, David
Minneapolis, MN
Director, District 33 Steelworkers of America Union
Franks, Ronald Dr.
Duluth, MN
Dean of the School of Medicine, University of Minnesota
Fraser, Don
Mayor of Minneapolis {DFL)
{Not running for re-election)
Garland, Bob Dr.
St. Paul, MN
President, Ramsey Healthcare, Inc. (large, private hospital)
Guest of Vance Opperman
Grant, Carol
Minneapolis, MN
Attorney
DNC National Finance Council Member
Grindal, Ted
Minneapolis, MN
Attorney
Democratic Party Activist
·Legal practice represents medical clinics, hospitals, and
medical providers
Guest of Vance Opperman
Growe, Joan
Minnesota Secretary of State (DFL)
1984 DFL Senate Nominee against Rudy Boschwitz
Gurtin, Joe
Minneapolis, MN
Health Care Advisor, Sage Nursing Homes co.
Guest of Tom Foley
Hasselmo, Niles
Minneapolis, MN
President, University of Minnesota
Guest of University of Minnesota, Humphrey Institute
Hasselmo, Pat
Minneapolis, MN
Wife of Niles Hasselmo (President, University of MN)
League of Women Voters member
Guest of University of Minnesota, Humphrey Institute
�Humphrey, Skip
St. Paul, MN
Minnesota Attorney General
Clinton/Gore Co-Chair
1988 DFL Senate Nominee against Senator Durenberger
Son of Vice President Hubert Humphrey
Huntley, Gail
Duluth, MN
Vice Chair, Minnesota Democratic Farmer Labor Party
Jefferson, Richard
Minneapolis, MN
State Representative from District 58B (DFL)
Vice Chair Transportation & Transit Committee in MN House
African American community leader
Recently defeated in st. Paul mayoral primary election
Johnson, Craig
st. Cloud, MN
Legal Counsel, Minnesota Association of Anesthesiologists
Guest of Vance Opperman
Johnson, Alan
Minneapolis; MN
Advisor for Opperman, Heins, and Paquin law firm
Jones, Jean
St. Paul, MN
Elementary school teacher, Prosperity Heights School
Active in Health Care Ministries, a clinic which provides
health care services to the working poor
Guest of Congressman Bruce Vento
Kaplan, Art
Health care columnist for the St. Paul Pioneer Press,
syndicated to 60 papers nationwide weekly
Physician at the University of Minnesota
Very supportive of the health care reform effort
Will be interviewed by Toa Brokaw on Sept. 22nd after the
President's speech & on the TODAY Show on sept. 23r4
Kaplan, Elliot
Minneapolis, MN _-.·
Chief Exec. Officer, Robins, Kaplan, Miller & Ciresi Law Firm
DNC Business Leadership Forum Member
Kaplan, Eloise
Minneapolis, MN
Ph.D. candidate in Psychology at Univ. of MN
Public health advocate
Wife of Elliot Kaplan
�Kaplan, Sam
Minneapolis, MN
Partner, Kaplan, Strangis, and Kaplan
Senator Paul Wellstone's campaign treasurer
DFL Party Activist
Kaplan, Sylvia
Minneapolis, MN
Wife of Sam Kaplan
DFL Party activist
Wellstone Finance Committee member
Kayser, Marlene
St. Paul, MN
Clinton DNC convention delegate
Former President of Planned Parenthood of Minnesota
Guest of Congressman Vento
Keffeler, Jean
Minneapolis, MN
President, Minnesota Board of Regents
Guest of University of Minnesota, Humphrey Institute
Kline, Sue
Minneapolis, MN
Attorney
Political activist concerned with women's issues
Kushi, Lawrence Dr.
Minneapolis, MN
Assistant Professor, Public Health and Epidemiology,
University of Minnesota
Asian American community leader
Lawrence, Barbara
Minneapolis, MN
Marketing rep. for FACS Telemarketing/Fundraising Firm
Political activist concerned with women's issues
Lewerenz, Sarah
Duluth, MN
Democratic National Committee member
Linoff, Alan
Son of Edith Edelman (Marian Wright Edelman's mother-in-law)
Lucas, Peggy
Minneapolis, MN
second Vice President, League of Women Voters
Partner,. Brighton Development Corporation
�Maddox, Ron
Onamia, MN
Executive, Mille Lachs Band (Ojibwe Nation)
Resort Owner
Democratic Party activist
Former Member of St. Paul City Council
Political Consultant
McGrann, William
Minneapolis, MN
Attorney and managing partner, McGrann, Shea, et al law firm
Former staff member of u.s. Senator & Governor Wendell
Anderson
McGrath, Mike
st. Paul, MN
State Treasurer (DFL)
McGuire, Bill
Minneapolis, MN
CEO, United Healthcare
McLaughlin, Dan
Chief of the Bureau of Health, Hennepin County Medical Center
Host for Health care Watch Party on Sept. 22
Health Care Task Force member
McMahon, George
Roseville, MN
Investment Banker
Former st. Paul City Council Member (OFL)
-Guest of Congressman Bruce Vento
Moe, Roger
Erskine, MN
Minnesota Senate Majority Leader (DFL)
Mondale, Ted
St. Paul, MN
Minnesota state Senator (DFL)
Clinton/Gore co-Chair
Son of Walter Mondale
Nelson, Carol
st. Paul, MN
Registered nurse and volunteer at United Hospital
Wife of Grant Nelson
Guest of Vance Opperman
Nelson, Grant
st. Paul, MN
Vice President & Chief Financial Officer, West Publishing
Company
Guest of Vance Opperman
�Nelson, Judy
st. Paul, MN
Arkansas native
Minnesota Clinton/Gore Campaign staffer
Nelson, Marilyn Carlson
Minneapolis, MN
Vice Chair, Carlson Companies
Exxon Board member
Humphrey Institute Board member
Former chair, United Way
Nelson, Glen
Minneapolis, MN
Vice Chair, Carlson Companies
Husband of Marilyn Carlson Nelson
Guest of University of Minnesota, Humphrey Institute
Nelson, Rick
Eden Prairie, MN
Associate Chair, 3rd cong. District Dem. Farmer Labor Party
Partner, Faegre & Benson Law Firm
1992 National Dem. Convention Rules Committee member
Nelson, Wendy
Minneapolis, MN
Daughter of Marilyn and Glen Nelson
Guest of University of Minnesota, Humphrey Institute
Novak, Steve
st. Paul, MN
State Senate (DFL)
MN Senate Jobs, Energy, & Community Development Committee
Clinton/Gore Campaign Steering Committee
O'Connor, Evie
Minneapolis, MN
Women's Leadership Forum Trustee & Exec. Board Member
Wife of Pat O'Connor
1988 Gore supporter
O'Connor, Pat
Minneapolis, MN
DNC Trustee
-·
Founding Partner, O'Connor & Hannan Law Firm
1988 Gore supporter
Ogren, Paul
Shoreview, MN
President, state Alliance for Universal Health Care
Author of Minnesota Care health care legislation
Former state Representative
Health Care campaign spokesperson
�Opperman, Vance
Minneapolis, MN
President, West Publishing company
Managing Partner, Opperman, Heins, & Paquin Law Firm
DNC Trustee
Owens, Mary Ellen
Duluth, MN
Co-owner of Owens Forest Products
Nurse practitioner and political activist
Penny, Tim
u.s. Representative, 1st Congressional District (DFL)
Agriculture and Veterans' Affairs Committees member
Peterson, Bill
Eagan, MN
Secretary-Treasurer, Minnesota AFL-CIO
Prescott, Leonard
Shakopee, MN
Little Six, Inc. (Indian Casino Company)
DNC Business Leadership Fo~um Member
Quam, Lois
care Advisory Committee member
Vice President, Public Sector Service of United Health Care
(health care management for purchasers, users, managers, &
providers)
~ealth
Rechelbacher, Horst
Blaine, MN
President, Aveda Hair Products (manufacturer of
environmentally friendly cosmetics)
DNC National Finance Council Member
Redmond, Larry
Minneapolis, MN
co-Chair of October 1992 fundraiser attended by VP Gore
DNC Finance Committee for July 1993 Dinner attended by VP Gore
Reichgott, Ember
New Hope, MN
Clinton/Gore Co~hair
State Senator (DFL)
Minnesota Attorney General candidate
Roitenberg, Ruth
Minneapolis, MN
Hosted private reception for Vice President Gore in July 1993
Planned Parenthood activist
�Sabo, Martin
u.s. Representative, 5th Congressional District (DFL)
Appropriations and Budget Committees member
Scheffler, Lenore
Prior Lake, MN
Vice President for Government and Corporate Relations, Mystic
Lake, Inc. (casino located on Mdwektown Sioux Indian
Reservation)
Skubic, Mark
Woodbury, MN
Manager, Federal Government Relations for Health Partners
Former Asst. to the Minnesota Commissioner of Health
Sletten, Jill
St. Paul, MN
Administrative Assistant, State Senator Steve Novak
Clinton/Gore Campaign Staffer
Stafford, Rick
St. Paul, MN
Chair, Minnesota DFL
Staten, Marcea
Minneapolis, MN
Vice President and Assistant General Council, Medtronic
(manufacturers of health care equipment)
African American community leader
Struthers, Margo
Minneapolis, MN
Attorney, Oppenheimer Law Firm
Tchelbei, Ronda
Minneapolis, MN
Health Care Advisor, Sage Nursing Homes Co.
Guest of Tom Foley
Vento, Bruce
u. s. Representative, 4th Congressional District (DFL)
Banking, Finance, & Urban Affairs and Natural Resources
Committees member
Wellstone, Paul
United States Senator (DFL)
Energy & Natural Resources, Labor & Human Resources, and
small Business committees member
Select Committee on Indian Affairs
�Wildfang, craig
Bloomington, MN
Attorney, Siegel, Brill, Greupner, Duffy Law Firm
DNC National Finance Council Member
Wodele, John
St. Paul, MN
Recently defeated in primary for Mayor of Minneapolis
Executive Asst. to Ramsey Co. Attorney Tom Foley
Former Executive Director, MN Democratic Leadership Council
Campaign coordinator for Clinton Minnesota campaign, primary
and general
Wurtele, Angus
Minneapolis, MN
President, Valspar Paint Company
Former DNC Trustee & Walter Mondale contributor
Wynia, Ann
St. Paul, MN
Former Majority Leader, MN House of Representatives (DFL)
Former Minnesota Commissioner of Human Services
University of Minnesota Board of Regents member
Possible candidate for u.s. Senate in 1994
�September 16, 1993
HFAL1H CARE SUMMIT '93:
NATIONAL PROPOSi\.LS, :MINNESOTA PERSPECIIVES
DAlE:
LOCATION:
Til\1E:
FROM
September 17, 1993
University of Minnesota
1:15pm
Kim Tilley, Amy Nemko
L PURPOSE
To deliver the keynote address at Rep. Sabo's 1993 Minnesota Conference on Health
Care Reform.
D. BACXGROUND
1993 Minnesota Conference on Health Care Reform
The conference brings together state and national leaders in health care, business, and
government to analyze the major health reform proposals before Congress of which
the Clinton plan is the dominant legislative proposal to be discussed. Prior to your
keynote Judy Feder is scheduled to make a detailed presentation on the
Administration's health care plan and Lois Quam is moderating a panel. Of the 40005000 expected to attend, 3500 are present by invitation and the rest of general public.
Sponsors of the program include the Columbia Institute, the Hubert H. Humphrey
Institute of Public Affairs, and the University of Minnesota, in conjunction with
AT&T, Blue Cross/Blue Shield of MN, CGNA Health Care, the Mayo Clinic, the
Minnesota Hospital Association, the Minnesota Medical Association and more.
Carlson Lecture Series
The Carlson Lecture Series is an ongoing event at the Hubert H. Humphrey Institute
of Public Affairs. In honor of your appearance, the lecture series and the conference
were combined.
-·
In 1977 the Carlson Lectures were founded by Curtis L. Carlson in memory of his
friend Hubert H. Humphrey and his commitment to public service. The purpose of
the lectures, accordingly, are to continue the awareness of the issues that were
important to Mr. Humphrey. Made possible by a $1 million contribution by Mr.
Carlson, the series is held in the Northrop Auditorium at the University of
Minnesota.
�Previous speakers include: George Bush, William F. Buckley, Jr., Jimmy Carter,
Rosalynn Carter, Abba Eban and more. (NOTE: Anita Hill was 1992's Distinguished
Carlson Lecturer.) His daughter, Marilyn Carlson-Nelson, will present a
Distinguished Carlson Lecturer plaque to you.
DI. PARTICIPANTS
Rep. Martin Olav Sabo (D-MN), Chair, House Budget Committee
Nils Hasselmo, (haz-zl-mo) President, University of Minnesota
Marilyn Carlson-Nelson, daughter of Curtis L. Carlson (There is a possibility that
Mr. Carlson may be present as well, but this hasn't been confirmed yet)
IV. SEQUENCE OF EVENTS
•
•
•
•
•
•
•
Orval Hansen remarks;
President Hasselmo makes opening remarks;
G. Edward Schuh introduces Rep. Sabo;
Rep. Sabo intros HRC;
HRC delivers keynote address (Sabo, Hasselmo, Marilyn Carlson-Nelsonwill be
on the stage during the speech);
Marilyn Carlson-Nelson makes brief remarks and presents the plaque to HRC;
Rep. Sabo concludes the keynote presentation and the event moves on to the
Members panel (see next briefing).
V. PRESS PLAN
Open press.
VL REMARKS
Prepared by Lissa Muscatine.
- - - -
-----------------------------------'
�EVENT PARTIOPANI'S BIOS
Curtis L Carlson
Mr. Carlson is a business executive who was born and raised in Minneapolis. He is
the President of the MIP Agency and the Chairman of the Board of the several
companies including, Radisson Hotel Corporation,. Radisson Group Inc., Colony
Hotels and Resorts,Inc., Carlson Real Estate Investment, Inc., and TGI Friday's, Inc.,
Dallas. He is also on the Board of Directors of several other companies and he is the
Senior Vice President of the University of Minnesota Foundation. Mr. Curtis is on
the Advisory Boards of University of Minnesota Curtis L. Carson School of
Management and the University of Minnesota. Mr. Carlson gave a donation of $25
million to the University, making this contribution the largest single gift ever to a
public university
Nils Hasselmo
The 13th President of the University of Minnesota. Born in Kola, Sweden, Mr.
Hasselmo received the Mauritzon Fellowship and came to the U.S. to study at
Augustana College, a college founded by Swedish immigrants in Illinois. In 1961 he
completed his Ph.D in Linguistics at Harvard University. He was an associate
professor of Scandinavian Languages and literature and the University of Minnesota
in 1965. In 1983 he served as Senior Vice President for academic affairs and provost
at th~ University of Arizona. Mr. Hasselmo returned to the University of Minnesota
in 1988 to become the president of the University.
Orval Hansen
The President of the Columbia Institute for Political Research in Washington, D.C.
Mr. Hansen is a lawyer and a former Congressman from Idaho. From 1956-62 and
1964-66 he was a member of the Idaho House of Representatives and served as the
house majority leader from 1961-62 Mr. Hansen was also a member of the Idaho
State Senate from 1966-68.
Marllyn Carlson-Nelson
.Ms. Carlson-Nelson is presently the Vice Chair of Carlson Holdings, Inc. and she is
expected to be the successor to her father, Mr. Curtis Carlson, the President of the
company. She is also on the Board of Directors of First Bank System, U.S. West
Communication, Exxon Corporation, and the Advisory Board in Washington, D.C.
.Ms. Carlson-Nelson and her husband Dr. Glen Nelson are members of the Jackson
Hole Group of Minnesota -(Glen Nelson is the Vice Chair of MedTronic). Ms. CarlsonNelson is on the Advisory Board of the Hubert H. Humphrey Institute of Public
Affairs. Last year she was awarded the Minnesota Office of Tourism's Outstanding
Individual in Tourism Award • .Ms. Carlson-Nelson graduated from Smith College
and is a friend of Luella Goldberg, the interim President of Wellesley.
�September 16, 1993
MEMBERS PANEL
DATE:
LOCATION:
TIME:
FROM
September 17, 1993
University of Minnesota
2:00p.m.
Kim Tilley
L PURPOSE
To allow for an exchange on the general need for health care reform and the
Administration's health care plan.
n.
BACKGROUND
This part of the event is unscripted. Congressman Sabo's office offered to let us
provide the moderator with a list of questions to be asked but we declined because it
was our sense that the other Members would not allow themselves to be scripted.
m
PARI1ClPANTS
Congressman Sabo
Senator Dave Durenberger
Senator Paul Wellstone
Congressman Rod Grams (R-MN)
Cong:ressman Jim Ramstad (R-MN)
Congressman Bruce Vento (D-MN)
Nils Hasselmo - President, University of Minnesota (He is moderating the
discussion.)
Lois Quam
(NOTE: All the rural Members declined an invitation for reasons that are not dear.)
IV. PRE$ PLAN
Open.
V.
•
•
IV.
SEQUENCE OF EVENIS
Sabo makes overview remarks and then turns the panel over to President
Hasselmo;
Nils questions the Members and HRC (NOTE: The Members bypass the
moderator and question HRC directly).
REI\1ARKS
Informal.
j_ ____ _
�September 16, 1993
l\1E:MBERS PANEL
DATE:
LOCATION:
TIME:
FROM
September 17, 1993
University of Minnesota
2:00p.m.
I<im Tilley
L PURPOSE
To allow for an exchange on the general need for health care reform and the
Administration's health care plan.
n.
BACKGROUND
This part of the event is unscripted. Congressman Sabo's office offered to let us
provide the moderator with a list of questions to be asked but we declined because it
was our sense that the other Members would not allow themselves to be scripted.
m
PARil<lPANTS
Congressman Sabo
Senator Dave Durenberger
Senator Paul Wellstone
Congressman Rod Grams (R-MN)
Congressman Jim Ramstad (R-MN)
Congressman Bruce Vento (D-MN)
Nils Hasselmo- President, University of Minnesota (He is moderating the
discussion.)
Lois Quam
(NOTE: All the rural Members declined an invitation for reasons that are not clear.)
IV. PRE$ PLAN
Open.
V.
•
SEQUENCE OF EVENTS
Sabo makes overview remarks and then turns the panel over to President
Hasselmo;
�•
Nils questions the Members and HRC (NOTE: The Mem~rs bypass the
moderator and question HRC directly).
IV.
REMARKS
Informal.
�.:·.
,..·:
P..eea.u tor w ttJ) & to
~-v~
Jackie L. Eder Itt
-
*
*
National Health
Policy Council
X.
·
-=1747 Pennsylvania Ave~ue
.· ~
-
pa.....Director
r.:A]NM
Suite 900
Washington, DC 2
phone:202/~S675
fax: 202/833-1274
·.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. list
SUBJECT/TITLE
DATE
National Health Policy Council Meet and Greet Reception at Brown
Universty. Guest List. [partial] (4 pages)
10/08/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Melanne Verveer
OA/Box Number:
17607
FOLDER TITLE:
Background on Healthcare Reform [4]
2006-0223-F
ab616
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)[
Freedom of Information Act- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) of the PRA[
P2 Relating to the appointment to Federal office [(a)(2) of the PRAJ
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA[
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors Ja)(S) of the PRAJ
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a~(6) of the PRAJ
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIAJ
b(3) Release would violate a Federal statute [(b)(3) of the FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIAJ
b(8) Release would disclose Information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�/
*
NATIONAL HEALTH POLICY COUNCIL
*
National Health
Policy Councll ·
Meet an4 Greet Reception at Brown University
Guest List (Alphabetic)
Pri4ay, October 8 1 1993
Jeffrey Alexan4er
Brown Rudnick Freed & Gesmer
30 Kennedy Plaza
Providence, RI 02903
401{331-7331
l,.:,r:;'•· ')(:i:·.· ,. .;,.,::!'\: (bJ(S),~>
(Health lawyer.
'"
.:;.;.
j. :.!
Firm has offices in RI, MA, and CT.)
Larry Brouchar4, D.O.
President, American Osteopathic Association
Box 670, 4 Lambert Street
Narragansett, RI 02882
401/783-4546
I, ·.:§1v1 ·t~i~i,r;;:;!:ll-\l~#tic:~:(b )(sJ;!~j,t,i.i~l:'?JffiCY ;:hF 1!''fl:•<; .1
(Steve Gleason is a D.O.)
Robert carniaux
Director, Compensation & Benefits
Hasbro
1027 Newport Avenue
Pawtucket, RI 02862
401/727-5654
l'11ii!$x'W"3!:txf!c~!;.!ltlti\H1?)(6}:·1:'.•. . ·•.'1.:r::l'lt;·''i'll•'l': .,., .. 1
(Instrumental in getting Hasbro to sponsor event.)
Jeffrey Chase-Lubitz
Brown Rudnick Freed & Gesmer
30 Kennedy Plaza
Providence, RI 02903
401/331-7331 Ofc
1":! i• 1:•!it''!.~i!i(\;;tjr;fSHtlii~'fl(6)(6) 1·1,i%.;, :1 lfl;:!:lt~!::;\1\t"'!;;/.'l
k:i•:
(Health lawyer.
.
1601 N.W. 114th Street
Suite 130
Des Moines, lA 50325
phone: 515/nl-7270
fax: 515/ll:Z..7257
Firm has offices in RI, MA, and CT.)
Oflices
1747 Pemasylvanla Avenue, NW
*
Sulte900
Washington, DC 20006
phone: 202/833-5675
fax: 202/833-1274
�.
,.-
...
_,..,._
..
~
.....
~·
~
......
_ ..
·-·-
--
..
:•
Arthur Coia
President, Laborer's International Union of N.A.
Providence
to support the Clinton Plan.)
Joanne Coia
(Spouse of Arthur Coia)
Providence RI
Darren Corrente, Esq.
Laborer's International Union of N.A.
Providence RI
Christine Corrente
(Spouse of Darren Corrente)
Providence
Clare Greqorian
(Spouse of Varton Gregorian)
Providence, RI
401/863-1000 Ofc
SSN: on file
varton Gregorian
President, Brown University
Brown University
Providence, RI
401/863-1000 Ofc.
SSN: on file
Artemis "Artie" J. Jolikowski
Chancellor
Brown University
Providence, RI
401/863-1000 Ofc
SSN: on file
Martha Joukowski
(Spouse of Artie Joukowski)
Providence, RI
401/863-1000 Ofc
SSN: on file
....--___,....
�I
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I
·"
Sherry Len Turner
Senior Vice President, Employee Relations
Hasbro
1027 Newport Avenue
Pawtucket, RI 02862
recently
Hasbro. Originally from Texas.
in getting Hasbro to sponsor event.)
Instrumental
Jerry Liqon
President, Hasbro Manufacturing Services
Hasbro
1027 Newport Avenue
Pawtucket, RI 02862
401 121-m~~l{
B4war4 Loniewaki, D.o.
American Osteopathic Association
313 592-8636
Richar4 "Rick" Pollack
Vice President, American Hospital Association
550 F Street, N.W. #1100
Washington, D.C. 20001
202 626-23
..
in the day.)
suzette Rabinowitz
Cranston Day Care Center
401/461-1000 Ofc
(Friend of Ira Maqaziner.)
Jim Ray
General Counsel, Laborers• International Union
202 466-6790~~~~
(Sat on panel earlier in the day.)
Irwin Re4lener, M.D.
NHPC Board Member
317 East 64th Street
New York, NY 10021
ili6Wiiii$-i"fri'iiilliilli
(Served as Co-Vice Chair of the Professional Review Group. Involved
in children's health issues at Children • s Hospital in New York
City. Irwin will introduce you to quests at reception.)
�·,
'
,.
Alfred Verrecobia
CEO
Domestic Toys
Hasbro
1027 Newport Avenue
Pawtucket, RI 02862
40 727-5654 Ofc
Robert J. Waters, Bsq.
NHPC General Counsel
1050 Connecticut, #500
Washinqton, D.C. 20006
202/857-6398
Former A.A.
Tom
in. Health lawyer at Arent, Fox.
Counsel to Health Reform Project.)
I!
I
I
I
General
�-·
June 29, 1993
MEMORANDUM FOR HILLARY RODHAM CLINTON
FROM:
sUBJEcr:
Kim Tilley, Amy Nemko
Briefings for Wednesday, June 30th
Briefing for Ways and Means Health Subcommittee Meeting
- Member Information
Briefing for Daschle Communications Meeting
(NOTE: Secretary Shalala will attend this meeting.)
- Senate and House Health Care Leadership 'To Do" List
- Strengths of the Plan
- Memo on Health Care Briefings for Members of Congress, etc.
- Health Care Reform Today (i.e. daily message sheet)
- "Daschle Seeks 'Health University' Prior to Committee Debate on Reform•
Bureau of National Affairs Article (6/22/93)
Intern Reception Briefing
�PRIVILEGED AND CONFIDENTIAL MEMORANDUM
TO:
FR:
RE:
cc:
Hillary Rodham Clinton
Chris Jennings
Ways and Means Subcommittee Meeting
Melanne, Lorraine, Steve, Jeff, Distribution
June 29, 1993
Tomorrow you are scheduled to meet With the Democratic Members of
the House Ways and Means Subcommittee on Health. All of the 7-Member
Subcommittee, with the exception of Congressman John Lewis, will be In
attendance. (Although you are very familiar with these Members, a brief profile
on each of their health care backgrounds Is attached for your reference.) In
addition to the Members, the Ways and Means staff of David Abernethy, Trlcla
Neuman, and Jamie Reuter will be present.
BACKGROUND
Tomorrow's meeting was requested almost Immediately after
Congressman McDermott made public statements about his multi-Member
single-payer meeting wtth you. Apparently McDermott's comments about
separate single-payer "subcommittee" meetings with the White House egged on
a number of the Ways and Means Subcommtttee to complain to Pete Stark and
urge that he request one on their behalf.
MEETING SUBSTANCE AND FORMAT
Mter talking with you yesterday afternoon, Ira and I discussed what
would be the best material to present to the Committee Members. We decided
that the optimal course would be to provide them with a fatrly detalled outline
of the plan as we currently envision lt. Attached for your revtew Is the 10 page
document that has been prepared for this purpose. The summary does not go
into any great detail about the two most dlftlcult Issues: financing and shortterm cost containment. However, Ira and Judy will be prepared to discuss the
options In some detail.
David Abernethy and I agreed this afternoon that the best format for the
meeting tomorrow would probably be one that starts off wtth some brief
opening comments from you, followed by a proposal from you about how best
to structure the limited time constraints faced by all. Based on my
conversations with David, Ira, and Judy, I believe you should consider
suggesting the following format for the meeting:
�( 1)
Pass out the document that summarizes the current state of the plan
and allocate 20 minutes for Judy to present It;
(2)
Following the presentation of the written document, have Ira briefly
outline the financing and the short-term cost containment options that
are now betng discussed Internally;
(3)
Allocate the bulk of the meeting and the next 45 minutes or so to any
and all questions, comments, suggestions the Members will have on
what they have just heard; and
(4)
Finally, reserve the last 15 minutes to get the Members' advice on
process, timing, political strategy regarding the health reform proposal.
At the conclusion of the meeting, we will need to pick up from the
Members the paper that was distributed. (This is something that happens all
the time in the Congress.) To ease this process. it would be helpful If you
mention the need to pick up the paper before you turn it over to Judy for her
presentation.
The last point I would make Is that we should be careful to say that the
plan as we currently envision It has taken Into account many of the
suggestions and priorities of the Members of this Committee. Moreover, the
President will want to review his final decisions with the Leadership and the
Members before he unveils the Iegtslatlon.
�I
I
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I •
I
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I
WAYS AND MEANS HEALTH SUBCOMMITIEE
June 29, 1993
CONGRESSMAN PETE SIARK W-CA), CHAIRMAN - For some time Congressman
Stark has backed a single payer model for health care reform based on extension of Medicare
to the entire population. As via:-chainnan of the Pepper Commission he voted against its
pay-or-play plan -- partly because it was not a single payer plan but more importantly
because in his view, it made concession to more moderate to conservative elements of the
Commission without winning their support.
As the First Lady knows, Stark is outspoken and does not have a problem aiticizing anyone.
Earlier this year, Stark released a letter from the Director of Cai-PERS (the health insurana:
plan for California public employees) in which the Director denied that his approach was
managed competition. He released a report from the Congressional Budget Office that
compared various reform models in terms of their abilities to control costs. While the report
found that a single payer approach would do a better job than managed competition, it used a
pure managed competition model so its findings are not directly applicable to the combination
plan being developed by the Administration is developing.
Stark's behavior is often unpredictable. However, he respects Rostenkowski and will be
unlikely to go against his chairman.
Recent Developments: Stark continues to publicly belittle the Administration's health reform
efforts and those charged with developing the plan. A June 16th AP story discussed how
Stark had become a chief antagonist to the Administration on health care reform and laid out,
in detail, some of his verbal bombshells. However the article also quotes Stark as saying that
he is a "soldier" and that all he wants is a real bill with details and "empirical, absolute" cost
controls. (Stark opposes voluntary measures, he compares them to voluntary taxes.)
CONGRESSMAN MICHAEL ANDREWS ID-TXl - Congressman Andrews is a moderate
to conservative Democrat. A new member of the health subcommittee, Andrews supports
managed competition. He sponsored the Conservative Democratic Forum's bill based on that
approach along with Congressman Cooper (D-TN). This bill gathered strong support at the
end of the 102nd Congress and helped stall efforts by Congressman Stark to move his health
reform bill through the Ways and Means Committee. Lack of consensus among the
Democrats caused Chairman Rostenkowski to end consideration of health reform measures.
On a substantive level, Andrews supports a tax cap on benefits and the use of excise taxes,
particularly cigarette taxes, to fund health care reform. He is nervous about cost controls and
the impact they might have on managed competition. He will also look out for rural health
care. Congressman Andrews has many hospitals in his district, and his district tends to
motivate his vote. While close to the Chairman, Andrews will not necessarily follow his
lead.
�Most of the people involved with legislative targeting on the Health Care Task Force believe
his vote is a long-shot. In fact, Majority Leader Gephardt lists him as a "no. • However,
Lorainne Miller believes he is within reach, that he wants health reform, and if the President
releases a very moderate package, he might be with us. The bottom line is that while
Congressman Andrews will require significant work but should he support the plan he could
be very influential with the CDF crowd.
Recent Developments: Congressman Andrews and a group of physicians from his district
met recently with the First Lady and Dr. Phil Lee of HHS. He was very happy with the
meeting and very appreciative of the attention they received.
CONGRESSMAN SANDER LEVIN (D-MI) - Congressman Levin is quiet member who
can be helpful behind the scenes. He is not particularly close to Stark, and doesn't always
follow his lead. He will be influenced mainly by unions and their retirees. In addition, Levin
has a large teaching hospital in his district and he actively defends Graduate Medical
Education payments. He helped draft the Stark-Gephardt compromise in the 102nd and was
one of the last defenders of the Medicare Catastrophic Act.
Congressman Levin believes that consumers want fraud, waste and abuse cut before they are
willing to pay more. He also believes that the Administration can cut costs by using home
care and living wills. He feels that Congress will need plenty of Presidential leadership and
warns about over-promising.
Recent Developments: Congressman Levin has been clamoring for more meetings and
undoubtedly was one of the Members who contacted Congressman Stark about having a
meeting with the rust Lady after the McDermott cosponsors meeting.
CONGRESSMAN BEN CARDIN W-MD) -Congressman Cardin filled Majority Leader
Gephardt's seat on Ways and Means in 1989. Cardin is an insider and a team player who has
been loyal to Chairman Rostenkowski. Although not particularly close to Stark, he has never
crossed him. Cardin worked with Stark to draft the Stark-Gephardt health care plan in the
102nd Congress. Although relatively new to the House, is no newcomer to politics.
Maryland is a state out in front on cost control initiatives and Cardin will be protective of its
initiatives. Cardin has advocated an all-payer rate setting system like the one he helped
create when he was in the state legislature. In addition, he believes the federal government
should adopt national standards and use the states for implementation. He urges the President
and the First Lady to conduct extensive consultation before introduction. Cardin also believes
that health care reform should be done this year.
2
�CONGRESSMAN .JIM MCDERMOIT a>- WAl - Congressman McDermott's key rote in
health care reform is obvious to all. His influence goes well beyond his being one of only
two physicians in the House, his closeness to Speaker Foley, and his lead role as a single
payer advocate. He is well-liked by his colleagues and at home in Seattle. His support of
the final package will be key and every effort is being made to gain that support.
McDermott's checklist of criteria for measuring health care refom1 proposals includes:
universal coverage; portability; a standard package sufficiently generous for people to stay in
the system; choice of physician or provider; elimination of pre-existing condition exemptions;
verifiable cost-containment; cost-containment applied to the entire health care delivery
system; simplification of the administrative system; access for roral areas and inner cities;
elimination of insurance company second guessing of medical decisions; and reduction of
administrative costs in the health care budget.
Recent Developments: Following the meeting with the First Lady on June 23rd, Rep.
McDermott stated that "we're getting into the realm of where it would be possible for us to
support it [the Administration's plan]." However he still was seeking assurances that there
will be "nothing standing in the way of a single payer system." That meeting was also the
driving factor behind today's meeting -- after all the publicity that meeting received other
subcommittee members also wanted the opportunity to meet with the First Lady.
Congressman McDermott met with The Speaker and the Majority Leader today (June 29th).
By all reports that meeting went very well.
GERALD KLECZKA a>- WD - Congressman KJeczka is a nine-year
House veteran and one of the newer members on the Ways and MeailS Committee and its
Health Subcommittee. He is from a safe, largely Polish, Democratic district from the south
side of Milwaukee, Wisconsin. Known as a street-smart combative politician, be votes
dependably with the Democratic Leadership. He is a smoker and takes money from the
tobacco lobby. Kleczka was a cosponsor of Congressman Russo's single payer bill in the last
Congress but Congressman Gephardt considers him a reliable vote for the Administration's
health refonn initiative.
CONGRESS!\fA~
3
�PRIVILEGED AND CONFIDENTIAL MEMORANDUM
TO:
FR:
RE:
cc:
Hillary Rodham Clinton
Chris Jennings, Steve Edelstein
House and Senate "Message" Meeting
Melanne, Steve, Lorraine, Jeff, Ira, Distribution
June 29, 1993
Tomorrow you are scheduled to attend the second meeting of the Joint
House-Senate "Message" group on health reform. Congressmen Gephardt and
Bonlor wUl represent the House. Senate attendees will Include Senators
Mitchell, Daschle, Pryor, Kennedy. Rockefeller. Reid, Boxer, Wofford and
Kerrey. Senators Moynihan and Riegle have been Invited but their attendance
was not confirmed.
This meeting Is a follow-up to last week's meeting In which the Message
group laid out their "to do" list of tasks to be completed before the launch of
the plan. At tomorrow's meeting Jeff Eller will lay out the structure of the
"warroom" and discuss the message of the day brleftng sheets to be faxed to
the Hill every evening. He will also describe the plan for the "Health Care
University" to educate Members, Administration officials and supporters and
field any general questions regarding the communications plan.
Bob Boorstln will respond to the first three Items on their "to do" llst wtth a
particular emphasis on the strengths of our plan. A draft of talking points on
the strengths.
Attached for your review are: 1) the message group's "to do" llst, 2) the
dally message sheet faxed to the message group this evening, 3) the Health
Care University memo, and 4) the strengths talking points.
�To: Health Care Oroup
Fr. Senate and House Health Caro Leadership
The following Jist includes some of the tasks that need to be completed for a successful
launch of the health care refonn proposal. The tasks listed below are meant to be shared
by a variety of organizations not limited to, but including the White House, House, Senate,
NHCC and other gJ"aS$roots organizations.
1. Launch Date Criteria/ Laypch Date Public Message
· need agreement on criteria we need to meet before we're ready to launch
For ex.ample, the President should announce his fllan ~ublicly only when:
- the policy is complete and sufficiently detailed
·back-up numbers are adequate and available (costs, savings numbers should
be vened with CBO to avoid post-announcement controversy)
- message points and name of bill are vetted and available
- infonnative material on strengths and vulnerabilities is available
• back-up infonnation sheets are adequate and l\'ailable
- endorsing groups are identified, committed and ready to endorse publicly
- opinion-lead~ supponers are identified, committed and rclld~ to support
publicly
• gran root~ upc:l'alion ia in place
- Member infonnation level is adequate
- Member endorsers are identified, sufficient, and ready to endorse publicly
• le&al questions have been answered to the extent that no major stnlctural
changes will be required and no obviouKiy valid constitutional problems
will arise
• legislative strategy is developed. a.grccd upon with Committee chairs
·proposed date fits reasonably with Presidential and C.ongreisional schedules
· need coordinated public message on launch date
2. Message
· need to develop and agree upon strona central theme
· educate Members, Administration officials, supporters re: messase and how to stay
on it
· how to infuse it into all parts of effort
1
�3. Strengths lbt • key strengths, talking points on our plan :
· security (evea if you switch jobs, lose: your job or have a pre-existing condition)
. eliminates loopholes and fine print • no more battle with insurers
· &reater consumer choice of health benefits plans
· improved quality of care
· putting the brakes on escatatins health care costs
• comprehensive coverage for all Americans
· simplicity, will reduce paperwork for you and your doctor
. help for small businesses who will have increased bargaining power and lower
costs for premiums
. help for big businesses who are being consumed by health care costs, improving
competitiveness and job growth
. positive impact on state and local budgets
. helps families deal with financial hurden of long term care
. increases role of doctors and patients in medical decisions .
. more consumer information and protection
4. Vulnerabllltt - identification and response:
· families already face rising costs • this will increase thdr costs
. ta.xes win increase
go,·emmcnt can't get anything done 21nd this is just another go..·ernment program
· employer mandates
· nuioning
· loss of choice
govt. workers, others who now have exce1lent coverage
· abortion
. quality
. untested plan, no one has tried to reform this system on this scale before
. refonn may increase spending not decrease it
. unfair to young people
. the system would be so complex that it would collapse
S. Opposition reuareh • determination of vulnerabilities of other plans
· competing proposals (on and off Hill)
· special interest gl'oupa who are mounting their own attack campaigns (NHCC)
. identify health and other groups 1hat oppose reform, who are they? why are they
opposed? What is the eft'eot of their opposition?
· use DPC health contact for information from other Senate offices
2
�6. YlslbWty
· establish weekly visibility plan
• recess plan
· media agenda before launch/after launch
. coordinate public events, publications. statements for maximum impact
7. Effec:tlve ways to reaeb and Involve Members
· Health University
· consultation groups
. effective use of existing House/Senate forums (caucus, DPC)
8. Health Groups/Grassroots
·need to identify and involve the allies (consumer, labor and business organizations)
(NHCC & DPC) in grassroots effon
9. Party Grassroots
. activate pany troops
to
educate others and build support
10. MaWna Dsts
· Media: need comprehensive press lists including specialty and regional
press; coordinn.te existing lists (NHCC, DPC &. WH)
. Academics, Health Care Leaders
. Other outreach: groups, elected officials
10. Rapid Resoonse
· who will lead effort
· mechanism for response
11. Coordlnadon with White House. Senate & House
. identify point persons who will stay in dafly contact with each other in \\t"hitc
House. Senate and House (staff) to coordinate, address issues as they develop
. eslablisll health care working group with representatives from eaoh
· House/Senate mirror organizations (message board groups)
· education (Health University)
· legislativo scheduling (Leadership)
3
�12. Coordination with State/Other Elected OtDcla)s
• ways to involve Governors active in reronn
. ways to involve state legislators, mayors, etc.
13. Coordination Syttemwtde
. National Steerina Committee might be appropriate framework (or coordination
among all engaged in refonn effort
- Adminisntion
- Congressional leadership
-
DNC~"HCC
• DCCC and DSCC
·DOA
- Labor {AFL)
- Othen
13. Calendar
. calendar for task accomplishment
4
�STRENGTHS OP THB PLAN
1) security (even if you switch jobs, lose your job or have a
pre-existing condition)
"Under the current system, one in four Americans will
lose their insurance at some point over the next two
years. Today, if you or your child gets sick, if you
switch jobs, if you want to start a small business, you
can lose your insurance. Under the President's plan,
you'll get health security.
Lose your job -- and you'll still be covered. Get sick
-- you'll still be covered. Start a small business -you won't have to worry. That's what insurance is
supposed to be all about. The President's plan asks all
Americans to take responsibility for their health -and offers health security in return."
2)
Putting the brakes on escalating health care costs
"Right now, what you're charged for health care is
draining your savings, threatening your salary,
bankrupting businesses and exploding our deficit. We've
got a health care system that's overloaded with excess
paperwork, outrageous fraud and waste, and con artists
looking for a fast buck. And if we do nothing, things
will only get worse.
The Clinton plan will change the way things work. It
will crack down on those insurance companies and drug
companies that are making excessive profits -- but not
investing in better care. We'll aggressively go after
the people that exploit loopholes to make a profit. And
we'll stop the overcharging and put the brakes on
rising costs."
3)
Improved quality of care
"First, the Clinton plan will guarantee every American
a comprehensive benefits package that emphasizes
preventive care to keep you healthy instead of waiting
until you get sick. We'll give you more primary care
doctors and nurses.
And for the first time, we're going to require doctors
and hospitals to give you information about the results
of the work they do. You'll know how each health plan
is doing -- and what the people who use that plan think
of the care they get. 11
�4) Greater consumer choice of health plans
"Today, you're at the mercy of the insurance company
that your boss decides to contract with. You're told
what health plan you've got to use -- and even forced
to give up your doctor if your doctor's not part of
that plan.
Under the President's plan, you're in the driver's
seat. You'll get to choose among health plans -- giving
you the widest and best choice of how you get your
care."
5)
Preserves doctor choice
"The doctor-patient relationship is in danger. More and
more employers are forcing their workers to switch to
health plans that may not allow them to see the doctor
they're used to.
The Clinton plan will preserve your right to see the
doctor of your choice. Reform will put consumers in the
driver's seat. You -- not your employer or some
insurance company -- get to choose your health plan and
your doctor."
6)
Eliminates loopholes and fine print -- no more battles
with insurers
"We're all sick of it: the endless, confusing forms;
the insurance policies that you need a translator to
understand, the fine print that strips you of your
coverage when you need it most.
That's why the President's plan will put you in the
driver's seat. Simple forms. Plain language. A
comprehensive package of benefits -- and no loopholes
or fine print to take it away. You shouldn't have to
battle insurance companies to get the benefits you pay
for -- and with the President's plan, you won't.•
�7)
Comprehensive coverage for all Americans
"Right now, millions of Americans have insurance that
isn't there when they need it. Some things get covered,
but often the insurance company points to hidden limits
in the fine print to rob you of benefits you thought
you had.
The Clinton plan will guarantee every American a
comprehensive benefits package that can never be taken
away. And it includes more than a couple of trips to
the doctor. Hospital care -- covered. Lab work -you're safe. Preventive care -- so you and your
children stay healthy. Prescription drugs. More options
for long-term care. Together, it adds up to health
security for all Americans -- the knowledge that you
will always be able to get the care you need when you
need it."
8)
simplicity, will reduce paperwork for you and your doctor
"Under the Clinton plan, you'll be able to wave goodbye to the endless, complex forms and all the hassles •.
Because we're going to scrap the system that produces
so much paper that even if you've got the patience to
wade through it, you probably don't understand it.
We'll take the forms from the 1500 different insurance
companies and make them into one.
And we're going to let medical professionals practice
medicine again. Today, nurses and doctors are forced to
spend time filling out form after form -- time that
could have been spent caring for patients. Some nurses
have to fill out 19 forms for each patient -- and then
those forms are checked and checked again. That won't
happen after reform. 11
9)
Eliminates fraud an4 abuse
"Right now, fraud and abuse run rampant throughout the
system. While some people file false claims about
procedures that never happened, others figure out how
to exploit the loopholes in the maze of forms. Either
way, they're making a profit
and you're getting
ripped off.
The Clinton plan cracks down on fraud and abuse. We'll
toughen penalties for people that try to game the
system. We'll eliminate the loopholes that let people
make a fast buck. And we'll hold all health plans
accountable by requiring them to provide easy-tounderstand information about their results and success
rates -- so abusers have no place to hide.•
�10)
Help for small businesses who will have increased bargaining
power and lower costs for premiums
"Right now, the cost of insurance for small businesses
is spiraling out of control -- bankrupting small
businesses across the country. The smaller your
company, the more you pay for insurance and the faster
your premiums are rising. And small businesses are
going broke trying to keep pace with rapidly rising
premiums.
If you're a small business owner who covers your
employees now, this plan will bring your costs under
control. We'll stop the insurance schemes that
discriminate against you and drive your premiums
through the roof. We'll fold in workers' comp and the
medical part of auto insurance -- so you don't have to
pay for three insurance policies for each worker. And
we'll enable you to team up with other small businesses
and negotiate for the same rates that insurance
companies give the big quys.
Under the Clinton plan, everyone benefits because
everyone takes responsibility. Small businesses that
provide insurance shouldn't have to pick up the tab for
firms that can't afford it.
If you're not able now to cover your employees, reform
will help make insurance affordable for you, your
family, and your employees. The plan will ask everybody
-- workers and employers alike -- to chip in for health
care. And coverage would be phased in and government
assistance provided to make it easier to provide
insurance."
11)
Zmprovinq competitiveness an4 companies' ability to create
jobs
"Right now, many businesses are falling behind because
of the enormous burden of rising health costs. Take the
auto industry, for example. Health care costs add
$1,100 to the price of every car made in America -double the cost added to Japanese imports. So companies
can't hire new workers -- and they're at a disadvantage
in the global marketplace.
The Clinton plan will reduce health costs for many
companies. Health reform will free up money to create
new jobs and increase incomes. And the plan asks all
employers to take responsibility for covering their
employees -- so some businesses aren't stuck with the
bill for people who work for companies that don't
provide insurance."
�i•
12)
Positive impact on state and local budgets
"Right now, health care costs are spiraling out of
control -- bankrupting state and local governments. And
our federal deficit means we have had to cut programs
like Medicare and Medicaid -- leading to an even
greater burden on state and local budgets.
Comprehensive reform will ease this burden. The federal
government will lead the way, and work in partnership
with state and local governments to control the costs
that are bleeding our communities dry. State and local
governments will no longer be asked to go it alone in
facing exploding costs.•
13)
Helps families deal with financial burden of long-term care
"Too often, American families are bankrupted by the
long-term care costs of family members. Often, the
elderly and disabled are forced into nursing homes
because they have no other options. We need a system
that offers real choices to the elderly and the
disabled.
People want to remain in their homes and communities,
and the Clinton plan will provide services to make this
posssible for more Americans. There will be more
services available -- so that seniors and disabled
citizens who can't manage on their own can remain in
their own homes or communities for as long as
possible."
14)
Increases roles of doctors an4 patients in medical decisions
"Right now, doctors have too many people looking over
their shoulders, second-guessing their professional
judgment. They're buried under an avalanche of
paperwork that does nothing to help deliver highquality care.
The Clinton plan takes away the hassle, the secondguessing by insurance company representatives at the
end of a telephone line, and the time spent doing
paperwork. It restores the treasured doctor-patient
relationship and allows physicians and patients to work
together to make medical decisions.•
�15)
More consumer information and protection
"No longer will consumers be at the mercy of their
employer or insurance company when it comes to choosing
a health plan or seeing a doctor. The Clinton plan
empowers consumers to make educated decisions about how
and where they get their care.
After reform, you'll get a "performance report" that
gives you easy-to-understand information on each health
plan -- what doctors and hospitals are included, an
evaluation of the quality of care, a consumer
satisfaction survey, and the price. And you choose your
plan. If you want to switch plans later, you can do it.
It's simple."
16)
Emphasizes preventive care
"We have the most sophisticated health care available
anywhere in the world. But there's something wrong with
a system where you're guaranteed a triple bypass, but
you can't be sure that your child gets the shots she
needs.
This plan offers a new bargain: you take responsibility
for your health and your children's health -- and we'll
cover preventive services: regular physicals,
immunization, and tests like mammograms. And you won't
have to pay for them anymore.
Emphasizing preventive care is a new approach based on
what's always worked -- keeping you healthy instead of
waiting until you get sick. It will improve health and
save us all a lot of money at the same time."
�PERSONAL AND CONFIDENTIAL MEMORANDUM
TO:
FR:
RE:
Through:
cc:
Hillary Rodham Clinton/Jeff Eller
Chris J., Lynn M.
HEALTH CARE UNIVERSI'IY
Ira, Steve, Melanne, Jerry K., Karen P.
Distribution
June 28, 1993
Senator Daschle and other Members of Congress (such as Majority
Leader Gephardt) have repeatedly raised concerns about the limited education
level of Members as It relates to health care. The Senator has promoted the
establishment of a kind of "health care university" for Members of Congress.
He and Congressman Gephardt both believe the "classes" should be open to
Members of both parties.
Jeff E. has suggested expanding the congressionally-oriented health care
university concept to educate and train appropriate Administration
representatives. Other Members, ln particular Senator Pryor, have repeatedly
emphasized the need to have designated (and Administration-educated)
advocates situated throughout the country to serve as credible "talking heads"
to combat the predictable organized opposition that the Administration and
nervous Congresspersons face.
We belleve that establishing a health unlverslty-Uke entity (from now on
referred to-- at least temporarily-- as health care briefings) has great
potential to meet the goals outlined above. An effective educational outreach
effort would help ensure a consistent Administration health care reform
message and be Invaluable for those who are testlfytng at hearings and briefing
Members of Congress. In addition, 1f done well, lt would:
(1)
Reinvigorate the "need for action" mentality that, until very
recently, had been effectively fanning the flames of desire for
comprehensive health reform 1n the Congress;
(2)
Ease Congressional concerns about, and raise Member comfort
levels with, the President's proposal to address the problems:
(3)
Better enable perspective Congressional supporters to explain,
defend, and sell the President's proposal; and
(4)
Be utilized to help educate surrogates In home Congressional
districts.
�Achieving success In briefing Administration, Congressional, and other
tnfluentlaltndtvtduals will depend on the abillty of the health care briefings to:
( 1) communicate our message In a simple, understandable way; (2) utilize staff
resources most effectively; and (3) be responsive to the Information needs and
time constraints of those we will rely on to support the President's health
reform Initiative. To develop and Implement an effective educational briefing
process we wlll have to successfully:
•
Target the Issues
•
Target the Best Personnel to Make Presentations
•
Establish a Staff/Intake and Scheduling Process
•
Prepare the Briefing Materials and Presentations
•
Brief and Train the Briefers
•
Develop a Workable Timetable.
Thls memo provides our recommendations on how best to meet these
requirements. It has been reviewed and approved by Ira and the
Administration's health reform legislative affairs team (headed up by Steve
Ricchettl and Jerry Klepner). Mter you and Jeff review the proposal, It would
be adVIsable to· have It also reVIewed by the Senate Democratic Polley
Committee (Senator Daschle) and the House Democratic Caucus (Gephardt's
designee and Chair of the Caucus -- Congressman Hoyer).
If the President Is gotng to unveil hls package by not later than late
September, the Implementation of the start-up recommendations for the
health care briefings must occur almost lmmedtately. At the end of the memo
is a worplan tlmellne that has been prepared to help wtth scheduling.
One last point: the health care briefing concept proposed ln thls memo
can also be utillzed for many other purposes as well. We have yet to talk In
depth wtth Mike Lux and Bob B. on this, but John Hart has expressed a good
deal of Interest In It betng extended to certain select and Influential
intergovernmental (state and local) audiences.
�TARGET THE ISSUES
The briefings should convey a simple, concise message and be
responsive to what we know to be the major thematic priorities and
Interests of the majority of the Congress. As a first cut, we propose llm1tlng
the briefings to no more than 10 broad-based Issues:
(1)
An Overview of the Plan, its Design and its Philosophy;
(2)
Consumers in the New System;
(3)
Cost Containment and Budgets;
(4)
Savings, Costs and Financing;
(5)
Small and Large Businesses in the New System;
(6)
Health Care Providers in the New System;
(7)
Federal/State Roles;
(8)
The Elderly in the New System;
(9)
Rural Communities and the New System; and
(10)
Urban Communities, Underserved, and the New System.
Issues such as Medicare, Medicaid, Veterans, Federal Employees Health
Benefits, medical malpractice, anti-trust, quality, publlc health, benefits, etc.
would be incorporated Into the above mentioned categories. Special and more
detailed briefings on these and the whole range of other Issues would be
provided to Admlnlstratlon representatives, Congressional Members and staff
on an as-needed and requested basts. (A detalled Issues Ust has been
prepared for specialized briefings and ls Included ln the appendix.)
�TARGET THE BEST PERSONNEL TO MAKE PRESENTATIONS
Briefing Members of Congress always has the potential for great benefits,
as well as great risks. The key Is for Members to leave the presentations both
Impressed with the substance of the Information gtven and the competence
(and UkeabUlty) of the presenters.
Included In the definition of a competent Congressional briefer Is to
know -- gotng In -- what are the historic sensltlvltles of the Members present:
In other words, to know what to say and how to say It, and to know what not
to say. If the personnel chosen meets these criteria, the benefits to these
briefing are almost boundless. If, on the other hand, Members leave
presentations wtth a sense that brlefers are either Incompetent, arrogant,
condesendlng. and/or disrespectful. an effort with the best of Intentions could
well turn out to be a total disaster. All of this Is to say that the personnel
chosen for Congressional briefings Is critically Important.
Policy Expert Resources
Within the White House health care working groups and the
Departments Un particular, HHS), the Administration has an Impressive array
of health care pollcy experts who could serve In briefing roles extremely well.
(In most cases, Ira and Judy -- In particular -- have been, and llkely wlll
continue to be, very well received.) Having said this, the other brlefers that we
will need must be evaluated carefully -- keeping in mind not only how
competent they are, but how well they will be received by dlft'erent collections
of Members. (We have prepared a tentative staff resource llst linked to the ten
topics previously mentioned, but tt Is undergoing final review by Ira and HHS;
in any event, It will be a continually updated list based on thelr performance
and Congressional reception.)
Legislative/Policy Resources
We strongly advise that those most farnUlar with the Congress and their
predlltctlons --the Administration's Legislative Affairs staff-- play a major
role ln briefing the Members and the staff on this Issue. The White House and
Departmental Legislative Affairs staff (particularly at HHS) have strong and
long-standing relationships with the Members and staff that should be utllized
to the benefit of the Administration's health reform effort.
At every briefing, there should be one Legislative Affairs Administration
representative who has equal status to the policy presenter. This ls absolutely
necessary to best assure that no situation gets out of hand, that there IS a
pollttcally sensitive Individual always present. that there are careful notes of
the meeting. and that responsive follow-up occurs.
�ESTABLISH A STAFF/INTAKE AND SCHEDULING PROCESS
The scheduling of the university and other requested briefings should be
coordinated out of the War Room. This work should be closely coordinated
with the Department of Health and Human Services' Office of the Assistant
Secretary for Legislation (ASL and other Departments as necessary). In
addition, lf desirable and appropriate, we should work closely wtth the House
Democratic Caucus and the Senate Democratic Polley Committee to help
coordinate topics, schedules, and rooms. The schedule of all briefings should
be updated dally, provided to Steve Rlcchetti/Chrls J./Jerry K./Karen P., and
announced at the morning Communications meeting.
To ensure that the briefing operation Is a success requires an
experienced and pollttcally sensitive staff person who can work closely with the
Congressional Leadership and Administration personnel In meeting the
scheduling and substantive needs of the Members. We propose that Steve
Edelstein take on this role (In addition to his other responstbtlltles) and work
wtth Lori Davis and other staff at HHS to assist him. Depending on the
volume of and desire for briefings. additional staff (perhaps a full-time Intern
who Is mature and responsible) may be required.
PREPARE THE BRIEFING MATERIALS AND PRESENTATIONS
In order to ensure the delivery of a consistent. simple. understandable
message. we need to prepare educational materials and the presenters In
advance of the briefings that all staff can and should use. Educational
materials should Include charts, graphs, detailed outlines to guide
presentation, questions and answers as appropriate. These materials and
presentations should be user friendly and targeted to speclflc audiences.
Working With the Initial approval of Ira and Judy, as well as the
Legislative Affairs staff. Steve E. wm assign one pollcy expert to each of the
Issues chosen for briefings to take the lead In preparing the substance of the
briefing materials and their presentation. He wtll make certain that each
presentation Is finalized on time and In the best format possible. The
Communications staff wm review and edit the briefing materials for clarity,
directness, and consistency of message.
The presentations wtll also be screened by Legislative Affairs staff to
ensure that they meet the needs of the audiences. (They wtll know who Is
attending because we propose to limit the size of each brleftng to between 2535 Members and have them signed up In advance of the brteftng: we belleve
that such a small structure wm best assure a less lecture-like atmosphere and
better encourage a give and take constructive discussion.)
�Each "class" will be structured to briefly outline the problem(s) with the
current system, how the President's proposal addresses the problem(s) (lf
relatively non-controversial), and the rationale behind the Administration's
proposal. The briefings will be designed to last no longer than 60 minutes:
20-30 minutes (at most) of presentation and 30-40 minutes for questions and
answers. On an as needed basts, these classes wtll be repeated to enable
Interested Administration representatives and Members of Congress the
opportunity to learn about (and be comforted by) the substance and rationale
behind our proposals.
Substantive and detailed presentations about the most controversial
policy recommendations -- 1f they are even avallable -- of the President's
proposal should be avoided. There Is great concern among the Congressional
Leadership that controversial recommendations -- such as financing, exact
cost containment mechanisms, etc-- could lead to publtc and potentially
problematic disclosure. Instead, the two Majority Leaders have suggested that
we detail the options we are considering to address the most challenging
Issues.
BRIEF AND TRAIN THE BRIEFERS
Communications staff will be needed to provide guidance to all brlefers
on how to orally deliver their presentations In an easily understandable
. manner. In addition, before each presentation, the Legislative Affairs staff
from either the White House or the appropriate Department (usually Jerry
Klepner's shop) will brief the presenters on who will be In the audience. what
Issues are particularly sensitive, what Issues to highlight/avoid. and how best
to present complex, potentially controversial materials to them. As mentioned
previously, Legislative Affairs staff wtl1 accompany and participate In all
briefings with the Congress to assure that Member response ls closely
monitored and documented, and to assure that appropriate follow-up occurs.
DEVELOP A WORKABLE TIMETABLE
We need to make a final decision as to when It would be most
appropriate and useful to commence the health care seminars. Senator
Daschle originally envisioned the "classes" beginning only after the legislation
had been Introduced. Majority Leader Gephardt belteves It Is advisable to hold
a series of briefings into one or two days of presentations In an attempt to hold
a dry run-- presenting options not final decisions-- In an effort to begtn to
work out the kinks and determine what briefing format wtll work the best In
September.
�There are arguments on both sides of the appropriate start-up
ttmeframe Issue, but we assume that Senator Daschle will defer to
Congressman on this Issue. Should this be the case, the "dry-run" briefings
could commence as soon as late July or early August. Both strongly believe,
however, that this not occur until we are comfortable With the materials and
presenters before we go to the Hill.
Lastly. Congressman Gephardt has initiated an lnvttatlon for the First
Lady to speak before the House Democratic Caucus soon after she returns
from her July trlp (roughly the 21st). The concept behind thls presentation is
for Mrs. Clinton to reinvigorate the Members Into. once agatn, feeling that
health care reform is a political and economic Imperative.
One last point: If we proceed with the establishment of the health
care briefing formats, we must make certain that the Committee
Leadership Is well aware that these presentations are not substitutes for
the normal detailed consultations that will take place with them. To
assure them that this is not the case, we must schedule and conduct
regular briefings with the Chairmen and their staff. If we do not do this,
they are likely to view these briefing forums as an Insulting gesture. THIS
WOULD NOT SIT WELL AND WOULD BE UNWISE.
�WORKPLAN TIMELINE
Activity
6/27 71Il. 7JJ..2. 7/19 7/26
Target Issues
9/13 9/20 91:J:l
:-------:
:------------:
:-------:
:--------------:
Target Personnel
Finalize Staffing
Prepare Briefing
Materials
Brief the Briefers
Bone the Message
HRC CAUCUS PRESENTATION
CONGRESSIONAL BRIEFINGS
8/2-8/30
91§
: ----------: (on how best to communicate/
legislative prep)
:---~-------:
(communication
and leg. prep
continues)
:--------------------:
:---------:
: ---: Dry run
1st briefing
before recess
:----------------:
RETURN TO briefings
and continue them
even after
introduction on a
bipartisan basis.
�APPENDIX
HEALTH CARE UNIVERSITY
DETAILED LIST•
Coverage
•
•
•
•
•
•
Working Population
Part-time Workers
Nonworking Population
Medicaid
Early Retirees
Undocumented Persons
Benefits Package
•
•
•
•
•
Cost sharing
Preventive Services
Mental Health
Abortion
Updating benefits through Board
New System Design
•
•
•
•
•
•
•
•
•
•
National Health Board
National Administration
State role
Regional Health Alliances/
ERISA/Corporate Alliances
Health plans
Rural
Urban
Risk adjusters
Inter-alliance trust fund
Long-term Cost Containment
Transition
•
•
•
•
Insurance Reforms
Short-term cost controls
State phase-In
Enforcement
�Costs and Financing
Structure of mandate
Cost of reform
Other Revenue Sources
Quality Management and Improvement
Performance Report
Accotintab111ty
CLIA
Practice Guidelines
Information Systems/ Administrative Slmpllficatlon
Medical Malpractice
Anti-trust
Fraud and Abuse
Medicare
•
•
•
•
Managed care (AAPCC reform)
Point of service option
Prescription drug benefit
Waiver option- Medicare Integration
Medicaid
•
•
•
•
•
Managed care Incentives
Maintenance-of-effort
Budgets
EllgtbUtty requirements
Wrap-around benefits
Long-Term Care
Disabled
Prescription Drugs
Other Federal Programs
Veterans Affairs
FEHB
Indian Health
Military: DoD/CHAMPUS
�Medical Research Initiatives
PHS
Essential Providers
Population-based Prevention
Workforce Development/Medical Education
Primary Care Incentives
Graduate Medical Education
Academic Health Centers
Ethics
�Copyright (c) The Bureau of National Affairs, Inc., 1993
DAILY lABOR REPORT
JUNE 22, 1993
1993 DLR 118 d9
LENGTII: 868 words
SECI10N: CURRENT DEVEWPMENTS.
TITLE: DASCHLE SEEKS 'HEALnl UNIVERSITY' PRIOR TO COMMfl"IEE
DEBATE ON REFORM.
TEXT:
Sen. Tom Daschle (D-SD) June 21 said the White House is reacting favorably
to his proposal for a "health university"--a forum for House and Senate members
to review the Clinton reform plan before it is taken up by individual
congressional committees.
In a separate address, Rep. Earl Pomeroy (D-ND) indicated that Congress may
have difficulty passing Clinton's health reform plan if it includes a 7 percent
payroll tax.
Speaking at a health reform conference sponsored by Faulkner & Gray Inc.,
Daschle said that health university "classes" would initially override the
responsibilities of various committees, allowing members "to come to some
conclusions prior to the time we come to official consideration" of the Clinton
plan. He emphasized, however, that the discussions would not impinge upon any
committee's jurisdiction or replace the regular committee process.
While no final strategy has been agreed to, Daschle told BNA that he has
discussed the idea with White House officials and other senators and generally
received a positive response. The White House would be a "major player" in
setting up the sessions through the Senate and House leadership, he said
Daschle explained that hour-long classes would be held in the morning, three
or four times each week, for perhaps a month or two after the Clinton plan is
unveiled. A variety of national health experts would be invited to discuss
various topics, such as Stanford University professor Alain Enthoven to talk
about managed competition, he said. White House officials also would explain
various parts of the administration's plan, he noted.
The classes would allow all members of Congress, both Democrats and
Republicans, to consider the Clinton health care plan at the same time rather
..................._______________________
�have it separately debated in various committees, Daschle told reporters.
"Because [health reform] involves so many committees, it is better to give
everyone access to information simultaneously, not sequentially," he said.
Both Democrats and Republicans have been open to the health university
concept when briefed about it, Daschle said. "So far, no one has said that's a
goofy idea," he said.
If the Clinton plan's unveiling is postponed until September, the House and
Senate leadership will have plenty of time to develop the health university idea
and other strategies further, Daschle added.
Payroll Tax Would Be Controversial
In a separate address, Pomeroy noted that House members who voted for
Clinton's energy tax proposal (the Btu tax) already have used up a substantial
amount of political capital and suggested that additional taxes on business to
finance health reform will be very unpopular with members.
Anyone who votes for a 7 percent payroll tax would be doing so "at the total
expense of one's political future," be said.
While no specifics have been revealed, a "waged-based premium" or payroll tax
has been mentioned by White House officials as a leading option for financing
health reform. Rates that have been frequently suggested in recent months are a
7 percent tax on employers and a 2 percent tax on employees, sources said.
In an earlier address to the conference, Judith Feder, principal deputy
secretary for planning and evaluation, Department of Health and Human Services,
said the overall outline of the Clinton plan is in place, but details of
financing are still "under discussion."
The .introduction of the health reform bill will "immediately follow"
congressional deh"berations on the administration's economic package, Feder
added. "'The exact timing is somewhat unclear, but we're still looking toward a
summertime introduction," she said.
Asked whether Medicare would be folded into the new system, Feder said it
would remain a separate program for the time being, but noted "it is possible
that states can explore integration of the two systems" in future.
Plan Merges Competition, Regulation
Following Feder's remarks, Walter Zelman, a senior health adviser helping
craft the White House reform plan, told the conference that passage of health
reform is likely because of the convergence of three necessary elements:
perception that a crisis exists, an emerging consensus on solutions, and
�presidential leadership.
Zelman said the Clinton plan would merge elements of competition and
regulation to "get the best of both approaches." Private health plans will
function "in a very competitive market," but under a government-set budget that
limits insurance premiums, he said.
By limiting premiums for a bundle of services and forcing health care
providers to live within the budget, the government can avoid dictating how much
providers should be paid for every service or how delivery should be structured,
and thereby allow for private innovation, Zelman said.
The primary risk with capitated payment systems--that providers will cut
costs too much--would be held in check by improved outcomes data, better
practice parameters for physicians, and more information on consumer
satisfaction, Zelman said. Health insurance purchasing cooperatives would be
able to "punish" plans who are not serving their enrollees by not contracting
with them, he said.
�THE WHITE HOUSE
WASHINGTON
JUNE 29, 1993
RECEPTION WITH WHITE HOUSE SUMMER INTERNS
DATE:
LOCATION:
TIME:
From:
I.
JUNE 30, 1993
SOUTH PORTICO
5:30 P.M.
Gail A. Britton
PURPOSE
You, the Vice-President and the First Lady will be greeting the
first session of White House summer interns. There will be
approximately 250 interns at this photo-op, which is designed to
express your thanks for the hard work that they have put in over
the summer.
II.
BACKGROUND
This year's White House Intern Program was launched June 1, 1993.
There will be two summer sessions, and a fall and spring session.
There are approximately 250 college students in each session. The
current session ends on July 9.
The students in the program are regionally and racially diverse;
they represent 40 states, and at least 1/3 are minorities. In
addition to working in the different departments, interns
participate in a weekly speaker series, issues briefings and
community service projects.
III. PARTICIPANTS
* Vice-President
* First Lady
* 250 White House Interns
IV.
PRESS PLAN
White House photographer only. Closed Press.
V.
SEQUENCE OF EVENTS
Provided by Social Secretary.
VI.
REMARKS
Remarks provided by Communications Office •
.................________________________
�--Vein..........................................Conceited
Artery......................................The study of P.aintins;s
Bacteria ................................The back door of a Cafeteria
Barium...................................What dacton do when a patient dies
Bowel......................................A letter like a, e, I, o or u
Cesarean Section .......... .A neighborhood in Rome.
Cat Scan.................................Searching for kitty
Cauterize .........:······...............Make eye contact with her
Colic........................................ .A sheep dog
D&
,
c .......................................Where Wa.shinAton is
Duate ........................................To Uve long
Enema...................................... Not a frien-:J
Fester........................................Quicker
Genital ..................................... Not a jew
G.I. Series...............:..............Soldier baU game
Hangnail ................................. Coar hook .
•
lmpotent................................Disringuished, well known
Labor Pain ............................. Getting hun at work
Medical Staff........................A dc<"tor's cane
l\.1orbid ......................................A higher offer
Nitrates.....................................Cheaper than day rates
Node ...........................................Wa.s aware of
Outpatient. ............................ .A person who fainted
Pap Smear.............................. .A fatherhood rest
Pelvis .....:..................................... .A cousin to Elvis
Post Operative .................... .A letter carrier
Recovery Room ................. .A pb.ce to d-l uf1hol!tery
Rectum .......................................DanR near killed 'em
Seizure........................................ Roman Emperor
Tablet.. ........................................ .A sm:ill table
Tenninallllness .................. Getting sick at the airport
Tumor.........................................More than one
Urine ............................................ Oppositc: of you're out
Varicose ......................................Nc:uby
•
,
or. oruu F. Ha.-.sen
1990 wCamalback #3C6
Pt:oenix, /11. 85015
�•
October 7, 1993
MEMORANDUM FOR PATTI SOLIS
cf,
FROM:
LYNN MARGHERIO
SUBJECT:
HRC/PROVIDER FORUMS
Per a meeting with Mrs. Clinton and C. Everett Koop, here's a schedule of the first
provider forums. Some of them are already arranged; others need to be scheduled (or
arranged with surrogates if not possible).
I'll follow up to see what is/isn't possible.
Scheduled forums:
October 19-
Institute of Medicine - Washington, D.C.
8:45 - 9:45 AM
HRC is already scheduled to address the annual meeting of the Institute
of Medicine, the medical branch of the National Academy of Sciences.
The event draws about 400 decisionmakers and opinion leaders in the
medical community.
Suggested format: Brief remarks by both HRC and CEK, followed by
Q&A from the audience.
Suggested topic: a general discussion of health reform and how it
impacts physicians - - a special emphasis on academic health centers,
antitrust, malpractice, quality.
10/31 - 11/1? -
American Academy of Pediatrics- Washington, D.C.
HRC is already scheduled to keynote the American Academy of
Pediatrics event in D.C. HRC has agreed that CEK should be present
also to accompany her at this event. The White House needs to ask
AAP for this to be arranged.
Suggested format: HRC delivers brief opening remarks to frame the
discussion. CEK moderates questions from the audience. CEK will
provide questions to us that he will pose to HRC to lead off the session.
...._________________________________
----------
�Suggested topic: how reform addresses concerns of pediatricians and
children's hospitals - - including preventive care, essential community
providers, health education, school-based clinics
November 74:00 - 5:00 PM
AAMC- Washington, D.C.
Need to confirm.
This meeting brings together medical students, deans of medical
schools, directors of admission, medical students, and representatives of
community hospitals and national specialty organizations.
Suggested format: Dr. Koop would introdu~ the First Lady who would
deliver remarks and then open it to questions and answers.
Suggested topic: a general discusSion of health reform and how it
impacts physicians - - a special emphasis on academic health centers,
antitrust, malpractice, quality.
Subsequent forums:
?
I would recommend a pace of one forum every two to three weeks. We have
discussed a possible schedule with Dr. Koop to bring us through December:
November 19 -
AAFP - Patient Education, Scottsdale, AZ
This meeting is about patient education. Dr. Koop suggested HRC hold
a panel-type forum here. Dr. Koop would not be able to attend.
November 22 or 23 - Urban Forum - Location TBD
At a location to be determined, this forum would discuss the impact of
health reform on inner city communities.
Suggested format: an interdisciplinary panel discussion of local and
national physicians and non-physician providers. Q&A to follow.
December 2, 3 Tri-state Rural Forum - Hanover, New Hampshire
Dr. Koop has made initial arrangements with the governors of Maine,
New Hampshire and Vermont to host a rural forum at a neutral site- the Koop Institute in Dartmouth, NH.
Invitations will be made to the 2200 physicians in the tri-state area,
working through county and state medical societies and the state
�directors of health. Dr. Koop estimates that approximately 1/3 of the
area's physicians can be expected to show.
Suggested format: a panel of local physicians, followed by Q&A from
the audience. To showcase the possibilities of technology, we could
link up the Institute with rural providers or the VA hospitals in the area.
December 6 - AMA House of Delegates - New Orleans, lA
3:00 - 5:00 PM
This is the governing body of the AMA, representing county and state
medical socieites in the SO states. Each delegate has an obligation to
report back to his or her community following the meeting. Depending
upon our relationship with the AMA, this meeting could be ideal venue
for a provider forum. · To be arranged with President's schedule.
�Health Security Plan
Briefing Materials
I.
Executive Summary
II.
Plan Summary
m.
The Process
IV.
Savings and Controlling Costs
V.
Jobs and Health Care
VI.
"If You Like Your Insurance Today... "
VII.
Medicare
IX.
Questions and Answers
X.
Mrs. Clinton's Minnesota Speech
�1HE HFALTII SECURIIY ACf OF 1993
Health Que That's Always There
Evety American citizen will receive a Healdl Secmity Can1 dJat guarantees you a
comprebemive piCkage of benefi1s dJat can never be taken away.
Guaranteeing comprehemive benefits that can never be taken aw~. Controlling health care
costs for cormuners, business and our nation Improving the quality of American health care.
/ni:reming choices for comumers. Reducing pape1Work and simplifying the system. Making
everyone respomible for health care. These are the principles of the Health Secwity Act of
1993 and they are ..m1. negotiable.
In America, rights and respomibilities go hand-in-hand We will mk everybody to pay
something, even if your contribution is small. Everyone must msume respomibility. No one
should get a free ride.
Most important, we~ going to offer new opportunities and new incentives for people to st~
healthy - and to treat small problems before they become big ones. Our goal should be to
keep people healthy, not treat them c(ter they become sick.
Wlat's
Wm._ Widl dle Omnt System
The things that are wrong with our health care system are threatening everything that's right
with American health care.
•
Over the next two years, one out of four of us will be without health coverage at some
point. Change jobs, lose your job, or move - and your insurance company is currently
allowed to drop you.
•
Today's system is rigged against families and small businesses. Insurance companies
pick and choose whom they cover. Then they drop you when you get sick. If you
have a pre-existing condition, you usually can't get any insurance at all.
•
Insurance companies charge small businesses as much as 35% more than the big guys.
•
Only 3 of every 10 employers with fewer than 500 employees offer any choice of
health plan. Millions of Americans have almost no choice today.
•
Twenty-five cents out of every dollar on a hospital bill goes to bureaucracy and
paperwork - not patient care.
•
Fraud and abuse are exploding, costing us at least $80 billion a year. That's a dime of
every dollar we spend on health care.
•
Our nation's health costs have nearly quadrupled since 1980. Without refonn, by the
year 2000, one of every five dollars we spend will go to health care.
�The Health SecuritY Plan
Every American citizen and legal resident will receive a Health Security Card.
Once you get your card, you can n-ever lose your health coverage -- no matter what.
If you get sick, you're covered. If you change jobs, you're covered. If you lose your
job, you're covered. If you move, you're covered. If you have the courage to start a
·
small business, you're covered.
Your Health Security card guarantees you a comprehensive package of benefits that
can never be taken away. The package is as comprehensive as the ones that many
Fortune 500 companies offer their employees. And in critical ways-- like paying for
preventive care and prescription drugs -- the package gives you more than big
companies provide today.
You will be able to choose your doctor. Everyone will have a choice of health plans.
You'll be able to follow your doctors and nurses into a traditional fee-for-service
plan, join a network of doctors and hospitals, or join an HMO. Your boss or
insurance company won't decide how or where or from whom you get your care -you will.
Almost everybody will be able to sign up for a health plan at work, like you do
today. You'll get brochures that give you easy-to-understand information on several
health plans -- which doctors and hospitals are included, an evaluation of the
quality of care, a consumer satisfaction survey, and prices. If you're self-employed
or unemployed, you can sign up at your area health alliance, which will be run by
consumers and businesses and bargain for affordable health care for you.
The federal government will set up a national health board -- a board of directors
to set standards and make sure you get the comprehensive benefits and quality care
you deserve. State governments will set up health alliances give consumers and
small businesses the power to buy affordable care; and the businesses with 5, 000 or
more employe,es will be allowed to operate as "corporate alliances. "
Insurance companies will be required to use a single claim form to replace the
thousands of different forms they have today. So when you get sick, you won't be
buried in forms -- and neither will your nurse, your doctor or your hospital.
•
•
•
•
•
•
Secmity of guamnteed, comprebemive benefi1s.
Health care cosa that are under controL
Improved qtmlity of care.
Incremed choiceS for comumeJS.
Less papenvork and a simpler system
Respomibility from evetyone.
That's wbat the Health Secmity Act is all about.
�Principle #1:
SecuritY; Qmnm1ml COIIJilRhemiye
benefits.
Over the next two years, one of every four of us will lose health coverage for some time. The
Clinton plan guarantees that you will neYei lose your insurance - no matter what. All
Americans will receive a Health Security card that guarantees you a benefits package that is
as comprehensive as those offered by most Fortune 500 companies... and then some. Here's
· how the plan guarantees security:
•
Makes it illegal for imurance compmies to deny you coverage became of ''preexisting conditiom." The Health Security Act also makes it illegal for insurers to raise
your premiums or drop you because you get sick. All health plans will be required to
accept anyone who applies - healthy or sick, young or old
•
Guanudees coverage if you lose your job. The proposal guarantees that you will keep
your health coverage even if you lose your job, with the employer portion picked up
by Federal revenues and savings. Under the cwrent system, if you lose your job, you
lose your health insurance.
•
Guanmtees coverage if you swireh job§, move or start a small luiness. You will
always be protected- no matter what. Today, if you switch jobs, move or start a
small business, you can fmd yourself without health insurance - and risk bankruptcy.
•
Emplmizes peventive care. The comprehensive benefits package goes beyond
virtually all cwrent insurance plans by covering a wide range of preventive services,
including mammograms, Pap smears, and immunizations - at no cbalge to yoa It puts
a new emphasis on helping you stay healthy, rather than waiting until you get sick.
Prevention saves money and improves people's health.
•
Includes prescription drugs. Many insurance companies and Medicare have failed to
cover prescription drugs. But drug costs are breaking family budgets, forcing many
older Americans to choose between food and medicine. Health insurance should cover
prescription drugs. The Health Security plan does.
All Americans will be guaranteed coverage of :
• Preventive Care ( i.e., screenings, physicals, immunizations, mammograms, prenatal care)
• Doctor Visits
• Prescription Drugs
• Hospital Services
• Emergency/Ambulance Services
• Laboratory and Diagnostic Services
• ·Mental Health and Substance Abuse Treatment
• Expanded Home Health Care
• Hospice Care/Outpatient Rehabilitation
• Vision and Hearing Care
• Children's Preventive Dental Care
�Prjnciole #2:
..
Savi._; Con1mlliqr hm'th care cos1s.
Here's how the Health Security Act will control health care costs:
limi~
•
how much imunmce compmies can mise your premium Insurance companies will
no longer be able to raise your premiwns as they please. Today, insurance companies
hike your premiwns - sometimes at several times the rate of inflation - if you get sick, if
someone in your family gets sick, and for any other reason.
•
Introduces compe1i1ion to the health cme lllllketplace. The Health Security plan will
release the chokehold that in today's system, insurance companies have on all of us consumers, nurses, doctors, and businesses. Reform will encourage competition - forcing
costs do'Ml as health plans compete by offering high-quality care at an affordable price.
•
Cmcks down on fraud. The health security proposal makes health-care fraud a crime and
imposes stiff penalties on those who cheat the system. It prohibits doctors from referring
patients to outside facilities, like labs, which they O'Ml a piece of. It stops the kickbacks ·
that some laboratories give doctors in an effort to get their business.
•
Asks the drug compmies to hold down prescription drug prices. The Health Security plan
asks drug companies to take responsibility for keeping prices do'Ml, without setting prices.
In today's system, overcharging nms rampant -certain prescription drugs cost Americans
three times more than people pay in other industrialized countries.
• . Reduces p~penvork. All health plans will adopt a single, standard claims form by Jan. 1,
1995. Along with other measures to streamline the system and free nurses and doctors
from excess bureaucracy, this will reduce paperwork, cut red tape, and save money.
•
Squeezes the w.Bte out of Medicme am Medicaid By slowing the growth of these
government programs, the proposal uses funds that have been wasted on excessive charges
and fwmels them into comprehensive benefits. Under reform, Medicare will be expanded
to cover prescription drugs, and there will be a new long-term care program to help cover
home- and community-based care. Today, Medicare and Medicaid spending keeps going
up and up. But the elderly and poor aren't getting any extra benefits. Health security will
change that.
Principle #3:
QmliQ'; Maki._ the world's best care bette&
•
~izes peventive care. The Health Security plan puts a new emphasis on preventing
· illness before it becomes a medical crisis. Prevention will improve the quality of care by
helping people stay healthy rnther than treating them after they get sick. The benefits
package fully pays for a wide range of preventive services; the vast majority of today's
insurance plans don't cover a penny.
�• Gives consumers the power to judge the qualijy of care. Conswners will receive quality
"report cards" that provide infonnation on the perfonnance of health care plans and
.patient satisfaction. These report cards will hold health plans accmmtable for meeting high
standards. The National Quality Program will help states share information on health plan
perfonnance.
•
Refonns malpmctice. The President's proposal will limit lawyers' fees in order to
discourage frivolous medical malpractice lawsuits. It will also encourage patients and
doctors to use alternative fonns of dispute resolution before they end up in court. This
will help eliminate the "defensive medicine" that drives up costs· and hurts quality doctors ordering extra tests because they fear lawyers looking over their shoulders.
•
ntcomages cooperation in nnal and mban meas. Rural residents will have access to the
· latest technology and emergency services through telecommunications links set up
between local doctors and advanced networks of specialists and hospitals. In urban areas,
the plan will increase investment in public hospitals and community health centers.
•
Provides incentives for more family doctors to pmctice in nnal and mbm meas. The
health security plan will give financial breaks to doctors and nurses who work in
underserved rural and urban areas. It will expand the National Health Service Corps. Two
of three rural counties today do not have enough doctors and 111 rural cowtties have no
physician at all.
•
Inc~
ftmding for prevention researth. The National Institutes of Health (NIH) will
expand research in areas like children's health, and health and wellness promotion.
Preventive care keeps people healthier and saves money at the same time.
•
Promotes researth on tbe effectiveness of treatmems. Today, a lack of information about
the most cost-effective methods of treatment often leads to expensive defensive medicine
and wide variation in treatments and costs. The plan's investments in research into what
treatments really work will help improve the quality of care.
Princiole #4:
Choice; Preseni._ aql incnai• wbat you have tnQor •
-
•
Preserves your right to choose your doctor. The proposal ensures that you can follow your
doctor and his or her team to any plan they might join. Today, more and more employers
are forcing their employees into plans that restrict your choice of doctor. After refonn,
your boss or insuian~ company won't choose your doctor or health plan - you will.
•
Inc~ your choice of heal1b pan. You will be able to choose from among all the
health plans offered in your area - no matter where you work. Only one of every three
companies with fewer than 500 employees offer any choice of health plan. After refonn,
every employee will be able to choose a health plan.
�• Puts comumers in ibe driver's seat The Health Security Act brings competition to health
care- unleashing the market forces that will lower costs and improve quality. Giving
small businesses and conswners the power to band together in alliances will level the
playing field and give them the same bargaining strength as big businesses.
•
lncreMes optiom for long-term care. The President's proposal will make it possible for
more Americans to continue to live in their homes and communities while receiving care.
Today too many families are split apart when insurallce or federal programs only pay for
· hospital coverage. The plan will help put an end to this situation and give families the
options they deserve.
Princiole #5:
Simplicib': Beduciog papenvork and cuUiog red mpe.
•
Gives everyone a Healdt Security Gud. The card - with full protection for privacy and
confidentiality - will allow for electronic billing and the creation of health care
infonnation networks. This will reduce paperwork and simplify the system.
•
Requires imumnce compmies to me a single claim form The Health Security Act will
reduce the insurance company red tape that forces doctors and patients to spend their time
filling out forms and fighting bureaucrats. All health plans will adopt a single, standard
claims fonn by Jan. 1, 1995. It will enable doctors and nurses to spend more time talcing
care of you - and less time \Westling with paper.
•
Eliminates fme print. Everyone will get a comprehensive benefits package - and what you
get will be spelled out in easy-to understand language. If you get sick, insmance
companies won't be able to point to fine print and deny you the coverage you've paid for.
•
StJeamlines billing ~imbmsement for doctors, muses and hospUIIs. The comprehensive
benefits package, a standard rules and codes for payment, and elimination of excessive
government regulations will reduce confusion. Doctors, nurses, and hospitals will have
more time to care for patients; and all of us will benefit.
•
Relll)ves ibe bmden on luiness of negotiating imunmce. Groups of businesses and
consumers - regional health alliances - will negotiate for high-quality care at affordable
prices. This will simplify today's system, where hmdreds of thousands of businesses
negotiate with more than 1500 insmance companies. The burden of finding insmance will
be lifted - and sq will administrative costs - which can nm as high as 400/o of total
health costs for small business.
Principle #6:
Respomibilib': Makiog evel)"one rapomible for healdl que.
• Cmcks down on fraud. The health security proposal makes health-care fraud a crime and ·
imposes stiff penalties on those who cheat the system. It prohibits doctors from referring
patients to outside facilities, like labs, which they own a piece of. It stops the kickbacks
�that some laboratories give doctors in an effort to get their business.
•
Asks tbe drug compmies 1D hold down pmcription drug prices. The Health Security plan
asks drug companies to take responsibility for keeping prices down, without setting prices.
In today's system, overcharging nms nunpant --certain prescription drugs cost Americans
three times more than people pay in other industrialized coWttries.
•
F..mplaizes preventive care. The Health Security plan puts a new emphasis on preventing
illness before it becomes a medical crisis. Prevention will improve the quality of care by
helping people stay healthy rather than treating them after they get sick. It offers you full
coverage of a wide range of preventive services, but asks you to take responsibility for
keeping yourself healthy.
•
Refonm malpractice. The President's proposal will limit la")'ers' fees in order to
discourage frivolous medical malpractice lawsuits. It will also encourage patients and
doctors to use alternative forms of dispute resolution before they end up in cowt. This
will help eliminate the "defensive medicine" that drives up costs and hurts qualitydoctors ordering extra tests because they fear la")'ers looking over their shoulders.
•
Everyone con1ributes, and no one gets a free ride. In America, rights and responsibilities
go hand-in-hand Everyone will get a Health Security card that guarantees you a
comprehensive package of benefits that can never be taken away. But we will ask
everybody to pay something, even if your contribution is small. Small businesses and
low-wage workers will get substantial discoWtts on the cost of insurance, but everyone
must take responsibility.
HOW 1HE SYS1EM IS FINANCED
The financing proposal was developed Wlder the most rigorous and conservative forecasting
standards. For the first time, representatives from ~ federal agency involved in fiscal
accoWtting and fmancial projections have been brought together to work out the numbers.
Then teams of actuaries, health economists and other fmancial analysts from outside the
government served as auditors and consultants, checking and rechecking.
The system is financed from five major sources:
1) Medicare savings - The savings from reducing the growth of Medicare
are based on
specific, scorable policy proposals. Every penny of these savings will be channeled back into
benefits - prescription drugs and long-term care - for the .people which these programs
serve.
2) Medicaid savings - The rate of growth of Medicaid can be reduced primarily by folding
the acute care portion of Medicaid into the overall health care system. Since everyone will
be insured, there will be savings in "Wlcompensated care" - the money that goes_ to doctors ·
and hospitals to compensate for caring for the Wlinsured
�3) Savings from federal employee health care costs- As all federal workers are integrated
into the overall health care system, there will be less expense to taxpayers to provide for their
health care.
4) Reducing the benefits of tax-free compensation- By reducing the rate of growth for health
insurance, the President's proposal lowers the ammmt of compensation paid as tax-free health
benefits, and frees up money for higher wages, wages for new workers, or profits - all of
.which are taxable and thus bring in new federal revenues.
5) Sin taxes- There will be some new "sin taxes," the composition of which is not yet
decided.
In addition, there will be other savings. Reducing paperwork and administration, cracking
down on health care fraud, and emphasizing prevention will save money in the long-run.
PAYMENT SCENARIOS
As a rule, most individuals and families in which at lemt one person works will pay a
mcgimum of 2QOA of the ave~e health plan premium in their area Those who choose a
lower cost plan -from among those offered in the area - will pay a little less than the
2QOA ave~e. Those who choose a more expensive plan will pay a little more, m they do
today.Empkzyers who czgrently PW IQQOA of health !Jendits m'D' continue to do so.
1\vo parent family with children: Two parent families with children - whether one or
both parents work - pay a maximum of 20% of the family premium offered by the
average plan in their area. If both parents work, they choose how to pay their family's
share. They can have the share deducted monthly out of either paycheck or write a
check to the local alliance.
Couple: Working married couples- whether one or both spouses work- pay a
maximum of 20 percent of the average plan premium. They can have the share
deducted monthly from either paycheck or write a check to the local alliance.
Single-parent family: Working single parents with children pay a maximum of 20 %
of the average plan premium for a single parent policy.
Individual: Working single people pay a maximum of 20% of the average premium for an
individual policy in their area.
· Part-time worker with no unearned income: Part-time workers pay a maximum of 200/o of
the average plan premium for their policy type in their area.
�EXCEPilONS
Exceptions are provided for: (1) the self-employed and independent corztrcrtors; (2) parttime worlcers who hlA'e unearned income; (3) families with incomes below 1500/0 of the
poverty level; and (4) semonal worlcers.
Self-empoyedlindependent contmctors: The self-employed and individual
contractors can deduct from their taxes .100% of their health care costs. As
with any small business, they pay the employer share. They also pay an individual
share. If a finn earns less than $24,000 a year, it is eligible for subsidies.
Part-time workers with unearned income: Part-time workers with unearned income pay a
maximwn of 20% of the average plan premiwn for their policy type - individual,
couple, two parent, or single parent family.
I
I
i.
The nwnber of hours someone works determines how much of the prem:iwn is paid by the
employer and how much by the individual. For example, an employer would pay
40% of the prem:iwn for someone who works half-time. Payment of the remaining
40% of the premiwn depends on how much a person makes in unearned income, with
subsidies provided on a sliding scale for those whose incomes are below 2500/o of the
poverty level.
Families with incomes below 150% of the poverty level: Families at this level are
eligible for discounted premiums and pay a maximwn of 200/o of the employee's share of
· the average plan premium. This applies to individuals making $10,455 annually;
couples with incomes of $14,145; families of three earning $17,835; and families of
four with incomes of $21,525.
~onal
workers: Seasonal workers pay a maximwn of 200/o of the average plan
premiwn in the area where they reside.. Those whose incomes are 150% of the
poverty level or below are eligible for discolDlted premiums. If they have Wleamed
income and are not working, seasonal workers are treated the same as part-time
workers.
Unemployed and non-working: Unemployed individuals and heads of household who
make less than 150% of the poverty level are eligible for individual subsidies on a sliding
scale. Those with tmeamed income pay all or part of what would nonnally be the
employer's share of the premium.
Those whose incomes are 2500/o of the poverty level or less - pensioners, for example are eligible for discounts on what would be the employer's share. They are not eligible for
· individual subsidies, and pay the nonnal individual share of the health premium.
�Cost Estimates: The Process
The most open policy making process in history: The President encouraged
participation from the American people, all categories of health care providers, the
business community, and every level of government. Since ~he process began, the
Administration has actively reached out for advice -- bringing in more than 1,150 groups
to meet personally with the President, the Vice President, the First Lady, Mrs. Gore,
Secretary Shalala, Ira Magaziner and others.
Congressional Consultation: In developing its health care reform proposal, the
Administration has based its research and policy options on the significant foundation of
work that many Members of Congress have laid in the last 20 years. In order to benefit
from this expertise - and build strong, bipartisan support - the Administration has
regular, broad based, and substantive consultation with members of Congress,
including an extensive bipartisan outreach effort. As we move ahead, this process will
continue.
More than 1,500 meetings have taken place to date with health care providers,
consumers, business, and labor groups. They include:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Over 55 physicians groups
40 nursed groups
Over 50 hospitals from across the country
69 medical colleges
15 seniors groups
24 groups focusing on long-term care issues
19 groups representing the disability community
70 groups specializing in mental health issues
22 women's groups
30 children's advocacy groups
64 minority organizations
16 rural groups
92 groups representing small and large businesses
33 labor organizations
All groups were encouraged to submit written proposals and recommendations to the
Task Force, which formed the basis for debate and policy development. As policy options
were narrowed and recommendations prepared, the First Lady and White House officials
have continued to consult on a daily basis with a wide range of groups - with the
expertise and the practical experience to analyze the President's health care reform
proposal in the light of its "real world" applications.
Unprecidented process of outside review: The health care financing analysis undertaken
by the administration has been rigorous. We tapped the best analytical talent inside and
outside the federal government to get it done. In creating the analytical foundation for our
�estimates, there was an unprecedented degree of outside review of our assumptions and
methodologies from nationally recognized consulting and accounting firms and from
Fortune 500 companies. That's why we're so confident that our estimates are credible.
Urban Institute modelers and a team of non-government actuaries and health economists
followed the model building and estimating process throughout, and offered analysis and
suggestions. They immersed themselves in the model.s early on, made significant
contributions to the methodologies finally used, and came away impressed with the
amount of analytical rigor underlying the models and with our commitment to accuracy
and prudence.
Unprecedented intergovernmental scrutiny and cooperation: In addition to the
outside groups, a team of actuaries and health economists from all the branches of
government that do financial analysis and cost estimating set up a working group back in
February, and have been working together ever since. They have shared data and worked
through assumptions and methodologies in much greater detail than has ever been done
before. You know, a lot of the people involved in this effort have been working on health
care numbers their whole professional life, and they'll tell you they've never been part of
anything like this.
Estimating a complete health care system overhaul is obviously an immensely complex
task. Reasonable people can differ about assumptions, so our team tried to consistently
err on the side of conservatism.
This process gives us strong confidence in our numben: The process and rigor give us
strong confidence in the numbers in the current draft. The savings estimates are under
continuing review by OMB, Treasury, and HHS as adjustments are made to the plan based
on our continuing consultation. Policy and technical adjustments will of
be made
as any major policy like this goes through the normal process of review, but we will
continue to maintain the high standards we have proceeded by so far.
eourse
President Clinton formed the Task Force on National Health Reform in January with a
clear charge: Reject the traditional way of doing business in Washington - where a few
people draft legislation in a back room, never including the people while will be affected
by the policy. Instead, the President asked the Task Force to "listen to all parties" and
consult widely with all of the people whose lives will be helped by health reform.
�SAVINGS
Higbligha:
We know dlis can wolk. 'lbe"''s DO "'MOD why our inenumonal competiton spend
so much less dian we do on healda c~ - - yet daey ins~ all of daeir people JDSI daey provide
richer benefi1s. 'lbe"''s evidence out dae"' in plaes dud have gone to competition, dud
provi den can and will cut daeir cosa substantially and quickly.
California hospitals have kept daeir growda ndes well below dae national average - 9% venus 30% over 1983-1990.
1be Sme of Minnesota hM kept ia annual ndes of inc"'.e 1% below smewide trends
for die l•t two yean - - primarily • individuals have chosen loweJ'ocost plans.
Gennany and Japan have been able to keep dae growda in daeir healda
to GOP while oun have been growing at 9% and tOo/•
c~
cosa down
1be Mayo Oinic hM kept ia growda down to 3.9,...
Health care spending can be reined in to meet the budget caps through cutting out the
waste in the current system - - streamlining administrative overhead and increasing the
productivity of doctors, nurses and other health care workers.
The major cost containment mechanisms under reform come from increased
efficiencies through competition. Budgeting the rate of growth in the health care premium
acts as a backstop to the competition - - a commitment to downward pressure on costs that
can further bolster competitive savings.
Washington State and Minnesota have recently passed health refonn legislation that
combine principles of managed competition with strict cost containment measures. In
Minnesota, the mte of growth in health care spending must decline by at/east ten percent a
year for five yean, beginning in 1993.
Giving incentives to providers to deliver more cost-effective care and reducing
administrative costs can free up dollars to both insure all Americans and make their health
care more affordable.
The reform proposal first takes cost out of the system by:
•
Cbanging die incentives in dae insUnlllce IIUUket to compee on quality and
efficiency radaer dian avoiding hig•cost patients
•
~paying
healdl plans, changing dae incentive from ''doing mo"'" tD ''doina it
�beuer''
Under today's system, doctors get paid for each test and procedure they
perform. That means, the more they do, the more they get paid. Under reform, health
plans work under a fixed prepayment - - a budget that provides discipline - - changing
the incentive from doing more to competing on quality and efficiency.
In Nonhem Califomia, Kaiser Pennanente members have 25% fewer hospital
days per capita than other residents.
•
Reducing variation in pradice pauems widlin and between communides
through research and beUer inConnation exchange
Boston residents get twice as much care (costing $300 million more annually)
than residents in New Haven, Connecticut. The difference in spending is not· due to a
difference in the quality of care patients receive.
Open-heart surgery that costs $21,000 in one Pennsylvania hospital costs as
much as $84,000 in another hospital in the same state. A.nd, the lower-cost hospital
had better outcomes.
•
Streamlining administration
Under today's system, as much as 30-40% of the premiums paid by small firms
support the overhead of brokers, insurance agents and underwriters. Large firms pay
·significantly less for administration - - closer to 5-7% of premiums. Under reform,
firms with 5,000 or fewer employees join health alliance where administrative and
purchasing functions are consolidated. Economies of scale result in a lower
administrative burden for the system as a whole.
A growing share of the health care dollar pays for processing paper and
complying with regulations. For every one doctor hired at a hospital, there are four
administrators. Under reform, a single claims form replaces the hundreds of different
forms. A standardized benefits package, and standardized reimbursement rules,
procedures and regulations scale back administrative overhead.
•
Maki111 consumen cost conscious
Under today's system, consumers often do not know how much health care
costs. Employers pay their premiums; insurers pay the tab. Under reform, consumers,
not their employers, decide among health plans based on price and quality. Choosing
"higher-cost plans means consumers have to pay more out-of-pocket Choosing lowercost plans drives providers to find ways to become more efficient
In 1988, the state of Minnesota changed its contribution from 100% of the state
fee-for-service plan to 100% of the low-cost plan serving a given county. Due in large
�part to consumer switching, annual rates of increase have been at least 2% below
statewide trends for the last two yean. Estimated system Sllllings are $23 million over
the last three yean, and $12 mil/ion in 1993 alone.
•
Stleaa1bening consumer baJJaining leverage
The Health Insurance Plan of Califomia (HIPC) received bids that were as
much as 55% lower than the same plan offered by the FEHBP.
In Orlando, the 78-member Centml Florida Health Care Coalition succeeded in
negotiating better prices with regional hospitals that enabled the Orange County
School BoanJ to keep 20 teaching jobs it had planned to cut. The coalition persuaded
hospitals to analyze why costs and quality of care differed for patients with the same
illnesses. With this infonnation, costs per hospital discharge fell 2%.
An Enforceable Budget - 1he Back-up Engine for Cost Control
While there is ample evidence that lower cost growth will be driven by competition
and increased efficiency, the health security proposal builds in a back-up measure to
cost control: an enforceable budget.
The budget is met through capping the growth in premiums individuals and businesses
pay for the comprehensive benefits package, similar to the caps proposed by
Kassebaum, Danforth and enacted in the State of Washington.
�JOBS AND HEALTH CARE
Comprehensive health care refoml is a necessary element in a compehensive economic
growth strategy to bring down long-tem1 economic growth, reduce the deficit, and create jobs.
Today, the rising cost of health care is a hidden tax on employers- hurting businesses,
depressing wages, limiting job creation and threatening our competitiveness. The bottom line
is this: most businesses provide health care to their worlcers, and health care refom~ will/ower
their health care costs- allowing them to create jobs and increase wages.
While no one may be able to give you a precise estimate of the overall job impact,
there is no question that for small businesses to manufacturers like Chrysler and US Steel,
costs will be controlled and money will be freed up for job creation. The Wall Street Joumal
said that '1or many small businesses, saddled with escalating health care costs, President
Clinton's health care package comes as an unexpected windfall." Studies show that the fastest
growing small businesses are the ones that provide health insurance. In addition, there will be
jobs created in the health care industry, particularly for nurses and home health worlcers who
will be providing more care.
1.
HEALTH CARE IS ONE ELEMENT IN A COMPREHENSIVE ECONOMIC
GROWTH AND JOBS PLAN:
Health care reform is one element in a comprehensive economic growth plan to lower
the deficit, lower interest rates, and create jobs. The current system is hurting job
creation, because rising health care costs have served as a hidden tax on employers
leading to less job creation and less wage increases. Does anyone dispute that we
would have better job growth in our country if we kept costs at the level that our
competitors do?
NEGATIVE JOB STUDH3 HAVE BEEN BOGUS. THEY FAIL TO ANALYSE
THE SUBSIDH3 AND OTHER DEI'AILS OF CLINTON PLAN:
1.
The current studies put out by the NFIB are bogus studies that do not consider the
discounts provided to low-wage small businesses nor the positive effects that lowering
health care costs will have on businesses that currendy provide insurance.
3.
THE CLINTON PLAN WILL LOWER COSTS FOR MANY BUSINI3SI3,
LEADING TO IHGIIER WAGES AND MORE NEW IIJRES.
Most businesses provide health care, and we are going to lower their costs, which will
make it easier for them to hire future workers and give wage increases to their existing
workers.
4.
SMAll BUSJNE!SE! WHO PROVIDE COVERAGE WILL llA VE
LOWER
�NOTES ON JOBS AND HEAL1H CARE
Page 2
COSTS:
Most small businesses provide health care to their workers -- paying high
administrative costs and bear tremendous risk if even a single worker in their business
gets sick. Small businesses pay as much as 35% more than big businesses. And it is
uncontroversial that our plan will lower health care costs for these small businesses,
giving these firms more money to hire more workers and pay their existing workers
higher wages. So this will be a job creator for small businesses that do provide health
msurance.
Listen to the lead of the Wall Street Journal on Monday. "For many small businesses,
saddled with escalating health care costs, President Clinton's health care package
comes as an unexpected windfall." r Small Business See Burden. Getting Li6hter, II lbll
Street Journal, 9/13193]
5.
WILL HElP THE FASTEST GROWING SMALL BUSINESSES: Studies
show that the fastest growing small businesses are the ones that offer health care
insurance to their workers. These firms will see their costs go down under the
Clinton plan. So health reform will help those firms that are creating the most
jobs and growing the fastest.
6.
MANUFACTURING JOBS WIUBENEFIT:
Manufacturers ·• the employers that pays the highest wages to average
people •• have been forced to lay off workers and that our health care reform
will have a dramatic effect on lowering the costs of manufacturers and
making it easier for them to compete and create new jobs. Currently,
American automakers pay $1100 more per car than their competitors in
Japa1;1. Making this part of our economy stronger is especially important
because it creates more exports, which is key to greater job creation.
7.
INCREASED HEALTH CARE JOBS:
There will be job creation in for health care workers that serve people -·
instead of pushing paper. Joshua Weiner, a health economist at the
Brookings Institution, predicts that the Health Security Act will create
750,000 home health care jobs, and that overall the plan will be a job
creator. (Reuters, "Health Care Reform Impact on Jobs," 9/16/93)
8.
HAWAH- LOOK AT THE EVIDENCE:
Since Hawaii asked all employers to provide insurance for their employees
in 1974, the unemployment rate has dropped to one of the lowest in the
nation (2.8% in 1991), and small business creation rates have remained
�NarES ON JOBS AND IIEAL1H CARE
Page 3
high (the number of employers grew almost 200% from 1970 to 1991). In
addition, only 2% of Hawaii's "rainy day" fund·· set up to assist the
smallest businesses •· has been used. [The Hawaii Department of Health, June 8, 1993]
9.
NO MORE JOB LOCK OR MEDICAID LOCK:
People who are in jobs they want to leave but can't for fear of losing their
benefits will be freed to switch jobs or start a small business, meaning more
jobs and greater productivity. And tens of thousands of people on welfare
will no longer have the disincentive of Medicaid benefits without the
guarantee of future benefits to keep them from taking a job.
10.
MINIMUM WAGE- LOOK AT THE EVIDENCE:
Because we limit the amount that any small business employer would have
to pay, health care reform is the equivalent to a modest increase in the
minimum wage for those firms that currently do not provide health
insurance. Yet, studies by economists at Harvard and Princeton show that
increases in the minimum wage do not hurt job growth, and that in fact, it
can make it easier to hire people. These were not abstract studies: these
were real world studies of real small businesses and restaurants in
Pennsylvania, Texas and New Jersey. Real studies that would again support
that health care will certainly not cost jobs, and will create many new jobs
in manufacturing and growing small businesses.
�JOBS AND HEALTH CARE
Comprehensive health care refonn is a necessary element in a compehensive economic
growth stmtegy to bring down long-tenn economic growth, reduce the deficit, and create jobs.
Today, the rising cost of health care is a hidden ua on employers- hurting businesses,
depressing wages, limiting job creation and threatening our competitiveness. The bottom line
is this: most businesses provide health care to their worlcers, and health care refonn will lower
their health care costs- allowing them to create jobs and increase wages.
While no one may be able to give you a precise estimate of the overall job impact,
there is no question that for small businesses to manufacturers like Chrysler and US Steel,
costs will be controlled and money will be freed up for job creation. The Wall Street Joumal
said that ''for many small businesses, saddled with escalating health care costs, President
Clinton's health care package comes as an unexpected windfall." Studies show that the fastest
growing small businesses are the ones that provide health insurance. In addition, there will be
jobs created in the health care industry, particularly for nurses and home health worlcers who
will be providing more care.
1.
HE4LTH CARE IS ONE ELEMENT IN A COMPREIIENSWE ECONOMIC
GROWTH AND JOBS PLAN:
Health care reform is one element in a comprehensive economic growth plan to lower
the deficit, lower interest rates, and create jobs. The current system is hurting job
creation, because rising health care costs have served as a hidden tax on employers
leading to less job creation and less wage increases. Does anyone dispute that we
would have better job growth in our country if we kept costs at the level that our
competitors do?
2.
NEGATIVE JOB STUDIES liA VE BEEN BOGUS. THEY FAIL TO ANALYSE
THE SUBSIDIES AND OTHER DETAILS OF CLINTON PLAN:
The current studies put out by the NFIB are bogus studies that do not consider the
discounts provided to low-wage small businesses nor the positive effects that lowering
health care costs will have on businesses that currendy provide insurance.
3.
THE CLINTON PLAN WILL LOWER COSTS FOR MANY BUSINESSEY,
LEADING TO lliGIIER WAGEY AND MORE NEW 1liRES.
Most businesses provide health care, and we are going to lower their costs, which will
make it easier for them to hire future workers and give wage increases to their existing
workers.
4.
SMALL BUSINEYSEY WHO PROVIDE COVERAGE WILL liA VE
LOWER
�NOTES ON JOBS AND HEALTH CARE
Page 2
COSTS:
Most small businesses provide health care to their workers •• paying high
administrative costs and bear tremendous risk if even a single worker in their business
gets sick. Small businesses pay as much as 35% more than big businesses. And it is
uncontroversial that our plan will lower health care costs for these small businesses,
giving these firms more money to hire more workers and pay their existing workers
higher wages. So this will be a job creator for small businesses that do provide health
msurance.
Listen to the lead of the Wall Street Journal on Monday. "For many small businesses,
saddled with escalating health care costs, President Clinton's health care package
BusineBB See Burden Gettin6 Li6hter," ~
comes as an unexpected windfall."
rSmaU
Street Journal, 9/13/93]
5.
WILL HELP THE FASTEST GROWING SMALL BUSINESSES: Studies
show that the fastest growing small businesses are the ones that offer health care
insurance to their workers. These firms will see their costs go down under the
Clinton plan. So health reform will help those firms that are creating the most
jobs and growing the fastest.
6.
MANUFACTURING JOBS WILL BENEFIT:
Manufacturers-- the employers that pays the highest wages to average
people -- have been forced to lay off workers and that our health care reform
will have a dramatic effect on lowering the costs of manufacturers and
making it easier for them to compete and create new jobs. Currently,
American automakers pay $1100 more per car than their competitors in
Japan. Making this part of our economy stronger is especially important
because it creates more exports, which is key to greater job creation.
7.
INCREASED HEAL77l CARE JOBS:
There will be job creation in for health care workers that serve people -·
instead of pushing paper. Joshua Weiner, a health economist at the
Brookings Institution, predicts that the Health Security Act will create
750,000 home health care jobs, and that overall the plan will be a job
creator. (Reuters, "Health Care Reform Impact on Jobs," 9/16193)
8.
HAWAH- LOOK AT THE EVIDENCE:
Since Hawaii asked all employers to provide insurance for their employees
in 1974, the unemployment rate has dropped to one of the lowest in the
nation (2.8% in 1991), and small business creation rates have remained
�NOTES ON JOBS AND HEAL1H CARE
Page 3
high (the number of employers grew almost 200% from 1970 to 1991). In
addition, only 2% of Hawaii's "rainy day" fund·· set up to assist the
smallest businesses ·• bas been used. [The Hawaii Department of Health. June s. 1993]
9.
NO MORE JOB LOCK OR MEDICAID LOCK:
People who are in jobs they want to leave but can't for fear of losing their
benefits will be freed to switch jobs or start a small business, meaning more
jobs and greater productivity. And tens of thousands of people on welfare
will no longer have the disincentive of Medicaid benefits without the
guarantee of future benefits to keep them from taking a job.
10.
MINIMUM WAGE- LOOK AT THE EVIDENCE:
Because we limit the amount that any small business employer would have
to pay, health care reform is the equivalent to a modest increase in the
minimum wage for those firms that currently do not provide health
insurance. Yet, studies by economists at Harvard and Princeton show that
increases in the minimum wage do not hurt job growth, and that in fact, it
can make it easier to hire people. These were not abstract studies: these
were real world studies of real small businesses and restaurants in
Pennsylvania, Texas and New Jersey. Real studies that would again support
that health care will certainly n_ot cost jobs, and will create many new jobs
in manufacturing and growing small businesses.
�Health Security Plan
"If vou like your insurance today ... "
Summary
People who like their health insurance today have a lot to gain from the health
security plan First -- and most important -- they'll get something that no amount of money
can buy in today's insurance market security. Lose your job" You're covered. Want to
change jobs" You're covered. Your child gets sick" You're coverged. You just can't
guarantee that today.
People who like their health insurance today will also get increased choices , the
chance to stop trading wage increases for the same health benefits, and preventive care
benefits that will keep them healthy. Even those Americans who are satisfied with what
they've got now have plenty to gain. And they'll probably pay less. for better care.
Today
Millions of Americans have worked hard to get the solid health benefits that they
enjoy today. A,lmost all of us have been forced to trade increases in our wages in order to
maintain the same health benefits we had the year before. Or worse. And millions are
locked into their jobs; they want to find better jobs but can't leave because they fear losing
health insurance and not being able to get a new policy.
Even those with excellent health insurance packages live in constant fear oflosing
that protection. Insurance companies hold all the cards: they can drop you for almost
any reason. If you move, change jobs, or get sick, your insurance can disappear over
night and, if someone gets seriously ill, bankrupt your family.
Health
S~curity
The Health Security plan gives every American -- even those who like their health
insurance today -- something no amount of money can buy today: guaranteed security. All
Americln$ will receive a Health Security Card that guarantees a comprehensive package
of benefits that can never be taken away. No ifs, ands, buts or fine print. No longer will
American families be asked to make significant decisions - about where to live. work or
how to care for a sick relative -- based on discriminatory insurance rules.
The plan also:
• Protects you if you lose your job. Let's say your company offers you a Cadillac
health plan today. That's great. But what happens if the company has to cut back and
you lose your job? You lose that Cadillac plan and end up naked in the middle of the
road.
�• Increases your choices. Today only one of every three companies that employ
fewer than 500 people offers employees a choice of plan. And rising health care costs
and the bottom line are putting choice out of the reach of more people everyday
Tke Health Security plan guarantees you a choice of at least thr~e plans in every area:
a traditional fee-for-service plan like many people have today, a network of doctors
and hospitals, and an HM:O-type plan. You ·- not your boss or a benefits manager -choose from whom and how you'll get care
• Helps restore lost wage increases. The Health Security plan will give millions of
American workers their first real chance for wage increases in years. For two decades
rising health care costs have robbed American workers of wage increases they need
and deserve. If we do nothing, health costs for an insured worker will rise from I in 5
to 1 in 4 dollars in just seven years. By giving business the bargaining power it needs
to get affordable health care and helping provide for retirees -- whose health costs are
killing some big manufacturers •• the Health Security plan helps workers.
• Guarantees preventive care. By providing a full range of free preventive care
benefits, the Health Security plan offers all but. a few Americans something new: care
to keep them healthy, rather than coverage for after they get sick. Preventive care
benefits include such things as physicals, immunizations, mammograms and Pap
smears.
�MEDICARE
SCORABLE AND SPECIFIC: The S 124 billion in savings from reducing the growth of
Medicare mentioned in the current draft, are based on specific, scorable policy proposals
They are not based on any vague caps or assumptions that could be subject to dispute.
REDIRECTING :\IEDICARE SPE~DING TO INCREASE BE~EFITS: This proposal does
not involve cuning Medicare-- it mvolves spending Medicare money differently, by reducing
the growth in payments to providers and increasing benefits for older Americans. The savmgs
m Medicare wlll be rechanneled so that benefits for seniors will increase through expanded
coverage for prescnption drugs, and through a new home· and community· based long-term
care program. Semors making over S 100,000 may pay higher Part 8 premiums, but because
the lion's share of savings come from lowering the growth in some provider payments, the
new benefits offered to seniors wtll dwarf any reductions in the growth of benefits needed to
get the $124 billion in savings. And what most older Americans pay •• their share of the cost
of health premiums -- will actually decline as growth in the cost of Medicare comes under
control, reducing annual cost increases not only for Medicare but also for Medigap policies.
REASONABLE LEVEL OF SAVINGS: The level of savings are reasonable and comparable
to the savings called for in other major health reform alternatives as well as the most serious
entitlement caps called for during the budget process. The $124 billion in Medicare savings
is an amount comparable to the health reform alternative offered by the Senate Republicans,
which propose about $100 billion iri savings, and less than the savings called for by the more
liberal single-payer proposals, which save more like $1 SO billion from Medicare, and by less·
than the amount the Republican budget alternative would have likely achieved as scored by
Congressional Budget Office.
lliE SAVINGS ARE POLmCALLY ACHIEVABLE: The political viability of these savings
have been questioned because of the controversy that normally is associated with Medicare
savings. Yet, this is a different ball game. As mentioned above, this is not about reduction
benefits for Medicare or shifting costs to the private sector, this is about redirecting savings to
new and expanded benefits for the population these programs serve: the older Americans. As
Majority Leader Mitchell has stated, if you take $8 out of a persons pocket. and put back $10,
most people will think they are better off. And because it is done within the context of
comprehensive health care reform, it will not shift costs to the private sector and will be part
of a plan, that will increase health benefits to older Americans.
·
CONSISTENT Wrnl PAST POSmONS: During the budget process, President Clinton
stressed the need to stop the spiraling rise of health care costs, but stressed that it had to be
within the context of health care .reform so that reductions did not lead to hidden tax on
premiums by shifting costs to the private sector or lead to· reduction in benefits to middle
class Americans. These reduction in the growth of Medicare will increase benefits and not
shift costs due to the new heath care reform and back-up control mechanisms.
�QUESTIONS AND ANSWERS
Will I still be able to see my own doctor? Will I have to pay extra?
And will my doctor and I be free to decide how to treat my illness?
I have a group insurance policy through my employer. ·Will that change?
Will our premiums and co-payments go up?
Will I be able to choose my Own we of health insurance? And can I buy extra insurance ifi want
it?
Will anything be done to reduce and sirnpli6' all tbe insurance foons I have to fill out?
What happens ifi change jobs? Will I risk losing health insurance coverage?
What if someone in my family has a pre-existing health condition? Will they be covered?
Will the quality of care my family receives be hurt under a new system?
I'm retired and on a fixed income. Will my Medicare coverage be affected?
Will costs be controlled in a way that doesn't interfere with my medical care?
Will everybody in America have health insurance? And, if so, how will we pay for this?
How will this plan help small business?
Isn't this just creating more government bureaucracy and regulation?
What makes you think you can control costs and still provide quality care?
When you force evety<>ne into HMQs as a part of your plan, aren't you going to be "rationing"
care?
How are you going to help people in rural areas get care?
What's going to happen to the Veterans' health system?
Don't the boards of the health alliances offer plenty of opportunities for political corruption?
�Q.
WiD I stiU be able to see my own doctor? WiD I have to pay extra?
A.
Yes. You wiD be able to choose your doctor. Everyone will have a choice ofhealth
plans. You11 be able to follow your doctors and nurses into a traditional fee-for-service
plan, join a network of doctors and hospitals, or join an HMO.
What you pay will depend on which plans your doctor joins. There will be a range of plans
available at a range of prices and your doctor will be free to join a number of plans -- so
the choice will always be yours.
Q.
And wiD my doctor and I be free to decide how to treat my illness?
A.
Yes. Under the current system, doctors have too many people looking over their
shoulder, second-guessing their professional judgment. Reform will get insurance
companies and the federal government out of doctor's offices and leave your medical
decisions to you and your doctor --·where they belong. Consumers will have more
information about benefits and risks of treatments and will be more involved in making
decisions about their own health care.
Q.
I have a group insurance policy through my employer. WiD that change?
A.
No. If you want to continue with the group insurance policy you have now, that's fine.
But, under reform, if you want to change plans you can. All Americans - from employees
of the local car wash to the big auto companies - will have more choices of health plans.
Many Americans today are tom from their family doctors when rising costs force
companies to choose only one plan for all their employees.
Q.
wm our premiums and co-payments go up?
A
Premiums will decrease for two-thirds of Americans. And many of the plans that will be
offered require just a small payment ($10) for each doctor visit (i.e., co-payment). Many
of these plans will have no deductible (the amount you pay until your insurance kicks in)
at all. No matter what, no individual will pay more than $200 per year for their deductible
and no family will pay more than $400. (Deductibles under the present system can be as
high as $3,000.)
Q.
WiD I be able to choose my own type of health insurance? And can I buy extra
insurance if I want it?
A.
Of course. You will always be able to choose your plan. Today, rising health care costs
have forced businesses to limit the health plans their employees can join and sometimes
the doctors they can see. That won't happen under the Health Security plan. No boss will
�be able to tell you what doctor to go to or what health plan to join. You'll have the choice
of at least three plans - a traditional fee-for-service plan, a network of doctors and
hospitals, or an HMO.
You will always be free to purchase any additional insurance you want, although these
added benefits will not be tax-deductible. The insurance industry will be monitored
though to make sure you don't get ripped off by companies trying to sell you duplicate
coverage.
Q.
Will anything be done to reduce and simplify all the insurance forms I have to fill
out?
A.
Yes. The Health Security Act will streamline the rules, reduce the paperwork, and make
the system make sense. It will do away with all the different claims forms and confusing
bureaucratic rules. You will no longer get a bunch of forms in the mail - and then cross
your fingers and hope that you've tilled them out right. The one, comprehensive benefits
package means that you will no longer have to worry about what's covered under which
policy or what you might have missed in the tine print. Most importantly, this
simplification will mean that the money you pay goes to health care - not bureaucracy.
Q.
What happens if I change jobs? Will I risk losing health insurance coverage?
A.
No. The Health Security Act will guarantee that you will never lose your insurance
coverage -- even if you change jobs, lose your job, move, or start a small business. It will
be illegal for insurance companies to drop you for any reason.
Q.
What if someone in my family has a pre-existing health condition? Will they be
covered?
A.
Absolutely. Under the Health Security plan, it will be illegal to refuse to insure people just
because they've been sick. Health plans will have to accept you - healthy or not - and,
most important, they cannot charge you more for being sick. And you'll have the security
of knowing that no one can ever take your benefits away from you.
Q.
I'm retired and on a faxed income. Will my Medicare coverage be atTected?
A.
No. Older Americans who receive Medicare will continue to receive all the benefits they
do today. In addition, the Medicare program will be strengthened by adding prescription
drug coverage and expanded options for home and community based long term care. If
you're on Medicare, you'll actually have more choices after reform. You can continue to·
receive eare like you do today or choose among different health plans that may offer fuller
benefit packages and lower payments.
�Q.
Will costl be controUed in a way that doesn't interfere with my medical care?
A.
Certainly. Costs will be controlled by eliminating the waste, fraud, and abuse in the
current system - not be cutting comers on consumers.
Doctors will be in control of their professional decisions. Patients will finally be asked
their opinion and will be given all the information they need to make their choices. You'll
get a consumer "report card" that you can use when you choose or change health plans. It
will tell you what people think of the care they have received under each health plan and
will have objective measures of results to help you compare one plan to another. And if
you don't like your health plan, you can change to a different plan or a new doctor.
Q.
Will everybody in America have health insurance? And, if so, how wUI we pay for
this?
A.
All Americans and legal residents will be guaranteed a comprehensive package ofbenefits
that can never be taken away. Everyone -- employers and individuals - will be asked to
take responsibility for contributing something, even if its only a small amount, to the cost
of their health care. At the same time, we're going to aggressively control costs and cut
the waste, fraud and abuse from the current system.
Q.
How will this plan help smaU business?
A.
The plan will offer significant discounts to help the small firms who are getting killed by
rising costs. The Health Security Act will lower costs for the two-thirds of small
businesses that now provide insurance by as much as 500/o. It will make insurance
affordable for those small businesses that now want to provide coverage but can't afford it.
Q:
Isn't this just creating more government bureaucracy and reguladon?
A:
No, it's today's system that's weighed down by bureaucracy and regulation. When the
President and Vice-President visited a hospital here in Washington, they saw piles of forms
that are eating up doctors' and nurses' time - time that could be better spent with patients.
In hospitals today, the number of administrators is increasing four times faster than the
number of doctors.
The President specifically rejected a government-run system, opting instead for a system
based on what we have today. His reform proposal will free doctors from the avalanche of
paperwork, and streamline the system. It will create a single claims form, and it will reduce
regulation of doctors and hospitals to cut the unnecessary paperwork for doctors and
patients.
�Q:
When you force everyone into HMOs u a part of your plan, aren't you going to be
"rationing" care!
A:
First of all, let me emphasize that we are going to preserve and expand choice in the health
care system. Everyone will be able to choose their doctor. No one will be forced into
anything-- there will be a traditional fee-for-service option in every region of the country.
As today, it is likely to be a little more expensive than sorne other plans. But everyone will
be able to choose from a variety of health plans - which is something that most people
can't do today. Today, only 1 in 3 companies with fewer than 500 employees offer any
choice of plan. So we will see increased choice.
And we're going to maintain the finest quality of care in the world. We're going to
guarantee everyone comprehensive benefits, including preventive care, so that we keep
people healthy instead of waiting until they get sick. When opponents of the plan talk
about "rationing," they're just trying to scare the American people.
Q:
How are you going to help people in rural areas get care!
A:
Right now, two-thirds of rural counties do not have enough doctors. It's no wonder. Rural
doctors provide more charity care than any doctors in the country, and they often get paid
late. In many cases, rural doctors can't even take a day off because there isn't another
doctor for miles around.
The plan will include incentives for doctors to practice in rural areas. Specifically,
it will expand the National Health Service Corps and their loan repayment
program, increase incentives for medical schools to train more primary care
doctors, and give states flexibility to develop programs that are more responsive to
rural needs.
The plan will also help break the isolation of rural doctors by encouraging networks with
regional medical centers, hospitals and other doctors. By sharing skills through
technologies like interactive video, it will give rural residents access to the kind of care
once available only at major medical centers. And it will use nurse practitioners and other
health professionals to increase the availability of care.
In addition, the Clinton plan will give rural residents the bargaining power they need to get
affordable coverage and access to high-quality care.
Q:
What's going to happen to the Veterans' health system?
A:
The VA health system will remain intact. And veterans will receive all the benefits they do
today. The VA health system will also be able to organize their hospitals and clinics into
�health plans that will compete with other plans to enroll veterans.
Q:
Don't the boards of tbe bealtb alliances otTer plenty of opportunities for political
corruption!
A:
No. First of all, the plan has very strict rules preventing anyone associated with the health
care industry from serving on the board of an alliance. Only representatives of the
employers and consumers who receive coverage through the alliance can serve on the
board. The board and the alliance will be held accountable, with all its workings in full,
public view. If any problems were to develop, there would be a powerful constituency everyone who gets health care in that region -- with an interest in solving the problem
immediately.
The alliance's responsibilities are limited. It acts as a purchasing agent - and makes sure
health plans meet certain standards. It cannot reject any health plan which meets the
standards specified in the law~ it must accept all qualified plans.
�E X E C UT I V E
0
F F I C E
0
F
T H E
P R E S I D
20-Sep-1993 04:26pm
TO:
Abraham L. Newman
FROM:
Margaret M. sun tum
Office of the Press Secretary
SUBJECT:
09L17 Mrs. Clinton's
Ke~note
SEeech in Minn.
THE WHITE HOUSE
Office of the Press Secretary
Internal Transcript
September 17, 1993
REMARKS BY THE FIRST LADY
AT TOWNHALL MEETING
Minneapolis, Minnesota
MRS. CLINTON: Thank you very much. I am delighted to
be back in Minnesota, honored to be at this university of excellence
on this occasion to address this most important subject facing our
country. I want to thank Congressman Sable, in particular, for
inviting me to this health care conference and for his dedication
over the years to health care issues and his skillful leadership on
the budget committee, both of which have made him a very welcome
presence in Washington over a long period of time, but particularly
in these last few months.
I am also delighted to be here with my friends, Senator
Wellstone and ourenburger, whom I have gotten to know since moving t
Washington, and appreciate greatly their advice and counsel. I don'
think any state has two Senators with whom I have spent more time
talking about health care. And it has always been a very important
exchange for me.
(Applause.) And I also want to thank Congressmen
Vento, and Ramstead and Grahams for joining me here and also for
being part of the many consultations that I have been P.rivileged to
take place in the Congress that I have been participating in in whic
they have attended.
We are on·the brink of a great national discussion abot
the direction of health care in our country. And it is particular!~
�appropriate that I would have the opportunity to discuss those issueE
here in this state, a state whose rich contributions to American
culture are undeniable and too numerous to mention.
There are few states, if any, that can lay claim to the
kind of pioneering work that Minnesota has done repeatedly over the
decades, breaking new ground on the social issues that faced our
country. And there is no place in America that can lay claim both tc
the Mall of America and the Mayo Clinic -- (laughter) -- or the
Metrodome and the Copperdome or the Cathedral of St. Paul. And I
always believe that everybody in Minnesota is· above average, anyway.
so, I'm just delighted to be here.· (Applause.)
- 2 -
There is no area of leadership more important than what
you have already done here in this state in health care. We see it
from one end of the state to the other. We see it, certainly, at the
Mayo Clinic, sometimes called the most innovative doctor's office in
the world. We see it at the University of Minnesota, which has
historically paved the way in all kinds of new breakthroughs,
including cardiovascular surgery, the training of primary care
physicians for rural areas. And I particularly want to compliment
the program at Duluth which has turned out more rural health care
family physicians and trained more -- (applause) -- Native American
physicians than anyplace in the country.
(Applause.) And I always
ask myself: If one medical school can do it why can't others? And
we need to ask ourselves about that with respect to many of the
programs we see here in Minnesota.
In Henopen County, for example, we have a program to
provide coverage for uninsured residents. And today when I visited c
community health clinic, I heard about the patients. whose uninsured
care is picked up through the combination of programs -- Minnesota
care, county contributions, local contributions -- that is rather
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3 -
unique in many parts of the country. And, certainly, this
legislature's courageous bipartisan efforts to establish a program of
health care, to begin to implement it, to set budget targets and
encourage integration of the health delivery system stands far and
above what has been able to be accomplished in many other states. So,
given this impressive history, it is not surprising that we are here
in this state to talk about the future of health care.
In just a few days, the President will outline the
principles underlying the National Health Security Act. This
initiative marks the first time in years that the Congress will have
before it a comprehensive measure to provide health security for all
Americans. This is an issue that has been considered in Congresses
many times before. Many legislators have come forward with proposals
ever since the 1930s. Other presidents, starting with Franklin
Roosevelt and including Harry Truman and Lyndon Johnson and Richard
Nixon, ~ave come forward with comprehensive health care legislation.
But there was always some reason, some timing, some excuse why we
could not move forward.
When this process began many months ago, the President'~
goal was to design a. program that would fulfill the American promise
of affordable, high quality health care for every citizen. That
promise is founded on a fundamental belief: that good health is
every American's most cherished possession, a source of collective
strength and prosperity for our nation. It is also founded on a
conviction that every American should have the right to necessary
health care. This is not a new idea, nor a revolutionary concept. WE
have talked about it for years. But while we have talked, the
problems, the challenge~, the bureaucracy, the red tape, the costs o:
health care have continued to accumulate. so it is time to move
beyond talk, time to move out bf the auditoriums and the clinic
offices, the water cooler discussions, into the halls of Congress to
establish the basic principle that every individual is entitled to
health care security.
(Applause.)
The process of drafting the plan that the President wil.
propose has involved literally thousands and thousands of people fro1
all walks of life and from every corner of every state. We have
listened to those who tend to the sick, the doctors, the nurses, the
technicians, the employees in hospitals and hospices. And we have
listened to those who receive care. · The patients who know firsthand
the benefits and pitfalls,of our current system.
We have listened to those who thought they were secure,
but lost that health insurance and joined the 2.25 millio~ Americans
every month, who for some period of time, lose their healthinsurance. We have listened to the stories of job lock. We have
listened to the excruciating tales that come from people being denie
insurance coverage because of pre-existing conditions. -And we have
heard from businesses large and small, and from insUrance companies
that provide health insurance coverage.
We have talked to governmental leaders at the local
�state levels to talk to them about what challenges confronted them.
And we have especially enjoyed the counsel and advice of people from
Minnesota -- people like Lois Kwan, who is here on the podium and
others who are in this audience who have given of their time away
from their families, away from their businesses, away from their
practices, to spend countless days in Washington helping us make sure
we got it right.
Now, what we are coming forward with out of this process
is the beginning of a planning effort that will involve, we hope,
everybody in this country. One of the first conclusions I reached is
that there are not just experts in health care who sit in medicai
schools or other places around our country. There are 250 million of
- 4 -
us who are experts in health care.
All of us have some experience
�would, we believe, necessitate a rather complex administrative
structure. But we also believe as that approach sets forth that the
key is individual responsibility.
What we would like to do i~ to build on the system we
already have. An employer-employee based system in which everyone is
responsible for contributing. That model allows us to achieve reform
without compromising the core principles that we believe in. If we
do that, then we know that for those employers who are currently
insuring at the level of benefits that we think should be the
guaranteed level, there should be savings -- and we believe there
will be -- savings even in the first year.
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.
.
�- 10 sha~e .in the health care system.
Everybody must pay something,
because everybody must assume responsibility for their health care.
a
The way the current system operates, some people pay
lot -- some employers, some individuals; some people pay some, and
too many people pay nothing. We have to put an end to the free rides
in the medical system. Everybody should be responsible to pay
something.
(Applause.)
Individual citizens have to bear responsibility, and
there are only three ways that can be used to finance universal
health care coverage in this country. There is the way that many in
Minnesota and Senator Wellstone favor, which is a system which
transfers away from the private sector wholly onto the government the
total costs for health care through taxes; there would be ways to
replace both business and individual contributions in the form of
insurance premiums.
(Applause.)
There is also the way that we've introduced just last
week by a number of Republican Senators, to require an individual
mandate in which individuals, much as we do now with auto insurance,
would be responsible for buying health insurance, and.low-income
individuals below a certain level of income would be subsidized with
vouchers.
(Applause.)
Now, both of these approaches would move us toward more
responsibility than we currently have. And we and the task force
looked very carefully at both of these and learned a lot from each.
We considered the single-payor approach. But the task of raising
taxes to replace all that private sector investment, plus ot~er
considerations, ·seemed to us that we ought to focus instead of on the
way a single payer system is financed, on the qualities that it
contains, namely universal coverage, administrative simplification,
and the like.
so the strengths of the single-payor approach, includin~
the savings we believe will come, have been continued in the
President's approach.
We also explored the possibility of requ1r1ng
individuals to buy health insurance, but we had a number of questions
that we are still explocing with Republicans in the Senate as to how
that practically would be done.
How, for example, would we insure that individuals will
really go out and buy the insurance, and what system will we use to
require ·that they do so. How would we prevent employers from
suspending or eliminating coverage for employees, particularly
.
low-wage employees who would then fall into the subsidy pool that the
government would pay for. And that would require increasing
subsidies that a growing number of people that might be.thrown into
that pool, which would, in turn, raise the government's involvement,
both financially and administratively, because to keep track of the
amount of subsidy each indiv~dual would require to track that person
�bypass in Pennsylvania in one hospital and pay $20,000, and you can
get it in another and pay $80,000. Based on careful analysis,
comparing the same kinds of patients at the same state of disease,
there are no discernable quality differences. But without that
information that enables us all to make informed decisions and
enables those within the system to consider alternative ways of
performing medical services, we will not know whether what we are
getting is good quality or not.
The sixth principle is responsibility. Responsibility
should permeate the system, and for too long it has not. Too many
people have not taken responsibility for their own health. And we
need to insure for the first time ever that everyone pays their fair
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done, like insuring the uninsured? We have studied this very
closely, as many of you in this audience who have been involved in
the health care system know, there is not anyone I have spoken
with -- doctor, nurse, hospital administrator, technician, patient,
advocate for patients -- who does not tell me stories about the
ridiculous decisions they confront because of costly bureaucracy and
regulations that affect how they can make decisions.
I was home in Arkansas recently, and an ophthalmologist
whom I know came to see me. He said, "I've been following what
you've been doing, and I wanted to give you some evidence as to why r
think you're on the right track." And he produced for me hospital
bills from some of the patients whom he serves. And he explained to
me how he performed the same procedures in various hospitals to the·
same kinds of patients, and hospital charges would vary from $900 to
$2300. We are caught in a system that rewards those kinds of
differences, because we have not been willing to face up to how we
could provide health care more cost-effectively.
There are some who will argue we can't get savings out
of the public. system, out of Medicare or Medicaid, and we cannot get
savings out of the private system. And, to them,. I ask: Are we lesE
efficient? Are we less able to deal with our health care problems
than every other country with whom we compete? I don't think so. We
may have to change the way we think. We may have to let go of some
cherished myths about what care costs and start thinking about ·what
it can or should cost. But there is no way we can justify spending
the amount of money we are currently spending. And one of the
President's goals is to set in motion a process where we will begin
to save money that can be better utilized to provide real benefits tc
people who are left out of the system now.
The fifth principle is, we have to preserve and enhance
quality. And we can accomplish a lot by collecting data and
comparing standards and outcomes, and then publishing what we know.
If we are truly going to have informed consumers, then we need to
have what some of your health care providers are now beginning to do
report cards about quality, so that consumers can make comparisons
and m~ke decisions.
Without quality standards, we will continue to see wild
variations in prices, too many unnecessary procedures, too little
emphasis on primary and preventive care, and too little consensus
about the most appropriate treatments for many common illnesses.
I go back to my friend, the ophthalmologist in Arkansas
He was the one who performed the surgery on each patient. ~he
outcomes were the same. There was a relatively minor cataract
surgery in those instances . . There was no difference in quality,
only difference in price.
The State of Pennsylvania, as have other states, have
been collecting information about how much certain procedures cost
and then correlating that cost with quality. You can get a coronary
�- 7 -
expect when we walk in the door.
(Applause.) We have the
opportunity now in reform to reverse and eliminate that paperwork
jungle that has beset our health care system.
This morning in Washington, the President went to the
Children's Hospital there, along with Vice President Gore, to present
the kind of single form that we hope to be able to move toward so
that all who provide care will be spending their time doing that
instead of hiring people to fill out forms in the future.
If we can begin to tackle and finally conquer this
paperwork complex system that we have created, we will save billions
of dollars and free up, literally, thousands arid thousands of hours
for doctors and nurses and others to do what they were educated to
do.
The third principle is choice. More and more; the
current system is limiting choice for consumers. Employers who bear
the cost for most people's insurance who are insured make the choice
as to what plans will be available and increasingly limit that
choice. With the health security act, individuals will choose from
among the plans in their area. They will decide whether they want tc
join an HMO or a PPO or a fee for service or,·yet, some uncreated
network that will deliver the care in the way, at the price, at the
quality that they want.
If we preserve choice, what we have done is not only to
give the power for making that decision to the individual, we have
given the responsibility to the individual. We need better informed
consumers in health care. Most people know far more about the car
they buy than the health insurance plan they subscribe to. They
don't know how to make distinctions among.the varying kinds of
services that are offered. We need to provide incentives for them tc
do so, and choice is the principle that will lead them in that
direction~
Fourth, we have to realize savings in our new system. Wt
now spend, as many of you in this audience know, 14 percent of our
national income on health care. We spend as much money on health
care in America as the entire economy of the country of Italy. And
if we do nothing, if we do not insure one more person, we will be
spending 20 percent of our national income on health care.
What that has meant is not only an extr·aordinary
explosion of commitment of resources to health care, but it has been
a major factor in slowing down and stagnating the wages of working
people. Any of you who work for a living, like most of us do, any ol
you who represent workers, you know that the battles of the last
decade have been over how much money could be pushed into benefits a~
part of the total compensation, taking it out of wages. This has no1
been good for ·our economy, nor for our workers. It has particularly
hit hard middle-class families that have struggled to keep up with
other costs in their household expenses.
�forms that "as a patient," in her words, "might confront without
adequate education or understanding, I was, as I always am,
overwhelmed. Stack after stack of paper came my way." And I know
that is the situation for so many people, confronted by government
programs with forms and confronted in the private sector with
insurance forms.
But it is even worse in our hospitals and doctors'
offices. In the last 15 years, hospitals, on average, have hired.
four administrative and clerical employees for every doctor. We have
turned nurses who went to nursing school to care for patients into
bookkeepers. We have watched as we have tangled our hospital
administrators and those who work in our hospitals in a web of
-
6 -
paperwork that there is no relationship to the care that you and I
�Other countries in the world do a much better job than
we do with their health care expenditures. Canada is the next
highest to us, at about 9.4 percent. But our other major industrial
competitors, like Japan and Germany, are between eight and nine
percent, and they cover every one of their citizens with a more
generous benefit package than we do,on average here at home.
If we do not attempt to get savings out of this system
as we reform it, we will only be freezing in the inefficiencies and
cost structure that are such a problem for us now.
There are some who say: How can you ever get savings
out of this system which is so complicated, and how can you come with
- 8 -
a reform that will achieve savings when there 1
·s
so much work to be
�- 5 -
that we will bring to this national discussion. And what we want is
a solution that solves the problems we face and gives people the
security they deserve and they currently lack.
But those of us who have worked on this plan don't think
we have all the answers or that the answers we come forward with are
coming down in tablet form. We think there's a great deal of
opportunity for us to work in a bipartisan fashion to hear the
responses, to begin to make sure we come with a plan that will get it
right and will assure people that we have listened.
But there are some principles that we have to insist on.
We may be able to discuss the details together and come up with
better ways of accomplishing these principles than the ones that our
process has produced. But there are certain bedrock principles that
I think all of us should agree we need to meet ..
The first principle -- the most important
is
security. That means we have to reach universal coverage as soon as
possible.
(Applause.) This is a principle founded not only in the
human tragedies that come too often to our attention because of the
denial of health care. But in the economic realities that until
every American is insured and does have health security, there cannot
be the kind of cost-effective approaches to providing health care
that we expect to achieve savings so that as we move through the
system, we can begin to enhance quality while, indeed, we provide
security.
When we talk about security, however, we are not just
talking about giving people a health security card, ·although that
will be done. We are talking about what that card will entitle a
citizen to. We must provide a comprehensive benefits package so that
it is guaranteed to every American. It is not enough to have coverage
and access unless that coverage and access takes care of your medica}
needs when they arise. And it is our firm belief that the package ot
benefits should emphasize primary and preventive health care.
It has been for too long that we have had our sys.tem
rewarding the wrong kinds of behaviors. We have not encouraged
people to seek well child care. We have not encouraged people to
seek the diagnostic tests that could point out a problem early. We
have not encouraged.the diabetic to be able to go and afford the kine
of scans and tests that are needed to make sure that her condition
doesn't deteriorate. But we have paid for the operation, we have
paid for the chronic illness. It is time we put primary and
preventive health care at the head of the list of what people need
and deserve.
(Applause.)
The second absolute principle is, we have to simplify
this system. We cannot permit it to continue unchecked, spewing out
more forms and more regulations in both the private and the public
sector every year that goes by. This morninq, I spent ~ime visiting
with a nurse who helps patients eligible for assistance to fill out
the forms that those patients face. And she went throuqh the list o
�-
11 -
That will represent savings to the vast majority of
businesses, both small and large, which currently insure. We also
want to be sensitive to businesses that are currently insuring but
not at the level of benefits that we think are necessary. And we
have worked out a system to subsidize businesses that would need some
assistance financially to meet those requirements.
But of course, there are businesses that now do not
provide any health for their employees whatsoever. For many of those
businesses the idea that they would be required to do so poses grave
problems to them. But on the other hand, those businesses now are
taking advantage of a system both through their owners or through
their employees that the res.t of us pay for.
There is no easy answer as to how we finance a system
that includes every American. But we have, since World War II, used
the workplace as the location for assuming responsibility would be
met. By building on that, we do not dislodge what has become the
accepted means of thinking about insurance in America. You would get
your insurance through your workplace, if you are unemployed you
would be subsidized by the government.
We also believe that the Medicaid program as we know it
now should be ended.
(Applause.) And Medicaid recipients should be
eligible for insurance along with their friends and neighbors through
large purchasing pools. And they should not be identified in the
system as being any different from you or me.
(Applause.) So that
we will have, we hope, a seamless system in which everyone, including
those currently on Medicaid who work, everyone who works will
contribute something bases on their ability to pay to their health
insurance. And all businesses will contribute something on behalf of
their employees.
Now, what will this initiative mean for Minnesota?
First, let me say that many of your state innovations guided us in
developing this plan. We know from what you have done that this
cannot happen overnight, it must be built in stages, but that we must
have goals and principles that we do not detour from.
We know from your forward thinking health plans that
emphasizing primary and preventive care leads to lower expenditures
and significant savings. We know from the Minnesota State Employees
Group and from AFSCME's leadership in this area, that families can
get better, more affordable health care by purchasing coverage
through large groups. We know from recent efforts in places like
Willmar and Chisago City that integrated health c·are serv.ices can be
established in rural areas.
And we know that if we put our minds to it, as I alreadj
mentioned, with the University of Minnesota Medical School at Duluth,
with the right incenti~es, medical students will g~ into primary care
and practice in underserved areas so that we will have the manpower
we need to make good on the promise of universal coverage.
�We have seen what can happen here in Minnesota by the
changes that you· have already accomplished. You have also showed us
how the federal government too often has been an impediment to
reform. That is not the way it should work.
Let me assure you that the President's initiative will
give states more flexibility.to move forward with reforms that are
appropriate for each state. For example, regional health alliances
will create a mechanism for covering all citizens, and will,
therefore, eliminate the need to get waivers or changes in ARISA. We
hope that the kind of flexibility that will be given to states will
enable Minnesota to pursue what is best for Minnesota and permit'
Texas to pursue what is best for Texas.
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Reform will benefit Minnesota in other ways, as well.
Because you are further along than most states in organizing
integrated delivery systems and setting budget targets, you will move
toward lower costs more quickly. That puts you in a much more
competitive situation than other states could claim.
If we begin the process of considering the President's
plan now, and move forward in the Congress with the assistance and
help and guidance of people in places like Minnesota, we should be
able to reach consensus on the kind of health care plan this country
needs in time for us to begin implementing it over the next
few years. Every year that we delay, we continue to increase the
problems we will face when we finally meet the challenge. Back in
1977 Hubert Humphrey sounded this prophetic alarm. He said we don't
have any health protection program in this country. We have a
sickness program. You have to get sick betore you get anything.
(Applause.)
We need a program on how to prevent disease. Otherwise
there will be no end to the.costs of health care. Hubert Humphrey
was right when he spoke those words 16 years ago, and unfortunately
he would be right if he were here with us today saying the~ again.
Now, I don'.t want to underestimate how difficult the
challenge ahead of us will be. There are many who are already
filling the airwaves with scare tactics and fears about what reform
might mean. There are ~ lot of people who stand to make a lot of
money if the system doesn't change. And there are a lot of people
who stand to lost a lot of money if it does. One of my hopes as we
move forward in this debate, is that every time you hear a charge,
every time you see an ad, every time you listen to someone talking or
the television about what reform will bring, you ask yourself: Am I
hearing someone who is giving me his honest opinion as objectively
presented as he can? Or am I hearing someone who either is or
represents some interest who is likely to suffer financially if we
make the changes that need to.be made? If we insure every American,
for example, there will no longer be need for people to sit furiousli
figuring out how to eliminate people from coverage so that we don't
have to pay for them. {Applause.)
This debate will require the best that America has to
offer. But if we can agree on the principles, then I am absolutely
confident there are enough people of good faith and of informed
opinions and of compassion and good sense in the United States
Congress that we can work out the details. That is my fervent
desire. I just want, at the end of the day, however we struggle ovez
the technical parts of this, to know that we are all moving in the
same direction together, that we are not giving up the goal of
universal coverage or on the.hope of choice and enhanced quality.
And based on my e~perience over these months in the Congress, I have
every reason to believe that that will be the outcome of the efforts
we will undertake.
And I have to confess, that as I sat on the White House
�lawn on Monday watching representatives of two ancient enemies come
together to sign a Declaration of Principles of Peace, and then to
shake hands, I thought to myself: there were people all over the
world who, every single day, against dangers and obstacles we cannot
even imagine, got up and worked for peace, who believe that, someday,
the leader of Israel and the chairman of the PLO would have to meet
and ag~ee to end the war.
But that would never have happened without people who.
believed it would. Now, surely we in America, who have more
blessings and more security and a brighter future than has ever been
dreamed of in most of the world for most of history, can put aside
the divisions that for too many years now have kept us apart. Can
get beyond part of the wrangling and ideological name-calling and
come together around what makes this country what it is. And one of
the most important challenges facing us is to achieve a health care
system that includes every American for which we, then, can be proud
to have done our part. That's what's going to happen in the months
to come -- but only if you all help make it so. Thank you all very
much.
(Applause.)
END
�
Dublin Core
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Title
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Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
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White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
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1993
Identifier
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2006-0223-F
Description
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This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
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72 files in 6 boxes
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Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
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William J. Clinton Presidential Library & Museum
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<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
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Background on Health Reform [4]
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First Lady's Office
Melanne Verveer
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2006-0223-F
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Box 2
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2068127" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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1/8/2015
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42-t-2068127-20060223F-002-007-2015
2068127
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https://clinton.presidentiallibraries.us/files/original/7b496529a53aa02bc75bc2c5bb4284d2.pdf
d6f58b0dcb8fcf9bdbff08838a30941b
PDF Text
Text
Clinton Cancels Abortion Restricti
tjz·sjcr3
·~! Reagan-Bush·Era·
THE
w
.\~Hl"'lf.TO!'j P~T
'Gag Rule' on Qinics, Federal Ban
On Fetal Tissue Research Are Lifted
By Ann Devroy
Waabinatan Poet Staff Wnter
In a sharp break with a decade of
Republican rule, President Clinton
yesterday overturned several restrictions on abortion 20 years to
the day after tbe Supreme Court
legaliled the procedure.
Aa aatiabortioll demalltraton
marcbed outside tbe White Baa.,
ca. moved to reveae actiea8
tallea by ..............Reaald
Reap& aad Gecqe Baelr tilt .llllf·
curtailed abortiDa "'ar - should be of .. ~ .....
abortbl is . . . . bat rare,•
Clintoa Slid.
At a tele9iaecl: 0911 Office ceremony, Cliatoa:
• Lifted restrictioos oa abortiaD
counseling by...,_ but pbyaiciaaa
at federaDy faadlld clillica. The restrictions bad ~ to be lmowD 18
the "abortioa ~~~-.
• Lifted reatrictiDal Oil federallJ
sponaored
medical of fetal tiall& · · llid be.,.
affected duriDI . eledilm C8IDpaip by ftnrl••at Yidiml of dila
betel aad , _ . _ . , a..e wbo
pJeaded rib ....... lllda fll! r i
held the pcwi',f., of an1.
=
• Ended restrictions on United Na·.
tions population programs that had
prevented use of U.S. funds for ef·
forts that include information or
counseling on abortion. The restric·
tions came to be called the "Mexico
City Policy," for the city where it
was announced, and Clinton said
they had severely timited iDteraatioaal family plaaaiDa aad populatioo control.
• Returned to cweiUII U.S. llliJ.
itary hospitals the rilbt to pelfaqa
11atioas as loq as tbey are ,...
. ... with private, DOt fedenl. ....
• Ordered tbe penllllellt to ~
view tbe BuaiHra biD Clll the pri-.
vate importation of RU-486, the
French abortioD pill. aad to ead tbe .
ban unless there is a clear medical.
reason not to.
The actiolis, two daJ& after Clbf.
ton took office, fulfiD a campalab
pledae to abortiaa rilbta poupa
althoqb tbe presideat paRlayed
lia . . . . . ODe8 tbat leblnllllilt=
iall ~ to WCIIIIIIl . . . tllli{
m•,..n,aotasmatbltQISI r·
be
ta abartiiL.
vented women-in many cases
poor women-from obtaining abor·
tiona. Clinton also supports chang·
ing the legislation that prevents the
District of Columbia from funding
abortioas for poor women, but that
move must be taken by Congress,
wbidl tried for sev~ years but
failed to override a Bush veto.
Clintoo's actions were hailed by
abortion rights activists, scientific
reeearcben, population-control ex·
perts and a nnge of other groups
that bad fought limits for 12 years.
They were attacked by the anti·
abortiGG movement as a capitula·
tic1a to abortion rights "pressure
lfOUPI" that want no restrictions
wbatever on abortion.
.·. The statements in response to
tbe actiaaa esempiified the differ·
eat plaaes oa wbidl the abortion
aqiiiMDt ia beia8 waged: Neither
politidaaa DGr abortion ricbts ac·.
tiviala waat to be portrayed as
bic:kfaa abortion, only backing ~
..... rilbta to cbooee appropriate
·
;.r:;.. CGIIICilale viltlilllt
evaJdli&i a·
ciald.
IDidica1 care.
:...._CbeopeaiqAbortion oppoaeats
iasae to be portrayed as
of
the floodpta to
preaideat . . _
ODI
ciD to ftiDIJVe restricdaal -
.....
Ill ~AI.C'A 1 ·· ~··
_____ r-----------------···
._-:
t
ABORTION. From Al
....
- abortiaa Oil demand.
·· Cllataa'a actiaaa, said IIIIDor.
Smeal.
·~
.•
presideat of the
.....
Feaitalat.
�Transition~s
Health Care
Analysis Was Pessimistic
High 'lhb Projected/or Expanded-Coverage·
by Spencer Rich and Dana Priest
Wuluftctan Post St.alf Wnten
President Clinton's health care
transition team, in a preliminary
budget document presented to him
last month, indicated that it may be
impossible to expand coverage to
the nation's 37 million uninsured
without substantially increasing the
federal deficit, raising taxes or imposing sharp price controls on med·
ical services.
Administration officials yesterday
declined to make a copy of the document available or to discuss its
contents, but sources within the
·administration and the transition
team· confirmed the accuracy of a
· report on the options paper published today in the National JournaL
Administration sources said tbat
'after Clinton ·reviewed the paper's
preliminary figures and found them
"'distasteful to the administration:
· he asked the team to consider llld
calculate the cost of a wider array
of
·
Results of tbat _.....
• optiODS.
·~r·
sis bave not been announced.
·
_ __.
The optioal paper ........._._
coats over a five-year period far
three dileaent approadles and •
sumec1 tbat tbe aovemment woald
pay aD tbe costs of c:overiq tbe
uninsured. UDder tt.e ~
..tions. tbeJ preaeatecl tbe follawiq
sc:enariol:
• To acllilve uaivenll- .._
: W:0:an~~
- · - · - UJ
further reducing the rates Medicare pays to doctors and hospitals.
The result would be an additional
$22 billion in deficit spending.
The options paper said several
types of new taxes could be used to
raise the money necessary to pay
for universal coverage. Taxing
some health benefits could raise
roughly $110 billion over five
years, an alternative Clinton did not
discuss during the campaign but
indicated after the election he
would consider.
Another option is imposing the
Medicare payroll tax on an employee's entire salary-not just the first
$135,000, as at present. This was
estimated to bring in $30 billion
over ftve years. A 3-percent tax on.
hospital revenues would raise another $70 billion.
The options presented in the report did not c:alculate what the aov·
emment's costs would be if some of
the IDiinsured were to be iDaared by
their ~- Durina the camPlilo. Clintoll propoeed that employers be required to cover their
fuD.time workers over a pbue-in
period. If that plan were to become
policy, the penllllellt'a COlt would
be leas thiD show ill the three apo
tiona detailed.
The optioa8 paper alao said tbat
an
reatrucluriDa
the bealtb care .,..
tem Ulling tbe "maaapd competitioft• model tbat Clint• Jaa •
doraed would reduce the- lilt of
bealtb care in pueral very~ ill
:!.
a:..-:-.:::=_:
from 19M to 1998, of wbicb 1138
billiaa could be offlet by stnlq tD belp aliet die c:oit ~ ",.,;,. .
..f._~ Cll~Tbeand odler . CGftrlll.
..
... .
~
--~PICHiiiill.
~ . · 't'illlb:IIW.
.._. ...,._
: . . ..... ltill bave to apeod hiO ...., dlat Clian ... bll. JriMt..
: biDiall tba periacl to . . . tbe tiiD Iliff. beliete tbl - - - froa
..
I
. .
: price- ·. UIIPW1IIII ,.._._ ._ .
• •o -........w-_..___, ........_ _ UJ'
.die .................
.....,-liM ~ llijlt •
I'
ii
I 1999, die a.-,_ caat ..ad be
...... fnlm 19M to
: 1991. trader dlia optiaa. abGat $95
l .¥DiaD eaald be . . . . by ClttiDI
I
abala -
= -·-
tab a few yean tireali&
•
,Tbe estimates appeal' to....Cliatao with a· aeriaaa political di-
lesllmalallil ....... . , . . . . ,
l:Jidk... PQmellt ra8. ...., camPiiaD .....,...._.._......
·~ ..._ ro be ·flid a bJ tbe Amertc:uw bne. -llelllll . . .,..
DINIIIIIII. ~otlamela aDd toamrnl lllllllacan J I &
..···-of
r
UDder tile - - approadl. ill
«!'Mil
· ltllt'_antil"l99'1 and waald
..,...:c..._,__ _.. antil .,.,: CGIIII &fllr
would . . .
nor....
wbicb..,. ICCIJ . . -
of DariDt die
tbe Gnla Damiltk l'ndll:t. .
~
.... Ida
CJ•.-wa.
31nt
~dna :plla
biiiii;JI ~~--.... ... . ...
_ ·.
..
............~riiaecill, · · -
· ·•:· ~J
14-
:
r;. :· . . . . l
.,
�11101193
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Draft #7
Text as Prepared for Delivery
Par Immediate Release
November 2, 1993
RECORD TESTIMONY OF TREASURY SBCRETAltY LLOYD BBN'l'SBN
BEFORE THE
SENATE PINAHCE COMMI'l'TD
Chairman Moynihan, senator Packwood. Zt is a pleasure to
have the opportunity to discuss the President's comprehensive
health reform plan with you today.
As you know, this is an i~sue which holds great interest for
me, and one on which we worked closely with one another over the
years when I was chairman of this committee.
Reform of the health care system is one of the President's
hiqhest priorities and an integral part of his economic strategy.
From the beqinninq, this administration has been dedicated
to raisinq the standard of livinq in this country for us and for
our children. over the long term the only way to ensure hiqher
standards of livinq is to have faster real wage qrowth.
Faster real waqe growth requires investment in plant and
equipment. But when this administration took office, the
country's debt and deficits were qrowinq faster than the economy.
This ~as drivinq up interest rates and creating ~ climate that
was hostile to business planninq and investment.·
·
The first thing we had to do was get our deficit headed
down. OUr budget plan and its $500 billion in deficit reduction
has provided the basis for economic growth ana risinq wages. As
soon as the oritical elements of the plan emerged. last winter,
interest rates beqan to fall and they have been falling ever
since. 'l'bey•re the lowest they've been in 20 years. The
interest sensitive sectors of our economy are responding, and we
are well on our way to a healthy and eteady, investment-led
recovery.
~eficit reduction by itself, however, will not ensure higher
standards of living. Por too lonq now, riein; health oare costs
have been a clrag on waqes and profits. So now we turn to health
care reform. Let me assure you, from an economic standpoint,
failin~ to act is not an option.
When employers pay their
rise also, workers• paychecks
average worker today would be
if health insurance costs had
workers more, but health care costs
don't go up as they should. The
earning at least $1,000 more a year
not risen faster than wages for the
�11/01/93
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TREAS/PlTBLIC
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last 15 years. some projections show that if nothing is done,
every bit ana more of projected wa9e increases in the cominq
decade could be consume4 by health care costs. Talk about qoin9
backwards!
As a nation, we spend 14 percent or GDP on health care. Bo
other developed country spends near that. Japan spends 7 percent
and Germany 9 percent. If nothinq ia done, health care will
consume more than 19 percent of GDP by the year 3000.
Maybe spendinq all this money would be worth it, ir we saw
qood results. But other countries have lon9er life expectancy
and lo'lier rates of infant mortality. 'rhey spend less and they
cover everyone. We're spendinq more money and not providinq all
Americans the security they need.
The Health security plan addresses the fundamental problems
with the current system. The current system costs too much, and
the real traqedy is that too many people have inadequate coveraqe
or lack coverage alto9ether. We are the only major
industrialized nation without universal coveraqe. Nearly 15
percent of our population -- more than 37 million Americans -have no health coverage. About a third of those are children.
Another 23 million Americans are underin•ured.
This lack of universal coverage is not a problem just for
Every time someone without insura11ce shows up at
the emergency room and is treated, every one of us who has
insurance foots the bill. Estimates show that many corporate
insurance premiums are 10 percent hiqher than they need be in
order to pay for uncompensated care. Removing that burden will
end the cost-shifting to businesses and individual policyholders.
the unins\U'ed,
Universal coverage is critical to qettinq costs under
control. I remember when Lawton Chiles was chairman of the
Budqet Committee in the Senate, He was convinced that it was
necessary to control health care costs before exten41nq ooveraqe
to everyone. Lawton left the Senate and became governor of
Florida. Within less than a year he was telling this committee
that he had chanqed his mind. Bavinq universal coveraqe ends the
cost-shifting that hurts our businesses and individuals who have
to pay hiqher premiums tor the treatment ot those who lulve no
covaraqe •
•
'l'he Health Security plan takes on the coveraqe issue, It
will provide security to Americans an4 shift resources to more
productive uses. As a result, same businesses will see their
costs fall, and others will oe able to offer insurance for the
first time. Slower cost growth will allow workers to enjoy
faster growth in real wages, and universal coveraqe will ensure
that workers no longer have to fear losinq their health insurance
coveraqe if they ~hange jobs or want to start their own
�-- ...
..,
-
-·--- --- --·-
.u·vv .. ·
a.a~a.,r
3
businesses.
a
'-'-&..IAV~
DRAFT
To avoid major disruptions, the new system will be financed
primarily like the current system. The key to makinq this plan
effect!ve is to build on the system of insurinq individuals
through their employers. Most wsinesses, small and large,
already cover their workers. Nine of every 10 Allerioans with
private health insurance get it throuqh work. Just as they do
today, employer and individual health insurance premiums will pay
for the bulk of hQalth coveraqe.
Employers will be required to pay 80 percent of the averaqe
premium. However, the plan li1Rits the perc:entaqe of payroll that
would be devoted to health care premiums to 7,9 percent for large
firms, and provides discounts for small low-waqe firms and
individuals of modest means. unless they qualify for a fully
discounted premium, individuals will be asked to contribute the
balance of the total premium oost.
The President's plan not only has important benefits for
individuals, over the long run it can lower what business must
spen4 on health insurance. By the end of the decade, preliminary
estimates indicate total bUsiness spending on the services
~overed by the health security plan will fall by $10 billion.
That savings could be used.to hire more workers, to increase
wages and benefits, to invest in plans, in equipment, in training
or education or research.
And, while it's doinq all that, it can also level out the
playinq field for small businesses when it comes to premium
rates.
Before I deal with some of the specific revenue issues,
there are three qeneral points I want to make.
First, our plan is the only comprehensive proposal that
spells out exactly what will be provided and how it will be
financed. This is the only fiscally responsi~la thing to do.
Durinq the developaent of the plan, the administration consulted
with the nation's best actuaries and health care experts. I feel
confident we have approached the estimatinq process in a very
responsible way.
second, we have protected both the private sector and the
public sector from cost overruns by insisting on accountability.
And third, this plan will J)e phased in, which allows
sufficient time to make adjustments should we find that
modifications are needed.
our plan clearly spells out the coste to the federal
government and how we are qoinq to pay for them, including
�u1o1193
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discounts to eligible businesses and individuals, lonq term care
and the new Medicare drug benefit. Funding for these, and for
program improvements will come larqely froa slowing tbe growth in
Madioare and Medicaid, a 75-cent increase in the tax on a pack of
cigarettes, an assessment on large companies that choose to
establish corporate alliances, and increased revenues as
compensation shifts from non-taxable health care benefits to
taxable wages,
Now, as to some specific revenue items in the bill. our
proposal contains a number of issues that have been of particular
interest to this committee over the years.
As you know, the plan includes a proposal to increase the
tax on tobacco products. specitioally, the exoiae tax on
ciqarettes would be increased by 75 cents per pack -- raisinq the
federal tax from the cu~rent level of 24 cants to just under a
dollar a pack. The administration also proposes to increase the
federal excise tax rates on all other tobacco products.
As Senators Bradley and Chafee and others on the committee
have been sayinq for years, increases in tobacco taxes will
promote better health -- not just amonq adults, but very
importantly amonq our Children. I am particularly concerned
about the use of tobacco products by adole~cents.
Although we know it will promote better health, I want to
elaborate briefly on this point. ~is is an entirely appropriate
way to finance health care for several reasons.
First, tobacco consumption is the leadinq preventable cause
of death and disease in the United States. As members of this
committee know, it accounts for about half a million deaths a
year and billions of dollars in health care costs.
Second, since the President's health care plan does not
allow differential health insurance premiums for
smokers and non-smokers, the fact of the matter is non-smokers
will baar so~ of the increased health costs of smokers.
ge~erally
Studies by the Department of Health and Human Services, as
well as the canadian experience, demonstrate that raising tobacco
taxes can successfully discouraqe the use of tobacco products by
the young. This is particularly true for the proposed increase
in taxes on smokeless tobacco. Studies have shown that nearly 20
percent of male high school students use this type of tobacco.
and it presently is taxed at a disproportionately lo~ rate in
comparison to cigarettes.
The health security plan also contains a 1 percent payroll
assessment on l8r9e employers who opt to form their own health
alliances. T.hat will contribute, among other things, to
.
�U/01/93
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uzoz nz
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5
DRAFT
underwriting important work in health research from whiCh every
American benefits. Employers who belonq to the re;ional health
alliances also will ass~st in supporting this work.
Another major revenue source in the packaqa ie the tax
receipts that will result. This accounts for abOut $~3 billion.
Let me explain.
Increased competition, qreater costconsciousness on the part of both consumers and providers, and
other cost containment measures will lower health insurance
costs. As tax-prererred emplo!fer health care costs qo down, more
worker compensation will come Ul the form of taxable wages. That
will generate more income and payroll taxes, despite the
increasec! number of workers covered.
There are other tax provisions in the President's health
plan that will accomplish many of the goals or this committee.
For AXample, the ind.ividual income tax health il'Uiurance
deductions for self-employed taxpayers will be increased to 100
percent of the costs of the comprehensive benefit package.
Members of both parties on this committee have been tryinq tg get
that done for years. xt•s time we qat it done. We propose that
a self-employed taxpayer could clatm the full deduction once the
state of residence establishes a re;ianal alliance. The 25
percent health insurance deduction for self-employed workers will
continue until the 100 percent deduction is applicable.
In addition, I know that •any of you here are very
interested in making certain our rural residents, and those who
live in the inner cities, have adequate access to quality health
care. This plan 4oes that with incentives that encouraqe doctors
and nurses to locate in underserved areas.
we are proposinq two tax incentives to encourage adequate
medical care in all areas of the country. A physician who works
full-time in an area designated as beinq short of health
professionals can receive a tax credit of up to $1,000 per month
for up to 60 months. other health care providers working in
these areas can receive a tax credit up to $500 per month. In
addition, physicians who work in these areas will be able to
expense an additional $10,000 for medical equipment.
There are other ways the tax system will :be used to achieve
other•objectives of the health plan. Fgr exa~le, it will expand
and improve lonq-term care options, stressing home ana communitybased services and the improvement of the tax rules governing
private long-~erm care insurance.
The plan proposes to modify the current tax trea~ent of
long-term care expenses and insurance. Long-term care expenses
incurred by certain incapacitated individuals will ~e treated RS
deductible medical expenses, and taxpayers will be able to
�11101193
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exc~ude up to $150 a day from taxable incOme for benefits paid
under qualified long-term care policies. In addition, employers
could deduct the premiums paid for these policies, and ._ployees
will aleo be able to-exclude the value of thia emplOfer-provided
coverage from taxable income.
Senators Pryor, Dole, Packwood and I tried to 9et that done
in the ~ast congress. I am pleased to say that this bill
includes that change.
One last point that many on this committee have been
discussing ror some time. ~is legislation will base the
Medicare Part B preaiums on income. Many aembers have supportacl
this proposal. High-income taxpayers who enroll in part B will
see their premiums increased from about 25 percent of program
costs to about 75 percent of program oosts. The additional
premiums will be paid by single taxpayers with income above
$90,000, and married couples with income above $115,000. We
anticipate this will affect fewer than 1 aillion people.
OOIICLV8ZOII
The administration has offered a bold and comprehensive plan
to qive Americana health seo~ity and take charge of health care
costs. Next year alone, before we can fully pbase in our plan,
our health care bill will exceed $1 trillion. That's one dollar
in every seven in our economy.
The plan we have dr&rted accomplishes everything •any of us
tried to do in the last session, and much more. You aay ~ecall
that last year we worked together to fashion several·proposals
that, taken together, would have made important but incremental
progress in extending health coverage to low income families. I
helped develop four of those bills because at the time it was as
far as I thought we oould qo in aC!hieving some refora of the
health care system,
Things have changed. It has, in fact, been a sea change.
Americans recognize that our health care system needs a
comprehensive overhaul. You can see that refleoted in every poll
in every newspaper you pick up. Americans are ooncerned about
what's beoome of our system of health care, and they have a right
to be.
'
It is clear to me that we are going to do something this
term. You need only look at the legislative landscape to figure
that out. There are no fewer than half a dozen plans out on the
table. There is quite a bit of similarity among them. For
example, all but one call for aoae form of competition. Every
plan ~ants to qet rid of exclusions for pre-existing conditions.
Every plan offers a choice of health p~ans and providers. Each
proposes refonus in our malpractice system. And each propose
�11/01/93
18:50
TREASIPLmLIC AFF
'8'202. 822 1999
7
DRAFT
increasing the deduction for self-employed Americans.
We have a significant amount of common ground here. But
only the president's plan is truly universal and comprehensive.
It provides universal aov~age, builds on our existing sy~tem of
obtaining insurance, contains a Medicare drug benefit, a lonq
term care benefit, cigarette taxes, a requirement that employers
help pay for health insurance, and it has a budget to ensure it
is fiscallY responsible.
I've been waiting a long tiae tor a president wil11nq to
take the lead on this issue. The health care problem will
cripple our economy if we don't act. I'm proud to be part of an
administration willing to seize this opportunity.
·
President Clinton is committed to universal coverage and
comprehensive benefits, with lifetime coverage, and coverage and
cost protections for every American. He is committed to choice
in health care.
Furthermore, President Clinton is intent on seeing that the
quality of health care improves. He wants to reduce the
paperwork burden for individuals and employers. He wants to make
everyone responsi~le for health care. And, he is intent on
financinq the Health security plan in a responsible manner, Tbis
plan does all of that with minimal government intrusion.
The President wan~s a bipartisan solution to thie problem.
lt is an American issue, not a partisan one. The President looks
forward to workinq with the members of this cammittee, and others
in congress, to enact a comprehen&ive and lasting reform of our
health care system.
Thank
you ..
-30-
008
�Cll
•O
I
REVENUE PROPOSALS IN HEALTH SECURITY ACT
,C)
t!!fl
10128193
PIOP088I 1/
Elective
Dale
Filcalyaars
19117
1998
l$ mllllcn8)
1994
191S
1996
0
0
0
12,269
0
0
11,1~7
-100
1/1194
D
t/I/S7 /2
-500
-600
0
·o
s.ooo
0
0
D
0
-68
-t7
-172
-1
-3
-3
0
0
1/1115
0
1/1/!15
0
1!199
2000 1994-00
I]ECEIPTS
1 lncreaaeln tax en IDbacco procllcla
2 .•asaavnen1 on eotpOrabt albnce empJoJel8
1011/94
3 Efllctaalanp~Dfet mandabt, DOll canta1nrnant. and ad:llldla8 en lndWicllnlllncorne
and payroll taxae
4 Hedh lnaJr.ance
a bcr.ae In daducUon 1Drtlea11h lnsuraac:a COliS o18111f-amp1oyed lndlwldUaiB
b l.tnlla1bna on elltluslon of ~-provided hellbh CCMIIagaln caleteda plana
5 La'lg-lalln C8IW
'•.
1011.195
111/98
a Q.lllilled tmg-llnn care &8PIIca uaateclu medlcaJc. .
b T1ea1martof lang-taun cant~
c Tax lrNimalt ol..x:elllat8d d8alh t.ne111a
"'
·~
u
....
g.
.....
(ll
~
lncome-f8lalmg o1 f8llr8a healll IUil8ldle8
b Eally ntllrHhaalth annamant Sl
c Poat-rellremant medbd and lh lnlurance I8IIIMI8 and ndlrea heallh IICCClUnl8
maintained br panalon plana
9 Tax llaatrnenl of h8all1 care organizatbna
.....
......
......
c
......
0
......
12
OTHER ITEMS
10 Recapture of Medicare Pan B sub&ldlea
..
c
.....
8,000
10,800
ZS,CIIQ
-1,700 -~ -3,100
8,300
7,7GO
8,800
-9.801)
TOTAL:
-194
-199
-532
-7
-1,646
-29
-143
-643
-8
-15
-2
~
-·
-11
-4
SOl
53
544
2.224
74
76
80
84
18
455
0
0
100
0
3S
0
0
43
a
0
21
2,381
100
4,683
51
4,359
5I
67
210
11,433
21&
0
0
96
169
18S
205
656
11,130
14,224
20,750
21,809
33,404
31,611
144,595
0
0
0
0
0
0
211
1,531
0
-125
0
-10
-2
-17
-5
-tO
0
0
158
a
53
1/1185
0
0
0
1/11'97
0
1/1191
~/1/98
10/1/95
1Cl/1195
-·
-5
918
81Jj
911
1,416
1,004
3,856
1,470
1,357
500
4,500
5,600
5,800
7,292
18,200
2,242
4,J34
(784
1/¥0
8,2&1
29,348
m
Notes: 11 El&tim8188 are not lbrollan OJ1 belwaen m-budget and Dlr-bldget ellacla
2J Umttattons en the exclusion far auppl&manbd heat'~ cxwarage (Including anf*'yar-pald copays and daductlblea) ww bB allacUve In 2003..
31 P.ropoaal will apply to early rellr888 fiOIII federal govammant. Eatlmale lnc:llldas eflac1 d proposal m govammant outlays.
C)
.....
.....
1"'4
I
'
.
...
•
-
--
-- --
--
--
- -
-
-·
-41
1,518
1,700
0':1
.....
.....
21.800
-186
-437
-8
-134
-118
1/1196
11 Extand Medicare Haspltallnsuranc• 1lll to all State and local gD'ol8mmant anJ*;lyaaa
12 Aasaaananlon premiums In regional alllancas
I<)
&6,217
24,1811
-23
TOTAL:
.....
6,210
0
a
Cll
ID,Ol4
-179
-341
8 Redrae healtl
Cll
-900
10,348
&,120
-248
1/1196
1/1196
I/1J94
1(1196
70ompllance
a Modiftcalb1 10 •lf-emplcJyrntnt 1lllt ttaa1ma1t ot ca1atl S corpcr.uon lh81'1haldlnl
1(1/98
and paflnera
b E'mpbymlni!NIUI-3D Clap altar d/o/8
c
-1GO
10,888 10,813
4,940
5,G60
700. :S,IOD
-101
d Credit for coat of peraonal B8lllatance amylcl required br 8MJIIoV8d hdttkllala
6 Tax~ lorh811111 leMca proWdens h lhartaga .....
a Tlllt CflldJt for healll profealonals
b Expensing fDI mecllc:al-.ulpmant
'..J
·~
3.750
Depamlent or lle Treasury
Ofli:e ct Tu AnatvsJs
�'
i~
I.
..... :··----.. ..
"The Progressive Policy lnsti;~~andate
for Change charts a bold new ~~r~e for
re"·iving progressive go,·ernment i~.Smerica~
It offers creative ideas for tackling America's
toughest problems and a new governing
philosoph)· based on opportunity, responsibility
and rommunit~ This hook really looks beyond
the old Left-Right debates of the past and
tries to move us toward a better future."
-President-elect Bill Clinton
1.
'
I
'
�Is
A Progressive Plan for Affordable,
Universal Health Care
JEREMY
D.
ROSNER
INTRODUCTION
In 1970, U.S. public and private spending on health care
roughly equaled our public and private spending on education. In
1992, we will spend more on health care than on all of educationplus all our nation's spending on defense, prisons, farm subsidies.
food stamps. and foreign aid. 1 Health care costs, climbing at twice
the rate of inflation since 1981, have become the fastest growing
major expense for the federal government, most state governments, many businesses, and millions of American families. 2
Health care spending increased from 7 percent of our national
output in 1970 to about 14 percent today, but few Americans
believe the value of that care has doubled. 3 Ninety percent of all
Americans are dissatisfied with the health system, the highest level
of dissatisfaction among developed nations. 4 More than 60 million
Americans periodically lack health coverage and 35 million lack
any insurance whatsoever. 5 Insured families increasingly find their
coverage at risk due to job loss, small businesses' difficulties in
affording coverage, or benefit cutbacks for corporate employees
and retirees. Despite the high quality and degree of choice within
parts of U.S. health care, the cost of our medical system has
outstripped its value.
Reforming that system may well be the largest domestic initia-
107
�108
MANDATE FOR CHANGE
tive for the next administration and Congress. Their new policies
to control health spending and expand coverage will not only
touch the health and security of most American households, but
will also affect some nine million workers in an $800-billion economic sector, a figure that approaches the entire economy of Great
Britain.
Most Americans agree our health care system should deliver
high quality care, reasonable prices, broad access, and consumer
choice. Yet the debate over reform is deeply divided. The most
widely reported division is over how to finance expanded access to
health insurance: whether to adopt a government-financed singlepayer approach, an employer-based pay-or-play scheme, or a system of tax credit vouchers. This, however, is not the most
important choice. Far more fundamental is the choice of how to
restrain our health system's runaway costs. Many on the political
right, including the Bush administration, suggest "the market,"
without fundamental reform, can cure the health care system's ills.
Some on the left suggest that "the market" does not apply to
health care, and so government must step in to set limits on health
care prices, and perhaps to become the sole health insurer as well.
This is a false choice. The proper role for government, on health
care and elsewhere, is neither to let broken markets run amok, nor
to replace the market with bureaucratic mechanisms that set prices
and allocate resources. Rather, government's primary role should
be to improve the market's ground rules in order to decentralize
decision making, spur innovation, reward efficiency, and respect
·
personal choice.
The new administration's goal should be to achieve comprehensive health care reform and universal coverage without imposing
public price controls and bureaucratic budgeting mechanisms on
the U.S. health care system. We offer a comprehensive, marketbased proposal built on the concept of "managed competition,"
which would result in universal coverage, restrained costs, incentives for efficiency and high-quality care, more equitable government subsidies, state innovation, and consumer choice. This
approach offers the next administration a distinctly American
model of reform-one that could leapfrog the performance of
systems in other nations by building on the best of American
medicine, capitalism, and federalism.
A Plan for Affordable, Universal Health Care
109
THE PROBLEM: FLAWED MARKETS
While the U.S. boasts many of the world's premier medical
facilities, research institutions, and scientific breakthroughs, there
is broad consensus that the health system requires fundamental .
change. Its problems are legion: soaring costs; declining insurance
coverage; workers unable to change jobs due to uninsurable medical conditions; burdensome bureaucracy; rising billing fraud; little
access to care for rural and inner-city residents; too many specialists and too few primary-care providers; inadequate prevention
efforts; overuse of expensive technology; few affordable options for
long-term care; doctors practicing ''defensive medicine" to avoid
malpractice suits; tragic numbers of low-birthweight babies; and
high rates of unhealthy behaviors such as poor diet, smoking,
alcohol and drug abuse, teen pregnancy, and firearms violence.
Yet many of these diverse problems trace back to one root cause:
bad incentives. "Fee for service" insurance plans leave patients
and physicians with little incentive to economize in demanding or
prescribing tests and procedures. Insurance regulations, which
allow premiums to be pegged to health status, give insurers an
incentive to "risk skim"-to enroll healthier firms and reject firms
with older or sicker employees. Most workers lack incentives or
opportunity to seek more efficient health plans, since they receive
an open-ended federal tax subsidy on their benefits, since most
have little meaningful choice among plans, and since there is little
information available on the relative performance of health plans.
The list of skewed incentives goes on.
These adverse incentives add up to broken, inefficient, "cost
unconscious" health markets. In well-structured markets, producers and consumers, pursuing their self-interest, can discover the
best values-goods that meet a need at the lowest cost, sales that
reap the highest profit-and their competition to find these values
yields innovation and opportunity for society at large. But when
consumers, providers, and others pursue their self-interest under
our health markets' ftawed rules, their efforts rarely single out the
best values and often lead to socially harmful outcomes, such as
inftated costs, unnecessary procedures, shrinking coverage, and
discrimination against those with past illnesses. The first order of
business should be a thorough reform of the ground rules in our
health markets, particularly insurance, which is the funnel for
most personal health spending.
But the idea of market-based reform has bogged down in polarized philosophies and rhetoric. On the right, President Bush intro-
�110
MANDATE FOR CHANGE
duced a health care reform proposal claiming it relied on the
market to solve the system's ills. 6 That claim was untrue. Although
the Bush administration's plan used market-based vouchers to
provide somewhat greater access to insurance, it failed to remedy
the worst incentives in the current health market. It did not reform
the tax treatment of health benefits. It would not have led to
universal insurance coverage. It did not create new insurance rules
·and institutions sufficient to end the risk skimming that has all but
destroyed the private insurance market for small employers. As
one commentator notes of the Bush plan, "ineffective proposals for
market reform risk discrediting the whole idea. " 7
While the Bush administration's plan fell short, many Democrats in Congress have proposed single-payer or pay-or-play plans,
most of which would significantly expand government's role as a
direct insurer, and would rely on payroll taxes that could slow job
creation and penalize low-wage workers. More troubling, however, most leading single-payer and pay-or-play plans call for national health care budgets and price setting, on the implicit
grounds that market principles simply do not apply to health care. 8
This is demonstnJbly wrong. Certainly, there are many market
failures inherent in health care, 9 and market forces cannot cure all
of the health care system's ills. In particular, there are severe limits
on how well market forces can work for direct consumer purchases
of basic medical services; for example, no one could be expected
to compare hospital rates at the moment they are struck with a
heart attack. Yet most of American health care is provided
through the private sector, and there is ample evidence that consumer choice and market forces can function effectively-under
the right rules-in health insurance.
Democratic leaders in Congress deserve credit for drawing attention to the soaring health costs, benefit cutbacks, and gaps in
insurance that have beset the nation's working families. But the
bureaucratic models of reform that many of them have proposed
would fall short of their authors' progressive goals. There is an
opportunity now to move beyond the false choices that characterize the current health care debate--to recognize that market-based
reform need not be callous or incremental; that universal coverage
and restrained costs do not require public price setting; and that
competitive markets can be consumers' and progressives' ultimate
weapon.
We propose a Progressive Plan for health care that would comprehensively reform the health markets' ground rules, achieve
universal coverage, enable consumers to shop for better value
A Plan for A«ordable. Univenal
H~tb
Care
111
health plans, and focus providers on the highest value ways of
delivering health care. The Progressive Plan builds on an approach
to reform known as managed competition. Its core idea is this: The
best means to hold down health costs is a market competition
among private health plans that publicly report on their outcomes;
and that competition must be managed by intermediaries to ensure
the plans compete on the basis of value rather than risk. 10 As
explained below, this concept is already working successfully in
the health plans for public employees in California, Minnesota,
and the federal government.
At the close of the last Congress, a path-breaking bill based on
this approach, the Managed Competition Act, was introduced by
Representatives Mike Andrews, Jim Cooper, Dan Glickman,
Dave McCurdy, and Charles Stenholm, and by Senators John
Breaux and David Boren. It represents an important change in the
terms of the health care debate, for it proves that reform can be
comprehensive and market based. That concept appears to hold
bipartisan appeal; both Governor Clinton and President Bush invoked "managed competition" during the recent campaign. The
test will be whether the market-based aspects of this approach can
survive those in Congress and elsewhere who seek to expand public
price setting, and whether the comprehensive aspects of the approach can survive the many vested interests who would prefer not
to reform our health system much at all.
THE CURE: A PROGRESSIVE PLAN FOR
HEALTH CARE REFORM
The Progressive Plan for he<h care reform calls for a statebased, market-driven, pluralistic approach to achieve universal
coverage and restore the link between health spending and health
value. 11 While it differs in some respects from the managed competition plans already proposed, what is noteworthy are the central
ideas it shares with them: reliance on consumer choice in wellstructured markets rather than on publicly-regulated prices to
control costs; reliance on private health coverage rather than on
expanded public programs (such as Medicaid) to achieve universal
access to care; tax reform to make government subsidies more
progressive and less inflationary; and better incentives and information to help providers focus on the highest-value forms of health
care. The Progressive Plan would work as follows:
1. Consumer choice. The best way for the U.S. to weed out
�112
MANDATE FOR CHANGE
low-value health care spending is for individual consumers to
exercise choice among health plans-to vote with their own dollars on which health plans strike the best trade-off between economizing resources and delivering high-quality health care. To
ensure that happens, the Plan requires every American to have the
opportunity and obligation to choose among at least two privatesector health plans. This goal is effected through the tax code and
other provisions, as explained below. To the extent consumers
choose a higher-cost plan rather than a cheaper one, they must pay
the full difference out of their own money without tax subsidies.
l. Universal coverage. The Progressive Plan would require
health care coverage for all Americans. Universal coverage is fully
justified on the grounds of equity, humanitarianism, and individual opportunity. But it is particularly important, on grounds of
efficiency, in a market-based system. Without universal coverage,
health providers in a newly competitive environment would minimize their uncompensated care for the uninsured in order to gain
a price edge. Even more than under the existing system, the uninsured would be driven to delay needed care, which can result in
more severe and costly health problems later, and to obtain care
in less cost-effective sites, such as emergency rooms. The only
effective way to prevent such discrimination against the uninsured
with its resulting human toll and cost shifting is through universal
coverage. This argument suggests a strong reason for those concerned about market efficiency to call for universal coverage, and
it highlights a major economic shortcoming of supposedly marketbased reforms, such as the one proposed by President Bush, which
do not achieve universal coverage. 12
3. Managed competition. For health plans to compete on the
basis of value rather than risk skimming, the competition must be
managed under some new rules. It must revolve around a standardized package of benefits, to be set by a new national board. 13
It also must be managed by an intermediary (health insurance
purchasing cooperatives, or HIPCs) that can weed out practices
that discriminate on the basis of health risks, aggregate the purchasing power of many thousands of consumers, and give small
firms and the self-employed the administrative economies now
enjoyed by large firms.
How it would work: Federal legislation would define minimum requirements (size, governance, solvency, etc.) for
HlPCs. through which most consumers would purchase their
basic insurance coverage (the standardized benefits package).
A Plan for Affordable, Universal Health Care
113
HlPCs could be quasi-public agencies. nonprofits. and potentially could take other forms as well, but in any case could not
also be in the business ofoffering health plans. 14 Each year, the
HlPCs would contract with a range of competing health plans
and present this full range ofplans to their customers. Consumers would select a health plan for one year, but then be free to
change plans during an annual "open season." The HlPCs
would provide their customers with materials that describe the
plans and their performance, and act as the sole point ofdirect
marketing allowed between insurers and consumers-another
provision essential to prevent plans from risk skimming. To
enable the creation ofHlPCs and other parts of this plan, state
laws restricting managed care would be preempted and the
existing federal preemption of state regulation of employers'
own health plans would be repealed. 15
4. Informed consumen and pro'riden. In order to create better
information for both consumers and health providers, the federal
government would define a set of reporting requirements for health
plans, on such data as their use of resources, health outcomes, and
patient satisfaction. This data would not only help consumers
make informed choices among health plans. it would also become
a critical body of data in helping providers determine what procedures and technologies work best.
How it would work: Plans that agreed to report such information regularly (and that met other federal guidelines) would be
certified as "accountable health plans." HlPCs could only
market standardized benefit packages offered by accountable
health plans, and consumers could only receive the tax credit
described below if they subscribed to such a plan. 16 Accountable
health plans would report the required information on a periodic basis to a new federal agency, just as competitors on our
stock exchanges are required to report on their performance to
the Securities and Exchange Commission. The new agency
would develop procedures to protect patient confidentiality. A
private-sector panel would set reporting standards. just as one
now sets accounting standards to ensure that corporate reports
flowing to the SEC are comparable.
5. Tax reform. The Plan would end the practice of excluding
employer-provided health benefits from taxation, and provide instead a tax credit against consumers' health costs. By doing so, the
�- --·-
114
---
__________
MANDATE FOR CHANGE
Plan would eliminate one of the most regressive and inflationary
sets of incentives in the current health care system.
How it would work: The Progressive Plan would only let firms
deduct health benefits costs if they offered their employees a
choice among at least two accountable health plans; and if they
contributed a fixed dollar amount for each employee's basic
health coverage, regardless of which plan was chosen, with the
amount not to exceed 100 percent of the lowest cost accountable plan in the region. This provision ensures that consumers
bear the full extra cost, or pocket the full savings, of choosing
a costlier or cheaper plan, and would steer employer contributions toward accountable plans. In addition, the Plan would
make any employer contributions to an employee's health benefits (directly, or through a HIPC) taxable as income. (Workers' W-2 forms would report both cash income plus any
contribution the employer made toward health premiums.)
Today s exclusion of these contributions from taxation would
be replaced by a refundable fixed-amount tax credit for all
households, up to some maximum income level, who subscribed to an accountable health plan through a H/PC. 11 To
help achieve universal coverage, all taxpayers would be required to enclose a certificate as part of their federal income
tax return proving they had obtained coverage. 18
6. Insurance reform. Federal law would set mandatory standards
for state health insurance regulation, barring discriminatory practices among other things, and requiring all health plans to make
coverage available and renewable without regard to preexisting
conditions.
How it would work: The new law would ban health plans and
insurers from charging different rates to different individuals,
except to reflect certain actuarial factors or differences among
contracts negotiated by different HIPCs. 19 When consumers
bought basic coverage through a HIPC, they would be presented with a choice ofplans, each with a schedule of rates for
all members of that HIPC. Insurers marketing supplemental
insurance also could not set rates based on the health experience of individuals or firms ( ..experience rating''). States and
HIPCs would be encouraged to experiment with various forms
ofprivately funded reinsurance and risk adjustment-systems
......................._______,
..._.
A Plaa for Affordable, Universal Health Care
___
115
to compensate health plans for an undue distribution of highcost patients. Both HIPCs and the new federal SEC-like health
agency would be empowered to investigate and discipline insurer practices by health plans that were found to be aimed at
screening out high-risk, high-cost customers. such as only locating offices in wealthy neighborhoods.
7. State innovation. The Plan would make states the primary
engine of reform,_ to spur responsiveness and innovation. The Plan
would remove the barriers that effectively prevent states from
pursuing comprehensive reforms, and then require that all states
achieve universal coverage by some established date. The federal
government would provide new resources to help them achieve
this goal. Each plan would likely craft a unique approach, but the
resulting plans would essentially be employer-based (like the Jackson Hole Group's plan), single-payer systems with competing private insurers (like the Garamendi proposal), or tax credit systems
with little or no link to employers (as under the Heritage Foundation's approach). 20
How it would work: States would be required to enact a market-based model of reform that would achieve universal coverage for the standardized benefit package within a specified
period (say, four years). 21 This transition period would enable
states to phase in such provisions as new financial obligations
for small busine'sses. The acute care portion of Medicaid (everything but long-term care for the elderly and disabled) would
be abolished. States would continue to receive federal Medicaid
funds in order to equalize their funding capacities, with some
revisions in Medicaids allocation formula to ensure that states'
resources match their needs. States would be required to meet
the acute care needs of their poor and disabled populations by
subsidizing their purchase ofprivate coverage through HIPCs.
Federal waiver policies for both Medicare and the long-term
care portion of Medicaid would be amended, to create more
presumption toward innovation. Ultimately, Medicaid and
Medicare could be fully integrated into the HIPC-based system. Federal provisions would ensure interstate portability of
benefits. To promote public scrutiny of each state's choice of
system, the federal government would collect and publish annual data on per capita health costs and outcomes by state. n
�·-
116
---··
MANDATE FOR CHANGE
8. Other. The Progressive Plan would also include:
Medical malpractice reform, including both limits on awards
and creation of alternative dispute-resolution methods.
• Federal leadership in cooperation with insurance plans to accelerate development of standardized and electronic billing
and medical records.
• Federal and state efforts to expand the supply of health professionals and facilities in rural and inner-city areas, where their
scarcity creates medical hardship and hampers the creation of
effective health markets.
• Initiatives to address health-related behaviors and habits,
among both patients and providers, which lead to poor outcomes or higher costs, including: expanded support for community-based efforts to improve outcomes; changes in federal
policies regarding alcohol and tobacco; and possible changes in
medical education curriculums and federal funding for medical
research.
•
HOW THE PROGRESSIVE PLAN WOULD
WORK FOR AN AVERAGE FAMILY
In many ways, consumers will obtain their health care much as
they do now. They will still obtain health care through a range of
private health plans, from health maintenance organizations
(HMOs) to "preferred provider" physician networks to systems
that virtually run on a fee-for-service basis. Each will have different rules about how enrollees choose their personal physician, how
to see a specialist, and which hospital to use, and some may have
very few rules on these issues (this will be one of the key aspects
of the choice consumers will make among plans).
But in other ways, consumers will encounter a very different
health care market. The biggest change will be that consumers, not
their employers or the government, will make the decision of
which health plan to join; and consumers, not their employers or
the government, will pocket the savings that flow from making
wise choices.
Consider Mr. Smith, an employee of a firm with 50 employees.
He and his family currently have no choice among health plans;
his firm offers one insurance plan, and pays half his premium. He
has a heart condition, and knows that he would have trouble
obtaining insurance if he changed jobs. Under the Progressive
__________..................
_______..______
.._
A Plan for Affordable, Universal Health Care
117
Plan, by contrast, Mr. Smith can choose among a half dozen
private health plans through a local health insurance purchasing
cooperative (HIPC), and none ofthe plans can refuse to cover him
for any reason. Once a year, during open enrollment, the HIPC
sends the Smith family a booklet that describes the health plans
with which the HIPC has negotiated contracts for the year. The
booklet describes each plan, its resources, and its past performance, as measured by newly collected data on health outcomes,
patient satisfaction, and the like. All the plans offer identical standardized benefits packages (although some also sell supplemental
plans, to cover additional services). The data on outcomes, collected from all plans and regularly disseminated, helps Mr. Smith's
health plan deliver his health care in the most cost-effective way.
During the first year of the Progressive Plan, Mr. Smith chooses
the lowest price plan. Two years later, however, he decides this
plan has been too restrictive in letting his family see specialists.
That year, he switches to a plan that offers more freedom in
selecting and seeing specialists. This plan costs somewhat more,
and Mr. Smith himself pays the full difference.
The money Mr. Smith's employer was previously spending on
health benefits, prior to enactment of the Progressive Plan, is now
paid to the HIPC, and stays the same regardless of which health
plan Mr. Smith chooses. That contribution shows up as taxable
income on Mr. Smith's W-2 form; but he receives a federal tax
credit that roughly offsets the additional taxes that result from this
new "income" (as long as he attaches a certificate when he files his
taxes proving that he is covered by an accountable health plan).
The reforms in each state may vary somewhat. But all states
must ensure that the poor (as well as the unemployed, self-employed, etc.) can afford and obtain private coverage through a
HIPC. All states will receive federal help in reaching that goal,
since all of their low-income residents will receive a sizable, refundable tax credit. But each state may adopt different ways of
providing the last margin of financing for their uninsured population, and may adopt different methods (such as mandates on employers or individuals) to help ensure that coverage is universal.
CONSUMER CHOICE IN ACTION: THREE
PUBLIC EMPLOYEE HEALTH PLANS
There is already practical evidence that managed competition
works. The health plan for federal workers and the ones for public
�MANDATE FOR CHANGE
A Plan for Affordable, Universal Health Care
employees in California and Minnesota already incorporate many
of the features described above, and the results are impressive.
The Federal Employees Health Benefits Plan (FEHBP) covers
some nine million Americans under a system that gives them a
market-based choice among a wide range of competing private
plans. This competition, managed by the federal Office of Personnel Management (OPM), helped hold FEHBP cost increases to an
annual rate of 12 percent from 1980 to 1988, compared to 14
percent for private sector premiums over the same period. 23
Minnesota also runs a multiple choice health plan system for its
public employees, with about 120,000 persons covered. In the
mid-1980s, the state changed the system in ways that made it more
market-based and similar to managed competition. The state saw
a dramatic slowdown in cost increases soon after. While the system's average premiums grew at double digits throughout the
1980s, their average annual growth rate for 1990-1993 has been
6.8 percent. 24
The California Public Employees Retirement System (CALPERS), which covers some 800,000 people, has also proved the
ability of a large health insurance purchasing cooperative to spread
risk, cut administrative costs, and provide consumer choice. Like
Minnesota, it recently changed its structure in ways that make it
more market driven. Partly as a result, after seeing average premium increases of 16.9 percent and 11.3 percent in the two previous years, CALPERS's average premium increase was only 6.2
percent for 1992-1993, the first year premiums were negotiated
since the rule changes. 2' ·
These systems, along with various studies, demonstrate that
managed competition can dramatically control health costs, and
that in well-structured health markets consumers can make informed choices based on the relative value of competing options. 26
The question arises: If millions of public employees already benefit
from such a system, why shouldn't all Americans have the same
opportunity?
care costs, not by having the public sector set universal health
budgets and prices, but by using consumer choice and decentralized market forces to weed out the low-value parts of our excessive
health spending. 27 While managed competition relies on regulation
of the health market in certain ways, it focuses on regulating the
ground rules of the competition, not the prices or volume of specific medical procedures. Price controls-public regulation of the
price and volume of most medical procedures, as practiced under
Medicare-appear to promise speed, certainty, and accountability
in restraining health costs. But their proponents ignore the limitations of Medicare price setting and, more generally, the dismal
record of price controls and central planning, from U.S. gas lines
in the late 1970s to the worldwide fall of command economies in
the past four years. 28 Specifically:
Markets are more likely to bold down health costs. While some
have charged that all-inclusive national health budgets would lead
to rationing, it may be more likely such budgets simply would not
be met. Since most budgeted plans do not change the system's
inflationary incentives, their effect would be like putting a lid on
a boiling pot without first turning down the heat. At some point,
the lid blows off. Medicare's price controls and existing state
health budgeting efforts have an escape valve: Providers can make
up any money lost due to the price controls by raising rates on
nonregulated services or customers. Comprehensive budgets could
make such cost shifting impossible, but then public budget-setters
would win far fewer battles with providers. Exceptions and waivers would proliferate. Consider the Gramm-Rudman law: Congress exceeded every one of its supposedly binding annual budget
limits-in the law's fifth year, by over $265 billion.
The Progressive Plan and other managed competition proposals, by contrast, simply tum down the heat, and provide a more
comprehensive and sensible way to temper both consumer demands for services and provider demands for compensation. Public officials are not well suited to resist consumer and provider
pressures; their political survival depends on saying yes. Health
plan managers and personnel are ideally suited to balance those
pressures; their economic survival depends on focusing both patients and providers on the most prudent and effective forms of
care.
Markets are more effective at reducing low-value spending.
Price controls, which have little means to reward high-quality
medicine, would lock in or exacerbate the inefficiencies of our
current health system. They would tend to cap prices for good and
118
ADVANTAGE ONE: MARKETS CONTROL
HEALTH COSTS BETTER THAN PRICE
SETTING
The Progressive Plan and other managed competition plans
have many advantages over the other major health reforms. The
most important is that they control the nation's runaway health
119
�MANDATE FOR CHANGE
A Plan for Aft'ordable, Univenal Health Care
bad providers in equal measure. There is little question that Canada, Germany, and other nations with budgeted health prices have
held their spending below American levels. But neither their experience nor our own suggests that public budgeting in the U.S.
would help us weed out low value health care spending. 29 State rate
setting (especially for hospitals) has had mixed results. 10 Medicare's system for pricing hospital services has restrained public
spending in part by shifting costs onto private payers. 11 Public
efforts here and abroad to limit physicians' fees have often resulted
in physicians compensating for those limits by increasing their
volume of procedures. 12 Medicare's new effort to control total
physician costs, with across-the-board cuts in physician rates if
necessary, may result in doctors performing a higher volume of
services than needed, and not necessarily focusing on the procedures of greatest value to the patient.}}
Under managed competition proposals, such as the Progressive
Plan, the driving force for cost control would be neither a politically determined budget ceiling nor bureaucratic judgments about
what constitutes a wise expenditure of health resources. Rather, it
would be a consumer-driven competition among health care plans
to provide the highest quality care at the lowest cost. Plans that
cut costs without sacrificing quality could lower premiums and
attract more customers. This competition would spur health plans
to negotiate more aggressively with medical providers over prices.
It would drive hospitals and clinics, in tum, to make hard choices
about which acquisitions of expensive technologies they prudently
can delay. It would leave health plans and physicians free to
innovate on higher-value ways to deliver care while giving them
better information for determining what procedures and delivery
systems produce value. With this focus on value, the U.S. could
actually leapfrog the health care systems in other developed countries-going from the most costly and arguably least efficient system in the developed world, to the only universal health care
system organized around the principles of value and efficiency.
Faster, less bureaucratic, and more innovative. While budgets
sound like a quick way to control health costs, public price setting
is notoriously bureaucratic and slow. It would take years to develop the studies, regulations, and enforcement mechanisms
needed to budget all ofU.S. health care. Consider what it takes just
to run Medicare, which accounts for less than a fifth of U.S. health
spending. The Health Care Financing Agency (HCFA), which
administers Medicare, must work with insurance carriers in each
state to oversee more than 400 million bills from 7000 hospitals
and 500,000 physicians, using 475 hospital price codes, and 7000
codes for physician payment. 1• Changes in this system proceed
slowly. It took Congress and HCFA some five years to develop
Medicare's new rate-setting system for physicians, which will
phase in over an additional four years. That system's adjustments
to physician rates each year will rely on 15-month-old data, and
the system's methodology is required to be updated only every five
years. n Medicare's regulations often lag years behind clinical innovations and provider scams. In the interim, existing regulations
may discourage the use of newer and more cost-effective procedures, or overpay for an obsolete or low-value procedure. While
Medicare has yielded its recipients many benefits, it would be a
mistake to extend its cost-control techniques to the rest of the
health care economy.
Market-based systems need some degree of regulation and public bureaucracy to set and enforce ground rules to ensure that
specific health plans do not suffer from an undue concentration of
high-cost patients, and to administer certain subsidies. But specific
negotiations over prices and measurements of output and quality
are left to private, decentralized negotiations, which tend to be
quicker, more flexible, and less politicized. In FEHBP, for example, each of the participating health plans is free to negotiate rates
with physicians and hospitals at will, and is instantly rewarded for
cost-saving innovations. As the table on the next page suggests,
this approach, relative to Medicare's centralized public price setting, leads to fewer public sector employees and fewer pages of
statute and regulation per person insured. Certainly this is partly
because HCFA carries out more of the insurance process for Medicare than OPM does for FEHBP. But that begs the question of
what functions need to be carried out by the public sector, and the
table suggests that FEHBP has produced an answer that relies far
less on government. Nor is the issue administrative simplicity;
Medicare boasts much lower administrative costs than the current
private insurance market, probably including carriers that participate in FEHBP. The point, rather, is that private health plans in
a competitive environment are more dynamic: they can and will
exert stronger, quicker, and more fine-tuned cost controls internally than public regulators can impose from the outside. While
private health plans have their own bureaucracies (including their
own budgets and, often, price schedules), compared to public
agencies each is far smaller and unencumbered with congressional
second-guessing, multiagency sign-off procedures for new regulations, civil service rules, and other public constraints.
120
121
�MANDATE FOR CHANGE
Ill
A Plan for Affordable, Universal Health Care
A Comparison of Bureaucracies: Medicare vs. the
Federal Employees Health Benefits Plan (FEHBP) 36
Federal Employees Administering per
Million Covered Lives 37
FEHBP
Medicare
ti·i~i:i~~Jii~ZJJ.i>)~;~:~:- :~:·i~~;2:]
Pages of U.S. Statute and Regulation per
Million Covered lives 38
FEHBP
Medicare
•
~<7~],:_\~::71f1i~:.i-:i::'. . ~;.:\~.:,~i.~t·;
,I
More accountable and less politidzed. Supporters of aU-inclusive national health budgets claim that approach ensures political
accountability. But the accountability is more to organized interests than the public. The history of Medicare is replete with cases
of organized groups acting through Congress to add coverage for
specific illnesses or procedures, or to aft'ect changes in specific
prices. If alJ of American health care functioned under a public
·budgeting system, health care firms and professions would have
even more reason than they do today to make campaign contributions and exert political pressure on the health experts setting
prices and the elected officials approving them (particularly members of key congressional committees). Populous states could be
expected to use their political clout in Congress to press for favorable formulas in determining how the national budget was to be
apportioned among the SO states.
By contrast, the Progressive Plan and managed competition
would be more accountable to the public. The key pressure point
would be consumers' individual decisions about which plans to
choose, not the decisions of a few public officials. Smart health
plans would invest less on influencing public price-setting processes, and more on finding ways to cut costs without losing customers in each year's open enrolJment.
123
Markets make government accountable in the right way. In a
sense, health budgets make government over-accountable. They
make every problem into a political problem, even on matters best
resolved by the private sector. Every provider who feels his rate
inadequately reflects some local variation; every patient who suffers waiting for use of a scarce technology; every hospital forced
to effect layoffs-each of these individually wrenching problems is
laid at the feet of the local member of Congress, and, ultimately,
the party and the president responsible for creating and enforcing
the public budget. And each effort to address such crises begets
more detailed regulation.
Under managed competition, there is still accountability. A
disgruntled patient can switch plans; an unhappy doctor can sign
on with a different health plan. But, unlike in a budgeted system,
neither is likely to focus as much resentment on public officials.
The purpose of such an arrangement is not to abdicate public
accountability, but rather to limit public accountability to the
kinds of decisions the public sector is best suited to make. The
public sector is the right place to make decisions about subsidy
levels, methods of raising revenue, and the ground rules for health
markets. It is the wrong place to make judgments about the relative values of procedures, providers, and systems for organizing
and delivering care.
Mixing budgets and markets. Over the past year, the center of
gravity in this debate between public budgeting and market competition fortunately has shifted toward markets. Unfortunately,
many health reformers who have begun recognizing the value of
competitive health markets still maintain we should expand public
price controls and budgeting, either as a short-term solution, or as
a complement to private competition. 19 New endorsements for
national rate setting from prominent physician groups make this
kind of mixed strategy seem politically possible. 40
Some degree of public budgeting will need to occur under
managed competition-if only to budget Medicare and public subsidies for lower income consumers. But, generally, a mixed strategy is a bad prescription. It repeats the key mistake of U.S. health
care policy over the past 30 years: adopting fragmented policies for
different parts of health care rather than one cohesive strategy.
One leading argument for a mixed strategy-that tight budgets on
fee-for-service medicine, with exemptions for HMOs, could push
more providers into HMOs-ignores history and politics. There
are few if any examples of regulators intentionally driving their
subjects (even inefficient ones) out of business; more often, those
�124
MANDATE FOR CHANGE
A Plan for Affordable, Univenal Health Care
who cannot survive in the market find a way to survive in the
legislature. Thus, such budgets might simply perpetuate a safe
haven for inefficient delivery systems. Moreover, the mammoth
effort to create and enforce an all-inclusive national health budget
would drain political and intellectual energy from the effort to
create well-structured markets. Any ambitious health economist,
politician, or lobbyist would want to be in the middle of the decisions over the budget and its price controls. Efforts to create a
fundamentally new set of market rules would likely be placed on
the back burner, where, in American politics, nothing ever boils.
A better strategy is to give a comprehensive market-based approach a chance to work. Later, if policy makers felt the need to
do more to limit costs, they would be better able to do so. At that
point, the system's incentives would work with budgets rather than
against them-the heat would have been turned down under the
pot. The information systems set up under this Plan would be
producing more of the data needed to pursue budgets.•• The fact
that public budgeting remains an option may well prompt cooperation from some in the provider community who understand that
their enlightened self-interest lies with better markets, not more
regulation of prices and volume.
most generous health plans, who tend to be better paid, receive a
larger tax subsidy. Because the subsidy takes the form of an exclusion, its value is higher for taxpayers in higher marginal tax brackets. According to one analysis, these tax provisions provide 30
times more benefit to households earning more than $100,000, on
average, than to those earning under $10,000-and they provide
no benefit at all to those who lack private health insurance.•)
The Progressive Plan would end this inflationary, expensive,
and regressive tax policy. The exclusion of health benefits from
taxable income would be replaced with a fixed tax credit, which
would have the same dollar value for all who receive it (apart from
low-income households, who would receive larger credits), and
which would give consumers no tax benefit for buying a more
costly plan. In addition, since both corporate and individual tax
benefits would be linked to competition and would favor accountable health plans, the tax code would become an instrument of
efficiency rather than inflation. While other managed competition
proposals reform the existing tax exclusion somewhat differently,
some reform of these tax provisions is essential to make managed
competition work well.
The Progressive Plan would improve equity in other ways as
well. One is that it would derive the bulk of the funding for
expanding coverage from the progressive federal income tax,
rather than from payroll taxes, which can be regressive and can
slow job creation. A second is that it would end the acute care
portion of Medicaid. While Medicaid's creation in the 1960s created health care access for millions, the program is today a deeply
flawed way to meet the health needs of the poor. And while many
states have been creative in their efforts to make the system work,
its basic design has led to problems that have succeeded in angering taxpayers, governors, doctors, hospitals, and recipients alike.
One of the worst aspects of most pay-or-play strategies is that they
propose to expand Medicaid. There are many reasons government
should ensure that all Americans can obtain health coverage, but
few reasons government itself should be in the health insurance
business, and fewer still to expand a program that has fared so
poorly. The Progressive Plan, and other market-based approaches,
would enable government to provide for the acute care needs of
the disadvantaged in a far more efficient and equitable manner.
ADVANTAGE TWO: MORE EQUITABLE
GOVERNMENT SUBSIDIES
One of many anomalies in the health care debate is the lack of
attention to the inequities of the current tax treatment of health
benefits. While reformers justify universal coverage in the name of
equity, many of them ignore the distributional implications of the
health provisions in our tax code, which are unfair not only to the
poor and unemployed, but also to working middle-class Americans.
The fact is, the treatment of health benefits is one of the most
pernicious elements of our tax code. These provisions are a prime
culprit in rendering consumers and health providers cost unconscious and thus fueling health inflation. The current tax provisions
are also enormously costly; in 1991 they lost over $66 billion in tax
revenue, including federal income and payroll taxes, and about $88
billion including state taxes. 42 Those billions are distributed regressively, giving far more subsidy to upper-income households than
those with lower or middle incomes. Because the current personal
exclusion regarding health benefits is open ended, those with the
125
�__
_____.........._____,_..__.....
MANDATE FOR CHANGE
A Plan for Affordable, Universal Health Care
ADVANTAGE THREE: STATE-BASED REFORM
IS MORE RESPONSIVE AND INNOVATIVE
age. Others, such as Oregon and Georgia, have conducted extensive public debates over health care reform and have built great
support for particular types of reforms.
Moreover, experimentation among the states will yield needed
data about the relative merits of differing approaches to reform.
Such data are particularly important, both substantively and
politically, in the context of market-based reforms. Notwithstanding years of experience under FEHBP and other similar systems,
as discussed above, critics of market-based reforms often complain
that such approaches are "almost pure theory," unsupported by
empirical evidence.•, A system that resulted in SO different variations on market-based reform with universal coverage would certainly cure this alleged empirical vacuum. The states would
become prolific laboratories for testing how well different financing, regulatory, and delivery systems work in restraining health
costs and rewarding high-value care.
126
Most of the leading comprehensive health reform proposals
would create one financing system for the entire country. Some
leave a role for state administration and an opportunity for state
waivers. But very few start with the notion, which seems justified
in a federalized nation, that states should fashion their own reforms and financing systems.•• To the extent reformers justify a
uniform plan, they tend to cite two reasons. The first is that current
federal laws make it difficult for states to innovate effectively on
health care reform. The key federal law regarding pensions blocks
states from regulating self-insured employers, the federal tax code
makes it impossible for states to change bad tax incentives, Medicare and Medicaid put hundreds of billions of health dollars
beyond the states' effective control, and tax competition among
states discourages states from moving to universal coverage unilaterally."' The second argument for national uniformity is that
health care should be thought of as social insurance, and social
insurance programs (like Social Security) are best run as national
efforts."'
These two arguments are both right and wrong. Current federal laws do block effective state innovation in reform. But the
right response is to amend the offending federal laws, not to
preempt state reform. And while n~ti~nal health ca~e reforn:' is
aimed at creating some level of soctal msurance, whtch requares
some degree of federal action, it is also aimed at impro~ing efficiency, which almost always benefits from decentrahzatton. As
one study concludes, "states are the logical unit through w~ich
to organize health care in a country as large as the Umted
States...•7
In fact, there are abundant reasons to give the states the opportunity and obligation to choose their own paths toward universal
coverage and reform. First, there is tremendous variability among
the states, their health care needs, their institutional ':apacities,
and their civic cultures. Such key variables as per capata health
costs, concentration of physicians, and enrollment in HMOs vary
by more than 100 percent among states... Their experience in
health reform also varies widely. Some states, stich as New York
and Massachusetts, have extensively regulated health care over the
years. Some have already adopted sweeping reforms; Hawaii, for
example, has already attained nearly universal health care cover-
127
CONCLUSION
Many of the challenges facing the new President, from making
our streets safer to making our products more competitive, are so
complex, deep-rooted, and increasingly global that the limited
levers of federal policy are likely to produce only incremental
improvement. Health care is an exception. Our health care system's problems of high cost and shrinking coverage are problems
the new President can do something about. Without question, any
effort to enact comprehensive health care reform will be a pitched
battle, and reforms once enacted will take several years to work
fully. But unlike so many other problems, the new President can
have confidence that a legislative victory will actually result in
far-reaching, near-term change.
If the new President does make health care reform a personal
priority, the nature of that reform w•lllikely be one of the hallmarks of his tenure. The model of reform proposed here would not
only end America's lack of universal coverage and its spiral of
health inflation, but also transform the American health care system in ways that reflect this book's signature ideas: consumer
choice; political decentralization; progressive taxation; less public
bureaucracy; the use of market forces to achieve public goals;
encouragement of innovation; and a renewed emphasis on individual responsibility.
This course of reform is achievable. Many of this Plan's central
�•
128
MANDATE FOR CHANGE
ideas have already attracted support from progressive Republicans, moderate Democrats, liberal health reformers, and enlightened private-sector leaders who might be less supportive of
reforms that rely on a greater level of government intervention.
The public is clearly ready to support comprehensive change. The
opportunity is real.
MANDATE FOR ACTION
1. Create a new system of managed competition for
health care. All consumers would choose among private
health plans within a system that ensures the plans compete on the basis of value rather than risk skimming. A
well-managed market competition is a far better way to
restrain wasteful health spending than imposing public
price controls and budgets across the U.S. health care
system.
2. Better information for consumers and providers. Create a new system to collect comparable information from
health plans on their financial and clinical performance,
to be used both by consumers choosing their health plan,
and by providers deciding on the best course of tr~at
ment. This information is essential to help consumers
comparison shop, and to focus providers on the most
effective and efficient ways to deliver care.
3. Reform the tax code's treatment of health care benefits. Replace the existing subsidies with a fixed tax credit
for households that choose qualifying health plans. The
existing tax treatment of health benefits is regressive and
inflationary, and must be changed for reform to work
well.
4. Make the states the primary engine of reform. The
system should be state based in order to spur responsiveness and innovation. Once certain federal laws are
changed, states can and should develop their own market-based, universal coverage models of reform.
Educating America: A New Compact
for Opportunity and Citizenship
TED KOLDERIE, ROBERT LERMAN, AND
CHARLES MOSKOS
INTRODUCTION
More than ever before, America's prosperity hinges on how well
we educate and train our people. Yet our public schools are failing
to meet new standards of performance being set by our global
competitors. Our secondary schools are not producing graduates
whose academic skills match those of their counterparts in other
advanced countries. We are not doing as good a job as those of our
economic competitors in preparing young people for work, a failure that strikes hardest at the "forgotten half' of America's youth
who do not attend college.
For those who wish to attend college, the problem is not quality
but access. Soaring costs, which rose 51 percent in the last decade
for private colleges and 31 percent for public colleges (adjusted for
inflation), are putting college beyond the reach of average working
families.•
These two problems-the inferior quality of our secondary
schools and lack of access to America's excellent system of higher
learning-stand as obstacles both to individual opportunity for
aspiring Americans and to the revival of our nation's ability to win
in the world economy. The new President, therefore, must make
revitalizing U.S. education an urgent priority of his administration. He should marshal public support for a radical redesign of
129
�..
,
WOMEN'S HEALTH
(.
·.:..,.
Women are increasingly the victims of life-threatening illness, yet
still are at the bottom of our medical research agenda. Funding for
research into breast and ovarian cancers, osteoporosis and other
diseases remains inadequate. Although women are more likely to use
health care than men, they are less likely to have insurance:
•
Women make up a larger portion of the population holding part-time
jobs and clerical or sales jobs--jobs which usually don't offer health
insurance to employees.
•
Women tend to live longer and require more long-term and home health
services that are often not available or affordable.
•
Many women must rely on their spouses for health insurance, and risk
of being dropped if they divorce or if they are widowed.
•
From the beginning of the health reform process, women's health and
preventive care concerns were at the core of the program. The Health
Security plan will emphasize the kinds of care and research that protect
women's health and guarantee comprehensive care.
Comprehensive Benefits
•
Under the Health Security plan, all women will be guaranteed
coverage regardless of health status, marital status, employment
status, or ability to pay.
•
Women will be guaranteed a comprehensive package of benefits that
will include unprecedented free coverage of a wide range of preventive
services, including mammograms, Pap smears, diagnostic services, and
prenatal care.
•
The plan includes coverage for health services that help prevent
unwanted pregnancies.
Preventive Health
•
(_,
'
The Health Security plan will cover a schedule of preventive
screenings, tests, and checkups covered in only a few of today's health
insurance policies. These include regular mammograms for women
�Women's Health
Page2
(- ..
with a close family history of breast cancer and will be covered under
the regular cost sharing provisions, like other medical procedures.
\ ....,.,---
- ..
•
The nationally guaranteed comprehensive benefits package will also
include free coverage for mammograms every two years for women
over age 50 free-of-charge--no matter which plan someone chooses, as
an extra incentive for those most at risk.
•
Preventive services included in the comprehensive benefits package
are provided at ages specified by the report of the U.S. Preventative
Services Task Force. These recommendations can be modified by the
National Health Board as new information becomes available.
Supports Women's Health Resear.ch
•
New research initiatives will concentrate on child health (including
birth defects, prenatal care, and adolescent health), and illnesses that
primarily strike women -- including breast cancer, ovarian cancer, and
osteoporosis.
•
Medical research initiatives will be expanded to include efforts to
isolate and cure diseases such as breast cancer and cervical cancer.
Expansion of Home and Community-Based Long-Term Care Services
•
The addition of a new home and community-based long-term care
program and the expansion of nursing home coverage will help reduce
the undue burden hom by many women caregivers.
October 8, 1993
�SECURE, COMPREHENSIVE CARE:
BREAST CANCER COVERAGE UNDER TilE HEALTH SECURITY PLAN
Women QllJ Increasingly the victims oflife-threaJenlng illness, yet still are at thf
bottom of our medica/ reseenh agenda. Funding for research into breast and ovarian cancen,
osteoporosis and other disease~ remains lnadequaJf, Of all the health problem1 American
women foe•, howe••r. bntatl cancer 11 th• d•tldllllt.
/' /,
~ (.,.J .,._,J-
A,).,
'The Facts on Breast Cancer In Americau
:n"" -
.~
b,·., r
·
•
•
2.6 million women in tho U.S. have breast cancer today, and this year another
182,000 American women will be diagnosed with the disease, approximately
one women every three minutes. (National Breast Cancer Coalition)
•
(
One in nino women in the U.S. will develop breast cancer in her lifetime.
(National Breast Cancer Coalition)
46.000 women will die from breast cancer this year in the U.S., approximately
one woman every 12 minutes. (National Breast Cancer Coalition)
-,
'-,
•
There is no known cause or cure tor breast cancer.
The Health Security Act addresses women's health care seriously and comprehensively,
suaranteeing coverage to all women, regardless of health status, marital status. employment
status, or ability to pay. Specifically. tho Health se,uriSy Plan wjll cover a sc;hedulo of
w:oventiye screenioas. tests and checkups at no cost protutioo available io gnly a few of
todax's insuraocg policies.
BREAST CANCER EARLY DnECriON AND CARE COVERAGE
UNDER ntE REALm SECURITY PIAN
M,edlcally neceasaa or apo!1)pdatc cag: Women or any age can receive clinical services,
including clinical breast exams, and mammosrams at any time when they aro medically
necessary or appropriate with cost sharing as specified by their plan.
Care (or womcn at dsk: Women or any ase who are defined to be at risk or breast cancer by
tho National Health Board will receive additional visits, including clinical breast exams, ancl
mammograms at a schedule appropriate to their risk status with no cost sharing.
(~_/
Cag Cor all womcgs All women receive reaular clinician visits. including clinical breast
exams, every three years from age 20 • 39 and every two years from aae 40 • 64 with 110
cost-sharing. All women will also receive routine scroenina mammograms every two years,
beginning at age SO, with no cost sharing.
�In addition, the followjn& secvices are covered for pap smears;
Paolnelylc CIIDIJ are covered annually for women who have reached childbearing ago and are
at risk of c~rvical cancer as part of c::linical preventa~ve services with no cost-sharing. Once
three negattve smears are obtained, pap smears are covered every three years for wornen age
20 • 39 and every two years for women 40 and above. If the patient is at risk for fertilityrelated infectious illnesses, pap smears may be covered more frequently.
Addjdonal .gap smeap: Additional, or more frequent pap smears may be done at any time
they are medically necessary or appropriate. In these cases. the services are covered w1/h cost·
sharing as is any other medical procedure.
SUPPORTING WOMEN'S REALm RESEAROI
UNDER 111E HEALnl SECUIUI'Y PLAN
The clinical p~vendve servi(es packa&e will be supported b)' slanincant inc:~aes
investment~ ha b~ut uncer ~search.
. ·_,
c~·
'
•
In
This year the National Institute of Health's breast cancer research budset increased by
44 percent. from $208 million to almost $300 million.
"
Additional Increased lundlna tor early detedlon and p~vendve seavlces Is available dlrouala
the followlna aaencles, which have increased investment in their own breast cancer research
programs:
•
•
•
Centers for Disease Control
The Food and Drug Administration
Tho Department of Defense
From $71 million to $71 million
From $3 million to S13 million
This year earmarked $210 million
for breast cancer research.
Under reform. new research initiatives will concentrate in prevention ot many illnesses
affectins largo numbers of women, includina mental health, reproductive health and
osteoporosis.
r··.)
~-··
�...
/
···.
• Breast cancer Is the most common form of cancer In
American women. It rarely occurs In men. An ostin1ated 2.6
million women In the U.S. are living with lno't cancer: 1.6
million who hove boon diogno\ed ond on estimated 1million who
do not yet know they hove the di5coso.
• One out of nine wo~ntn In the United States will deverop
breast cancer In her lifetime- a risk that was ont out
of 14, In 1960. This yoor, a new case of breast cancer will be
dlagnas11d every three minutes, ond owoman will die from breast
cancer every 12 minutes.
• In 1993, approximately 182,000 new cases of breast
cancer will ~.diagnosed and 46,000 will dlo from the
disease.
• We dv not know what CQU50$ broast cancer or how to
cure lt. Wom{~fl with hn·a~! ,;,llCCr arc <lying at the
sarnc rate 1oday as they did in the 1930s, and the same
basic: methods of treatment .uc b(.'ing U$ed: surgery,
and radiation.
~hemotherapy
• Since 1960, more than 950,000 U.S. women han died
of breast cancer. '!'his is mon· than two times the
n\lmlH•r of all Amakans who have died in World
Wars J and II, the Korean, \'ictJ1;Ull ~nd Persian Gulf
Wars. Forty-eight percent uf these deaths occurred in
the last ten years.
• Thirty eight percent of African American women wtth
breast con(tr will nat live more than five years, and
2S% of white Amerl(an women with breast cancer will
not ltve more thun five years. F()rt)' percent of all
women with br<:ast cancer ill"<' dc-cld within ten years.
• Every woman Is at risk for breast cancer. The risk of
d<"veloping breast \anccr incrc.tscs as awoman ages, if
she h.,~,, r.unily hi~tory oflm·:l~it l.'an<.·er, has never had
dtildrcn or h;ld her 11r)t child :lftcr age )0. ~ost breast
Cllnccr (over 70%), however, 1.>CC\1rs in wumcn who
have no identifiable risk factors.
t?O'd £OO'ON SO:C:
£6,£(: 1)0
�.
,/
.....
• Breast cancer Is the leacflng cause of death for wamtn
40·44 and thelecsdlns cause of cancer dtaths In women
15·54, Incidence of breast cancer increases with age,
rising sharply after age Cony. Two-thirds of all breast
cancers occur in women over 50.
• Mammography does not prevent or curo breast cancer,
It can only detect It •early•. In this conrexc, "early•
means that the tumor can be there Cor six to ten years
before it is detected by mammography.
• Most Lreast lrr•sularltles are fou"d by women
them•elves, yet many womtn do not know how to
perform Lreast self•examlnatlon and few do so regularly.
CONTAct:
THE NATIONAl BREAST
CANCER COALITION
FOR INFORMATION ON HOW TO
HElP FIGHT TO END THIS EPIDEMIC
P.O. Box 66173
Washington, D.C. 20035
(
__ .'
-
• -- •
- -- • -
• ,"'! ...
�CAMPAIGN FOR WOMEN'S HEALTH
WHO MAKES UP THE CAMPAIGN •••
The Campaign for Women's Health is a broad coalition of over eighty national, state, and grassroots organizations
representing more than eight million individuals nationwide. Member organizations include women's groups, labor
unions, health care organizations, and others concerned about women and their health.
CAMPAIGN GoALS AND PRINCIPLES...
The Campaign is working to ensure that health care reform meets our principles and goals, including:
.,.
UNIVERSAL ~CCESS. Everyone must have access to quality health care. Employment and marital status,
ability to pay, age, enrollment in public assistance programs, and pre-existing conditions must not be barriers
to care .
.,.
COMPREHENSIVE BENEFITS. Our health care system should offer a broad package of health services to all,
including primary care, preventive care, screening, diagnostic, and treatment services, a full range of
reproductive health services, including family planning and abortion, and long term care•
.,.
PROVIDERS AND SETTINGS. Health services should be available from a choice of providers, including
physicians, nurse practitioners, physician assistants, and other allied health practitioners. Services must be
available in a variety of settings, ranging from the home, to large medical centers, to small rural clinics•
.,.
ACCOUNTABILITY. The health system must be accountable to women and their health concerns. Women who
represent the broad spectrum of women's health interests must be included on any health boards,
·
commissions, or other advisory and regulatory boards.
.,.
RESEARCH. A reformed health system must include a national research agenda with increased attention to the
health needs of women. New studies on the he8lth of women must be initiated and ongoing research project
must include women.
The Campaign for Women's Health has been an active player in the health care reform debate:
• The Congressional Quarterly reported that the Campaign for Women's Health is the organization •most
likely to succeed in winning Hilll\ry Clinton's favor. •
• The Campaign's Model Benefits Package for Women in Health Care Reform has been a key document in
the current debates~ Linda Bergthold, Co-Chair of the Benefits Working Group of the White House Task Force on .
Health Care Reform described the model benefits package as •the most thorough and specific package I've seen. •
A Project of O.W.L.
666 Eleventh Street, NW, Suite 700, Washington. DC 20001
(202) 783-6686
FAX (2021 638-2356
�FOR IMMEDIA1E RELEASE
SEPTEMBER 24, 1993
CONTACf:
SHARON FISCHMAN
202-328-5160
STATEMENT OF MARCIA GREENBERGER,
CO-PRESIDENT OF THE NATIONAL WOMEN'S LAW CENTER,
ON REPRODUCTIVE HEALTH CARE AND THE HEALTH REFORM PLAN
For decades, the health needs of women in the United States have been underfunded,
overlooked and cut out of key health programs. Correcting these inequities is long overdue.
President Clinton's health reform plan can provide comprehensive health care for all American
women, but its promise must be turned into reality.
President Clinton's health care plan contains critical improvements in health care for
women. It stands for the principle that all women, regardless of age, economic or health status,
will have access to health insurance. Whether a woman is employed, where she is employed, or
the size of her employer will not dictate her eligibility for insurance. And changing jobs will no
longer put women at risk of losing their insurance. Access is key, and for us -- to borrow a now
popular phrase -- non-negotiable.
But access is not the only question. Also key is whether a woman's basic health care needs
will be covered. And no area is more central to women's well being than reproductive health. For
many women, gynecological exams are the only regular health care they receive. Pre$ident
Clinton's plan guarantees coverage of preventive health services that run the gamut from routine
checkups for pregnant women to diagnostic and screening services such as mammography and pap
smears. Although these are progressive and important additions, if they are to be truly preventive
and if the plan is to live up to its promise, they must be provided more frequently than currently
indicated in the plan. Short-sighted cost cutting measures that put women's lives in jeopardy are
unacceptable. Pap smear and mammogram schedules need to follow accepted medical standards.
Family planning services, including access to contraceptive care, are essential to the health
of women and their families. The Center is pleased that the health reform plan covers "family
planning services," but we will work with Congress to ensure that ''family planning services"
clearly cover education, counseling, infertility services, screening and treatment for sexually
transmitted diseases, and voluntary sterilization. The plan should also explicitly state that
contraceptive drugs and devices are included as a basic benefit
And, it is of of critical importance to women nationwide that the Administration ensure that
"pregnancy-related services" is defined as including prenatal care, labor and delivery, post-natal
care, and termination of pregnancy. The range of providers covered by the plan will ensure that
women can receive the diverse styles of care available currently. The inclusion of a range of
providers is both essential to women's primary care and cost effective.
(more)
NATIO\AL WOMEr\'S LAW CE\TER
�NATIONAL BLACK WOMEN'S HEALTH PROJECT
Public Education I Policy Office
PRESS RELEASE
SEPTEMBER 24, 1993
Julia R. Scott, Director
CONTACT: JULIA R. SCOTT
202-835-0117
NATIONAL BLACK WOMEN'S HEALTH PROJECT PRAISES CLINTON'S
HEALTH CARE REFORM PLAN; BUT SEEKS INCREASED ACCESS TO SERVICES
AND ANTI-DISCRIMINATION PROVISIONS
"The National Black Women's Health Project (NBWHP) applauds the President's commitment
to reforming our health care system and improving the health of our population," said Julia R.
Scott, Director of the NBWHP's Public Education and Policy office. "We are particularly
pleased that the reform plan emphasizes preventive health care and covers the full range of
reproductive health services, including abortion, which is a critical element of 'pregnancy-related
care.'"
Scott said, "However, we are concerned about access to services for poor women---many of
whom are African American and other women of color---and the absence of strong antidiscrimination provisions. Currently, care for pregnant and postpartum women whose family
income is as high as 200% of poverty are covered, at no cost to them. Under the Plan,
however, subsidies will be only be available to families whose incomes fall under 150% of
poverty. This means that many low-income pregnant and postpartum women will have to pay
for health care that is currently provided by the governments. Health care reform should not
force women to make a choice between feeding their family and paying for health care.
Discriminatory atittudes and practices especially against the poor, women of color, the elderly,
and people suffering from diseases that carry a social stigma must be eliminated. •
"In addition, Medicaid currently pays for supplemental services such as transportation for
Medicaid recipients. The Plan will continue providing such services for AFDC/SSI cash
recipients only," said Scott. "This represents a major loss for non-cash recipients, many of
whom are pregnant and postpartum. These services are critical for this vulnerable population."
Scott said, "If these issues are not resolved, they will translate into critical barriers to care for
the poor.
1615 M Street. N.W. • Suite 230 • Washington. D.C. 20036 • Phone (20:!) 835-0117 • Fax (202) 833-8790
�FOR IMMEDIATE RELEASE
September 24, 1993
AMERICAN
CONTACT: Gabrielle Lange
.
2021785-7729
Gillian Ray
2021785-7731
AssociATION OF
STATEMENT OF EXECUTIVE DIRECTOR ANNE BRYANT OF THE
AMERICAN ASSOCIATION OF UNIVERSITY WOMEN
UNIVERSilY
AAUW'S 135,000 MEMBERS POISED TO TAKE ACTION
WOMEN
On behalf of the Am~rican Association of University Women and
its 135,000 active members, I applaud the President's and
Congress' commitment to securing the basic right of health care
reform for all Americans. AAUW strongly supports health care
reform that provides comprehensive reproductive health services,
including abortion and emphasizes primary and preventive care in
a variety of community settings.
As a leader in the Campaign for Women's Health, we are prepared
to join the other eighty organizations representing eight
million local activists in launching a nationwide grassroots
mobilization campaign to educate women across the country about
what is at stake for them in health care reform. Our strategy
will add millions of women's voices to the call for equitable
health care, and together our needs will be addressed in the
public debate.
Women's and girls' health needs have been long-ignored by the
male-dominated medical and political communities. Not only are
women the major consumers of health care services, but they
constitute the majority of health caregivers as well. Health
care reform must cover all our health needs to be meaningful and
effective. Singling out a condition for discriminatory
treatment is wrong and inadequate and we will not stand for it.
(more)
1111 SIXTEENTH STREET N.W., WASHINGTON, DC 20036-4873
202 785 7700 FAX: 202 872 1425 TDD: 202 785 7777
�;
CONTACT: Vicki O'Reilly
(202) 783-6686
MEDIA RELEASE
For immediate release
September 23, 1993
WOMEN'S GROUP SUPPORTS HEALTH CARE REFORM
WASHINGTON, DC -- President Clinton's health care reform proposal
offers substantial benefits to midlife and older women, leaders of
the Older Women's League,
Washington,
D.C.,
a
national advocacy group based in
said today.
"In recognizing that universal
access to health care is an essential right, the President has
taken an important step forward for all Americans -- especially
women," said OWL President Lou Glasse.
"We are pleased that the President's proposal authorizes
states to adopt single payer systems," said Glasse.
"OWL believes
that a single payer system of health care financing is the best way
to contain costs without sacrificing quality of care.
In the
meantime, we are pleased that the President has proposed a plan
that will cover part-time workers_, workers in small businesses and
the unemployed."
"It is women who are most likely to hold low-paid and parttime jobs," Glasse stated.
"For too long, many women have relied
on a husband's insurance plan to meet their health care costs,
leaving them without access to coverage if they were widowed or
divorced."
-more-
Older Women's league
666 11th Street NW, Suite 700 • Washington DC 20001 • (202)783-6686 • (202)638-2356 FAX
····!:'·~
.. ;·
�Add one
"OWL applauds the President's emphasis on long-term care,
within
homes
and
in community settings,"
said OWL Executive
Director Joan Kuriansky. "This is a vital concern for women who
both provide the bulk of family caregiving and are most likely to
require such care as they age.
Long-term care services in a full
range of settings -- at home, in community care facilities and,
when necessary,
in institutions -- must be available under a
comprehensive plan."
"We must ensure that state governments have adequate funds to
offer a full array of long term care services," Kuriansky said.
"At the same time,
we will work with the Administration and
Congress to avoid possibly excessive Medicare cuts -- which could
lower the quality of care and limit the number of health care
providers willing to serve Medicare patients."
Additional provisions of the President's proposal which OWL
praised are:
•
The coverage of preventive as well as acute care services.
•
The assurance that consumers may choose their own health care
providers.
•
Significantly expanded coverage of prescription drug costs.
"OWL's founders both died of breast cancer," Glasse stated.
"It
is
long
past
the
time when
Pap
smears,
mammograms
and
appropriate cancer treatments are unavailable to many older women.
We support cancer research and treatment schedules which provide to
women adequate and appropriate care."
-more-
�Add Two
"OWL
commends
the
President
and
Ms.
Clinton
for
leadership in bringing reform to this point," Kuriansky said.
their
"We
pledge to work with the Administration and Congress to successfully
ensure that every person in America has access to comprehensive
health care."
Founded
in
1980,
OWL
the
first
national
membership
organization to focus exclusively on issues of concern to midlife
and older women
provides leadership on health care issues. OWL
is represented on the three-member board of the Long-Term Care
Campaign.
It is the Convenor of the Campaign for Women's Health,
a coalition of 80 women's,
labor, and health care organizations
representing over 8 million Americans who seek to ensure that
women's voices are heard in health care reform.
-30-
�fd- c_
Senate Finance Hearing 9/30/93
SEN. MOYNIHAN: Thank you, Senator Breaux. Senator Chafee?
SEN. JOHN H. CHAFE.B (R-Rl): Thank you, Mr. Chairman.
Mrs. Clinton, I want to join in welcoming you here and pay
tribute to your tireless efforts in this area. I'm absolutely certain
that health care would not have the prominence it has now but for your
personal involvement, and I think we're all grateful to you. You've
been wonderful.
'
I just would like to point out one thing in connection with your
conversation with Senator Rockefeller and the points he raised.
Your plan does have an individual mandate to the extent of the 20
percent.
MRS. CLINTON: Yes, sir.
SEN. CHAFBB: In other words, the individual is responsible for
paying a portion of his or her -- the employee - insurance. Whereas
ours makes the individuallOO percent, yours makes him 20 percent. So
it's a difference of degree --
MRS. CLINTON: '11lat's right.
SBN. CHAFBB: -·more than the total difference.
The other point is, sort of referring back to what you were
tallcing with Senator Breaux about, regarding the taxation of benefits
over a certain level. In our plan we go into that; your plan you
defer that, but as I understand it, it is your intention that down the
road that would occur.
MRS. CLINTON: Yes.
SEN. CHAFEB: There would be a level - caD It the reasonable
level of beneftts. ADythlng above that would be taxable to the
employee and non-deductible by the employer.
MRS. CUNTON: That's absolutely rlaht, senator.
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Sill. LUOR r:IIIR/B. CLDr1'0ll
PAql 72
01/21/13
X X K point.
JiltS. CLIIft'Oif: And you're absolutely rlpt, and none of ua clo. I
aean, what ve are ~ing to create, aa senator Duz'~er aaid, ia a
dynaaio .arkat tbat reeponda to prlae and quallt.r and give• real
choice to conavaera, unllJca what uleta in IDAilY place• nov where there
ia no choice vhataoever; you don't have a lov, lladia or averave o:r:
hi;b plan, you've vot very little ace•••· And ve want to increaae
that ud ve ':r• 90in9 to watch tbat very carefully.
.
SIN. JCD"liiDYI ftllftk you vary auch. We have one final queationer
hare, our toocl friend senator Wofford, wbo baa bean one of our real
leadara on health ~•, and we'll bear hla tueationa nov.
•• knov that you have anotbe:r: baarin9 to te.tify, ao ve will not
have a aecond rounc:l of queationa, although ve' 11 aak our oolleaguea if
they do have quaationa to aubalt tha in· vritint. And after Sanator
Wofford, if there 1• a •ember that wanted to aay a v.r,r brief final
comment, we'd entertain that aa vall.
Senator Wofford?
SEN. HARRIS WOFFORD (D-PA): lira. Clinton, l'• happy to join
Senator Jeffords and others aa a coaponaor of th1a bill becauae J
think it not only :r:etle~a ay own bill of a fa&r and a half ago, but
it'• daai;ned to aaet the teat• that the preaident put to u1, and they
vera the teat• that I put to the people of Penn.ylvania two year• ago.
Kr. Cbainaan, you have carried thia ball tbz'o'Lip thick aJl4 thin
over the year•, and too aany of tboaa yaara have been thin yeara.
Harry Truman vaa beaten back when he tried to advance thia ball half a
century avo, and Riabard Hixon 25 yeara avo. But I believe ~· t:ilaa,
thanka to a president or the Uftited staua who ia committed and to tbe
-;-:-=~..-:ruat ·~ady ·or4Z• .land..:and .. tbe .~a~~·~ vQr~ .~at.. You have done,
.
lira. Clinton, we'r• voing to taka the ball acroaa the-voal,ine o:ta ... -·-···· .......
time. You won't fix the OOIIIlon oold, but I do thinJc that you ua
;oing to -- we ~ogatber, •• we presa hard, are 9oin9 to fix aany of
the aajor probl... of our ayataa that are vexint the American people.
Before J allk tbe quution ! want to allk about ea:r:ly ret:lreu and
worker• ooapenaation and poaaible aavinga there in thia ay•t. ., I
would like to introduce you to aoaaone behind you who helped ae
acsvance the all up in Pennsylvania, Dr. ltobert Ryniclc (ph), vho vaa
the -- Robert, atand up a ainute -· a leading ophtbalaolo;iat of
Pennsylvania, vbo said to ae, vben we were talkinf about how to refora
the health care ayatea, •senator, ve can refona the ayata, we can
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- . LUIOJt Cll'l'l/8. CLIJI'1'0if
ot/11/13
decide bov if ve ••~ the voal. And I jut vie you'd take thia
and take it to the people of PaneylYallia 11114 aay, in
tbia conatitution if you're ~9ed with a ariae you have a rlgbt to
lavyuJ it'• even ao&-a fundaental if you're aiok to bave a ri9bt to a
doctor.•
conatitu~ion
I took the l:aall froJD Ilia and ran vith it, u4 you're throvinq the
great !Mill to u now to ulce a reality of tbat.
On early retireea, %'4 be intereetecl 1ft YOUI" zoainding t:hia
beuinv What you're propoalnv there, ino1wlin; any coaente you bave
on any uort•tena •a•ur•• to atop the •ound •• the 9Z"eat ret.zoeatin;
aound of aapan.$.• preeaed J:»y 'their own coat czolai• vithuavin; froa
reducing or cancelling the ~nefit• for e~ly retireea.
DS. CLDTOJU 'fbank you, senator. But before I etart, I aut
aay 'that nona of ua aight be aitt1q bare if it bad not J:»ea to:r: your
courageous caapaip tbat vas waged on pi"'vidinf Ilealth care to every
citiaen of Pennaylvania. And that vaa a oall that vent out around the
country with your viatozy, and I'a just pleased that you will be part
of actually delivei119 on that promiae to your people and to the
people of tbis nation. And I'• very grateful to:r: the leadarllhip
you've ahovn on tbie iaaua.
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OJ/21/13
PAGB 74
x x: x iaaue.
I Jmov of yov deep aoncam about retirees, paRiaularly thoae are
being denied health benefit• Vh1Ch ther thought they had, in a aenae,
paid for throu;h coll.ective bargainint afJI'eauta and tbz'oup other
a9Z'eaanta vith aployua over their vorJc 11vaa, ud 1:t ia a aerioua
prol)la. An4 it ia a probla J»tb for the ift4ividua1 who ia, pchape,
unpredictablJ in their live• denied haaltb oare Vben they aoat need
. it, and it ia an eaonoaic probla for aany of our ooapaniea which have
laborecl under auch greater coste than thelr coapetitor• 1ft tzyin9 to
meet their health care needa.
.
We have proposed tbat the burden of retiree ~efita of thoae who
retire between the agaa of 55 and &5 attar a certain eat period of
work who are not yet eli;ible for Kecl1aare be taken off of the baCks
of the aployara and be shared between the eaployer• and the federal
government. We bava coa~ad thia out at about $4•1/2 billion a yea~.
wa believe it ia sound public policy beaauaa it doea ~•laaae an
enormous amount of economic potential in the ma~katplaca by takin~
ia lmrdan that aome aployara bear but moat do not. The -ployara
ould continue to be raaponaible to~
•
ant under
thai~ contract•· o ·
ind of lump aua a
t, ~ut
the a eral governaent would pick up the rea ,
vou parantae
health aacurity to those individual• vho are cau~bt between their work
livea and Medicare elivibility, Which va think would be an appropriate
kind of aecurity to extend to thn vith tbair maJd.ilg the contribution
aa they were able. And if they vent to vorJc after t:hay retired, they
would be required to do ao.
SEN. WOFFORD: Do you have any thought• on a atop-gap 11eaeve
auCb aa aome of ua are propoaing ~tween nov and vben va deliver the
goode of a univaraal, affordable health aecu.rity ayat..?
-MRS. CLIIITQlf 1 · We ·-will certa-inly look at ~t... .-% '• aware of . .the.
legislation tha~ you have aponaored an4 your atron~ statement• on
behalf of that le~ialation. Obvioualy, we hope that the Convr••• will
deal with health care refor.a axpeditioualy ao that it aay not be
nacaaaary for any transition or atop•vap, but we will certainly keep
that under aonaideration.
SEll. WOFFORD I And any laat vorda or fi~at worcla on VOZ'Jcer' •
companaation and hav it will be included in tbie aa a way or aavinga
for bu.aineaa?
.
liltS. CLIHTOH: We vu:y ncb would lilca to aee the vorkar'a
compensation health care benefit• integrated into the national health
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PAGI 75
01/21/13
care .Y-'•· •• thiDk that would be a vreat l:leftefit to aull IN8ifteaa
putic:ularly, !nat to all wainua that ue nov paying iftcreaaintlY
high worker'• campenaation pr..iuma. We alao would like to work
towu-d an integration of the enth-e vorJcU"'a cap ayata if ve are
.able ~ aaJte adequte eoatitutea for vorkplaae aafety an4 the Jd.ftda
of lnclu~enta for •afety that the CNZTent. ayat• providea thl"outh the
experience rating of ina~anae prea1uae in that ayat... But at tbe
vary beg1Mill9, ve would like to begin by integratint that portion of
vorJcw'• cap in~g P• llul~ cue paput !ill&t tbe employer and
employe• vould .bare ana &avlng the accountatife health plana then
contract to delivU' the kinda of health aazviau tbat vorke• algbt
need, 1Mlu41NJ rahuilitation aenioea.
Lt--8Eif. WOJ'FOitD 1 ftal'lk you.
8111. XINifiDY 1 We oomputed the tiae. ••· find a.nator KaaauaWD
bad one ainu~• left, aftd it ae... •he baa one YerY . . .11 queation.
And I thil'lk we'd like to juat -- (laughter).
·
SIN. DSS~tnh 'lila advantat•• of baing ·a ranking aaber and a
thoughtful chairman. I appreciate it, and I appreciate, ~·· Clinton,
all the time you've given. But there ia a vitaeaa coming tomorrow,
and % would kind of like to gat your anaver to tbia queation.
I '• aure each and every one of ua bare have at one ti•e or
another triad to help oonetituanta in our •tat•• raioe aoney to cover
coatly experimental procedurea, particularly ~anaplant procedure•,
and have done fundraiaara and •o forth. In thla caao, thia 1• a
motbar who baa a aalitnant melanoma who•• aelt-in•uro4 -- her
eaployer'• •elf-insured plan doean't cover coat.ly procad~e -experimental procedure. ·
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01/21/1,
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PAGB 71
'
proced~e.
Sbe baa 90fte ~oup all the traditional traat.ent protocol• and they
baven 't worked, and they're recoaaen4inv a bone ~ov t.ranaplant.
would aucb a procedure be OOY81'e4 under the plan aa 1t'a dev1aed nov
-- the aoatly expariaen1:al procedvea, transplants?
IIRS. CLD'l'OJfl %f a proaadure ia tzuly apRDalltal, ao that it
• not yet proven in a~opriate re..~ah tria1a ita a11niaa1
ecfiaaoy for treatinv a CU"tain diaaaae, it vi11 not a. oonaiderecl for
.cluion in the 9WlJ:'Uteecl benefits pacJcage, but accountable health
plana, aa they do nov, will oeztainly be frM to offer any proaecl••
tbat they ohooae to do ao. once a p:rooedve .1a at111 considered
expariaantal but provable, tban it . .y be conaiderad by the national
board to M included in tbe benefit• paoJcage. So tbere will be aoae
time la; there.
What we have been telling people in tbe condition of tbe waaan
you deacribed ia tbat bealtb plana currently aue available around the
country aome procedvea tbat. othv health plana do ftOt. 'l'here are
soma that provide reiabura..ent for bone .arrow kinds of procedures
vith respect to breaat cancer and other klnu of cancer, and otber
plans Which do not. We believe that that will continua to be the
caaa, b\lt nov the conaaer will be al:»le to chooaa tho plan tbat doe•
provide that kind of tl"eataant ao that there v111 M a clear up-front
commitment if -- we provide the aervice even thOGfh it ia at111
con•idered maybe expert-ental and not totally prDYen, you or I will be
able to join that. or ve will lMa able to buy 1ft tbe •upplaental
ina~anca market coverage for that, vbich ie not naw readily
available.
So ve think that the nat effect will be that thia WOJDan, and
women like her, will have much vraater choice to gain ooverate for
·~·~ia procedur.e befora tbe. na'iional ~ard_yere .~o 1l•~ide ·it· could be part of the benefit• paCkage aa a utter of cour•e· .
.
1111. DSSDA.mt: So you wouldn't appeal to the alliance?
health alliance would not .aka a daclaion Z'8f&r41nt --
'l'he
ICRS. CLIII'l'Oif: Well, the health alliance would in tile first
inat.ance decide vbetber it vaa go.t.nv to offer tbat eervlce, and if 1t.
id, then it would be part of tba benefits that the health plan iuelf
ere to offer. And What ve a lao think would be available ia the
''~oint•of•aervice option that we want every plan to offer, includinv
the oloaad panel 111108, ~·• that would ~en H a 'afen"al. ftere
aight have to tie eoaa additional payaant, but it voulCift't be the kind
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PAGI 17
1111. L&IOa CIITI/8. CLDITOll
01/21/13
of bo~lfic oo•t• tbat nov are faced br individual• who are out tbere
all by theaaelvea.
And I'd M bappy, ift preparation for your vitne•• tomorrow,
Senator, to bave witten dovn exactly Vbat our pracduzoe 1• vitb acme
exaaplu an4 aoaa aaenarioa aa 'to bow we beli.va 1t would vork, if
that would ~ helpful.
!'bank
1111. DSSIBAml:
SBII. KDJIII)Y:
)'CN
very IIUcb.
hat a cloaini bl'ief c:cmunt
r.- any
aenator.
Senator Dodd?
'fbank you very ac:b, e. C!lainan. AM juat vezy
if I can. One, I 'uat wanted to -- I appreciate your
coaenta about t.be pbanaceutlcal induatzy. Senator Siaon raiaed t.be
iaaue an4 you talk~d about trying to find thia a1x hue. And I juat
- and I know you're aware of thia, and like any othw 1ndu8try 'there
are good pya and bad pya, I
But imPortant to note, I tbiftk,
that it takea on the averave &bout $400 ailllon and 12 yeara for a
product to 90 from laboratory to aarket, and only about one in 5,000
actually •aka it tr• the laboratory to tha .arket.
SIR. DODD:
~iefly,
vu•••·
And •o aa we look at individual pieces here and it can aauae our
level of anver to riaa. But looking overall at the in~edible
contribution overall that tbat industry baa made to tha bealtb of this
country is aoaetbiftt that % think neada to be aphaaiaad. An4 I raiae
that in the context -- and maybe you'd ude a M'iet coaent on it, if
you would -- I've liatened to you countless tiaaa -- and talk about
tba .role of the privata sector, how iaportant it ia, that Whatever
plan va develop ~ extremely aanaitiva to aaall bua1nasa in tbia
country, bow critical that COIIponent· ia to this country'• aconomio
aucc•••· Thera ia out thara thia notion aomabov that this ia antibuaineaa, that this ia particularly anti-small buaineaa.
-·JIOU ·- ... · ·-·- -·-· ·
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�Public Health Initiatives and savings
1)
Amount of Public Health Savings/Offsets
"Public health savings:
6 Table)
Issue:
-$13b (1995-2000)" (Appendix, Sept.
The assumed public health savings are too fast and
excessive.
·
While public clinics will receive some new reimbursements
from their clients for covered services, the savings may
not come quickly and could result in a significant cash
flow problem. In addition, these clinics have specific
cost problems, provide basic services to undocumented
persons, and provide a range of uncovered services to
other vulnerable populations; offsets in these programs
will also result in visible political problems. These
services should receive continued grant support and be
expanded; assumed savings should be slpwed or dropped.
2)
Formula grants for access
"New Formula grants to States provide funds to ensure access to
health care for low-income, underserved, hard-to-reach, and
otherwise vulnerable populations." (p. 183)
Issue:
3)
These services should be provided through existing grant
mechanisms to serve such populations (e.g., community and
migrant health centers, family planning clinics, Ryan
White, etc.) No new formula grant should be proposed.
co·re Public Health Functions Formula Grant
"Funds are distributed ... on a formula •••• States are required to
maintain their current level of support •••• Accountability ••• is
monitored through reporting progress in achieving health
improvements." (p. 147)
Issue:
Formula grants ar~ difficult to follow, account for, and
oversee; cash-strapped States will supplant existing
efforts and maintenance of effort restrictions are
unenforceable (no baseline is measurable) • A new public
health infrastructure project grants progr~ for State
and local health departments should be proposed instead;
no formula grant should be proposed.
�4)
Priority Health Problems Initiative
"[The initiative] also focuses attention on specific health
problems of regional and national significance to consolidate
categorical programs into an integrated health system, reducing
administrative burdens." (p. 144)
Issue:
5)
Consolidation of categorical programs that have been in
place will limit available funding and undermine existing
efforts.
Increased funding for ongoing programs with
administrative simplification and expanded demonstration
authority should be pursued instead and the new proposal
should be dropped.
Essential community providers
"Independent health professionals and health care institutions
operating in underserved areas may apply to DHHS for designation as
essential community providers.
Plans are. required either to
contract with essential providers at a capitated rate no less than
that paid to other providers for the same services or to reimburse
them at rates based on Medicare payment principles. By the end of
five years, providers either become integrated into health plans or
join together to create new community-based health plans. At that
time, plans must either demonstrate their capacity to provide
access for all participants or continue contracting arrangements
with essential providers." (p. 184)
Issue:
6)
The contracting protections tor essential community
providers should be extended beyond five years and
extended to include protection against excessive r1sk.
Family planning clinics, which serve as primary care
providers for many women, should be presumed to be
essential as well.
Amount of Public Health Investments
"New public health initiatives:
Sept. 6 Table)
Issue:
+$17b
( 1995-2000)"
(Appendix,
There are significant missed opportunities here. Public
health services (both basic public health and service
delivery) require significant new investment, far beyond
this level.
(TB control ·alone during could reasonably
consume $3. 5b over this period, and failure-·to provide
this will predictably result in significantly expanded
costs to the Plan and its alliances.)
It is unclear if this line is supposed to include the
proposed $9b of biomedical/health service· research
initiatives as well. If so, this is significantly worse.
�.
.
Medicaid and Low-income Issues
1.) Premium Subsidy Levels.
"An individual or family eligible for a subsidy pays the
difference between: (1) their plan's premium and (2) the sum of
their subsidy and So percent of the average premium in the
alliance." (p. 226)
Issue: To assure the poor a realistic choice of a fee-forservice plan, the premium subsidy must reach premiums higher than
the average in cases where there is no fee-for-service plan
available in the alliance with a premium at or below the average.
2.) Cost-Sharing Subsidy Levels.
"In areas not served by a plan or network with low cost
sharing and a premium at or below the average premium in the
alliance, individuals with family incomes less than 150 percent of
the poverty level qualify for subsidies to cover co-payments and
deductibles." (p. 227)
Issue: Cost-sharing subsidies must be available even in plans
with low-cost sharing and even where the premium is at or below the
average premium in the alliance.
3.) Sliding Scale for Premium and Cost-Sharing Subsidies.
"Subsidies are available to individuals and families with
incomes up to 150 percent of poverty." (p. 226)··
"In areas not served by a plan or network with low cost
sharing and a .premium at or below the average premium in the
alliance, individuals with family incomes less than 150 percent of
the proverty level qualify for subsidies to cover co-payments and
deductibles." (p. 227)
Issue: Individuals with incomes below 100 percent of poverty
must receive subsidy coverage for all premium and cost-sharing
obligations.
A sliding scale should apply between 100 and 150
percent of poverty..
·
4.) Entitlement Nature of Subsidies.
"Subsidy costs are borne by the Federal government."
(p.
222).
"Federal payments for subsidies are net of State Medicaid
maintenance of effort payments to alliances." (p. 237).
Issue:
For Federal budget purposes, the Federal subsidy
payments must constitute an individual entitlement in the same
substantive and procedural senses · as current Federa·l Medicaid .
matching payments do; they must not be subject to annual
appropriations caps.
5.) Bona Fide DSH Hospitals and other Essential Community
Providers.
"Phase down the [Medicare] DSH adjustment by 1998. 11 (p·. 198).
"[Medicaid]
DSH payments
will
be
eliminated.
The
implementation schedule for this proposal is under review."
(p~
203)
"Independen·t health professionals and health care institutions
�operating tn underserved areas may apply to the DHHS for
designation as essential providers.. Plans are required either to
contract with essential provide~s at a capitated rate no less than
that paid to other providers for the same services or·to reimburse
them at rates based on Medicare payment principles. By the end of
five years, providers either become integrated into health plans or
join together to create new, community-based health plans. At that
time, plans must either demonstrate their capactity to provide
access for all participants or continue contracting arrangements
with essential providers." (p. 184).
Issue: The Medicare and Medicaid DSH subsidies must not be
phased out with respect to bona fide DSH hospitals identified by
the Secretary until the alliances certify that universal coverage
within that institution's service area has in fact been achieved.
The contracting protections for essential community providers
described at p. 184 should not be limited to 5 years, and should be
extended to include not just minimum payment guarantees but also
protection against the shifting of excessive risk to the provider
by the p l_an.
6.) Medicaid LTC Services.
"[c]urrent ·M~dicaid programs for those who do not meet the
eligibility criteria of the new program of community-based services
for people with severe disabilities are replaced with a new
community-based LTC program for low-income people. The Medicaid
community ·LTC ·services which are combined into the new low-income
program are:
personal ·care, home and community-based waiver
services, frail elderly, CSLA services, the lon-term care portions
of home health care, targeted case management, clinic services, and
rehabilitation services." (p. 156)
·
"Eligible individuals are assessed and receive a plan of care.
There is no further entitlement to community services." (p. 156)
Issue: Existing Medicaid LTC community services must remain
individual entitlements as under current law.
7.) Supplemental Services.
"Supplemental services for cash recipients will remain as in
current law.
Under consideration is conversion of supplemental
services payments for cash and non-cash recipients into a block
grant ••• " (p. 201)
Issue: The current entitlement of Medicaid eligibles (cash~
non-cash) to supplemental services, especially supplemental EPSDT
services, must be maintained.
8.) Illegal Aliens.
"Undocumented persons are not eligible for guaranteed health
benefits •••• Individuals living in the u.s. without proper
documentation may continue to use emergency and other ·health
services as provided under current Federal law.
Health care
institutions that serve a large number of· patients who are not
eligible for coverage continue to receive Federal funding to
compensate for their car~." (pp. 16-17)
·
Issue: Is this Federal funding discretionary or entitlement
authority? How much is it?
�COMMENTS ON MEDICARE PACKAGE
GENERAL COMMENTS
o
Overall, this package is excessive in light of OBRA 93
cuts and other proposals in the package.
o
Deficit reduction should not be built into this plan.
There are no assurances about what will be required of
Medicare for deficit reduction in each of the future
years covered by these Medicare cuts.
o
The implementation of some of the largest cuts are not
coordinated with the transition to universal coverage.
HOSPITAL CUTS
o
The phase-out of DSH & IME payments begins Oct. 1, 94 - clearly would be disruptive to institutions serving
uncovered patients. Phasing should be delayed.
o
Capital payment cuts are too high, given cuts in place
under OBRA 93 and need for c~pital in financially
vulnerable public & voluntary hospitals. Need targeted
capital assistance program for vulnerable hospitals.
PHYSICIAN CUTS
o
The 3% reduction in the fee schedule conversion factor
is not strongly supported. Seems to be arbitrary cut.
o
Tighter expenditure targets assume physician services
grow at same rate as overall economy. Speed of these
cutbacks could result in Medicare payments to doctors
below payments in private sector. Should provide a
phase-in for this change in growth rate that follows
overall phase of growth limits.
BENEFICIARY CUTS
o
Income testing Part B premium has potential to drive
out healthy/wealthy. overall policy on individual
responsibility for premiums should not put Medicare
beneficaries in a worse position. If premium is raised
for higher income people, it should not exceed 20% of
Medicare program costs, putting higher income
beneficiaries in comparable position to others.
o
Setting Part B premium in law beginning in 96 is based
on using CBO Part B estimates. These. are higher than
OMB e·stimates resulting in a higher actual dollar
premium amount. Part B premium would bring in about
28% of program costs against OMB baseline. Congress
should continue 25% policy as included in OBRA 93.
�Medicare Savings Proposals
(All Proposals In Addition to OBRA 93)
Proposal
5-Yr. savings
($ in billions)
Hospital-Related Cuts
Continue PPS MB cuts
at -1%/yr
$8.9
Cut IME to 3% in 96
16.7
Phase out DSH payments by
98
21.5
Continue inpatient capital
cuts
10
Set rates for hospital OPD
services*
22
TOTAL Hospital
$79.1
Physician Cuts
Tighter MVPS formula (bring
growth in line wjGDP)
$6.7
Base future MVPS on target
rather than actual
2.3
Cut conversion factor 3%
2.8
TOTAL Physician
$11.8
Other Providers
Competitive bids for labs
$2.8
Lower HHA cost limits (100%)
1.9
Set cost limits for LTC hosp.
1.4
Competitive bids for Part B
services
TOTAL Other Providers
• 9.
$7.0
�.. · y
' ' "'T \I \IT/ I' "T
"T
. :.ill.·-.
September 20, 1993
To~
Chris Jennings, Melanne Verveer
From: Sheila Nix
RA· Sl!lnator Kems1y's Coccarna pn the Hog!tb Scoyrjty Aot
The following is a recap of the concerns Senator Kerray voiced at
last Friday's meeting:
1. _confidence in the cost estimates, Senator Kerrey is concerned
about tha accuracy of the oost estimates.
He does not believe tha
plan can be financed by cuts in Medicare and Medicaid and excise
taxes. The issuance of a Health Security Card does not assure high
quality health care. The nation has been able to afford high quality
care because the United States Is a wealthy nation. We must
continue to improve the economic status of the citizens as well as
the country.
2 ... _New Entltlement. Senator Kerrey is concerned that the plan is
being sold as a new right for every Americans and the reciprocal
message of responsibility is not being voiced. Senator Kerrey is
also concerned that since the federal government has not been able
to control ourront entitlement spending. it will not be able to
control the costs of a new entitlement.
3. Who Deojdes? Senator Kerrey is concerned that decisions
regarding the definition of health will be made by insurance
executives or government bureaucrats and there will not be an
ndoquate disousslon of health Issues by the American public. The
public needs to engage in a broad based discussion on costs and
benefits within the health care system.
4. Structure of the Alliances. Senator Kerrev Is concerned that the
system will not provide incentives for low-cost, smaller
competitors.
Already, large alliances are being formed by those
entitles that have contributed to the problems of the current health
care system.
��Beneficiary Increases
Raise Part B premium (to 75%)
for high income beneficaries
$6.1
Add 10% co-pays to HHA visits
(after 30 days)
8.3
Add 20% co-pay to lab services
7.0
Set Part B premium in law
TOTAL Beneficiary Hits
15.9
$37.3
Other Savings Policies
Extend Medicare Secondary
Payer -ESRD & Disabled
Cover all state & Local
workers
TOTAL
GRAND TOTAL
$3.0
8.1
$11.1
$146.3*
*This savings item is used to pay the costs of bringing
beneficiary cost sharing for hospital outpatient services to 20%
of prospective outpatient rates. Thus, the Grand Total of $146.3
billion includes $22 billion that should be netted out, leaving a
total of $124.3 billion in savings.
�HEALTH CARE
REFORM PROJECT
FOR IMMEDIATE RELEASE
September 15, 1993
Contacts: Charlie Leonard
Andrea Sussman
202/296-2777
m~V@K~ @~
~~~~((b\00$ ~@~
0~£00@~,
OO@W.
2550 M N.W.
Street,
Washington, D.C. 20037
Consumers. Business. Labor, Providers and Older Americans Launch
Campaien in Support of Comprehensive Health Reform
Coalition Vows To Act As Watchdo&.
Uaes HIAA to Withdraw Ads
Project Asks Conl!reSS to Endorse Reform Principles
WASHINGTON, DC -- A unique alliance of business, consumers,
labor, health care providers, and older Americans today announced its support
for comprehensive health care reform and its intention to act as a watchdog to
hold opponents of reform accountable. The Health Care Reform Project -representing more than 50 million Americans -- is the most diverse
organization and the largest coalition to enter the health care debate.
Lena Archuleta of AARP described the coalition as "the face of
America seen from every angle and in every light --- and without regard to age
or race or wealth. The organizations in the Project represent a total
membership of 50 million American men and women and share among .them
years and years of fighting for health care reform."
Signaling that the Project intends to take its watchdog role seriously,
AFL-CIO President Lane Kirkland delivered a tough message to one initial
opponent of reform. "The health insurance industry, for example, has already
started running an apocalyptic television advertisement implying that President
Clinton's plan will bring benefit reductions and limits on choice to the middle
class. We intend to see that they don't get away with it," he said. Kirkland's
remarks included a request to HIAA for them to stop running their ad.
"Our health care system is failing both our nation's families and its
economy," said Becky Cain, President of the League of Women Voters,
speaking on behalf of consumer organizations in the Project. "The question no
longer is 'Why do we need health care reform,' but 'How fast can we get
reform so we ca11 have the quality, reasonably-priced coverage we all need.'"
At a Washington news conference, Iohn M. Tudor, Ir., MD.,
President of American Academy of Family Physicians announced the Project's
eight principles of comprehensive reform (copy attached). The Project also
�sent a letter to Congress asking Members to show their support for health care
reform by signing and returning the statement of principles, and offering to
sponsor town meetings jointly with them.
Margaret Jordan, Vice President for Health Care, Southern California
Edison Company, warned Congress of the dangers of inaction. "Health care
costs are growing out-of-control and the action of individual businesses alone
are insufficient to address this problem," she said. "As in the private sector,
this growth in health care spending diverts funds from other important
initiatives ... which are key to improving our competitive position."
Members of the Project pledged to mobilize the full resources of their
organizations and their members to push for comprehensive health care reform
this year.
The following organizations are founding members of the Health
Care Reform Project: AFL-CIO; American Academy of Family Physicians;
American Academy of Pediatrics; American Airlines; American Association of
Retired Persons (AARP); American College of Physicians; American Nurses
Association; American Federation of State, County and Municipal Employees
(AFSCME); Campaign for Women's Health; c,tholic Health Association;
Chrysler Co:rporation; Citizen Action; Families USA; League of Women
Voters; National Association of Children's Hospitals and Related Institutions;
National Association of Social Workers; National Education Association;
National Health Policy Council; Howard Newman; Older Women's League;
Service Employees International Union; and Southern California Edison
Company.
-30-
�Founding Members
Press Contact List
HEALTH CARE REFORM PROJECT
Press Contacts: Charlie Leonard, Andrea Sussman (202) 296-2777.
AMERICAN ACADEMY OF FAMILY PHYSICIANS
The American Academy of Family Physicians, headquartered in Kansas City,
Missouri, is the national medical specialty society representing 75,000
practicing family physicians, family practice residents in training and medical
students. Press Contacts: WDC: Rosemarie Sweeny, Vice President
(202) 232-9033; Kansas City: Robert Graham, MD. Executive Vice President
(800) 274-2237.
AMERICAN ACADEMY OF PEDIATRICS
The American Academy of Pediatrics is an organization of 45,000 pediatricians
dedicated to the health, safety and well-being of children, adolescents and young
adults. Press Contact: Graham Newson, Assistant Director (202) 347-6137.
AMERICAN AIRLINES
Press Contact: Degee Wilhelm, Managing Director, Government Affairs
(202) 857-4204.
AMERICAN ASSOCIATION OF RETIRED PERSONS (AARP)
AARP is the nation's leading organization for people 50 and older. It serves the
needs and interests of its nearly 33 million members through legislative advocacy,
· research and community services provided by a network volunteers. Press
Contact: Peter Ashkenaz, Media Liaison (202) 434-2594.
�AMERICAN COLLEGE OF PHYSICIANS
The American College ofPhysicians, founded in 1915, is the nation's largest
medical specialty society, with 80,000 member physicians practicing internal
medicine and its subspecialties. Internists provide the majority of adult primary
care in the United States. Subspecialties of internal medicine include cardiology,
endocrinology, gastrointerology, oncology and numerous other areas of
medicine. ACP publishes the Annals of Internal Medicine. Press Contact:
Kathleen Haddad, Senior Associate, Public Affairs (202) 393-1650.
AMERICAN FEDERATION OF lABOR AND CONGRESS OF INDUSTRIAL
ORGANIZATIONS (AFL-CIO)
The AFL-CIO is a national federation of87 unions with 14 million members in
virtually every known occupation. Press Contact: Colleen O'Neill
(202) 637-5027;
AMERICAN FEDERATION OF STATE, COUNTY AND MUNICIPAL
EMPLOYEES (AFSCME)
AFSCME is the nation's largest public employee and health care workers union,
with 1.3 million members. Press Contact: Bob Harman, Director of Public
Affairs (202) 429-1130.
AMERICAN NURSES ASSOCIATION
The American Nurses Association is the only full-service professional
organization representing the nation's 2 million Registered Nurses through its 53
constituent associations. As the largest group of front-line health care providers
in the country, the American Nurses AssoCiation has worked for nearly 100 years
to assure high quality health care for all people. Press Contacts: Marie Morse,
Political Director (202) 554-4444 ext. 450; Joan Meehan, Press Liason (202)
554-4444 ext. 244.
CAMPAIGN FOR WOMEN'S HEALTH
The Campaign for Women's Health is a coalition of 80 women's
organizations, unions with large female meberships and health care
organizations who have come together to ensure that women's health care
needs will be adequately met under health care reform. Press Contact: Vicki
O'Reilly (202) 783-6686.
�THE CATHOLIC HEALTH ASSOCIATION OF THE
UNITED STATES (CHA)
CHA represents 1,200 hospitals, health care systems, nursing homes, and related
organizations nationwide, constituting the largest single group of not-for-profit
health care facilities in the United States. Press Contact: Jack Bresch, Division
of Government Services (202) 296-3993.
CHILDREN'S DEFENSE FUND
The Children's Defense Fund exists to provide a strong and effective voice for
all the children of America, who cannot vote, lobby, or speak for themselves.
CDF pays particular attention to the needs of poor minority, and disabled
children. Their goal is to educate the nation about the needs of children and
encourage preventive investment in children before they get sick, drop out of
school, suffer family breakdown, or get into trouble. Press Contact: Lynn
Bowersof, Director of Media Relations (202) 662-3613.
CHRYSLER CORPORATION
Representing over 90,000 employees in 45 states and the District of Colombia.
Press Contact: John B. Guiniven (202) 862-5409.
CITIZEN ACTION
Citizen Action is the nation's largest citizens organization with 3 million members
in 32 states. Press Contact: Ed Rothschild, Media Director (202} 775-1580.
FAMILIES USA
Families USA is the consumer group fighting for health and long term care
reform. Press Contacts: Arnold Bennett, Media Director {202} 737-6340;
Aviva Shlensky, Deputy Media Director (202) 737-6340.
THE LEAGUE OF WOMEN VOTERS OF THE UNITED STATES
The League ofWomen Voters is a nonpartisan, political organization that
encourages the informed and active participation of citizens in government and
influences public policy through education and advocacy. Press Contact:
Maggie Simpson, Public Relations Manager (202) 429-1965.
�NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS AND RELATED
INSTITUTIONS (NACHRI)
NACHRI represents the nation 1 s children 1 s hospitals as well as children 1 s
specialized facilities and pediatrics departments of major university centers
devoted to the healthcare needs of all children, including children with special
health care needs and children of low income families, as well as the training
of future pediatric providers. Press Contacts: Ira Allen or Lisa Tate
(703) 684-1355.
NATIONAL ASSOCIATION OF SOCIAL WORKERS (NASW)
NASW represents 145,000 professional social workers. Nearly two-thirds of
NASWs members practice as primary care providers in such health and mental
health care settings as hospitals, community health and mental health centers,
managed care and private practice. Press Contact: Lucy Sanchez, Director of
Public Affairs (202) 408-8600.
·NATIONAL COUNCIL OF SENIOR CITIZENS
NCSC is a national advocacy organization, representing 5 million senior
citizens with 5,000 clubs and councils nationwide. Founded in 1961, it was
the leading organization in the fight for Medicare and Medicaid. Press
Contact: Patrick Bums (202) 347-8800
NATIONAL EDUCATION ASSOCIATION (NEA)
NBA is the largest union in the United States representing 2.1 million public
school teachers, support personnel and higher education faculty. Press
Contact: Michael Edwards (202) 822-7564.
NATIONAL HEALTH POLICY COUNCIL
NHPC is a. bi-partisan, not-for-profit consensus development organization that
includes consumers, providers (physicians, nurses, hospitals, etc.), business and
union leaders. Press Contacts: Steve Gleason, Washington Representative
(515) 222-7270; Liz Shannahan, Director (515) 222-7270.
�HOWARD NEWMAN
Currently Dean of the Robert F. Wagner Graduate School of Public Service at
New York University; Administrator of the Health Care Financing
Administration in the Carter Administration ( 1980 - 1981 ); President of the
Dartmouth-Hitchcock Medical Center, Hanover, NH (1974-80); Commissioner
of the Medicaid Program in the Nixon Administration (1970-74). Mr. Newman
is an independent member of the Health Care Reform Project. Press Contact:
Howard Newman (212) 998-7410.
OLDER WOMEN'S LEAGUE (OWL)
OWL is a national membership organization advocating on behalf of mid-life
and older women. Press Contact: Vicki O'Reilly (202) 783-6686.
SERVICE EMPLOYEES INTERNATIONAL UNION (SEIU)
With more than one million members in the U.S. and Canada, the Service
Etitployees International Union is the fourth largest and fastest growing union
in the AFL-CIO. It is the largest union of health care workers in the nation.
The union also represents public employees, office workers, janitors and
workers in a range of service occupations. Press Contact: Denise Mitchell
(202) 898-3320.
SOUTHERN CALIFORNIA EDISON COMPANY
Southern California Edison is the nation's second-largest electric utility (based on
number of customers) and serves nearly 11 million people in Central and
Southern California. Press Contact: Margaret Jordan, Vice President Health
Care (818) 302-5519.
�HEALTH CARE
REFORM PROJEO
The Health Care Reform Projec;t
Mission Statement
n~~ V©~~~ ©~
b\rJd~~~((£00§ ~@~
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OO@W.
2550 M N.W.
Street,
Washington, D.C. 20037
AFL-CIO
The Health Care Reform Project is a nonpartisan coalition of consumers,
business, labor and providers whose members are committed to comprehensive
reform of the U.S. health care system through the passage of national
legislation that will:
AFSCME
American Academy
of Family Phyeiciana
American Academy of
Pediatrics
American Airlines
American Association
of Retired Persona
American Collage
of Ph~iciana
American Nuraea
Association
Catholic Health
· Association
Citizen Action
Families USA
League of
Women Voters
National Association of
Children's Hospitals and
Related Institutions
National Association
of Social Workers
National Health
Policy Council
Service Employees
International Union
Southern California
Edison Company
1. Assure all Americans • the security that they will never again lose
their health care coverage, that all of us will be protected, and that
coverage will be comprehensive and affordable.
2. Slow the growth of health care inflation by eliminating waste,
fraud, and overcharge throughout the health care system.
3. Improve the quality of health care for all Americans.
4. Make the health care delivery system better serve the needs of
people and communities and foster, enhance and promote the health
and wellness Qf all Americans.
5. Simplify billing and record keeping for both patients and providers
in order to concentrate health resources on patient care.
6. Protect consumers by assuring they can continue to choose their
health care providers, are given meaningful information for making
those choices and are assured of representation on key decisionmaking bodies.
7. Promote the coordination of patient services across the full
continuum of care, including both acute and chronic illnesses.
8. Provide adequate and equitable financing to ensure an immediate
and sustained financial commitment to fulfilling the promise of
comprehensive reform.
�The Project is not tied to any particular legislative proposal, but all
participating organizations are united in their conviction that Congress must
enact comprehensive health ,care reform without delay.
The project members have joined together to work more effectively for
comprehensive reform. The Project seeks a bi-partisan solution to the health
care reform crisis, working with the Administration, members of Congress on
both sides of the aisle, other interested organizations, and the public in support
of proposals that achieve our objectives listed above.
We will mobilize an effective expression of public support for comprehensive
health care reform by sharing information and resources, presenting unified
messages, and coordinating our advocacy activities.
In joining this coalition, each member organization retains its autonomy
regarding specific legislative proposals or modifications that it may support.
The coalition will operate as a support structure to member organizations to
better enable them to work on behalf of all Americans for comprehensive
health care reform .
.
....
�The Factual Case for Reform
HEALTH CARE
REFORM PROJEO
TK: VOICE OF
1\MERICANS FOR
CHANGE, NOW.
2550 M N.W.
Street,
Washington, D.C. 20037
The Health Care Refonn Project is committed to comprehensive health care
refonn because we believe Americans are spending too much to get too little.
Refonning our health care system is essential for our citizens, our economy,
and our future.
The facts are conclusive: we are in an indisputable crisis, in need of
immediate solutions.
Today, too many Americans don't have peace of mind about their
health care coverage.
•
Bvery month, 2 million Americans lose their health covemge. Over the
next two years, 1 out of every 4 Americans will be without health
covemge at some point.
•
10 million children under the age of 18 don't have health care
covemge. Often, parents are insured through jobs but can't afford copayments for dependent covemge.
•
40% of American families have had health benefits cut back. Other
American families are denied covemge because a child has asthma or a
parent has diabetes.
•
1 in 5 workers say they or a family member are locked in their jobs
because they fear losing their health care covemge.
..
•· 85% of Americans who have lost health insumnce-~.workers and
their families.
•
Most employers now provide health insumnce, but nearly 1 of every 3
small employers say they expect rising costs will eventually price them
out of health inSUI3.Dce. ·· ·
··
..
-,
..;.,·~-.'
'. ·-
..
; - -.,..;.:t ..••
~-
Today, health care Inflation Is out of controL
•
Fmud and abuse cost America $80 billion -10 cents of every health
care dollar.
• .25 cents of every health care dollar on a hospital b~ goes to
Administrative costs and does not buy any patient care.
• ·A Blue Cross/Blue Shield study found that the cost of nearly identical
healthcare benefits packages varied by as much as 350%.
�•
How much Americans are charged for health care has quadrupled since 1980. If
current practices continue, one out of every five dollars America spends will be
spent on health care in the year 2000.
• Health care prices are rising at twice the rate of inflation. Because of health care
inflation, American families took the equivalent of a 5 % cut in take-home pay in
1992 alone.
• By the end of the decade, American workers will lose $655 in income per year if
health care continues to eat up wage increases. Without reform, health care for the
average family will double by the year 2000.
•
Each American family would have added $12,000 to their personal savings if health
care costs had been kept to the rate of inflation from 1980-1992.
•
America spends more than 14% of our income on healthcare - the highest
percentage in the world. Canada, which spends 9.4% of its income on healthcare,
is a distant second. Our major international competitors - Japan and Germany spend approximately 8% of their incomes on healthcare. (The U.S. ranks only 16th
in life expectancy, and babies born in the United States are twice as likely to dies in
infancy than babies born in Japan.)
•
Of the top 20 drugs prescribed to non-elderly patients, six more than doubled in
price in the six year period 1985-1991. Four of the top 20 drugs prescribed to the
elderly more than doubled in price during the same time period.
•
Our nation's health care inflation is skyrocketing. Health care cost America $250
billion in 1980 and $800 billion in 1992. Without reform, health care spending is
expected to rise to $1 trillion in 1995 and $1.6 trillion by the year 2000. In 1990,
America spent an average of $2566 per person on healthcare. Without reform, we
can expect to pay $5700 per person by the year 2000, $14,000 per family.
Despite our extravaganf spending, America does not maintain high quality
health care for ourselves and our children.
•
America spends twice as much on healthcare as most other industrialized nations
and enjoys a reputation for having the highest quality health care in the world but, by some critical measures of health, the United States ranks much lower than
most other industrialized nations. · ·
·
•
America ranks 20th in-combating fatal heart disease.
•
America has a higher rate of infant mortality than 20 other nations, including Japan,
Germany, Canada and Taiwan.
•
Doctors are spending an ever-increasing percentage of their time on paperwork,
leaving less time for patient care. The average doctor's office spends 80 hours a
month on paperwork alone·. One patients stay in a hospital can require up to 19
different forms.
�..
To: Melanne Verveer
From: Andrew Hil:sch, National Health Policy Council
Re: Conference Attendees at the Mayo Clinic on September 17, 1993
Today's DaLe: Monday September 13, 1993
-----····-----·-------··---------····--------·-··-----····----------·----------·----------··----------·-----
The Mayo Clinic wants to invite it's Board of Governors. Officers and Councilor~.
auu State and Fecleral Public Att"airs Committees.
1be National Health Policy Council (NHPC) wants to invite it's national sponsors
and Board of Directors.
Attached is a list of state and local health officials. In addition, we intend to invite
the following people:
All members of the U.S. House of Representatives from MN
Both Republican and Democratic State Party Chairs
The Lt. Govemor--J oanell Dyrstad
The Secretary of State--Joan Cir~w
The Attorney General--Skip Humphrey
The State Auditor-Mark nayton
Ellen Benavittr.s
Bernie Broemer
Artr.aphtn
Tom Foley
Te.d Johnson
Todd Johnson
Dan McLaugh.lan
Steve Miles
Evie and Pat O'Connor
Larry Redmond
Vic Rosenthal
Jim Schmidt
Jill Sletten
Gordon Springer
Ellen Stankiewicz
Chris Stone
Kip Sullivan
Eileen Weber
SWVe WeLc.cll
John Wodele
Because of time constraints, we need to begin inviting people by noon on Tuesday.
If yuu have any questions or problems regarding individuals on this list, please let me
know. 1 can be reached by SKYPAGE # 8293142 or at (507) 281-8000 Rm. # 1101.
�(T)
Combined Mayo/NHPC Public Li.st
H. R. Clinton Broadcast
Phillips Hall, Siebens Building, Rochester, MN
11..
7-8 p.m, Friday, September 17. 1993
last name
first name
title
1.
Andersoll
Cathe:ine A.
2.
Employer :Representative,
MHCC
Aroskar
Mila
N f-t
3.
Barbre
Joy
Minnesota Chamber of
Connnerce, MHCC
4.
Banon
Linda
Commissioner
Minnesota DepartmeDt of
Emplayee Relations, MHCC
5.
Bednarczyk
&tty
SlillJ MN
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6.
Benner
Peter
AFL..ciO Representaive
E
7.
Benson
Senator Dume
s~reNWmri~~Ak~~
8.
Berglin
Senator Lim:la
Senate Majority Leader/Health
9.
Bishop
Representa1ive Dave
Rochester
10.
Brost
Dr. Gerald
Provider Representative,
11.
·cadwell
Lama
MHCC
Children •s Defense Fund
12.
Canney
Sean
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RCB
salutatio*i
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Governor and Mrs.
Arne
15.
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John
Minnesota Department of
Health
Representative Roger
Vice ChairiHealrhiHHS,
House
Consumer Representative,
MHCC
Minnesota Medical
Association, MHCC
L
Cbiotti
16.
17.
D'Aqui1a
DoloresM.
18.
Daube
Dr. Jasper R.
19.
Ehlen
Dr. K. James
Health Plan Representative,
MHCC
20.
Frerichs
Representative Don
Rochester
21.
Geier
Dr. Richard
CEO. Olmsted Medical
Group. Rochester
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22.
Greenfidd
Represi21tafve Lee
House Heal:b/Fmance
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23.
Greenman
Virginia
Consumer
24.
Gutknecht
Representative Oil
Rochester
25.
Hallin
Gayle
Provider Representative,
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26.
Halvorson
George
Mmnesota HMO Council,
MHCC
27.
HBJD!lCher
Fr-..d
Business Heallb Care Action
Group
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H~t~Bon
Dr. Stuart
Mbmesota Medical
Association
29.
Haugen
Dave
Minnesota Department of
Health
30.
Hazama
Mayor Chuck
Rochester
31.
Hoagland
Mel
Labor/Management
32.
Holtmeier
Wayne
Minnesota Chamber cf
CoiDDI:rce Representative,
MHCC
33.
Art
University of Minnesota
34.
Kelly
Dr.RobenT.
Rura1 Physician
Representative, MHCC
3S.
Kiscaden
Senator Shetla
Senate Minority/Health
36.
Lutes
David
MHCC Committee Chair
37.
Maxwell
Wtlliam
Chair
Mintle!Ota Hospital
Association
38.
Miller
Mary J.
IDSlJJ'aDCC Federation of
Minnesota, MHCC
39.
IS)
Kaplan
Mondale
Ted
State of Mimeso1a
40.
Monis
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41.
Musicant
Gtetchen
Minnesota Nurses
Association, MHCC
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RicbardM.
43.
O'BJien
Marylo
Minn Dept. of Health
Commissioner
44.
Ogren
PauJ
Hoose Majority LeaderJHealth
emeribls
45.
Peterson
Vfilliam
AFL-CIO Representative,
MHCC
46.
Peterson
Donna
State Department of Health
47.
Piper
SenatcrPat
SenatmtHealth Policy
48.
PodWke
Mike
Obnsted County Board Chair
49.
I.D
Quam
l.jz
Assistant Conunissioner
Minnesota Department of
42.
Blue Cross Blue Shield
Representativ~ WICC
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51.
Reisbetg
Bernard D.
Employer Representative,
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MHCC
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52.
Rob:nson
DDugl;;.s
53.
Rogness
S1Cve
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AJsoci!ltion. MHCC
Piesident
Mzmesota Hospital
Association
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54.
Rother
John
AARP (national)
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55.
Sanders
Dr. Paul
Executive Directcr
Minnesota Medical
Association
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�56.
Scandrett
Mic1uJel
Execlltive Director. MHre
57.
Schaubacb
Ms. Judy
Labor Union Representative,
MHCC
58.
Schulz
Larry
ISN Committee Chair, RCB
59.
Selby
Nancy
Oty Council President,
Rochester
60.
Shea
Catherine
CNS
61.
Ski-mer
Lynn
Chair, Regional Coordinating
Board
62
Smth
Jacquline B.
Consumer Representative,
MHCC
63.
Smth
Andrew
AMA Board of Trustees.
MHCC
64.
Steffen
Natalie
Commissioner
Minnesota Deputmmt or
Human Se."Vices, MHCC
65.
Swain
Tom
Chair.MHCC
66.
TwDmey
Chris
Chair, Reg.. Coordinating
Board
67.
Ulland
James
Commissioner of Commerce,
MHCC
Bob and spouse
CEO, IBM, Rothester
68. 69. Unterberger
�OVERVIEW OF :MINNESOTA HEALlH CARE REFORM
S(Th.1MARY
OF LEGI.SLATION
The state mandates that all employers with more than 50
employees must offer HMO as an option.
The Children's Health Plan was created for non-Medicaid, low-income
pregnant women and children under six. In 1991, it was expanded to
include all children to age 18. This was funded by a minimum annual
fee and a one-cent cigarette tax.
Healthright the plan based on the report made by the
Minnesota Health Care Commissio~ passed the legislature and was
vetoed by Gov. Carlson.
Minnesotacare was passed and signed by the Gov. Carlson.
June- Another bill passes in which budget targets were set, spending
limits imposed, and further reforms were initiated.
Minnesota Health Care Commission is preparing for 1994
session to further expand access to care.
1972
1988
1991
1992
1993
1994
:MINNESOI'ACARE
An accomodating bi-partisan effort produced this legislation, and strong public
support pressured the governor to sign in 1992 The plan expanded publicly
subsidized coverage for low income uninsured persons, created a state-sponsored
purchasing pool for small businesses, gave a tax exemption for insurance to selfemployed persons, and imposed reforms on individual and small group insurance
markets. The delivery system includes competing HMOs, while private businesses
have begun contracting directly with providers to improve quality and cost
effectiveness of care. Minnesota is currently phasing in universal access to health
care.
1. Funding
Five percent iitcrease in cigarette tax
Two percent hosptial tax on gross patient revenues
Two percent tax on provider gross revenues
One percent-tax on gross premiums for nonprofit health
services plans and HMOs
*note - a suit is pending concerning the legality of the provider tax on
out-of-state doctors
(violation of due process guarantees and laws
governing commerce between states)
�2 Health Care Cost Containment Commission created to:
Set target for slowing health care costs by 10 percent a year by 1993
Statewide and regional goals established on total spending
Foster regional health care planning
Restrain providers by retroactive monitoring of expenditures for high
tech items
Review effects of treatment methods
Prohibit insurance companies from denying coverage to small
businesses or refusing group policy renewals
3. Rural Health Advisory Council created to:
Provide state aid to rural hospitals in trouble
Make scholarships, loan forgiveness available to medical students
choosing in return for practice in underserved areas
4. Regulation of Small Group insurance
Companies assured coverage renewal
Portability between plans regardless of pre-existing condition
Modified community rating
To do business in state, insurers must make coverage available to any
group regardless of pre-existing conditions of employees
5. Small Employer Insurance Reform
State allows small employer plans to be sold that are exempt from
mandated benefits and less expensive
Employers with 2-29 employees are eligible (If 75% of
employees participate)
Health carriers must offer two small employer plans
Child health supervision services and prenatal care are not subject to
coinsurance or deductibles
6. Medicaid
Expanded eligibility for women and children
Offers 30 optional services
Medicaid managed care program
7. Minnesota Comprehensive Health Association
Provides insurance to those unable to obtain health insurance at a
standard rate due to pre-existing condition
�1993 AND BEYOND
In 1993, reforms focused on cost containment and restructuring the delivery
system. In the long term, providers would contract with "integrated service
networks" (ISNs), or be reimbursed in a rate-regulated all-payer environment ISNs
will be required to meet public health goals, to make care more preventative. The
networks are expected to cut spending one percent a year for five years. These
networks of providers ISNs would be liscenced by the state. Doctors and hospitals
who choose not to participate will be subjected to additional state regulation under
the all-payer system. The ISN structure was contained in a bill passed in June 1993.
10/93 Data Institute will be operational- a public/private collaboration of
individuals that will oversee the direction of research on health service performance
12/93 Minnesota Health Care Commission to release plan to cover remaining
uninsured Minnesotans by 1997
(at present plan will only cover 40 percent of uninsured)
Health plans will operate ISNs released
1/94
Two percent provider tax imposed (joins hospitals)
US Department of Health and Human Services will make
2/94
recommendations to ensure Minnesotacare expenditures don't exceed
the programs revenues for '96-'97 ($237 million deficit expected this
year)
ISNs operational
7/94
All-payor rate setting system operational
(for providers not iri ISNs)
sumq\er/94 Report card listing medical results and costs may be available
HMO/ non profit provider tax effective
1/96
MN Health Care Commission disbands
7/96
-·
�September 16, 1993
HFAL1H CARE :MEETING Willi SENATOR DURENBERGER
DATE:
LOCATION:
TI:ME:
FROM:
September 17, 1993
Augsburg College
3:30p.m.
Kim Tilley, Amy Nemko
1 PURPOSE
Senator Durenberger arranged this event to illustrate the successes of the Minnesota
health care market within a managed competition system.
ll. BACXGROUND
Senator Durenberger and his office view this event as an opportunity to present you
with information as to how keep businesses healthy under health care reform. In
their eyes, the burden of the event falls on them, not you.
The audience will be a mix of providers, academics, hospital administrators, and a
few state people. (FYI, Curt Johnson, Chief of Staff for Governor Carlson, is
supposed to attend.) The central theme should highlight the group practice tradition
in Minnesota and its contribution to competition in the health care marketplace.
Minnesota has a high penetration of HMOs and PPOs, and burgeoning networks of
integrated service systems in rural areas. This tradition is of central importance to
MN's success in keeping costs low and quality high.
m
PARI1CIPANTS
Senator Dave Durenberger
George Halvorson - President & CEO, HealthPartners
James Reinertsen, M.D.- Eresident & Chief Quality Officer, HealthSystem Minnesota
Rick Norling - President & CEO, Fairview Hospital and Health Care Services
Terry Hill- Executive Director, Minnesota Center for Rural Health/Northern Lakes
Health Care Consortium (He also chairs the Minnesota Deparbnent of Health
Rural Health Advisory Committee)
Approximately 75 people to attend.
IV. SEQUENCE OF EVENIS
�•
•
•
•
•
•
•
•
Welcome and intro of HRC by Sen. Durenberger (He will also give an
overview of the Minnesota marketplace and why competition works);
HRC makes brief opening remarks;
George Halvorson provides an overview of managed care successes in
Minnesota with a focus on how the HMO and PPO penetration - 70% in the
Twin Cities - has kept costs low through administrative efficiencies and
competition on the basis of price, quality, etc.;
Dr. James Reinertsen provides an overview of issues of quality and consumer
satisfaction in the MN managed care market - that is building quality into an
integrated network health care delivery system;
Rick Norling provides an overview of how hospitals have adapted to the
competitive environment;
Terry Hill provides an overview of building networks to rural areas;
HRC questions the presenters (NOTE: Contrary to the beginning of the
program, which is quite structured, this part is less well defined. While they
presented this as an opportunity for you to ask questions of the presenters,
they may very well have questions for you. The possibility also exists that
questions will be taken from the audience. Senator Durenberger will moderate
the discussion.);
Sen. Durenberger makes concluding remarks.
V. PRE$ PIAN
Oosed press.
VL REMARKS
Brief remarks.
�AUDIENCE LISI
Bill Adams, Lake Region Hospital. Worked on Jimmy Carter Campaign
Scott Anderson, President of North Memorial Medical Center
Charles Anderson, President of Augsberg
Ed Belkin, Communication
Elizabeth Bennett, Wife of Prominent Minneapolis Atty.
Jim Binger, former chairman Control Data Corp.
Mary Brainard, Executive Director and COO, HealthPartners. Former CEO of
BluePlus of MN.
Ward Brehm Small Sized Business Owner
Dave Bums, Office of Senator Durenberger
Rod Burwell, Chrnn. of Augsburg College Board & Member of Fairview Hospital '
Board.
Carolyn Canfield, Augsburg College
Lloyd Cherne, CEO Cherne Medical
Dr. Oark Duluth, M.D. Clinic
Michael Conly, Senior Vice President Employee Benefits Division, Northwestern
National Life Insurance Co.
Jerry Crest, CEO Mankato Hospital(RRC 70 beds)
Dolores D' Aquila, Northern MN Businesswoman
Dave Durenberger
Mary Edwards, Office of Senator Durenberger
Albert Eggart, 3M
Jim Ehlen, Medica CEO (HMO)
John Erickson, small businessman
Rick Evans, Chief of Staff
Terry Finzen, CEO Methodist Hospital (Mnpls.)
Fole M.D. Vice President, United HealthCare Co.
Susan Foote, Office of Senator Durenberger
Die
, .D. Medical Director Select Care(PPO)
John Frobenius, CEO Sl Qoud Hospital (Urban Hospital 400 beds)
Ed Garvey (Mpls atty.)
Bill George, President and CEO Medtronic, Inc.
Greg Gerloff, Administrator Grand Forks Oinic
John Grotting, Operations Officer HealthSpan (COO)
Dave Gruenes, State Senator
George Halvorson, President and CEO, HealthPartners
Dianne Hahn Knight, Office of Senator Durenberger
A. Stuart Hanson, M.D. President, Park Nicollet Medical Foundation/Pulmonary .D.
at Park Nicollet/Pres. of Minn. Medical As.
Greg Hart, General Director, University of Minnesota Hospital and Clinic
Tim Hansen President and CEO, HealthEast
Terry Hill, Director, Northern Lakes Health Care Consortium
Tim Holets, Administrator, Olmstead Oinic
�Bob Holman, Independent Health Care Policy Consultant
Curt Johnson Deputy Chief of Staff, Office of the Governor
Verne Johnson, Chairman of Governors Long Term Care Board
Jim Jaunted
Gayle Knenvold, CEO MN Association of Home for Aging
Ted Kolderie, Private Consultant
John Krawelski, Professor and Director, Institute for Health Service Research,
University of Minnesota
Jim Lawson, Administrator Tri-County Hospital Wadena
Shirley Leatherman, V.P. United Health Care.
Peggy Leppin.k, State Representative
Patricia MacTaggart, Vice President Managed Care, Delta Dental Plan of MN
Jan Malcolm, Sr. Vice President of Governments and HealthParbters
Walter MCOure, Director, Center for Policy Studies
Joe McErlane
gary Mcllroy, MD
Dan McLaughlin, Chief Hennepin County Bureau of Health
Marcus Menz, CEO Preferred One (PPO)
Roger Metz, Administrator. Winona Hospital
Dick Mulder, MD Rural Physician (Married to Glen Nelson)
Glen Nelson ((Married to Glen Nelson) COO Carlson CO. Diverse Hotel interests
include Radisson Hotels
Dick Niemiec, Sr. V.P. Blur Cross Blue Shield
Beverly Nilsson, Dean Nursing Augsburg College
Rick Norling, CEO Fairview Hosp. Health Care System
Steve Orr
Mike Osterholm, M.D. State Epidemiologist
Ron ·Paczkowski
John Paulson, Exec, Dir. MeritCare
John Perkins, MD
Wayne Popham
James Reinersten, M.D. President of Chief Quality Officer
Jim Rheinerstenm M.D. Speaker
Steve Rogness, CEO, MN Hosp, As.
Darwin Root, Itasca Medical Center
Paul Sanders, M.D.
Dick Schroeder, M.D. Affiliated Medical Center
Getty Setterberg, Private Consultant
Dr. Shau, Interim Dean, University of Minnesota Medical School and Deputy Vice
President for Medical Affairs
Jerry Simon5on, Pres. of Cosmetics Connector Co.
Frederick Slunecka, President and CEO, Mci<ennan Hospital
Andrew Smith, M.D.
Larry Solberg, Former Chair of MMA
Robert Stevens, Adm. of New Ulm Hospital
�Dave Strand, Sr. V.P. Medica
Tom Swain, Chairman, MN Health Care Commission
Cheri Templeton, RN.
Dale Thompson, CEO of Nursing Home, Cambridge MN.
Bob Van Why, Dir. of Regional Services, Duluth Oinic
Bob Waller, M.D. CEO of Mayo Oinic
Don Wegmiller, President MCG Health Care Compensation
Steve Wet:zell, Dir. of MN Business
Whelock Whitney
Dave Williams
Ed Wingate, CEO of Dayton Hudson Corp.
Scott Wordelman
�002
U.S. Senator Dave Durenberger
invites you to a special working meeting
with
First Lady
Hillary Rodham Clinton
3:30-4:30pm (NOTE TIME CHANGE)
September 17, 1993
Hoversten Chapel
Augsburg College
~eapolis,~esota
THE MINNESOTA HEALTH CARE MARKET:
COMPETITION WORKS
Agenda:
Introduction; The Minnesota Health Care Marketplace
Senator Dave Durenberger
Opening Remarks
First Lady
Hillacy Rodham Ointon
Managed Care Succes."es
George Halvorson, CEO, HcalthPartners
Issues of Quality
Dr. James Reinense.n. President and Chief Qualiry Officer, HealthSystem Minnesota
How Hospitals have Adapted to Competition
Richard A. Norling. CEO, Fairview Hospital and Health Care Services
Designing Rural Networks
Terry Hill, Director, Northern Lakes Health Care Consortium
Open Discussion
Oosing Comments
SenatOr Dave Durenberger
Attached is a map of tbe Fairview parking area. Pleue plan to park in one of
their lots, and please arrive 30 minutes prior to the beginning of the meeting. If
you have any questions, caU the Senator's Minneapolis at 800 .. 752·4226 (in-state
WATS) or 612-370-3382. Fax: 612·370·3395.
�FIRST LADY HILLARY RODHAM CLINTON
REMARKS TO HEALTH CARE SUMMIT '93
UNIVERSITY OF MINNESOTA
MINNEAPOLIS, MINNESOTA
SEPTEMBER 17 1 1993
[Acknowledgments)
I'd like to thank Congressman Sabo, particularly, for
inviting me to this health care conference. I also want to thank
him for his dedication to health care issues and his skillful
leadership on the Budget Committee -- both of which have made him
a welcome presence in Washington these last few months.
I'm particularly honored to be here in Minnesota, a state
whose rich contributions to American culture are undeniable.
After all, how many states can lay claim to the Mall of America
and the Mayo Clinic, to the Metrodome and the copper dome of the
Cathedral of st. Paul, to Garrison Keillor and Prince?
Sinclair Lewis, who was born in Sauk Center, once said: "To
understand America, it is merely necessary to understand
Minnesota. But to understand Minnesota, you must be an historian,
an ethnologist, a poet, a cynic, and a graduate prophet all in
one."
I can't claim to be any of those, but I can claim to know
one thing about Minnesota: This state has led the nation when it
comes to innovative health care programs.
Those of you here today embody Minnesota's pioneering spirit
-- a spirit that runs broad and deep. We see it at the Mayo
Clinic, sometimes called the most innovative doctor's office in
the world. We see it at the University of Minnesota, which
historically has paved the way in new cardiovascular surgery and
the training of primary care physicians for rural areas.
We see it in:
**
**
the state's progressive health plans;
in its innovative county programs -- such as one here in
Hennepin [pronounced henna-pin] County to provide coverage for
uninsured residents;
** in the legislature's courageous, bipartisan effort this
year to establish budget targets and encourage integration of the
health delivery system;
** and, just this week, in the unveiling of Medica's groundbreaking report card for health care consumers. [Medica is the
local health plan affiliated with United Health Care).
Given that impressive history, it's not surprising that we
are joined here in Minneapolis to talk about the health and wellbeing of Americans -- and the health and well-being of America.
-
----
-----
------------'--
�In a few days, the President will outline the his national
Health Security Act. This initiative marks the first time in
years that Congress will have before it a comprehensive measure
to provide health security for all Americans.
When this process began many months ago, the President's
goal was to design a program that would fulfill the American
promise of affordable, high-quality health care for every
citizen. That promise is founded on a fundamental belief that
good health is every American's most cherished possession -- and
a source of collective strength and prosperity for our nation.
This is not a new idea, not a revolutionary concept. Harry
Truman fought vigorously to provide all Americans with the
opportunity of health care 50 years ago. Since then, others have
echoed his concern. But despite good intentions and lots of
debate, little has been done to resolve a crisis that grows more
complex, more cumbersome, more costly every day.
Now we are at a crucial time in our history when we must
move beyond talking. We must move beyond wringing our hands and
worrying and wondering whether reform can work. In the months
ahead, we must join together and stand up for certain guiding
principles that will guarantee the health and well-being of our
children and grandchildren in the years ahead.
The process of crafting this legislation has involved
thousands of people from all walks of life and from every corner
of every state: We have listened to those who tend to the sick -doctors, nurses, technicians, and employees in our hospitals and
hospices. To those who receive care -- the patients who know
first-hand the beauties and the pitfalls of our current system.
To those who have lost insurance because they got sick or moved
or switched jobs.
We have heard from businesses -- large and small -- and from
insurance companies that provide coverage. We have talked to
governmental leaders in the states and in Congress. And we have
consulted with many wonderful health care experts -- like your
own Lois Quam -- who generously shared her knowledge of health
care reform. and particularly rural health issues, with us at the
White House.
From this ongoing, national dialogue, the President took the
best ideas available and devised a plan that amounts to a
uniquely American solution to an American problem. A solution
that is realistic, politically and substantively.
In the end, what emerged was a reform initiative built
around basic principles that will reshape our health care system
to serve ordinary, hard-working people who now lack the security
they deserve.
2
�This is not to say there won't be disagreement over details.
I'm sure there isn't absolute consensus in this room about how to
improve our current system. But I am convinced that across the
nation there is consensus about the core elements of reform
elements we cannot afford to dilute, or weaken, or strip of their
meaning.
And I think there is universal agreement that health care
costs, which have mushroomed from $12 billion in 1950 to $900
billion today, threaten the personal and economic security that
each of us wants so much to preserve.
The first principle the President demands is security. Every
American should have health security no matter their personal
circumstances. They should know they are entitled to health care
even if they lose a job, switch jobs, get sick, or move to a
different city.
Today, millions of hard-working Americans have no insurance
or lack adequate coverage. In many cases, the policies don't pay
for primary or preventive care. In other cases, the policy is
canceled in the event of a serious illness.
[anecdote here about the New Orleans woman with a lump in
her breast)
Under the new system, every American will receive a health
security card that entitles them to a comprehensive package of
benefits and guarantees them health care when they need it.
The second absolute must is simplicity. We need to stop
wasting time trying to decipher impenetrable rules and
regulations and forms and fine print. If Minnesota's motto is
"Land of 10,000 Lakes," our health care system's motto now has
become: "Land of 10,000 extra forms and regulations."
The fact is, our system is so convoluted that it isn't even
a system. It's a hodge-podge that virtually nobody understands.
So we have to make it simpler and more efficient and we will do
that by creating one standard form that doesn't require a PhD to
figure out.
The third principle is choice. More and more, the current
system is limiting choice for consumers. Employers choose for
most individuals, and they choose on the basis of cost. But with
the President's Health Security Act, individuals will choose from
among health plans in their region. They will decide whether they
want to join an HMO, a PPO, a fee-for-service network or perhaps
some other innovative system that will be developed in response
to reform.
3
�Fourth. savings must be a part of our new system. We now
spend about 14 percent of our national income on health care.
Canada is next highest, at about 9.4 percent. our major
industrial competitors, Japan and Germany, are between 8 and 9
percent. And if we sit idly by, afraid to take on the challenge
of reform, we will be spending close to 20 percent by the year
2000 -- without assuring security, without assuring choice,
without assuring primary and preventive care, without demanding
more responsibility from our citizens.
Fifth. reform must oreserve auality. That's a necessity. And
we can accomplish it by collecting data and by comparing
standards and outcomes.
Without quality standards, we will continue to see wild
variations in prices, too many unnecessary procedures, too little
emphasis on primary and preventive care, and too little consensus
about the most appropriate treatments for many common illnesses.
[anecdote here about the opthamologist in Arkansas who
performed the same procedure on two patients at different
hospitals and their bills were $900 and $1,400 with no difference
in the quality of treatment].
The sixth principle is responsibility. For the first time
ever, we will insist that everyone pay their fair share in the
health care system. Everybody must pay something because
everybody must assume some responsibility for their health care.
There will be no more free rides.
And I'm not just talking about individual citizens.
Responsibility also applies to insurance companies, who will no
longer be allowed to refuse coverage or bounce people once they
get sick. Responsibility applies to drug companies, who will not
get away with charging three times more for prescription drugs
here in the United States than they charge overseas.
Responsibility applies to employers who don't cover their
employees, thus driving up costs for employers who do.
Responsibility applies to those who submit fraudulent bills,
abuse the malpractice system, and engage in wanton profiteering
at the expense of honest, hard-working citizens and health care
providers.
The president's plan will put people's interests first by
demanding responsibility and, for the first time, imposing
criminal sanctions on businesses and firms that take advantage of
the system.
Obviously, one of the most difficult challenges in any
reform effort is determining the best way of financing health
coverage.
4
�We considered a single payor system, which I know is very
popular among some of you here. But that would require raising
taxes to replace private sector investments -- a gargantuan task
that seemed unfeasible for a number of reasons. still, the
President's plan incorporates many strengths of a single payor
approach -- universal coverage, administrative simplification,
and provable savings.
We explored the possibility of requ1r1ng individuals to buy
health insurance, and many members of Congress are enthusiastic
about that form of financing. But there are some huge obstacles
to overcome with individual mandates: How do you ensure that
individuals will really go out and buy insurance? How do you
prevent employers from suspending or eliminating coverage for
employees? And how do you subsidize the growing number of people
thrown into the marketplace?
The third approach was to build on the system we have -- an
employer-employee based system in which everyone is responsible
for contributing. That model allows us to achieve reform without
compromising the core principles we must insist upon.
So what will this initiative mean for Minnesota?
First, let me say that many of your state innovations guided
us in developing a plan for the nation.
For example, we know from Minnesota that health care reform
cannot be accomplished overnight and must be built in stages~
We know from your forward-thinking health plans that
emphasizing primary and preventive care leads to lower
expenditures and significant savings.
We know from the Minnesota State Employees group -- and from
AFSCME's leadership in this area -- that families can get better,
more affordable health care by purchasing coverage through large
groups.
We know from recent efforts in Willmar [pronounced Wil-mer]
and Chisago City [cq] that integrated health care services can be
established in rural areas. We know from the University of
Minnesota Medical School at Duluth that, with the right
incentives, medical students will go into primary care and
practice in underserved areas. I understand that the University
of Minnesota Medical School now ranks first in the nation in
training primary care physicians and that more than half the
graduates of the medical school this year opted for that form of
practice.
And we know from the Mayo Clinic's pioneering use of
telecommunications networks that there are exciting new ways of
5
�bringing high-quality medicine to rural areas -- and to the rest
of the nation.
These are all
equally important,
federal government
reform. And that's
important lessons for us nationally. But
Minnesota also has demonstrated that the
-- too often -- has been an impediment to
not the way it should work.
Let me assure you that the President's initiative will give
you more flexibility to move forward with reforms that are
appropriate for this state. For example, regional health
alliances will create a mechanism for covering all citizens and
will obviate the need to get waivers or changes in ERISA. [do we
want to say this?]
Reform will benefit Minnesota in other ways as well. Thanks
to the legislature's bipartisan efforts, Minnesota is further
along than most other states in organizing integrated delivery
systems and setting budget targets that will spur lower costs.
That puts the state in a good position to adopt the national
reforms quickly. If that happens, your citizens will be among the
first to enjoy health care security, comprehensive benefits, and
the other rewards that go with a simpler, more efficient system.
When, in a new century, our children and grandchildren look
back on this effort, they will be able to judge whether we were
willing to meet the test of history.
For 50 years now, the naysayers and cynics have won the
battle. For 50 years, they have profited at the expense of hardworking citizens and dedicated health care professionals. And for
50 years, as the debate over health care has raged, the nation
has stood still -- watching costs explode and forms proliferate,
watching as doctors and nurses have become overwhelmed by
paperwork and ordinary Americans have fretted more and more about
their health care coverage.
By 1977, as we continued to spin our wheels, one of
America's great leaders, Hubert Humphrey, sounded his own
prophetic alarm: "We don't have any health protection program in
this country. We have a sickness program. You have to get sick
before you get anything. [We need . . • ] a program on how to
prevent disease. Otherwise, there will be no end to the costs of
health care."
Hubert Humphrey was right when he spoke those words 16 years
ago. And he would be right saying the same words today.
We can, and must, do better.
Here in Minnesota, you are proving that there are ways to
encourage healthy behavior and prevent disease. You are proving
l _ _ _ _ _ _ _ _ __
6
�that there are ways to cut costs and simultaneously offer
security. You are proving that ordinary Americans appreciate the
need for good health and are not going to be scared away by wellfunded lobbyists and unfounded fears of change.
As a nation we must show the same resolve. We must not throw
up our hands, not give up the fight, simply because the skeptics
are loud and the obstacles great. We must seize the moment that
history beckons us to take.
If Yitzhak Rabin and Yasser Arafat can shake hands on the
South Lawn of the White House and agree to an historic peace • •
• . If Frederick de Klerk and Nelson Mandela can share a stage in
Philadelphia on July 4 and talk about racial harmony and
democracy . . . surely we Americans can overcome historical odds
and agree on ways to improve our health care system.
With your help, we can achieve reforms that are
compassionate, fair, and lasting. With your help, we can meet the
test of history.
Thank you very much.
###
7
�l\1INNESOIA DELEGATION
Overview
Senator Durenberger announced on Thursday (9/16) that he would not run for reelection in 1994. This is not surprising giving the ethics and even more personal
cloud under which he has bee~ operating in recent years. Needless to say, there has
been continuing press coverage in Minnesota of his problems and they will surely be
rehashed in the coming days. Melanne wanted to emphasize the delicacy of the First
Lady's position on this trip in how she positions herself publicly with the Senator.
In A September 9 Minneapolis Star Tribune story about the First Lady's trip, they
quoted a White House aide saying "we think Minnesota is a very key state... that's
done a lot of health reform within its borders. It's got a very interesting bipartisan
delegation that has a lot of expertise." Also, Kate Michelman attended an August 27
NARAL fundraiser in Minneapolis and said: "I think the President is going to
include it (abortion) as he said, but I don't know if he's going to fight for it. H we
lose, it will define abortion once and for all as a political issue and not as a health
issue."
The St. Paul Pioneer Press asked readers on September 4 to send in letters answering
the question: "What are your expectations for federal health care reform? What
should the federal plan do to balance the needs for universal access to basic care and
the costs of making care available?" The same paper ran an editorial September 13
which concluded: "Like many folks, I want to see more details before I embrace the
Clinton plan. But it appears to include all of the best ideas for extending coverage to
the uninsured while curbing the spiraling costs of care... The challenge will be to
prevent powerful special interests - small business, insurance and provider groups from picking the plan to pieces before it can be enacted and tested." The same paper
reported in August that Sen. Wellstone and Rep. Grams were in rare agreement that
their constituents were angry about inaccessible and unaffordable health care.
SENATOR PAUL WELISTONE (D=MN)- As you know, Senator Wellstone's major
concern in health care reform is mental health. Despite his strong bias toward single
payer and his suspicions of managed competitio~ he has been willing to work with
the Administration and wants to see health care reform enacted. Wellstone's other
concerns include rural health, consumer choice and state flexibility (so that Minnesota
might pursue a single payer option).
Recent Develo.pments: At the August 4 Small Business Committee meeting, Sen. .
Wellstone stated he thought a payroll tax might be easier than a premium tax for
small businesS. In a September 2letter to the First Lady signed by 14 other
Democrats, Wellstone wrote of his opposition to artificial caps on the length of
treabnent for mental health disorders. In the September 6 issue of the Washington ·
Times, Wellstone expressed his belief that the liberals in Congress would have more
of a voice this time than during the budget vote. Bu~ he added, "It would be a
�mistake to think that round two is going to be the liberals opposing the President"
Wellstone told the Minnesota Star Tribune on September 12, "I am skeptical as to
how much the savings will be." He expressed understanding of the political
constraints facing the President, saying trying to sell the Canadian plan to the public
could mean "being clobbered or accused of wanting to raise people's taxes."
SENATOR DAVE DURENBERGER (R-;MN) - Senator Durenberger has just
announced that he will not run for re-election in 1994. It is too soon to tell how that
decision will affect his decisions during the health care debate. He has been a key
health care player, serving on both the Finance and Labor and Human Resources
Committees. While he has been viewed as a possible ally, especially given his close
relationship with Senator Rockefeller, Durenberger's recent comments to Chris
Jennings reflect his moving away fro~ rather than closer to, the Administration.
This is especially noteworthy because his public comments have indicated a
willingness to seek consensus. He has caused some discomfort in the planning of
this trip by first telling the White House he would downplay his own event and then
doing just the opposite - to the consternation of Rep. Sabo.
While Minnesota has passed its own reform legislation, Durenberger does not
believe that a consensus yet exists for national reform. Minnesota is also the nation's
capital of managed care/HMO delivery systems and has historically been more
efficient than other states in terms of the delivery of health care. Senator
Durenberger will be very concerned about the allocation of the global budget,
particularly that it does not reward the inefficient at the expense of the efficient
In earlier meetings with health care staff, Durenberger indicated his nervousness with
any price controls. He said he thought we could get some savings for speeding up
implementation of the new physician payment system. He also urged us to find a
way to fold Medicare into whatever we do and stressed that he, unlike some
Republicans, thinks we can and should do health care this year, He expressed
reluctance about universal coverage- and its associated costs- in the near term.
Recent Developments: On September 3, he told the Minneapolis Star Tribune: "I
believe that we should get costs under control first, by reforming the delivery of
health care, and then phase in coverage for all... We simply cannot afford to offer
overpriced, inefficient carei · It will break the bank, and we will all be losers." The
paper reported that a Durenberger aide said the Senator was relieved at reports that
the administration would phase-in coverage of the uninsured. In the September 4th
issue of the National Journal, Senator Durenberger is quoted as saying that the White
House could lure as many a 20 GOP Senators to its side if it makes a few key
compromises that he sees within reach. In the September 8 issue of the Wall Street
Journal, he stated, "I like this idea of [only Medicare and Medicaid caps]. I think it
will force us to deal with the entire problem." Reiterating his belief that bipartisan
agreement is indeed possible, he said in the September 13 issue of the Los Angeles
�Times: "There really are many more areas in common than there are disagreements."
However, on September 14, Durenberger met with Chris Jennings and seems to be
moving further away from us, not closer. His vote may well depend on whether he
decides to run for re-election.
REPRESENTATIVE 1\fAIUIN SABO (D-MN): Unfortunately, the Minnesota bip has
resulted in bruised feelings on the part of Congressman Sabo. This is partially a
result of the usual House/Senate jealousies but was exacerbated by Senator
Durenberger's overplaying his own event. It is therefore important this we sooth
Rep. Sabo. Part of Sabo's being disgruntled may have been related to his having to
drop an ERISA waiver for his state from the budget plan. Sen. Durenberger had
opposed the waiver. Sabo is a thpughtfulliberal, respected for his political sagacity
and attention to detail, and was, of course, key to the budget debate. He is part of
the influential Democratic "basketball caucus."
Sabo is a McDermott co-sponsor. He also co-sponsored Rep. Matsui's Children and
Pregnant Women health insurance act.
Recent Developments: In a 9/14 meeting with Chris Jennings, Sabo seemed
impressed with the plan but skeptical about the financing. Although he felt better
about the numbers by the end of the briefing, you may want to reinforce the solidity
of our financing plan. Sabo believes that the plan spends too much on subsidies for
small business, but he understands the political necessity of them. He thinks that the
abortion issue is a potential plan killer. Finally, he is very pleased with the
consultation process and the inclusion of Republicans.
REPRESENTA11VE BRUCE VENTO (.0-MN): A former union worker, teacher, and
state legislator, Congressman Vento is a perfect fit for his St. Paul disbict. Vento is a
"legislative workhorse" who has been known to overtalk an issue. He serves on the
Natural Resources and Banking Committees.
Vento is a McDermott co-sponsor and considered eminently gettable.
REPRESENTA11VE JIM RAMSTAD (R-MN): Congressman Ramstad is in his second
term. He replaced Bill Frenzel in the House and Ramstad considers Frenzel his
mentor. Ramstad sits on the Small Business and Judiciary Committees.
While Ramstad's general health care views are not knowf\ he is pro-choice. He has
been interested in emergency medical care for children. He worked on issues
·
involving chemical dependency in young people, cocaine babies, and the
handicapped while in the state senate. At that time he also dealt with a personal
�alcoholism problem. Pro-choice and considered a good guy, local groups are said to
be influential with Rep. Ramstad ..
In Marc~ the First Lady wrote to Ramstad about the coincidence of both Ramstad
and the President attending the same Boys Nations meeting with President Kennedy.
Ramstad held a town hall meeting in late spring attended by Lois Quom. She noted
that Ramstad was supportive in his comments about the First Lady and about reform
in general. He was careful to note that while he voted against the President's budget,
he hoped that the health care reform package would receive bipartisan support. He
left open the possibility of his support for the package.
REPRESENTATIVE ROD GRA:MS (R-MN): Congressman Grams won his election
with the third lowest winning percentage of any 1992 House candidate (44%). His
most pressing concerns are lowering the deficit, cutting taxes, and decreasing
government regulation. Facing a tough re-election in 1994, he will be sure to pay
close attention to his district's large employers, which include Honeywell, 3M, and
Northwest airlines.
His health care views are not knQwn. He has indicated that he opposes abortion.
Grams co-sponsored Rep. Michel's HR 101, the Action Now Health Care Reform Act
Recent Developments: The Minnesota Star Tribune reported that at a town meeting
in August, Grams' constituents were apprehensive about the federal health care
proposal. During the recess, he was also said to have heard from a number of
constituents angry because they felt health care was unaffordable and inaccessible.
�September 16, 1993
D.C I 1WIN OTIES, 1\fN I ROCHESTER, 1\fN I D.C
Central Avenue Clinic I Simplification Event Briefing
-Talking Points on Administrative Simplification
Working Staff Meeting w I Oinic Staff Briefing
Meet and Greet w I Local Elected Officials - List
Health Care Summit '93 Keynote Address Briefing
- Event Participants Bios
(NOTE: Draft program is in the binder pocket)
Speech
Panel wl Members of Congress Briefing
- Information on Members
Health Care Meeting w I Senator Durenberger Briefing
- Audience List
-"Minnesota Health Care Market Competition Works" Booklet prepared by Senator
Durenberger
Meeting w I Mayo Oinic Officials Briefing
- Information on the Mayo Oinic and Mayo Model are in the binder pocket
Satellite Link Up Briefing (Rockefeller)
- Profiles of Featured Faiiuiies
- Meet &: Greet List
- Letter from MN Resident Regarding Health Care
Minnesota Political Briefing
-Overview of Minnesota Health Care Reform
�September 16, 1993
VISIT TO 1HE CENIRAL A VENUE a.INIC:
ADMINISIRATIVE SIMPLIFICATION EVENT
DATE:
LOCATION:
TIME:
FROM:
L
Friday, Sep. 17, 1993
Minneapolis, MN
10:30am-11:00am
Kim Tilley, Sara Morris
PURPOSE
Senator Wellstone requested you visit this clinic. In addition, this event is meant to
highlight the need for administrative simplification.
II.
BACl<GROUND
The Central Avenue Oinic is a community based non-profit corporation which has
been providing health services for 22 years. The clinic, merged with the Fremont
Oinic (also in Minneapolis) forms Fremont Community Health Services, Inc. (FCHS).
They are concerned with providing high quality health care to all members of the
community, ensuring community based control of all aspects of the clinic's
operations, and enhancing community awareness of health care issues through
outreach and education.
Annually, FCHS provides 25,000-30,000 visits to 7,000-8,000 patients. In 1992, 85% of
the patients had incomes below 200% of the federal poverty level. 38% were
uninsured and 50% were using Medicaid. 42% are 19 years or younger and 25% are
people of color (predominantly African-American).
The clinic provides a range of health care services, from prenatal to geriatric. The
majority of the revenue is derived from patient fees (60%). f'CHS uses a sliding fee
scale based on federal poverty guidelines for uninsured people.
In the clinic's waiting room, several patients and a few clinic staffers will be waiting
to speak with you about achieving simplicity in the health care system. (See
attachment on administrative simplification.) Mary Linden, an RN, and Deanna
Mills, the clinic's administrator, will be among those talking to you in the waiting
room. Ms. Mills is very excited to have the opportunity to meet with you. She said,
"rarely does a beacon this bright shine down upon our clinic. We feel as if we have
been given a gift"
(Note: someone from Senator Wellstone's staff will be talking to the patients before
you arrive to explain the sequence of events and try to make them less nervous.)
�Ill.
PARTIOPANIS
Senator Paul Wellstone
Sheila Wellstone
Deanne Mills, Oinic Administrator: Ms. Mills was a dental hygienist for 5 years and
then a health care administrator at the University of Minnesota. She
specializes in maternal and child health, and has two adopted children. She
has been at FCHS since June of 1992
Dr. Scott Dyre, Medical Director: Dr. Dyre has been the clinic's medical director since
1981. He graduated from Brown Medical School in 1976 and completed his
residency in family practice at the FCHS local community hospital, North
Memorial Medical Center. He has served on boards and volunteered with
many organizations in the Twin Cities over the past 12 years.
·
Mary Linden, RN
Patients:
Jeanne Fish, a pregnant woman 3 weeks to her delivery date. Covered
by medical assistance.
Bob Johnson, Jeanne Fish's husband
Brooke Holmes, mother of a 7 month old child, pregnant with 2nd child
(due in May). She works at Sears and had her hours cut from 2025 to 10-15 because she can't move furniture while she is
pregnant. She has applied for Medical Assistance.
Sandy Louden, uninsured patient who has been self-employed and
bankrupted due to her medical bills. She is on the board of the
clinic.
William Kaunzer, 2 years old and has a rare form of muscular
dystrophy.
Julie Kuehl, William's mother. She and her son are covered by Medical
Assistance.
Joni Brockway, self-employed and uninsured. She makes too much to
qualify for Medical Assistance and her income changes each
month which makes her eligibility for Minnesota Care uncertain.
Sarah Brockway, Joni's two year old daughter. She was born through
the clinic's prenatal program.
Judith Bess, laid off and left uninsured. She has diabetes and has had to
make choices about her treatment due to financial constraints.
Mike Standal, uninsured since 1989 when he left his job to go to work
for himself. He is married with 3 teenage children. The whole
family is covered by Minnesota Care which costs $35 a month.
IV.
SEQUENCE OF EVENTS
•
•
•
Arrive waiting room with Senator Wellstone
Met by Deanna Mills, Dr. Scott Dyer, Mary Linden, 10 patients
Staff presentation on paperwork & administrative simplification; walk through
of step by step process an uninsured pregnant woman must go through to get
prenatal care and deliver her baby
Open discussion
•
�~»
Walk to conference room
V.
PRE$PlAN
Qosed press
VI.
REMARKS
Administrative simplification
How community based health care providers fit into the reforms.
�Administrative Simplification
Today's health care system is awash in paperwork. Insurance overhead eats
up a significant percentage of each premium dollar, paying for admistrative staffs,
underwriters and marketers working in 1500 different insurance companies.
Doctors and hospitals spend more and more of their resources keeping up
with all the paperwork, billing forms, codes, inspections and regulatory procedures
imposed on them by insurers and the government.
And consumers find themselves confused and overwhelmed by the fine print
and the form-filling.
How did we get here? Government and private insurers have set up elaborate
documentation requirements and procedures for hospitals and doctor's offices to
follow to prove that they are not keeping patients in the hospital too long, seeing
patients too often, or charging too much. To keep track of all of the differences
among health plans, hospitals and physician's offices have had to hire more coders,
clerks and administrators. What were once small back offices have grown into
sprawling utilization review, coding, medical records and billing departments,
which spend countless hours determining whether an individual has coverage,
which insurance company is the primary payer, what services are covered, how
much to bill the insurance company and what codes to use, and how much to
charge.
•
Under health reform, the "hassle factor" is reduced for doctors,
hospitals and other providers through standardization and
streamlining of reimbursement and reporting requirements.
•
With the introduction of a standard, comprehensive benefit package,
providers no longer go back and forth with health plans to determine
the level of services that are covered. Under reform, the services that
are covered do not vary from plan to plan; standard cost-sharing rules
among plans also simplify accounting for providers.
•
A single, standard reimbursement form and standardized reporting
requirements· replace the hundreds of different claims forms and
reporting requirements providers have to comply with today.
•
A coordinated inspection process replaces the multiple inspection
processes that hospitals and doctor's offices undergo today.
•
The Medicare program participates in the reforms to simplify and
streamline reimbursement and claims processes. Specific reforms are
aimed at rebuilding the trust between hospitals, doctors, patients and
�the government.
•
Regulations of clinical laboratory testing are refocused to emphasize
quality protection while reducing administrative burden.
09/14/93 09:49 AM
I
�September 16, 1993
VISIT TO TilE CENJR.\L A VENUE a..INIC
CONFERENCE .MEETING
DATE:
LOCATION:
TIME:
FROM:
1
Friday, Sep. 17, 1993
Minneapolis, MN
11:00am-11:30am
Kim Tilley, Sara Morris
PURPOSE
To discuss the essence of community medicine and why the clinic is unique, and also
to explain how community based health care fits into the upcoming reforms.
II.
BACKGROUND
On the way to the conference room you will be accompanied by Dr. Scott Dyre,
Deanna Mills, and Mary Linden. This is considered a "tour" by the clinic but is
actually just a walk down the hall and is a non-media event During the walk, Dr.
Dyre will discuss the clinic's pharmacy, how they make drugs available, and in
general, discuss the care they provide.
ill.
PARTIOPANTS
Community Clinic Consortium:
Renee Vanman Wixon, CCC Board President
Deb Anderson, Director, CCC
Paul Ogren, Director, MN Alliance for Health Care Reform
Donna Zimmerman, Director, Health Start (St Paul School Based Clinic)
Liz Myre, Director, Teen.;.Age Medical Service (TAMS)
Tom Yardic, Director, West Side Community Health Care
Peg LaBore, Director, Family Tree Inc.
Central Avenue Clinic:
David U ppgaard, Private Practice Dentist and Community Board President
Sandy Louden, Community Board Member
Deanna Mills, Clinic Administrator
Scott Dyer, MD, Family Practice, Medical Director
Mary Linden, RN
-·
Vicki Mongeau, RN, FNP, Family Practice Nurse Practitioner
Jean Blum, Founder, Executive Director
Tom Ellis, P A, Physician Assistant
Chyrrel I<ribit, RN, PNP, Pediatric Nurse Practitioner
Communitty Health Care Advocates:
Terese Zink, MD, Physician, West Side Community Health Center
Mary Azzahir, Director, Way to Grow, School Readiness Program
Tim Rumsey, MD, Physician, United Family Health Center
�Anne StGermaine, PhD, RN, Coordinator, Minneapolis School Based Oinics
N.
SEQUENCE OF EVENfS
o
Walk through clinic with Dr. Dyer, Deanna Mills, Mary Linden to conference
room
Members of clinic staff and community board will discuss the clinic's history
in the community, what the clinic does, and thank the First Lady for her effort
to make the health care system work for all Americans
Consortium members' statement on the importance of community based and
primary care, and their concerns about the future of reform
Brief remarks from the First Lady
Open discu~ion
•
•
•
•
V.
PRESS PIAN
Oosed press
VL
REI\fARKS
The importance of community based and primary care
�MEET AND GREET
MINNEAPOLIS, MINNESOTA
SEPTEMBER 17, 1993
Anderson, Dennis
St. Paul, MN
Legal Counsel, Good Samaritan of Minnesota (national chain of
retirement homes)
Guest of Vance Opperman, DNC Trustee and party activist
Anderson, Irv
International Falls, MN
Speaker, Minnesota House of Representatives (DFL)
Former Minnesota House Majority Leader
Anderson, Marjorie
Onamia, MN
Chief Exec. of Mile Lacs Indian Reservation (Ojibwe Nation)
First female to hold this post with Native American Tribe
Benavidas, Ellen Minneapolis, MN
Director of Health Policy, Hennepin County Medical Center
Health Care Task Force member
Host of Health care Watch Party on Sept. 22nd
Berg, Tom
Minneapolis, MN
Attorney
Former u.s. Attorney (DFL)
Possible candidate for u.s. Senate
Berglin, Linda
Minneapolis, MN
State Senator (DFL)
Possible candidate for u.s. Senate
Author of Minnesota Care legislation
Bergsgaard, Donna
st. Paul, MN
West
Publishing
Company,
Minnesota DFL P~ty Activist
Guest of Vance Opperman
Executive
Vice
Blackshaw, John
Minneapolis, MN
Vice President, TUnheim Satrizos, Inc. (PR Firm)
Former Chief of Staff & 1990 Campaign Manager
for Sen. Paul Wellstone
President
�Bloodgood, Patricia
Minneapolis, MN
Partner at Opperman, Heins & Paquin Law Firm
Early Clinton/Gore supporter
Guest of Vance Opperman
Borman, Marvin
Minneapolis, MN
Attorney
DFL Finance Committee
Father of Tom Borman
Borman, Tom
Minneapolis, MN
Partner, Maslen, Edelman, Borman, & Brand Law Firm
Co-Chair of October 1992 Minnesota fundraiser attended
by Vice President Gore
Bopp, Kevin
st. Paul, MN
Arkansas native
Minnesota Clinton/Gore Campaign staffer
Brommer, Bernie
Oakdale, MN
President, Minnesota AFL-CIO
Carlson, Arleen
Minneapolis, MN
Wife of Curtis Carlson (Chairman of the Board & CEO of
Carlson companies, honored by King of sweden as swedish
American of the year)
Guest of University of Minnesota, Humphrey Institute
Cowles, John & Sage Fuller
Minneapolis, MN
Clinton/Gore Campaign supporters
Members of the Cowles Publishing family
(Cowles Publishing owns the Minneapolis Star & Tribune)
Cowles, Jay & Page
St. Paul, MN
Jay and Page are the son & daughter-in-law of John Cowles
Members of Cowles Publishing family
Davenport, Rick
Edina, MN
Administrator, surgical consultants, P.A.
Guest of vance Opperman
Dayton, Judy
Wayzata, MN
Wife of Ken Dayton (Dayton Hudson corporation)
DNC Finance & Democratic Party activist
�Dayton, Mark
st. Paul, MN
Minnesota State Auditor (DFL)
1982 DFL Senate Nominee against Senator Durenberger
DeHarpporte, Ron
Edina, MN
owner, Gibbco Surgical Laboratory, Inc.
Wellstone supporter & contributor
Drury, Joan
Minneapolis, MN
Founder and CEO of Harmony Foundation, a women's empowerment
organization
Browning-Ferris Industries (BFI landfill/disposal company)
heiress
Edelman, Edith
Marian Wright Edelman's mother-in-law
Eisberg, John
Minneapolis, MN
Attorney
DNC Business Leadership Forum Member
Entenza, Matt
Husband of Lois Quam, Health Care Advisory Committee
Attorney General Skip Humphrey staffer
Foley, Kevin
Minneapolis, MN
Brother of Tom Foley (Ramsey County Attorney)
President, Wabash Consulting Firm
Clinton/Gore Campaign, advance staffer
Foley, Pat
St. Paul, MN
Brother of Tom Foley (Ramsey County Attorney)
Marketing Development Analyst, West Publishing Company
Foley, Tom
st. Paul, MN
Ramsey County Attorney
Clinton/Gore Co~hair
Minnesota Democratic Leadership Council Co-Chair
Forciea, Pat
Minneapolis, MN
President, Missabe Inc. (Sports Marketing Firm)
Wellstone Campaign consultant
Forciea, Cathy
Minneapolis, MN
Chief Financial Officer, Missabe Inc. (Sports Marketing Firm)
�
Dublin Core
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Title
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Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
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White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
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1993
Identifier
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2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
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72 files in 6 boxes
Provenance
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Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
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William J. Clinton Presidential Library & Museum
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
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Paper
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Background on Health Reform [3]
Creator
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First Lady's Office
Melanne Verveer
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2006-0223-F
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Box 2
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2068127" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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William J. Clinton Presidential Library & Museum
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Adobe Acrobat Document
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Reproduction-Reference
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1/8/2015
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42-t-2068127-20060223F-002-006-2015
2068127
-
https://clinton.presidentiallibraries.us/files/original/86ef9881cb2dcaa67629af58d8221e04.pdf
a1a0cfafac91f212b8839bd80a378dd3
PDF Text
Text
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. fax
SUBJECTffiTLE
DATE
HIAA REALITY: Real People, Real Problems. [partial] (2 pages)
11111/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Verveer, Melanne
OA/Box Number: 17607
FOLDER TITLE:
Background on Healthcare Reform [2]
2006-0223-F
ab631
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. :Z:Z04(a)J
Freedom of Information Act- [5 U.S.C. SS:Z(b)J
PI
P:Z
P3
P4
b(l) National security classified information [(b)(l) of the FOIAJ
b(:Z) Release would disclose internal personnel rules and practices of
an agency [(b)(:Z) of the FOIAJ
b(3) Release would violate a Federal statute [(b)(3) of the FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIAI
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIAJ
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIAJ
National Security Classified Information [(a)(l) of the PRAJ
Relating to the appointment to Federal office [(a)(:Z) of the PRAJ
Release would violate a Federal statute [(a)(3) of the PRAI
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRAJ
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
:Z:ZOI(3).
RR. Document will be reviewed upon request.
�SENT sv:xerox Telecopier 7021 ;11-19-93
i
.
4:04PM
POR RELDSE UPON DILIVBRY
STA'l'BDN'l' OP
KIN THORPE I PH. D.
DBPUTY ASSIS'l'AN'l'
SBCRETARY
01' DAII1'II AHD HOMAH SBRVICJI:S
BIFOU THE
SUBCOIOIITTEI OH HEAI/l'H AHD '1'HB BNVIRONMENT
COMMI'l'TIE OH BH.ERGY AND COMMERCE
tnfiTJ:D
STATES ROUSB
01' REPRISBN'rATIWS
HOVIMBBR 22 1 1993
�SENT sy:xercx Teleccpier 7021 ;11-19-93
4~04PM
r-
1
I'
Good morning. I am pleased to have the opportunity ~o
discuss with you this morning the process by which financinv and
premiums underlying the President's health care refor.m proposal
were modeled. Because of the high standard aha sets, it is
always a pleasure to listen to but a task to follow Alice livlin,
I.
BaOkf&'OliDd
Batimates of premium coats, national health spending, and
government program costa under health care refor.m have been
necessary in the decisions leading to a health care reform bill.
During the policy development process, exploration of alternative
policies required estimates of the cost impacts of each poss~le
variation. Specific areas included analyses of premium caps, the
impacts on businesses of mandated employer payments, the effects
on households of mandatory purchase of coverage, and the
budgetary affects of the discount schedules.
The development of estimates of this trpe is obviously a
complex task. Numerous data sources offer information on current
spending for medical services by a variety of payers and for a
wide range of population subgroups, but there is no single data
set which captures all spending for all services through all
sources of funding.
Federal surveys, especially the 1987 Rational Medical
Expenditure survey, offer the ~est characterizations of national
spending. The National Health Accoun~a 9anarated by the Health
Care Financing Administration (BCFA) summarize the beat available
data on total national spending by type of service and source of
fund. Producing estimated spending under health reform, however,
requires devalopinq a comprehensive baseline summary for
literally hundreds of affected sub-populations, and estimating
the future apeftding patterns aaao~iated with the reform.
Estimates of future costa of ~efo~ are primarily derived
through modeling transfers of current spending among the various
channels of payment. Estimatinq the impacts of changing primary
payers is relatively straightforward, given a baseline of
�..
~ ~-
-
--
2
national health •pandin·;. More difficult is estimating the nat
impacts of fee upgrades and paying for uncompensated care, since
reimbursement levels will be set to achieve some recapture of
these increased outlays for current services. Also difficult. is
estimating the induced spending attributable to new or enriched
insurance coverage. Because of lack of data, estimates must be
baaed on imperfectly representative experiences of government. and
private insurers as well as the results of academic studies of
the demand for medical care.
Due to this complexity, multiple methodoloqies, data
sources, and models were needed to produce estimates of premiums,
discounts, and the overall effects of reform options. Major
contributors included HCFA'a Office of the Actuary (QAct), the
A9ency for Health care Policy and Research (ABCPR), the Treasury
Department, and other government a;encies. Rumeroua consultants
assisted in the process, with major modelin9 contributions
provided by the Urban Institute.
Description of ~be Major Models
A.
~be Urb&D lDititu~e'a 'ranafer Jncoaa ND4e1 ('RIM2)t
The Urban Institute baa developed a miarosimulation model
called the Transfer Income Model (TRIM2). This model has been
used to analyze the financing of national health care reform
plans, and has particularly fo~uaed on the distributional effects
of such proposals. TRXM2 is based upon the Maroh 1992 current
Population Survey (CPS) and combines data from a number of other
sources in order to provide a complete basis for assessing acute
care health spending by the non-elderly in the u.s. populat.ion. 1
The complete model has been aged to 1994, and all results are
presented in 1994 dollars.
The TRIM2 model simulates the employer group health
insurance system, non-group or indiv~dually purchased health
JJ.
Historically, TRIM2 haa been used to analy1e current and
alternative tax and transfer pro9rams.
1
�• , ·nw1 "" ••••v•t'••• rv••
'11-IV-ve
'-••vvrl'l ,-
--
..
3
insurance, out-of.-pocket spending, and the Medicaid pro;ram. The
model assigns spending under these programs/systems at the
individual and family levels BAd adjusts for regional variation
in premium levels. It ia then possible to assess tbe
,.
distributional effects of the financing of the curran~ health
care system. Detailed tax calculations allow the analysts to
examine health spending on an after-tax basis and to calculate
the after-tax value of employment-baaed health benefits. TRIM2
can also be used to simulate the distribution of health spending
and health care financing burdens under alternative assumptions
about how insurance would be provided and financed.
1.
~he Bealtb Care Financing Admiaiatratioa'a Special PoliGr
Aaalyaia Model (8PAM)I
HCFA'a Special Policy Analysis Model (SPAN) database is also
based upon the March lt92 Currant Popula~ion Survey (CPS). The
March 1992 CPS acta as the host fila, with each person on it
being statistically matched to a person on the 1'87 National
Medical Bxpanditu~e Survey (NMES). Health ezpenditurea and
utiliaation from the NMES person record are than linked to the
CPS record, and the entire da~a set is controlled to be
consistent with 1994 National Health Account data. The
parameters used in ~he linking the NMES file to the CPS were
disability status, age and ;ender, family income, and insurance
class of the person.
Once each CPS person waa linked to a NMES record,
expenditure data by service (hospital inpatient, hospital
outpatient, ate.) and source of payment (out-of-pocket, private
insurance, Medicare, Medicaid, etc.) were attached. This file
was then aved to 1994 throuvh two steps. rirst, the 1992 CPS
population was we~;hted to aum to the 199C Social Security
Administration (SSA) non-inatitu~ionaliaed population (about 20
million more than Census estimates). This was done by ave (20
age groups), gender and marital status.
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Second, the total national health expenditures by this &SAweighted CPS population (the SPAM population) were then
11
benchmarked" by service categQry, channel of payment, and age
category to the aggregate totals in the projected 1994 Rational
Health Accounts.
c.
~he Agency fo~ Boalth ca~e Policy aad •••••~h'• limulation
Model (UIIM) a
ABSIM is based on ABCPR's 1987 Rational Medical Bxpenditure
survey (NMES-2), which is the moat recent national effort to
collect comprehensive, person-level profiles of health care use,
spending, and insurance coverage. ABSIM currently is designed
only to analyze the non-elderly (under 65), noninatitutionalized
civilian population residing in the United States. Although the
NMES-2 data were collected in 1987, demographic variables have
been aged forward by reweighting individual recorda. New weights
take into account changes in the distribution of the population
by age, race, ~ex, insurance atatua, and poverty status observed
between the November 1987 and March 1gg2 Current •opulation
Surveys. Additional demographic aging is baaed on Census
projections of the population by age, race, and sex beyond 1992.
Real growth in service-specific health expenditures and insurance
premiums have been incorporated through adjustments based on the
appropriate rates of changes in HCFA's National Health Accounts
and its projections.
.
ABSIM draws primarily on the NMBS-2 Household Survey and ita
two derivative components, the Health Insurance ~lan Survey
(HIPS) and the Medical Provider Survey. The Household Survey
sample, roughly 35,000 individuals and 14,000 households, 11
representative of the civilian noninstitutionaliled population of
the United States in 1987. completed all rounds of data
aollea~ion.
The Medical Provider Survey obtained infor.mation
directly from the physicians, hospitals, and other providers uaed
by a portion of the household sample. Thaae data were used to
edit and supplement household survey data describing use of and
spending on health services. HIPS data were collected from
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employers, unions_, anc:i insurers and include premi.UDUI paid by all
sources and specific provisions of baseline private insurance
coverage. They also provide information about the organizations
offering insurance coverage and include in the oase of employers,
firm and establishment size, industry, and location.
Other data sources were incorporated when needed for
specific purposes. For example, survey data from the Health
Insurance Association of America were used to project market
shares for fee-for-service, BMO, and preferred provider health
plana by region. Annual survey data from the Aaerican Hospital
Association were used to determine the allocation of hospital
spending between inpa~ient and outpa~ient services and to
identify local areas in which at least one BMO is operating.
County Business Patterns data were used to tmpute average payroll
for employers, using a statistical match based on industry,
location, and firm size. The Internal Revenue Service's
Statistics of Income data were used to expand NMIS-2 income data
and to calibrate the AHSIM tax module.
zzz.
Premium Bsttmation UD4er Refo~
Both BCFA and AHCPR estimated the cost of health insurance
premiums under reform. Their estimates are in 1994 dollars and
reflect the benefits included in the comprehensive benefit
packaqe . Competing approaches .·ware intentionally used to enhance
confidence in the estimating process, and to permit selection of
the more conservative estimate where variation in modeling
outcome was identified.
A.
Health Care PiDancing A~Dilt~atioaa
The first step in HCPA's simulation process was to determine
each individual's insurance status. The modelers used CPS
indicators for this, and considered a person to be insured if
he/aha was· covered by employer-sponsored insurance, other private
insurance, CHAMPUS, Medicare, or Medicaid. BCfA then adjuated
health expenditures to reflect the coverage offered through the
.
I
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re;ional alliance plan.,· · That coverage is for hospital care,
physician and other professional services, prescription drugs,
and durable medical equipment Qther than vision and hearing
products, Therefore, the analyata excluded all other National
Health Accounta expenditure categories.
The coat of coverage for mental health, dental, and
preventive care in the standard benefit package was estimated
separately, fram aggregate data, and added in at the end of the
process. Once expenses were ad~uated for coverage differences,
the modelers applied the fee-for-service plan deductibles,
coinsurance, and coat-sharing ltmits to each person covered
through the regional alliance. ·
An insurance-induced demand adjustment was applied to all
those enrolled in the regional alliance. The basis for the
induced demand was the difference between out-of-pocket spending
under current law and that determined by the reform simulation
already described. The induction factor varied by type of
service. Post~induction apending is equal to the expenditures
calculated previoualy plus (or minus) induced spending,
Following these steps, HCFA imputed ezpenaea to currently
uninsured people. Existing patterns of usa for the uninsured
person were diacarded, because those patterns are influenced by
the absence of insurance. An tmputation file was created for
each service covered under the regional alliance. To create the
file, insured people were divided into groups according to
gender, four age classes, and three poverty status classes.
Bxpenditures were tabulated for each group to deter.mine: (a) the
proportion that had no expenditure and (b) mean expeftditurea and
use for each decile of the user distribution. Bxpenaes were
imputed for uninsured persona using these imputation files.
A final simulation wa1 per~o~d to model whioh people were
covered by the alliances. People were divided between the
corporate alliance and the re;ional alliance according to the
worker status of the adults in the insurance family, and were
asaiqned to one of three policies: individuals (and couples with
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7
no dependants), one adult plus dependents, and two adults plus
dependents, Lastly, analysts applied the family limits on outof-pocket spendin9 to detarmdna the plan benefits and copaymants.
In order to qanarate an upper-bound subsidy estimate,
whenever a two-earner couple had one worker in a large fir.m
(5,000 or mora workers) and one in a fir.m that would be covered
through a regional alliance, the couple waa assumed to choose
coverage in the regional alliance. This maximizes the potential
discount costa qiven that no government discounts are available
through the corporate alliances.
After plan benefits had bee~ determined, premiums were
calculated for each of the policy and alliance types. An offset
was applied to expanses to reflect currant-law cost-shifting
attributable to uncompensated care. Currently, private sector
premiums are higher than they would be if there were no
uncompensated care in the system since providers pass these
unpaid costa on to insured, payinq patients. Under reform, all
persons will be insured; consequently, baseline premiums should
be reduced to reflect the elimination of non-payers from the
system. A load factor was applied to the benefit coat per
policy. The load factor was 15 percent for the re;ional
alliance.
a.
Agency for Health care Po~icy an4 Research•
ABCPR's method of qe~erating premium estimates has seven
steps. Firat, following conventions in health economics, ABSIM
eatimatea a two-part model of expenditures for each service. ~he
unit of observation is the person. The first equation in each
service's set of two equations estimates the probability of using
the service at all aa a function of demographic, income,
insurance, employment, and health status meaaurea from the 1t87
NMBS-2. The second equation estimates annual expenditures on the
service for all uaars of the service, as a function of the same
explanatory variables. Combining the resul~ of these equations
(i.e., multiplying the probability of usa times the coefficients
�8
in the second equation):yields an equation that predicts
expenditures for each type of person. Predicted expenditures are
aged to ltt4.
Bealth expenditures for each person are then predicted for
each of the ten services included in the ABSIM Model using this
system of equations. Predictions for both the p~obability and
the level (given any use) of an expense were made !or each peraon
baaed on these regressions. The procedure aaaigna the same
expected values to people with private insurance and similar
personal characteristics, based on a hypothetical "avera;e 11
insurance policy .. Bxpected values are modified to take into
account specific plan provisions using information from the RAND
National Health Insurance Experiment about the effects of such
provisions. Reform expenditures are imputed to all people in the
model using a stochastic process that maintains observed
correlations in expenditures across service types while
controlling for the demographic characteristics and health status
of individual NMBS-2 respondents.
BVery individual included in the ABSIM Model actually had
three types of reform expenditures assigned to them, indicating
their (assumed) behavior under fee-for-service (JPS), managed
care (HMO), and preferred provider (,PO) insurance ar~angemsnts.
Bxpenaes !or benefits paid, coat-sharing and noncovered services
were calculated separately for each type of plan by applying
alaims-prooeasing logic to the.' appropriate eatimated expenditure.
Premiums for each type of insurance plan were computed on the
basis of average benefits paid per insurance policy plus an
administrative load set at a percent of benefits paid. In this
way, each person was taken into account in computing initial
premium levels. Premiums were adjusted for current ~egional
variations in prices.
Individual choice of health plans under refo~ was modelled
by randomly assigning health insurance unit• to one of the three
types of plana (PPS, HMO, PPO) deacribed above. ~he assumed
probabilities of aelaotin9 p~icular plana were baaed primarily
'
,·
�SENT sv:xerox Telecopier 7021 i11-19-93
i
4:09PM
202 385 8148i.11
'
upon market aharas observed by the Health Insurance Association
of America (HXAA) in their annual surveys, trended forward to
1994. These estimates were modified by assuming a 10 percent
reduction in FFS under refor-m as a reault of managed competition.
Market shares were allowed to vary on the basis of region,
urban/rural location, and the availability of discounts for outof-pocket (OOP) expenses and premiums.
Two passes through the data are made to compute the final
set of premiums. The first pass implements decision rules
regarding the diatribution of premium payments under rafo~. It
alao computes the coat of nonoovered services and coat-sharing
requirements borne by individual households. Based on these
calculations, the model dete~nes the extent to which a
household's direct oosta will be offset by supplemental insurance
and OOP discounts. ln the aecond pass through the data;
expenditures are increased to reflect additional spending induced
by supplemental insurance and 00! discounts. Insurance premiums
are then adjusted to reflect these higher expenditures.
IV.
Discount Batimates
The President's health care refor.m proposal includes a
number of different discounts, targeted at different payers.
There are two employer discounts: one directed at all fi~• in
the regional alliance, and one,.diracted at small firms with leas
than 75 employees. There is a discount for the family share (20
percent of the ac~uarial value) of premiums and for out-of-pocket
payments for both working and nonworking low income families.
There is also a discount for the 80 percent premium share for
those families who do not have at least one full time worker (or
equivalent), including early retirees. The major models are
atmilar in how they estimate moat components.
8aployer Diacouata•
The 9eneral firm discount conaiata of a 7.9 percent of
payroll cap on all firm premiums, regardleaa of firm siae,
A.
�- gJ:f11
IH •
10
provided the employer ia in the regional alliance. If the coat
of providing 80 percent of the adjusted premium per worker
exceeds 7.9 percent of firm payroll, the federal discount is
equal to the difference between the two amounts.
The amall firm discount schedule (see Appendix A) provides
lower payroll caps (below 7.9 percent) for firma with less than
75 employees ADd average pay below $24,000 per year.
Diaoouata !or the lelf-lmplore4.
Those individuals who are self-employed are obligated to
make a contribution to·the alliances based upon the same achedule
used to determine small business payments.
So, for example, a
self-employed person who is also employed by a firm and who is
working a full-time, full-year job for wages or salary has no
fur~her obligation with regard to the 80 percent/employer share.
Similarly, an individual who works full time for wages for 8
months and then quits that job and becomes aelf-employed would
only be obligated up to a maximum of 4 months of the 80 percent
o£ the adjusted per worker premium for his/her health insurance
unit type,
•·
c.
Discounts to Low laoome Pamilies.
Low income workers and non-workers (those with family income
leas than 150 percent of pova~y ) are eligible for government
discounts to assist in the payment of the family share of the
premium and to assist with family out-of-pocket payments (coinsurance and deductibles).
Pamilies below poverty do not pay
more than 3 percent of income for their family premium share
contribution; those with income below $1000 have no premium
contribution. Pamilies at or above 150 peraent of poverty are
2
:trho family lile apeciflc paY8It)' pideUDei'UIId are:
aiqte - lunily size ia 1
couple - family - Is 2
liqle parat family - family u ia 3
dual pareat family - famil)' u Ia 4.
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··nv 1 v·,.- , v·• v" vI' • • •
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11
responsible for 1-'ayintj -the full 20 percent share, or 3,t percent
of family income up to $40,000, whichever ia leas. The
government discount is equal t9 20 percent of the actuarial
premium for the health insurance unit type, leas the calculated
family contribution. For purposes of this calculation, family
income ia equal to adjusted ;rosa income leas unemployment
compensation plus non-taxable interest income.
An out-of-pocket spending discount is available for those
families below 150 percent of poverty who live in an area that
does not provide access to a low coat sharing (BMO) plan. In
such cases, the family ia only o~ligated to pay the coat sharing
that would be required if the family had actually enrolled in an
BMO (i.e., $10 copaymant for outpatient services); the remainder
is financed by the government.
Families without at least one full time worker or
equivalent, may be required to pay at least some portion of the
80 percent adjusted premium share that is covered for workers
through their employers. Families with non-wage income below 250
percent of poverty are eligible for some subsidization of this
obligation.
Families below poverty do not pay more than 5.5 percent of
their non-wage income for this portion of the premium, and
families with leas than $1000 in non-wage income have no required
contribution towards this port~on of the premium. Hon-wage
income is calculated as Adjusted Gross Income (AGI) leas wa;ea
and salaries leas unemployment compensation and lela selfemployed income.• Income in this category includes: rents and
royalties, interest (including non-taxable interest income),
dividends, altmony, capital gaina/lossea, the taxable portion of
~
1.
2.
uamplea of familiaa wttb a •f\dl dme WDibr eqllivalaat• 111:
each apouae wolb hllf time for the ft&11 yaar;
cu 11p01110 works tuu limo for 8 months ad tho OCbor worb full limo for 4 moatba.
~e ICtualleai.wioD eatcludea Wllplllldlllariu up to $60,000 per year. W~p~ 1114 alariaa iD IIUlOB8 of
Ibis IIIIOODt COUDt toward& thia caAladoa. 'l1le $60,000 eatcluliOD oap 'M8 DDt IJJOdelled, llllkiq. tho su'blidy
MtimaleB IIOIDeWbat over-tta.S.
�--·-
--------
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·-·- ... -.. --...-
12
sogial security, partnerships, and. trusts. ABide !rom these
items, other categories of exgluded income are: wal!ara
pa.YJil8nta, VA benefits, worker's. compensation, child support
income, inherited money, and. proceeda from life insurance.
D,
Discouaota,
Pamilies with retirees• are eligible for a spacial
discount. When fully phased in, government discounts cover the
!ull 80 percent/employer share for non-working re~irees.
Government discounts are offset to some extent bf the emplorera
of retirees who work part time and the emplofers of working
spouses. !'or example, a 58 year old man who is working half ~ime
will have half of his employer contributions made by his employer
and half of his gontributions will be made by the federal
government. No government discount is necessary when a retiree
has a full time working apousa, as the spouse's employer's
contributions will fulfill the coverage responsibilitf. However,.
if a retiree is married to a non-worker, the government discount
will cover the couple (or family).
Ra~i~ee
1.
lsttmatea of Distri~utioaal Impact of Disco~ts
~IM1
In the TRIM2 model, employer obligations (either BO
percent of the adjusted premium for each worker or a percent of
total payroll) are calculated for each yorker; there are no !i~
per se on the CPS, although ea6h worker has employer information
associated with them. TRIK2 assigns fi~ average payroll
information from the county Business Patterns (CBP) data to each
worker, using a statistical matching procedure that relies on
industry (the 3-digit SIC codes), state of residence, and
establishment aize. In addition, an average firm premium il
imputed ~o each worker.
'rbe policy defiue retiteell u thcle acmworkcn who bave fulfilled a nquiJemeat of a mlni!DQ!I111J1Dber of
wortiq qurtlln ud who aN betweeD tile 18M of 55 IDif 64, illclualve. Howevw. the mo&tels lleiq uaed to
aimulaa. the COIIt of tbe plan c1o aot have data OD qu.vtera W01kocl. CcGeequeatly, all bulivi4uals 55 to 64. 9fiao 111'0
aot worklq or wolk put time or past year, are modalled u beiDa elislble fot the ll*ia1 nd!IIIUbaidy.
�13
The employer's payment is proxied by the comparison of
average pay ~imes the appropriate percen~age cap (3.5 percent to
7.1 percent) to 80 percent of the average firm premium. If the
80 percent of the average firm premium is less than capped
average pay, the employer would pay 80 percent of the correct
adjusted premium for each worker. If, on the other hand, capped
average pay is leas than 80 percent of the average fi~ premium,
the employer would contribute 7.9 percent (or the appropriate
percentage less than 7.9 percent) of total payroll to the
·alliance.
BCFA/AIIXMa -In the SPAM and ABSIM models, the basic
calculations of employer discounts are similar to those in TRIH2.
Stmilar approaches are used ~o estimate o~her discounts.
v.
Ratioaal lpeadlag lmpac~s
The change in spending produced by health reform can be
summarized in te~s of the impacts on businesses, household•, and
governments. Present business spending is here limited to
employer contributions for employer-sponsored health insurance
and for active workers and retirees. Under refo~, employers are
required to pay 80 percent of the average worker premium in their
area (net of discounts) for most workers. Those employers
currently paying more than the required employer contribution
percentage, or buying richer c~verage (e.g., lower coat-sharing)
are assumed to con~inue to pay'more than the required minimum.
The calculations of changes in business outlays are •imilar
in TRlM2 and SPAM. If an employer currently pays more than 80
percent of premiums, TRIM2 increases .mployer spending under
refo~ to match the proportion contributed by the employer
currently, as long as this does not exceed ourrent spending. ~~
maintenance of the aurrent proportion would eaceed current
spending, it is assumed that employers increase their spending
only to the point of current spending. Worker contribution• are
reduced accordingly. This first part of supplementation ia then
increased to add the coat £or enhancin9 the richness of coverage
. ~·
.
�--
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-
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• -- -
•
• -·
•
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•
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•
14
up to the currant level,.of plan richness associated with each
currently insured worker. The cost of matching the currant
richness of benefits is paid by the employer and the worker in
proportion to current premium contributions.
In the BPAM model, additional coverage is assumed wherever
currant payments are better for the family than modeled future
paymenta under the mandated benefit packa9e. Supplementation
amounts are accumulated equal to the difference between current
and required benefits. Bmployer contributions are assumed to
cover the supplement, although employer payments for the required
coverage are held to the mandate~ minimum.
The ABSIM Model assumes that both employers and households
attempt to hold their spending on health insurance constant from
baseline to reform. To the extent that baseline spending on
employer-sponsored insurance exceeds expenditures required under
reform, employers are first assumed to buy down their employees'
required contributions, If baseline spending exceeds rafo~
requirements for either households or employers after taking this
transfer into account, the ABSIK model then allows both
households and employers to buy supplemental insurance, Por each
health insurance unit in ABBIK, the actuarial value of supplemental insurance purchased under reform cannot exceed baseline
levels. ~he total amount of supplemental inaurance is also
limited by the level of potent~al out-of-pocket expenses (costaharinq plus noncovered services) under refor.m. Supplemental
insurance ia also assumed to carry a higher administrative load
than basic health plans, 25 percent in moat recent simulations.
Any employer excess that remains after buying supplemental
insurance is assumed to increase other tax-preferred fringe
benefits.
Household apendin; is defined to be the employee
contributions for employer-sponsored health insurance, direct
premiums for non·group coverage (under the current ayatam) or
direct purchase of alliance coverage (under refo~), and aostaharin9 payments, In the baseline, the employee contributions
�SENT
sv:xerox Te 1ecop1er 7021 ; 11-19-93
f: 12PM
..
202 395 8148:#17
15
are defined ~o include employee payments irrespective of tax
s~atua; pre-tax employee contributions are oounted as employee
payment• despite IRS treatment .of such sums as employer
contributions. To the extent supplementation implies higher
business payments, household •pending is reduced by like amounta.
Total changes in coat-sharing are aalcula~ed as the net of
reduced paymanta due to new and enriched coverage, against
increaaad cost-sharing attributable to required purchase of
insurance leading to increased utili1ation and aom. personal
payments (rather than reliance on uncompensated care mechanisms).
Government apending changes reflect transfers between the
Federal government and other levels of government, as well as
increased Federal responsibilities (particularly in arranging
disooun~s for low•wage firma).
laseline Federal spending is
primarily Medicaid and Medicare. Under reform, Medicaid non-cash
populations move into alliance plana, with some direct business
payments. Similarly, more Medicare recipients fall under working
aged rules, with direct employer contributions reducing Medicare
responsibilities.
State and local baseline spending is primarily Medicaid,
although significant sums are currently spent on other programs,
most notably direct payments to hospitals. Under refo:m,
Medicaid savings will be redirected under maintenance of effort
requirements for uae in paying.diaaounts for low-income
populations in the alliances.
�16
APPIHD!X A
·Small
&ve~age
Parzroll
Pirm
Pi~
Discouats
liae · of PJ.m' (IIUIIbezo of lmployees)
Less Thu
25 to 50
10 to 71
25
Less $12,000
$12,000-15,000
$15,000-18_1_000
$18,000-21,000
$21,000-24,000
Greater Than
$24,000
3.5.
4,4,
5.3t
6.2.
7.1,
7,,,
4.4.
s.:n
5.3.
6.2.
6.2.
7.1.
7,,,
7.1.
7.9.
7.9.
7.,.
7.9.
'Because 75 WDiken wu DOt a h u bnet iaoluded ia dao data • bo1q lllld, 111011e1ere were uW to
a firm aiiB of 100 for tbis mbeicly c:alGUiatioll. Olvea. tblltllo &Ubaidiea wJD apply ODly to lira up to flizD 75,
tbe Nllllll overoatimate tho mbaidy coets.
\a
�To:
Jeff Eller
Steve Richetti
Lorraine Miller
Christine Heenan
Melanne Veneer /
Mike Lux
John Hart
From:
Chris Jennings
Re:
The Affordable Health Care Now Act of 1993
FYI.
�09-14-93 08:32PM- FROM CUNG:- HASTHT
TU- ~4JbTI J~
- riJUUU!:,
J. bENNIS HASTERT
COMMITTEE ON
14TH DISTIUCT, ILLINOIS
ENERGY AND COMMERCE
Z•S:J "-TDWft"
t1o1o1~<
W&SIOINGTON,
COMMITTEE ON GOVERNMENT
OPERATIONS
Orrocr Bw••ooNc
DC 30&111·13.14
£XECUTIVE COMMmU ON
12021 225-2976
27 lllou'"
Aov~•
Snon
60510
1708)408-1, 14
Q..T&.,I&,IL
1007 ~AIN STRUT
MENDOTa, IL 81342
18, 6) 638-3322
COMMITTEES
Qeon1rtil of tbe 1lnittb 6tatti
~CLCCT
COII!IIoiiT'TEE ON
~UNGER
l{tou•r of 1\rprtstntatibtj
fllasbington, JB(( 20515-1314
BIOGRAPIDCAL SKETCH- CONGRESSMAN J. DENNIS IIASTERT, R-IL-14
After having taught government and history for 16 years at Yorkville {11.) High
School, Congressman J. Dennis HasLerl is now playing a role in both as a member of
the l03rd Congress.
Congressman Hastert, 51, was elected in 1986 to represent the 14th Congressional
District of Illinois, a suburban landscape of high tech firms, small and large industrial
complexes and expansive farm land.
He is .a. member of the powerful Energy and Commerce Committee. which reviews
nearly sixty perc~nt of all the legislation that eventually reaches the floor of the ·
House. The committee's jurisdiction includes energy policy, interstate and foreign
commerce and trade, broadcast and telecommunications policy. rood health and drug
issues. In 1991, Hastert was asked by Bob Michel, the Republican Leader, to serve
on his Party's task force on Health Care Reform - a roJe which recently led Michel
to appoint Hastert as the House Republican representative on the new White House
Health Care Reform Task Force, chaired by First Lady Hillary Rodham Clinton.
Hastert serves on the Health and Environment, Energy and Power and
Telecommunications and Finance Subcommittees.
His second committee assignment is on the Government Operations Committee,
where he serves as the ranking member of the Environment, Energy and Natural
Resources Subcommittee. Hastert's service on the Government Operations
Committee provides him with opportunities to brin~ both economy and efficiency to
the federal bureaucrac¥, and also allows oversight mto agencies as varied as the
Environmental Protection Agency, Nuclear Regulatory Commission and U.S. Army
Corps of Engineers.
·
-
PIIINfiO 0111 AGCYCI 10 PAPIN
�09-14-93 08:32PM
FROM CONG: HASTERT
TU 94J5l! J8
. tOOjTIJ
r~
Rep. J. Dennis Hastert
He was also honored this year by his fellow House Republicans with an appointment
to the post of Deputy Minority Whip.
During his years in Congress, Hastert has pushed legislation to reform the budget
process, balance the federal budget and cut government waste. He has also led a
nationwide fight to repeal the unfair Social Security Earnings Test, which
discriminates agarinst seniors who choose to continue working after they reach
retirement age.
Concerned about the environment, Hastert has led the fight to defeat a massive
experimental baleftll/landfill proposed for the northern part of his district. He has
also worked for the removal and proper disposal of eleven million cubic. feet of low
level thorium waste currently sitting in West Chicago, Illinois.
Hastert has enjoyed strong editorial support from the newspapers in his district, and
he has been the recipient of the "Outstanding Legislator'' award by numerous groups~
He is parlicularly proud to have been named a Friend of Agriculture and to have won
the Golden Bulldog Award in each of his years in Congress for fighting against waste
in government.
Prior to his election to Congress, Ha5tert served three terms in the Illinois General
Assembly, where he spc:arheaded legislation on child abuse prevention, property tax
reform, educational excellence and economic development.
He is a 1964 graduate of Wheaton {ll.) College and earned his master's degree from
Northern Dlinois University at DeKalb in 1967. He is married to the former Jean
Kahl and they are parents of two teenage sons~ Joshua and Ethan. The family resides
in Yorkville.
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SUMMARY: THE AFFORDABLE HEALTH CARE NOW ACT OF 1993
IMPROVED ACCESS TO AFFORDABLE HEALTH CARE
TITLE I:
SUBTITLE A:
INCREASED AVAIIJABILITY AND CONTINUITY OF
HEALTH COVERAGE FOR EMPLOYEES AND THEIR
FAMILIES
PURPOSE:
To expand access to affordable group health coverage for
employers, employees and their families and to help eliminate
job-lock and the exclusion of such individuals from coverage due
to preexisting condition restrictions.
This section:
1.
Requires employers without existing health benefit plans to offer to eligible
employees at least one plan meeting an actuarially defined standard of
coverage. The plan must cover essential and medically necessary medical,
surgical, hospital, and preventive services. Employers are not required to make
any premium payments for their employees.
2.
Encourages employers to facilitate employee enrollment in health plans through
multiple employer purchasing arrangements or state-sponsored accessible health
benefit systems.
3.
Limits preexisting condition restrictions under all employer health benefit plans,
including self-funded plans. F.liminates pregnancy as a preexisting medical
condition and provides coverage for newborns at birth.
4.
Ends job-lock by assuring continuous availability of health coverage by
prohibiting preexisting condition restrictions for those who are continuously
covered.
·
5.
Prohibits employer health plans from being canceled or denied renewability
except for the following reasons: (a) nonpayment of premiums, (b) fraud or
misrepresentation, and. (c) noncomplianct: wilh plan provislons.
�SUBTITLE B:
RElt'ORM OF' THE HEALTH INSURANCE MARKETPLACE
FOR SMALL BUSINESSES
PURPOSE:
To expand access to health insurance by making private health
insurance marketed to small employers more affordable and
available regardless of an employee's health status and previous
claims experience.
This section:
1.
Requires insurers. who sell insurance in the small group market to offer health
benefit plans to all companies who employ 2 to SO employees. Insurers would
be required to sell at least three plans to small·employers: (a) a Standard Plan
to be comparable in benefits to those plans currently available in the small
group health insurance market; and (b) a Catastrophic Plan with higher cost·
sharing provisions for health care services; and (c) a Medisave Plan that
includes catastrophic coverage with an integrated family medical sav~ngs
account.
Insurers must accept every small employer and every eligible employee of a
small employer who applies for coverage under a plan. Insurers may not place
restrictions on the eligibility of an individual to enroll (e.g., no medical
underwriting) as long as such an individual is a full-time employee. Uninsured
employees.would have a c:hoice·among the three plans.
2.
Requires plans to cover essential and medically necessary medical, surgical,
hospital, and preventive services. The National Association of Insurance
Commissioners (NAIC) will determine target actuarial values for the Standard
and Catastrophic Plans. Insurers would have the flexibility to develop the
benefit provisions as long as they meet the target actuarial values established by
the NAIC for each plan.
The Medisave Plan must include catastrophic coverage plus an integrated
medical saving account providing for the reimbursement of health care expenses
including the deductible and/or coinsurance.
3.
Places limits on premium rate variations charged to small busine~se.~ which
would be based on underwriting factors other than geography, age,. gender, and
plan design.
4.
Limits annual increases to the change in an insurer's new business rate plus 15
percentage points.
5.
Encourages States to establish reinsurance pools.
2
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IMPROVED EMPLOYER PURCHASING POWER AND
MORE AFFORDABLE HEALTH COVERAGE
PURPOSE:
To improve access to health coverage and lower insurance costs
for both small and larger employers by encouraging the
establishment of multiple employer purchasing arrangements and
by eliminating costly state reguh1lions.
This section:
1.
Facilitates the ability of employers to form groups for the purpose nf
purchasing health coverage. Reduces costly regulation, allows any group of
employers to purchase insurance. and helps ensure the solvency of self-funded
multiple employer health plans.
2.
Helps lower costs, eliminates inter-state barriers, and provides a level playing
field between insured and self-funded plans by eliminating burdensome and
expensive state mandates.
3.
Encourages the formation ot· multiple employer health plans by removing IRS
regulatory barriers involving geographic limitations and business commonality
tests which now prevent such groups froin using tax-exempt 501(c)(9) trusts to
lower costs.
4.
Preempts state laws which restrict the development of cost effective managed
care programs. The provision sunsets five years after enactment.
3
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HEALTH DEDUCTION FAIRNESS
PURPOSE: To provide the self-employed with tax treatment for the purchase of
health insurance equal to that of other Americans who now receive a tax
exclusion for empioyer-paid health benefits.
This section:
1.
Gradually increases the current law tax deduction for cost of health premiums
for the self-employed from 25% to 100%. (Cost $4.7 billion nver S years; a
Medicare payment change per Title IT, Subtitle F, imposing a 10% co-insurance
requirement for clinical laboratory services on Medicare beneficiaries provides
sufficient savings to offset any revenue loss due .to this provision.)
SUBTITLE E:
Part 1.
IMPROVED ACCESS TO COMMUNITY HEALTH
SERVICES
Increased
A~thorization
for Community and Migrant Health Centers
PURPOSE: To expand capacity of communities to meet the health care needs of their
citizens, especially lower incomt: and uninsured individuals through
expanding the number of community. and migrant health care programs
and the resources available to them.
1.
Increases the current authorization for Community and Migrant Health Centers
(C/MHCs) to expand access to primary care services. ($1.5 billion overS
years)
PART 2.
Community Coordination Demonstration Grants
PURPOSE: To facilitate community health services planning and improve delivery of
health care services. ·
I.
Authorizes demonstration grants for communities for improved delivery and
coordination of health care services ($45 milliun over 5 years).
4
�SUBTITLE F:
PART 1:
IMPROVED ACCESS TO RURAL HEALTH SERVICES
Rural Emergency Medical Services Amendments
PURPOSE:
To improve emergency medical services operating in rural
America.
This section:
($15 million)
1.
Establishes an Office of Emergency Medical Services (EMS) to provide
technical assistance to state EMS programs.
2.
Provides incentives for improving state EMS programs through a matching
grant program. These grants will encourage better training for health
professionals and provide necessary technical assistance to public and private
entities which render emergency services.
3.
Provides federal grants to states for demonstrations of telecommunications links
between rural and urban health care facilities.
PART 2:
Air Transport of Rural Victims of Medical Emergencies
PURPOSE:
To develop air transport systems which will enhance access to ·
c.mcrgcncy health care services.
This section:
($15 million)
I.
Provides federal grants to states for the development or improvement of rural
air transport systems for medical emergencies.
5
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PURPOSE:
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Extension of Special Treatment Rules For Medicare
Dependent, Small Rural Hospitals
To continue adjustments in payments for rural Medicare dependent
hospitals in order to assure ready access to health care.
This section:
1.
Extends adjustment included in the Omnibus Budget Reconciliation Act of 1989
(OBRA 89) providing small rural Medicare dependent hospitals with an
additional hospital payment to offset unique financial risk from treating a high
percentage of Medicare patient~ under the prospective payment system. ($70
million for one-year extension)
PART 4:
PURPOSE:
24 Hour Emergency Care in Rural Alreas ·
To establish Rural Emergency Access Care Hospitals QWACHs)
for the purpose of providing 24 hour emergency care in rural
areas.
This section:
1.
. Permits existing rural community hospitals participating in the Medicare
program, to .maintain their Medicare status as a rural community hospital after
meeting criteria of eligibility as a rural emergency access care hospital.
6
�SUBTITLE G:
STATE FLEXIBILITY IN THE MEDICAID PROGRAM:
THE l\1EDICAL HEALTH ALLOWANCE PROGRAM
PURPOSE:
To allow states to develop guaranteed access to health insurance
for the entire state population. States will be provided more
flexibility and allowed to extend Medicaid to cover more of the
uninsured while working with the private se~tor to bridge the gap
between Medicaid and employer-provided 'insurance.
This section:
I.
Allows States to redirect Medicaid funds into Health Allowance Programs
where eligible individual~ wilt he able to enroll in private-market health plans.
2.
Provides States with the option of increasing eligibility to the Health· Allowance
Program up to 100% of the Federal Poverty Level.
3~
Provides States with the option of setting up a sliding scale subsidy whereby
individuals up to 200% of the Federal Poverty Level could buy-in to the Health
Allowance Program.
4.
Allows States to develop pooling mechanisms so that all other f~milies and
individuals without insurance (part-time workers, early retirees, etc.) can join
Accessible Health Benefit Systems for the purpose of buying health insurance.
SUBTITLE H:
MEDICAID PROGRAM FLEXIBILITY
PURPOSE: To give states more flexibility to enroll Medicaid beneficiaries in HMOs
and PPOs. Under current Federal law if a State wants to require
Medicaid recipients to enroll in health maintenance organizations
(HMOs), it must submit awaiver application to the Health Care
Financing Organization (HCFA). These waiver applications are granted
for only a limited period of time and cannot be renewed. These
procedures have greatly limited the ability of States to enroll Medicaid
beneficiaries on HMOs.
This provision:
1.
Allows States to enroll Medicaid beneficiaries in HMOs and PPOs without
having to submit cumbersome waiver applications. St.ate.'i would be given the
option to mandatorily enroll Medicaid beneficiaries provided they meet Federal
quality a.lii~urance standards.
7
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TITLE ll:
.J
HEALTH CARE COST CONTAINMENT AND QUALIIT
ENHANCEMENT
SUBTITLE A:
PART 1:
PURPOSE:
MEDICAL MALPRACTICE LIABILITY REFORM
Medical malpractice and product liability 1·eform
To improve access to fair compensation for those injured while
receiving medical care and to increa~e the availability of health
care services by reducing the costs of both medical malpractice
liability premiums and defensive medicine.
This section:
1.
Initiates Federal reform of medical malpractice liability actions by linking
federal dollars to malpractice reform initiatives.
2.
Requires that health care liabihty action include, in addition to health care:
providers and professionals, medical product producers. Medical products
mean both drugs and dc:vices as defined in the Federal Food, Drug, and
Cosmetic Act by the Food and Drug Administration (FDA). That punitive
damages relating to medical product liability not be awarded against a medical
. product producer if the drug or device was subject to approval by the FDA or
generally recognized as safe and effective as E'.Stahli~hed by the Federal Food.
Drug, and Cosmetic Act~ except in the case of withheld information,
misrepresentation, or illegal payment.
3.
Requires all medical liability disputes in a state to be initially resolved by a
dispute resolution process prior to entering the court system as a condition of
the receipt of federal funds under federal health related programs, including tax
deductibility of health insurance expenses.
4.
Places a $250,000 cap on non·economic damages. (Punitive damages are
handled separately.)
5.
Directs that punitive damages awarded by courts be paid to States to assist in
funding their efforts to reduce medical malpractice. Includes a definition of
punitive damages as compensation over and above the actual harm suffered,
awarded for the purpose of punishing a person for conduct deemed to be
malicious, wanton, willful, or excessively reckless.
8
�6.
Allows for structured periodic payment of compensatory awards.
7.
Places limits on attorneys' contingency fees.
8.
Limits the liability of the detendant to his/her proportion of negligence.
9.
Sets a uniform statute of limitations for plaintiffs of all ages.
10.
Clarifies a uniform standard for determining that a defendant has acted
negligently.
11.
Imposes a higher standard of proof for liability associated with certain obstetric
.
serv1ces.
12.
13.
Discourages frivolous court actions by requiring the plaintiff to pay the
. defendant's legal fees, if the plaintiff loses.
Allows Federal and State courts to determine a fee bond amount based on a
reasonable determination of anticipated court costs and includes the use of
cert~n property in li~u of bond.
PART 2:
Requirements For State Alternative Dispute Resolution
Systems (ADR)
PURPOSE:
To permit the Secretary of HHS (in consultation with the Attorney
General) to be able to certify the States' alternative dispute
resolution systems.
This section:
1.
Establishes basic requirements for ADR. It requires the Secretary to report to
Congress within 5 years about the effects of State ADR systems on cost,
access, and quality of health care.
9
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SUBTITLE B:
AD1\11NISTRATIVE COST SAVINGS
PURPOSE:
To reduce the administrative cost of our health care syslem by
streamlining the insurance billing system and utilizing the latest
technological innovations in information processing.
PART 1:
PURPOSE:
Standardization of Claims Processing
To simplify payment for medical services; eliminate unnecessary .
overhead and administrative cost; reduce billing fraud and abuse;
improve the collection of clinical i~formation for research; and
improve health care quality.
·
This section:
1.
·2.
Requires the Secretary of HHS to set standards for the use of magnetized
Medicare cards and issue them to beneficiaries.
3.
Requires hospitals, physicians and carriers to conform to the uniform claims
reporting standards.
4.
Requires the Secretary of HHS to design a clearinghouse for primary and
secondary payor information for the working aged and other Medicare
beneficiaries who may have employer-provided coverage.
S.
Requires use of the Social Security number as the identitier for all medical
claims.
6.
.
Mandates the Secretary of Health and Human Services (HHS) to develop a
standard claims form and data set for electronic transmission of health coverage
information and billing data.
Provides protection for individual privacy regarding claims and medical
records .
7.
Overrides state laws which prevent the sole use of electroruca11y transmitted
)
claims and other medical records for payment purposes.
10
�PART 2:
Electronic Medical Data Standards
PURPOSE: To improve quality of patient care by assuring the development of more
usable medical records.
This section:
1.
Requires all hospitals to put in place an electronic patient care information
system by January 1, 1996," which meets standards set by the Secretary.
PART 3:
Development and Distribution of. Comparative Valoe
Information
PURPOSE: To provide consumers information necessary for cost and quality
conscious purchasing of medical services.
This· section:
1.
Requires states to make availabl~
value of medical services.
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11
consumers information on the comparative
�SUBTITLE C:
MEDICAL SAVINGS ACCOUNTS (MEDISAVE)
PURPOSE: To provide incentives for health care cost consciousness and allow any
savings to accrue to the individual and family through the use of Medical
Savings Accounts.
This section:
1.
Allows tax-free deposits to Medisavc Accounts to reimburse medical expenses
and pay for long-term care, catastrophic, Medigap, and Medicare premiums.
2.
Requires that a Medisave Plan be linked to the purchase of a health insurance
policy with a deductib1e of at lea~t $1.800 ($3,600 for family). The cost of the
health insurance policy and contributions to the rdedisave Account are tax
deductible.
3.
Gives individuals the incentive to control health care spending by accumulating
the Medisave Account to pay for medical services.
4.
Allows amounts in the Medisave Account to accumulate from year to year.
Interest accrued is not considered taxable income.
S.
Allows employers to contribute to a catastrophic plan integrated with a
Medisav~ Account similarly to the way they do for employer-provided health
plans today.
12
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SUBTITLED:
ANTI-FRAUD
PURPOSE:
To strengthen the penalties for fraud in health care services.
This section:
1.
Includes private mail carriers in the Federal mail fraud statute.
2.
Allows for the forfeiture of property either involved in the health care fraud
·scheme or obtained with the proceeds of the scheme (post conviction).
3.
Requires the payment of restitution including 3rd party payers and
beneficiaries.
4.
Increases funding for the HHS Office of Inspector General and FBI to detect
and investigate health care fraud. Increases funding to the Depanment of Justice
to develop a health care fraud unit to improve prosecutions of health care fraud
cases. Funded through provision #~.
5.
Fines and civil monetary penalties collected put into trust fund established to
assist funding for health care fraud unit and investigations and prosecutions.·
6.
Provides whistle blower protection and reward if information leads to
prosecution for health care fraud (additional discretionary authority to the
Attorney General-- qui tam suits remain in place).
7.
Enables all payers to use Medicare antifraud provisions to protect their
beneficiaries from fraudulent activity.
8.
Allows for imprisonment when an individual knowingly and willfully engages
in a fraudulent act that results in serious injury to a patient. (Pending)
13
�SUBTITLE E:
MEDICARE PAYMENT CHANGES
PURPOSE:
To allow more Medicare beneficiaries to participate in health
maintenance organizations and other managed care arrangements.
This section:
1.
Eliminates the current requirement that HMOs which serve Medicare patients
have o. membership that is no more than 50 percent Medicare and/or Medicaid
beneficiaries.
2.
Expands existing law to allow managed care netw~rks (HMOs and PPOs) to
provide Medigap benefits to Medicare beneficiaries in all 50 states on a
·
permanent basis.
3.
Directs the Secretary of Health and Human Services to consolidate the
administration of Medicare Part A (Hospital Insurance) and Part B
(Supplementary Medical Insurance) over a five-year period.
SUBTITLE F:
REMOVING ANTITRUST IMPEDIMENTS
PURPOSE:
To provide communities an opportunity to coordinate regionally
the delivery of health care by exempting such activities from
certain antitrust constraints.
This provision:
1.
Provides a ''limited exempti~n" from antitrust laws for all providers entering
into joint ventures using a notification and pre·clearance process. Liability for
providers entering into joint ventures and fulfilling the notification and preclearance requirements would be limited to actual damages. (Eliminates treble
damages)
2.
Provides a compJete antitrust exemplion for all providers entering into joint
ventures that meet criteria developed by Secretary of HHS and Attorney
General that demonstrate greater efficiencies, expanded access, reduced costs
and elimination of excess capacity, associated with shared high technology
equipment, medical services, or ancillary ~ervices. Exemption can be repealed
if conditions under which complete exemption was granted change.
14
�SUBTITLE G:
ENCOURAGING ENFORCEMENT ACTIVITIES OF
1\fEDICAL SELF-REGUI...ATORY ENTITIES
PURPOSE:
To reduce medical costs and improve quality by enabling
physicians and other health care professionals to police
themselves.
This section:
1.
Limits the economic liability of professional self-regulatory bodies when
engaged in standard setting and enforcement activities which are designed to
promote the quality of medical care but which are not conducted for purposes
of financial gain.
2.
Allows for. the courts to award that a plaintiff pay the legal fees of a·
substantially prevailing defendant in certain antitrust suits relating to standard
setting and enforcement activities.
3.
Requires federal agencies to consult with appropriate professional
self-regulatory bodies in carrying out standard setting or other regulatory
activitieS.
·
15
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LONG TERM CARE
PURPOSE: To enable the elderly to use savings to buy long term care insurance .
products. and to purchase home nursing care.
This section:
1.
Allows individuals to save for long term care by providing tax-favored
treatment to qualified long term care insurance policies. Also it permits
permanent life insurance, 40l(k) and IRA savings to be u~ed to pay for longer
care and to be excluded from taxable income.
2.
Allows States to offer seniors access to an asset.protection plans, and allow
State.~ a choice in the amount of asset protection they offer.
16
�September 14, 1993
INTRODUCTION
Over three years ago, Senate Republicans formed a Task Force
to study our health care system. Since its formation, the Task
Force has been meeting regularly to examine our current system,
its problems, and the myriad proposed solutions.
We have directed our efforts toward creating a reform
proposal that reflects the views of an ideologically and
regionally diverse group of Republican Senators. We are united on
the goals of maintaining and improving the high quality of our
current system, controlling the escalating costs borne both by the
private sector and government, and ensuring that all Americans
have the security of access to stable and affordable health
insurance. We believe we have developed a proposal that meets
these goals by building on the private health care system.
The Senate GOP Task Force proposal is based on the premise
that, on the whole, our health care system works. The 85% of
Americans with insurance have access to high quality care - the
finest in the world. For most of them, health insurance premiums
are affordable right now. But there are serious problems that if
not corrected will threaten the security of all Americans.
The intent of our proposal is to minimize disruption to the
working parts of our system, while seeking to correct the problems
that jeopardize even its most successful facets: the spiraling
rate of growth in health care spending and the hidden costs of
providing care to those who do not have health care coverage.
In examining this issue, members of the Task Force have
concluded that while our system does not need radical revision, it
does need comprehensive reform. Our proposal makes a number of
changes to facilitate and enhance competition in the health care
marketplace. These changes, combined with provisions to give
consumers information that will help them make cost-effective
choices, will lead to improved quality of health care and a
significantly reduced rate of growth in costs. In addition, our
proposal will ensure that all Americans gain access to affordable
health care without adding to the federal deficit.
Our proposal is divided into two sections. The first
consists of the structural reforms in our health care system
designed to improve the availability, security, and affordability
of health insurance, and to improve the efficiency of health care
1
�September 14, 1993
while holding down escalating health costs. These changes can be
enacted immediately. The second provides federal financial
assistance on a phased-in basis to those for whom insurance
remains o~t of financial reach, even after the changes outlined in
the first section are completed.
STRUCTURAL
REFORMS
Current insurance market practices favor large employers and
give these employers some measure of control over the health care
costs of their workforce. Their large number of employees enables
them to negotiate better insurance premium rates with insurers, or
to negotiate reasonable prices directly with health care
providers. ·rn addition, with few exceptions, all of their
employees pay the same premium and are not denied coverage on the
basis of health status. Employers also are able to deduct 100% of
the cost of health care coverage, and employees receive these
benefits tax-free.
The Senate GOP Task Force proposal extends these same
advantages to individuals, to small businesses and their
employees, and to the self-employed. First, the proposal
requires insurers to provide coverage to everyone regardless of
health status and limits insurers' ability to charge higher
premiums to those who are sick. It prevents insurance companies
from marketing and selling only to healthy individuals and groups
by reforming the private system, establishing purchasing
cooperatives, and making risk adjustments between plans.
Second, the proposal allows individuals (such as workers with
no employer-paid insurance) and the self-employed to deduct the
cost of their health insurance premiums. Today, the self-employed
can deduct only 25% of their premiums and individuals, none at
all.
Throughout our proposal, we have remained sensitive to the
notion that "one size does ~ fit all." The proposal sets broad
federal guidelines within which states, communities, insurers,
providers, and businesses can operate. We include options and
special incentives to expand and improve the availability of
quality medical care in frontier, rural, and inner city America.
We also realize that in some instances, states may want to go in a
completely different direction in delivering health care to their
residents. We give states the ability to move forward on their
own versions of health care reform without subjecting them to
unreasonable federal restraints.
2
�September 14, 1993
:te proposal also restructures the treatment of health
insu=ance premiums in the federal tax code. Current tax subsidies
of e~ployer contributions to health plans over the next five years
wi~l amount to about $60 billion annually.
These subsidies are
available only for employer-paid health premiums and not for the
individual or the self-employed. They provide for full tax
preference regardless of the quality, cost, or efficiency of the
plan. We spread this benefit more fairly by making it available
to individuals and the self-employed. In order to make consumers
more cost-concious in their selection of plans, the proposal
limits the amount of premium costs that can be tax-free to
individuals and deductible to employers.
Our proposal also makes a variety of changes to the system
that we believe will stop the uncontrolled growth of health care
costs and improve the quality of care.
It reforms medical liability laws to reduce the unwarranted
lawsuits and irrational damage awards that have led providers to
order unnecessary tests and procedures and to practice defensive
medicine.
It reforms anti-trust laws which prohibit hospitals and
physicians from sharing costly medical equipment and capital to
make more efficient use of health care resources.
It establishes standardized forms and electronic information
reporting and exchange requirements to eliminate bureaucratic red
tape and reduce administrative costs and burdens.
·
We believe that we will reduce costs and improve quality by
providing consumers and health care providers with more
information. With better information, consumers can make informed
choices about health insurance plans, providers and treatment
options. In addition, by expanding outcomes research and practice
guidelines, health care providers can remain informed about the
most cost-effective procedures and treatments.
COVERING
TBE
UNINSURED
Of those who are uninsured, at least 40% have incomes greater
than 200% of poverty. The structural changes outlined earlier
will significantly increase the availability, security, and
affordability of high quality health care for most of these
Americans. In addition, we believe these changes will slow the
3
�' '
September 14, 1993
rate of growth in health care expenditures, in both the private
and public sectors.
There w~ll, however, be some Americans who will not be able
to afford even reasonably priced health insurance. The second
section of our proposal lays out a plan to make available a
federal voucher for those individuals and families who, without
financial assistance, cannot afford coverage. The voucher will be
equal to an income-adjusted percentage of the cost of the standard
benefit package, and will be used to purchase coverage from a
certified health plan.
As was indicated earlier in this paper, we believe that our
proposed structural changes will lead to substantial federal
savings. It is our understanding, however, that, at this point,
the Congressional Budget Office (CBO) will credit only limited
savings to any reform proposal other than a highly regulatory;
Canadian-style, single-payor system.
Moreover, we also are mindful of the admonition of the Office
of Technology Assessment (OTA) that, "There is a startlingly wide
range of estimates of the impact of the selected approaches to
health care reform on the areas of the economy examined." In
light of these points, we have concluded that the most prudent
approach is to pursue reforms in federal health care programs that
will slow the rate of growth in federal spending and then use
those savings to pay for a schedule of increased access for the
poor. Our proposal contains plans for an accelerated phase-in if
structural changes in the health care marketplace result in
greater or earlier savings than currently scored by CBO.
We are very mindful of the fact that budget savings estimates
are, in fact, just estimates. They are based on assumptions about
future behavior of consumers and providers and the efficiencies of
the markets they impact. Our experience with budget estimates
tells us that for major program changes, these estimates have been
an imprecise predictor of actual savings. We do not believe that
we should promise the American people a new entitlement program
that we are not certain we can pay for.
Our proposal sets in place the following phase-in of federal
assistance. By the end of 1995, all individuals with incomes of
below 90% of the federal poverty level will receive federal
assistance. By 1996 it will increase to 120%; 1997 to 140%; by
1998 to 70%; by 1999 to 200%; by 2000 to 240%. This coverage will
be financed by limiting the rate of growth in Medicare and
4
�September 14, 1993
Medicaid from 12% to 7%.
In addition, our proposal requires the
Congressional Budget Office, or other appropriate entity, to make
an annual assessment of whether or not the structural changes have
achieved greater savings than originally projected.
If so, the
phase-in will be accelerated accordingly.
If, on the other hand,
the savings in a given year are inadequate to finance eith~r an
acceleration or a scheduled step, the phase-in of assistance will
be delayed unless Congress finds an alternative financing
mechanism.
5
�September 14, 1993
SECTION
PART
1 .
A:
BAS I C
Insurance
I:
BASIC
AND
STRUCTURAL
REFORMS
REFORMS
Market
Reform
Purpose:
to eliminate competition between insurers
based upon selection of low-risk consumers; to ensure
competition based upon quality, price, service, and
choice.
Intended result:
to increase availability of
insurance to individuals and small business employees;
to provide health security, control costs, and improve
quality of care.
A.
Qualified Health Insurance Plans will:
1.
Guarantee eligibility to all applicants.
2.
Guarantee availability throughout the geographic
region in which the plan is offered.
3.
Guarantee renewal to all participants except in
instances of non-payment of premiums or fraud.
4
Not discriminate on the basis of health status.
5.
Offer the standard or catastrophic benefit package.
6.
Offer an adjusted community rate premium (after a
transition) for individuals and small businesses
defined as 100 or fewer employees who purchase
through a purchasing cooperative. During the
transition:
a.
rating bands will be applied in the first
year; over the following years they will be
narrowed to an adjusted community rate.
States may shorten the phase-in.
b.
individuals who cannot demonstrate coverage in
the previous year may be subject to a sixmonth pre-existing condition exclusion for
expenses related to an illness that was
evident within the previous three ~onths.
7.
Offer a community rate to individuals and small
businesses who do not purchase insurance through a
cooperative.
8.
Participate in risk-adjustment.
9.
Meet quality standards.
10..
Comply with administrative standards and
reporting requirements.
11.
Meet solvency criteria.
6
�September 14, 1993
2.
Administrative
Simplification
Purpose:
to provide uniform federal guidelines for
standardization of electronic data exchange and
reporting to reduce red tape and bureaucracy and to
eliminate duplicative forms.
Intended result:
to lower costs, streamline
operations, provide information on technology and
quality, and generate a "report card" for consumers to
compare quality of plans.
A.
The Secretaries of Health and Human Services (HHS),
Department of Defense (DoD), and Veterans Affairs (VA), and
others appointed by the President, will make up a Federal
Administrative Standards Panel. A Commission composed of
private sector experts will advise the panel.
B.
Duties of the Panel
1.
Adopt data standards, within two years, for the
electronic reporting and exchange of health care
information. Such standards should be:
a.
based on existing, widely-used criteria.
b.
designed to include data related to
enrollment, eligibility, quality measurement,
utilization management, risk assessment,
patient satisfaction, outcomes, appropriate
data to monitor access to health care
services, and other data sets as deemed
appropriate by the panel.
c.
contain strict measures to ensure
confidentiality of data.
2.
Establish business practices for operation of a
nationally-linked health care information database
system.
3.
Develop appropriate civil and criminal penalties
for non-compliance.
c.
Oversight and implementation of standards
HHS is responsible for oversight, enforcement, and·
implementation of data standards; and for establishment
of a certification procedure for database, computer and
network vendors.
3.
Medical
Liability
Reform
Purpose:
to resolve disputes more effectively and
efficiently; to reduce the practice of defensive
7
�September 14, 1993
medicine, unnecessary tests and procedures; to identify
and correct bad practices; and to ensure that those who
are the victims of negligence are fairly compensated.
Intended result:
to lower medical costs and to
improve quality of care.
A.
B.
C.
D.
Mandatory, non-binding Alternative Dispute Resolution
(ADR)
1.
Parties must participate in an alternative dispute
resolution system established by the state.
2.
Plans are required to explain this process in their
descriptive materials to beneficiaries.
Litigation
1.
If one of the parties in the dispute wishes to
challenge the result of ADR, he/she may do so
2.
If the decision rendered in court is less favorable
to him/her than in ADR, he/she shall pay all legal
fees subsequent to ADR.
Damages
1.
Non-economic damages are capped at $250,000.
2.
Malpractice awards shall be reduced for any
collateral source payments to which the claimant is
entitled.
3.
Periodic Payments
Claimant will be required to accept periodic
payment as opposed to lump sum on awards exceeding
$100,000.
4.
Punitive damages
50% of a punitive damage award shall be paid to the
State for activities approved by the Secretary of
HHS to improve monitoring, education, and
disciplining of health care providers in that
State.
Reform of Procedures
1.
Statute of Limitations
a.
except for minors, no health malpractice
action may be initiated more than two years
after the date on which the alleged injury
should have been discovered, and in no event
later than four years after the date of the
occurrence.
b.
with respect to injuries alleged to have
occurred to minors (under 6 years of age), no
health malpractice action may be brought after
reaching 12 years of age.
8
�September 14, 1993
2.
E.
F.
4.
Joint and Several Liability
For non-economic and punitive damages, liability
for payment of damages shall be based on the degree
of contribution to the negligent act.
Practice Guidelines Rebuttable Presumption
Providers following practice guidelines approved by the
Agency for Health Care Policy and Research (AHCPR) shall
have a presumptive defense against malpractice claims.
Products: drugs and devices
1.
All medical liability reforms listed above apply.
2.
If approved by the Food and Drug Administration
(FDA) and used properly, no punitive damages will
be allowed.
3.
If FDA approval was based upon misleading or false
information, the prohibition on punitive damages
will not apply.
Quality
Assurance
Purpose:
to ensure that health plans have an approved
quality assurance plan, to establish national standards for
reporting quality information, and to expand the availability
of information available to health plans and health care
providers on practice guidelines and outcomes.
Intended result:
to maintain the high quality of care in
our current health care system and to provide information to
consumers on the quality of each health plan to assist in
selecting a health care plan.
A.
B.
c.
Health insurance plans must have a recognized quality
assurance program as defined by the Secretary of HHS.
In developing such standards, HHS must consult with
recognized private sector entities engaged in quality
assurance, such as the Joint Commission on Accreditation
of Healthcare Organizations, the National Committee for
Quality Assurance, or other recognized organizations.
Plans must provide quality data including information on
outcomes and effectiveness in the format developed by
the Secretary of HHS in conjunction with the Federal
Administrative Standards Panel.
AHCPR is directed to expand its present research agenda
to include the following:
1.
A fund investigator to initiate research on the
relationship between treatments and outcomes.
2.
Priorities for the research community to strengthen
9
�Septe~~er
14, 1993
the research base.
Effectiveness trials in collaboration with medical
specialty societies and qualified health plans.
4.
A clearinghouse and other registries on clinical
trials research data.
5.
Continued and expanded development of practice
guidelines to provide information to health care
practitioners and plans.
Establishes a Medical Research Trust fund to guarantee
funding for medical research.
3.
D.
5.
Anti-Fraud
and
Abuse
Purpose:
to expand criminal and civil penalties for fraud
and abuse in our health care system.
Intended result:
to provide a stronger deterrent to the
billing of fraudulent claims and to eliminate the waste in
our health care system due to these practices.
A.
B.
C.
D.
E.
6.
Requires the Secretary of HHS to establish and
coordinate a national health care fraud program, and
establishes the Anti-Fraud and Abuse Trust Fund to
finance these efforts. Monies from penalties, fines,
and damages assessed for health care fraud would be
deposited into the trust fund.
Increases and applies civil money penalties now
available under Medicare and Medicaid to fraud in all
health care programs.
Allows competitors to sue health care providers who
defraud Medicare and Medicaid for damages if the
government does not bring charges against the fraudulent
provider.
Requires health care providers who are convicted of
health care fraud felonies to be excluded from the
Medicare program.
Requires HHS to publish the names of providers and
suppliers who have had final adverse actions taken
against them for health care fraud.
Antitrust
Reform
Purpose:
to reduce unnecessary duplication in our health
care system and to allow providers to share resources.
10
�September 14, 1993
Intended result:
to reduce costs in,
to, our health care system.
A.
B.
C.
D.
7 .
and increase access
~he Attorney General, in consultation with the Federal
7rade Commission (FTC) and the Secretary of HHS, shall
establish competition guidelines and safe harbors for
state-licensed health care providers and for qualified
health plans and buying cooperatives, including
guidelines for areas where competition cannot function
effectively, e.g., certain rural areas.
The Attorney General, in consultation with the FTC and
the Secretary of HHS, shall promulgate standards and
procedures to issue on an expedited basis waivers, which
shall exempt persons and organizations in the health
care market from all penalties (civil and criminal)
under the anti trust laws. The Departments of Justice
and HH_S, and the FTC, shall establish procedures for
expedited waiver review.
Cooperative ventures in the health care industry, when
not deemed approved by certificate or other public
license, shall be subject to the rule of reason
analysis.
Buying cooperatives may be organized to represent
consumers.
1.
Such cooperatives shall be deemed single entities
under the antitrust laws and shall not be found to
be illegal combinations in restraint of trade under
the antitrust laws.
2.
Such cooperatives shall be subject to the antitrust
laws for any anticompetitive use of buying power,
unless subject to safe harbor or approved
certificate.
Rural
and
Inner
City
Special
Assistance
Purpose:
to acknowledge that pure competition may not work
in certain areas of the nation, particularly medically
underserved areas, both urban and rural; that additional
funds and services need to be provided for these special
needs populations.
Intended result:
to assure that persons living in rural
and inner city areas have acce·ss to high quality health care.
A.
Grants to States for Coordination of Health Care
Services
11
�September 14, 1993
1.
B.
8 .
A block grant to states will be established to
assist in the delivery of health care to
populations residing in rural and inner city urban
areas.
2.
States will develop a plan for expanding and /or
coordinating existing state and federal health
programs, or could use funds to provide services
for which federal funds are not currently
available.
Additional Requirements for Health Plans serving Special
Needs Populations
1.
Health plans will be required to provide additional
benefits to populations in defined geographic
areas.
2.
Health plans will be compensated for these services
either through a method of enhanced reimbursement
or through a grant program.
Primary Care Provider Education
Purpose:
to increase the number of health care providers
who choose the field of primary care as opposed to specialty
care.
Intended result:
to increase the number of primary care
providers in medically underserved areas.
A.
In order to increase the number of primary care
providers
1.
Medicare graduate medical education (GME)
demonstration authority would be established.
a.
Under this authority, seven states and seven
health care training consortia would pool GME
funds, which would have otherwise been paid
directly to hospitals by Medicare.
b.
This would allow states or consortia to
experiment with methods of changing the
physician specialty-mix.
2.
National Health Service Corps funds would be
increased.
3.
Health professions funding through the Public
Health Service for primary care provider education
would be increased.
12
�September 14, 1993
9.
Long-Term
Care
Purpose:
to clarify tax treatment of long-term care
expenditures vis-i-Vis other health care expenditures and to
es~ablish consumer protection standards in long-term care
insurance.
Intended result:
to provide the same federal tax treatment
to long-term care expenditures as applies to other health
care expenditures; to encourage greater participation in
providing for long-term care need~.
A.
PART
1 .
B:
Tax Clarification/Insurance Reform
Clarifies that all long-term care services
1.
(institutional, home, and community-based care) are
treated as medical expenses under cuirent tax law:
a.
long-term care expenses and insurance will be
tax deductible (above 7.5% of Adjusted Gross
Income).
b.
payments under long-term care insurance
policies will not be taxable when received.
c.
employer contributions to long-term care
insurance will be tax-free fringe benefits.
Clarifies that insurance companies can deduct
2.
reserves they set aside to pay benefits under longterm care policies.
Requires that long-term care insurance policies
3.
meet certain minimum consumer protection standards
to receive favorable tax treatment.
ESSENTIAL
STRUCTURAL
REFORMS
Establishment of Small Business
Purchasing Cooperatives
and
Individual
Purpose:
to provide the market advantages of large
employers to individuals and employees of small
businesses and to provide more information to the
consumer.
Intended result:
to lower the cost of health care
coverage, to lower administrative costs; to provide
more information to the consumer, and to achieve bettei
service and quality.
13
�Sept.er.Lber 14, 1993
A.
B.
c.
States will establish geographic areas in which
individuals and small businesses may form purchasing
cooperatives.
1.
The State may authorize one or more purchasing
cooperatives in a geographic area.
2.
Interstate agreements for geographic regions
encompassing more than one state can be
established.
3.
States will be responsible for making risk
adjustments between all health plans operating in a
given geographic region, in accordance with federal
guidelines.
The membership of these purchasing cooperatives will be
limited to employers and employees in businesses of 100
employees or fewer, and to all other individuals not
enrolled in an employer health benefit plan who live or
work in the geographic area.
1.
Purchasing cooperatives must allow all eligible
businesses or individuals to join.
2.
Purchasing cooperatives may be governed only by the
members.
3.
Purchasing cooperatives will collect premiums from
members and forward them to the appropriate plan.
4.
Purchasing cooperatives must offer eligible
individuals the opportunity to enroll in a health
benefit plan within thirty days for new enrollees,
or after first becoming eligible to enroll in the
purchasing cooperative. Each fall an open-season
date will be set by the Secretary of Health and
Human Services. During that time, purchasing
cooperatives will allow eligible individuals to
enroll in a benefit plan or to change the plan in
which they are enrolled.
In addition, they will
maintain a special enrollment process for
individuals who experience a change in family
status during the year.
5.
Purchasing cooperatives can charge members a
limited fee to pay for operating expenses.
6.
Purchasing cooperatives will distribute to their
members information regarding prices, outcomes,
enrollee satisfaction, and other information
pertaining to the quality of the plans offered
within the purchasing cooperative.
Small business associations that currently offer health
insurance to their members,·and that exist for reasons
other than to offer health insurance, will be allowed to
14
�September 14, 1993
continue to offer health insurance plans to their
members, but will be subject to the same insurance
market reform requirements as the purchasing
ccope.::-atives.
·2.
Responsibility
A.
Individual
for
Coverage
Responsibility
Purpose: to ensure that all Americans have health care
coverage.
Intended result:
to require individual
responsibility, increase consumer awareness of costs,
reduce cost-shifting and bad debt due to uncompensated
care.
1.
2.
B.
A requirement for individuals to obtain health
insurance coverage is phased-in based upon an
individual's ability to purchase the standard
health plan, and will be tied to the phase-in
of federal assistance for low-income,
uninsured individuals. The requirement also
can be met through enrollment in Medicare,
Medicaid, VA, or CHAMPUS.
The penalty for non-compliance, once
the proposal is fully implemented,
will be equal to the average yearly·
premium in the local area plus 20%.
Small
Employer
Responsibility
Purpose: to ensure employees of small business are
given an opportunity to make informed health care
choices.
Intended result:
to increased choice and to increase
awareness of quality and cost issues.
1.
2.
An employer with 100 or fewer employees may either
join a purchasing cooperative in the geographic
area in which it does business or offer a standard
benefit plan through a qualified health plan.
The employer will collect and send premiums and any
operating fees to the purchasing cooperative or
health insurance plan on behalf of its employees.
15
�September 14, 1993
3.
4.
5.
C.
An employer is nQt required to contribute to the
cost of premiums or operating fees.
In an area with multiple, competing purchasing
cooperatives, the employer will select the
purchasing cooperative.
The purchasing cooperative will supply the employer
with information for his or her employees.
For the purpose of this provision, an employee is
defined as any individual receiving a salary from
the employer.
Large
Employer
Responsibility
Purpose:
to maintain participation of large companies
to control costs.
Intended result:
to maintain a competitive
marketplace, to increase potential for quality
improvements, and to increase awareness of cost issues.
1.
2.
3.
Tax
Employers with greater than 100 employees may form
cooperatives or other entities for the purpose of
purchasing health insurance.
Multi-state employers may make a decision whether
to treat each employment entity or location as a
single entity for the purpose of determining
whether or not it may obtain coverage through a
purchasing cooperative in its geographic area.
Treatment
Purpose:
of
Health
Care
Costs
to create equity in the tax code.
Intended result :
with insurance.
to increase the number of Americans
Purchasers of certified health insurance plans will receive
favorable tax treatment up to a limit - the so-called "tax
cap."
A.
Tax-free fringe benefits
1.
employer-paid health insurance premiums up to the
amount of the tax cap will be tax-free to the
employee.
2.
employer-paid health insurance premiums in excess·
of the tax cap will be taxable to the employee as
income.
16
�September 14, 1993
B.
C.
D.
E.
Deductibility
1.
the cost - up to the tax cap- of a plan will be
fully deductible to individuals and the selfemployed, regardless of employment status.
2.
the deductibility of health insurance premiums paid
by individuals for certified health insurance plans
will not be limited by the 7.5% medical expense
deductibility floor; all cost-sharing, co-payments,
co-insurance, deductibles, and other out-of-pocket
costs will continue to be deductible only to the
extent they exceed 7.5% of Adjusted Gross Income.
Employer deduction
1.
the cost -up to the tax cap -of providing a
certified health insurance plan can be deducted by
the employer.
Tax Cap
1.
the tax cap applies both to the excludibility of
health insurance provided to an employee by an
employer and to the deductibility of health
insurance premiums paid by an individual.
2.
the cap is calculated as the average cost of the
lowest priced one-third of the certified health
insurance plans offered in the purchasing
cooperative area in which an i.ndividual lives or
works.
Medical Savings Accounts (MSAs)
1.
an MSA will be available for those individuals
electing the catastrophic benefit plan option.
2.
contributions to an MSA will be tax-favored up to
the amount of the tax cap, i.e., they will be fully
deductible if made by the individual and excludible
from taxable income if made by the employer.
3.
the cost of the catastrophic benefit plan premiums
must be subtracted from the tax cap in determining
the amount of contributions to an MSA that will
receive tax-favored treatment.
4.
funds remaining in an MSA at the end of the year
can be carried forward to the subsequent year.
Amounts carried over from a previous year will be
subtracted in computing the applicable tax cap for
the individual in the subsequent year.
17
�September 14, 1993
4.
State and
Plans
Purpose:
Federal
Certification
of
Health
Insurance
to ensure plans are of high quality.
Intended result:
to ensure high quality care, fair
competition, consumer security, and standardization
sufficient to allow consumer evaluations.
A.
Plans must be certified, by the state in which they are
offered, as meeting the following federal guidelines, in
order for a purchaser of a plan to receive favorable tax
treatment under the Internal Revenue Code:
1.
B.
5.
demonstrate the ability to deliver the full range
of services required by the standard benefit plan
throughout the geographic area in which they are
offered, as defined by the State. States may not
require plans to cover specific providers or types
of providers.
2.
comply with special requirements for designated
underserved areas.
3.
provide the required arbitration procedures and
information about alternative dispute resolution
(as defined in the benefits and malpractice
sections) .
4.
establish a provider risk management program to
prevent or provide early warning of practices that
may result in injury.
5.
comply with risk adjustment requirements defined by
the state.
6.
comply with the standard administrative reforms.
7.
meet quality criteria.
8.
demonstrate insurance market reform (outlined
earlier) .
9.
meet solvency criteria as defined by the Secretary
of HHS.
The Secretary of HHS will establish a federal procedure
to approve any plan offered by a multi-state employer.
Benefit
Package
Purpose:
to meet basic health care needs; to limit the
ability of insurers to use benefit plan design to
attract only the lowest risk individuals; to ensure that
18
�September 14, 1993
p:ans compete based primarily on product - service,
quality, price - rather than on the health of their
subscribers; and to make equitable tax subsidies
available to all Americans.
Intended result:
to ensure that consumers can draw
comparisons between plans; costs are controlled; access,
quality, and services delivery are improved.
A.
B.
C.
6.
Standard Benefit Package Guidelines:
1.
Medical and surgical services and equipment.
2.
Prescription drugs and biologicals.
3.
Preventive health services.
4.
Rehabilitation and home health services related to
an acute care episode.
5.
Severe mental health services (narrowly defined).
6.
Substance abuse services.
7.
Co-payments and deductibles for all but certain
preventive health services.
8.
Plans are required to cov~r the cost of a service
~ if it is medically necessary.
The benefit
plan does not create an entitlement to each
benefit. Other benefits may be purchased, but will
not receive favorable tax treatment.
Alternative catastrophic benefit plan with an integrated
cash value medical expense account or income-related
deductible.
1.
Same benefit parameters as above.
2.
High cost sharing, including deductibles
(Amount rolled over from year to year)
Benefit disputes
1.
Plans and enrollees are required to resolve such
disputes through a timely, mandatory, bindingarbitration process.
2.
Enrollees must show by a preponderance of the
evidence standard that the plan's ftecision to
decline the service is inappropriate based
upon available scientific evidence.
Benefits
Commission
Purpose:
to ensure members of Congress will not become
embroiled in debates about whether to include specific
types of benefits, procedures, providers or treatments
under pressure from special interests. To allow for
adjustment of the standard benefit package while
19
�Septernber 14, 1993
ensuring that the cost of the package can be covered
with a reasonable, affordable premium.
Intended result:
to set a rational, appropriate
benefit structure, to control costs, to increase focus
on efficiency and effectiveness.
A.
B.
c.
D.
Appointed by the President, and Majority and
Minority leadership in the House and Senate.
Charged with clarifications in benefit plan.
1.
Required to report a clarified benefit plan to
Congress within six months; is precluded from
adding, but may reduce benefits. Congress will
vote on .the proposed changes within 60 days of its
submission en bloc - no amendments (similar to the
base closing process) .
2.
After year one, changes (additions as well as
deletions) to the package can be recommended to
Congress by the commission once a year; those
changes must be voted on en bloc.
3.
Coverage decisions about new procedures or
technologies generally are made by individual
health plans. Plans may petition the Commission
for a coverage decision under the following
conditions:
a.
in the event a new technology or procedure
shows evidence of substantial benefit ~
substantial cost, the Commission can exercise
its discretion to make a national coverage
decision, including an evaluation of the cost
consequences of the decision.
b.
in the event a new technology or procedure
becomes highly contentious, the Commission can
make a national coverage decision in order to
minimize disruption and dissent among the
public.
c.
in both of the above circumstances, if
the Commission acts to allow coverage,
the decision must be voted upon by
Congress.
Prohibited from specifying providers and providerspecific services.
Required to treat severe mental illnesses in the same
manner as physical health services and subject to the
same limitations and cost-sharing.
20
�.
.
September 14, 1993 ·
7 .
Ability
of
States
to
establish
an
alternative
system
Purpose:
to permit states flexibility to enact reforms to
reflect alternative proposals.
Intended result:
to allow experimentation in health care
reform to more effectively meet the needs of the American
people.
A.
B.
C.
D.
E
F.
PART
C:
Any State may choose to establish its own system, by
submitting a plan to the Secretary of HHS that
demonstrates it can meet reasonable standards.
Such a plan must be reviewed, and either accepted or
rejected, by the Secretary of HHS within 90 days.
The plan must show that generally the same percentage of
individuals will be covered within the same time frame
as the national average.
The State's annual rate of increase in health care
spending must equal to, or lower than, the national,
annual health care cost growth rate.
The plan must be budget-neutral to the federal
government.
The State is required to:
1.
meet all federal data collection standards and
requirements.
2.
comply with federal medical liability
reforms.
3.
offer a health benefit plan that has similar
benefits and is actuarially equivalent to the
standard benefit package or the catastrophic
alternative.
TREATMENT
OF
EXISTING
FEDERAL
PROGRAMS
l.
Medicaid
.The Secretary shall establish a per-capita federal payment
based on historical Medicaid costs. States may provide
coverage to beneficiaries through a private purchasing
cooperative, a managed care plan, or other alternative. The
per capita rate of growth will be limited to the national
average.
2.
Medicare
A.
Within one year of enactment, the Secretary of HHS will
conduct a study and report to Congress on the phase-in
of current Medicare enrollees into regionally-based
21
�Septernbe:r 14, 1993
B.
3.
purchasing cooperatives. Current enrollees will have
the option of remaining in the existing Medicare fee-forservice plan or entering into a revised Medicare risk
contract until the phase-in plan is approved by
Congress.
Medicare risk contracts will be revised and expanded to
experiment with new models of service for the elderly.
Federal
Employees
The Office of Personnel Management (OPM) will have the option
of allowing federal employees in some areas to join the
purchasing cooperative and of forming purchasing cooperatives
with small businesses.
4 .
Public
Health
Service
No change in existing program.
5.
Veterans
Administration
health
benefits
No change in existing program.
6 .
Department
of
Defense
and
CHAMPUS
No change in existing program.
7.
Indian
Health
Service
No change in existing program.
COVERAGE
PART
1.
A:
By
AND
FINANCING
GUARANTEED
COVERAGE
II
AND
WORKING
POOR
AMERICANS
PHASE-IN
1995
By 1995, those
level (who are
with a voucher
individual and
2.
SECTION
FOR POOR
with incomes below 90% of the federal poverty
not eligible for Medicaid) will be provided
to purchase health care insurance through the
small group purchasing cooperatives.
By 1996
By 1996, the coverage for individuals will increase to 120%
of poverty level; by 1997 to 140%; by 1998 170%; by 1999 to
200%; and by 2000 to 240% of poverty.
3.
Vouchers
The vouchers for those eligible for assistance will be
financed by reducing the combined average rate of growth in
22
�September 14, 1993
Medicare and Medicaid from 12% to 7% over six years. The
program changes made to reduce the average growth rate are:
A.
~ed.: care
1.
Increase Part B co-insurance.
2.
Means Test Part B premium.
3.
Eliminate disproportionate share adjustment.
4.
Eliminate payments to hospitals for enrollee bad
debt.
5.
Reduce IME and GME.
6.
Impose modest co-payments for labs and SNF.
B.
Medicaid
1.
Eliminate Disproportionate share payments.
2.
Managed care.
PART
B:
ACCELERATED
PHASE-IN
The guaranteed phase-in will be accelerated in the event the
Congressional Budget Office (CBO) certifies additional federal
savings from other structural reforms.
23
�Withdrawal/Redaction Marker
-
.I
Clinton Library
DOCUMENT NO.
AND TYPE
001. fax
SUBJECT!TITLE
DATE
HIAA REALITY: Real People, Real Problems. [partial] (2 pages)
1111111993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Verveer, Melanne
OA/Box Number: 17607
FOLDER TITLE:
Background on Healthcare Reform [2]
2006-0223-F
ab631
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a)(
Freedom of Information Act -IS U.S.C. 552(b)(
PI National Security Classified Information ((a)(l) of the PRA(
P2 Relating to the appointment to Federal office ((a)(2) of the PRA(
P3 Release would violate a Federal statute ((a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA(
b(l) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIAJ
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) of the FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIAJ
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�11:11:93
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CHLOPAK.LEO~A.R_D._ _ · - -
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HIAA REALITY
HEALTH CARE
REFORM PROJECT
Real People, Real Problems
THE YOIUOf
AMERKAHS FOR
CHANGt NOW.
2SSOM Sheet, M.W.
WasiWigloa. D.C. 20037
(b)(6)
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Roger Amadon of Jackson Bole, Wyoming is a small businessman. He owns
and operates Unilink Computers and provides each of his 40 employees with
health care coverage from the Principal Financial Group, an HIAA member.
Over the past seven yean, their premiums have more than doubled and the rates
increase by 20-50% a year.
Cindy Jane Child of West VirgiDia is a nurse practitioner. She worked in a
federally funded clinic for 8 years and founded a women's health center.
Dr. Alfred E. StDiman of Southbridge, Massachusetts is a gastroenterologist.
He is a Master of the American Academy of Physicians and the Governor of the
Massachusetts American Academy of Physicians.
�11111/93
15:01
tf202 296 4501
CHLOPAK.LEONARD.
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ltiMAlUCS OF DR. ALFRED E. STIUMAN. MACP
Good moming. I am an internist subspeciatizing in gasttoenterolocy and a solo praclitloner in
Southbrld&e. Massachusetts, about 65 miles west of Bosron. I am a master of dte American.
College of Physicians and 10vemor of the MassachusettS chapter.
If the tta&ic floods that StrUck ,the Midwest this year had come in the fonn of insurance company
paperwork. no one in the state of M"lSSOuri would be alive today.
I am one doctor, and I have two employees whose only job is to shuttle insurance fonns and
handle insurance company intrusions into the cloctor-patient relationship. Rarely, anymore, can
physicians provide a service without an insurance company challenging the need for it. For some
reason, insurance companies Chink .their clerical workers have sounder medical judsment than
physicians. Needless ro say. most of their challen&es to care are inappropriate and, in the end,
proven wrona.
What are the 1oats of insurance companies? To ensure the provision of quality patient care?
Hardly. Insurance companies do everything they can to restrict care, avoid payina and protect
their bottom line. Insurance companies cause anguish to patients who wouy that they won't be
reimbursed. Ins\lJ'Iftce companies cause hassle to physicians. Insurance companies drive health
care costs up, not down.
The problem with these insurance company practices is tbat they arJ not based on sound medical
judgment. Denials of care by Insurance companies trigger prolonged, multiple exchanJes of
phone calls and letters. These problems are especWly acute for my colleques In primary care
practice, many who spend several hours a day on the phone justifying to insurance clerks why
their sick, elderly padents need hospitalization.
The message is clear. Our current health care system values the medical Judsments made by the
nation's 1500 insurance companies more than those made by medical professionals. The current
system values the riabts of the insurance industry over the rights of patients. Insurance company
seconc:l·guessina detracts from quality patient care~ and it drives up health care costs. These are
dollars wbich should be used to provide more care to more people.
The insurance indusu, wmts to preserve the sta.tus quo because the SQtus quo serves the
industry's own best interest, not the interests of patients or the goal of quality care.
�:
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from Montana co Alabama, frcrn New Mexic:o ro Rhode Island,
69 indepmdenrly-opcrared Bl111 Crou «Jtd Bla11 Shilld health ins~rance
companies serve 61million Amtric:ans in every communi"!' in this counay,
Nationwide, Blue Cross and Blue Shield welc:omcs hMhh can nlann. For
yeal'l. we have Aid mar all tN.aren mUR be required ca cake aU comen
reaardles& of health or nnployment KINa. No insurer should be allowed to
drop a&StOmm if they 1ft sick, al\d no one should have ro wale for COVtNp
when they chanp jobs. Our proposal also calla far wtlvtnal covcrap. a
awndatd benefits paclcaiC and cost conrainmem throuah • • care.
Ancl now, a dramatically improved health care sysmn is within our reach.
Presidlt'lr and Mn. Clinron an rnakins a renwlcablt efforr. and a MW
lcaislario!taoeslOConpaLweac 1/wero.•at.ShilldwillwOtkharcl
for inldaCftftfnr,
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whose ftlm appraadt makes health can rno11 eofto4Hcive. We are
&quenina ouc .... wtm campurerized clairna proceMinJ. And we an me
only in~uren-th"*IJh ourCariq forChildnn Propma-whooffer fm
CCMrap fot kida whole paNfttl cannot alford ia&utaiiCI bur wbo clo • .
q\lllify for Medicaid.
Wldl 10 much PfOSnll beina made alnady, we .,. COIICiftlld abollc
proiiQUII to era• ntw,IOYfi'IUMIU-nan buteat.u::ncla and Wuhinpon·
defined eloGal buclpa. loch are unnecesury eo achievt die het1th cue
nfonft aD Americans wam.
ShWd"•
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Bur wt can 1t11m forward when we ha~ ap ..IMIH•
wm•panofmuclcbafe-aadwiD......,.•biPIIIIof•
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Bernard R. TlllftOWIId
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28 • WIDNUDAY, OCTCUA 27, 1H3 • USA TODAY
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PREVENTION OF COMPLICATIONS IN CHRONIC ILLNESS
ISSUES RELATED TO BENEFITS
The President has emphasized the importance of prevention in designing the comprehensive
benefits package
•
benefits package provides excellent coverage for primary preventive services
•
benefits package does NOT provide adequate coverage for secondary and
tertiary preventive services
some services documented to be effective in preventing complications
in patients with certain diseases are NOT COVERED
most services required to treat costly complications ARE COVERED
•
this type of benefits package:
CREATES DISINCENTIVES for patients to take the necessary steps
to prevent costly complications
REDUCES BENEFITS for patients whose policies currently cover
these preventive services
REDUCES HEALTH STATUS for patients who cannot afford to
purchase these preventive services (exacerbating discrepancies in
health status according to socioeconomic status)
INCREASES LONG-TERM COSTS
EXAMPLE: INTENSIVE INSULIN THERAPY IN TYPE I DIABETES
•
The Diabetes Control and Complications Trial (DCCT) has demonstrated that
intensive glycemic management can delay the onset and slow the progression
of microvascular complications in patients with insulin-dependent diabetes
mellitus (IDDM).
•
Treating 500,000 patients with IDDM for nine years could potentially prevent
100,000 cases of retinopathy requiring photocoagulation, 100,000 cases of
clinical grade proteinuria, and 50,000 cases of significant neuropathy.
1
�•
Intensive insulin therapy requires two types of services not explicitly covered
in the benefits package:
strips for self-monitoring of blood glucose
training in skills for self-management
•
Strips for self-monitoring of blood glucose
although meters for self-monitoring of blood glucose MAY be
included in the benefits package (as durable medical equipment), the
strips required to perform each test are NOT covered
strips are classified as nondurable medical devices, NOT
biologicals
strips for intensive management of IDDM cost $1 000/year (cost
for 500,000 patients with IDDM would be $500 million)
currently covered by some insurance policies (including
Medicaid in certain states)
without strips, intensive glycemic management is not possible
•
Training in skills for self-management
DCCT used a team of physicians, clinical nurse specialists,
nutritionists, and behavioral specialists who worked in a coordinated
fashion to provide patients with the skills they need to treat
themselves
currently, good methods are available to certify qualified diabetes
education programs and providers
if these services are not explicitly covered, patients either will not
receive them or will get them in more costly and less effective ways
services that can be provided better by trained nonphysician
practitioners will be provided by physicians so that they can be
billed as physician visits
services will be fragmented among different providers,
compromising coordination of care
2
�....
OPTIONS
•
Include general language (perhaps under the section for preventive services)
stating that services and supplies documented to be effective in preventing
complications in patients with known diseases will be covered in the benefits
package
The National Board can then specify coverage under this policy
•
Add under "Outpatient prescription drugs and biologicals"
FDA-approved drugs, biological products, strips for self-monitoring
of blood glucose, and insulin
•
Add under "Services of physicians and other health professionals"
Includes inpatient and outpatient medical and surgical professional
services, including consultations and training in skills for selfmanagement, delivered by a health professional in home, office, or
other ambulatory care settings, and in institutional settings.
3
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�November 2, 1993
Dear Mr. Gradison:
The Health Insurance Association of America has
distinguished itself as the single worst exponent of false,
misleading and deceptive advertising on health reform. The
deliberate distortions you have promoted with your multi-million
dollar advertising campaign are irresponsible and reprehensible.
The various ads you have aired over the past weeks are
replete with deliberate distortions, including:
e your ads deceitfully stated that Americans will lose
choice in picking doctors and other providers -- when, in fact,
the proposed reforms would restore and preserve choice;
e your ads falsely suggested that Americans will lose
health insurance benefits -- when, in fact, the proposed reforms
would guarantee comprehensive coverage for everybody; and
e your ads irresponsibly stated that premium limitations
would result in denials of care -- when, in fact, it is the
insurance companies' cherry picking practices that deny care and
your opposition to premium limitations is based solely on the
insurance industry's greed for ever larger profits.
These false ads have been aired by HIAA on behalf of the
so-called "Coalition for Health Insurance Choices" -- a group
that masquerades as speaking on behalf of America's families
when, in fact, it was created and is fully controlled and funded
by HIAA. Here again your ads have been misleading and deceptive.
We call upon you to pull your deceitful ads off the air so
that a thoughtful dialogue and debate can begin.
The American people deserve a sincere and honest discussion
about the alternative proposals for health reform. More than any
other interest group, you have infected this debate with false
advertising. It is time for you to engage this debate honestly
and forthrightly.
Are you. prepared to pull these false and misleading ads?
We look forward to your answer.
Sincerely,
�i •
THE WHITE HOUSE
OFFICE OF THE PRESS SECRETARY
JANUARY 25, 1993
---------------------------------------------------------------STATEMENT OF PRESIDENT CLINTON
Good afternoon.
As I travelled across our country this past year, no stories
moved me more than the stories of those families struggling to
pay for health care. I listened to Marie Kostos, a working mother
in Columbus, Ohio who had to quit work in order to get Medicaid
coverage for her infant, who is stricken with spina bifida •••• To
Mary Annie and Edward Davis, a New Hampshire couple who faced the
terrible choice of having only enough money to buy the food they
needed or the prescription drugs they had to have •••• And I
listened to a group of coal miners in Beckley, West Virginia
some of whom had worked the mines for more than 30 years but were
at risk of losing their health benefits.
Their message to me 7- and to the Congress
was simple:
it's time to make America's health ·care system make sense. It's
time to bring costs under control -- so that every family can be
secure in the thought that a medical emergency or a long illness
will not mean bankruptcy. And it's time to bring quality coverage
to every American -- to cut back on the paperwork and the excuses
and make health care a right, not a privilege.
As a first step in responding to the demands of millions of
Americans, today I am announcing the formation of the President's
Task Force on National Health Care Reform. Although the issue is
complex, the task force's mission is simple: to build on the work
of the campaign and transition, to listen to all parties, and to
prepare health care reform legislation that I will submit to
Congress this spring.
The task force will be chaired by First Lady Hillary Rodham
Clinton and will include the Secretaries of Health and Human
Services, Treasury, Defense, Veterans Affairs, Commerce, and
Labor, as well as the director of the Office of Management and
Budget and senior White House staff members.
�.
'
I am grateful that Hillary has agreed to chair the task
force -- and not only because it means she'll be sharing the
heat.
As many of you know, while I was Governor of Arkansas,
Hillary chaired the Arkansas Education Standards Committee, which
created public school accreditation standards that have since
become a model for national reform. In 1984-85 Hillary served
as my designee on the Southern Regional Task Force on Infant
Mortality.
She was the Chair of the Arkansas Rural Health
Committee in 1979-80.
And she has also served on the Board of
the Arkansas Children's Hospital, where she helped establish
Arkansas's first neo-natal unit.
-2-
I am certain that, in the coming months, the American people
will learn -- as the people of Arkansas did
just what a great
First Lady they have.
Here in the White House, Hillary will work with my domestic
policy advisor, Carol Rasco, my senior policy advisor, Ira
Magaziner, and the head of my health care transition team, Judy
Feder. I have asked all of them to be as inclusive as possible
and, as part of that, we are inviting the American public to
write us here at the White House with their suggestions. All
suggestions should be sent to the Task Force on National Health
Care Reform, The White House, Washington, D.C. 20510.
We will no doubt be criticized by some for undertaking
something much too ambitious. But as I said in my inaugural
address, we are going to have to make some tough choices. In the
months ahead, powerful lobbies and special interests will attempt
to derail our efforts. We may make those p~ople angry, but we're
determined to come up witb the best: possible solution for
America.
'
I know -- as you know -- that we must reform our system.
We're kidding ourselves if we think we can deal with the deficit
unless health costs come down. If things don't change, American
workers and exporters will remain one step behind in global
competition. And most importantly, unless we do it now, American
families will continue to face tremendous financial hardship. We
must not delay.
�Contact: Dee Dee Myers
(202) 456-2100
Lisa caputo
(202) 456-6266
FOR IMMEDIATE RELEASE
Monday, January 25, 1993
PRESIDENT CLINTON FORMS HEALTH CARE TASKFORCE
WASHINGTON, D.c. -- In effort to' develop a plan for high quality,
affordable health care for all Americans, the President today
announced the formation of a taskforce to develop legislation for
comprehensive health care reform.·
"It's time to
time to bring
secure in the
will not mean
bring quality
paperwork and
privilege."
make America's health care system make sense. It's
costs under control -- so that every family can be
thought that a medical emergency or a long illness
bankruptcy," the President said. "And it's time to
coverage to every American -- to cut back on the
the excuses and make health care a right, not a
The President's taskforce, which is expected to report a plan by
the end of May, will be chaired by First Lady Hillary Rodham
Clinton. The health care taskforce will include Secretary of the
Treasury Lloyd Bentsen, Secretary of Defense Les Aspin, Secretary
of Commerce Ron Brown, Secretary of Labor Robert Reich, Secretary
of Health and Human Services Donna Shalala, Secretary of Veterans
Affairs Jesse Brown, Office of Management and Budget Director
Leon Panetta, Assistant to the President for Domestic Policy
Carol Rasco, Assistant to the President for Economic Policy
Robert Rubin, Council of Economic Advisors Chair Laura Tyson and
Senior Advisor to the President for.Policy Development Ira
Magaziner.
Magaziner will lead an interdepartmental working group which will
coordinate policy development for the taskforce. Health care
transition director Judith Feder will assist Magaziner and other
senior transition officials will be members of the working group.
The taskforce will work cooperatively with members of Congress as
well as with state, city and county officials in developing its
proposals. It will conduct an outreach program to seek verbal
input and formal written submissions from interested citizens and
groups across the country.
The process will seek advice from people like the many the
President met during the campaign, for whom rising health care
costs and lack of adequate health care coverage are causing
severe hardship.
-- more --
�The President said the legislation will be based on the following
principles:
o
To slow the growth of national health care spending.
o
To provide universal access to high quality care for
all Americans.
o
To ensure consumer choice.
o
To maintain a private, competitive health care system.
o
To cut the health care bureaucracy.
While her husband was Governor of Arkansas, Mrs. Clinton chaired
the Arkansas Education Standards Committee, which in 1984 created
public school accreditation standards that have since become a
model for national reform. In 1984-1985, Mrs. Clinton served as
her husband's designee on the Southern Regional Taskforce on
Infant Mortality. She served as the chair of the Arkansas Rural
Health Committee in 1979-1980, and has served on the board of the
Arkansas Children's Hospital, where she helped establish the
state's first neo-natal unit. In addition, ~rs. Clinton
introduced a pioneering program that trained parents to work with
their children in pre-school preparedness and literacy through
Arkansas' Home Instruction Program (HIPPY).
Those interested in submitting ideas should write to:
President's Health care Taskforce
The White House
Washington, D.C. 20500
###
�The Commiltee adopted a scope
statement in May to use as undorm
guidelines as the Commibce's Uvee
J':
I
I,
i
suboommittees - elemef*uy. junior Standards Comma·nee
higrvmiddle and high school - propose standards. Concems conwnon lo ished..CUrrenl standards were adoptan areas listed in the slatcmenl in- ed in 1965 and became law in 1969.
eluded high expeclations. staff deAmong lhe ideas considered bV lhe
velopmeltt. pupil-teacher inleraction. su~llees ._ __ ~ :-.-...-.-...~
.-:enu--...o.y ;...-.~.-..w.~ disci.__
•oawv . . _ . ·-~
....-· """"""'_ .. "~""'"'..
. gradualioo ruquiremenls lo 20 units.
pline. assessmanl. instructional lead- changing ht ontry date tor first grado
erstip, a core curricufum.leadersnp fromOclober 1 to July 1. kMcring the
from the state level. access lo and age by Wttlch a studenl must have enavailability ol certain programs such roled
be aduissable to kindergaras special education and gifted 1en cind grade one. mandalory kindereducation. inceolives for prolessional garlen, requtred computer ccuses
development, sufficient support ser- and expanded minirntm perlormance
Yices and access to lechnology.
testing to include cammunicalion. and
The Commiltee will present its Olher skills.
reconwnendation in December lo the
Govemor Clinton. when he spoke
Slate Board o1 Educalion for adoplion. ao the Slate Education Board in Jwle.
The Board. under lhe Quality Educa- said that "we have a historic opportulion Acl of 1983. roost adopt new sian- nily and a historic obligation" to make
dards by March 1984. Schools have strides in Arkansas educalion beunhL June 1987 to comply or be abol- cause of the Committee's effor1 on curCOtiBMied ... page 6 riculum standards and because of the
coincidental eflorls by lhc lcgislalurc
or
•
0011....... fnJm page 1
to arrivo at a constilut•onally
acceptable funding lormula I<H
schools. The State Supreme Courl
ruled reconlly thallhe stale's lormut,
tor distribution of funds 1o districts i~
unconstiluhonal. Clinton said ht
wanted the funding and curriculu"'
efforts to dcvt!lop jointly
The Canmitlee members servu •• a
on lhc elementary subcommittee ;w
Margarel Glover. principal ol ~adov.
Park Elementary School at North Lilli•
Rock: Lyndal.angfordoi.Jooesboro. ;,
social studies leacher al Noltletor•
High School; Bett foster of MansiiCI(l
a PTA officer and rncmbcr of Ihal rk;
lrict's curriculum commirtcc: and I ls
Oil VanZandt of Springdale, arfl(~Jlb(•r
ol the Springdale School Roard at '' :
head of r.ounsclor educalion at tho
University ol Arkansas at f<Jy(~tev;u, ·
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·Education-·-----------------------·--·---
No More Dragging Up the Rear ___ _
Arkansas bo11·s ro pressttres ro pur schools ro rite res1
edu..:.:ui,,n 10 .),. ri..J!l,.;~; -.. :> l''"!l JnJ ~~~ IJ..:l ph~s·~s Sa~> En..:ls,•n
"Th" as..>ne ••ithe .,.,,r;~t pll~·..:s an the L' S
t-.:en the Do~pJ~o..:h ~·f the.- r.Ju,•n·s
(,•r tho: te3.-hlng rr,•fo:SSI•'n ..
s.:h(''l s~stems. \1Jn~ p..'o.•rl~ f.!'1Jn..:eJ
dtstn~·ts in the stJte hJ'e un~ ~ ;nJ••"'n
The: rl:f,•rm N•'~ram IS J \l~·t,>r~ f,>r
s.:h ..x,lh->uses staffed b' Sl"~me ,,! :he I''"'. Chnt ..,n. h1msc:lf 3 pr->du.:t of Arl.:anS.Js
est·pa•d teachers '" the ~:c>untr~ C,,n)•J·
pu!-11..: S.'h'"-'IS A 1968 graJuJt~ "'(
cr. f~,r e'l.amplc. the Th,,rnt ..,n s.·~·"-'1 diS· Ge,•rec.-t,'""" L'nl\erstl\. he IS a Rh .. >d~s
tn.:t 1total enrollmenl: J001. l,x·a:~.! '"the: s..:h,,ljr_ earne..J a Ia"' do:gree at Yale anJ
umt>cr c ..,untry c>fs.luthern Ari.Jns.n. The be~ame the natll.'n's y..,ungest G ...,\ern ..•r
last lime liS tenlh-graders t ..x,l.; <he t-Jsic:
111 197~ The le21slature ap~"•inteJ an
sil;•lls test they pla.:ed in the tx•u,•:n 12',
eJu..::au ...,n-standards ..:.•mmntee in M3).
.,f nau ..,nal scores. The average tcJ.:hers fie3de..J tw the G .."ernClr"s .,.,(e. L:a"'er
salary· is only S 11.663. and not "'"e :e.t.:her Hill:af\ Rl"ldham Clint ...,n. "'ht..:h held
IS .:enified to teach phys1cs. fc>ret~n lanpubh.: meeungs a.:ross t~ state: 3nd pu~
guages l,r art. Sa)·s Kai Ericks..,n. C\eCu·
llshed its prellminar)· re.:ommend:ui~ms
;;,e secreta!')· of the Arkansas EJu..:au,,n
-\ss...-,;tataon tA.E.A-1: "Edu.:ltr~'n has
ne,er been a high pn.>my in Ari.Jn!l.'ls."
Unul nll'-'. th.tt IS. LJst month Dcm,,.
~·rati.: G~''ern->r B1ll Chnt''"· r. pusheJ
:hr..'utth legnlative ref,,rms th3! -...111 ur~raJe a.:ademtc requirements. icngthen
the s.:hool day and. to the ..:onsten:.ttic>n of
S.."~mc: edu.::uors. for..:e all ,,( th, st:ue·s
:4.000 tea..:hers to pass b3si..: c,,mpeten..:y
tests ..,r ll)SC their JCIM To p3) r~'r tnts. legl:ololh.>r') r3tS.:d the $:lies ta' t•' ~- fr.>m
~· • • he '.Jr~rest such !1'1.:-rease in the state)
htstl"~ry. providing :an 3dllattl)nal S 1
mtilion. The reforms follo~o~. the ~Jilcrns
set by Florida and C31ifornl:! c3rher
this year. E,·en M1ssiss1ppi. "'ht.:n .>n..:e
shared the nation's a.:ademi.: spcndtng
b:ascment. passed a rci...,rm pr..~gram l:ast
December to upgrade liS schools. G,wer""'r Clint(ln told legtsl3tors that Arl.ansas
h3d no choice but to foil<'"" suit
Clinton tells the tuchers' W'lion that competency eums are necesSMY
.... lo;e~ motivall\ln r...,r tf)
do
Poi1Shi11g Q bud lmGgt. gtlllllf nd "/txc-ustJ Grrd pultiiiK I. ids .first.
wmethtng abc>ut Arkansas' sch ...
".''s as the
hope th:at the state ~o~.ill be able t•' attract in September The Clintons "'ent on the tains that .. ,r ~o~.e are g,,,ng "' re~stablisn
ne" mdust~· by produc:in8 gr3du:ues "'ith stump torether 10 build up !!r3S)·r•X'IS the tc3.:hing professt.>n 3S a professtlln
nc.::eSSOlry sktlls. Dedared Clinh~,., •n Sep- s•.arport. and the st:ate was s:atur:lted with
'-'l.>rth\ of respect. there ha\e tO be s.lmC
tember: "Do ~-ou bclie'e that G,~ me3nt br~oll:hures that e\plamed the reforms and st:andards c>f indt\'idual a.:.:,,untabilit" ..
for us t"' drag up lhe re:ar ..,,. the.- n.tu . ,n·s ur2ed: ··~ ..., m ..,re e\.:uses. Let's ~ut ,,ur
.
~bn~ parents 3nd educ:ators Jo· sup~.:onl.)m) fore,·er.'" Allh,>ugh the :~:ate has
kads 1n lirst pla.:c."
P..'rt the ref..,rms. S:ays Elaine Dum:as. :a h·
wme e,.cellent schools . .:>thers brc poorly
t>r:~rian at Little Ro.:k's Cen~r:al Hi1rh
,,me ...,f the ref..,rms: in.:reJsing the S.:h\'11.'1. "If I ..:an·t pass the test. I d,,n·t d·e·
"'" nati.:>nal achievement tests. A pnmary
lenrth ...,r the school da)· fr,,m fi,.e t,, ser'c: I\' t>.: '-'Orking with young pc..,ple ...
rC3SCln is la..:k offunding fl.'r )"C:lh ..),.rl.;an·
sas has remained at .:>r ne:ar the b..,n. ,m of SY: h"urs. and ad,·ancmg the age at .~ p;.•ll tal..en b)· a Lillie R""'" tele\ •si.:>n
.
the SO SlateS On e:\pendllures fc-~ ca.;h Of "'hi.:h students .:an quit !.Chool from IS tc> station found that 6S' ( of those quesits 41:!.000 students Last )·e3r Arl.;ansas
I&. Begtnnmg next year. thirJ- and sill.th· tioned ra,·oreJ the sales·t:l' in..:rease anJ
spent only S2.035 for ca..:h studcnL .:om- grad.ers will be required tc> take basic 61 r; appro"ed of teacher testing. The sup, pared with a national a'·erage c>f S~.9S2. skills tests. and after 1987. eighth-graders port has surpmed e'en Clinton. "'ho hu
placing it just aro..-e South Car.;~lina. will ha\e t.., pass tests in subJects such as a three-yeu-old daughter last month in
Utah. Mississippi and Alabama Arkan- 1 reaJing and math to enter htgh !.ehool.
Fort Smith he was approa.:hcd b)' a shabsas· teachers earn 3n :l\eratzc .;~f only &1me educat.>rs predi.:t that the Sl3te will bih· dressed \IoOman in her ~Os who told
S I 5.029. comp3red ""ith the nau~'nal a\- h:l\C t.> build as m3f1)' as 2.SOO .:lassrooms hi,;, th3t she '-'JS the only one or her f3merage of S~ 1.671. Admns State EJ:.~.::uion and hire SC\me 3.SOO tea.:hers o'er the ily "'ho could read "'ell enc>ugh t.., hold
Director Don Robens: "We deseO"\e a bad ne\t three years be.:01use of proposed do...,n a job. She said. the Go"ern.:>r recalls. "We didn ., le3rn "'h;1t we necdeJ tC'
image for those t.,..c> f3.:t.>rs al..,ne ·
changes
Only ;s~; of l.1st iall"s h1~:-. >.:hool
Of .til the refNm~. the tea~her-:est1ng !cJrn. and "'c didn't knJ~o~. "'h3t "'e .,.ould
need,,, ~o;,.,..., .... IL mJ~ be :,"ltJ IJ!e f·~~ us t-u·.
pr.;lgr:~m h:ls produ.:e\3 the m,-,.,i angu1,;h
graduates entered .:.JIIcgc . .:omp.!~eJ "'llh
a nauon:ll average vi 53'!. Of the state·s All tea..:hers will ha'e :o pass tests 1n 1t's not too late f,,r the pe~o,ple "'h,, c.Jm'
behind us..
-ByCI/i,McCr~IJL
3 -o d 1stn.:ts. 170 d~' n•': vffe~ :! f,,re1gn
r.:lJint. "'r1l1nt. mathemJtr:s and 1n
!.JnguJge. 91 ha\e no ~heml:i.tr' .::J:>>e.s. 1hc:1r )~.:1::ed ;Ut'>Jc:.:: J'eJ> Tih---;~ .... i':,' R~I'Orl~d by D;n·id S. J.Jd s"n/litrl~ Rod.
P
ut-11~·
!.J! '"'' t>..· r~.;·Jr:~J l·• :.11..: m,•r~ •r.11r1tn..:
JnJ 1f the.-:- ."Jnn,•t ""''' th~ :.:s:• t-.~ 1'-1•-=:.
the~ "'" "''...: ti'1..::1 J••t-) The: .),. E .),. .
J I~ 000-m~mt->..:r :1~il1:tlc: ,•f th.: l'''•...:r·
.-:JI 'Jll,•nJI E\J~~JII•'" .),.,s,....-IJtl·'l" h,,,
:JI!o::J the te):Jni' ,,~·,.,,"...: t,•;l !.HI!.: m.t·
J•'fll~ ,,f t~J~hc:r;:
·
Arl.ansas ~ffi.:aJI:; Jre ..: . .•n)1Jcnng usang the '\:ua,•nal Tc:J.:her E\Jmlnau,ms
' ' T.E tdc\lscd b~ th.: Edu.::ttl,,n ... l Tc:st·
ang Sc:r\l..:e • E.TS 1 f~.•r be{:mnan,!! tea..:h·
ers Opp..•ncnts ,,f the testing piJn h:l\c:
(,lund a surpristng ally 1n E T S Prestd..:nt
Greg~•r) Ann g. "'hll has SolaJ that he ""111
n,,t all''"' the N T. E. tc> be used f,,r tcsllnl!
'eteran tc::t.:hers. Sa~s Annr· ·Tc:st~
Shl'UIJ nl.ll be used f\1r pra.:ti..:mg lCJ.:her)
bc.::1usc bcuer informati\'n l'n thetr perfNm3n.:e is a'ailable. based on l)ken·in&
"'h:lt the)' a.:tually do in the t:13ssroom
"ith students ... Clinton. hl"lwe,·er. m;1in·
•
••
r&AC
so
'"i ,,,
S
-----------------------------~
�\
PRESS CLIPS
1. "Historic Opportunity to Make Strides, Clinton Says: Committee
Moves Toward Deadline, Education Update, Arkansas Department of
Education, August 1983.
2. "No More Dragging Up the Rear," Time, December 26, 1983.
3. "Drop Cited in Death of Infants," Arkansas Gazette, March 15,
1985.
4. "Program for Newborns in State Seen as Model," Arkansas
Gazette, November 21, 1985.
5. "Mrs. Clinton outlines Plan for Upgrading Education, says
Opportunity at Hand," Arkansas Gazette, July 28, 1983.
6. "Education Report Issued; Stop Excuses, State Told," Arkansas
Gazette, September 7, 1983.
7. "Mrs. Clinton Says She Found No One Happy with Schools,"
Arkansas Gazette, August 24, 1983.
8. "Mrs. Clinton Wins Praise from Panel," Arkansas Gazette, July
28, 1983.
9. "Panel Urged to Emphasize Math, Science," Arkansas Gazette,
June 24, 1983.
10. "Clinton Names His Wife as Head of Commission on New School
Standards," Arkansas Gazette, April 23, 1983.
.
.
11. "Decline in Expectations of Education is Traced by Mrs.
Clinton to '60s," Arkansas Gazette, September 11, 1983.
12. "National Education Report Called Blueprint for State,"
Arkansas Gazette, April 28, 1983.
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.•.,._, ~ .... _,_. -.--·
Aagust 198:,
Volame21
lW1UMber3
Arkansas Department of Education
~Historic
Opportunity' to Make Strides, Clinton Says
Committee Moves Toward Deadline
The 15-member Arkansas Education Standards Conwnittec conducted
public mectWlg$ in every county in the
stale on seven nights in July to gatte
views and suggestions for ils recommendation of new curricull.Wfl stan~ds for Atkansas schools.
Approximately ll:XYJ persons
attended lhc 75 sessions. Each Comminec member conducted five county
niiCCiings and Hillary Rodham Clinton.
Commitlee chairman. presided a1 one
sesSO'l. also. Governor Clinlon. members ot his Slafl and AOE represenlat•ves attended sessions.
Additionally. during a ninc-flOUJ
marathon session at the AOE July 5.
over 45 groups presented lheir fOOOillmettdations lo lhc Committee OUlef
g.oups submitted Wf"len presentations lor consideration.~The CommiUce wil have ils first
drafl recommendarion wrillen by
_,
�DOCUMENT•
0~
I
RCCESS I
H(AOLINE
urop
O~T£
THE ~R~ANSAS AAZETTE
Section: CITY
Pfl8f •
1 0
3
03115/85
SOURCE
1
AG13113
•
•
c~ted
1, deatne or
~nfanto
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24A
<Copyr 1ght 1989)
loti llary Rodha"' Clin~o11 1 the w1te of Go'ilrnor Bdl CUnton, Uld
Thuraday that a1nce 1978, 1nfent deatha in Arkanaaa ~ vo decreased
~1Qni,1eantly, ~aktn; Arkensaa the only atate ln the
uth bee1dea
Texaa with on infant Mortality rate below the nat1one average.
Hrn. Clinton end Margare\ Whillock, executive dir tor of
Arken•as Peace Linke, spoke to reporter• durin; ihe 3 h ennuftl
eon,erenc= of the Southern Aaaoc1atton on Children Und r 6 at the
E~celaior Hotel. The Mte\1ng, which will end Saturday, d~Aw about
1,0G0 pe~onte, Leacnere, pay:holo;1ata and dey care wo kera. It
included apeeches, d15play booths, toura, and deMonatr tion, relased
to oarly ~li,ldhood, peece education, child abuse and o her aapecte of
core for the young child.
Hra. Cllnton to lei reporters that 1 report of the S uthern
Governora Aeaocietlo" ahowea tnet Arkanaea'a i"fant •o t•lity rate in
1~7B ~ae 16 deatna for e'terv 1,101 live birtha. Tne rae hit
decl1ned to 10.1 infant deathe for t'lery 1.111 birt~a. belcw the
"a~ional rate of 11.5 infant deaths for e'lery 1,111 bi tha, ahe aaid.
The Mortality rete hat declined for black •• well •• ~ 1to lnFanto,
she 1a1d.
Mra. Clinton a\tr1buted the 1"prove~enta to her hu
1n1t1at'"' end be~ter atate progra"o· She ea1d that 11
Al"llanau had deve~oped rural health r.linicl •nd ~ode p
evallable to pregnant .wo111en: 1ncrtued H11 nu111ber of n
l'ledical profeuionala 'in \he .steh Health Oepor~~•nt; •
l'leternel and child health pro;re~e, and IKDinded l'lidw~t
1n the southeastern Arkanaaa.
·we 1n Arkaneae need to know thai we can 111ake progr
11ohl care
111 and
panded atate
ry progra111a
11,' she
Uld.
Thora re"a1na ~~ whole litany of proble1111 that 111u1t
addressed,' ahe aald, and ltated tee~·•;ed preg~enc1e1
funding of all cnlld health needa •• t~o of the grobleM
Whilloek. ~ho etocrl in ror Setty a~~p•r•, w1fe of
Bu~pere, aaid Peace L1nka wee concerned eepeciallv with
children how to re~olve ecnfl~ata, work cu-operatlvely
responsible c1ti,ens,
be
nd 4ntdequate
•
~enator Dale
teaching
nd be
Kevln J. Swt~k, the prooldont-elo~t of t~e Southern Aaaoctetion
on C~tldren, announced • new publication celled "Act1n; On Whet We
Know• Oevelo~ina E''•ctlve Progr&"D Fur Young Children,' which wee
writt&n by ~~~bert or the group and which addresaea early childhood
educat1on. C1"'rental 1nvolvel'l•nt and ch1ldl'lood atreu, e ng other
IIUbJeCh,
l~rt1
•
End nf
Curren~
s·
c;teff Phot.c t:y Ad
IArt Capt1on: Hillary
Sour~e:
~tory
Roocnod
Total AG
Her·,pol
Cl1nton
~odha"
ho~da
Southern 6ove nora
,
�'·
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ACCESS I
I-IEAOL ir~E
OCCIJMENT•
I OF
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for newborMI in
'"r 1ll bab:e1 praised
Ryl1~e:
DATE
SOIIRr.E
CAROL
Credit:
Gazette
1
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PAGE •
1
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ao MQdel Tranaport
network
MATL~CK
w11~tn;ton
Bureow
ll1211S6
THE
A~KA~SAS
Secbon•
6AZETTE
<ACI
CITY
Pe;e •
SG
,.,.
t..I~CIIINGiON
< Copyr.LgM 1~09 i
Cl~i;i
WASriiNGTON _
1to\ew1dt \ransportet1on
twor"k for
urve 11 a l'!odel for ot r southern
help reduce lntant I'IOrtiUty, ICC:Ot"dlng to a reoor-t
~r~onsos'a
oertouctly lll rrewbornt ahould
ote\u ~o
rclaa::tcd 11onao~.
!he report, t:aud on 1 yeer"·lon; atudy t::y the Sout er-n Regional
FQr;e on Infan\ Mortal1ty, noted that Arkenaee'a ·nfant
per 1,0~0 bir-tha waa the loweat rote 1n the
South and wo' JUSt be!ow the natlonal average of nearl 11.9. The
rtgur-e' ore fro~ 1~~3, the ~oat recent year- tor wnich eta 11
Tao~
rH.wtollt'l r-ate of 10,7
avel!able.
~rkaneos ~•• ~raised for o elx-~oer-ola grogra~ th
el'lbulet~ces to bring nr-!ouely lll Mhtborna f,..o
specul
t prov'~••
ouUying
hoapita4s \o the Arkanoae Chlldren'a Hoap1tal at Littl Rock w~ere
t~ei receive special1zed care, The Task Force urg~d ot •~ etatea to
prov1de a1~1ler eervicea, and 111d ~rkanaea aMou\d ado t other
prcgra~e that have proven auccteeful elaewhera t" t~e
OYih,
Has edopt~d few ot~era
E~cept for the newcorn tr-ansgorteticn networ-k, A~k naae hao
adopted v1r~uelly none of the "eeaurea th•t \he Teak F rce ooid wo~ld
lower infant Morhlitv,
1U t.nhnt I'IC~taldy "•te· •• r-el'la1ned
str1k1ngly lower tha~ other Sou~~arn atatet. 0~. Raa G e~, author vt
the ropcrt, adMtttad in en interview Monday that Arken
was .. , , irony• st1e couldn't ex,l•in. She eud ~hat ~o~tu e Arkauoee'1
over-all ~ortality ~ate ••• rAletlvaly low, tha~e ~•r-• •po~~ele of
proble~s" 1n eo~e countiaa, ~nd black• ~ad a ~~ch n1gn r ra~e then
whLha.
A~ong the Taak Fo~e~ reco"~•ndatione we~e that 1te oa '~prove
benet1ta ur.der the Aid t.o Fa111aUea wUh Ce10e11dent Chll r·en and
.,.t
Mtd1c41d
e~rocret"'l,
""holie.,
a,:~ecaJ.
ola.ntge fe-r pre1,111 n\ teen-agere,
ltrengthen ft!lllllh 11lan"in; s:;~r-ogra"'• aet up l'lobde hoe
for r-ural arP.'"' and adopt le._ulatlon r-equir1n~ hoaplt
all wo~•n in labor eve" 1' they have no inaurenge.
PrAiaed for "1dw~fe p~o;~•~
A~lr.•.,••• waa p~und for adopt!ny one other" I'"ICO"~
report: Allow1~Q cert~'led nurec-~1dw1Vtl to provide p
end to
•
delive~
b4biea
'h-care un1t1
la to ad~tt
dat1an ln the
natal care
1n ho1~1~1111.
The 44-per~on Teok Forwo, en ~r~ of \hi Southern
ernora
Assocaation, 1"cludod Lhree ~e~bera fro~ ~rkerieaa: Ftra Lady ~lllery
Clin\o~, Un1tod ~tete• Sana\or Oele s~~pera and Or, Rob rt H. Fiaer,
c~a1r~an o, pad1etri~a e~ Lne Un1veraaty of ~r~enaea fo
~ed1cal
Sc:1encee.
Or. Rae Gr.:ad 1 out..,c:r ot ihe
alt~et~on ~•• •on ir~ny• Dhe
End of Stor":r Resctaou
re~ort,
aarut~ed \ha~
couldr't explain.
11a~'1
�:AN-25-93 MON 12:22
liUb In
l;VU•II'I'IC;J~I.:I
U l\1
1\CIIl;:)..,,:,
w
r.cy Jack Ma·
whether sat·
1gnal rccC!l'JCr
rm to-tl'.e same
perly llnes as
dis~ on Scenic
'me cornplalnts
oard members
. the dlsc might
requirements.
lt!d before the
•rdinarice that
oninc the discs
Is.
Hubbell was
by Mctrop!3n.
P. 02
zcbo on hLs la.t at the corn~.
Ridg~ Road and G Slreet..
Today will be generally sunny
and hot w~th higt'is in the mid-90s to
around 100 dc~rces.
Rallnon o£ 3817 Glcr.mcrc R
for a variance from sclbac'r<
quir.:mcnts .to build a ear:;>ort
N(lrLhcast and Southeast Arkansas
nl'arly 100 degrocs in most of Ccn·
tral A:-kansas. At 2 p. m. and 3 p.m .•
r. the Board di· . the temperature Wi!S 100 de5rces
J
•
Wednesday.
~V
at Jacksonvtlle. the National
WM.1 hPr ~P.rvice 5aad.
·
+ Denied a request by W.
the front of his house.
Mrs. Clinton Outlines Plan
.
For UpgradinQ Education,
Says. Opportunity at Hand
.. a.3
'
•
•
o
.7-.:~r
Clinton. tepeatlng many
o( lhe pomts her husband the gov·
~ supported by · crnor had made an hour earner in a
separate speach. outUnad Wcdnes·
1ents and pub·
1er $19,729 ror · d~y for th~ slate vocational-Tech·
budget. The meal. Education Advisory Council
provtc1ed $49,· her mtenllons tor tmproving the
state's system of education as
the year.
Rock's repre. cnalrman o.c the Education Stand•
!troplan Board ards C!)mmatlcc. •
"We have an opportun1ty tllat
~rt was a "m1s~
may nev~r come again ar.d if we
~ut how mucn
propria ted .I or d?n't seize it, we·u fall further 'be·
he city's 1983 h~nd,'' she told ·about 40 Council
n.embe~s aM guests who gave her
· ed. Hubbell re·
re wasn't any a stand1n g ovation. when she nn\\'t passed an lSMQ Mr 1
30:~·u~ute ~c1drcss.
She. said 1t s 1mportan~ that the
st eh.ose to ige passed by the new standards her committee rcc·
ommcnds not be unambitious. "If
vague."
they are. we'll Clnd our~S¥lvu:. Lu t.llc
positioo of having set new stand~
·ed
anl~ Lhat will still leave u1 behind
,usan Fleming· states like Florida and Texas and
1e, Inc .• which Llie state5 we're in competition
o have been ar· with in our region," she said.
I Its request for
Mrs. Clinton re,·iewed the high
Board deferred points of· the Committee's recom·
l. Both funding ·
mendation,, all of.,J·hlch ~re tent:l·
1sldered b~· the tive at this point:
.
1esday.'s.agenda
Mandatory full-day kiAdergar·
1ality Foods for ten designed to prepa~ children
1Strial develop. for the fi"t ~nd s~ond 'grades.
nstruct ·a new
Classroom sizo restrictions ·in
~lllary.
I
ual instruction prograrn.
* A teacher-student ratio of 25-
t~ 1 ln grade!· fuur 1.0 six and an-
other mandatory competency tC!st
after the sixth 1ratle. Retention in
the sixth grade will be required ol
thOse not pas:iing.
AnoLher promotional and com·
petency lt:~l atter the elgnth
grade to make &urc students arc
ready for hi!ih school ins.truction,
with retention mandatory ror
tbose not passing.
A requirem€!nt of 20 units in
. grades nine to 12 for graduation,
with l5 units mandatory, and dis·
tricts required lo olfer mor6 tnan
40 courses at least every two
*
*
y~ars
· .
.. .
She su.d also. dLscipUne must
be a policy. I d~n't belleve we
have to put U'P w1tl\ the kinds of
disrup~~ons that I've been hearlns
about.
.
State Representative John M.
Lipton of Warren. tbe chairman of
· the Col.lncil, said in opening remarks that the state must find
,.....more money than just the amount
that will ensure that school dis·
tricts don't lose money through a
new formula. He Silid $100 million,
· the amount most oft~ ..dlscuS$ad:
grades onG to lhreo. prob:ably 2·0 lo be providl!d by ralsing the sales
pupils per teacher, to allow more tax a cent. "moy not be enougb."'
individual ins~ruction. ...' .
. "What i! we sper.d $100 million
A' competency. test after the and we need new progr~ms later
'\hard grllrlP. with two allernat\veR and we have no money for them~
ror falllng students: .Staying in thQ ·That's. where we need to take a look
third grade or entering an individ· at cxemolions.·· he said.
*
*
now ~Q\t\ptn"'n\
~ at 4807 Asher
or the propo:sed
*.
. Business Imiu a lour·block
1.
•
norStiU,-Retuctanrto Give Details---
)~dor S~~~.i~~ "~~,~~i~n-~n- ~·c_hT~?,!~,~.I
t\'l!ln [). Jmmakrr
,'iNiiur
m·nl h~r ,, nul)•:d
- -·-·
�JAN-25-93 MON 12:23
; aner
P. 03
...-:~-:~~\ l OT .) JUUYt!~
... nd tax
· cleused
w. York
.h term-
IReject Request
as sen·
jail for
~o pay a
Bentley Turned Down
On Call for Grand Jury
I
;taurant
:on ana
d a new
upril!m~
ltCOI
of
nl!rican
in· Ma·
archri·
was a
egime':J
3
sta.bilI
ground
:ennedy
e spa.cA
l:lndcd
2.5 mil·
•t sl'\ape
a hand·
tt's pol·
n, wa~S
United
1udge in
1 Jatnes
~cutivcs
oration.
:·ork on
million
r grant·
tanker
1es.
•
:1·80
',8
es8A
nlB
.cUil40
·4D
-,n ~-~B
A.
·2A
!
I
1
'
Juri('~.
stnittle-
:\ftl¢1 11
·
,
:
,
··.Judge Lofton declined to.s.ay wh...- :
he rejected the rr.~uc:;t Juo~e Hcri- '
dricks said h~ check~tl th<! cost of
thtt rllc~nl Pu~aski Countv Grand
Jury and !ou!\d that $55."000 t'.a<i ,
+-...nan:-,.,!lid -and·dartm·were·pending ~
for
t that much more. Besides.
hf': said, making.dP.ci!\IO:l!l on
whether to file charges in criminal
investigations ;'comes with t~e ter·
1rds Air
lUth Af·
d from
ause of
Two of the three PulosOi County
circuit judges who try crimin<d
C:lliOS Tu~,.r.lay turn<!d down Prosc:cuting Attorney Wi!bur C. (Dubi
Be[1Uey's request that they call a
Grand Jury to investl&ate two recent shootings hy law ofCiccr:o.
Bentley said Juoges Floyd Lofton
and Lowbc:r Hendricks rejected his
request. H~ thC!n a:~ked Judgo John
Langston, who promisQd to confer
with the other two judges before
giving his dedsion, Bentley sa1d.
The county has six circuit jud~es.
but the 'three others usually don't
handlt! criminal cases or call Grand
ritory" of b€ing prosecutin~ <Htor·
ney.
Qt\ August 17. Sh<>rdf"s Dcpul)
-Oitlt PhOto by
Doug Porterfield shot a wom~n he
Mrs. Clinton: Passing illiterate students is 'educational fraud.' said he was trying to arr~st on a
. .
prostitution charge The ~a.·oman.
Cynthia Robertson, 22. of 3~ Jefle=-·
son Drive, who was snot ln the ~ack
of the head, was rC!least'd frl)m t:m·
.
'I-J-f3
versity Hospital Tuesday a~:l .appeared in Little Rock Munlctpal
Court for a bond hear;ng l)n an at·
By MARION FULK
We Arkansans have to quit making tempted capital murder c~.argc
Geten• S\alt
excuses and accept instead the chal· The po~\ce. charged ~er based or.
The Education Standards Com· JangQ of cxcellE!nce once and for Portt!rhclci s stattmcnt t~.H he shot
~ittee Tuasday released its prelim· all."
•
her a!~er she tried to bad. l'.er car
1nary report listing new recom·
A school that •·passe~illlterate or . over hlm. S~e has pleaded l"l~·xt'nt
mended standards lor the s~t~·· semi-literate students commits edu- I On Bentley s re~mme~~..at l';r, she
school!, and ~mary Rodham Chn·1 cational fraud," she said. "There is was released on 1 S~ \.'Ov ·,·rog:-:.
ton, the Comm1ttee cha.irman. spok.e , a !ccling of urgency and a need for zance bond.
.
_
I str~ngl_yof~hen{'edtolmprovcedu· ch:1nges in ~duc.:1tion. t£ we do not 1 On August ~5 ~~ .. ~·r- '·.-:;::
C<~~,1 on 1n Ar~&.~m;&ls.
.
Sl!IZC the OPI'OI'.lUiHLY we have now. 'I R~yno\ds, :! ~ · ~~! : · ~ '·
· · ·. · :
.
Our: schools are not do.tng as we will go backwards."
, Drive. was shot. b:· P': · ~ :-, • _. ~ r
1 gooa a JOb as they must:· she said at
The rccommcndauons. which had 1 Staflo.rd when !:lt.i!! ~.: ~;
'l a press c.onftrence. ·'While there been announced ::.s they were ap·! test h1m en a r:r1s·~ .. ~ • f •
:-nay be'many c~ses !or our di· 1 ·
Reynoljs \US wv-..-: ~.: .1
1 lemma .. t~ere 1s on!y one solutit'n. 1
'
(Se~ Tl~·lr>c~. Page 4:\.~
1 d·~r.
~
'7/ .. /.: :
~
Education Report·. Issued;
Stop Excuses, State Told
I
I
4
• ("·:
�MON :2:25
J~N-25-93
P. Q~
......:. ...
-~~A···
..
·----:-~--~-=----=-..,.-----
Contln_ued from Paga .1A.
...----------...-Educatlon..Assoei:ttion.-one of-about-· a
LR s h I o·
~-~ ' ~=-~=~~~;:;:!j:~.~~~nc!
. ,.
C OQ
50 persons· present, called the ro- J
0
IStrJct_
ac
~rt "ambiUo~,'' ~~ ~ld 1~0 AEA !
I
in~ further comments.
r
Blacks made up 70 per eent of
Mrs. \.Cllilton said she expected
·~f~!ants. But "the real heart" of thA
the enrollment in lhe Little Rock · leRistat~ve ·s~port for the recom·
• tecommendatlon;; is the testing pr~ . S~hool Dislriet Tuesdar.the mendattons. I think the legislature
--gffUTt-th.at b~ .tn.P.n~urP. ar.r.mtntahll·
sixth day, and ·total enrollment.- _Is J:ommi~ted .to .qualllJ_educa.t.lon..
ity, Mrs. Clinton S&ld
was 19,162. There were 5,627 The constltuenC)' that exists for ed· I '
'!co'uraes and talco a variety of
·~·iQurses beyond current' require·
'AI:Jsolvll!lly Essential'
. Cl'
Her husband• Governor B1l1. 1nton. said in a statement alter there·
t
1 d ...... t.th
d
por was re ease ww e propose
standards "are ambitious but abst>·
luLcly essential u we are to move
ahead ~n makt g
•
n rea 1 1m provements in education. When imple·
mented these stand d ·n ·
Arka
d its
~hWl Rl\ve
of ed~~=~~~~ the N::!~e. e qua ty
Y
·
Dr. DOR Rober ts. dl rector of t he
division of general education in the
t t Ed
· De
·
sa e_ ucauon part~ent. said
that if the recommenctauons were
adopted as proposed they would
··significantly improve education tn
Arka
"
ar
I
nsas.
.
.
N1w Standards
Thc finrtl Committee report will
be present~cl in Dec::ember to the
et:1to Board of Educoation 4nd to Lhc
~eg!slature by January 1. The Board
u to set new standard& by March 1,
and districts that don't meet the
. · standards by June 1. 1087, will be
merged with other. districts. The
Committee wlll c:onthWe to ~·!Jrk on
· the report until then.
Dr. Robeftt s~id hC! didn't know
whitq students, 13,338 blnck stu-
ucational excel~ence is growing day
.
dents and 197 "other·· students, by day. People are tired of children
d'
d
· ff'
goin& to school and not learning:" 1
Accor Lnl to sehoo1 !stricto ,•. -·sh-· dd ~"" t i h
.
cials
.·
e a eu ~.111 n er presentations 1
·
to· leg1
'slatlve com mitt- the re- ,
~uesday was tho last day the
......_..
cnrolln;e.nt will be .reported until sponstll generally was favorable.
tho offu~ual count " mada OctoShe said a r~commendatlon that
b 1
the school year be extended from
er ·
175 180 d
·
Onthcsixthd.ay4yearago ~nto
ays, Wit h teac her con·
rollment was 19 313 anfthe ,d.is· tracts being for it·least 1110 days,
trict was 68 por ~en•. black.
had received more criticism than.
Ten schools, all primary intfar· other proposals. Many dlstrtcts al· .
. . ..,. •
·· .·
ready have 180-dav vean.
modlate or a1
amant~~>'. school~.
Th
~~
were more than so per cent
o recommendations lo the re· .
black. Threo - Carver, Ish and. port reJeased Tuesday have been
M't h 11 _
t approved at various times by the 1
l c e
were 100 per cen
comma'ttee since 1 began work m t
.
bla~lt. Rightsell was 96 pP.r cPnf
_t
If
black and Gibbs was 93 per eent May· The· Committee completed
hiAI'tc. WilliAm,. MagnP.t ~~bnol workontherepartAugust%8.
was 47 per cent black, the only
· Amona.the reports• other recom-~t'hnnl to h"' mAjority whit~
mendaUons are that:
;
The average teaeher salary in ~
scrvieco and other options. "It will each school district be equal to the
be chaJlenging lor districts to meet average teacher salary in states
·the rQquirements, but 1 am confi- contliUOUS to Arkansas.
dent large and small districts will
A study on merit pay be implemeet them;"·Mn. Clinton s~ud.
mented durins the 198-i·BS year.. At the end of the third, sixth and
Students ~e required. _to attend ··
aighth grados, ttudonts wt~uld be re. kindergarten: now 1t's optional.
qui red to take competency tests. In
Students be required to attend
t.h11 thfrtt gr:uin. !::turlPntA wnnht t.Ake school from the age of 6 through j
mathemaliCK and reading tests; in 16. Now it la 7 through 15.
the Ul)per two erades. the tests
The schOol day be at lea·st 5 1~ 1
would be in reading, math, language hours, a ht~lf hour more than is
arts. science and soctalstud.ies.
now required.
Students· would be required to
Units required for graduation
pciss the eighth grade test in order to be increased from 16 to 20. Fifteen
I
*
*
*
*
what tbo state Board would ny
ahout all f1rovbdon!l of the report
but that the Board "is interested in
uperadinl educatron and this does
that.··
No orice ta~ has been put on the
.
r~commcndutions. Mrs. Clinton dn'd be promoted. Retesting would be al· would be spec:iCh.'<f cutJrn·s in Eng·
..
.. . . . _Qr:_._~ob_e_r...t:s_satd. but Or. Roberts lowed and special programs would •llsll, math, science, social studies, c
'
added that estimates are bein·g·ae- be developec!:Tor-studenu wno ·pt1ysical education.- health and line 1. ·.. ---~elo'J)ed-aild-should·bcneadyw~thin· ·didn~t-·pass-initially.-At-the--lowet'-··arr&-Now.,..onJy.
.six.are..specWed.: ill.
···-~·-·~--·~·a week·or·.tw·6;.Not-all recommend a;: ·.:.te-.zels, ,stu~ts could be. promoted;..; .}r;~·;T.he.· pupil-.tcach£r .r.iltio. be r_$:
. tions would mea:t increased costs; despite tow test grades.· but only duced from ~ to 25 ln kind<!rgart~n · (I·
*
*
I
but many would.
:\·s t'OSsibla that
-
. . ·,,,.
I
'
S')ffiC dist.nc:l:::
·:·. ·.·: :-·.~·· ··.,- .-.~.,.·
1
~ftcr partlc.:iputinl!: in n•n!tm:nc.:~:, ond 1 to 3S in other cradcs to tho lr
1 nnd Clfter special prograrr.s were following: 1· to 20 !n kindergartens.·' tt
~r:v:-:t:::df~r:~oo,nr.
·
il,.tt:l
?~
\"
g~:4~£1" :np
thrnneh
t:
�.
:AN-25-33 MOH 12:26
..
.............
-
..,".. '
"·" .... ....
..: ~
-recommendations is the testing pro'------·giam-that ls...to ensur!Uccounta.bll·_
... '
ity, Mrs. Cllnton said.
~
·~
?. 05
,,- . h k
mcndattons. 1t In Ute 1
eglslnt~re
~ixth· day-and-total- enrollment- ~ommltted tu 'luallcy.-educatio
tne enroumt!nt m ~nu a..1uu: n~r.
St.'hnol Oilltrir.t Tuesday, the
-
.
""'~" l !U R2.. There were 5.627
The constituency tha~ exists .ror ed·
ucatlonal exce\1~11te as_grow1n.g day
'Absolutely Essential'
dentS and 197 "other" students, by day. People are tired of ch1ldre~
Her husband, Governor Bill C!in· according to school district offi• __ 1oin1 tu _s_c~~l. and not learning:
ton, satd In a statement after L"'e ro· cials.
·
S~aiideCI l.hat m her presentations
port was rele~sed thatlht! proposed
Tuesday was the last day the to ·legislative committees~ tho restandards ''are ambitious but abso· enrollment will be reporLed until sponse generany was favora.ble.
lultely ~~t=nliid lf we are \o r.1ove
lhe oHicial count is made OctoShe aaid a r~eommend:1_taon th:at.
ahead ln making real improve. ber 1.
th~ school year be extended from
mtmL) in ~tluc:itUOn. When imple·
On th~ ~ixth da)' a ycar.ago, en17., to 100 daya, ~lth teac:hat conmcntc:d. these stand~rds will give ro\lment was 19.313 and the distracts being for at leas~ 190 days,
AI"Aansas and lt.s people lhe quality
triet was 68 per cent.black.
hod received more _crltt~lsm than.
of education they deserve."
Ten schools. all primary,lnter· other proposals. Many dlltric:ts al·
Dr. Don Roberts, director of the
mediate or elementarf schools, ready hove180-d:ay years ..
division of general education in. the were more than 8(f per cent
Tbe reeommendations an the r~
state Education Department, said blac:k. Three _ Carver, Ish and· port rel<.>:ased Tuesday hav~ bePn :
that if the recommendations were Mitchell ..... wcro 100 per cent appro~ed at various times by the I
adopted os proposed they would
black, Rightsell was 96 per c:ent . Committee slnee l.t ht'!g:.n work in .
"significantly lmprove education in black and Gibbs was 93 per cent May. The- Comm1ttee completed ,. ·
Arkansas."
black Will tams Magnet school wcrk on the report Augu~t 28.
New Standards
was t7 per cent black, the only
~mong .the reports• other rec:omThe final Committee report will ·scbool to be majority white.
mend4tlons are that:
be presented in December to the
Tho average teacher salary in
state Beard of Education and to the services and other options. "IL will 1teil~o:h school di5triet. be equal to the
le~islature by January 1. The Board be challen&lng for districts to meet I average teactler salary in states 1
is to set new standards by March 1, ·the requlremonts, but I am confi·l' cunU¥uous to Arkansas.
and districts that don't meet the dent large and small districts will
A study on merit pay be implc- standards by -June 1, 1ga7, will be j meet tMm;"-Mrs. Cllnton said.
nu:nted durins the 1904·86 year. ··merged with other. districts. The
At the end of the third, sixth and
Students ~e required. . to •ttend
Committee will continue to w'Ork on eighth grades, students would be re· 1\.indercart.en; now it'a optlorual. ·
the report until then.
qui red to take competency tests. In
Studants be required to attend
Dr. Roberts said he d1dn't know the third grade, students would take school trom the •1e of 6 through
-what the state Board would say mathematics and readlna tosts; in 16. Now U Is 7 throuah 15.
·
about all provisions of the report the upper two grades, the tests • The schcsol day be at least 6~~ j
but that the Board "is interested in would be ln reading. math, language hours, a half hour more than is
upgrading education and this docs arts\ science and SOC!ialstudles.
POW required.
that."
Students would :be required to
Units required tor graduation
No price tag has been put on the pass the eighth grade test ln order to be increased from 1& to 20. Flftetn
• recommendations. Mn. Clinton ~n·d- -be promoted·. Retesting would be al· would be specified courses In. Eng •.
_: _ _Dr:-.._t\Q..b,e.rts. said. but Ur. Roberts lowed and spec tal pro&rams would •llsh, rrutth, science, social studle11,
...
'
added tllat estimates are being·(f;.- 'b'if developed: ror·stu1f·e·nu· w'ho ·-physical ·edueation;· health and fine
.. ~-_;_:!~~~~:~~!!ld.~~~Jd·beTeady·'Withln·· ."dldn~t··pas&':"l:UUaUy:-At-the··ltiwt!l'-··8r.ts.;.:Now,~only;AK-ure-ipeci!ie~d.... ir
--- -----a·weeK·or·.two:Not·all recommends~- ~lcvols,.stu~ts·:could .be~promoted;... ;;.*.~.T.h~:..PUPil~lcach~r;r.attQ. ~ ..rs:.
. uons would mean increased ~OSt!; desplte low' t~~t Knd~), bul only duead from 1 to 25 In kindergarten d
but many would.
· after participating in conferences and 1 to 35 ·in other grades to the t!
lt:s possible tbat soma aistric\S and after spectal progr•unM were foll~wing:--1-to· 20-in· kindergarten•.- ll
-- _ ____w.m_cJtoose ·not .,to. meet the. new developed for them.
.
·
. 1~to 23 ln grades one through t:
standarc1s and.in\tead consolidate.,1
is-:--·-.--, ·
.. three, 1 to 28 in gradu four ti
. _~ut M~. Clinto~ ~ouldn't speculate .. r a· .~*fVJ~e
•,
.
through s~x a~d 1}~. 3~. in gra~m; t'
white student.B. 13,S38 black stu-
*
*
*
*
*
-,G •
on how many wouh1
b~ .:ltluln~~~.:..a
Govorno1' Clanton prauuPd thll seven through 12, Wtlh
a limit of
Committee, saying it uhas aimed 150 pupils a day per teacher ln the
,,..., II
.
I
D'
,
hteh, wnrlcP.rl hard wlt.hontpay fttr ~P.~nnitary arades by 1987 By
\..i ""engln(liOf
lSfrlcll
months, and has done a great ser·· 1990, the recommendation ls 'that
Tbo rocomm.,nn:ainnq wnnttt ;~1. i vice Lotbe people of Arkansas.''
the ratlo be 1 to 20 in graces one
tow districts to meet some require· I 'l'hirtr.en of the 1& members at· through three and 1 to 25 in grades
m('l1f~; rhrn11gh Pdllr.M.ional tcl~vi·l1 tended the press conference. Pcuy four through six.
sion, computer hook·ups. sharing Nabors, president of the Arkansas
Distrlc:ts provide computer in·
-;;::;;:;;;;:;;;:;;===--~-&.;.aiiiiiiiiiiiiiiiiiiiiiiii;;i;;;;;;;;;;;;~;;;;;;;;;;;;;;;::;;;;;;;;;;;;;;~l structlon.
·
.
· Phone·. . _
.
State Senator Ben Allen o1 Little .
laser Letters
2 25 5995
Rock; ch"alrman of the Senate Reve- I
nue an~ TaJtation Committee, said 1
(Lettershop Ser\itces)
--- --p·R·-...·c-- ·10-N -M- A. ... ~TING. SERv· aco:::s, INC.
··..;
Tuesday he intends.to ask Comm:t·-i
c 15
nm.
"'
.
. tee members Monday to discuss the i rr.
as a result of the recommendations.
I
*
#1_~ s_~~.?-~~~F~R.D PL~~~--
_
··--· ·--·- __ : ~?~~~~~~ltr~:.;~~~i,~!~:~~-~~~-~,~~~~j_~:
�JAN-25-93 MON 12:27
!". Ub
· ;(Se~ STOR~ on PAge f\A.)
A brief rain shower about 4 p.m. Tuesday feR oa
·consumer
Only Mod~
Deficit Soars
$21.4 Billion
During July
O.zen•
Pr••• Se~lo..
..
WASHINGTON'- The sovern-
ment paid out $Z1.4 billion more
t!Hln it took iB last month, pushlns
Its detlelt apending closer to thereeorcl projcctocl for the year, Trea1~
ury Department figures indicated
TucsdGJ.
Tbe report sald tbe July deficit
brou1hl the shortfall for the 10
moalhs of flseal1983, wbleh started
October 11to tl78.8 ~lUloa.
. The Reaaaa admlntstratJoo is
pred~ctlnl &ha' apeod1na will aurpasa income Ill the CUITent flseal
0
· Hilk.
:inion: A etatus report to tht educatora.
1;,.-z:r-IJ
, • l :(lt 0 n says she FOUn: year
. :
'
.
Mrs
.
bllllon and for aU of
flseal 1984 by 1179.7 bllllon. Laat
No On,: Happy Wit~ Schools ~uw;:.deficlt •••• record •uo.,
0
:
•
•
•
•
by t209.8
0
•
8y MAJ\JON li'VLK
o.zett• "'•"
In letters, phone eaUsand bear·
ings around the state, Hillary Clinton said she baa yet to llDd anyone
who is satisfied With the state's edacatlon 1,atem and. who ''belleves
we ean !lOt do better."
She spoke Tuesday to· more tban
1,000 Little Roek School District
teachers and admiDlstraton.
The only person who bas come
elose to saytng education need not
be improved was a auperinf.eadent
of a amallschaol dlatrlct, she &ald.
One or the members of the Eduea-
lion St.anllards ColUmlt.t.ee, which
is wriUogonew standards for Ar-
~kansas
ac:boola and which ¥rs.
-
cnnton heads, told her of tha au·
so far tllil year, lntereat pdd on
perlntendent wbo spoke 1 , one of the pubUc debt aloae baa amounted . ===~
the county hearinp held by the to 1108.3 billion.
E'!.
Committee.
·
The Treasury report said last
She tald parents teachers and moatb'l defldt came on o\ltllly. ot
other• were disc~asina Maher tGS.SI bllUoa asainst receipts of
standards at the hearin& aad ev- fts.ll~ btlUon.
Economists Inside and outside
· Low Psy, Ststut CrNtlng
10vernment have lliihl the lcnc·
Ttacher Crista, Pag• 7A
term deflelto could dampen the eco.
nomlc: r.K.-overy.
eryone was ••generally letting tl·
cited'· at the possib1Uty of raisin& D()w Droptl0.!26
requirements.
Meanwhile, the Dow Jones averThe suporlntcnc1ent ln,c:rruplcll
the discussion and tried to take
c:w~r tbe meeting, she said. " 'I
(Sec NO ONE on P:~ge 7A.)
Stnre Clerk Fatally Shot
•so of
Unitt
Bumpet
former
Mondal·
niDK rr
World
ported t
~0
industrials, up 40 points in
the previoua two weeks to pierce the
1,200 barrier, ret.reated in Jlstleu
tn its
C"Olumn.
dale's s
tradinl Tuesday, falllng 10.26
he'll wi
pointJ to 1.192.89: .
Wlltlam LeFevre, an analyst at
Pm·('•ll. r.raham and Co., said the
blssest 1lagle factor in the decline
_.as the Treasury Department re. r('·~ t!'::~ •.t-e ~ederal dt-fk:t h.-1~
dcnttal
already
uatpo~
1
Then
date cr.
�JAN-25-93 MON 12:28
P. 07 .
ARKANSAS GAZETTE, Wednesday, August 24, 1G83
:tting No One Happy
.
.
.
.
Crisis; With SchOols,
Says: . Educa.tors. Told
.
. I
. .
,
good teachers tonunuad rron1 Pag·i 1A. . .. · ··
m ln ·the first
o do with ·more thlnk we're dolng a good job, we're
doing' fine job,' he ,ald. 'Wht tdU
aiel one way of 'em JAck,· ho sald to a young man tn
blDg profession the front row. 'You went oft to the
t rnore dlfflcult unlve~slty, tell 'em you got· a good
l by ralsln& en· ~uc.atlon·bere.'"
·
., . .
..With all the courage be could
.sy in this COUD• muster, thi youn1 man said,. 'Iaure
a c.l ass room wlsb I could have taken Spanish.' "
'We'.ve allowed. ·Later, she said she dldn•t· know
:'lto It and once' the name of the tupertntericlent or
the district. ·
·· ··
.Mra. Cllnlon, wife of Ciovvrnor
Blll ·Clinton, also· reviewed other
· ;s ln.the ;eport;. chllDIW the ConunU.tee baa prO.
'- of the atates poiad, pramptln1 enthusiastic aplaaal tlYorasc plauae from tbe sroup.
.·
•2o,ut...
"We want to focos on the elemen·
aal4riaa u· a tar1 level. We want Lo require
:1oney spent on kindergarten and require that no
nc, the amount · child attend lint arade uutll he
lent Increased graduates from .an aeeredlted kln:.
$2,91 '1 from dcrgarten~·· That brought immcdl·
ate applause.
, UZ,769 for a
.The Comm1Uee ia alao recom·
bor secondary
a bachelor'a
. U,:iOO below
ae .aext. lowest
) for a eoUege
sa· .admlnlstra'ns thereafter:
yeera for the
$50,000 for an
PERF
=================
mending lower pupn-teacber ratloa
(the apoclfics ba.von't been asreeit - - oa) and a menl!Oil of that brouiht
mort vlaoraUI applause.
T~aehers
'
ancl prlaclpals later·ln·
terruptecl her apeech to applaud;
recommeudatlons that all IC!hools
ba roqulrecl to bave pidance cowa! selors; a.new promotion policy, and
t6d At $18,000. a eall for strk!tar dlselpllne and IUP. port for teaeher?. bJ admlnlstraton.
. :1 ·
Rfl{lron
· The promat.lrin· pblt~y wnu1d rft.
rkansas ranked qulre that aU students be tested at
! region ln l)er 1the end of the third. alxth and eilbth.
!or ~lementary crades. Astudeat wbo failed the test
lstudents.
aL the lower two cradea would have
>er student, and bls record reviewed, .1 apeclal pr~
•. th~ Ml)' Rt~tP." &J'&m developed and lf necessary,
.g above the na- he would repeat the grade.
n 7 per student.
At tbe etghth srac1e, a student ·
l93 expenditure woulcl be reqwrecl to paaa the test
ranked below be£ore bcing promoted, "no matter
nssourt, u.s87; bOw good an a\hlct~,be la or who hla
id Nc·~ Me);:~ 0 . 1parents ml.ght be, she Bald. The
· ·
~~..:...."'\~-~
:.-! . ·:i'::~e~~:.,:·.!'r:~td:.-:
'::::r~~!e~j.
�~ION
•••u&J
UU ..
Ul'
12:29
•.Uil3t..IU&--I
:'iestically."
· n T Mini1 um
tins
e,ement requlr•
1imum of 9 mil
3in annually ar
urchase of up t·
1s. (After Rusr
1e maximum.
Russra to
on rnC!tric
·. (ormally
12 mllllon
: has pur•
1e USDA
a whether to a ·ow add!·
rchnscs.) Brock said the
PACT on Page 1jA,)
P. 08
t1 ane.l to Put. ~potltght on Lrtrr~
aezen• .. ,o.. ~~·~~eu
1''~1 and congressiOnal tnvcsliga·
· WASHINGTON - (n~·oking the
,na.mc of th.c late crime tightcrs
Ehot Ness and Senator John L. Me·
Clallan (Dem., Ark.), l'residen~ nea·
gan Thursday named a 20-member
commission to put heat on organ·
ized erimc by &ubjcctlng it to the
spotlighL of publlclty.
Whil4! pralsina the cHorts of the
73. o( the Cnilcd Stat
cuitCourtol Appeals
Judge K.aulman. r
tors who have been chasing
mobsters for tho last hall-century.
Mr. Reagan .told a White House
Rose Garden gathering: "Tbe tlme
has come for all of us to assist in the
flght to break the power uf lhe muiJ
torney General Wi
SmUll and Fat Dlrec
ln America."
torcyle and prtson ga·
Webster, called crln
Including new elemer
The commlss!on wm be heaiJt:cl
by federal Judge lr\'tng Kaufman, 1
.
•.
'
(See REAGAN ""
2@ti3
1-
"'%
Mrs. Clinton
Wins Praise
From p
P..lltl
'
By JOHN BRUMMETT
aa~elle
9!111
Hllhtry Cliuwn, her P\lbll!:
~ENE
WORSHAM
'ouucs ID Back~rouod
;ham, Younts
1in Absence
lAMES SCUDDJ:;R
CJuollo 8t.ll
r ~orth Little Rock Po·
· Blll Younts did not atceting of the Civil Scrnmlsslon Wedn~sd'ay
·ause the city a~torney
tlm lt wasn't necessary
to attend,· L. Gene
• Younts' a.ttorney, sald
.
Omild~c
our busines:s
rOLD on Paee 11A.)
prutlle
rising in her role as chairman of the
Ellu~diun Slaml~tnla Committee.
testified fer 90 mlnut.es·Thursday to
a h~Bi&lative committee and won
ravo reviews.
"I think we've elected the Wl'ong
Clinlon," state Representative
~~i!J, ~~~~-
Lloyd Oeo..se o! Danville:
I
rv Statton, esu to .snow
'Visual Resumee, • Page 11A
barrassing Mrs. Clinton and e\·ok·
ing laughter arid a few nods of
agreement.
The other one - Governor Bill
Clinton -· · dropped in on the meetIng of the legislative Joint Perform·
ance Committee, which conducted
day-long hearings on education Is·
- s •"
Preventing Meltdown
sues, to observe as hla wife fielded WhPn FrnP.sl McKJy of Jensen Construction Company P•'k'~ JO t.,
legislators' questloQS wlth ease and .iet some relief from the heat at 3 p.m. Thur&daJ. 1! w~s a :>Jo•-:.t.
sraco. He was not in the r('om whon g~ees in Little Rock. McKay a"d other cweat·soakld wol'\tr\ ~o~ta'l! ;
on an section of Interstate 630 near the Arkao:sc~s C"1·1(hr \ J )~
{See PLAN on rage UA.)
ck BuYs $54 in Food ·
Feed Family.Jor Week
NGTON (AP) - Agri·
•cretary John H. Htor.k.
tire farmer who owns a
· . : . . -: .r: ~~~ cap~:C!~,
l
this year, reeds about 22 million
low-income Amert('Ans.
Congr~ss
is expected to vote today on a sup·... ,P,.._n"""~' ._. ...... ,.. .. t"l"'".,<: r ••
..... ·- .......... '!''"r.-..r, ... - .. ... .
'•
~
pltotograph wos taken. (Article on Pa&e 3A.)
�JAN-25-93 MON 12:31
wants to c:oatlrme.tO have hearings,
. whlc.Ja
DJM)'
wdl c.:onUnuas ou
<d
:'into the late fall· or early .winter."
, li~. added that. "if 1 am forced· to
participate • • • I will expect to be
pafd addltional compcnsaUon b7 the
city at the same rate u Mr. Ontahun~y and Mr•. [l'hlllp} Kaplan [an
attorne){ for the Clty Counc:n~··
Worsham sald that an ordinance
the City Council approved Tuesday
o(lerinc to settle. tfae c:o.nfllct wlth
Plan Presented
.To legislators ·
By MrS. Clinton
Continued from Page 1A.
Younts was a '.'legal contract" and George make his com men~.
that tho Civil Service Commlsalon
Repr,.sentatlve Bill Stephens of
was no.w "le.gally and morally· Conway closed the .meetin1 by say··
~ound · to dismi.ss eharses· agalnat ins hll aonfl4enee in the !ducAtitu'l
Slys Worsham Notified
.
However., Dillahunt)!, 'ttie Com·
mission's attorney. said earlier.
l'hursday that he· had' Followed the
, tnstruc~lons the Commlsslon ga.ve
1im Wednesday night and notlfJed
Worsham in .. a band·writlen letter
.bat Worsham BIICI'Younts had untlt.
100n toc1ay to a1ree on a t~e whea
:hey would meet with the Commls·
ilon.lf they don't.meet the deadliae
:h• Commission said It ,rou1d 10
•bead and resume 1 trial of Younts
"telt week on seven c:harses acalnst
· 1i1n.
·
Dtllahuntr couldn't be reached ror
~omment aUer Wonham helcf his
lreSI conference.
.. .
ln the ordinance, the Counen
1greed to pay Younts U~:140 for his
.egal and "out-of-pocket expenses,
>ack pay and retirement and other
)enefits in return for blS reslgnatiOD
llld dismissal of a tZ.I million led·
!~l Ja.wsu.u:. The Count::1llndleated lt
Nould pay a maxlmuln of $4!,000,
'ut no naure was Included ln the orlinanc:e.
r.
a .,..., .. 1'"1; ,.,
J ·
~-" ·
,
P. 09
aanization called the Food, Rc~
search and Action Center, located ln
Washineton.
·
'1'hls ls no toston whether John
Block ls bolnaacns\tlve to lhe needs
of low~lncome peopte or whether
the Thrifty Food Plan is adeq_uati,"
ahe said. "He doesn't face any of the
problems low-income people face."
Pact ln~reases ~
Standards Committee had rlsec
~hlef Yountl."
,,...#!
C"-L.'i..:U~l't'C \Uli:I,;~V' V'
Sale of· Grain
aft.r hoarlna Mrt. Clintnn•ll f)resen·
eonunuvd from Pea• 1A.
tatlon. · · ·
Mrs. Clinton outllned for t!\e 1e1·
lalatora the recommendations her
Committee 11 likely to mak'e mandatOry full~day kindergarten; a
20-to-1 pupil·teacher ratio In early
elementary 1rades, promotional
tests. after the third, sllth and
eighth arades and more math and
science units tn hl«b school. amona
othen; She said the Committee
probably will recommend a18S-day
.{
r
(
minimum /urchase at curreil't
pric::es woul mean at least 51.6 tfll·
lio.2.._a year for American farmerv:..
-.-n~ aareement allows the Sovtet
·union to reduce the minimum for
com and wbeat to 8 milllon tons t7y
buying 500,000 tons ot sOybeans or
soybeaD meal In any year.
•
The old live-year agreement,
whlctl expires September 3U, called
Jor the Soviet Unlol'l to buy a mini·
mum or 8 milUoa tons and a maXimum of a million tons. The Sovl4t
Union purehased nearly U milllOn
tons from the United States las.t ·
year, and about 6 million tons so f!r
this year.
..
Negotiations resumed last sprtns
after belr.gsuspended for about 1•
months by the Reagan·adminlstr~·
tton because of the martial law
crackdown ln Poland. But .bulb
Brock and Block said there was .no
major political message behind tb..e
sale.
~:
Asked buw t.b" a gJ"eeme!\-t.
squares with President Reagan~s
I
t
!
school year. 1 10-day addition to the
cam·ent requJI'E!ment.
She also said 10methinl needs to
be done about extracurricular interruptlona of the school day. partieularly In the sprin1 as the achool
year nean aa end. '.'We've eonfuaed
our students." she said. "When you
play, you sbogld play bard. :And
when you work, you should work
hard. But you shouldn't confuse the
two." · ·
She pratsecs the Arkansas ActJvl·
'tiea Assoctatlon, which covema ath·
lettca and otber school aettvlties,
for eonslderlns a requirement that
aU .xtraeurrleular actJvltle• lr1 crltlclam of the Sovtet Union as perwblcb 'two or more schools are. par· petrators of· revolution ln ·Central
.
I
'I
'
rrit inleng to· "' 01'ect ..
Worsham said Thuraday aft· ~lpatln1 be held- after 1 c:lluol America,. Brock aaicl the Savtct.S
11
!moon that ''we intend to eollect ev· boors.
·
·
have been suppOrtive of some mis~ry ntckel he (Yaunt.IJ is due,•• and
Repreie,ntaUv.e. L. LdDoc) Bryan chief here and alaawhere."
·:
11
1e added, "If It figures •135.000, of 'Ru~aellvllle complained that if
1 penonally view thiS tlnel of ~n
;hcy'rc soln& to_lAY lL" ·
, •·
the state epand1 An addJUonal tJ:OO. action [the apeemontl as a positive
Mayor Reed ThompsoQ said after mtlllon for the public schOols, u step/' he said. 11 Maybe you need· to
Xoral\am•a pra;a c,oafll"lftC!. that Mt'. Clj1ltOII II ezpeetod to propostt, do thll sort of thln& tn MnW t.ha.t
'thls is all mm-nam,•: addlnl ~t about '70 million of that wl111o to tb~re are alternatives to the neil~
'Ronham and Younts were "hoping' teachtr utarit~~ undi\P the eurrent t.htA rhatorie we've had on both
;o haf\1 thelr teeth·'Jnto'80methtril ratto.·leavtnc only tao mUllon f9r aldes and that'there ean besom~
·-b=-t ,_,m g~t thent. a Uttle more ·~~~ edncatlpn· improvement. Mrs. thlnc conatructlve in the rclatlon:noney."ThompSQn said that, lf nee· Clinton dlsasreed wlth him.
ship ll we work at it"
!ssary, he would veto the ordinance
•iFrom everythlmt I've observed,
- ·an action that Worsham &aid . everythlnc 10. back to teacher aal· 1
NO'flUi OF REDEMPTIO~
tlt\n:sdayJf.OUldn~t_be_.lelal...=-ot.. aries.:!...lhe.aald ....!!l'h~aiority_of 1•
~~:~=·WAaLTrreS, ~~
~ropose that the City Counc:U repeal the money should go into. teacher II.ES~, ~D OF G•~E COUNiTY
it.
· - salarles. lfost of the things we want
BVIU\
n&:oU1
•
serore the Council met and ap· to a~ompllsh are based on DC\ter
.
AIUtANSAS
3}c~·e:1 tht ord!nance. Tuesday, the teachers and better-paid teachers.''
SIMiLEF,AMILY MORTGAGE
<
I
l
i
. -- j
.·--··'
. -.- .. -!.;!,-.,, ... .' .• ,.,. -
.
-----
R£~£.W!BOSO~
',·.-t,: ._; .. , '
I
�JAN-25-93 MON 12:32
1". JU
n DfQCKea.
short·circ.ult economic recovery.
•1,1rt ruled that the House ot The House passed the resolution, ·
tat1ves exceeded l~ con· 239 to 186, and the Senate ve final
I
I ~w.en.when,.exerclslng ~ngresslona
.f'lrntlr~i'Plitbn··-rd'··are -r.tr7"~cali n4 r .....-=..:.w~T~~+~~2'·~tt
..
:ton and Natlonallty Aet,lt veto any tax or spendlnl measures
:~e
attotneyaeneral's decl· that violate bla economle program,
ilve deportation tor a Ke·
jent wbo had overstayed
.
.
.
Stolon Cartel Pspart
Vssd In '80 RBCI, PBQI 4A
· aurger said the action by ; - - - - . - . ·- - - - -
was, 1n effect, legtslaUon. , even thw"h lhey u21¥hL b~ required
utution, he said, permits ; under t,he budset blueprint. He
1 to be·enact·tcl'only ''in 'ic:... l"'W<:rll"t· bi able to vetOthe budget res·
a ainale, finely. wrought l oluUon, which is merelf a culdellile
~Uvel)'
1
COtJSldered pt·oc~ · for concr•donal approprtaUoDL
nely "passage by a major· . In considerlns the budget com·
1 Houses
and presentment P.t,:Omlse, Senate~RepubUeana_wert
~sldent" ·ror
hsi· signature· ·toi-i)betwMii loyaltQ to Mt. Rea,.
pa and the aeecl to honor the COD•
-1# WIIHhotO
Pope, Wolclech Jaruzetski.
Pope· Ends Visit
ll1utte Prt~l S1Mc11
ocedure, the chief jusUce gresstonal budgit process, whleb .. Pope John Paul II ended his
be "elumay" ·and ·',neffl· requlred eompromt&cnrith Ubcra\1 elght·day Polish pilgrimage
t, he contiDuf;!d, "With all and moderates lD both haues on Tbunday ln a secretlvc meeting
11 flawa of delay, untldl· taxes, domeatlc ependlns and dewith Solldarlty founder Lecb wa~
potential for •abuse, we fense spendhtJ.J
·el found a better· way to ·- ·~rin&· the ·House ..debate- on-tho .l~'&Ad.~~~~~\9-~~T-~J!.l~""llr
·reedom than by maklns tax cap, Repruentatlve Dan prayer ''that gwu Ww ,rtumph'.
'
1e af pcwer aubjee\_ta_the Rastenkowalci (Dem., Ul.), chairman 11\ his nativ$1aDd.
'~ese days have been ao un·
!rafted restraints spelled of the Wa)'l and Means Committee, tor1ettable for me," tbe pon,Uf
:onatUution." ·
ll:llcl tho propOoocl UmltAUon would
rt's theory encompasses ra\18 '8 bllll6ft nex\ year and f21 said ln a message to t'oland's
.
·
bllUon over the.aextthree yean.
(SCe POPBon Page lOA.)
~GRESS' on Page lOA.)
Compared to federal budget dell-
~!!'!.~-~--~-·~~!!!. ~!!!!!!!!!!!:~~~I!!:!!!!!~.-~-~--~'I!!!:'~~B!I!!!alll!!l!!--!!1!!!!!!!!!!~~~!!!!!!!!!!!!!!!~==~.!!!!..... .
.• ..~.
>i-der.ed
Panel Urged
b- ,_q..t.a
To Emphasize
Math, Science
�. JAN-25-93 NON
.. ___ ·-· .... .
12:3~
..
P. 11
·~:~:J~::rr--Panerur-9iecltotmphaSize --~ - ~.?..~ :~.~=~~~~·
h I
:lum witb rna. I ·
have been sat
~ma;.~pa~~~
I
.
.
·
Math, Science in Sc Oo s
thre• daugbtets, Car'·
LitUe Roe~, Ltnc1a Ca :
~=~~·~·,~:
d for a job wen
Just athlettd,''"lhe said. ~
nlce Foster of Saa Ji r
• •
n 11 many sen- CQnt1
nutd rrom P111 1A.
Many students .aid SC!hool admln·
Cteophua DeWitt of J.
·~uld have Jlke 'aoea un •ft.er age 17.'' Mrs. Clinton istraton dlc3n't llve enoash bocklns
Fla., and 11 lrandchll
showed excel· said in an lutarvlew.
to teacher& who atress academics,
arran1ements w1U be ~
. ·-·
-···- ·- !lle Com~ltte!'~ ~~bco~mlttee sht satd.One &ll"l sald.a.ilc,... prlnciRuffia ind Jarretl t: .
.v,~!.~-·~·~.C!..•n·.. ~tu~yl~a. '&~p Tclioor_~~!_1'1c:ula de- . pal. enforced estabtlahed.stanc!arda
. ~ii8~ 0~-~~!!..ry ~~ v'
searcri' •ml. cJded to proposo 11ii\ t!iiCo uiilti Of at her lcbout. barrlns 1lrls from
Jerry Lavon Lewis J
.ovatlve.''
m~thematlcs and 1elence be re- eheerleadlnl and boys from ath·
. a 4ormer jour· qu•ttd for IJ'IIduotion.
· ledcs because of &cadmdc deflateD•
Jerry Lavoa Lewis
ak Grove, testiPrevloualJ, the Committee ·had c:les M 1 result the lfrlaald some·
monthS, of lll Eaat
. she bacm•t cur- aettled on a two·unitreq~lrement In bodj thr.sw 1 p~mpkin· thro~gb th•
Street. dled Sunday. ~~
:aUBt 1\ waa ber ea subject. but Mn. Clinton, wlfe prlnolpal't wladow. parents
hls parents, Kathy 1
te articl~ sub- of Covomor BtU CUatoa, said In an ~<:reamed at hlm ancl t4ckl weN
and Jerry. Lewll Sr. 01
1embers. Judge lnte.rvlew that the subcommittee scattered in hla driveway, Mra.
stster, Tomllua Lewis ;
ston wa11 .... , the decided not to ad4r... the lesue Cllnton sald
ancl.hls.arandparent i
~~rnatlsm. 1 .' Ru· frOM a ..minimum standpoint." and
. ·
Johnson, Irma Brllte ·,
ound to have waa eoncomecl that wltll the attenSbe sald some students ausgeated
Lewis Brister and MaH
.tloiiof-the-aru. ..tlon.focusecl.Jiatlonali)'_Oif.needLin. short•nlng class perlodl fro~. "-----oWttl~.'-'lllUo 1
OWl emb4tTB» eduoatlon. .Vk~ m\pt WP bJ nunotel fbl5lftmu~bTd
a.m. Saturdly ln Htl
."he satd:
not settln11111her atandardL ·
squeeze hl elcbt el&Bln• • .Jay. In·
HoD\e by Rev. wuu: ~
1 it was ••a sad
Mn. CUntoa 1aJd •he'd leamP.d In stead of six.
will be tn Rest In Pe~
ilr educational conversatiou wUb gifted students Also Thursday, the Slandar~s
Garden~.
;cbool prinCipal at Arkan.sa1 Olrli ·Stat• and the Committee announced the acbeduJe
:ee from a state Covemor'a Selaool for tbe OUted of meeUup its members wUl bold
Mrs. Carrie Hill
rlte.more Ut.er- and Taleat.cl that ther.- wu "a lot la all 71-countles durin& July. Eacll
Funeral lor Mr•
tees. Howe\'er, ol blttemea toward admlnlstraton· meetlns wW be from l to I p.m..
aged 71 of 3718 \i.
.one In thla dell- and coacMI."
·
and speetnc locaUona wlU be an·
,h . • •
•
e expect more
She nlcl a student complained noulced la~r. Tbeachedule: ·
·
; ~ d~~~·rn
101ltloa."
that he bad ask.-d an automobile July 1 - Raone, Faulkner,
Chu.:a ln Htc · 5 B
.crh'Old"thlt·Mr. -deater~to~advertlae-tn-the-achool· Gr~.-.retterson;-~Uer.Na: .
-·,es-nnPeaee~
peteaL.to..aee.v.e__n~'!.:'.P.1 RI.of."-•,..n.d ?1!!-J~~e..t..••l!l- ~ada,.Ouat,hltJl, Pulaskl•.SallDe•. S~--- -- _- -by-Ruffln-anci.Jarr~ll .
l.Sll of spelling 11 .. war
e1P na wae seaool wa~ baaUan, Vnlon, Washington and
·
·
l dcflolonelea maklnlaearavallabletotheeoach~ WhltaCounttes."
•
McKinley Gray
·d:t~l! l::a• 'A Lillie lfm•tle'
Julr 11 - Ashley. Bu~er. Clark,
Funeral for McKlnl€
':aid.0 .. ur •
Her husband, like maD)' Arkan· Crawford, CToaa, Crant, Hemr18, af Route 1 Box .~
sana, ,II entliualaatle abOut sparta, atead, Llncolft. Perry, Poln1ett.
who dled . $1lnday, wt
hatBartdJJI had Mrs. CUnCOD dld. ·•sut I"CbiU u·1 Scott, S.vlor and Van Ruren Cnunp.m. Saturcf"ay 11'1
'17 or outatand- time we ttarted settlni a little fa- tlas.
.
; . Cburcb ln Bigelow b:
Ill prevlOUI Jobs nat\c about math and IClence, Dol
July 12 - Ct~hDraa. Desha..
vis.. Jurlal wm be i:
...;·~·~ij·ii~~i-i~~~ii~·i·~--~·~··i·i--~~-~~-Drew, Fulton;··BotSprlna;~Boward,- ..
... Cemetery_by_Ruffin
!
Johnson, t.awranc:a, Lonoke. New•
toD IIJd Polk CollilUes.·
·
Stanl. T8 d W1 D
.
.Tu1y 14 - Beaton, Bradley, Dial•.Y
c
·tas, ·Garland, Independence. ·tzard, · ·
· Stanley Ted Walle<
Marion. MiaslJsippl and Phllllps
623 Clanton Road.
.
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COuntles.
.
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Rock. died Thurlldoy.
· July 18 - Chlcot, C1aJ, CleveLittle Rock. 1oa of
land, Cclumbta, Crittenden, FrankMarr Sarrc:irt WalloC:I
llft, Madison, Manne-~·. Pike. :·Pop.t;··
Ured electridan and
Searey and Sharp CoUnties.
St. Mary's Cathotlo Cl
July It - Artansae,·conway,
ofColumbu-. Amerie~
Cratsbead, Jackson, Llttle River.
novoloat and ProtP.t-:
Loaan, Pralrle, St. Frln<!il and Yell
the Elks and. W
god:
c.;ounuea. ·
·.
World. Survlvol'! are a
July u - C-'hQUn,· Carron; L-a·
J: Walloch of NorUJ Li:
fayeue, Mm'i1'cua•ery, Randolph,
A Al~ter. Irene Hale of
Stone ud Woodruff Counties. . .
Rock. Funeral arrant
}
.
~m-erSale
113· ,
be announced by Gri
Healey and Roth.
�JAN-25-93 MON 12:35
Prt~Sf,$ (.;A '1 ~#e.
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rtsi~icts--. . -~ER.nton~Nffin~~iiis)iiite~i-~~ '"lrrelliSf~
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li-.:J3-S'3. .
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re-Back- -A-sHeacl-ofEommission· . ·'[-. --Science~ r
3SOO(r~OffNew5cho015tanilarJ. ~Two--ArrJst
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\P) - Tbe GreeD
Goveraor Blll Cllntoa IDDounced Mn. Clinton. 3&,~ a lawyer, sald the
a Sprlnga Sehool Friday that be was apP!'lntlrtl bil focus of her work· wou14 be edu~:
11· ·fold-they"'"iiiiiir 'tflftt~R xm ny ·R'oi!lilltr· CltlRD'ft;" as lroiJlT'itiiima:s·-..;.- an4 ·Dllr
5-;000"·to·carrolf- ehalrmaa of the: l&·~ember commla-- "pirtlc:ularly ·tnteres\ed ·ta lmpro~
ta1 funds weu sloa that will draft uew standards for mathell'faUtl aftd IC!~ lft~OD
ro four·years a~o.·- .tha.aCat.e.~a-.public .sch601a.. lbat could - aad tbat .thalilul or eonsolld"atlGd:.
' boards 'met-·111. resulUa eOIISOtldauon ta 1887.
. · abould not diStract from wrttiDl n:~:
rhunday· ntpt to
•unu paranteea .that I will have a aLandards. She llld abe would maj·at
about the siiua-·. persoa Wllo ts.ctoser ·to me Ulaa any· ·oa repreaenl.aUOil for, 1maU achooJs
:o thelr attenuoa 011e elle overseelnl a projeet ..tbat Is ln the commlssloa•a dellberaUona. ·. ;..
itlve.Jolnt- Audit-- moi'Limportut to. rnt. Uaan. anJ,thJng · ·• Sbe atd -addlttonal·money wu. nac·
·
iiil\r"""' . .e"""Dbi~OT·
...... .
ii
else" Mr. Clinton uld.
''1 . •b
t
b···~
•-coiiimTiilo·a-w.•-sm·,~. :bco':.:~~~:01 ~::~:r;,:ic 'ha:'
Dtatr.ict.uld hlJ .~~:.oup le,talatlon passed.cfurtna.the to make· 10mt· cbolce•. nch :.•
11t DW81 118,301. recent lectllattve aession lttel WAI 8 whet~ to spend 11 mu~ money.,aa
1 lollnstoa· of thl eomp~omtse proposal offered •• an "opUonal aetlYltlta or extraeurrl~~
ric~ •aid be .. d aJt.Gmatlvo to etronaor propoaod bl111 tar acuvtuw," buL alai,waaa'L •P~-:·
war paid .tl0.7J7.. lor.scbool conaol1daUon..JL.cans .for. ·etfle. -:... ~ :. .·-- -· .. ••.. -~ -.:
•DO-lo tbo-lleft)f .tbl.eommlJI• .to.~mpleteltur.ork.. ------··-· · ·~;.:_
tbat tJae dlstrlct bJ J~nuaey 1984 and ror ac:bools. to Fee/1 Oualilied
~~·~.
addlUoul ss.ut. . ~.t. the new •t.andardl by tbe ICbOol Mrs.
eaid lht fol\ cr.aalifitt7
fill AHetfed year beg!Mlna ta ttrt or be ·dftlbu:. for. tb~ job because "I've. aoae ~to;.
..
. · ·dit~t.'l'Jle 1alD.i~e~ tiiat the·ao•· acbool 8 Jario part 'of mv)lfow(in~·
!aU,. were made.. e~iior, or his deslsnee, would be l'v L ....... 11;t..•vect In e•..!..•..u.- ac
s oftlea. Megge~~oo ebalrman.
·
• u.n:u vua
..-vv•u ..:}i
•ra would affect
Mr. Clinton salci hls wile would be UviUcs oneS vlaltlltl w~th: teac:b~ ~
lncludlna·couhtJ able "to provide more ·couslsteDt. 1 volunteer. But l doa t ~ at t~
!II.
·
· sustained work for-the commlaalon'' job with. a ll'fat d~al of. ·~rt~., ·
,kesmaft refused· tbaft ·ba.wou14 ·because of other d&o'lo Tlle:commJttu.tllaU.beea ap~n~.
Clln""'
a audlllt ww be· mands on· tall time.
lbJ th• atat~. EducatJoa. Board} ~~11ted to Ute COm· ~ •
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provide expertise. and we11 bave.~
1
111 ·Aalldown the 'Rtght TIJing to Do
•t.aff available that will provide.,~,
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1 "J don't know lf lt'a a polltleally pert assistance.'' ··
Auditor Char.Jes wlse mov~" to ~ppoint ~·.~laton
~c •crkod ea_rU•~-~1• ylar fn t~.
because of the ••· the leader of a IJ"OUP tbat wUllD· succeaaful mUiaae eampalp by t)\e:
errors the atate dlrcet1y41a41 with the •olatne eo~l- L!ttl,• Roek Sebao~- DlstrMt."fbe CU~~;.
c:OUDty'l books ld&UOD Issue. Mr. Clinton Slid. 'But t0t21 daughter, Clietlea, I, will de ~.·
nsc:ol year a held U'• th• ''-"t thiftl to do • • • . My tstttly ~at~nd the. Little Roc:k pubt e
auspldon II tllat lt wtll be 1ooc1 poll· ac:bools." Mra. Clinton aatd.
.
Memben of the commission Wil)'Bue&nl Menibcr tt~• bfl!t.Anle lt'a 1nnd &overnment,
:ed .whether the and 1~ 19~~rnin.nt la lnevltably receive oo aalai'J and wlll be paid lid!
replar per-diem expeDsea.
·I··
me rcapoaaibllUy alwaY& aood'~ll\lcs...
......
;e tbe state was
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~~d~~~~a.oov4 • -Former-•-·a·w.ver:.:lf::2····M··.·~---·-~--··.-"--·· .·
· Oftl--..;fOIJ.R.S·-:~, .._ c:t:~tl! ern~?':-··!---:-.-_-.·-:
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·TEXARKANA ;... A fi
'destro1t"ct'llrlf 1tit~j
•oa• bu.ildin1 aid ·lhous;
1't.tn 1ft aquipmo~ at Ark;
1Uih .khooL..Iuil'exarkl
a.m. Thursday, h polio~
· :sgt. Claude ;Wens sal•
Cboper, 11, ant il lT·ye
-~·
nile, botb of Texarkan
f,I!Sted about !0:8G un. T
CouDt)
• ol $25,000 bond eacb. .
• ·Wells laid tbe ccen·ai
tbi elasarooms with pc
•nil cbemlcall found in
··-··mrde· i trail ·out-lo-th•
--parklq 1or"Welli'Utd
cbemieala wu ignlted frr
in( lot. No cstlmatc of
IM!en made.
· ·- :~lirriil C"lin..cta,-a ipo
the school. uld Friday t
deat.royed the building, 30
several mtc:roscopes and
..• vil~ct_ca:pette rtcorder
· s~pn equipment ·as wen· a!
~nada
Hid a robot. p\
Jtudents at the :
.Umasod by tm6kt..
· "We don't know what
wilt be aalvaaeable '*:a
has been allowed tft tie l
beca11se af. the c:b~lc
tHere," sha said. . ;·
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Cana~a lloilld Ul"ra wu
of toxic fumes or aa upl
~lenee
th,e cheml~ata. ncppnta
· Environmental PioteeU·
and the tehoor• '"anne
· were at the ecboci Frida·
tho sltuauon.
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�JAN-25-93 NON 12:38
P. 13
Declin.e in Expectat~9ns q. 11 ,
0f Education· Is -Tr:aced ~- ---·· -··syJ\ArsA CliillQiifO~~r6~S~--~:-"c ·-
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�JAN-25-93 MON 12:37
a"*''".... t" ..,. • .. \.V4W .... ••••••w" •••••••
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gram. which wm be broadcast at 1 rlcular activities."
p.m. today~
.
Mrs. Cllnlon said umy husband
· ··"PMJ)Ie have lost a lot of tonfi· has said tnn"tantly, and· I" agree
· dence In themsel~·es and ln their In· with blm 100 per eent, that If all we
· ~t.ltutlona, whether it be govern· cUd wal to raise money to oti~ toto
"!; ...••..:
. · mentorchurcltcsorpublicschooll,'~ our existlng-system~.. he ·could-not .
~~ .·' ·
. :;: .. she said, b~t a~ded. ''Now, I believe. justifv ..that • • • • But if .w~ have
~;· :·:: ·
·. : · ~al we are eoinin& out of thafPc·. some plans IIJd proposal-..and pro-·;:;565·~.. r.1od where we are once again under· ·v1 ms that we think wUJ· make a
· ~:,~-. ~:· ··
stand1nl that as a nation fre have to definite improvement ln publle edu•
expect somethin1 of our.selves." . ~a lion. then we should be able to
Mrs. Clinton also s11d the bas&c .convince any taxpayer to support
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recommendation her .Committee that"
would make to the co~ernor and the ~
le«Lslature was that the state...'re·
.e.v Jo"" w. ~,. turn to a traditional definition of ed·
ucatlon, of requlrinl that teachen
teach and students learn. and thal
!T workers Tanya schools do wbat they are suppoied
'~rk al~n&, u~ ~-. ~.do\ Wlil.£~)1 to trlnsmwknowl•'
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:l'_o·ai·.·Ta··r-..-sp·'til~- ·~·
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Great .Atklnfal edae and tile abnny to. applj it:'
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the Army Eng!·
Mrs. Ctinton*alUCS tier. ConunU·
Association. Vol· tee's purpose was to define quality
I
ouaut ''"' Nt•
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Jk's Landing and education and recommend 1laodPARKIN (AI'} - A caboose and·
ed their stations arda for 1t without referenee to the three tanker cars of 1 Missouri Pa·
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size of a school dlstrlct or whtttber lt cltlc Linea train derailed at t:4S
· •·
·p:in. Saturday In· a"curveibOia~a·- ·! ~.
a;g;;;;;·---··iii··· ·should be consollda~ed with in."
iiii
11 otber. ··we .are. makln& nu Judi·
..... 'mcnta'about size," &he said: '-rhere
are districts In ovr atate rl¥11~ ao.v
. .. ..
wblch are small that are doinl an
.
· ·
quarter·mlle west of Par~ln, and . 1. . ;
·~out 10,000 sallons of 'coal·tar . ~ ·. ~
aplt!ed out of one of .tho tdnkert, the
·_ . :
state Office of Emerseny Services
·~xcenent job uf· educaLini chlldrea, aald.
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·.P•rtlcularly In .tha.baslc.. skUls•..• :.Workers built. a levee to contain- :.....:-.:.-.
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·. ··· ··--:~~ ·n,u-e~001fii!il1iita'Nnot"'aman.. •tL· ""
1tri,Colit' t4r;:-w~liwal·1ea~s ~to-::
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. . ... '~-· ll'~~·.q,_ .······-A-·· ~- ·.. .. .· . .••.. t~ .
e •ton.anuca~ "And 'tb• .fells- • · Tbe· tar is hiahlj flammable, and .·;.
lature,':whlch began this.wbole "roe- lt-wum all tbree.tanlcers.
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• --·-:.. --- -eu-ari4~&UWI&hecnrecomm!Rcc,. -~·orew wiUi'1iuVj'iqulpmiiitto·--·'7· ·
.··· ··: .. ·.:.:=..::: ...n:ta~e_lt_veey..c;le~ tbat.onee uallty_ :set the~ cars. . l)ack 'Onto. tbe tracks
:~~~~ ...dr:~!~t~o~. ~!lcfiD~~ 11
111
would be conaolldatad.".
,
~
i:· ·ri·ii~~~!-~~~~--=-;~-:~~·· . ··-..·~·-·.
tt.
f
Pollution Control and Ecol-
ou Department ls to lnvesttaate
-~
Deetmbtr 1 tn tha atate treated at th~ Cross County Rosf)ital
·•
.· Mrs. Clinton'• Committee re·
~==~~a~~~:in!i~i:~:rli~ib!.'b:: .tho~!n;~:~n· ;v·i·ii tnJur.~d: a~d ···t ·
prG~ontecl
Beard of Education. The Board Is to and released.
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. . JEWELERS
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H~ye
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your Je:Welry appralaed. while )'OU w~it!
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_____Mc_C.AINr-MALL_ONLY._ ~j .
Wednesday, Tliursday, Friday
· Se.ptember 14, 15 & 16
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P. 15
JAN-25-93 MON 12:38
l
£
t~w~;.. '"'ver
dNID QlOD& LU" t.too-
~~~~
lft>r·l
a.s, n'i 't
hto.lr the ..,U14 &luff
A.nalla! il
~· yoat
tana-Wyomln& border.
the UkelJ cbolce of the atate Cor· acw
au
Mlninuam bida for lhc Powder rN.tlon Departmtnt lor • tempo- evld
In ••
JOHN BRUMMETT
Rlver 1~ war9. ~t..ln)alf only.a ~ryJ!.~.!l•~na l.aclllty for state werr
~-~· .:..;•.~·-··--oataeettll.,._..•. :··----~ ·-,0
eate, And hsd,., prlRon lnmat••· rellAbta sour~•
M
..,
Tho atate PubUc Servt~ Comm~~- _&ry.. represeatatlvea·aa•· confidential .. aald-Weclnesdaf~· - · ·grov
e.: ·- ·slon ·staff ·recommen~fd 1ilf"8Tlfer tdddlna Information "before the ulo, -· Q~v~_!)ll~, prJ»upakesm.an. · · .cess.
!lt·- -eent..lncrease- for-Arkansu .Power- mport-ia-a--·-.. --~ . ·iilCl lii iCboolll "Just one of tbe "ba\
al .and Light Company residential cas-o Dr. Miller, wlloll Jcldnclade• optlona" the De~artment i_a con- mn!
. tomera tn testlm~ny tUed _wedr:esdaJ.. -~~~JJ'Ltlte..C011ec~10JL.oLmiDetaJ,. _s&Aetlaa......._ ··
.
.- ·1-root
~ -ln··the~eo.mpany a-latest rate ~ase. 1aa. and on f01alU"· aald th• com·
SuperinteDdent Jutlu.s Brown of .~~~
18 .. _:1].~-~~~f. ~~~ccmu~en!t~~l_~n~r. ~-.l..pa: mittee -report· ,,.1 ·mlsleadln& bee ..the White HaD School Dtstrict ald
:t·
Tt
~
cen~ncrease
lor eommerelal and iD· ca~e lt failed tG 11ptaln· that tba t~laoa oUiclala were to meet
..,
., dus\l'lal users.·
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coal.leuea .are.oalJ for.uploraUoa. _WednesdJJ. Dl&bt .wl~ ~.school you
;. · · Also Wednesday, ReYIIolda Motala ·and development rl&bta. DOt for the board to~ tbe school• use.
Y.ou.
.....: -Compan.y,AP..and·-L'a·laraest-lln&le ·sal• Gt'l!oll1,CAU. "'lf&1
coa a
lrGWIUIM"Cil&'i are""""Uve liUlra·
Wast
15
n customer. filed a n!W elpt-Jear con•.. lned, the aovernment rnust receive inl at ~ al~. wblcb. lljuat out· ed~~~
1
-· .. Lraet- a&reerneot·it·~flaa·· reaebed·witb· raJiltlereqfttuf('ll'Utaif' H.!-per ·atde1bl Plalnvii.-Gam
ra aa
AP and L for PSC approval Ia eoa- cent Of the market value, hesald..
to die Anenal. Four of tbe bu11cl- mest
,t jUJicttoa wttfi ~e rate ease. Tbe eon- (Susan Rleff. an aide to United .tn&a contala alx to aeven class·
peril
· ':'1t
a·
By BRENDA TIREY
w·cra;. won ·the
I
!
,f
.
r
(See PSC on Page 15A.) .
. ...
.
'(See MilE on Pase T
A.)
•
.
. see SCHOOL 011 Page 15A.
M
llsh.
~~~~-=l
i
~ . (Jallici~-;BIU,P.flrif' liiiSt~te~ =Note~d-at Site:~: =:ft
.:.
· ·.
a,··MARGARET A!~~L~........wou14 certainly assess Arkansaa•a _Qf.~Bu.s~~Cr ash-·-·
b.iaL~ "'·""" lUlueii,.,Cllntun ..lald "·
· · · aa.neltllf
*
-II
to r '
=••u11'.
"The dlstresslnl ccmeluRln111" of Khools ln Upt of Lhe report.
Ga•"• •••" ""'"
natlonal.report on education released· "Tbls report wDl have • bl& effect Motorists drlvln&.• ~est o~ stale Glei
_ ...Dlo..H~~li:.Pl~JmJtely affeeP ev.•_-erobbcl.:..the..cou.ntrr," ·abe 1 a..S~'bcr. -::lllhwaJ:.IU ·Jiilt•berorcrlbr lnte~ · ·tion. ·
.;-- ··ery·.ehOOtCiill~-tllnta~" Ri~ry cauae you. can .bel that everJbody Uoa wl&b star...Bl&lwa)' 11 at Ullo sity ·
Radha _Clinton. eii~JnJIU_
.
tna-&o-'orCAdi~a·u:
·
olnaett-Oount)");-the-witu of tb
cc
f
cen y appointed C~mm&sslon oa Ed· ' Sht.ulci ahe expected.~~- to belp the llate'a wont acbool bus crash, can .be
sr
ueatlon ·for . ~"~·.•aJcl.:lY~~~~· :Commllllon ·"cleflll~rtoht:nad IIIJbJ~t~ to an optleal Uluslcn \tiat li.tr.a·
::· day. ·
·
·
· a'ru we:wam lb ll"allt ot the aaUoul teada to obseure 214'asharp curve. to .~ar
Clinton said In an interview tbat c:llma · u ••~....n..lLilaU_our...~tu,.
taht_the..Natlon~1 'l'rAMJ'Orta·- wou
5 -tbe-repor'r-releasect-by-.-Natlonar ea al'ftOmpetWve~M .
i.
Uon 8afetr Board said Wednesdaf.
of Sit
Commtssloll on ExetUenc:e·ln Educa.a
•
·
·Ntna ,w.r•ona were klUed and tt to st ·
·"
p deflge tbLJa
'l.n..lfM
. -wenrt1Jjln"I'Cl-Marc1T'"'t-wtrell-r a I
.. standards· we want·ln Arkansas Ia · Presldeat Keaaan'a response to \he Jonesboro school bus went out of -were ·
Uct\t. ot \he 1111Liuual cllmate:• uca report waa ..regrettably 1nslifflctent," (.'Ofltfol, overturned and crashed In a · Dr.
wlllllkely sene aS'••a blueprint for Clinton aaicl. .
· :·
·
dltc1ricross Hi&hway 11.
the P:
how wept oundva ou~ of the serl•
Tbe president satd the report ea. The Boar :whlch stlll Is iDvesti·l ary S
ous· state. of de!:t:rior~t~~-V!e't:,~. eur· .dor,se~t.bis. administration's -tall. lor ·I• 1· ~
..ldenk noted ·th• _phe· : ~hl-:h
· rently ln:~.
. ·· .
ttmitid federa.t.lnvolv.ement ·in ut; n
·· ·.
' Cr\~
..na.tional..r-eport-et
,.
~
_
,..vo untai'Y· correct n a le r ailed ednes·~· school:
tide 1Jf m~dt~c.rlty"' Iii the naUon'a ~u·ayer In acllools •nd abolishment of ·day tc.stat
WIJ Dlr.e.ctor Henry lc.ucd
.cb~lt.
··· · ·. . ...-.... --.. ~- thefederpt'Edueati9JIJ~!P.!I~Gl::_:_ 'Gray
• . .·---·-- at lea:
,
"'
- - .Thr~Qmborlarlaiftii'I'"COmm\1- ~II~ reterenc• to ~utU\et UmlUn& . · BralllJUn~aJ:. a_s~jtesman ~or the I natior..
· sion, . appo&nted last.w~k,-il_jb_;~rl~~ Jbt_1'.('le.:..of:.:.tbe .taderat::&onJ:nrtl
. ardrsaici..W~y;.tbat:.thecfinal-1 cal h i;•
- :wm;=ariifltil:'niW::ilindir'lr.Jvr.::nrr ~· . _______________ ...... ,_ :..~ .......... ~·-=- ·-·
_.
. I lh'. t
•
state's
..... • -
.
PE~)ic;.~hools.Jt..bU..nsllmet
(See.DlST~~G o.D ~age &A.).:· .. (~~ILLUSION on Page 7A.)
, ....... ······.·-· .. " ' } ' ·.
_._,_~,..--j.· ~ ;_,. .~ 3 ~
,..
'
.?/·:;,.
-
l g.le bi~
'
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ j
�P. 16
JAN-25-93 MON 12:39
•________
.: =-
--·--__..:....;..·-:-:...._
-~·
-···. ...
•'
•
·=--..;..::..· ~----..:.. ..
ii£:"1'nursday. Aoru 28. 10a:1
- --·----·-· -- -------
;-:~. ~: ... ______ ·-··:;:-·--·· -·-·--~A-.
· .•~·
·
--,.·--•
Must ~ifiht fof Ch.tnges·
:.
S\lperlntendeaL Ed Kelly said: "Th•
Commlssloa. bas
atvo uJ aa educa.
~ • lot of ammuftltlon. Bu' lt ~
no aathorlty, aftd ·the ·ffpOlt··~a-·not.:.=_
·t··N,.,,....... , ... d«nia-ilotof'ioocl' witisa •·
ierlli\el,d«<ltlaft4 :othera 111 educatloa -· -:
ue It to flaht for Ute chanaea·lt r.o.
onantencSocl.''
· ·
·
'•
Thoucb the Little Rock District '11
er.e o! the few ln the st.ate
tJ) ha\·~
1
'
'
·r
c
s
J
�..
P. 17
JAN-25-93 HON 12: ~0
..- ...... ~uwa :nuuea" oqaonLng He acaect, ··we·re not tompeting
'ururtSponalDUtty for ~ucatloa over next year meet the eommlsslm'l r•c· with_ ~~~.~o~~ .~-'r•xaa :a_n7-~~e...
tn ttatee. loaa.L•~~~l.. dla~tJ~_anct. ommendaUons;-ezcept-rot"lh -~;~- :o..aif:•tqiSijijlare JoiD'jl.ib'i com~
• ··-- ··~ienffdeali~witb only.two thlrda.of · -~14 eompuler sclenc:i· requiremtDt. tna for Jobt- •Uh an, lntertusUon~l
~~
The North l;lttll Roek and Pulaski marke~ an411 ~ou dOD t believe tJrR.
the.IMu•... ···--··---· · ·--
... ••The l.anJUIIt of the re~rt IPI• County ~hool Dlstrteta-rtQafre four. Jut ~~."k at tho label''" Jo.ilr
i\ · 1e1ta tllat thll fa • "•tJow pro,J..., years ol En1lleh. aa tbe Conunlatlon clothes.
·.
·'I
end I ~uld hope Uf't pralden& would ·recommended, but only two , 11,. Ia a move that a~Uclpat.-d anotflir
rethink 1111 declalon aad would ••· eacll of math, seltDet aad aoclal of the CoJnmlnloa •-!YU!!UOIIJ,Jbc_
o 5 aume tbe same kJnd olleade11blp lll+.aludler.iftst:en·bf·t~l 't'ifvorsit) ol At£anau Baard at
~ Whe area-ot-educauoa··u.lle llulft d• 11 1 mhttmum standard.,,. the COm· Trustee• lait •tek raised !!ltra~"-'···
fense," abe said. "beclase t~e ~!!. .mission,· Other dlstrletJ requlre1u1:-. ,-e1!1Jii"1Wfftfr: flSnti~ .Fiyettl~l~~e
·are certaiJlly ~ed op10ðctf.
St.tte lew saya dlltrle" must a.(la.r iJlJ!tiJ'YI
;•·u we dollilut~•ter_ernphaala.-. -m1wttnnrm-6n71afiiliitday1 of Ael.mllar.chanae Ia expected to lit
·oa. ~.atb .~aiilel~~~· for iftltance, . tchoul,. and .moat dlstrJct.t. Jiieludlnl Instituted for thl UnJventtr of A!:,_
bb•.ta.tba world ww •• ever llave a -~tbrte·lii NlltH~oiilty otter es· ·tansu at ·L1tt1e-Roct; ·lnt"i'JIIlter
miJi~--that:-.C~Jl: operate the.. klndl ·.ctt:y Ulat. some dlstriCts/lneludJftl educatlOD task force 11 lnv~UP.~IfJ_
·ortfil'p6na be'41 like eo ... develo~ .Little. .Rock -are 1110uaun 1.. wtth· ·tba,.oatbtliLJ~r·ratstn11tlnifarili·at
·~.tbe·aat decade?" -~ -· · ·-~ _ t~.bera..abo~tre~tendlna .. lhl.jelloo•· -ali'"ltlt..-supprtted~lfii'I"UI~
-'Unb.llt~velit·R,Is•rtt·58y• Jear, but onl, "' tlva to 10 da,... .. verJltlea. .
.
... _
Dr. Doa Robcr&adk.~tor_OI_tlw.._Woncfi,Abou#Col# ·
·'Ntclllaty·Coni'BffOI+ · " l
~,ti~IGCitl'ii'beP,Irtmtat, w~a Several ~f tlil tduoaton IJJtar- Dr. Carr_ Chemberleln. director ot
«m~ with Mti\J of tile report • vliwed,. while agreeln& with the rec- the_ atet.• Higher (dueatlan..Depart-.
fJn~_tn~•· called tbe preiJd~at.l re.: ommended 'f'luma••· wohderoa·tiow ment, eaTilbe r~port ••• • ttep to- •
·apoiiA to &be ropan ''UIIbelievable.. atates •ndJ~dlatrJeta .would .pa1•. ward achltvlnt·' a·Deee81817 conser--·- .• Ja.u.IDtmtlew.lle.wameclaaalnlt·ln··lcw"Uiem.·
.
••• betwoaa pvornt:n~!~ ·~ljon_.
'.
tei'Jireuaa. the a&qdr u •appord~•- --Buperlntencfen&· Joba Mnter· of· ·an~~·,rtvate·tf14u,Cry oa what we ez.
··-- ·•nr·partleular· paJltleaJ·)hUOJOplly. North .Little Rack pnlnt.d to •tate pact ol ..Sueal;loL"
·..
"Il'1o tM Important for. that t.o bapo lad fecleral law• of the Jaat fe• . Dr. Olamberlafn utcf be hoped the
pen.'': lit salcL ·.
·
)'Urt reQUlriiiJ pubUc achaala tA , . r•port •oald,lurther Jcle~~Wr DUds ..
Dr. Kal Enr.kson, ezecutJve aatrc· •pond to Qae Dtedl.ot aU •tudtall, Ia- .that-bave ~·dtad I~ 1ft ft.CC!~f. ·
tary'af.tbe.Arkansu EducaUoD A~ cladlftl·tbaM wbo Jn piiYtactllJ ud month~ Nlrlnt.lt euler to 1ahlevo a
elation. ecboed tbe Cfltktbm, callbtt l!leD&aUJ llaadJeepped. •uniS 11 ex· eon1en1111 about what lhouJ• ba doDe.
t~e presldeat~a proposals "unreal~$. penllva educetloa,•• u uld. He "Until we do that," he 11ld, "~e'U .
· tle, ~rtlcuJarty lD Upt .af the feet adde4 "1 UIIM we're cfolnl a beLter llmptr " spurUn1 olfla dUferent dithat tbl aatloaal coverameat llas job~ ner Wl&ll the reaoareea •• reetlcmL'~
.. ~- _ -·
.pre-~mpted the ~a.for ta1lna authnrt. bove,· beat we·n lrfllll to cover· aa
1r• ·.i fo ,.L
,
tlU.
ewfullot oftba waterfroaL"
us# rlgnl f\-nlfJQII ·•
. Willie Dr.. Erickson laid he was . ·wmer tald·lle believed tchooJa SUperldttndtat Eel Kell,sald: "Tbt
"not real apUmiatlq that muela wW could provide broad tducatlonal _. Commlsaloa bas Jfven us u adue,.
biPJM! ill ArkaDJU u a result of die vlcca w~le alao ~ettlnl blgller ltiDd· ton a lot ol ammun1Uon. But~ it ~"0 .~ ..
'"'dJ, 11~ did ·~reu.llopeJbl! tbf ~rd.t,_but.~~ame~'a.go&na to·btt no·autltor~~·-·"~ til~,!.!'~~ J~l.'.~- ·
.tlmel!DeSI.at ftl release ·W~d.lly,_ .to'.ina"'ID·tlae-modey·that ·toea wltlrlt; "P.InJTd"'d"o·qa ~1ij'OI goocl"imtesa ••
·added llnpet~ m '{I IIW ilifi com- .J.OI CIQ1.:..dOJ,_oa.tlle,.maney..tU&'a :pirbltendefttaaad·othert bl'edueatlnft • · ...
~mlsaloa oa.educaUoa._..:. ........ · ~· ·· a'Q'Ilit.lt now... - ... ·· · ·· ·
a~~ I& 1o nabt for tile ellanault rf6o ·
~ ~fte~poil~"midi aeveral recom- Dr. Ro~rta 1114 &haL wbne work ommended."
· · ·#
mendatlGftl. They lDeJudad: Jnertq.. M m1n, ol tbt Commlsaloa't 'recotn- nooall tH Little Rock Diatticl. ·IDI til~ acbool da7&a MVIII boU1'8i a· mtldatlou 11a1 alreadJ ·bepa ta tbe one ol· ibe few Ia the state to have
: _tebdlc& tht.aeboot.yoar·to 100 to 210 lt.IUI~ llopN_tbll-rc,ort...weuld··be· ·bOUI-lUtlhted11f11ltP.er itinaara,=--_.
. -d111...1DL.reqqlz:lDI-·Uae'-all-lllll_' )ie!•C!Ommoa aperlebOfl"·tblt •outd· .•i41Riiiiid1M amoiin£: Gfaeh~l
JIC.bool_atudnts. be~r~alred to·tate prompt ArnerJea111 and Ar~...... to. '&lme devotad to academic alQdl~.
four y•ara of En&tlati, t.hne l~F• .~.. ·tba ..td&JCIUoaal ueclt atu• ·Kellr'IIJd·be"ud GU,er educat6ts ....
.•ticll. of. mat!\, .telenca arut ·eocl.•!.dentt wan··fact.- _. . . . .--..·: -:-- "laCI a.o accep\ i-eapci'nalbliU, far fall•
· 1tuCIIJJl, aJJCt • half.year·ot"CCmput.er. Maa1 of Ute. needa ue noL tieln&. laa In recent Jeara to adequate)y
1
tele~
·
met. ·be aid; aDd. muy of .(~!"~:• promo~•· tbe -academic· need a a1··
.Lalt to Lot:•l
ltu4eatl ~t·not. be prepated ta eom· ~ebooll.
·
· ·,. ·
·· ·· u
im ltlo of sueb pete for·a· Job.
· .
..
Ackllowlodglnl t.ha' ac•\lemlc •~
·q11·~~~~en':ar; Je~to J~cal 1cb:i HOfhe d.aJ' when atudenta.can go to pectatloaa ..,. allpped In ~he Ja~t
·
·
school plck up ml11lmal skllla 11 dH"4ft4 or more. KollJGGlcl, l.tbll ...·..
boar.da, 1114 DO IUCb ltlftd&rdt exist nadl.!!idmmc. and mthmeUc, tbtn·: ·we.allshare-a~lat"'t b1imif lor·tli{i,"'' -M.
Boar'' ·
·
.
-~.l.ltlfiJ&Yel.-:-- ···~~-MirtO work at the·lOQ!aarmenL f&C• and be added • .,1 do11't thlnk eduear;, aa4 uve ·bappUlf.ev.tr. after· are· ·tort ·ltt tenerallsava doae tba Sot» we ·
•e•.oot•. ~.~lcb ·~~o~~:.!~h-?.e.P.~. IOii~-;""'Df.·holiena nld. .
.sbouJd.tia9e:when.lt eomna t.o IIIU~·-.--
-· St&&I"'Offte.tals 111trtlill1e, blab I
_- PropoSal-fo-=lrrtiore =JobiR!f~: -.-1
·
,:!~"!a~~ .:.1':-'--'-..!&- -·~·~~~-!~Ca.!~~!~. !•t••~.«'!~P.~. . ...... ;..,..~,...- ,..
~
- tJz•~rnmea~aUon&o;ll~t dlstriCtlf
!1:
&·~-;,. ·w·~~~~~ :·.:,
..
rg
I •
•
••
.
c
.
�-2-
Administration
Carolyn Gatz
Position:
Location:
Payroll:
Communications liaison
OEOB
commerce/120 days
Christine Heenan
Liaison with communications, public liaison and
Position:
intergovernmental
OEOB
Location:
Domestic Policy
Payroll:
Jennifer Klein
Drafting
Position:
Location:
OEOB
Volunteer (would like to keep)
Payroll:
Greg Lawler
Position:
Location:
Payroll:
Drafting/legislative negotiating
OEOB
(resume sent to Bernie Nussbaum for Counsel's
office)
Lynn Margherio
Position:
Policy Development
Location:
OEOB
Domestic Policy
Payroll:
Denise Ricketson
Position:
Administration Assistant
Location:
OEOB
Payroll:
HHS
Marjorie Tarmey
Position:
Special Assistant
Location:
OEOB
Payroll:
HHS
Policy Assistant (Simone Rueschemeyer or equivalent)
Position:
Location:
Payroll:
Commerce/120 days (Can we renew?)
Secretary
Position:
Location:
Payroll:
Assignee from another agency
�-3-
Policy Experts·
Gary Claxton
Position:
Location:
Payroll:
Insurance Reform
HHS
HHS full time hire (assigned to Task Force)
Judy Feder
Position:
Location:
Payroll:
Deputy Secretary/liaison to the Task Force
HHS
HHS full time hire (assigned to Task Force)
Roz Lasker
Position:
Location:
Payroll:
Quality and Information system
HHS
HHS full time hire (assigned to Task Force)
Risa Lavizzo-Mourey
Position:
Quality
Location:
HHS
Payroll:
HHS full time hire (assigned to Task Force)
Lois Quam
Position:
Location:
Payroll:
Underserved and rural issues
OEOB
HHS contract
Paul Starr
Position:
Location:
Payroll:
General Communication of the plan
OEOB
HHS contract
Robyn Stone
Position:
Location:
Payroll:
Long Term care
HHS
HHS full time hire (assignee to Task Force)
Walter Zelman
Position:
Location:
Payroll:
New Systems Development
OEOB
HHS contract (contract may extend until end of
year)
�-4-
communications
Boorstin, Bob
Position:
Location:
Payroll:
Communications Director
OEOB
White House
Cohen, Steve
Position:
Location:
Payroll:
National Press Scheduling
OEOB
White House
Jones, Arthur
Position:
Location:
Payroll:
Deputy Press Secretary 1 2nd Spokesperson - HHS
OEOB
White House
Muscatine, Allison (not hired yet)
Speechwriter
Position:
OEOB
Location:
Payroll:
White House
Offit, Meg
Position:
Location:
Payroll:
Specialty Press
Department of Agriculture (Can we assign?)
Prunti, Meeghan
Position:
Researcher
Location:
OEOB
Payroll:
White House
Solomon, Jason
Position:
Communication Aide
OEOB
Location:
Payroll:
White House
Slot/News Analysis
(on loan from a Department Slot/News Analysis
(on loan from a Department)
Slot/News Analysis
(on loan from a Department)
Slot/Researcher
(on loan from a Department)
susannah Wellford, Commerce)
�-5-
Consultants
Begala, Paul -- DNC
Greenberg, Stan
DNC
Grunwald, Mandy
DNC
Scbedulinq
Hayes, Charlotte
Position:
Surrogate Scheduling/Minority Outreach
Location:
OEOB
Payroll:
White House/VP
Hoffman, Alan
Position:
Location:
Payroll:
Surrogate Scheduling
OEOB
HHS (half/time)
Holton, Dwight
Position:
Surrogate Scheduling/Coordinator
Location:
OEOB
Payroll:
White House/Deputy Chief of Staff Office
Moffett, Julia
Position:
Location:
Payroll:
??
Event/Principles
OEOB
White House/Communication
Draftinq
Budetti, Peter
Position:
Drafter
Location:
Payroll:
HHS
Rosenbaum, Sara
Position:
Drafter
Location:
Payroll:
Through contract with HHS/Renegotiated
(in Sara's contract Greg Lawler)
*Rowland, Diane
Position:
Drafter
Location:
Payroll:
Kaiser Foundation VP through John Hopkins - free -
�-~,~
'.
-6-
Leqislative
Edelstein, Steve
Data Bank Project
Position:
Location:
OEOB
120 Days/White House
Payroll:
Jenninqs, Chris
Leqislative Strategist
Position:
Location:
OEOB
Payroll:
HHS
Correspondence
Slot/Correspondence
Position:
Director of Health Care Correspondence
Location:
Payroll:
(Included in budget submitted to David Watkins)
Slot/Correspondence
(on loan from a Department)
Slot/Correspondence
(on loan from a Department)
Slot/Correspondence
(on loan from a Department)
Slot/Correspondence
(on loan from a Department)
�·•
I
-7-
Public Liaison/Political/Intergovernmental
Mike Lux
Position:
Location:
Payroll:
Interest Group Coordinator/Outreach
OEOB
White House/Public Liaison
Molly Brostrom
Position:
Interest Groups
Location:
Payroll:
John Hart
Position:
Location:
Payroll:
Karen Politz
Position:
Location:
Payroll:
X
Liaison to the Governors
OEOB
White House/Intergovernmental
Liaison to Interest Groups/
HHS
HHS
Barbara Wooley
Position:
Interest Groups/Health
Location:
OEOB
Payroll:
HHS 120 day
Slot/Business
Position:
Location:
Payroll:
Liaison to business
OEOB
Slot/Mayors
Position:
Location:
Payroll:
Liaison to Mayors
OEOB
Slot/Counties/State Legislators
Position:
Liaison to county and state officials
Location:
Payroll:
�•
-aAdditional Requests
Jock Gill
Position:
Location:
Payroll:
Computer/technical assistance
Stan Gorsky
Position:
Location:
Payroll:
Telephone/technical assistance
AT&T
Additional positions
Policy Assistant (Susan Otrin or equivalent)
Position:
Location:
Payroll:
Rick Miller (or equivalent)
Business negotiations
Position:
Location:
OEOB
Payroll:
Jeff Davis (or equivalent)
Position:
Attorney/Negotiations and legislative drafting
Location:
OEOB
Payroll:
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
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72 files in 6 boxes
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Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
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William J. Clinton Presidential Library & Museum
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<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
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Background on Health Reform [2]
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First Lady's Office
Melanne Verveer
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2006-0223-F
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Box 2
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2068127" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
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William J. Clinton Presidential Library & Museum
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1/8/2015
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42-t-2068127-20060223F-002-005-2015
2068127
-
https://clinton.presidentiallibraries.us/files/original/e19b0a921f00ad2d441481cec8cc722b.pdf
2d4a082a33b2b4aa65c7f276ad595a83
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
MAR~[R
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
First Lady's Offic~
Series/Staff Member:
Mel anne Verveer
Subseries:
Misc. Subject Files
OAIID Number:
17607
FolderiD:
Folder Title:
Background on Healthcare Reform
Stack:
Row:
Section:
Shelf:
Position:
s
59
7
10
2
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECTffiTLE
RESTRICTION
001a. memo
Memorandum for Hillary Rodbam Clinton from Anthony Lake.
Subject: Naina Yeltsin's Request for Medical Assistance (1 page)
07/01/1993
P1/b(1)
001b. cable
Letter from Hillary Clinton to Naina Iosifovna Yeltsin. (2 pages)
07/03/1993
P1/b(1)
001 c. letter
Letter from Hillary Clinton to Naina Iosifovna Yeltsin. ( 1 page)
[none]
P1/b(1)
001 d. letter
To Mrs. Helen B. Semler. [partial] (1 page)
[none]
P6/b(6)
001e. paper
The Mrs. Yeltsin's Story, by Helen BoldyreffSemler. [partial] (1 page)
[none]
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Me1anne Verveer
OA/Box Number: 17607
FOLDER TITLE:
Background on Hea1thcare Reform [ 1]
2006-0223-F
ab613
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)]
Freedom oflnformatlon Act- [5 U.S.C. 552(b)]
Pl National Security Classified Information [(a)(l) ofthe PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified Information [(b)(l) ofthe FOIA]
b(2) Release would disclose Internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confid~ntial or financial
Information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy [(b)(6) ofthe FOIA]
b(7) Release would disclose Information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose Information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical Information
concerning wells [(b)(9) ofthe FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Melanne Verveer
Background Files on Health
care Reform
�Suite 250, 700 Thirteenth Street, NW, Washington, DC 20005, Telephone 202 393 1650 or 800
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American College of Physicians
Choice, Continuity of Care and Fee-for-Service:
Key Issues in the Clinton Health Care Plan
by Howard B. Shapiro, PhD
(for November, 1993 ACP Observer)
The Clinton health plan breaks the direct link between employment and health coverage
for the first time. This should increase the choice of health plans available to most
Americans and strengthen continuity of care and the physician-patient relationship.
Health coverage for most peOple is subject to the vagaries of employment. If your
employer switches policies from one year to the next, you may have to switch from one
doctor to another. If you change jobs, again you may have to change doctors. Worst of
all, of course, if you lose your job, your "choices" become sharply limited. This constant
and growing turnover of patients is a major source of frustration and anger for
practitioners.
Only 3 of every 10 businesses with fewer than 500 employees offer any choice of health
plan. Millions of Americans are able to see only those doctors who participate in the
single plan offered. That may be OK if that single plan is traditional indemnity insurance
with unrestricted choice of provider. But unrestricted coverage is increasingly rare.
Under the Clinton plan, employers will continue to fund the largest share of health
coverage, but will not provide policies directly to employees (except for firms with more
than 5,000 employees, which may make their own arrangements). Rather, both employed
and non-employed individuals will tum to the regional health alliance to sign up for
coverage. In most areas, they will have a choice among a number of qualified health
plans under contract. These will range from open, fee-for-service plans to closed-panel
HMOs, and are likely to include new types of organizations that reflect the growing
integration of health care providers.
Because the patient's relationship is with the health alliance, coverage should not be
affected by changes in job status or family events such as divorce or death that can also
result in loss of insurance. Through the health alliance, the patient can remain with a
health plan over time--and with the same doctors over time. This should enhance
continuity of care and strengthen the physician-patient relationship.
Opportunity for improvement
The issues of choice and continuity of care are powerful ones that are being distorted by
the health insurance industry and others bent on blocking health care reform. The fact
kW'\Il_4;;,. current system offers less and less choice and cOntinuity. The mechanism of
_'talliance offers the opportunity to reverse that disturbing trend.
�..
-2-
The next question is: choice among what? A bunch of look-alike managed care plans?
Physicians, particularly those in solo or small group practices, are worried that they will
be forced out of their current practice arrangements. This worry can be traced to the
rhetoric of the managed competition theorists, whose most extreme model foresaw all
physicians in managed care and each physician limited to only one affiliation.
President Clinton, while incorporating elements of the theory, rejected the more
aggressive models of managed competition. The Clinton 'plan allows the continuation of
multiple approaches to practice: Much as they do now, physicians will be able to retain
fee-for-service patients and participate in a variety of managed care plans, unless they
are in closed-panel HMOs. In addition, Medicare will continue as a separate program and
will remain largely fee-for-service. Physicians will continue to be reimbursed for their
direct professional services and for services which they supervise as part of their
practice.
Health alliances will be required to contract with at least one fee-for-service plan and
may contract with others as well. They may, but are not required to, limit contracts to
no more than three fee-for-service plans, but those plans will be required to accept "any
willing provider." These plans may link many solo or group practices, and will operate
like indemnity insurers, but with two important differences. The frrst is that payments
will be under a fee schedule negotiated between the health alliance and the providers for
those services covered under the national benefits package. That last phrase is important:
For services not under the benefits package, either because the service is not covered or
someone has chosen to go outside the national plan, the fee schedule does not apply.
The second difference from the current situation is that fee-for-service plans must
compete for subscribers under the budget constraints, just like any other plan in the
system. These plans may charge a higher premium (although there will be constraints
on that) as long as they can attract subscribers, and presumably they will. The challenge
to any plan--fee-for-service or managed care--will be to practice efficiently and
conservatively to be able to live within the premium payment.
An additional provision enabling patients to choose their physicians will be the option to
allow patients in a managed care plan to seek providers outside the plan for a particular
illness--basically a PPO-type of arrangement, with higher coinsurance for providers
outside the plan.
Competition based on quality
Efficiency and conservative practice patterns will be key to competing successfully under
the budget constraints. Many people argue that integrated networks or other types of
organizational arrangements can best meet these standards; in this thinking, the Clinton
plan will over time favor the growing organization of medicine. But this is an empirical
question, and one certainly can conceive of a lean and mean--and high quality--fee-forservice plan that could do well in this environment.
�-3The proposed budget enforcement mechanism may force most health plan premiums to
within a narrow band of variation around the average in a health alliance area. If that
happens, plans will be competing mainly on the basis of quality of service, including the
mix of physicians and hospitals, as well as amenities. Fee-for-service plans should be
able to compete successfully under those circumstances.
Finally, if a number of factors come together, there should be expansion of physiciandominated managed care plans, as opposed to the traditional, often unfriendly model of
insurer-owned plans. With physicians in control, there is no reason why a managed care
plan cannot provide the highest quality care and a positive practice environment-especially for internists, who will be highly valued by these organizations. With a boost
from the Clinton plan in terms of antitrust revisions and new loans to help meet capital
requirements, this more positive model of managed care should become a more
substantial presence.
·
Howard Shapiro is Director of Public Policy and the Washington office of the American
College of Physicians.
�MEMORANDUM
TO: Hillary Rodham Cltnton
October 21, 1993
FR: Chris Jennings
RE: Prescription Drug Issue
cc: Ira, Mike Lux, Melanne, Steve, Jack, Charlotte, Distribution
As you know, the pharmaceutical industry has rather publicly raised
concerns about a number of provisions of the President's health reform
. proposal. In particular, the Pharmaceutical Manufacturers Association, as
well as the biotech industry, are targeting the breakthrough drug committee,
the authority for the Secretary to negotiate with manufacturers over the costs
of new drugs for Medicare coverage, and the Medicare rebate.
Because of the industry's visibility and lobbying prowess, it is easy to
reach the conclusion that the manufacturers and their allies are the only
parties interested in the drug coverage and cost contalnm.ent issue. Obviously
this is not the case, but more importantly the groups are starting to provide
very public endorsements of our prescription drug provisions. It is interesting
to note that some of these groups, like Consumers Union, have indicated that
they believe we have already given in too much to the industry.
The organizations who have already written in represent tens of
millions of consumers, pharmacists, and advocates for the elderly and the
ill. The latter categories are particularly important to us because they have
decided not to buy into the "no more investment in needed research" scare
tactics by some in the industry. These vulnerable populations, who more
than anyone need breakthrough medicines; yet they are still confident
that their are more than enough incentives for the industry to continue to
invest in R&D.
Here's the list and their letters of endorsement for your information:
AFSCME Retiree Program
AIDS Action Council (representing 1,000+ AIDS organizations)
American Association of Retired Persons
American Society on Aging
Association for Gerontology and Human Development in
Historically Black Colleges and Universities
Consumers Union
�Families USA
Gerontological Society of America
Green Thumb, Inc.
Leadership Council of Aging Organizations
National Association of Chain Drug Stores
National Association of Foster Grandparent Program Directors
National Association of Meal Programs
National Association of Nutrition and Aging Services Programs
National Association of Retail Druggists
National Association of Retired Senior Volunteer Program (RSVP)
Directors
National Association of Senior Companion Directors
National Association of State Units on Aging
National Caucus and Center on Black Aged, Inc.
National Consumers League
National Organization for Rare Disorders
National People's Action
Older Women's League
PKR Foundation
Reflex Sympathetic Dystrophy Syndrome Association
Rett Syndrome Association
attachments
�CTO~POST
JACK ANDERSON and MICHAEL BINSTEIN
- ..
;- __
.
I.
. -·:
. ..
-~··..... _. ..
-Drug lnllustl-y ·se.:eds ·the .•Grass Roots'
be letters look 6k~ any other constituent mail . ' ·.-u~ Am~can dnig ~panjes can curb their .
that streams into the office of R~p. Ron .,,~~ .. ,. . :iminense profits and, at least, provide some
Wyden (D-Ore.hach day. Only m these
··
accountability on research, J feel our only recourse is
letters, the prepared text is crossed out and .
. :_for aovernment control; wrote another.
in my
replaced with a more personalized message: "This · · . opinion, is the biggest piece of (profanity) I have ever
junk mail came to me lrom these drug eompanies. - been asketl to back,• wrote a third. Wyden received
Pretty phony and self-serving. You should .be aware .·1beus u similar responses.
·
of the source if you receive any.•
· ·
- "'I tlWik the message here is that 80IDe of these
Sometimes the mOSt "SOphisticated lobbying
: slick aad fancy campaigns, particularly on the heahh
efforts end with the.most unsophisticated results. : · care issue, are starting to backfire: Wyden told our
This time, the drug companies stirred up a
_.
assOciate Jan MoDer. But, be added, "'I haven't found
mini-rebellion among Wyden's constituents.
many campaigns that have backfired like this.•
"junk mail" Wyden was warned about actuaDy was
· . Drug companies have ~de no
part of a growing phenomenon in
stand in the health rare11ebate...su.at · ·
influence-peddling: -using direct mail to generate :
Clinton mmounoed the formatioit otflil hea!thare
grass-roots pressure on a single issue.
· .task foree last Winter.· relations betw.een'ttae- : ·
The grass-roots approach bas been popular since
administra~on and. tb,e ~ ind~ have
the 1980s, when lobbyists discovered that many
ranged from open waifare toan~y deteb~.
members of Congress care far more about what .
When the administration came d ~t
their coastituents think tharfthe opinions of
spring, drug ~pames'tetatia-ted · • -.Mries of ·
high-paid lobbyists. But in this case, "'grass roots•
large newspaper ads ani! ~otialidefenitilut their
meant ghostwritten.
pricing policies .and str~ their~·
Wyden became a target because of his influence
developing new:~ :)lis~--~._ f
on the prescription drug issue. In recent years,
companies hatetbe.e~t:ireqinton"-laft':1=be,y;6ke
drug companies have been deluged With criticism
the fact that prescnption drugs • ~11nder
for hiking prices and making record profits w:bile
Clinton's "stan~~ pacJaie." .If'ahealth care costs are exploding. Wyden has been
"'price c:;ontrol" featiare that makeS~~··
one of the chief provokers of the pharmaceutical
· Fearing trouble, some drug ~e5'br$e from
industry.
.
. the industry's cllief,lob!>yiQg aRn, ~-~utical
Thus, Wyden began receiving letters signed by
Manufaeturers Association (P~.lnd forJned their
constituents but actually written by pharmaceutical
own coalition tofight ~eontiol6:"Wttlil'$J.inillion
interests. The letters, addressed to Wyden, were
budget, RX Partners employs somt:ef'the "ejlviest
sent to constituents with their names at the
bitters in the W~ll infl~~e. ~
bottom. All that was needed was a signature and a
former president Jiaimy Carter's p~-~,
postmark, and Wyden wouid receive a letter asking
Jody Powell. ~
; ·
· •·:· 1.
him to go easy on the pharmaceutical industry. ·
That leaves~~(~; ~~·s
To throw members of Congress off the scent, each
been 6eDding maD.~ W)'(J.eo'~~~A.ri Uipntific
of the letters was made to look a li~e different.
.
. survey"# severp,J drug com:m~·d ~
When members get a form Jetter, 1t's not taken as:' . -. found1l0 one eCQterto.~.
._ibiliqr~ 'J.8m
seriously as. a personal Jetter. ~the anonymous •
absolutely~ .~t.Ws ~ -~ ~_,~·,~>MA
authors vaned the exact wording, the letter font and . spokesman told us.
..so. · • · : · · ·
even the color of the paper. Nobody was fooled. ;
. The first person we reached at RX Partners wasn't
'1 resent the fact that the pharmaceutical lobby
sure, but added that "everyone involved in the
thinks we are this stupid . . . of course these folks
prescription drug industry is involved in sometbiug
need regulating. They have proved most unable Jo
like this.•.. Part of our program is, of course,
regulate themselves," one constituent wrote at the. . workin~ on the grass roots.• Shortly thereafter,
bottom of his letter. Drawn across the text of the ·
another representative from RX Partners caDect to
letter was a large circle with a slash through it,
assure·us that his group bad absolutely nothing to do
- with any direct-mail form letters.
along with the word "Not" in capital letters.
T
-nus.
The ;
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or:
�..
.-
..
October lS. 1993
Dear Mrs. Clinton.:
As 1he Washington voice of over 1000 mcmbcft AlDS orgaruzations, ~ applmd
your efforts in foanulating the health care ieform proposal. ~ you know,
instituting change takes CODI~&e. The innovative health plan put forward owdwi1s
a system that needs drastic change, and we are thriiied to witness the brave acts ~f
l
a new adrc.inistration.
of
'
'
.
Affordable prescription drug covemge is
utmost imponance tD ~s
communities. People living with AIDS and tho~ individUals who are BIV positi~
are groups most wlnerable to escalating drug prices. As AIDS research progres~.
AIDS communities will become even more defenseless against BSCalc:tinJ drag coSts
since prescription medication will undoubtably be a major contributor to any
vaccine or treatment.
·
·
i
cure,
i
~
withili the health plan deserve specitfe
commendation. 'Ibe cost containment measures are necessary and long-needed
provisions to ensure thai prescription drug coverage remain affordable under~
Medicare drug benefit. As you know, many AIDS patients receive medical care
through the Medicare system. Both the cosi conwnment provisions and the
inclusion of prescription drug coverage under: Medicare are necessary to ~
important drugs affordable and available as wen as keep premimn increases in
check.
·
i
Therefore. a number of specific factors
lEi~
Cat~tUaialr
AM N'W
S.Uu 700
W.Jn.z:IIJJ DC
20009
F-202 9861;4~
The proposed Breakthrough Drag Committee established under the National Dnt,g
Board is an imponant and overdue mechanism to keep drag prices at a reasonable
level Giving the Committee the ability to xeview new dmg prices, as oppo~ io
setting prices. strikes a careful balance. Review of drug pricing 'Will ensure thit
imponant research and development efforts will be maintained through adequai.e
corporate profits. In instances of federal involvement in dreg research. goveriune~t
review of the prices of jointly developed pro~ucts is a sens1'ble and equita.b~
measure. The prohibitive costs of AlDS treatrc~nt sach as AZf and Foscavir ~
wa.mings that price review is necessary.
·
7iJ 202 PB6 J;OO
Again, our congratulations for your efforts in proposing one of tbe most imporwit
pieces of legislations in recent hiswry. We look fotward to the system reforms
offered within the proposal to becoming a ~ in the near fumre.
·
Sincerely,
).aJ..~;7-Da.niel T. Bross
Executive Director
�.
r
•.
Fubltsher o1 Consumer Reports
October 19, 1993
Mrs. Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue, NW
Washington, D.C. 20500
Dear Mrs. Clinton:
The Administration's draft health care plan acknowledges the
importance of prescription drugs to the health care of American
consumers by including prescription drug benefits in the standard
benefit package that would protect all Americans, young and old.
It also recognizes the need to rein in the high costs of
prescription drugs by requiring rebates for prescriptions purchased
through Medicare and Medicaid, by encouraging health care plans to
negotiate lower prices, by authorizing the National Health Board to
study the reasonableness of launch prices for "breakthrough drugs,"
and by calling on the National Health Board to study to pricing of
prescription drugs when there is evidence that they might be
unreasonable.
The enclosed article "Do We Pay Too Much for Prescriptions?"
in the october issue of Consumer Reports provides strong evidence
for the need .for expanded scrutiny of prescription drug pricing,
and for regulation that goes beyond the provisions of the draft
health plan. we believe that it is too late for voluntary industry
efforts to limit price increases -- prescription drug prices should
be rolled back and then subject to regulation in order to offer
American consumers fair prices for prescription drugs.
Key facts reported in the article are:
Drug prices rose faster in the 1980's than health care
costs overall. Total u.s. pharmaceutical sales revenues
more than tripled during this decade, even though the
volume of drugs sold hardly budged.
During 1992, the pharmaceutical industry had the highest
return on sales, the highest return on assets, and the
highest return on stockholder equity of any industrial
group in the Fortune 500. Its 11.5 percent return on
sales was more than four times as high as the average of
all Fortune 500 companies, and almost twice that of the
second-most profitable industry.
The prescription drug industry spends about 30 to so
percent more selling and promoting its products than it
does inventing and testing them.
Washington Office
1666 Connecticut Avenue, Suite 310 • Washington, D.C. 20009-1039 • (202) 462-6262
This release may be used tor teg~imate pUJPOS8S only. Use of material from Cons~mers Union tor advertising or other purposes is prohibited.
$ 100% Recyclad • 15% Post Consumer Welle • Soy lrtlal
�2
Billions of taxpayer dollars every year ~upport
government research that pharmaceutical compan1es are
then allowed to use for their profit -- with very little
payback to the government and, until very recently, no
restraint on price. For example, in the case of the druq
Ceredase (an enzyme therapy for Gaucher's disease)
National Institute of Health scientists played a major
role in the development of the druq (e.g. , NIH discovered
the missing enzyme, fiqured out how to harvest it from
human placentas, modified it chemically to treat the
disease, and qave the drugmaker-- Genzyme -- $9 million
to spend on early clinical research). After spending
$29.4 million of its own, Genzyme qot marketinq approval
in 1991 and went on to sell $37 million worth of the druq
that year.
The druq costs up to $300,000 a year in
severe cases.
The Office of Technoloqy Assessment recently reported
that durinq the 1980s, pharmaceutical companies on
averaqe earned about 15 to 30 percent more profit each
year than needed to attract adequate investment capital.
All large industrialized countries except the u.s. impose
some requlations on drug prices. This results in u.s.
consumer paying more for drugs than people in many other
counties.
For example, the General Accountinq Office
reported in 1992 that average prices for druqs were 43
percent hiqher in the u.s. than in Canada.
No doubt, prescription druq manufacturers will oppose all
efforts to step up the scrutiny of prescription druq prices. The
time has come to put the interests of American consumers above the
profiteering of the pharmaceutical industry.
we look forward to workinq with you and the Administration as
the health reform plan works its way through the legislative
process.
Sincerely,
~~~
L1nda Lipsen
Leqislative Director
J~~
Manager, Policy Analysis
�LEADERSHIP COUNCIL
_________________of-________________
AGING ORGANIZATIONS
.
Dr. Danlel Tfu.usz, Chlz1rman
October 15, 1993
Dear Mrs. Clinton:
The Leadership Council of Aging Organizations (LCAO) commends the
President and his Administration for putting fnr~h a
comprehensive, innovative and constructive health reform
proposal. The proposal promises many vital improvements for
older Americans, including pre~cd.ption d1·u9 coverage in
Medicare, early retiree coverage that is secure ana affordable,
enhanced quality measures, and increased choices for families and
individuals.
partieul~rly note the im.portanel?. nf the proposed long-t:.erm
care program which would offer essential support for home and
community-based services for seriously disabled persons,
reg~1dless of age, that can keep them independent and support
families and other caregivers. This measure represents a vital
and overdue recognition that our health care system must be more
responsive to the situation of those with chronic illnesses and
disabilities.
We
We are also pleased that an outpatient prescription druq benefit
ror Medicare beneficiaries is included in the proposal. As you
know, the combined effect= of high price~, heavy utilization, and
~he absence of affordable insurance coverage for prescription
drugs have significantly reduced access to needed drug therapies
for older Americans. As a result, olOer Americans are more
vulnerable to avoidable health problems and more likely to
receive unnecessary and more expensive medical care.
Moreover, we commend the President for includinq effective ~
containment mechanisms as an essential p3rt of the Medicare drug
benefit. We are concerned, however, that pharmaceutical
manufacturers are already engaged in a major lobbying effort to
eliminate any meaninqful cost containment provisions from ~be
proposed plan. In fact, we understand that the industry's
leading association is attemptinq to scare Medicare beneficiaries
into believing that the·President'a coat containment efforts will
result in the absence of Medicare coveraqe for important
breakthrough drug therapies. We do not believe this is true.
In this regard, we strongly encourage the President to remain
commi~ment to contain prescription drug costs under
the Medicare drug benefit. If effective cost containment is
!1rm 1n his
1'HB MTIQHAI, oomvcQ, Olf fBI AQJND, IPIC., .oe 'ndrd 8b'Wt SW, 'IFultflwaDn. DC 20084
(aOJ.N?e-JIOO • fDD IJOIJC'IIJ.a8'74 • PAX f202)4'78-07U
�eliminated from the proposal, the Medicare druq benefit may
quic~ly become unaffordable to both ta~payers and beneficiaries.
This was clearly the case durinq the development of the Medicare
Catastrophic Coverage Act (MCCA). Due to the lack of effective
cos~ containment, the projected cost of ~he MCCA arug benefit
(and the resulting estimates of premiums to be paid by
beneficiaries) skyrocketed even before the bill made its way
through Congress.
The pharmaceutical induatry arquea that. P.VP.ry dollar sought by
policymakers to contain drug prices will come directly out cf
research and development of important breakthrough medications.
We believe this is simply fals~. Much more than legitimate
research and development activities go into the manufacturer's
p:rice of.·· a drug. Thus, drug manufacturers have many choices as
to where the~ can be more efficient and ~ut costs. In fact,
according to a recent study by the Senate Special Commit~ee on
A9in9, only 16 percent of the mAnufacturer's price of a drug goes
toward research and development compared to the 36 percent that
goes toward profits, marketing, and advertising. In addition,
drug manufacturQrs' revenue will increase substantially under the
President's plan as millions of Americans who currently lack
coverage for prescription drugs will gain coverage. Much of this
revenue could be used for legitimate research and developmen~
endeavors.
The Leadership Council of Aging Organizations commends the
President and his Administration for proposing a meaningful
heal~h
c~re
reform plan that ineludea important long-term care
benefits and vital Medicare drug coverage. we urge the
Administration to stand firm on the cost containment provisions
included in ~he p?'"an o that ~hese important benefi~s will remain
affordable to oth
xpayers and beneficiaries .
.. /
Si1'lc
,.,.
el
\
Daniel Thursz
Chairman
csee next page for oraanizat1one that have signed-on.)
�,
·.
The following Leadership Council of Aging Organization members
have signed-on to this letter:
AFSCME Retiree Program
American Association of Retired Persons
American Society on Aging
Association for Gerontoloqy and Human Development in Historically
Black Colleges and Universities
Families USA
Gerontological Society of America
Green Thumb, Inc.
National Association of Meal Proqrams
National Association of Nutrition and AqinQ Services Programs
National Association of State Units on Aging
National Association ~f Retired Senior Volunteer irogram (RSVP)
Oirectors
National Association of Foster Grandparent Program Directors
National Association of Senior Companion Directors
Na tioncal CC:l\JC1Js and Center on :elack Aged, Im;.
Older Women's League
··~-:-_..:::.:.··:·:·.
'
. ··;·.
�NARD
Chari~
M. West, P.D.
.
· ViciPreside111
'~\Y?CtllitJe
COMMUNI1Y RETAIL PHARMACY
Health Care Refonn Coalition
The Coalition Representing
RetaU Community Pharmacy In Anlerlctl.
NACDS
Ronald L Ziegler
President & Chief
E\~ectllit~ ·Officer
September _17, 1993
The President
The White House
Washington, DC 20500
Dear Mr. President:
On behalf of the Community Retail Pharmacy Coalition for Health Care Refomi we
commend you, Mrs. Clinton, and the members of the President's Task Force on
Health Care Reform for your efforts to reform America's health care system.
The Coalition, composed of the National Association of Chain Drug Stores and the
National Association of R~tail Druggists, represents the totality of community retail
pharmacy in America.
Specifically, we are pleased with your recognition of the importance of community
retail pharmacy and its cost saving and critical role in the delivery of preventive
patient care.
We believe your commitment to reform and the security it will bring to all Americans
deserves the strong and active support of community retail pharmacy.
Our Coalition - through our 112,000 community retail pharmacists and our more than
one million employees -- is prepared to communicate aggressively the merits of the
evolving plan in our efforts to further enhance and solidify public support for your
health care reform proposal. We will bring enthusiastic support through the
interaction of community retail pharmacists with millions of patients each day in more
than 60,000 drug stores.
NARD (representing independent retail pharmacy)
205 Daingerfield Road, Alexandria, Virginia 22314
Tei(703)68~200,F~(703)68~19
National Assodatlon of Chain Drug Stores
413 N. ~ S&reet, Alexandria, Virginia :Z:Z314
Tel: (703) 549-3001, F~ (703) 8364869
�September 17, 1993
Page Two
The Coalition can be espeCially effective in working with our pharmacists to convey
the value of new prescription drug coverage to the many uninsured and elderly
patients who visit their pharmacy each day. Vfe especially applaud your expansion of
Medicare benefits to include pharmacist services and prescription drug coverage that
will prpvide cost savings to the health care system as well as additional high-quality
services to Medicare beneficiaries.
·
The Coalition looks forward to being a continuing participant and supportive resource
throughout the public policy process on this important initiative.
o
L. Ziegler
resident and Chief Executive Officer
National Association of Chain Drug Stores
Charles M. West, P.O.
Executive Vice President
National Association of Retail
Druggists
�.. :
,-.
National
Consumers
League
.........
• ,~ FlftMnth Strett, tfN. luftiiii-N. W•INngtCJn. DC 20006. ~ 138-8t4n. PAX Ciii m-2114
October 15, 1993
'rhe President
Jalrtll.ltwdaa
cur
ICfllliDu
'l'he Wh1 te ao~··
washin;ton, DC
thCAW
Dear Mr. President:
Bublta Wardm
'I'he Netional cons~ners Laaque COIIJIIenda your couraqa
a.nc! ccm:ni tment to refor:ll our nation's health care aye tam.
Nip a,.,k.
Mcl'O.W
n-nrIUQ
. . . 114.
r.r.t/11"1
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lio.tOIIII)'
Nath=
ClfR
llatber~
lioMffl/1 , . . ,
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Delel~
No ,,wcla
WUU.Ialls
lo~ 8qtand
Ala11Bol=il
I. &O!IIrt B~a~M
Vk>la D. ll.rDwa
IYlb H.dllr Carew
Jmt CM1
J)a~
Cicnlk
~.DIIIIIIU.
~I>DtlrcM'
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"'-• OloYil'
lusuEma
\'iiPia n.«z
L&l.ll l:obiU
Barl"y ErMa
Mtndilh M. l.Qir
" Mol'llar Maru
OdCII!TI& Ma tbl!wl
Your plan reoogniaea tbe importance at conaWDara ••
genuine participant• 1n their own aare, emphaaizin9
pri11ary anl1 preventive care. We are particu.larly plaaaecS
with the propo•al that would prov14o out-patient dru;
benefits aa part of a nationally guaranteed benefib
paalcage.
'l'he Lea que baa long •ought a dru; J>anefi t tGr
We applaud your inelusion o~
thia important prov1a1on 1n the ADericiU'l Health Security
A.ct an4 commit our support to work to assure that this. be
pert of the final leqialative proposal. Of particular
importance we endorse your inclusion of effective cost
oonte1ruaent zecnanisms ae an essential part of t.be
M6c:Ucare druiJ benefit. we encour4qa you ~o remaln t1rm
in your coni taent to thia princi.ple.
Kel!icazoe benefie.f.a:-;Lea.
BCL 11 a
~ational
con&uBar orqanization that has
in eveey state ancS a network of oouuni~y
orqaniaations eaqerly awa.itiftq universal health care
reform. The consUJDara we represent need to be aasured
t.hat:. their mecUoationa are available, afforc!a.ble, an4
appropriate for their core.
aembera
Z)u~
Lcz)' Mil cbell
~J.Dtttl 'NawtOD
~!nPliiU&on
flbtt a.id
Mart!frl.ot.u
l'a!NI&IoJift
!IU:c l~•rttro
8anlgol A. ball
~ Barbd< . . .
~11rw B Sre'•ae
Jl.kkJ Sioollld
Ue .S. TAM'-Whelan
P&lllll& '"Oil
k~V.,IIAIII
a.tr I. VtDaDo
lobcrt \\'ellb
liNe Woe14ri4p
Representlnt Consumers for 91 Years
�..
,........., ...o.
_,__
National Organization for Rare Disorders, Inc.
._...... IIINI:Ior:
------.T-T~s
...,...
NORD • 100 Rt. 37, P.O. Box 8923 • New Fairfield, CT 06812·1783 • (203) 746-6518
....,_~,
.. GenoiiC ~ Graulll
-
October 14, 1993
~J~~.......,., Cnoi
5yriCIIOml
_ . . . , . , . . . , _ _ Inc.
Auoc>otoon
-Po~·- Soooty .......... Otll1rucl""' Inc. (A5APJ
-
srnnoom,...-
-..can
...
Mrs. Hillary Rodham Clinton
The White House
Old Executive Office Bldg.
Washington, DC 20503
Prlljlcl •
::~£~-~~
Aeoeartll- Inc.
___
lofigne-mtol~
Cllolcoi-TOOIII-
-.,
_......,....._
....
...
Dear Mrs. Clinton:
c;twan_,.t8~
Aeoeartll Socool'f
Comoloa .. Lango 5yntiJamo
...._,,Inc.
crsa- •-.IN:.
The National Organization for Rare Disorders
(NORD)
strongly supports the Breakthrough Drug Committee and
other pharmaceutical cost control measures outlined in the
President's health reform proposal.
Draatu--·Dncl WI*"" lht c.-. Inc.
~
Founaaton. Ire.
o,m.pnoc ~ llulooa
-AIIoc(D.E.B.R.A.)
ENn-o--""'-'
~yFounoaoon~
F - at Somatlootulcular Al7allll'f
~rciiFuna.lnc.
'-·Founclallontor_,_.&
Stun Typos (F .I.R.S.T.)
__
We are certain that health reform is doomed to failure
unless there are stringent measures to keep price hikes in
line
with
inflation,
particularly
prescription
drug
prices.
In addition, the nation sorely needs a mechanism
for holding down the prices of new drugs that reach the
market.
~s'""""""
F"""""""'lmemiiiOtlal
Hemoc:::Yomatoss FounoabOn. tnc..
....._,rtary
..._,
"'""'-
O...ue Founaauon
~·· o.eu. Soooty
~ Atnooca. Inc.
IIMiuno Dolconcy FourGIIIOn
....rnatiOt\ll Ft~
Prog'"""" iFOPi
Founaanon. 1nc: •
._maDONI, Ren s"'"""""
Clufic::anl
._matoonaJ.- DIM-
-"
......_,CYIIIIII-
NORD represents approximately twenty million Americans who
suffer from more than 5,000 rare "orphan diseases."
Each
of these ailments afflicts fewer than 200,000 Americans.
Most of these disorders are serious, debilitating, chronic
and some are fatal.
The populations we represent often
have
great
difficulty
obtaining or retaining health
insurance, and treacment very often requires expensive
pharmaceuticals that must be taken throughout life.
CJf Arnenc:a. Inc .
.._.., s,.,.,...... -
Mohgnant .. _ l l _
ot the unnee Swtn
O..U. Cotat
~doratJYo
, _ _ , _....Inc.
-IAGrefiOIOIN.... . . . . _ ,
AloOOQIArem
NIDonaiAuoc>anontor • -
Sockto Cell ou-. 1nc.
Ha1oonaJ Alull Founaancn
-Aaaocaauon. tnc.
c....... ·-
Synatamo
Nabonal Four.albOf'\ tor
Eco- Oysoiu&as
NallonaiFrogtiOXFouNIDonal Gaucr.r t=ounaaucn
NaDonaiL.etgn·s ou- F -
_.......
Nabonal ....,.an Founaenon
~
Sdo"""
_,,_IIOSIS-
Socool'f.
1,.:.
Naoona• MuniDOI
Naloona•
For this reason, NORD has been an outspoken critic of the
outrageous increases in pharmaceutical prices over the
last decade.
The following paragraph from the article,
"Do We Pay Too Much for Prescriptions," in the October
issue of Consumer Reports, is ample testament to the
industry's
single- minded
and
insensitive
pursuit
of
profits:
5ocool'f
NaDonaiPKU-.
RettnrtiS P.gmern:osa
Founcsanor.. Ire
frrfatona!
Hl:bona1 S,ogren 1 Synarome Auoc.
IUIJonal S;>umoelot T.,_,...
AllociNSTAJ
Naoonal Toy· Sells & Alllod
CtNua
Auocset10r.. Inc
Nlbonal T"'Dei'OUI 5oei'OSII
Auoaauon. tnc.
Naoonat Urea Cyao 0.00"'""' FCIITI.
Nabonal Vfllhgo Founc11110n. Inc.
N.urotaommos.a. tnc.
Ot::Ms.:·vt :::o~~!S~ Fou~l'!
Olllooennll tmpel"!ec:a Founaahan
Oxafooll & >lyporCIUIIU'II FouncllbDn
~~ O.Nue Founaauon. Inc.
"Last year the pharmaceutical i..~dustry had,
as usual, the highest return on sales, the
highest return on assets, and the highest
return
on
stockholder
equity
of
any
industrial group in the Fortune 500.
Its
11.5 percent return on sales was more than
four times as high as the average of all
Fortune 500 companJ.es
and almost twice
that of the second- most profitable industry.
Eight drug companies were among the 25
companies with the biggest absolute profits."
Parera ot GalaaOMmc Crtli:lren
,.,..._,., 0oseut Founaooon. trr.
PKR Founaanon
P,.,.,-WiHI SyncJ1'1).,.Aellex SymCIInebC ~
Synci!O..,._n
$dei'QOet'ma FeoerabOn. lrtc.
SO._.,.. Into E-.1nc.
Sjogren's 51"01>""' " - · I n c .
Tho"-L..S ............
Tho EAR...._,
Tho"""""""'"Gt--
r....... s""""'" _ ,
Tngonurw - r a i Q I I UMOd ~ny Fou-.lne.
liMed Parkii"'ICI"'
t:ourG~aon
11..-Po,.noa·-IOt
""'""""""'"·Inc.
0..0"''"'
Pwtmonor,.
V-Ial
Aoooc1811Dn
Wegonors Gronuoorn110111 ~
Gtowp
WiUiams Synctrorne Auoc:l8bon
Wilson's Dseue A.uooallon
Acarch Syndrome Newslener
Allborna Scoel'f1cr Stoop~
A.L.S Auoc:.auon G,.atlt
Ph•tmt!pl'laa CF\IDier
Am.rcat~ Bel'ars A.a.aoc::i81101'1, tnc..
Amencat1 Seft·t<olp CloanngN.J.
AAC orOno
Aucca1on tor ChiiCiren With
-.
RuAeR·So.... SY"''''"". Inc.
Center '"' Retearcn '" &eep
Clllrcct·Ma'II·TOOIIItmomatoo"lll
C!Winn'l~- ....
Pori AJIIom; -
ChroncG'I....-.101110-
Roclly Moumam Rasoutce & Tra~~~~~~
-
Ctw.-1111..--,
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Co-vtnn&l Aarenat Hypit'NN
.. IN:. (CAI<SAJ
Oevefet.~l ~OUf'GIIIIOI"'
Footiii'GI I'*IIU11
FoUfiCIIIoon tor
Nooe• & Uolo<
s-
tor Cllildtwn
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- F-
Aoowcf~TI\IIItor
Slty=
5yriCIIOml
~
SocktoC.I-~1110
T-GultCoat
SaiD'•
s.-ro Gnlup
s""""'"
SIIMgo-W-
Dedicated to Helping People with Orphan Diseases
Toumto SY"''''"" ....._~MD
r....... s,_ ...... ~
-Scclia
r..,.,. s,..a.,.... ....._ o1 OH
T.......,-cou.... FOUnclllllln
T.-....Sdo<oo• ...... ~U.
L---
v....... ,....._
·-.,.joorq -.g
...,.,._,._For-
pto- ...,,...,.. NOIID Gila
:~~~~·
�•
..
Mrs. Hillary Clinton
October 14, 1993
Paae Two
We believe in the free market system and the importance of profit as an
incentive for research and development. However, we also believe there
is a distinction between profit making and profiteering, particularly
when these profits are being made at the expense of essentially
helpless sick people.
While we have seen some evidence that the industry is beginning to rein
in its wholesale price increases for drugs on the market, we continue
to receive reports of increases at the retail level. Moreover, we have
seen little sign of moderation in the price of new drugs, particularly
"orphan drugs."
Ceredase, for instance, a drug used to treat a rare
genetic disorder called Gauchers Disease, is the most expensive drug in
history.
It costs over $300,000 for the first year of treatment and
drops off to a "mere" $140,000 annually thereafter!
Since many of the
breakthrough drugs currently in the pipeline at FDA are designated as
"orphan drugs", NORD is particularly fearful of what the companies may
charge for these new medications.
The proposed Breakthrough Drug
Committee, even though it could use more enforcement powers, is an
absolute must for health care reform.
The pharmaceutical industry will not lose money under your health
reform program. They will make up for price restraints through higher
sales volume and a sorely needed reduction of their outrageous
marketing expenses.
Therefore, we urge you to retain the provisions
for pharmaceutical cost containment, and especially the Breakthrough
Drug Committee, which will hopefully be able to moderate the prices of
new drugs.
Very truly yours,
~~
Abbey S. Meyers
Executive Director
ASM:aa
CC:
Chris Jennings
Ira Magaziner
�IU
October 20, 1993
Mrs. Hillary Rodham Clinton
The 'White House
Old Executive Office Building
Washington, D.C. 20500
Dear Mrs. Rodham Clinton:
National People's Action, a grassroots coalition of over 300 community groups, is writing to
inform you of our recent negotiations \Vith the Pharmaceutical Manufacturer's Association, and
to request your assistance in resolving the following matter. We are also requesting that you
seriously reconsider the "voluntary" proposal approach to restrain the cost of prescription drug
prices for the pharmaceutical industry.
NPA and P1\1A
N~otiations
NPA started a series of negotiations 'With the PMA in Apri11993 in Washington, D.C. One of
the major objectives of our leadership was to address the high cost of prescription drugs for low
to moderate income individuals, and increasing people's knowledge of the pharmaceutical
industry's Indigent Drug Program. The pharmaceutical indusuy·s program provides prescription
drugs free or at a reduced rate for individuals with low to moderate incomes.
In June of 1993, the PMA agreed to advertise its low income drug program in 10 cities. NPA
leadership requested that the program be advertised in neighborhood newspapers that. reflect the
racial and ethnic diversity of the cities. The PMA agreed to this. The. PMA also agreed to
show the ads to leadership for review before placing the ads. Enclosed is a copy of the letter
in which they agree to advertise the program.
In addition to the agreement for advertising we requested the PMA to fund and market local
groups for doing outreach on the low income drug program in low and moderate income
neighborhoods. See paragraph 2 for reference to this request.
However, it's now October, and they have refused to give us a date as to when the ads will be
completed for our review. We know that the PMA has nothing to lose- and in fact is probably
stalling on advertising its program.
110 N. Milwaukee Ave. • Ct\lcago, nnnole 10122-41~ • (S12) 24W038
�li.J
'·
-
1~4567739
P.
With only voluntary price controls for the drug companies in the President's health care plan
there is no incentive for the drug industry to advertise its current program. The drug industry
will continue to be subsidized for research and development, and now universal access for
prescription drugs. The cost will be passed on to the taxpayers -while the drug companies
continue to make unheard of profits when compared to other industries.
While NPA is in favor of comprehensive health care and prescription drug coverage for all
Americans, NPA believes that the pharmaceutical industry can do its pan presently, by utilizing
its low income drug program.
The PMA has been very reluctant to advertise its low income drug program which could make
the difference between life or death from some individuals. NPA wants the PMA to be
accountable to the promises it made to meet the prescription drug needs of low to moderate
income individuals. When the PMA developed this program their publicized intention was to
meet a cn1cial need in the community. Now, they are doing all they can to keep the program
a secret.
Cost Containment Proposal
NP A strongly urges that the final health care plan includes strong mechanisms to contain the cost
of prescription medications used under the Medicare program. We remember all too well that
a major omission with the outpatient prescription drug benefit in the Medicare Catastrophic
Coverage Act was a lack of specific cost containment measures on pharmaceuticals. As a result,
the cost of that benefit skyrocketed, and with it, the premiums that Medicare beneficiaries would
have had to pay to finance the program.
The cost of prescription drugs is a matter of life and death for not only seniors, but many other
Americans on limited incomes. Too many Americans have to make choices between buying
food and paying for their medications. A prescription drug benefit would go a long way toward
correcting this unacceptable situation. However, a prescription drug benefit must not exempt
the pharmaceutical industry from gouging the American taxpayer with its astronomical profits.
It is crucial that the President's plan address the excessive costs of prescription drugs for all
Americans. The only way that this will happen is through a cost containment proposal.
NPA strongly encourages you to implement measures that will require pharmaceutical companies
to limit both the annual increase in their weighted average price to the rate of inflation and the
increase in price of individual retail pharmaceutical products to the rate of inflation. ·rhis
specific price increase cap on retail pharmaceutical products is needed to protect consumers that
purchase their medications out of pocket against continuing excessive price increases.
NP A requests your support on both of these issues.
Sincerely,
~~
Gale Cincotta, Chairperson
�•.
•
..
FOUNDATlON
V'.l:.! \\';•haul Su ~,.,
Ki!IIINI• Ua~ MU bUIIIi
fCIIi-I~I·IM/i!l
Mlti-1'11·'7'/.IIM
t""'
'/'nu.•i'·'~~
I1<111IUIIIt'
(,.,,,,..
Jan-u .J c.;r~nl.ll~rr.
~~~.~
,~,
Juhu S limwuill
:
~\!'1'(:/inil'»lll/1
llua w u....;.
October IS, 1993
j;enu_. .. I Wio!lfiH ..,.,._
.,,,.,,,.,.,
IJo•IIJ!l~!.A
llt'o·n;;o•l
Jn'r:j"th 11 J\,uc-ni•·~
Mrs. HHlary Clinton
The White House
(.:Ord•'n l1~1~h
I h'lm~• tlcSC'h
Washington, D. C. 20503
f iml, .J\"114. L,,...,
Utnh J... ,d.•J•
Dear Mrs. Clinton,
.'tr:n:.•.:n,..,, ..-\/11'1~1,111' /!11.~ li/J
It is important to include pharmaceutical cost containment measures in the
President's health reform package.
,:;,.,,.,..,.,
l tur•.• ~t \1\ ,,•.tnw:um
.f .... .,.... I' c.. I.......
l' ,n\.
P,:t• h.t:~l
11)
~ (
Competition will help. but there also needs to be a plan in place to report to the
public if the price of a medication is unreasonable .
··h ~·
h.ut'!.t•
:,,j,. ,,:
\\,ul.iu~t·
•u 1 'u;.,
)olc.:plwn J H• 11ln' I'"'' '·IHl.t'
\;llr l.nh·•·r•l"
l .. ll'i• i;, I) \\1f'lu, t·h.IJ
.fnllll., Jl11pl:t1''" '~IU\.
Viu·tH•: I fq;;._.,
VI.
Pt1.1\o'll:hiiW
I'm not certain that a "Breakthrough Drug Committee" is the best plan, but
obviously HHS need be involved.
Thank you for your commitment and leadership.
"Hang in there! •
Sincerely,
A.uu~(,.,,,
(i~l"!'
l.Jt•:'"'
~.a,.,.!.
Kriq!l'l'
jillMo·M,,.,,.,
Juh~:•
"Dyke
President
I))·t.P
,.,,~,J,.,,
ll:.&n l.on""nu
.\•,.,.J,...... ,./,..,r·
JO:das
ca.+
�HELP US
REFLEX SYMPATHETIC DYSTROPHY SYNDROME ASSOCIATION
(RSDSA) - Founded in 1984
•
116 Haddon Avenue
Suite 0
Haddonfield. New Jersey 08033
(609) 795·8845
-. loud of OiR-ctc.y • .,.,.~,. r~.D.
o-•
....,..0...
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THE PAIN
...._yGierJlo.M.D .
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CODCeniM.IeM;,.,M.O.
AMNT F. Tl•- I.N.I.A.
c.y 'raufll. M.fol., CIC,Ctll
HDMrlrJ loerd of Oirectan
l•boriG . . . . "'-0.
....ilo11t 6 C.f.O.
,.................
llllnioul H.-~ . . Ufel18. Co.
h«MI;... Vico PraM!""
Oiof Oper.. i"l Officer
""'"- .......-~ou~ eo.,.
October 20, 1993
leftrM!S. • - •
..,_Oirctor
Natlollallnotilw,. Ill
-•oiMcollh
C.W"''"'"" ....~i• l, C•dl•
c-a.... lllrhe Uoltell II••••
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f~a~~~c;w,.lwf
o..;...,.ft d
the lloonl Ill
Dir ..lon- llwc Cr- eNI
.,.. Slliold of Malyland
Michell. - k •
Hillary Clinton
The White House
Old Executive Bldg.
Washington, DC 20503
Dear Mrs. Clinton,
,,,......,- u....,.;.y Df
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Jaoclirk..,trkk
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riM Uoil..t lli•iDrl•
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Doo!M.~""'o M.D.,,.,. D.
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lrhoonl ul M.dici,_
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f. Mic ..... l McWitlio"'o
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Host people with RSDS live in constant fear of loosing
everything they have, physically and financially. Many have
several prescriptions medications
that they must take
daily for many years or for the rest of their lives.
Because RSDS is a little known rare disease, a large number
of those afflicted with RSDS are denied disability
compensation and insurance, leaving them unable to obtain
their much needed medications and treatments.
We ask that you make every effort to retain the
pharmaceutical cost containment measures in the President's
health care reform plan.
Sincerely,
a~o~
Rosalyn Davis
Executive Director
cc: Abbey S. Hyers, NORD
Nelson Hendler, MD
Gary Bennett, PhD
Frank Davis
Concetta Renkun, HD
Adrienne Elias, Esq.
Sy"'phooy Orchmra
Dir.ctor of
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Not- H....Sier, M.O.M.S.
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INTERNAnONAL
RETT
October 15, 1993
SYNDROME
ASSOCIATION
......,,_
ltallly ..
~
Mr8. Hillary Clinton
The White Bouse
Old Executive Office Building
Washington, D.C. 20503
Socmarv
D~ kltiMI
TIWtu,..r
AlltiiiiiiJI-
..~ of 0.M"Ir>r>
Ed Ltwl. Clllt11111n
...,h ...,.,
Alllhunr Luo
P•ul Jarhim
Att~:
Diane ICa.u.er
a-tiM \'•reo
S..ft Zlftlm•rm•nn
,..,.,..;AJI-')Ila>•J
At~drc .. 1111~ M.D.,
a,,;,...,,
V~.Austria
Chris Jennings
Dear Mrs. Clinton
Jeaft AiCift!i, M.D.
hri1. france
C:.O.,• laAMt~ M.D.
Lot Anarln. Calift-rni•
Marpl'lt Boullion. M.O.
Boston. Mossoch ..ocrt•
lui•" lohah•w•••. M.D.
Zurich, SwoU••rlond
S.rojini tu~dcn, M.D.
l'orllond. Orvgon
Ma"' Colornan, M.D.
Ch1i~sc. llh,ots
On behalf of the parent• of the Rett Syn4rame Association,
we wish to urge the administration to retain the •sreakthrouqh Drug Committee• and other pharmaceutical cost
co~tainment measures in President Clinton's health reform
plan. Our organization represents over 2000 families
that will be affected by this measure.
ka,,.. Dtn, M.L>.
o.;,,, Pnr'u~ai
'l'uklo Fukuy•"'•· M.U
J•r•~
Chrillophcr Clllto.rs. M.C.
(;Otob>'¥ Swttd..,.,
ll.ict.or~ Hut. M.D.
Son O...o. Colof\lrno•
'""I' H11t..re. M.D.
Tukyc.
We thank you in advance for your
be.alf.
conside~tion
in our
Gottborli. Swoclrn
folkcr Honclcld. M.D.
Siaeerely,
Gotl'iP'I,tr.. CArm.H'l~
J•rntt H1rTit. "'.D.
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\lojo Holm. lo(D.
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C~o""', Sc.Jt!~nd
14won Kolodny. M.D.
Ne-.· 'York. ~~\IIIlo " " ' •
Patricio M11L1od. M.D.
Kathy Hunter
President
lf'ltish Colu,..ba. CaNd.:1
Hueo Moter, M.O
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8ollimoro. Maryla~d
'loohiloo Nom11ra. M.D.
TDl)'~ l•p•~
John Opou. M.D.
HeJtn.a. M'-'n\•1w
Alaa Percy. M.D.
lo~ft'.ir~Jhlrr.. ,t.lobomo
Moct.c: Pllillrp•"· M.D.
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Pilat ll.oodcl'lr. M.D.
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Jan "''ahlotro,.., M.D.
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Jollo Wlitof.. M.D.
WndOTI. ln~tand
Mi<htlt Z.prlli. M.D.
S...11. haly
Hutl• Zuahl>i. M.D.
""""""'· Trus
9121 PISCATAWAY RU .• I 2-B • CLINTON, MD 20735 • (301) 856-3334 • FAX (301) 856-3336
�MEMORANDUM
TO:
File
FROM:
Irwin Redlener, M.D.
DATE:
November 9, 1993
RE:
Problems with Canadian style single payer health reform
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
1.
U.S. Demographics, cultural and ethnic diversity and existing number of medically
underserved in the United States essentially very different from Canada.
2.
Having a single payer fee for service system is no automatic guarantee of access to care
for underserved populations.
3.
Single payer fee for service health systems may be more difficult to control for quality
of health care than more structured care environments.
4.
Single-payer, fee-for-service requires strict control of all fees in health care and strict
governmental control of resource distribution in order to meet underserved population needs.
Both controls, as well as financing concerns, require significant bureaucracy increases.
5.
The U.S. starts with a huge specialty and subspecialty imbalance which would drive an
encounter-based fee-for-service system in the wrong direction.
6.
A government budgeted fee-for-service tax-based system would be perpetually vulnerable
to political decisions cutting back care, endangering underserved populations.
�MELANNE VERVEER
�j:\reform\jurisd.
Administration's Health Reform Plan
Jurisdication of Ways and Means Committee
July 9, 1993
1. Medicare
a.
b.
Medicare prescription drug benefit
c.
"Incentives" for Medicare beneficiaries to join
organized deliver systems
d.
2.
Cost containment
Grant waivers to States to integrate Medicare into
State-based system
Mandate on employers and individuals--tax code is only
practical enforcement mechanism:
a.
Plan would require employers to pay up to 80
percent of the average alliance premium up to
fixed percentage of wages
b.
Plan would require individuals to pay up to 20
percent of the average alliance premium up to
fixed percentage of wages
c.
Self-employed and those with unearned income pay
premium up to a fixed percentage of income
3.
Surcharge (1%) on self-insured plans that form own
alliance
4.
Raise FUTA wage base to level of Social Security wage
base
5.
Penalties on States that fail to set up alliances
Reduce Highway Trust Fund money
6.
Standing-by authority to set insurance premiums
7.
Preferential treatment for long-term care insurance
8.
Tax credits for the disabled
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001a. memo
SUBJECTffiTLE
DATE
Memorandum for Hillary Rodham Clinton from Anthony Lake.
Subject: Naina Yeltsin's Request for Medical Assistance (1 page)
07/0111993
RESTRICTION
P1/b(1)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Melanne Verveer
OA/Box Number: 17607
FOLDER TITLE:
Background on Healthcare Reform [1]
2006-0223-F
ab613
RESTRICTION CODES
Presidential Records Act· (44 U.S.C. :Z:Z04(a))
Freedom of Information Act· (S U.S.C. SS:Z(b))
PI National Security Classified Information ((a)(l) of the PRA)
P:Z Relating to the appointment to Federal office ((a)(:Z) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted Invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified Information ((b)(l) of the FOIA)
b(:Z) Release would disclose Internal personnel rules and practices of
an agency ((b)(:Z) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4j of the FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
:Z:Z01(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001b. cable
DATE
SUBJECTffiTLE
Letter from Hillary Clinton to N aina Iosifovna Yeltsin. (2 pages)
07/03/1993
RESTRICTION
P1/b(1)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Melanne Verveer
OA/Box Number: 17607
FOLDER TITLE:
Background on Healthcare Reform [1]
2006-0223-F
ab613
RESTRICTION CODES
Presidential Reeords Aet- (44 U.S.C. 2204(a))
Freedom of Information Aet- (5 U.S.C. SS2(b))
PI National Seeurlty Classified Information ((a)(l) of the PRA)
P2 Relating to tbe appointment to Federal offiee ((a)(2) of the PRA)
.P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would dlselose trade seerets or eonfidential eommerclal or
finaneiallnformatlon ((a)(4) ofthe PRA)
PS Release would dlselose eonfidential advlee between tbe President
and his advisors, or between sueh advisors (a)(S) of the PRA)
P6 Release would eonstitute a elearly unwarranted Invasion of
personal prlvaey ((a)(6) ofthe PRA)
b(l) National seeurity elasslfied information [(b)(l) ofthe FOIA)
b(2) Release would dlselose Internal personnel rules and praetiees of
an ageney ((b)(2) oftbe FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would diselose trade seerets or eonfidential or financial
Information ((b)(4) oftbe FOIA)
b(6) Release would eonstltute a elearly unwarranted Invasion of
personal prlvaey ((b)(6) of the FOIA)
b(7) Release would dlselose Information eompiled for law enforeement
purposes ((b)(7) oftbe FOIA)
b(8) Release would diselose Information eoneernlng the regulation of
finaneiallnstitutions [(b)(8) oftbe FOIA)
b(9) Release would dlselose geologieal or geopbysleal information
eoneernlng wells ((b)(9) oftbe FOIA)
C. Closed In aeeordanee with restrietlons eontalned In donor's deed
of gift.
PRM. Personal reeord misfile defined In aeeordanee with 44 U.S.C.
2201(3).
RR. Doeument will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001c. letter
SUBJECTffiTLE
DATE
Letter from Hillary Clinton to Naina Iosifovna Yeltsin. ( 1 page)
[none]
RESTRICTION
P1/b(1)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Melanne Verveer
ONBox Number:
17607
FOLDER TITLE:
Background on Healthcare Reform [1]
2006-0223-F
ab613
RESTRICTION CODES
Presidential Records Ad- [44 U.S.C. 2204(a)l
Freedom of Information Ad- [5 U.S.C. 552(b)l
PI
Pl
P3
P4
b(l) National security classified information [(b)(l) of the FOIA)
b(l) Release would disclose Internal personnel rules and practices of
an agency [(b)(l) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information [(b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted Invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
flnanclallnstltutlons [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
National Security Classified Information [(a)(l) of the PRAJ
Relating to the appointment to Federal oflice [(a)(l) of the PRAJ
Release would violate a Federal statute [(a)(3) of the PRAJ
Release would disclose trade secrets or confidential commercial or
financial Information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRAJ
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy [(a)(6) of the PRA)
C. Closed in accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
OOld. letter
SUBJECTffiTLE
DATE
To Mrs. Helen B. Semler. [partial] (1 page)
[none]
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Melanne Verveer
OA/Box Number: 17607
FOLDER TITLE:
Background on Healthcare Reform [ 1]
2006-0223-F
ab613
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)[
Freedom of Information Act - [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) of the PRA[
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
. financial information [(a)(4) of the PRA[
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy [(a)(6) of the PRA) •
·
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose Internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed In accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record mislile.delined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Dear Mrs. Semler:
Thank you very much for your letter and for bringing to my
attention Mrs. Yeltsin's request for our help in improving dental
care for children in Moscow.
I will have the opportunity to meet with Mrs. Yeltsin next week
in Tokyo and I am very much looking forward to discussing this
and many other issues of mutual interest with her.
Since
receiving your letter, I have learned that plans have been made
to deliver American equipment for two dental clinics to Moscow in
August.
I am hopeful that Mrs. Yeltsin will be pleased to hear
next week that we can help to fulfill her dream of improving the
quality of care for _many of Russia's children.
I thought you
would also enjoy hearing about the progress that has been made
toward completing this project.
'·
Thank you very much for your efforts to bring this matter to my
attention.
Moscow.
I also want to thank you for the helpful guide to
I look forward to using it on my next trip to Russia.
My best wishes to you and your family.
Sincerely,
CLINTON
LIBRARY PHOTOCOPY
�THE WHITE HOUSE
WASHINGTON
June 1, 1993
TO:
Anthony Lake, Assistant to the President for
National Security Affairs
FROM:
Hillary Rodham Clinton
SUBJECT:
Naina Yeltsin
I have received the attached letter and article written by the
wife of the u. s. Consulate General in Milan, Mrs. Helen B.
Semler. As described on page 12 of her interview, Mrs. Yeltsin
has dreamed of establishing a children's dental clinic in her
country. Mrs. Semler also indicates in her letter to me, that
through Ambassador Armitage's efforts, they have been able to
"find the necessary equipment" for the clinic.
I would like to be helpful to Mrs. Yeltsin and apprised of the
status of u.s. efforts in this regard. Would it be appropriate
for me to call her and perhaps try to be of assistance?
I look forward to hearing from you soon.
�CONSULATE GENERAL OF THE
UNITED STATES OF AMERICA
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�THE MRS. YELTSIN'S STORY
BY Helen Boldyreff Semler
•I Believe in the Future of Russia.•
Throuqhout the remarkable political odyssey of Russian President
Boris Yeltsin, his wife Naina has maitnained a low profile. " I'm
only the President's wife" she insists. Her efforts to keep a low
profile and shun publicity led a Washinqton presswoman to dub her
a" Cold War wife". If anythinq, Naina is a woman who "came out of
the cold." She embodies an entire qeneration of Russian women who
qrew up in the Soviet Union, toiled for the "briqht Socialist future"
of her children only to see the failure and then collapse of the
Communist idea.
The friendly soft-spoken Naina can qrow stern when defendinq
her embattled husband and country:" My husband had been accused of
dismemberinq the Soviet Union",said Mrs. Yeltsin. "But this was not
his fault. This was Gorbachev's doinq. Had Gorbachev told the
Baltic states from the start that they could become independent
economic entities, the splitterinq of Russia could have been avoided.
Now everyone blames Yeltsin for everythinq. I hope he last out a
year," added Mrs •. Yeltsin with a note of bitterness.
Mrs. Yeltsin's words reflect the feelinqs of the men and
women on the street: the fear of spirallinq prices for oil,
the cost of food, corruption, crime and the erosion of President
Yeltsin's popularity.
The polularity issue, as such does not worry Naina Yeltsin:
•popularity fluctuates, but not the trust. People ~ontinue to
trust my husband." Naina's qreen eyes flashed with determination.
"I believe in the future of Russia. We wi.ll make it. It may take
ten years, but we shall make it ! •
The Home Maker
Seated in a comfortable red chair facinq the television set
which dominates Yeltsins' livinq room, Naina patted the arm of the
chair: "It needs re-upholsterinq", she said chanqinq the subject.
"In fact, all of our furniture needs re-upholsterinq. We brou~ht
it·with us
f.rom Sverdolvsk", she continued,surveyinq the sofa
and several more chairs also covered in red velvet fabric. "It's
old but homey.•
�Mrs. Yeltsin picked up a speck of dust from the qlass
top table and shook her head. "I haven't been home lonq enouqh
to even dust thinqs.• Naina was referrinq to knick-knacks displayed on the table, and the crystal, china and ceramic objects
in the larqe wall cabinet. None of them were antiques or items
of qreat value.
There were also many floral arranqements in the livinq room.
They were lovely, but the flowers were artificial. • I prefer
artificial flowers in the house", said Naina Yeltsin. "I can't
bear to cut flowers. They look so nice in their natural settinq.
In the sprinq I shall plant more flowers·and also potatoes at our
dacha."
The Yeltsins' apartment buildinq is located in what used to be
the ancient quild of Moscow coach-drivers; not a fashionable area
even today. The housinq reserved for the members of the Central
Committee of the former Communist Party, differs but sliqhtly from
those occupied by the diplomatic corps in Moscow: rectangular red
brick buildinqs span an inside court with untended qrass. The
apartment itself, has four rooms which the President and Mrs.
Yeltsin share with their youngest daughter Tania, their son-in-law
Lesha and their eleven-year-old qrandson Boris.
The kitchen is large and briqht and is equipped with a mircooven, "hardly a modern model", according to Mrs. Yeltsin. The
family usudly eats in the kitchen, as did Mrs. Yeltsin and I.
Naina does all her o~ housework and cooking. The meal she cooked
for me was delicious.
When asked about what she does in her leisure time, Naina
laughed: "Leisure, what leisure?" In addition to her qrandson
Boris, Naina also takes care of her oldest daughter's children
Hasha and Katia. She reads avidly to keep· up with the latest
developments, bears her share of official entertainment while
also attending to her husband's clothes: ".Perhaps it's a habit~
she says. • I choose his ties and look after his shirts and suits."
The American Interlude
The door bell rang. Mrs. Yeltsin who bas no staff went to
answer the door. She returned with a larqe framed pbotoqrapb of
Barbara Bush and herself taken in June of 1992 on the occasion
of Boris Yeltsin's presidential visit to Wasbinqton. Accompanyinq
Mrs. Bush's qift was a band-written note and the Russian trans-
�Mrs. ¥eltsln's story - p. J
lation. "She's terrific", beamed Naina recallinq her visit with
America's first lady.
"I want to remember every moment of this", Mrs. Yeltsin had
told the press on the occasion of her visit to Georqe Washinqton's
stately Mount Vernon mansion. There was somethinq symbolic in this
visit to the home of America's first president and the luncheon
which Mrs. Bush qave for some sixty women in Mrs. Yeltsin's honor.
Had Mrs Bush reminded Naina of what Georqe Washinqton had said upon
assuminq presidency -"I walk on untrodden qround"- Naina could have
ascribed them to her husband.
Like Georqe Washinqton, everythinq Yeltsin did and does "is
precedent." Earlier, on the day of the luncheon at Mt. Vernon,
President Yeltsin had set the precedent by beinq the first democratical
ly elected Russian president to address the joint session of the
United States Conqress. The date was June 17,1992 -exactly one
year and five days after the epoch-makinq election in Russia.
Seated in the first row of the visitors' qallery, Mrs. Yeltsin
outwardly controlled her emotions as her husband rose to address
the Conqress. The concentration, the anxiety, the tension were
in her eyes. Only when she heard the explosion of applause and
the ovation, did she whisper: "It went well. I am so proud." She
suddenly looked younq and happy. Could she have looked like this
at Boris Yeltsin thirty-six years aqo when her proposed to her on
the main square of Kuibyshev, an old Russian port on the' Volqa
River where his volleyball team was to play in the reqional competitior
The Courtship
Naina , alias Anastasia Girina was born in 1932 in the Orenburq
reqion of the Russian Federation to a family of poor peasants. "They
fared better than Boris' family," said Mrs. Yeltsin. She was referrinq
to Lenin's and Stalin's purqes durinq which millions were shot, uprooted and sent to labor camps where many farmers perished. "Our
livestock was confiscated, but at least my father was not arrested
as was Boris'. What a wonderful man he was: resilient and optimistic.
With ~~s qentle lovinq ways he was more like a mother to us."
Suddenly,.Mrs. Yeltsin's face clouded over. "Then this terrible
accident happened in 1968. A drunken motorcyclist rammed into my
father in front of his house. Tryinq to save mother, he stepped in fror
of her to shield her from the impact and was killed on the spot. I still
miss him," said Mrs. Yeltsin wipinq a tear.
�Mrs. Yeltsin story - 4
Although differing in temperament and appearance, Naina
and Boris have a lot in common. Both came from closely knit
families. Both knew poverty and privation.
Both learned
to
work as children. Both were accepted by the prestigious ural
Polytechnical Institute in Sverdlovsk, President Yeltsin's
birthplace. Both graduated from the Institute in 1956 with
construction engineering degrees.
When they met during their second year at the. Institute
Mrs. Yeltsin had not yet officially changed her name to
Naina.
Her leqal name was Anastasia but Boris called her
"Naia" or enderinqly "devushka", meaninq a "little maiden".
What attracted Boris to Naina was her modesty, friendliness
and warmth.
At first it was a platonic love, accordinq to
Yeltsin's bioqraphy: " She was one of the qanq of six boys
and six girls." The room housing the girls adjoined the
dormotory
Mr. Yeltsin shared with five other men.
met each evening and the orqanizer of all events was
Yeltsin.
After graduation, they separated: Naina went to
Orenburg, Boris spent the year workinq in sverdlovak.
"Boris had talked to me about marriage, but I never
knew if he was joking or serious.
All the girls
They
B~ris
�page 5
in our group were in love with him". Then one day, Mrs. Yeltsin received a cable signed by 'Sergei' , one of Boris' t::uddies.
"Boris
is suffering fran heart problans. Cane at once to Kuibyshev''. lauded the
cable.
Rananbering the complications Boris Yeltsin had suffered after a
bout with flu and not
findin~
anyone else who could help him, Naina took
the train to Kuibyshev."! had no problem finding the hotel where the
famous Sverdlovsk volleyball team was staying." Upon reaching the
hotel
Naina demurred. Nervous about going inside, she waited for one
of the team members to come out.
·~
should saunter out, but Yeltsin
himself, well and fit." said Mrs. Yeltsin.
" I then
learned" • she continued, "that Boris and Sergei wrote the
the telegram together. Sergei in whan Yeltsin had confided about 'his
heart problans' decided to speed things up. And so it was all decided.
We walked and talked all clay and all night."
Remembering this day, Boris Yeltsin wrote in his book " I fell
in love with her-tender hearted and good- for the rest of my life. She
accepted me the way I was, stubborn and prickly and, of course, it was not
easy for her with
me."
*
'n1e Yeltsins celebrated not one, bUt three
weddings: One with their friends in Sverdlovsk, the second with his own,
and the third with Naina's family in
Orenburg This was but the first of
their many tests of love.
*Quoted fran Boris Yeltsin's "Ispoved' na Zadannuiu temu", Moscow,l990
p.SS
�page 6
Riding the Tower Crane
Naina Yeltsin recalled the night when through a torrential rain she
her husband climbing
spottec:Va wind-driven tower crane. "Get down", it (the crane) will" collapse,
II
you will die", she screamed*. But Yeltsin, then working on his first construction project, kept climbing.
He brought the huge contraption under
control, just before the crane went off the rails. Naina also recalls that
for many years her husband dreamt about climbing the crane and crushing with it.
Indeed, Yeltsin's rise from a construction engineer to Sverdlovsk political
1
boss ( he became Communist Party member in 1961), to the first Secretary of
the Moscow City Party Committee and candidate member of the CPSU Politburo
in 1986, was a danger-filled ascent of the political ladder of power.
A Working Mother
"American wanen are liberated from house worries. Shopping is easy.
There are no queues. Food is plentiful and there are pre-cooked meals.
I hope one day we will be like them. For Russian wanen who work, keep house and
take care of the children the quest for food and the barest necessities of
life is a horrendous experience." Mrs. Yeltsin is very conscious of the
inflation.
Her husband ears 4000 rubles a month, which by recent dollar/
ruble conversion equals
20
US dollars. " How can one live when a pound
of meat is 125 rubles and the pensions range between one and three thousand
rubles?"
Mrs. Yeltsin never
dodges
questions.
Unlike her predecessor Raisa
Gorbachev who used to bombard Nancy Reagan with propaganda, Naina's answers are
honest and concise.
She also speaks from experience.
As a mother of two
daughters, Lena bom in 195'7 and Tania in 1959, she stood in lines, took
care of her family and held a full-time job.
Until 1988, when Mrs. Yeltsin
joined her husband in Moscow she was a construction engineer at the Institute
•
of Water Drainage in Sverdlovsk~ It was a demanding job since I had to
supervise a large staff, but I loved my work, " she said.
* Yeltsin.
p. 23
Nor
/
�page 7
could she count on her husband's help with children. "He usually comes
hane late from work at 10 or 11 at night. Should it happen fran him to return at
nine • it's a cause for a fanily celebration"* The only exceptions were Sundays
and holidays.
Togetherness
" Sundays wer celebrated ••• we went to the Restaurant ' Bolshoy
Ural' where we ordered dinner and ice cream" wrote Boris Yeltsin in his
biography. Holidays were fun-filled escapes with laughter, merry-making.
camping, hiking and boating. Only once there was a summer when the
children were too small to travel and Boris Yeltsinwent alone. Five
days later Naina received a cable: "Cane at once, I can't stand it".
Since then " we spend all holidays together", said Naina Yeltsin.
Despite President Yeltsin's gruelling schedule, Sundays and vacations are
still reserved for the family.
The favorite dish which Naina calls the "house
special" are pelemeni or meat d1111plings • Seated around the table the Yeltsins
relax, catch up on the latest news of their daughters, their son-in-laws and the
three
~rand-children.
Mrs. Yeltsin recalls that Tania, her younger daughter,
her boyfriend
llouldn' t admit to"/Lesha that Yeltsin was a member of the •nomenclatura •for
fear that he would reject her.
I said to her: ' He likes you as you are, even
though you are the boss' daughter. There's no problan." Yet when Taaia announced
her decision to marry Lesha, Naina referred the matter to Mr. Yeltsin: "Say
your word :• she told him, knowing fully well that the last word is always his.
Not this time. "She's the one to get married, let her decide" wrote Yeltsin.*
Naina likes to refer to her fanily as a "family of technicians". Lena,
following in her parents' steps is a construction engineer, Tania the second
child is a
~ter
technician. Naina and Boris did not hide their joy at the
birth of Tania's child - the long awaited boy. ( " We both love our daughters,
but knowing how nuch Boris wanted a boy .. I,too1 .wanted a boy to please him"
* ibid My/we
Yelt::in, page 46
*
�pageS
confessed Mrs. Yeltsin. )In honor of his grandfather, the newborn was
christened Boris and for the sake of the family continuity given the last
name Yeltsin. Like his grandfather, Boris Yeltsin Jr., a
wir~
dark-haired
lad, is an ardent sportsman and tennis fan. When Yeltsins moved to Moscow,
Boris parents gave up their flat and settled together with the in-laws into
the present apartment.
Luxury on Loan
For Naina Yeltsin the move to Moscow closed the first chapter of her
married life. She was now to enter the world of the pr1v1le1ed pol1t1eal east.
Her
husband's job as the candidate member of the mighty Politb.lro entitled them
to three cooks, four maids and a gardener. There were also other luxuries so
cherished by Mikhail and Raisa Gorbachev: the stretched "Zil" limousine, special
stores with foods not to be found elesewhere in Moscow, special clinics, beautifully
furnished apartment and dachas. "We were oven.ohelmed" said Naina Yeltsina when
shown Gorbachev's villa.
The Yeltsi.ns wanted
to know ,.no paid for all these luxuries:
The people
or the KGB? . "We didn~t want anything we haven't b.lil.t with our own savings"
I
I
said Naina.
I
all the.luxury .. is.on:.loaa.Nothing belongs to the members of COIIIIUniat elite, wrote
·
in Stalin •·s tiine
President Yeltsin, "Atot even their wives".* The Gorbachevs would soon learn the
She concurs with Boris that
the"probl~
with 'nomenclatu]:a' is that
'
veracity of Boris; Yeltsin's words: their beloved de-luxe villa in
Crimea was taken I!Nay from them and returned to Ukraine.
rAlso, JH\~ke Raise, Mrs. Yeltsin dislikes Moscow, the seat of the fotmerly privileged
class. " The seven years spent in the capital were the hardest. In Ekaterin~e
burg (former Sverdlovsk)/we we have lived for 35 years, life wasn't always smooth,
but each time I return to Moscow I suffocate."' said Naina Yeltsizl: ."In Moscow, my
ibid • Yeltsin, p. 72
�husband's hair turned white. In Moscow, also I stopped believing in Cormunism.'·
Naina's feelings about Moscow were juatlCl3blc Not only did she miss her
home and friends, but she was in constant fear for her husband's life.
Sleepless Nights
"We never go to bed before one o'clock in the morning", said Mrs.
Yeltsin. " I sleep when he sleeps." Since President Yeltsin seldan gets
more than four hours of sleep per night, Naina fares no better.
But during
the months that followed Mr. Yeltsin's defiant speech at the October 27,
1987 Central Committee Plenum, Naina hardly closed her eyes.
Boris Yeltsin
struck at the very core of the 'nomenclatura", the privileged political
class. Naina knew the risk Boris ran in at tacking the two 'taboos' : the
Communist Party privileges and the party leadership.
Gorbachev's glasnost
did not extend that far.
On Novanber 9th, thirteen days after the October Plenum, Yeltsin
collapsed. The sleepless nights, the tension, but above all the betrayal of
his colleagues were too much, even for Yeltsin.
His nerves shattered. with
pains in the chest and a splitting headache Yeltsin was rushed to the
hospital.
''They wouldn't even let me see him", said Naina. "Only on the second
day was I allowed to visit him in the Kranlin clinic. He looked terrible.
His headache worsened and he was punped full of vallum ..... Just then a
phone call cane fran the Kranlin. It was Gorbachev. " Mrs. Yeltsin did
not hear the conversation, except for her husband's interjection: "But
I can't even get up to go to the bathroan".
What
transpired was that
Gorbachev cognizant of Yeltsin's popularity and seething over Yeltsin's
personal attack on him, was plotting his rival's ranoval fran the Moscow
and Politeuro.
City Councili Upon hearing Yeltsin say that he could not get up, Gorbachev
allegedly snapped: " Never mind, the doctors will help you."
* Yeltsin,
p. 85
*
�page 10
seeina her husband struggling out of bed, Naina first tried to
plead with him, then said; "Over my dead body! " But Yeltsin went to
the meeting.
He was fired from his job, but survived because of the
tranquilizers pumped into him." Hours later, the doors swung open", recalled Mr. Yeltsin. Plekhanov the head of the 9th Department of the KGB
entered the hospital room. Behind him came the four body guards carrying
Yeltsin on the stretcher.
At the sight of her husband Naina could no longer contain herself. She pounced
on Plekhanov:''Tell Gorbachev, he is a Fascist.
He wants to kill my husband.
What a farce to give him bodyguards and then try to murder him."
ln the US
such and outburst would seem normal, but in the Soviet Union, even during
Gorbachev's openess, the KGB was a fear-inspiring institution, particularly
for people like Naina who grew up under Stalin.
Pariah's Wife
fhl4.l
Ancl,.s6 Naina's existence as a wife of a Camlmist party boss came to
an end. Gorbachev first tried to persuade Yeltsin to retire. (" He will ,
never get near politics again", Gorbachev allegedly said). Then Gorbachev
changed his tune and persuaded Yeltsin to accept the job as the First
Deputy of the State Committee for Construction, a humiliating d~tion. Yeltsin
his
took the job, but/ depression persisted. There were even talks of his attempts
to take his life, which Nai.na Yeltsin denies. Many Rusaiana beliew he was pushed
into the Moscow River on a winter night by his political eneDies.
But before long Boris Yeltsin realized he was not alone. " Of course,
we supported him as llllch as we could", said Naina. " We would sit by his
bed
through the nights, my daughters and 1 taking
turns. Nor did his friends
from Sverdlovsk and Moseow let him down. '"Thousands of letters, telegrams and
goodwill messages poured
of political
retira:~ent.
~n.
Yeltsin bounced back. There was no more talk
Gorbachev won the tirst round, but the battle was still
ahead."
Cut off from the Communist party base, Yeltsin became the people's idol,
a hero to the man on the street. Overcoming enormous odds, with 89.6 percent
of the votes, Yeltsin secured the decisive election to the Congress of USSR
�.
---
pagell
People's Deputies. In May 1990, Naina rejoiced at her husband's
election to the Chairmanship of the Russian Republic Supreme Soviet.
Yet ...tlen two months later Boris Yeltsin dr1111atically resigned fran
the Camlunist party and threw in his party card, Naina hung on to
hers. " I waited because I could not face the members of our housing
conmittee, all diehard Camunists. I stopped paying my dues, hoping
the conmittee would simply cross off my name. But then saneone said
that nothing would please the cannittee more than to "fire me and
make a big thing out of it in the press."
rhe August 1991
coup was to prove a yet greater test of endurance.
1
The Guns of August'
E.Ven today, Naina can hardly talk about the aborted coup.
I still relive the horror of these three (August 19-21) days."
as
During the days under seige in the White House -/the white skyscraper
housing Yeltsin's government is called- Naina heard only once from
her husband: "I'm alive and well",
said Yeltsin. "Don't· go outside and
keep the children in the apartment. You could be taken hostages."
The ...tlole family huddled together in Yeltsin's
four room apartment
with only three armed men to guard them.
Zhenia, Mrs. Yeltsin's personal bodyguard was full of praise
for her: "She was a tower of strength and inspiration to all of us.
She read to the children and played with them and cooked for everyone."
The worst .moment cane at one o'clock in. the morning of August 20th,
recalled Naina.
" There was a sudden announcement that the White
House was overrun by the. GKCHP, 'My heart stopped. Like the majority
of Muscovites tuned to ''The Ec.hc of Moscow" the only free radio that
kept on functioning, Mrs. Yeltsin did not realize that the superimposed message was phoney.
"I told my daughters not to wake up the children. If they
*
were to be shot, let them die in their sleep." she said.
GKCHP- The pro-Communist coup committee
�page 12
Interestingly, both Mrs. Yeltsin and Mrs'Gorbechev had visions of
their families being .shot, as were the Romanovs.
For Mrs. Yeltsin
the demise of Nicholas II, his wife, daughters and heir Alexis,
closer to home than for Ra1sa,
1••
• The house where the Russian imperial
family was assassinated was located in Ekaterinburg , or Sverdlovsk as
it was known to Naina. While party boss in Sverdlovsk, Yeltsin received
secret orders fran Politburo to level the site of Rananovs' last suffering.
lohen asked how she survived the ordeal, Naina replied: " I prayed."
The Yeltsins are all bapthed, but Naina never went to chureh before she
carne to Moscow, nor had ever had religious education. ''Yet when Iom in the
church I feel good. God has helped me to go through the ordeal."
The President's Wife
"I never thought niy husband would be President", said Mrs. Yeltsin.
As for herself she does not relish the role. " I shudder when people call
me first lady", she added. "It's different for Barbara Bush and other
wives of European leaders. In our country the conditions are totally different.
everything a wife says or does becanes a political intrigue, calculated
at hurting the President. I don't want to add to his burdens. He and
I made a deal that I would not mix our family life with politics, but
if possible I would like to do sanething, something for children."
'I have a dream'
Naina Yeltsin who can never resist hugging a child be he white, yellow
or black, has a dream. It is such a
s~le
dream, unless one lives in Russia.
"I would love to see a dental clinic for children, where Russian dentists
could learn and train in treating children's teeth and in orthodontics. OUr
dental eare is a disaster. There are ~roper pain killers, the drills are
antiquated and the children dread the sight of a dentist. But what can I
do.7 We need so many things in our country." she added with sadness.
I
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�page 13
would also like to see paintings of Russian 19th century masters
in American and European museums. • Unfortunately,• according to
Mrs. Yeltsin, • for the majority of Westerners, Russian art is
either the icon or the works of the early 20th century painters."
She wouid welcome an exhibit in the US illustratinq·the continuity
of Russian art traditions spanninq·pre-petrine Russia with modern
paintings. " If I had time", she added with regret, " I would go
every day to an art gallery or to a concert, a classical music concert,
that is.•
I asked her what she thought about Hillary Clinton. Mrs.
Yeltsin pondered then .answered: " It's hard for me to judge Mrs.
Clinton since I have not had a chance to meet her. But from what
I read, she seems to be an intelligent dynamic woman.•
Wrap It Up and Bring It OVer
Before leaving I wanted to know what Mrs. Yeltsin liked most
about America. Without hesitation, she replied: • Everything. To
quote a countryman of mine: 'Just wrap it up and bring it over.' "
I
I
I
I:
I
CLINTON LIBRARY PHOTOCOPY
�TABLE OF CONTENTS
'HOUSE
H.R. 1200, "American Health Security Act"
-- McDermott (D-WA)
1
H.R. 2610, "The MediPian Health Care Act"
-- Stark (D-CA)
2
H.R. 200, "Health Care Cost Containment and Reform Act"
-- Stark (D-CA)
3
H.R. _ _,"The Managed Competition Act"
--Cooper (D-TN)
4
H.R. 101, "Action Now Health Care Reform Act"
-- Michel (R-IL)
5
H.R. 1398, "Flexible Medical Access and Cost Containment Act"
-- Cardin (D-MD)
6
H.R.
, (Under development)
-- Kasich (R-OH)
7
SENATE
S. 325, "BasiCare Health Access and Cost Control"
-- Kassebaum (R-KS)
1
S. 1057, "The MEDICORE National Health Act"
-- Jeffords (D-VT)
2
S. __ , (Under development)
-- Chafee (R-RI)
3
''
�THE WHITE HOUSE
Office of the Press secretary
october 27, 1993
For Immediate Release
PRESIDENT N1MES JUDGES FOR ARKANSAS, MASSACHUSETTS AHD NEW YORK
President Clinton announced the nominations today of six
Federal District court judges in three states:
Harry Barnes, Western District of Arkansas
Nancy Gertner, District of Massachusetts
Reginald Lindsay, District of Massachusetts
Patti saris, District of Massachusetts
Richard Stearns, District of Massachusetts
Allen Schwartz, southern District of New York
"Each of these judicial nominees has had a legal career
distinguished by high levels of achievement and the respect of
their colleagues, n said the President. "I expect great things
from each of them on the Federal bench."
Barry Barnes has been a state court trial judqe in camden,
Arkansas since 1982. He had previously been a partner in the law
firm of Gaughan, Laney & Barnes, and served as a Municipal Judge
for Camden and ouachita County. He also served in the u.s.
Marine Corps for five years of active duty and thirty years in
the Reserves, from which he retired as a Colonel. Barnes, 61, is
a graduate of the u.s. Naval Academy and the University of
Arkansas Law School. He and his wife, Mary Mann Barnes, have
four children.
Nancy Gertner is an attorney with the Boston firm of Dwyer,
Col lora and G.ertner. She previously worked in practiced with
several other firms. In addition, she has served as a Visiting
Professor at Harvard Law School and as an Instructor at the
Boston University School of Law. Gertner earned her B.A. from
Barnard College, and an M.A. and J.D. from Yale University. She
is married to John c. Reinstein and is the mother of two
children. She is 47 years old.
(more)
�October 27, 1993
page two
Reginald Lindsay has practiced civil litigation at the firm
of Hill & Barlow in Boston since 1978. He has previously served
as Massachusetts Commissioner of Public Utilities, and as a
director of the United Way of Massachusetts Bay and the National
consumer Law Center. A graduate of Morehouse College and Harvard
Law School, he also studied at the University of Valencia, Spain.
Lindsay, 48, is married to Cheryl Hartgrove Lindsay.
Patti Saris is an Associate Justice of the Massachusetts
Superior court. She was previously a.United States Magistrate
Judge, and Assistant u.s. Attorney for Massachusetts, and served
as Staff Counsel to the u.s. Senate Judiciary Committee. Saris,
a graduate of Radcliffe College and Harvard Law School, is
married to Arthur I. Segal and has four children. She is 42
years old.
Richard Stearns has served since 1990 on the Superior Court
of Massachusetts. Prior to that, he was Assistant u.s. Attorney
for Massachusetts, serving as head of the general crimes unit,
chief of the criminal division, and senior litigation attorney
during his eight years in that office. He had previously served
in the Norfolk District Attorney's Office. Stearns, 49, holds a
B.A. from Stanford University, an M.Litt. from Baliol College,
Oxford, and a J.D. from Harvard Law School. He is married to
Patricia M. stearns.
Allen Schwartz is a litigation partner in the New York law
firm of Proskauer, Rose, Goetz, & Mendelsohn, and was previously
the senior partner of Schwartz, Klink, & Schrieber. From 197881, he was the Corporation Counsel of the City of New York. A
graduate of Baruch College and the University of Pennsylvania Law
School, he served in the u.s. Army and the Army Reserve from
1958-65. Schwartz and his wife, Joan Teitel Schwartz, have three
children. He is 59 years old.
#
#
#
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- 2 -
protections and safeguards we have built into this, particularly the
global budget. The reason the global budget mechanism is there,
albeit on a backup basis, is precisely to ensure that in the event
that managed competition does not produce savings at the rate we've
projected, although we believe it will, that that backup mechanism
can be invoked and that the ceilings on premiums which are inherent
in that mechanism will take effect. It would be mandatory. And I
think it's important to realize that with that tool, it's very
unlikely that the ceilings would be reached.
There is also, of course, the point which was made last
night, worth reiterating, about the cushion. There's a $45-billion
cushion over five years, built in for protection. I believe that is
indexed and so would grow. But that's precisely for purposes of
providing an extra degree of protection, and I think reflects the
fundamental conservatism of our projections. And it's simply our
view that it's far-fetched to think that the ceilings represented by
that capped entitlement would be breached, and that we'd have to face
the situation of dealing with that. Of course, nothing is guaranteed
in life, and the purpose of those ceilings is to prevent this being a
blank check on the Treasury. But we very much doubt it would come
into play, given the mechanisms and the safeguards that are in place
before that.
Q
How do you respond to Henry Waxman and his concern
that people are going to get cut off, they're not going to get the
care that they're being promised?
DEPUTY SECRETARY ALTMAN:
Well, Andrea, the first
answer is, it's -- the question was, how does one respond to Henry
Waxman, who is concerned that benefits could be cut off, The first
part of the answer is, we just don't agree on the likelihood. We
consider it unlikely in the extreme that that would happen. The
second is, there will be plenty of advance notice. There's an alarm
bell, or early warning type featured of this, such that you wouldn't
be surprised and you'd have time to make adjustments.
We faced a problem like that, albeit under very
different circumstances, in 1982 with Social Security. And if you
remember, the Greenspan Commission was established on a bipartisan
basis involving the congressional leadership. certain adjustments
were made.. There were no solvency crisis involving Social Security.
I think the mechanism worked. I have no idea whether any like
mechanism might come into play here. I'm just saying that it's not
unprecedented to face a situation like that. But, fundamentally, our
view is that it's not going to happen.
Q
can you tell us how that subsidy pool will work,
how the funds will carry over from year to year, and what that early
warning mechanism is?
DEPUTY SECRETARY ALTMAN: Well, on the first part of
your question I'm not the best witness •. And maybe-- do you want to
answer that? We'll come back to that in just a moment.
of some sort?
Q
Is it a trust fund?
What is it?
Is it an appropriated account
DEPUTY SECRETARY ALTMAN: You're talking about the
subsidies that float through the alliances?
Q
Right, the federal subsidy pool that is apportioned
to the alliances to cover employer and individual subsidies.
DEPUTY SECRETARY ALTMAN: Well, maybe I'll answer this
too broadly, but,. fundamentally, those payments, just like employer
premiums, flow through the alliances to beneficiaries. For example,
the maintenance of effort required in terms of Medicaid -MORE
�/
THE WHITE HOUSE
· Office of the Press Secretary
~or
October 27, 1993
Immediate Release
PRESS BRIEFING
BY DEPUTY TREASURY SECRETARY ROGER ALTMAN
AND SENIOR ADMINISTRATION OFFICIALS
The Briefing Room
4:12
P.M. EDT
MS. ROMASH: I know Andrea will protest. someone will
protest. The first five minutes, lights and sound. Mr. Altman is on
the record. After that, Mr. Altman will be on the record. The other
folks here are senior administration officials from a variety of
agencies who have played an integral part in crafting the plan.
They'll be helping and those folks are to be identified as senior
administration officials. Roger will be on the record.
Q
I think protesting in favor of having things on the
record is good journalistic principle, Marla.
MS.
ROMASH:
So noted.
DEPUTY SECRETARY ALTMAN: Good afternoon, everybody.
Basically, we're just going to take questions. I just want to spend
a minute in the beginning trying to clear up any confusion about
three things. There may be some confusion, I'm told, about the date
by which the President's plan is fully implemented, by which
··universal coverage is in the hands of all Americans, and that date is
the end of 1997. The first states come into the alliances in 1 95;
the second group of states in 1 96; and finally, the remaining states
in 1 97.
Second of all
difference
Q
Last night they said January 1,
DEPUTY SECRETARY ALTMAN:
Q
you're talking --
Is that the same?
DEPUTY SECRETARY ALTMAN:
Q
98.
By the end of
1
So what's the
97.
You're not talking fiscal years,
That's right.
So it's still January 1,
DEPUTY SECRETARY ALTMAN:
1
1
98?
That 1 s right.
Second of all, there's some reports this morning
misinterpreting this 3.9 percent cap on individual income. The
maximum-any person would pay is a share of their individual income.
That is a ceiling, that is not a mandate. Any implication that
everyone will pay 3.9 percent of their income for he.alth care is just
wrong. The average will be just under two percent, I believe, as
we've calculated it. The 3.9 percent is simply a ceiling.
.
Last of all, I want to say a word about this issue of
the cap entitlement.
Two or three points. It is most unlikely that
that ceiling would be reached, and that has to do with the
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�- 3 -
Q
They float from where? Is there a trust fund at
the Treasury? You're talking about carrying this over from year to
year, about having a cushion. Where do these funds come from?
DEPUTY SECRETARY ALTMAN: Well, you've seen the sources
of financing, I assume. You've seen the Medicare reductions, the
Medicaid reductions, the revenue impacts, the tobacco tax, the
corporate assessment. That's where those sources come from -- that's
where those funds come from.
Q
The President told us --
DEPUTY SECRETARY ALTMAN:
Q
No.
DEPUTY SECRETARY ALTMAN:
Q
implies a reserve.
Did I answer your question?
Go ahead, I want to answer it.
You're talking about having a cushion. A cushion
Is there a fund somewhere, a trust fund --
DEPUTY SECRETARY ALTMAN:
I see.
I'm sorry.
I see.
Q
-- something that is reserved for this purpose?
You're talking about carrying over from one year to another.
DEPUTY SECRETARY ALTMAN: The answer to that, if I
understand the question, is no. There's not a specific trust fund.
It's a matter of making conservative assumptions and then adding a
contingency to your estimates. It's a contingency factor in the
numbers themselves.
Q
Do you have estimates of how many low-income
Americans will receive discounts or subsidies, and how many small
businesses will receive discounts or subsidies, and what will be the
annual amount of subsidies for small businesses when fully phased in?
SENIOR ADMINISTRATION OFFICIAL: Let me just start with
the distribution of the subsidies. The discounts would go in the
following proportions: About 30 percent of it would go for employer
·payments.. And we're in the process now of making a breakdown amongst
employers by firm size about where those go, but 30 percent would go
for employer payments.
About 54 percent would go for households. Most of that
goes to individuals who are not working or unemployed. Three percent
of them go to cover out-of-pocket .subsidies for low-income
individuals. And as we've talked about, another 13 percent to 15
percent, in that range, is essentially this cushion that we built
into the baseline, into our base estimates.
on that, I just want to make a quick comment just to
reinforce this issue of the numbers and how we've estimated them,
because I think it's important to recognize that there's two parts of
this.
As we've talked about a lot, we have, in addition to our
best estimate, built-in a 13 percent to 15 percent additional amount
of money. But I want to make a point about just the base estimate.
Because, as Roger has already mentioned, that basic estimate is, in
and of itself, ·a very conservative number, and I want to just very
quickly_give you three reasons why it's a conservative number.
Any time in our estimates that we had an option of
having the numbers work against us in terms of increasing the deficit
in our modeling, we had that happen. For example, we had two
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'·
�---,-
- 4 -
estimates of the premiums.
premiums.
We took the higher estimate of the
The second example is that there are 10 million couples
in this country, one of whom would work in a regional alliance, one
of whom works in a corporate alliance. The families have choice of
where they want to receive care, through the corporate alliance or
through the regional alliance. As you know, if you go to the
corporate alliance, the federal subsidies do not flow out into the
corporate alliances. Many of those individuals would choose the
corporate alliance. We assume they all chose the regional alliance,
therefore making our subsidy estimates larger than they're likely to
be.
The third example is that, as you can tell from our
small firm discount schedule, that those are available for firms
under 75; the 7.9 cap is available for firms under 5,ooo. Then in
our modeling, we assumed that for the special small firm subsidies,
that all firms under 100 were eligible for this, even though the
policy is only for under 75. And we built that number into our basic
estimates as well. So there's a half a dozen of other more esoteric
assumptions that I won't bore you with, but just -- I want to make
the general point that that estimate in and of itself was a
conservative number on which we built an additional cushion on top
of.
Q
Could you tell us how this cap mechanism works? Or
could someone else tell us how that works? I mean what triggers it
and what happens?
DEPUTY SECRETARY ALTMAN: Well, fundamentally, there are
a lot of capped entitlements in the federal system and the pay-go
rules under the budget apply if the cap is hit. In other words, the
Congress can reduce spending in other areas to finance the excess
over the cap, theoretically, but not under present circumstances
certainly, raise taxes to finance the excess. It's not any different
than similar caps that apply today under the budget rules.
entitlements?
Q
such as?
Could you compare it to some other capped
.
DEPUTY SECRETARY ALTMAN:
the best example.
Food stamps would probably be
Q
Clinton had told us what he would not compromise
on. What will he compromise? Give us two or three or four examples
where he's prepared to compromise.
DEPUTY SECRETARY ALTMAN: I don't know, for some reason
that question kind of leaves me a little cold. I think the point is
that there are several principles -- you know what they are -universal coverage, a comprehensive and a defined benefit package,
choice, simplification, savings, quality -- which undergird this and
which are not negotiable. I would draw an analogy to the budget.
The President laid out a series of principles for the budget on
February 17th, and while the details in so many respects were revised
in the legislative process, as they always are, those principles were
in place at the ,end on August 6 when the final votes. were taken. And
that will be.the case today because public support for those
principles is so high.
The legislative process is what it is. It involves
compromise. It involves change. Mrs. Clinton has signaled so many
times that we're prepared for that. we want a bipartisan outcome.
And we think we can achieve a bipartisan outcome, but that requires
compromise.
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�- 5 -
Q
For example, the National Health Board. Is that
something that is negotiable, as the BTU tax was during the budget
panel?
DEPUTY SECRETARY ALTMAN: Well, I'm not going to get
into the issue of what's negotiable and what isn't. Nobody -- you
don't negotiate against yourself before the negotiations have
started.
Q
could you go through since a month ago the changes
you have made in your estimates of deficit reductions and savings -possible savings from Medicare and Medicaid and say what has changed
in your assumptions or in the plan overall that has caused you to
make those changes in the overall numbers?
DEPUTY SECRETARY ALTMAN: Why doesn't someone else come
up here with me so we can do it together.
SENIOR ADMINISTRATION OFFICIAL: What has to do in the
changes in the assumptions about savings in Medicare and Medicaid
savings and deficit reduction?
I'll just start on the Medicare piece of it. As you can
see the amount of Medicare savings that is in the President's plan
are the same as what was in the in the leaked draft. So they were
both around $124 billion.
Q
But isn't that in four years?
SENIOR ADMINISTRATION OFFICIAL: No, it's starts with
the same period. It's basically the same number over the same time
period.
on that side, had we technically -- we changed to a
higher CPI assumption, and if we used the same criteria to come up
with the Medicare savings that would have been generated with the
higher CPI, the number would have been a little bit higher than $124
billion. But we stuck with $124 billion because we had a package of
programmatic changes that we wanted to make.
The Medicaid side, again, you see that the estimated
expenses ~f the discounts are somewhat slower, only because of the
slight difference in the pace of when people flow into the system.
And on the other side, the Medicaid savings are a little bit lower as
well because, remember, the Medicaid savings are directly related to
the pace of when people come into the system. There's two sources of
the Medicaid savings; there's the phasing down of disproportionate
share payments under the Medicaid program. That phase-down happens
at the same pace that people come into the system.
Second, there is a savings to states as well as the
federal government for the cash assistance population because, again,
as states come into the alliance, the cash assistance populations are
folded in. And those savings to states happen then as people flow
into the system.
Q
And that accounts for all --
SENIOR ADMINISTRATION OFFICIAL: That accounts for
almost all of the differences in Medicaid savings between the earlier
draft and what's in the most recent numbers.
Q
When you say almost, what else is included?
SENIOR ADMINISTRATION OFFICIAL: There's a slight
difference there with respect to the assumption by the federal
government of picking up these state expenses for the wrap-around
services for kids. There are a set of services that are somewhat
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�- 6 -
outside of our covered set of services, transportation services and
so on, that we felt was just critical to continue and make sure that
those services to kids continued, and the state piece of that is now
going to be assumed by the federal
Q
That's less than 10 percent of the difference?
SENIOR ADMINISTRATION OFFICIAL:
percent of the difference.
That's less than 10
DEPUTY SECRETARY ALTMAN: There are also -- you asked
about the deficit itself, There are also a whole host of factors.
There's a different inflation assumption since the midsession review
was published, which has obviously an upward bias as far as costs are
concerned, You correct me if I'm wrong, but I believe the total new
revenues in the plan, which obviously has an impact on the deficit,
is a bit lower than the September 7th leaked draft by several billion
dollars. So it's a host of factors.
But I think a main point is, given the size of this
plan, the numbers didn't change very much. The difference on deficit
reduction is not really very large, given the six-year period
involved and the size of the plan and the astonishing number of
components of the plan.
Q
Could you review what changes you made on the early
retirees? Is the changes -- you now have an assessment on the
companies and the benefits?
DEPUTY SECRETARY ALTMAN: There will be three years
worth of assessments to the effect that 50 percent of the gains that
those companies would realize would be recaptured. After that, all
the gains would be to the account of the corporations. And those
assessments take place contemporaneously with the beginning of the
early retiree pickup, which I think is 1 96, 1996, I believe. Sorry,
1998.
Q
That's when the retiree kicks in?
Q
When you are talking about conservative
presumptions in your calculation, if you are putting the optimistic
ones in, what would be, money-wise, the difference?
SENIOR ADMINISTRATION OFFICIAL: If I was going to
actually, I was just in the process of trying to back out -Q
Some idea.
SENIOR ADMINISTRATION OFFICIAL: Out of the base
estimate right now, I can't give you an idea. I know that it's
probably -- I know that it's a nontrivial number because just the
second example I gave you of assuming all of those dual working
couples come into the alliance and receive, where appropriate,
subsidies, in and of itself is probably a large number. I don't have
the number with me, but I think it would probably be useful to lay
out the whole set of areas where we made some conservative
assumptions to see if we can't come up with some numbers.
Q
Does the cap in any way prevent deficit spending?
If the money does not come in, and services are being provided, does
the cap in any way prevent deficit spending?
DEPUTY SECRETARY ALTMAN: The answer is, yes. That's
what the· pay-go rules do. That's what such caps do. The difference
between a capped entitlement -- being very basic about it -- and an
open-ended entitlement is that if you reach the cap, you have to pay
for any excess over it. You cannot --
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�- 7 -
Q
So before a hospital can be paid or a doctor can be
paid if the alliance is out of money, Congress has to raise taxes or
cut spending, or come up with the money? Would it not just go out?
DEPUTY SECRETARY ALTMAN: There are a whole host of
other things that could be adjusted. Premiums could be adjusted and
so forth. But the point here is, it's very unlikely and it would not
in any sense happen overnight. There would be a lot of advance
indications to this effect and a process like I mentioned before that
we used in 1 82, some process like that would come into effect. I
don't believe we would ever get to the point, myself, where you'd
actually be at the cap without having determined already in advance
how to accommodate that.
Q
can we turn that question around -- if you don't
spend so much that you don't have the contingency fund of $10 billion
or $12 billion a year, will that money go directly towards deficit
reduction?
SENIOR ADMINISTRATION OFFICIAL: That's what carries
over year by year and creates a large -- could create a larger fund.
That would not get wiped off the pay-go score card.
SENIOR ADMINISTRATION OFFICIAL:
somewhere in a reserve.
That is held in fund
DEPUTY SECRETARY ALTMAN: Well, correct me, I don't
think we've proposed a specific fund mechanism for that.
SENIOR ADMINISTRATION OFFICIAL: No, I don't think
ther.e's anything in there. That would just be an accounting decision
in any case. But the notion is it builds up and carries over.
Q
Do you have an estimate of how much -- what
proportion of the health care burden, when the plan is fully phased
in, will be borne by American business and how that compares with
today's situation?
DEPUTY SECRETARY ALTMAN: Well, I think I saw the other
day -- and please correct me -- that American business as a whole
over the entire period would pay $25 billion more.
Q
Which period?
Q
That.• s $25 billion a year?
DEPUTY SECRETARY ALTMAN:
don't want to mislead you.
Let's get this straight.
I
·sENIOR ADMINISTRATION OFFICIAL: Again, the-- I told
you I'd get back to you on that. So you're raising it again,
appropriately •. It is after 4:00p.m., I remember. What we've done
is that we've looked at these numbers in two ways. One is assuming
that it was fully implemented in a particular year and then what
happens to what business and household and governments spend over
time when it's fully phased in.
As you've seen from our earlier draft and remains true
under this version as well, is that by 1998 and 1999, what business
in its entirety, what households in their entirety, and what
government spends is going to be less than what is projected under
the CBO baseline rate of growth and national health care
expenditures.
·
Q
By how much?
Q
Can we follow up on that?
percent of this
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Businesses pay 59
�- 8 -
Q
No, no -- it's a different number.
SENIOR ADMINISTRATION OFFICIAL:
Let him finish.
That's the fully phased
in number.
Q
What is the number?
SENIOR ADMINISTRATION OFFICIAL: Let me give you the
one-year number. I don't have the five-year numbers here with me,
but I will -- I promised I would get them to you and I will get them
to you. The one-year number is that if this was fully phased in -just so you can get a sense of the change in spending -- is that just
for the basic benefit package piece of this, that if it were fully
phased in during 1994, which, of course, it's not going to be, but in
1994 we're projected to spend about $998 billion.
DEPUTY SECRETARY ALTMAN:
As a nation.
SENIOR ADMINISTRATION OFFICIAL:
for total national health care spending.
Q
As a nation, overall,
That's not private --
SENIOR ADMINISTRATION OFFICIAL: That's everything -public, private -- that's all national health care e~enditures. If
the plan were fully implemented in today, because we're covering the
uninsured and the underinsured, we think national health care
expenditures would rise by about $60 billion to $65 billion.
Of that, about $25 billion would be new spending by
business, about $14 billion would be new spending by households,
about $35 or $36 billion would be new spending by government, federal
government. And we think that at least -- and this is the one that
we haven't been able to spend as much time on -- but there would be
at least a $14-billion reduction in state and local spending. That
number is probably a little bit larger. A lot of that reduction has
to do with the fact that state and local governments make tax levy
support to public hospitals to support those institutions for the
unins~ed.
.
SENIOR ADMINISTRATION OFFICIAL: I think it's important
to note, too, that of that $35 to $36 billion in government spending
-- a lot of that is a direct offset of what households and businesses
are now spending. Costs will come down for some businesses and some
individuals as a result of caps and discounts.
Q
But overall, the cost would go up for all parties.
What you're saying is the costs within these categories, some people
would pay more, some less.
DEPUTY SECRETARY ALTMAN: Let me just add maybe a point
that provides some perspective. Start from the proposition that
health care costs are rising.explosively for business today. And
that absent reform, health care costs will be a lot higher, say, in
the year 2000, than they are now -- a lot higher.
Q
Can you give us comparable figures, absent reform
how much it would go up in these various sectors if there were no
reform?
DEPUTY SECRETARY AtaMAN: I don't happen to have that
number with me. But we all know -- I don't have it with me.
Q
This last number -- this $998 billion figure -that's what spending would be without it being phased in and if you
had fully phased it in in 1994, it would be $60 billion to $65
billion higher than the $998 billion?
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�- 9 -
SENIOR ADMINISTRATION OFFICIAL: Right. I just want to
make sure that we all understand that that's hypothetical, because
the plan doesn't do that, all right?
Q
So when does the savings kick in?
SENIOR ADMINISTRATION OFFICIAL: Those are not the real
numbers of what's going to happen because that's not what's going to
happen.
SENIOR ADMINISTRATION OFFICIAL: What will happen, as I
started to explain, was that right now we spend about $998 billion,
the estimate is in 1 94. Without reform in the year 2000 we'll spend
$1.613 trillion. Okay?
Under the plan there will be a slight increase -- and I
have to give you the actual numbers -- there will be a slight
increase in household and business and government spending through
1998. And then spending will be less overall, starting in 1999, 2000
and the year on out. So there's a slight increase initially, and
then by 1 98 we'll spend less as the system brings itself in. And by
the year 2000, we'll spend less than what is projected to be under
the baseline.
Q
proportion of business spending versus
government versus household --
SENIOR ADMINISTRATION OFFICIAL: The proportions remain
almost the same. This is today predominantly a private system. It
will remain tomorrow predominantly a private system. Those
proportions shouldn't have much movement. But I'll give you exactly
what those numbers and proportions are.
DEPUTY SECRETARY ALTMAN: I'd just like to for a second
repeat or try to finish what I was attempting to say.
It's our view, or at least it's my view, that over the
long-term, business will spend less with reform than it would
without. As I said, you start from the proposition that business
costs are exploding here. You start from -- you add, I think, the
propositiQn that this is not only phased in over a series of years,
but then takes a series of years to take effect. And you know that
we've projected 19 percent of GOP if there's no reform, not a lot
less than that, a point and a half or so less than that by the year
2000 because the reforms don't have a chance to kick in too much.
But if you look out, say, 10 more years, you're going to see a much
lower percentage of GOP being spent on health care. And business, in
our.view, is going to be spending less then by a lot than it would be
spending without reform. That's important, because this calculation,
as Ken said, it's very theoretical -- it's a 1994 dollars
·
calculation.
But the reason -- what I just said, I think, is the
case, is the average proportion of payroll that large businesses pay
or at least a survey I recently saw of large businesses ranges -- is
in the 10 to 11 percent range. And under our plan, as you know, when
it's fully phased in, businesses will be capped at 7.9 percent of
payroll. So right off the bat a lot of businesses win. Moreover,
and this is an area of particular confusion, a majority of small
businesses today provide coverage. But listening to the opponents,
you'd think they didn't. But a majority provides coverage. And, by
the way, about 80 percent of employees in small businesses today are
already covered. Those people pay through the nose for health care
-- average is 35 percent more than large business -- 35 percent more.
So they're all going to be put on an equal footing with large
business because they're going to be part of the alliance system.
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�- 10 And the biggest business winners in this plan are going
to be small businesses that already provide coverage, which a
majority of them.
SENIOR ADMINISTRATION OFFICIAL: Seventy-five percent of
businesses under 100 are currently insured. I think another point
it's not only that the percentages may go down, it's that they're
going to have more stability. Right now, the greatest -- two great
problems for a small business insuring is, one, the high cost at any
one time1 but, two, you may do well for a year or two. In the third
year, someone gets sick and you go up 50 or 60 percent. The small
business needs much more stability than that, and this is going to
give it to them.
Q
·Roger, under the draft plan there was a schedule of
allowable health expense increases per year, CPI plus one-and-a-half
the first year, going down to matching CPI -- did that remain the
same?
DEPUTY SECRETARY .ALTMAN:
Q
That does not change?
DEPUTY SECRETARY ALTMAN:
assumption.
Yes.
Yes, no change.
SENIOR ADMINISTRATION OFFICIAL:
Except for the CPI
Q
One number that changed a lot in relative terms it
seems to me is the revenue gains. Didn't that go from 51 to 71?
DEPUTY SECRETARY ALTMAN: I'm glad you asked that
question. Let me clear that up. There's an apple and oranges -apples and oranges problem there. The September 7 leaked draft had a
$51 billion revenue effect. That was defined as the higher taxes
stemming from higher wages and profits as business expenses for
health care turned out to be lower than we have -- than without
reform, than baseline. By the way, I'd like to come back and say
that's a reason why business costs are eventually going to go down
because we think -- and the Treasury models and the joint tax models
show that wages and profits are going to go up. But anyway, that's
what that ~as defined as.
estimate,
offset by
September
cafeteria
no longer
Now, that figure became actually $23 billion in the new
which gets into the apples and oranges issue. But it was
certain other categories which were not included in the
7th plan, the biggest of which is the proposed phase-out of
plans. When this is fully phased in, cafeteria plans will
be tax free to the beneficiaries.·
Q
Only with respect to medical?
DEPUTY SECRETARY ALTMAN: Yes, only with respect to
medical expenses. And that raises over the six years rather large
numbers --$30 billion. And so the revenue impact on an apples to
apples basis actually went down. That has to do with certain higher
inflation assumptions and other things like that.
Then, of course, we have different -- when you take the
category of revenues as a whole, you have a decision that was made
since the September 7th plan on the tobacco tax, which was not, as
you all know, made on September -- by September 7th -- for the $105
billion figure which in the September 7th draft was largely a plug.
And now the figure that you have -- I think, it's $89 billion -- is
the actual estimate based on the actual policy.
Q
That includes the corporate assessment?
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DEPUTY SECRETARY ALTMAN: No -- I'm sorry, it does
include the corporate assessment. That's right.
And you also have some other factors, like this
recapture on the early retirees, But fundamentally the total amounts
of revenues that would be increased through all these policy changes
is somewhat lower -- unless my colleague corrects me -- somewhat
lower, I believe, than was the case on September 7th.
Q
Your documents here seem to be a little
inconsistent about what you've done to dental benefits for adults.
Can you explain what that would be and in how it phases in?
DEPUTY SECRETARY ALTMAN: Oh, I've suddenly got a
toothache. (Laughter.) Well, let's see. We have added adult dental
on an ultimate basis, not to be phased in, I think, until 2001 or
2002, which was not part of the September 7th plan.
Q
No adult dental before 2001?
DEPUTY SECRETARY ALTMAN:
That's the main change.
be covered.
SENIOR ADMINISTRATION OFFICIAL:
Q
covered.
That's the main change.
Emergencies?
SENIOR ADMINISTRATION OFFICIAL:
Q
Emergency injuries will
Emergency injuries are
Because this document says preventive.
DEPUTY SECRETARY ALTMAN: As I said, adult dental was
not in September 7th, and it isn't now. That's the main change.
That's the main change.
Q
But it's in the year 2001?
DEPUTY SECRETARY ALTMAN:
preventive?
Q
Right.
And is it all adult dental or is it emergency or
SENIOR ADMINISTRATION OFFICIAL:
In 2001 there's restorative and preventive.
Q
emergency,
Now, there's emergency.
Now, it's emergency.
SENIOR ADMINISTRATION OFFICIAL:
I believe now it's
SENIOR ADMINISTRATION OFFICIAL: Now, not meaning this
draft, now meaning as soon as the plan is implemented.
Q
So you're going to phase in preventive and
restorative over -- between now and 2001.
Q
change.
But immediately emergency for adults.
SENIOR ADMINISTRATION OFFICIAL:
Right, which is a new
DEPUTY SECRETARY ALTMAN: Children's dental is in the
now. That was in the plan before: that's in the plan now. The
main difference is that adult dental, preventive and restorative,
which is what most of the dental expenditures are, will become
effective in 2001.
pl~n
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Q
Do you think that Gramm's battle cry that it's
socialized medicine is passe or will it be picked up beyond that in
terms of the mentality in the country, generally speaking?
DEPUTY SECRETARY ALTMAN: I don't think that's going to
resonate at all. We're not -- the federal government is not taking
over a single clinic, a single hospital, a single doctor. It's not
taking over a single insurance company. There's no nationalization
of medicine here. The alliances are creatures of the states. The
states appoint the board of the allia·nces, not the federal
government. We're sticking with the basic system we have today,
which is an employer-based system, and building on that. Obviously,
the President could have decided to go with the Canadian style
single-payer system, but firmly rejected that -- too much government,
would have required a broad-based tax to pay for it. I don't think
that resonates at all.
SENIOR ADMINISTRATION OFFICIAL: This chart that you
have, just to reinforce Roger's point, is a snapshot of what the
premium contribution would look like when our system is in place.
And as you can see, 59 percent would come from business, 17 percent
from households. It would be 76 percent private which is, as people
said, roughly what it is today.
Q
But the number associated with that last night was
$321 billion, as I recall -·
DEPUTY SECRETARY ALTMAN:
expenditures.
Q
over the six years --
-- which is about a third of national health
SENIOR ADMINISTRATION OFFICIAL: No, no , that's the
six-year total. The $321 billion was for premiums. That was a 1994
dollar figure. There's $321 billion in premiums for the covered
services for both the regional alliance and the corporate alliance.
And that is showing the distribution of how those premiums are
financed.
DEPUTY SECRETARY ALTMAN: I 1 m sorry, I thought you were
asking about total increased federal costs.
Q
The $321 billion is about a third, or less than a
third, of national health expenditures.
SENIOR ADMINISTRATION OFFICIAL: Right, because that
doesn't include out-of-pocket spending. It doesn't include
expenditures on long-term care and nursing home. It's on things that
are outside of the benefit package.
Q
Could someone -- Mr. Altman, could you please
explain the rationale for the early retiree program? I mean, some
people say that it could be counterproductive at a time when all the
baby boomers -- the start of the baby boomers in seven years will
reach 55 and people are living longer. People say that there ought
to be a policy that encourages people to work longer and not retire
earlier.
~
DEPUTY SECRETARY ALTMAN: Well, first of all, it's a
step toward competitiveness. Some of America's most important
businesses are sagging under the burden of enormous costs for their
early retirees, people that, whether one likes it or not, choose
early retirement and already have done so. There's a very large pool
of early retirees out there who already have retired, where the
argument you just made about "wouldn't it be nice if they continued
to work?" is academic. And a lot of the auto companies and the steel
companies -- to pick two particularly prominent examples -- are
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experiencing enormous costs there, particularly since some of them
have more retirees than active workers. Perhaps the 55 to 65 yearold category is not a big as their active workers, but some of these
companies have two retirees for one active.
second of all, yes, there will be an induced retirement
effect. But on the other hand, that will create jobs for those who
replace them. And there's no way of knowing what impact that would
have on productivity. It's not a job loss to the economy.
But I think, fundamentally, we think it's -- we took
this step because this burden impacts our competitiveness. You know,
I •.m sure, that health care costs per vehicle are now higher than
steel costs, which is quite different than it is in, for example, in
Japan -- way different. And competitiveness was the reason.
Q
What is the proposed tax increase on snuff and
chewing tobacco and from where?
DEPUTY SECRETARY ALTMAN:
can answer that.
Q
My
colleague is here and he
What was the question?
DEPUTY SECRETARY ALTMAN: What is the impact of a
tobacco tax on non-cigarette tobacco products -- snuff, cigars,
right?
Q
Chewing tobacco.
DEPUTY SECRETARY ALTMAN: Chewing tobacco.
Philadelphia Phillies question. (Laughter.)
It 1 s a
SENIOR ADMINISTRATION OFFICIAL: The 75-cent-per-pack
increase for cigarettes was translated into a per-pound increase, and
that's applied to all tobacco products. I don't have the exact
number with me of how it will affect snuff or chewing tobacco.
Q
Is there any way to get that?
SENIOR ADMINISTRATION OFFICIAL:
Yes.
Q
But can I ask, just a question quickly, again,
about the caps on the subsidies? Am I right in understanding that
those are only on the subsidies or discounts, as you're sometimes
calling them, on payments to small low-wage firms and also low-wage
households, or are there similar caps also that are being made to,
for example, expenditures for the early retirees or expenditures on
prescription drugs? I mean, are these qlobal caps or are these caps
limited specifically to those two categories of federal expenditure?
DEPUTY SECRETARY ALTMAN: The only subsidy -- rather,
I'm sorry -- the only spending -- unless someone corrects me -- which
is not subject to a cap is the Medicare drug benefit.
subject?
Q
Medicare drug benefit is the only one that's not
DEPUTY SECRETARY ALTMAN:
Not subject to a cap.
Q
It looks like the overall picture, what you are
trying to do isn't giving the impression that there's personal
responsibility. You're working very much on personal responsibility
to push back price increases. So if your talking to Canadians or to
Europeans, everybody is complaining about the tendeney of people
sitting in the waiting room because it isn't very expensive. so you
aren't doing very much there. If would have a choice to push one
point in your plan to get personal responsibility moving to push back
price increases, which one would it be?
�- 14 -
DEPUTY SECRETARY ALTMAN: That's not the choice we're
facing. Our health care system in th'is country is so broken that -we're not required to face that choice. We're spending two to twoand-a-half times what other countries spend -- at least by the year
2000 -- for a similar result by some standards or lesser result. our
life expectancy is not higher than the other nations, the other G-7
countries. our infant mortality is higher, except for Italy. And we
don't provide universal coverage, and those nations do. There's
nothing unique about our demographics. There's nothing written in
our constitution. There's nothing in the atmosphere here that
requires we spend two to two-and-a-half times more than they do for
the same result.· It's the best evidence there is that the system is
broken.
And by the way, if that
would have been liquidated years and
that business would have been out on
It's a broken system. There's plenty
preserving choice and preserving the
that Americans today have -- and, of
through the emergency room.
MS.
ROMASH:
were a business, that business
years ago, and the operators of
their ear years and years ago.
of opportunity to fix it while
other access to medical care
course, a lot of Americans only
Last question.
Q
Do you have a ballpark figure on how many states
might opt to go with the single-payer system?
DEPUTY SECRETARY ALTMAN:
I don't.
Q
Is there some critical mass number that might in
any way affect managed competition, if so many states decide to opt
out and go with the single-payer approach?
SENIOR ADMINISTRATION OFFICIAL: It 1 s worth knowing that
NGA stated policy is one in favor of a managed competition approach,
so it's a majority of elected governors who think that's the more
appropriate system. That said, there are a number of states that
have a sort of single-payer culture, but we think the number is not
that large. But certainly, that's up to the states.
THE PRESS:
Thank you.
END
4:52 P.M. EDT
�THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release
October 27, 1993
REMARKS BY THE PRESIDENT
AND THE FIRST LADY
ON DELIVERING THE "HEALTH SECURITY ACT OF 1993 11
TO CONGRESS
Statuary Hall
u.s. Capitol
Washington, D.C.
11:25 A.M. EDT
MRS. CLINTON: Thank you very much, Mr. Speaker. I come
to the podium really to thank all of you. I want to thank the
Speaker and Majority Leader Gephardt, Minority Leader Michel. I want
to thank Majority Leader Mitchell and Minority Leader Dole. I want
to thank all of the members in both Houses and their staffs for an
extraordinary amount of work, advice and counsel. And I appreciate
beyond beinq able to express the stronq commitment that so many of
you brinq to this debate.
This will be, for the next months, an opportunity for
all of us to work toqether, to qo beyond politics as usual, to make
it clear to the American people that this President and this Conqress
hear them and are committed to solvinq their problems in a very real
way.
This bill is the result of literaily thousands of
many of whom are in this room and represented here1 but many
who are not, who are all over this country who have shared their
stories, who have written letters, who have button-holed their
members of Conqress or a Cabinet secretary to talk about what needed
tobe done.
p~ople,
What we have attempted in this bill is t~ put in one
place comprehensively the pieces of the health care plan. If we had
attempted to merely repeal pieces of other leqislation or make
amendments to them, or if we had decided that we would not include in
this such matters as public health, which are critical to a reformed
health care plan, we would have been able, of course, to produce a
smaller bill that would not had quite as many paqes, but would not
have had in one place everythinq that you will have to consider as
. you move forward.
We have also made decisions that some matters belonq in
this bill, such as the benefits packaqe. Others who have
alternatives have determined that that is somethinq that should be
left to a later day and a body other than this Conqress. We've put
it into this bill. I don't know how many thousands of paqes would be
replaced or repealed with the passaqe of a bill with these features
covered in it, but it would qo into the tens of thousands. We are
tryinq to have a document with the presentation of this bill that
will qive us a framework off of which to work.
I especially want to thank the members of the Cabinet
who are here and their extraordinary staff for the analytical work
that has been done to prepare this bill. And we offer the services
as would be obvious to work with members of ·conqress and committees
to analyze other bills and alternatives with the same level of
analytical dimension and economic analysis as has been brouqht to
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this bill, because if we are to have the kind of honest and open
debate that we know we need, we have to hold every possible proposal
and plan to the highest level of scrutiny to determine what it would
really mean and how it would really work in the lives of Americans.
That's what we owe the American people. That's what we
have attempted to do in this bill, knowing we have literally no pride
of authorship on many of the details and technical aspects of it.
That we leave to the legislative process with whom we look forward to
working. But we do have an historic opportunity.
Many of you, Republicans and Democrats, who have worked
and worried over health care for years, have told me that the one
thing that stood in the way of your being able to do whatever it is
you thought was best was you did not have a President committed to
seeing that through. I can tell you we have a President committed to
seeing that through. (Applause.)
And what this President and I and all who have worked on
this look forward to is a vigorous, honest debate that sheds light
and not just heat, and which is rooted in what is really happening in
our country. And I am absolutely confident that if we do that, then
in this Congress, in this next year, we will meet again to sign the
kind of bill that the majority of us will be proud to have been a
part of.
Thank you very much.
(Applause.)
SPEAKER FOLEY: Long before he made the decision to seek
the high office which he now holds, the President emphasized the
importance of health care reform for the American people. From the
time of the campaign to the inauguration, and every week and month
since then, the President has reiterated time and time again how
central the solution of this problem is to the welfare and economic,
as well as personal and social, of the American people. He has
provided the leadership clear and unfailing to bring this legislation
to the Congress. He will provide the leadership in the coming months
to see it enacted until, as many have said, that happy day arrives
when the Health Security Act of 1994 is signed by the President of
the United States, William Jefferson Clinton.
I'm proud to present you now the President.
(Applause.)
THE PRESIDENT: Thank you very much. Thank you, Mr.
Speaker, Senator Mitchell, Senator Dole, Congressman Gephardt,
congressman Michel. To all the distinguished members of the Congress
from both Houses and both parties who are here today, I thank you for
your presence and your continuing interests. I thank you for giving
Hillary and me the opportunity to come here to statuary Hall.
This has been a remarkable process. I can never
remember a time in which so many members of Congress from both
parties and both Houses had so consistent and abiding commitment to
finding an answer to a problem that has alluded the country and the
Congress for a very long time.
I want to thank the hundreds, indeed thousands, of
people who have worked on this·process which has led to the bill. I
want to thank the literally hundreds of members of Congress who
attended the health care university recently -- an astonishing act of
outreach by a bipartisan majority of the United states Congress to
try to just come to grips with the enormous complexity and challenge
of this issue.
I believe the Health Security Act, which I am here to
deliver, holds the promise of a new era of security for every
American and is an important building block in trying to restore the
kind of self-confidence that our country needs to face the future, to
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embrace the changes of the global economy, and to turn our nation
around. A nation which does not guarantee all of its people health
care security at a time when the average 18-year-old will change jobs
eight times in a lifetime, and when the global economy is emerging in
patterns yet to be defined can hardly have the confidence it needs to
proceed forward.
If our nation does that, I believe we will do as we
approach the 21st century what we have always done -- we will find a
way to adapt to the changes of this time7 we will find a way to
compete and win7 we will find a way to make strength out of all of
our diversity.
This legislation, therefore, literally holds the key to
a new era for our economy -- an era in which we can get our health
care costs under control7 free our businesses to compete better in
the global economy7 and make sure that the men and women who show up
for work every day are more productive because they're more secure,
and they feel that they can do two important jobs at once: be good
members of their family, be good parents, and good children and well
as good workers.
This is a test for all of us -- a test of whether the
leaders of this country can serve the people who sent us here and can
actually take action on an issue that, as tough and complex as it is,
is still absolutely central to moving us forward. And it is a test
that I believe we can all pass.
And so I have today just one simple request. I ask that
before the Congress finishes its work next year you pass and I sign a
bil~ that will actually guarantee health security to every citizen of
this great country of ours. (Applause.)
The plan that we present today, as embodied in this book
as well as the bill, is very specific, it is very detailed, and it is
very responsible. And though we will debate many points -- and we
should debate many points -- let me just make clear to you the
central element of this plan that is most important to me. It
guarantees every single American a comprehensive package of health
benefits. And that, to me, is the most important thing. A
comprehensive package of health care benefits that are always there
and they ~an never be taken away. That is the bill I want to sign.
That is my bottom line. I will not support or sign a bill that does
not meet that criteria. That is what we owe the American people.
(Applause.)
Now, as we enter this debate, which I very much· look
forward to, I ask that we keep some things in mind. First of all,
when we debate something that the administration recommends or
something some of you recommend, and it seem bewildering in its
complexity, I ask that it be compared against what we have now,
because none of us could devise a system more complex, more
burdensome, more administratively costly than the one we have now.
Let us all judge ourselves against, after all, what it is we are
attempting to change.
Secondly, I ask that we follow the admonition that
Senator Dole laid for us -- let us all ask ourselves as clearly as we
can, who wins, who loses, why is the society better off, and how much
does it cost or save. And if we know, let us say. And if don't
know, let us frankly admit that we may not know the answer to every
question.
We have gotten in a lot of trouble as a nation, I think
-- and I see senator Domenici, one of our great budget experts
nodding his head -- pretending that we could know the answer to some
things that we don't know the answer to. we have tried to be as
conservative as we could here in making sure that we have not
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overclaimed for cost savings or overestimated how small the cost of
things will be. Therefore, I think we have in our plan put more
money in than it will cost to implement this plan -- but better to be
wrong on that side than the other side. We have really worked hard
here. And I think we must all do that.
Thirdly, I think we should all say what are the
principles that animate this debate. For us, the principles are
simple -- they're the ones I outlined in my address to Congress, but
let me briefly state them again. They are security, over and above
everything; simplicity -- the system we create must be simpler than
the one we have; savings -- we cannot continue to spend for what we
have 40 percent more than any other country and much more than that
over and above what our major competitors, Germany and Japan, spend
to cover fewer people; quality -- we must not ask any American to
give up the quality of health care; choice -- people have to have
choice in the private system of health care. our plan would provide
more choices to most Americans and fewer choices to none. And there
must be responsibility -- to pretend that we can control the costs
and take this system where it ought to go without asking more
Americans to assume more personal responsibility is not realistic.
We have too many choices -- costs in our system that are the direct
result of personal decisions made by the American people that lead to
rampant inflation based on personal irresponsibility. And we have to
tell the American people that and be willing to honestly and
forthrightly debate it.
Now, our plan guarantees comprehensive benefits and
focuses on keeping people healthy as well as treating them when
they're sick by providing primary and preventive care. It reduces
paperwork by simplifying the forms that have to be dealt with by
doctors, by hospitals, by people with insurance. And that's
important. We know -- every one of us can agree on at least this:
that the paperwork in this system costs at least a dime on the dollar
more than any of our major competitors pay. We must deal with this.
That's a dime on a dollar on a $900-billion health care system. We
can't justify that. It has nothing to do with keeping people well or
helping them when they are sick.
We have to crack down on fraud. We know our system
today is so complex we waste tens of billions of dollars in
fraudulent. medical expenses that we can change.
We ought to help small and medium-sized businesses,
self-employed people and family farmers to have access to the same
market power in holding their costs down that big business and
government have today.
I agree with Senator Dole or whoever it was that said
this term "alliance" sounds foreboding, but an alliance is basically
a group of small and medium-sized businesses and self-employed people
and farmers designed to give them the same bargaining power in the
health care market that only the government and big business has
today. We must do that. We cannot expect people to be at that kind
of disadvantage, especially since many of them are creating most of
the new jobs for the American economy.
We should, and we do, protect our cherished right to
choose our doctors. Indeed, we try to increase choices for most
Americans. Most workers insured in the workplace have now not very
many choices about what kind of health care they receive -- only
about one in three have choices. Under our plan, all workers would
have more choices in the kind of health care they receive, without
charging their employers more for the workers having the option to
make that choice.
We preserve and strengthen Medicare. We give small
businesses a discount on the cost of insurance. We invest more in
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medical research and high-quality care. We must never sacrifice
that. That's something we want America to spend more on than any
other country. We get something for it. It's an important part of
our economy and an important part of our security. We should
continue to do that.
our plan rejects broad-based taxes, but does ask
everyone not paying into the system that is still there for them when
they need it to pay in accordance with their ability to pay. Twothirds of the funds that finance this entire system come from asking
people who can access the system today, who have money but don't pay
a nickel for it, to pay their fair share. And I think we ought to do
that. It's not right for people to avoid their responsibility and
then access the system that the rest of the American people pay for,
and they pay too much because too many people don't pay anything at
all.
so these are the fundamental elements of our plan, of
this bill. But above all, it guarantees true health care security.
It means if you lose your job, you're covered' if you move, you're
covered' if you leave your job to start a small business, you're
covered. It means if you or a member of your family get sick, you're
covered, even if it's a life-threatening illness. It means if you
develop a long-term illness, because you will be in broad-based
community rating systems, you will still be able to work. It means
that the disabled community in America, full of people, millions of
them, who could be in the work force today, will now be able to work
and contribute and earn money and pay taxes because they will be in a
health care system that will not burden their employers or put their
employers at undue risk.
That's what security means. It means that we will, in
other words, be able to make the most of the potential of every
working American who wishes to work during the time they can work.
It is a huge, huge economic benefit in that sense.
Every nation with which we compete has achieved this.
Only the United States has failed to do so. We are now going to be
given a chance to do it. And I think we must1 and I think we will.
(Applause.)
. I want to reiterate what I have said so many times. I
have no pride of authorship, nor do I wish this to be a partisan
endeavor or victory. We have tried to draw on the best ideas put
forth over the last 60 years by both Democrats and Republicans. This
bill reflects the sense of responsibility that President Roosevelt
tried to put forward when he asked if the Social Security program
includes health care. It reflects the vision of Harry Truman, the
first President to put forward a plan for national health care
reform. It reflects the pragmatic approach that President Nixon took
in 1972 when he asked all American employers to take responsibility
for providing health care for their employees.
It embodies the ideas, the commitment of generations of
congressional leaders who fought to build a health care system that
honors our nation's responsibilities, and who have tried to learn to
how we might use the mechanisms of the marketplace and the
competition forces that have helped us in so many other areas to work
in the health care arena.
This is a uniquely American solution. It builds on the
existing private ·sector system. It responds to market forces. It
attempts to do what I think we should all be asking ourselves whether
we're doing -- it attempts to fix what's wrong and keep what's right.
And that ought to be our guiding star, all of us, as we enter this
debate.
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I think by guaranteeing comprehensive benefits and high
quality, and allowing most people to get their coverage the way they
do now, leaving important personal decisions about health care where
they belong -- between patients and doctors -- we have done what we
can to do keep what is right.
I think by asking people who don't pay now to be
responsible by simplifying the system, by cracking down on fraud, by
making sure we minimize regulations, we are taking a long step toward
doing what is necessary to fix what is wrong, to improve quality and
hold down costs.
All of the alternatives that will be debated, I ask only
what I have already said. Let us measure ourselves against the
present system and the cost of doing nothing. Let us honestly
compare our ideas with one another and ask who wins, who loses, and
how much does it cost. And let us see whether we are meeting the
guiding principles which ought to drive this process.
But when it is over, we must have achieved comprehensive
health care security for all Americans, or the endeavor will not have
been worth the effort. That is what we owe the American people. And
let me say again, the most expensive thing we can do is nothing. The
present system we have is the most complex, the most bureaucratic,
the most mind-boggling system imposed on any people on the face of
the earth. The present system we have has the highest rate of
inflation with the lowest rate of return. The present. system we have
is hemorrhaging, losing 100,000 people a month permanently from the
health insurance system; two million people every month newly become
uninsured, the rest of them get it back. They are never secure.
The present system we have has an indefinable impact on
workers in the workplace, wondering what will happen if they lose
their health insurance. What does that do to their productivity, to
their self-confidence, to their family life?
The present system we have is eating up the wage
increases that would otherwise flow to millions of American workers
every year because money has to go to pay more for the same health
care. The present system we have, I would remind you, my fellow
Democrats and Republicans, is largely responsible for the impasse we
had over ~e last budget, and the fights we had.
Look what we did. We diminished defense as much as we
should, and some of us are worried about whether we did a little more
than we should. We froze domestic spending, discretionary spending
for five years, when all of us know we should be spending more in
certain investment areas to help us convert from a defense to a
domestic economy and put people back to work in our cities and our
distressed urban areas. We froze it. (Applause.)
We raised a good bit of taxes. And even though over 99
percent of the money came from people at the highest income group,
nobody in this Congress wanted to raise as much money as we did.
Why? Because we passed a budget, after doing all of that, in which
Medicaid is going up at 16 percent a year next year, declining -declining to an inQrease of 11 percent a year in the fifth year;
Medicare is going up at 11 percent a year next year, declining to
nine percent a year in the fifth year of our budget.
That's why we did that. We could have had a bipartisan
solution, lic~ety-split, giving the American people a plan that would
have reduced the deficit and increased investment in putting the
American people back to work if we were not choking on a health care
system that is not working. (Applause.)
Now, I don't know about you, but I don't ever want us to
go through that again. That is not good for the Congress, it is not
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good for the country, it is not good for the public interest. And
the most important thing is we can't give the American people what
they need. They want to be rewarded for their work. They want to
know if they're asked to go back to school, if they're asked to
embrace the challenges of expanded trade, if they're asked to compete
and win in a global marketplace -- that if they do what they're
supposed to do, they'll be rewarded. They want to know that they can
be good parents and good workers. They want to know if they get
sick, but they're still health enough to work, they won't have to
quit because of the insurance system. They want to know if they're
disabled physically or if they have had a bout with mental illness or
they've dealt with any other thing that can be managed, ~at they can
still be productive citizens. And the bizarre thing is that we could
do all this and still have a system that is more ef~icient and wastes
less than the one we've got.
So I ask you, let's start with this bill and start with
this plan, and give the American people what they deserve -comprehensive universal coverage. That's what we got hired to do -to solve the problems of the people and to take this country into the
21st century.
Thank you very much.
(Applause.)
END
11:52 A.M. EDT
�]
THE WHITE HOUSE
Office of the Press Secretary
september 12, 1993
Immediate Release
PRESS BRIEFING
BY
THE PRESIDENT'S SENIOR ADVISOR FOR POLICY DEVELOPMENT
IRA MAGAZINER,
AND MEMBERS OF THE HEALTH CARE TASK FORCE
September 12, 1993
The Briefing Room
3:35 P.M. EDT
MR. GEARAN: We'll have an opening statement on camera
by Ira Magaziner, and then he will be joined here with Ken Thorpe,
who is the Deputy Assistant Secretary for Health Policy at HHS; Nancy
Ann Min, the Associate Director for Health for the Office of
Management and Budget. After Mr. Magaziner•s statement there will be
no televised coverage of the rest of it, although it will be an onthe-record briefing.
Mr. Magaziner is a senior advisor to the President. We
have a sheet on it. You will be provided paper on this. Why don't
we, with all deliberate decorum, have Mr. Maqaziner join us.
MR. MAGAZINER: Good afternoon. I'd like to thank you
all for coming to what will be the first in a series of briefings on
health care as we head towards the President's speech on September
22nd.
First, I'm sorry to announce that we•ve already lost a
serious source of health care revenues that we'd expected. If we'd
only had the good sense to charge for all the copies of the draft
plan that are all over town, we probably would have solved all the
financing problems.
Q
What did you expect?
(Laughter.)
MR. MAGAZINER: In the coming days and months we•re
going to hear a lot about health care. But before we get into it, I
want to make a couple of points very clear. First, the debate is,
first and foremost, about the American people and their health
security. People are going to disagree on a lot of details. But we
are going to stand firm on what the American people need, and they
need guaranteed health security, comprehensive benefits, affordable
health insurance that increases their choices and improves the
quality of care.
Second, the administration is proud of the unprecedented
consultations that we initiated back in January and are continuing. ·
The draft proposal that is circulating around town is just that, it
is a draft. And we are ready and willing to work with everybody who
is committed to comprehensive health care reform.
Now let's turn to the numbers. At the very beginning of
this process the President asked for a commitment that we have
fulfilled. It was a commi~ment to undertake an historical attempt to
bring together the best minds in the country to help us design a
financing package for·health care reform, and we have fulfilled that
commitment. The numbers and analysis that underline the President's
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proposed plan for health security represent months of riqorous
analysis which brouqht toqether analysts from various federal
aqencies for the first time. We brouqht toqether actuaries from
various branches of qovernment. We had an outside qroup of private
economists and actuaries who audited the work that was done by that
team from within the qovernment, and they've examined and validated
the costs and savinqs projections.
The cost and savinqs projections in the draft document
are solid and we stand firmly behind them. These projections are
credible and conservative.
Everyone, both inside and outside the administration,
knows two thinqs for sure: we have to qet health care costs under
control before they bankrupt our families and our nation, and we are
not qettinq qood value for our health care dollar today. Too many
workinq Americans are losinq their coveraqe every day, and coveraqe
is erodinq for countless more. And all Americans pay too much for
their health care, and will pay much more if we do nothinq. No
American, even with health insurance today, can be sure that they
will have health insurance at this time next year.
There is some misinformation out there about what people
will pay under the plan and what they will qet. Let's be clear about
this. Onder the President's health care security proposal the vast
majority of Americans will pay less for the same or better health
benefits than they have today. And they will have two thinqs they
don't have today: Number one, a full packaqe of preventive health
care services, includinq thinqs like immunizations, mammoqrams, and
yearly physicals. And number two, the quarantee that your health
insurance will never be taken away no matter what. If you lose your
job, you're covered. If you move, you're covered. If your child
qets sick, you're covered. And if you want to start a small
business, you're covered.
The President believes, and he has said this since early
in the campaiqn when he made his commitment to health reform, that it
would be wronq to propose a broad new tax on the American people to
pay for the waste and inefficiency that riddles our health care
system. We must control the qrowth of health care costs, and that is
exactly what our proposal will do.
Here's the bottom line: The qovernment is qoinq to set
the standards, quarantee hiqh-quality affordable care, and then qet
out.of the.way.
Today•s system has too much insurance company red tape
and qovernment requlation. When somebody qoes to the hospital, the
bill is checked by checkers, and then by other checkers, and then by
other checkers. It's wasteful and it doesn't do anythinq to improve
the quality of care. our plan will mean less requlation of doctors
and hospitals, leavinq them to concentrate on practicinq qood
medicine instead of havinq to worry about fillinq out thousands of
forms every day.
Is there some area of more qovernment requlation in this
plan? Sure. There is requlation of the insurance· industry. The
insurance industry has run rouqhshod over consumers for too lonq in
this country. our plan makes it illeqal for insurance companies to
refuse to cover people with preexistinq conditions; illeqal for
insurance companies to raise your premium or drop you if someone in
your family qets sick; and impossible for insurance companies to
continue to charqe small businesses 35 percent more than they charqe
larqe businesses •.
Today there's no competition in the health care market.
Insurance companies can charqe you whatever they want for health care
and you have to pay it. The President's health security proposal is
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built around puttinq consumers in the driver's seat and forcinq
health plans to compete for customers by brinqinq costs down and
improvinq the quality of care.
Finally, in response to stories that appeared today, let
me make a few points. First -- and let me be very clear about this
-- the administration is not considerinq a tax on hospitals in order
to pay for this reform. There have been no discussions of such a
thinq since May when we were considerinq every idea that was
presented to us. And any suqqestion to the contrary is absolutely
untrue. we feel that hospitals must remain the cornerstone of our
health care system and our plan fully recoqnizes their critical role.
second, one report today contained some misinformation
about what individuals will pay under health reform. Employers can
continue to cover 100 percent of the employee's premium if they so
choose, and employees will not be required to pay more than 20
percent.
Third, there is misinformation about chanqes in
Medicare. Medicare will remain the federally-run proqram for seniors
and disabled that it is today. Medicare cost qroWth will be slowed.
However, even with slower qrowth, Medicare spendinq will increase at
roughly twice the. rate of inflation over the decade, and Medicare
recipients will qat new benefits -- prescription druq benefit and
help on lonq-term care.
Thank you very much. And now we'd be happy to answer
any questions that you might have.
Q
For my readers who live outside of Washinqton and
don't understand policy wonk talk, can you explain to us how you're
qoinq to pay for this?
MR. MAGAZINER: Yes. We're payinq for it, first, by
savinqs as we brinq the qroWth in health care costs under control.
Secondly, we're qoinq to be imposinq some type of sin taxes on
tobacco and perhaps something else.
Q
What is that --
MR. MAGAZINER: We're not sure yet. And we also are
qoinq to ask that employers and individuals all make a contribution
towards their health insurance and the health insurance of their
employees. That's the fundamental funding mechanisms.
Q
On the sin tax, can you talk about what ranqe
you're considerinq on ciqarette taxes?
MR. MAGAZINER: That is one decision that is still not
made yet -- is the final composition of the sin taxes.
Q
But you have a ranqe there.
MR. MAGAZINER: We have a ranqe, but I'd rather not qet
into it until we have a specific formulation, which we'll have this
week -- later this week.
Q
Could you explain a bit about the Medicare
situation? That seems to be one of the biq concerns,· that it's
impossible to slow the rate of Medicare qrowth at the rate you're
proposinq without quttinq the proqram certainly in terms of hospitals
that are larqely Medicare dependent. And some of the people who are
really credible that have seen your numbers tell you that this is
basically -- it's a joke. What's the answer?
MR. MAGAZINER: Well, I think, first of all, we've had
hundreds of experts from around the country who have been workinq on
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this plan and who have developed the Medicare piece of it in
consultation with Medicare experts at HHS and in the Congress. I
think the rate of growth that we are looking for in Medicare will .
still be twice the rate of inflation; that it will be accompanied by
a slowing in the rate of growth in the private sector as well, so
that there won't be the kind of cost-shifting problem that we often
run into.
In addition to that, the slowing of the rate of growth
actually benefits beneficiaries considerably because it slows the
rate of growth of the premiums they have to pay. Further, for the
hospitals that have a large share of Medicare and Medicaid people,
there are a number of features in our program which divert new funds
directly to those hospitals to support them.
There is what we call an essential provider provision
that means that they will receive extra funds from the federal
government. Also, those are the very hospitals often that are going
to receive the best benefit from universal coverage because they tend
to be hospitals that treat a high proportion of uninsured people -hospitals in rural areas or in poor urban areas. So we have taken
special recognition of those hospitals that would be affected in this
program and there will be additional funds for those hospitals.
To say one other thing about the Medicare savings -there are other proposals that have been made on health care reform
in the Congress which actually would call for bringing the rates of
Medicare and Medicaid growth to an even sharper reduction that what
we're proposing. If you look at the McDermott-Wellstone bill, the
single-payer bill, they actually bring the whole health care system
to a growth rate of about GDP in 1 95 or 1 96. The Stark bill that's
been proposed does it in 1 98. our bill does it about 1 99. And even
then, Medicare is still growing faster than GDP, although the private
sector is a little bit slower. So we think that we've been
conservative in estimating the slowdown in rate of growth.
DR. THORPE: I guess the only other thing I would say is
to put the Medicare savings in some perspective. You've all seen the
five-year summary numbers, which have been reported in various places
at $124 billion. And I think the thing to keep in context is that
over the five-year period; that's off a base of over $1.4 trillion in
Medicare spending. So if yo~ put it in a context of what these
numbers are in terms of the Medicare program, summing them up over
the five years, you'll see that this is something only on the order
of about eight or nine percent.
'
Q
-- in the real world, what is this going to mean to
doctors and hospitals? Where are we going to -- what is the hospital
of the year 2000 going to look like, or doctor's fees in relation to
today? Where is this all going to come out of?
MR. MAGAZINER: Almost everybody that we have talked to
this year who has had experience with the health care system, whether
it's doctors, nurses, clerks, patients, all know that there's
tremendous waste in this health care system~ The paperwork is
enormous1 the unnecessary tests that take place1 the fact that you
can look at two different hospitals in the same state of Pennsylvania
and one charges $80,000 for the same operation that another charges
$20,000 for and there's no difference in outcome, as has been
demonstrated in study after study.
Almost every study that's been done indicates tremendous
waste in this system. And what we need to do is try to get that
waste out, because it would be unfair to ask the American taxpayer to
raise some type of broad-based tax to continue funding that type of
inefficiency.
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Q
What happens to doctors' salaries, for example, or
incomes and hospitals' margins which they say are already -- a lot of
them taking --
MR. MAGAZINER: Well, hospital margins vary. Some of
the hospitals that serve underserved areas and rural areas or urban
areas do have profitability problems, and that's why we're taking
special note in directing new funds their way. But there are also
many hospitals in the country that are doing quite well and we think
that as long as hospitals can become more efficient, they'll continue
to do very well.
Q
Doctors?
MR. MAGAZINER: Doctors the same way. Doctors' incomes
have been going up much faster than everybody else's in the country
for quite a few years. If they can become more efficient in the new
system they'll continue to go up faster. But if they can't, then
they might see a slowing in the rate of growth of their income.
· MS. MIN: The level of spending on Medicare for
physicians will still -- the level of spending on Medicare for
physicians will still be growing at twice the rate of inflation. And
the level of Medicare we'll be spending on providers will still be
growing. We're just talking about reducing the rate of growth.
Q
Will doctors want to see Medicare patients under
the schedule that you're proposing?
DR. FEDER: What relates to that issue is some of the
people -- when you look at Medicare in isolation and people have
talked about constraining Medicare costs without constraining the
rest of the system, Medicare faces a real problem. It's always
playing catch-up and its patients are fighting for access with out
patients. Now ~a•re talking about doing this as part and parcel of a
reform which creates greater equity as well as overall constraint.
Q
Ira, one.of the things that seems to have surprised
some people is the number of new commissions and boards and the
likely size of the staff underneath the national health board.
Gradison, the former congressman who now represents the health
insurance industry, said on TV today, he predicted that that staff
for the national health board would create as many jobs as Vice
President Gore's reinventing government effort would cut.
(Laughter.) What do you think there's a need for a staff?
' MR. MAGAZINER: Well, that's a good line, but it's
inaccurate. We think that the national board is primarily going to
be playing an oversight role. It's not playing a regulatory role.
we don't anticipate that it will have much of any staff. The actual
work that will be done on, for example, new research on quality and
that type of thing, would be done in existing departments of the
government, not in the national board.
Also, we are looking for a system that would be flexible .
at the state level and primarily a state system, not a federal
system.
Q
This is the board is going to negotiate with all
the alliances and enforce the budget and is going to have very little
staff?
MR. MAGAZINER: No, it doesn't -- I mean, initially, it
will approve as a board of directors might the state plans. But it's
not goinq to have a larqe staff that does that work. That work will
be done elsewhere. It's basically like a board of directors type
operation, not an operation with a lot of staff. It won't be
involved in any kind of detailed negotiations. What it will do is to
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do things like make recommendations on updating the national benefits
package and that kind of thing.
Q
What's your target date for universal coverage?
MR. MAGAZINER: It depends on the state. What we're
looking for and expecting is that some states will be ready to come
in to the new system in 19957 probably the bulk in 1996, and maybe
some others in 1997. But we're saying that 1997 should be the
outside date for all states.
Q
end of
1
The end of
MR. MAGAZINER:
97, yes.
Q
1
97?
That people should be enrolled by the
-- parity between states?
MR. MAGAZINER: Well, there's not parity today in terms
of prices, if that's what you mean. Today the -- in fact, even
within states, you can go to Miami, Florida, or Tallahassee, Florida,
and see dramatic differences in the price of insurance premiums or
the cost in hospitals. And across states, there's dramatic
differences.
What we're going to try to do is over time -- we think
as more information is made available, those costs will begin to come
together. But initially we•re going to start out where states are.
DR. FEDER: But the key is that with the exception of
these couple of years, everybody is in. In that sense, there's
parity; everybody has got universal coverage.
Q
Ira, have you done any analysis on the overall
impact on the economy -- I think medical care is about one-tenth of
the overall economy. And how do you answer those critics who say
this is going to be a major job loser when you force employers to pay
for medical care?
MR. MAGAZINER: First of all, we have done economic
analysis and we're completing some additional studies now that we're
finalizing the plan. And health care costs now take over 14 percent
of the GOP. And if we do nothing, they're reckoned to go up to
almost 19 percent of GOP, even without insuring one more person. So
they eat up over two-thirds of the increase in GOP per person, and
over 120 percent of the increase in workers• wages if we do nothing.
There has been a hidden tax on American companies in
this country for decades, and that hidden tax is the rapid rise in
health care costs, going up twice or three times as fast as wages and
eating up money for investment, eating up money for wages.· What we
are going to do is to bring the growth of those costs under control
so that workers can have wage increases again and so that companies
can have capital to invest.
on the jobs issue, let me be clear about this: If all
we were to do was to impose a mandate for employers to pay health
insurance tomorrow, it would cost jobs. But we would not propose
that and that is not what we are going to do. .What we are doing is
changing a whole system so that, yes, employers that now don't
contribute to health insurance will be asked to do so, although small
firms will have a significant discount and it will be phased in.
However, we're also slowing the rate of growth and lowering costs for
many other firms, including the majority of small firms who do
provide health insurance. And when you reduce the cost that a
company has to spend on health insurance, that frees up money to
create new jobs. And since most small companies now provide health
insurance, and in the preliminary analysis we've done the fastest
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growing small companies now provide health insurance, we think that
there's going to be a net benefit.
Q
The administration has said it's willing to revise
this plan based on consultations with Congress. What are you willing
to yield on? What are you not willing to yield on? Will you change
the Medicare-Medicaid savings projections? Will you change the
composition of the sin tax based on what you hear on the Hill?
MR. MAGAZINER: Well, there are many principles -- and I
think the President will enunciate this in his speech more eloquently
than I can do for you today -- but there are many principles upon
which we won•t·compromise. We want health security for all
Americans. We want affordable health care. We want to simplify the
system and various other things.
However, we don't believe that we have all the answers.
We're not coming down from the mountain with the tablets and
expecting that we have all the answers. And so as people have better
ideas on some of these things we're willing to be flexible on how to
achieve the principles and the goals.
Q
Including financing?
MR. MAGAZINER:
Aspects of financing, potentially, yes.
Q
When you said you were opposed to a broad~based
tax, that that would be unfair to the American people now, would that
be something you could compromise on with congress?
MR. MAGAZINER:
I wouldn't expect so.
Q
How would you enforce the budget? What if
California says to you we just can't live within your budget, what
would you do?
MR. LEVITT: Hi, I'm Larry Levitt. We're not talking
about saying to California that here's your budget and it's your
problem to figure out how to do it. What we're saying to essentially
the health insurance market in each alliance area is here's what your
premiums are expected to go up by. And we expect in most cases that
the market will, in fact, produce rates of increase in line with
inflation and in line with the growth in the economy. If they don't,
there is an assessment mechanism1 essentially, a mandatory rebate
mechanism so that health plans in an area, if premiums in that area
·went up too fast, health plans whose premiums were going up to fast
would be required to rebate the difference to employers and to
consumers. And in addition providers would, in effect, would be
required to rebate their increases also.
Q
Ira, how do you expect to recapture the ·savings
without a tax, particularly on hospitals?
MR. MAGAZINER:
Q
Recapture --
savings in the system.
MR. MAGAZINER: Well, we expect the savings in the
system to go back primarily to those people who are doing the paying.
The employers and the individuals who are paying for their own care.
Q
Well, what happens if hospitals no longer have a
problem of uncompensated care and suddenly have a windfall?
DR. FEDER: I was just saying, when we talk about the
financing and the savings being a critical piece of financing the
federal share or the subsidies, those savings are monies that the
federal Treasury or state treasuries won't have to pay out anymore
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because we've constrained rate of growth.
we have in hand.
So those are monies that
The other savings that Ira is talking about in the
system are going to go back to employers and to consumers in general
because their premiums will be lower because those are out of the
system.
Q
so you're not thinking about any other taxes
besides sin taxes -- is that the only tax?
MR. MAGAZINER: The only thing, to be clear, there is a
set-aside that we're looking at which would go to all premiums, both
within the· regional alliances and also the corporate alliances, to
help pay for things like academic health centers and things -research that's done in academic health centers and teaching
hospitals, because that's infrastructure that everybody in the health
system benefits from.
I'd like to say one thing about the budget, and this I
want to emphasize from what Larry said. we don't believe that the
budget is the main mechanism, that the insurance regulation is the
main mechanism in controlling costs. We think the setting up of the
competitive marketplace is what's going to control the growth of
costs.
The insurance caps are really a backup mechanism so that
if in certain parts of the country the competition is not working
well enough at any given point in time, then the caps are there as a
discipline. But that's not the main mechanism.
Q
What happens to unions who have negotiated
contracts to health benefits that would exceed the benefit package?
MR. MAG~ZINER: They can continue to have them. We're
not going to make people worse off for what they've negotiated. They
continue to have them.
Q
Ira, just so we have a sense of order of magnitude,
besides the national subsidy pool, you've talked just now about what
sounds like two other pools for essential providers and the one you
just -- the set-aside you just talked about. When this thing is up
and running, what are those two pools going to have in them and where
is that money going to come from?
MR. MAGAZINER: That's defined in the draft, which I
·assume you have. (Laughter.) But basically, we are looking for a
pool that would increase what's currently in the graduate medical
education accounts and so on. That would come off of an assessment
of the premiums. It's actually built into the premium number. And
it's not anything new; it's built into today•s premiums as well.
The issue is that when you set up a pure competition,
that teaching hospitals and academic health centers often have a
higher cost because they have those research and teaching functions
in them. Today that's sort of averaged out in the system. When you
move to a competitive system those institutions might be at a
disadvantage unless you had a set-aside like this.
There was one other so~rce -- the essential provider is
going to be a direct federal contribution that will come out of some
of the savings we gain, and also initially out of some of the sin
taxes.
Q
What's the order of magnitude of that?
MR. MAGAZINER:
A couple of billion dollars.
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Q
can I ask you about the caps again? You've got a
limit on money coming into the system, but you really are not
controlling the other aspects -- for example, high tech, older people
getting sick. The costs will continue to go up, won't they, even
though you're limiting the dollars going in? So sooner or later,
aren't' the higher costs and limited dollars going to blow up on you?
MR. MAGAZINER: Well, I think the most important thing
to remember in this is that we're spending over 14 percent of our
economy on health care. Other nations spend 7 percent, 8 percent,
the Germans, the Japanese. They use high technology as well. They
have actually more old people who live longer.than our people do.
They insure everybody. They have a more comprehensive set of
benefits that we have. And yet, they spend less.
Almost every study that's been done has documented the
tremendous amount of fat and waste in this system. There is no
reason to believe that slowing the rate of growth in cost cannot be
taken out of that waste and has to lead somehow to poorer care.
There's going to be a lot of scare tactics used by people who are
essentially trying to almost blackmail us into saying if we don't
keep paying for all this waste and for all the fat, that everything
is going to be terrible and there are going to be long lines and your
mother won't be treated, and so forth and so on. That's nonsense.
There is a tremendous amount of waste in the system·and we have to
have high quatity standards to protect the consumer, but then also go
after that waste with controlling costs.
MR. KRONICK: I'd just like to amplify on that. Only in
health care do we expect that new technology is going to add to the
cost of producing output. In most of the rest of the economy we
assume that new technology will save money, and there are many
possibilities for that in health care as well.
More importantly, I think that Ira mentioned earlier the
comparison of Boston of New Haven1 that if you look at what happens
to Medicare beneficiaries in Boston, the expenditures are almost
twice as high per person as in New Haven. And nobody says that we're
rationing care to people in New Haven or that beneficiaries in New
Haven aren't receiving all the care that the need.
So we take this kind of what we•re spending now for
granted and that·we have to be spending that, and if we spend -- if
the rate of increase isn't as large as what we're projecting, that
something terrible is going to happen to us. And there is every
reason to believe that if we give physicians and hospitals the
incentives and the opportunities to use the resources that are
available more effectively, that they can figure out how to do that.
We have examples of that all over the country. And this plan is
intended to change the.environment in which hospitals and physicians
function so that they have the opportunities and the incentives to
use those resources better. There's no reason to believe it won't
happen.
MR. ZELMAN: I just wanted to add to something Rick was
.suggesting. This health care proposal is not a one-time fix in which
we expect to put a few things in place which will immediately wring
out the inefficiencies and waste that virtually everybody agrees are
in the system. It is a structured mechanism of setting health plans
competing against each other so that they will, over time, for the
next five, 10, 15 years, constantly be encouraged to compete with
each other to produce savings and to produce lower costs to
consumers. So it's a long-term kind of fix that we think will enable
the system to continue saving money over time, as opposed to a lot of
other proposals that suggest that the only way you're going to save
money is by just paying your doctors and hospitals in a regulatory
way less and less and less. So we think we've built in some longterm efficiencies here.
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MR. MAGAZINER: At the risk of overdoing some personal
stories here, the first time I went into the hospital for a hernia
operation I had to stay in for three days. And then the last time I
went in it was an out-patient procedure because of new technology. I
had my knee operated on about 20 years ago~ it was a two-week deal.
That same thing with orthoscopic surgery could be done now in a
couple of days stay in the hospital. So technology cuts both ways.
DR. FEDER:
Didn't know you were such a mess.
(Laughter.)
Q
I have two questions. As a result of the
consultations you had this week on the Hill, are you looking, for
whatever reason -- because of politics or whatever -- are you looking
for new sources of revenue now? And secondly, the tax that was
described in The Times today, maybe you wouldn't call it a tax, but
you have talked in the past about recouping the savings from
hospitals through an assessment, which we all translate into taxes.
MR. MAGAZINER: Let me be clear about this.. We talked,
as you know, about a million ideas in the past and in late April,
early May discarded that particular idea. And we have not talked
about it since. So what I think might have been inaccurate in some
of the reporting today is that we have not been having discussions
about new health reform sources of revenue and we have not had any
discussions at all about resurrecting any kind of hospital tax. That
went off the table in early May.
Q
So the answer to the first question is as a result
of these consultations, are you looking for other --
MR. MAGAZINER: No. The consultations basically could
affect -- I mean, what you have now in those numbers tables are a
draft. Through our own internal processes we intend to revise that
draft a couple of different times with the consultations.
You'll see some numbers move around in there -- the
deficit number may go up a little bit and down a little bit, the sin
tax number up or down a little bit, the Medicare number up or down a
little bit -- but we're not looking for new sources of revenue.
Q
·Surely, when you went up on the Hill, one of the
things I would imagine you got the most concern about was the slowing
of the rate of growth in Medicare and Medicaid, which is something
"they've never been able to do up until now.
MR. MAGAZINER: I think, first of all, discussions about
the slowing of the rate of growth of Medicare and Medicaid have never
been talked about in the context of comprehensive health care reform.
They've been talked about solely going for the deficit reduction.
For example, on Medicare, a very important point
the savings we're looking for in Medicare is smaller than the
investment we're looking to make in the Medicare drug benefit
long-term care. So the discussions in the past have not been
the rate of growth of Medicare so you can give. a drug benefit
long-term care. It's a very different discussion.
is that
and in
slow
and
To your other question, I will honestly admit that we
have heard from numerous people on the Hill about every one of our
revenue sources. There are ·people up there who are not wild about
the tobacco tax. There are people who don't like the Medicare attd
Medicaid cuts -- savings that we're looking for. There are people
who don't like the deficit numbers. There are people who don't like
different pieces of things, and that's natural. People have
different views.
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Q
Are you saying that in early May you ruled out a
broad-based tax -- in late April, early May -- and you simply haven't
gone back to any kind of consideration of a broad-based tax since
then?
MR. MAGAZINER:
Q
That's accurate -- hospital tax, yes.
To any broad-based tax?
MR. MAGAZINER: Well,. it was around that time that we
ruled out a broad-based tax as well, yes. We had done -- we started
January 25th with our financial analysis. And by early May we had
already run about 75 different runs of every different alternative we
could think of. And we took a lot of things off the table during
numerous discussions we had with the President in May. And the idea
of using a broad-based tax, whether it's an income tax or a VAT or a
hospital tax or whatever, was all taken off the table in May and has
not been discussed. It was at that point that we decided to go to
the employer-individual .responsibility route.
Q
There was some talk of placing an assessment on a
corporate alliance, a one percent surcharge, or something like that.
Are you going to do that?
MR. MAGAZINER: That's in relation to what I was talking
about earlier about the set-asides for the academic health alliances
and that type of thing. Whether it would be one percent or less is
being looked at. But it was always designed -- see, in some of the
ways we originally modeled the numbers, the regional alliances were
essentially paying for the whole set-asides for the academic health
centers, paying for things that were done for the underserved
populations and so on. And then we went back and said, well, wait a
second, because the corporate alliances are going to be on the same
footing as the regional alliances, shouldn't they also have to make a
contribution in their premiums as are going to be in the regional
premiums? That's the context in which we've looked at that.
We're still looking at that in relation to a trade-off
w:th the sin taxes within that amount of money, but no decision is
made.
Q
So you coula not do anything or you could have
some, or you haven't made the decision yet --
MR. MAGAZINER: That 1 s right. That piece that 1 s labeled
in your non-handout -- (laughter) -- that sin tax-corporate
assessment, we're playing with that total pool of money and deciding
the mix of that money. And that's still not decided.
Q
And is alcohol still included in the sin tax or
have you ruled out alcohol?
·
MR. MAGAZINER: I' 11 let you figure out what you think
sins are and then make the list.
Q
What other kinds of tax revenue are available then
if you're only going for a sin tax?
MR. MAGAZINER:
Just what we've put in here.
I mean, I
don't -Q
There is no other kind of tax, as liquor tax?
MR. MAGAZINER: Well, as I say, I think you need to come
up with your own definitions of sin. I'm not sure -Q
I wasn't talking sin.
You brought it up.
�- 12 -
MR. MAGAZINER: We're looking at a number of things that
could be broadly considered sin taxes, excise taxes on various things
that have traditionally been called that.
THE PRESS:
Thank you.
END
4:10 P.M. EDT
�THE WHITE HOUSE
,e of the Press secretary
October 6, 1993
PRESS BRIEFING
BY
ASSISTANT TO THE PRESIDENT FOR ECONOMIC POLICY BOB RUBIN,
COUNCIL OF ECONOMIC ADVISORS CHAIR LAURA TYSON,
SECRETARY OF TREASURY LLOYD BENTSEN,
SECRETARY OF LABOR BOB REICH,
SMALL BUSINESS ADMINISTRATOR ERSKINE BOWLES
The Briefing Room
1:35 P.M. EDT
MR. RUBIN: I'm Bob Rubin. I'm the Assistant to the
President for Economic Policy. As you know, we're here today to talk
about health care reform and its relation to the economy.
As the President said in his address to the Joint
Session, health care reform .is a social imperative, but it's also an
economic imperative. And it's a critical and integral part of his
total economic program.
I remember when I first was asked to take this job and I
started talking to the then President-elect about economic issues,
and it was apparent from the very beginning that when he thinks about
economic issues his mind immediately; amongst other things, turns to
health care. And he views it as inextricably and integrally related
to the economic future and health of this country.
Today you'll be hearing from various members of the
economic team as to why he feels that way and how we view health care
reform in relation to economic growth, job growth, and why we view
health·care reform as critical to the economic future of this
country. We're also handing out -- maybe we've already handed out, I
believe, two written pieces; one, the cost of failing to reform
health care; and the other, the economic effects of health care
reform.
The order of speaking will be Secretary Lloyd Bentsen;
then head of the CEA Laura Tyson; Secretary Bob Reich; and head of
the SBA Erskine Bowles.
Let me make one very brief comment myself, and my own is
a very practical perspective. I remember during the transition we
had a health care presentation, and afterwards I turned to Ira
Magaziner. At that time he wasn't in charge of health care yet. I
said, you know, it's a funny thing. Virtually every SEO that I've
spoken to in recent years -- and I'd spoken to enormous numbers of
them because I was in the financial service industry before I came
here -- has said that escalating health care costs are one of the
major problems of their company. Virtually every CEO that I had
spoken to -- and as I said, I'd spoken to enormous numbers of them
viewed the escalation of health care costs as a tremendous impediment
with respect to international competitiveness and exports. And
exports, as you know, are critical to economic growth -- have been in
recent years and certainly will be in the years ahead.
So I had the feeling then, and I've had it evermore
since then, that we simply have to get health care costs under
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control if we're going to have the kind of economic future we want to
have. Secondly, there are nonquantifiable aspects of health care
security and universal coverage which are of great importance
economically. A healthy work force is a better work force. You have
lower turnover, lower absenteeism. You can't quantify these things,
but they're very important. And, finally, as Erskine Bowles will
discuss, there's no question in my mind that when the small business
sector focuses on health care reform and understands it, and
understands how it relates to their long-term prospects, a great
preponderance of small businesspeople will be in favor of health care
reform.
With that, let me turn the podium over to Secretary
Bentsen. What we'll do is go through all our speakers first, and
then when we're finished, we'd be delighted to take questions.
Mr. secretary.
SECRETARY BENTSEN:
Thank you very much, Bob,
The message this afternoon is really quite simple. The
long-term health of our economy is absolutely dependent on health
care reform. Now, we're going to have the economic effect on jobs
discussed by Bob and Laura later. And, also, they'll be discussing
what happens if we don't have health care reform, how that affects
the economy. And Erskine will be talking about how it affects
business.
Now, let me say just a few things, We have the most
wasteful health care system in the world. You've heard the numbers.
We're spending now 14 percent of our gross national product on health
care. Our major competitors are spending six to nine percent, and
we're no healthier. And not only do the other countries spend less,
they cover everybody. We're the only major industrial nation that
does not provide full universal health coverage.
Thirty-seven million Americans without health insurance.
And that number is continuing to grow. But don't kid yourselves.
You're paying for every one of those uninsured, When CBS, NBC, ABC,
CNN or any business that pays insurance gets the bill at the end of
the month, they're picking up the tab for that uninsured parent who
takes that child to the emergency room at the hospital at the last
minute, In Texas, I know of one hospital that has $42 million worth
of uncompensated care.
Well, they're going to pay for it, alright. You're
going to pay for it. And you're going to pay for it right through
the nose, in increased costs for surgical care, anesthesiologists,
the beds, the hospital rooms.
One other point. We're hurting wages, If health care
had remained the same share of employers compensation to the employee
from 1975 to 1 93, the average American worker would get an annual
$1,000 pay increase after taxes, with no extra cost to the employer
or to the business. If current trends continue without reform, real
wages may be further reduced by $600 per year by the end of this
decade. So we have to fix it. We have to stop that cost-shifting.
We have to cut the waste, and we have to restructure the system so
that the resources are used more efficiently. And we have to bring
some competition into health care.
And with that, let me turn it over to Dr. Tyson.
DR. TYSON: ~hank you. I think.it's important to begin
a discussion of the economic effects of our health care plan with a
simple fact: Most American companies, even most small American
'companies, already provide health care coverage for their employees.
For most of these companies, the Clinton plan will ultimately mean
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lower costs, not higher costs, for the same or better benefits for
their employees. so this is the starting point. This is where we
begin.
Most American companies provide it already7 even most
small American companies provide it., and the plan will ultimately
lower cost for most American companies while providing better
benefits for employees. That's the reality.
There have been allegations from critics of the plan
that it will cause net job loss because it involves an employer
mandate, meaning that firms who are not currently providing insurance
will need to contribute to the insurance for their employees.
Certainly, for those firms who are not currently providing, the
result of the plan will be an increase in costs. We have taken that
into account by designing a very generous discount scheme,
particularly designed to help small firms and low-wage firms deal
with the additional cost of providing the coverage that will be
required. But many more firms will actually see their health cost
situation improve over time, especially those small firms who are
currently already providing.
And remember I said the majority of small firms already
providing. They are paying something on the order of 35 percent more
for health care coverage than their big firm competitors. For these
small businesses, our plan actually will mean an unexpected windfall.
And there are many small businesses out there, according to some
surveys, as many as two-thirds of small businesses currently not
providing insurance would like to provide insurance. It's not that
they don't want to, but given the way the insurance market is
currently organized the costs are simply impossible for them to bear.
So for many small companies who don't provide insurance, we're going
to offer them an opportunity to provide insurance in an affordable
fashion with discounts from us, and to thereby attract more talented
workers than they might otherwise be able to attract because they
currently cannot afford to offer health care insurance.
So, overall, our plan is a bonus to the business
community and will level the playing the field in the business
community7 will level the playing field between small businesses that
currently provide and those who do not currently provide, and between
small businesses who provide and pay a whole lot right now and their
large busine~s competitors who are getting better rates.
Now, because of all these beneficial effects it's
important to emphasize that there are many aspects of the plan that
we believe will tend to encourage employment over time. Remember the
critics have emphasized the idea that this may discourage employment.
There are many factors in the plan that will encourage employment,
because the majority of firms will see a cost improvement over time
and they can respond to that cost improvement in a variety of ways:
They can offer their workers higher wages. They can employ more
workers. They can see higher profits. They can invest more. They
can lower prices for their customers. There are lots of ways that
firms can respond to cost reductions.
We believe that some of that response will be an
employment response. Much of it will be a wage response. But the
models that exist don't allow you with any precision to distinguish
which response will be the dominant response. The basic point again
is that most American businesses will enjoy cost reductions, and that
will, of itself, tend to encourage employment opportunities and
higher· wage employment opportunities.·
second, the plan will certainly generate an increase a
net employment in the health care sector itself. We estimate that
early on, by 1996, there should be a net increase in the range of
400 1 000 workers in the health care industry. As cost savings begin
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to accrue in the health care industry we will see a slow-down in the
rate of growth of employment in health care, but never an absolute
fall. What we are doing here is we are shifting resources into the
health care sector up front and then slowing down the rate of
increase over time. So the net effect on employment and health care
should be positive in the short run.
Another aspect of the plan which encourages both
employment and mobility deals with the phenomenon of job lock and the
incentives for workers to switch jobs or to start a new business on
their own. We currently have a situation in which an estimated 30
percent of the work force have indicated that they feel locked to
their jobs because of the fear of losing continuous health insurance
should they change their employment choice, or feel they cannot begin
a new self-employed activity because self-employed individuals have
to pay exorbitant nongroup insurance rates and don't get full tax
deductibility of their health insurance premiums. So we are going to
make the work force more flexible, reduce job loss and increase the
opportunities for people to start new self-employed activities.
The plan will also reduce welfare lock. We have welfare
families who would like to leave welfare and go to work. But if they
leave welfare and go to work, they will lose their Medicaid benefits.
That is a very serious deterrent to moving people out of welfare. So
by reducing welfare lock, we will, in fact, encourage a growth in, or
a movement out of welfare into the work force.
Now, when you think of all of these effects, you reach
the following general conclusion. There are many aspects of our plan
that tend to encourage employment over time. There are some aspects
of the plan that tend to discourage employment, and there are
certainly aspects of the plan that tend to change the composition of
employment.
We've spent considerable time going over the plan,
analyzing the plan very carefully, looking at all of the existing
models out there for assessing these effects. We concluded that the
models are highly imperfect. There is no model out there which can
incorporate all of the pluses. None of the models actually
incorporate any of the pluses that I mentioned in assessing the
employment effects.
on employment
some positive
some negative
employment is
So by doing an analysis, we've concluded the net effect
is likely to be very small. But you're going to have
employment-generating effects, you're going to have
employment discouraging effects. The net effect on
likely to be very small.
Moreover, it is true that over time, those factors which
would tend to encourage more employment will strengthen, and those
factors that would tend to discourage-more employment will weaken.
So, over time, the calculus moves more and more in the direction of
net job creation. our position is the net effects are likely to be
small.
Now, having said that, let me address the issue of why
there are some studies out there, estimating losses in the range of
3.1 million jobs. We view these studies as flawed for a variety of
reasons. First of all, they're just erroneous. They are based on
errors about our plan. They do not take into account our subsidies,
they overstate what the premium costs of our basic benefits package
would be. They don't take part-time workers and treat them the way
we would treat part-time workers. So they've just got some errors in
their analysis.
They also make some technical economic assumptions which
we find to be unreasonable, inconsistent with the existing economic
literature. They overestimate how sensitive firms are in their
·
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employment decisions to a change in employment costs. Those are
parameters that economists use all the time. They chose, instead of
estimates that we don't -- we think are unreasonable.
And, finally, and most profoundly, the models that are
being used out there simply do not .incorporate any of the beneficial ·
effect on employment that I've already listed for you -- welfare
lock, job lock, the effects on the majority of firms will see a
reduction in their costs, and the fact of.a net increase in
employment and health care industry itself. Those effects are simply
not in the model.
So we really -- although we, ourselves, believe that the
employment effects are likely to be small, we are certain that these
very large numbers are just wrong, and they're wrong for all of the
reasons I suggested -- technical failures, economic assumption
failures, and the failure to take into account the plus sides of our
plan.
Finally, let me just end by emphasizing that employment
is not the only standard by which the health care plan should be
evaluated. It is a standard, but it is not the only standard. We
want to worry about the security and health of the American work
force, because to do that will give a more productive, more flexible
American work force, and ultimately, productivity and flexibility
determine high wages.
So the wage opportunities we can offer our work force
over time depend upon how secure they are and how healthy they are.
secondly, we are addressing inefficiencies, very large inefficiencies
in one-seventh of the national economy -- the health care sector. If
we do nothing to reform health care over the period 1993 to 1996, 40
percent of the growth in our per capita GOP will be gobbled up by
health care spending •. And even with that, the number of uninsured
will rise, and even with that, we will continue,to lag behind the
other advanced industrial countries in terms of indicators like life
expectancy and infant mortality. so something is wrong with the
health care sector.
To reform, to make one-seventh of the economy more
efficient presents a tremendous boon to the rest of the economy.
Because, ultimately, our living standards depend upon being
productive and using our very scarce resource very efficiently. So
we have to reform the health care sector to do that. That's another
way we'll get higher living standards for all Americans. Thank you.
SECRETARY REICH: Let me try not to repeat what Laura
said, and to provide a little bit of a conceptual framework with
regard to the kinds of job issues. There really are four separate
job consequences with regard to any health care plan. One of the
consequences has to do with competitiveness. And it was mentioned
already, but let me mention it again in the context of the
international economy.
American firms are now burdened in a way that most other
firms and most other nations are not. American firms have a huge
health care cost -- over $200 billion a year and rising very, very
rapidly. That means that the cost per product in the United states
is apt to be much higher than the cost per product emanating from
another country. That makes us less competitive. When we get health
care costs under control, we are making American industry more
competitive. When we get health care costs under control, we are
giving American industry, in effect, more money with which to invest,
to provide higher wages, to generate more jobs. And that
competitiveness effect should not be underestimated. That may be one
of the most important consequences of all. That's category number
one.
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category number two has to do with the jobs that are
moving into health care and moving out of the number of individuals
who will be moving into the job market and also out of the job
market.
Specifically, reference has been made to job lock and
welfare lock. Undoubtedly, there will be many people who, right now,
feel that they cannot get the kind of job that they want or are
entirely qualified for a much better job than they now have, should
be able to move on to higher responsibility, but are unable to
because they fear that if they lose their present job, they will lose
their health insurance. That is job lock.
If we eliminate that kind of job lock, we improve the
allocation of labor in this country. We create a better match
between what people are able to do and where the jobs are.
Welfare lock has already been alluded to. Many people
are on welfare, they would like to get off welfare, they would like
to join the job market. They can't and won't because they are so
afraid of losing their health insurance.
Number three, there are individuals, and there may be
quite a few, who would like to start their own businesses, who would
like to leave perhaps large businesses, start their own, but again,
fear of losing their health insurance, difficulties with regard to
affording health insurance on their own prevent those small
businesses from forming.
And number four, on the other side you have potentially
early retirees, people who would be moving out of the job market in
an earlier time than they are now in the job market because they have
access to health insurance. They're afraid now to leave because they
don't want to lose the health insurance that is provided by their
companies.
·
So these are the employment effects in terms of people
coming into the employment force, people coming out of the employment
force.
The third category has to do with actually occupations,
the kinds of occupations that will be created and the kinds of
occupations that will be stopped or eliminated or reduced.
Undoubtedly, the purpose of much of this plan is to reduce paperwork.
We have in this country now a fairly sizable paper health care
industry. A lot of people in insurance, clerical workers, people who
are putting data into computers and taking data out of computers, who
are monitoring forms. This does not generate health care. This
generates the monitoring of health care. These jobs would not grow
as fast' in fact, many of these jobs may be eliminated.
on the other hand, you have in the health care industry
itself in terms of the provision of health care many, many more jobs.
It is likely, for example, that the home health care industry is
going to grow dramatically. There's reason to believe that it's
quite inefficient to have a lot of people in hospital beds who are
now in hospital beds. They could do much better at home. If the
incentives were correct, they would be at home. They would be at
home attended to by home health care workers, and that cost would be
cheaper than keeping them in hospital beds. It's likely that, for
example, the occupation of home health care worker will increase
substantially.
And finally,. the fourth category, low-wage workers,
workers who are at the bottom of the income scale. We have tried to
arrange the discounts, we've tried to arrange the costs to employers
in such a way that any negative employment effect for those very low
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wage workers right at the minimum wage would be eliminated, or if not
eliminated, almost eliminated.
Remember that we're talking about, at most, 35 cents per
hour; more likely, for the minimum-wage worker in the small firm in
the range of 15 cents an hour. If you add that to the minimum wage
you're not even back to what the minimum wage was in real inflation
adjusted terms during most of the 1980s. Thank you.
ADMINISTRATOR BOWLES: I think the economic information
that we've heard here today simply reflects what I've heard as I've
traveled around the country over the last several months talking to
literally thousands of small businesses. And that is that these
small businesses, the vast majority of them, will absolutely
experience a much lower cost of their health care and be able to
provide the same or better coverage. So it really is a twofold
benefit that's reflected in these numbers that are presented today.
Not only will the small businesses have lower cost and,
therefore, be able to redirect those scarce capital dollars into
being able to go out and hire new employees and make capital
expenditures and grow their businesses, but also they'll be able to
have a happier, healthier, more productive -- and the key word is
more productive -- work force. So it's a real double benefit for
small businesses from the health care plan.
I should add that it's hard for me to imagine that you
can design a system -- or I should say a nonsystem -- that is more
anti-small business than the current nonsystem this country is
operating under. Today, small businesses experience annual increase
in cost of health care of 20 to 50 percent a year. Small businesses
today pay 35 percent more for the same health care coverage that big
business does -- 35 percent more. And the rate of increase in the
cost of health care for small businesses is 50 percent higher than
the rate of increase for big businesses.
And what are small businesses -- what are we able to buy
for these skyrocketing increasing costs? Almost nothing. We end up
being able to buy or afford a very bare-bones plan or something where
the deductible is so high that all we end up having is just
catastrophic coverage. And we're also subjected to all of the other
abuses in the health care industry -- everything from occupational
red-lining to exclusions for preexisting conditions.
And as I talked to small businesses, I heard over and
over again that they had tried on their own everything they could to
hold down the cost of health care. They tried switching programs.
They tried managed care. They tried self-insurance. They tried
reducing benefits, passing on a bigger cost to their employees.
Nothing helped. The cost of health care continued to escalate and
the abuses remained there.
And let me just reaffirm what Secretary Bentsen said:
Without universal coverage, believe me, there is no cure for the
small businessperson, because the uninsured will continue to get
health care, but they'll simply get it at the hospital at four or
five times the cost it would be at the doctor's office. And who is
that cost shifting on the back of? It's shifting on the back of a
small businessperson who's paying 20 to 50 percent more a year for
their health care cost.
The President's plan really does do a lot to help small
business. The key thing it does in'my opinion is it.really --it
shifts the power of the marketplace. It cha~ges the supply and
demand equation in favor of the consumer and the small business owner
and away from the provider and the insurance company. It really
does; it shifts the power of the marketplace. It gives us some
control over our destiny.
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And this plan also gives small business for the first
time what they've really looked for -- it gives them a chance to go
out and buy rock-solid real insurance, comprehensive coverage,
coverage that is just as good as that offered by most Fortune 500
companies -- not a bare-bones plan, not just catastrophic coverage,
but real insurance.
And the other thing it does is it makes that insurance
affordable. That's why the President fought so hard for the caps and
subsidies there, to hold down the cost of health care so it would be
affordable to small businesses. And the mechanisms are built in
there to hold down the cost of health care so it doesn't grow at 20
to so percent a year. And the system prevents the kind of abuses of
occupational red-lining and exclusions for preexisting conditions.
And it finally puts the self-employed on a level playing field with
everybody else, where we get a 100 percent deduction for our health
care costs instead of a 25-percent that's fair today. And the last
thing it does, it controls the cost of worker's compensation
insurance, which really is the only item on most small business'
income statements that are escalating at a greater rate than health
care cost.
I do believe that when most small businesses that I have
talked to lay this plan side-by-side with their current plan, what
they all say, almost without exception, is they see lower cost and
they see better coverage. This plan is good for small business, it
creates jobs, and I'm excited to have a chance to support it, also.
Why don't we do this in the interest of order? I'll
call on people, then we'll just refer the questions to whoever feels
best equipped to answer them.
Q
Did Congressman Cooper send over his plan for your
perusal? What do you all think of it, and can you pass anything
without the four dozen votes that were already behind him in the
house?
SECRETARY BENTSEN: Well, I think Congressman Cooper's
plan certainly contributes to the debate in a meaningful way. But it
has some serious problems. One of them, it does not have universal
coverage. And as Erskine was just saying, you're going to see the
cost-shifting take place, and you'll see small business bear the
brunt of it. And they will have, themselves, higher costs
continuing. So universal coverage is an essential. It is not there
in that one.
Another one is that they don't have the benefits
defined. That is done later by some national board. And it's
important that you know what you're getting before you vote on it and
what kind of coverage you're going to have.
I would say the third problem with it is the cap that's
put on the plan, the tax cap. And what you would see is a lot of the
major companies that have full coverage would be cutting back insofar
as that coverage, and I think that is a serious flaw in the system.
Q
Dr. Tyson, you said that you're not prepared to
offer specific estimates on the employment impact, but you know there
are short-term impact of net jobs created of 400,000?
CHAIR TYSON:
That was in health care.
Q
Right •. Can you offer how you got to that ~ath?
And how useful is that number if the Clinton plan really isn't phased
in by 1 96, in any real meaningful way?
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CHAIR TYSON: The number was purely within one sector of
the economy, so it's not an economy-wide number; I want to make that
clear. That was one thing that these standard models have not taken
into account, is what might happen to overall employment in the
health care sector. That does assume that there is phase-in at that
time. So if the phase-in changes, .then the dynamics of additional
job creation in the health care industry are sensitive to the timing
of the phase-in. That is exactly right.
Q
to this?
could you walk through some numbers of how you got
CHAIR TYSON: That was an estimate that takes into
account a projected reduction in the insurance clerical work
associated with the administrative cost simplification, and then also
takes into account increases in other providers.
David, what's the source -- David told me the source of
the number, but what is the source of the number? Bureau of Labor
Statistics, right. So this was looking at projected growth in health
sector employment -- various parts of health sector employment done
by the BLS, and then making adjustments in those projected growth
rates for health sector employment to take into account the
anticipated reduction in administrative and clerical on the one hand, ·
and the anticipated increase in home health care nurses and other
practitioners in the health care industry.
so it wasn't a precise modeling exercise in the sense of
sort of running a series of regressions, it's looking at a set of
baseline projections, and then adjusting those baseline projections
based on what we anticipate to be the effect of administrative
savings on the one hand, and increases in provider services on the
other.
Q
on the same issue, you are saying that your
economic models can't capture many of'whatyou think are· the
benefits, the economic benefits this plan would -- why shouldn't a
listener or reader take that as evidence of what many say as their
greatest fear about this plan, which is that it is just so large, it
is so large economically, that things are going to pop out somewhere?
Is that the reason why your model can't take into account the --
CHAIR TYSON: The reason why the models -- models are
not designed to do what they need to do. That is, let me just give
you a contrast. we did -- the CEA did, and the administration did
make a prediction of the employment effects of the economic stimulus
package, for example. Now, how did we get that? There are models
out there that have been estimated over several decades whose sole
purpose is to say if you change a tax·policy or you change a
government expenditure line, what happens to GDP and what happens to
employment? There are economy-wide models. You don't have to know
anything about different kinds of firms, small and large, and which
firms are getting an increase and which firms are getting a decrease.
You don't have to go down into firm level differences and firm level
differences in response.
So it was simple to do that exercise. There isn't any
model out there which allows you to distinguish, to make the kind -the list of distinctions that I have made here today, which is to
take into account welfare lock and job lock and changes within the
health industry and changes for those firms who get cost reductions.
We have to sort of make a set of ass~ptions on how they respond.
And for those firms who get a cost increase, we have to make
assumptions about how they will respond. And, ultimately, I think
the exercise becomes one of using incompletely specified models and
sets of assumptions to generate numbers. And my sense is -Q
can I follow up on that?
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CHAIR TYSON:
Sure.
Q
If you have this problem with employment, with
models of employment. You also have it with models of insurance
behavior, retirement behavior and various other things that the plan
makes specific claims about. Should we have as many doubts about
those numbers -- numbers, for example, that Mr. Magaziner --
CHAIR TYSON: All right, here•s the thing. Each of -for example, on the issue of utilization, for example, there is a
very good study, the Rand study, which is widely used as a standard
to predict how people will -- how utilization rates will respond. It
was designed specifically with that question in mind. The question
is, how does the utilization rate respond to a change in coverage.
Okay? So there are studies out there which think about what affects
retirement behavior. Okay? They are designed specifically to ask
that question. So I think you can get much more specific, precise
answers with narrowly specified questions.
When you get to the economy-wide impact on employment of
a plan which has a variety of offsetting effects, then you don•t have
the model that•s precisely designed to answer that question. It 1 s
really a difference. ·we have models that address precisely the kinds
of questions we needed to address to come up with specific estimates.
Q
What is the small effect that you•re talking about.
A small loss, at what year, 2000?
CHAIR TYSON:
Q
You can generate --
A small change?
CHAIR TYSON: You can generate both kinds of numbers.
Notice -- let•s just give you an example -- which is why I think to
give a number is to sort of provide false precision. The numbers are
speculative, because you could, for example, make an assumption about
how small firms will -- firms might respond to an increase in their
costs by adjusting downward their wages and not changing their
employment at all. And the firms who benefit could respond by
increasing employment and not giving any wage benefit. That kind of
run will generate a net positive number. It will be small, but you
get a net positive. You could do -- you could play the assumptions
another way. So our position is the net effect is small, the effects
that tend to increase employment strengthen over time and the effects
that tend to decrease employment weaken over time.
Q
Q
they?
What•s the range that the models show?
What is small?
Q
What•s the range?
If you have parameters, what are
CHAIR TYSON: Well, I can suggest to you that the range
is probably less than half a percentage point of employment.
Q
Up or down?
CHAIR TYSON: Up or down.
But I 1 ll tell you that I do
not feel that it is appropriate to speculate on the number because,
as I 1 ve just pointed out, any number is speculative and I can
generate a number for you on either side.
Q
No one has said anything yet about inflation.
you talk a little bit about those percents? ·
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MR. RUBIN: Laura, I think, would be the appropriate
person to do that. But let me make one comment if I could on the
comments that Laura was just making. She was referring to the models
and how economists approach this. I'll go back to the pragmatic
comment I made at the beginning of this. And I do think if you've
been in this world for a while, when you're dealing with economists,
you're dealing with business people and you have to make judgments of
what's going to happen. You sort of weigh the both. I think if you
ask most people, almost all people who run big companies what they
think, I think they'd give you an answer that's based more in viscera
than it is on anything that an economist can document. And the
viscera is that escalating health care costs have been an enormous
problem with respect to international competitiveness and they simply
have got to be gotten under control if we're going to be competitive
in the international world and have the exports we want to have.
CHAIR TYSON:
MR. RUBIN:
What was the question?
It was some question related to inflation.
Q
can you tell us a little bit about whether this
plan and , for example, pumping up the health care sector temporarily
will have inflation effects on the rest of the economy?
CHAIR TYSON: The problem with that question is that in
a way it's another side of the same question, because firms can do a
number of things when faced with a change in their health care costs.
They could try to -- firms that have higher costs could try to
increase their prices. Firms that have lower costs might very well
decrease their price. They might not, they might increase their
wages, instead. So it is very hard, again, at the economy-wide level
because there are such differences across firms to really predict
what the effect on the overall -- the economy-wide effect would be.
It's the same question sort of looked at a little differently.
Q
Have you got a range that you can give us, a range
on the inflation, upper or lower, as you've done generally for the
employment numbers?
CHAIR TYSON: Well, I'm sure we could. But my sense is
that, again, I feel that you should use numbers when you believe the
numbers can be defended with precision. But we're in a situation
here where we don't have the modeling capabilities -- not just us,
incidentally, nobody has the modeling capability to really get a
precise estimate of these effects. People will try to estimate them,
but I think that the correct position is that there are no precise
numbers on this, but that there is every reason to believe that the
net effect will be very small, because you have a lot of factors
working in one direction, offsetting some factors working in another
direction.
Q
Given the imprecision, what effect does this have
on your deficit reduction prediction of $91 billion? How firm is
that number as far as the result of health care reducing the deficit
Q
Treasury.
As well as your -- increased revenues for
Q
Yes. I mean, doesn't this have a peripheral effect
on all these so-called firm numbers that are in your plan?
SECRETARY BENTSEN: Well, once again, you have the same
problem that she's been qiscussing, is not having a precise number at
this point. And what we're doing, we're scrubbing the numbers.
We've gone so far as even to hire outside actuaries, outside
estimators to try to be sure that we have total objectivity in it,
and to be certain that these numbers aren't tilted, that they're the
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best numbers we can come up with. We've got them working on through
the night in Treasury, and I know OMB does, as we try to.bring these
about. But I can't give you a precise number at this point.
Q
Mr. Secretary, how do you end up with, for example,
revenue numbers that -- increased revenue numbers that require the
economy to behave in certain ways? If you can't predict the economy,
how are you going to predict these revenue numbers, or the deficit
number?
SECRETARY BENTSEN: I didn't say we couldn't predict
them. I said we're still working refining them. When you take one
facet of it, you can do it with laser precision. But then, when you
get to the interaction of those things, that's much more difficult,
and that's what we're trying to resolve.
CHAIR TYSON: can I say something about this? I really
think that -- think about the situation here. Plus or minus half a
percentage point of total employment is basically in a rounding error
-- it can be a rounding error for a monthly employment number.
That's the size we're talking about here -- a rounding error for a
monthly employment number. We can get the economy-wide effects on
tax revenues, and we can get the economy-wide effects associated with
subsidies with that kind of rounding error. The main point is, this
effect is small. It is a small net effect. So we're pretty
confident, quite confident that we can get the economy-wide
predictions that will give us what we need to make deficit
predictions and revenue predictions. We're talking about
just a
rounding error in a monthly employment number.
MR. RUBIN: Hold on one second. We're going to take one
more question. The President is going to do an event in about five
minutes, and that apparently preempts us.
Q
Secretary Reich, you said early retirees or people
who want to retire are now holding back from retiring because of the
lack of health care. If universal health care coverage is available,
how many more people do you think would be encouraged to retire, and
what kind of savings are we talking for corporations that now provide
health care benefits for early retirees and regular retirees?
SECRETARY REICH: The range we are dealing with is
But, again, I want to emphasize that we are
scrubbing those numbers and working on those numbers at this very
time. And those numbers, like all the other numbers, are subjected
to and should be subjected and will be subjected to not only a great
deal of review, but depend on the interaction of many of the other
factors that we have talked about before.
350,000 to 600,000.
Q
When you say you're scrubbing the numbers, how much
could they go up or down?
SECRETARY REICH: At this point, I don't know. I think
that that's the rough magnitude. But we are reviewing the numbers at
this very moment.
to companies?
Q
-- to 600,000 people.
What about the cost savings
SECRETARY REICH: And again, at this point, we don't
have a firm number. We're reviewing those.
THE PRESS:
Thank you.
END
2:19 P.M. EDT
�THE WHITE HOUSE
Office of the Press Secretary
October 26, 1993
For Immediate Release
PRESS BRIEFING
BY
SENIOR ADVISOR TO THE PRESIDENT, IRA MAGAZINER
AND OMB DIRECTOR, LEON PANETTA
Room 450
The Old Executive Office.Building
7:20 P.M. EDT
MR GEARAN: -- briefing. We expect just about four or
five hours worth of briefing for you this evening. (Laughter.) For
someone who went to evening law school, I feel quite at home here
sitting through this.
My name is Mark Gearan, and let me go through our agenda
for this evening and the terms of the arrangements that we've set up.
We'll go in the following order: Ira Magaziner, the Senior Advisor
to the President will speak on the record and not embargoed.
Q
MR. GEARAN:
Q
Is that a groan or a sign of excitement?
Can we get TV cameras in here?
MR. GEARAN: No. No, we're proceeding. Secondly, Leon
Panetta will follow Mr. Magaziner under the same arrangements -- on
the record and not embargoed. We will then go through some more
details of the legislation that will be as previously announced
embargoed until the President and Mrs. Clinton go up to Capital Hill
tomorrow. Judy Feder, who is the principle Deputy Assistant
Secretary.for Planning at HHS; followed by Alice Rivlin, the Deputy
OMB Director; Nancy-Ann Min, who is the Associate Director for
Health for OMB; Ken Thorpe, who is the Deputy Assistant Secretary of
HHS; and Gene Sperling, who is the Deputy National Economic Council
Director. The latter individuals that are embargoed will follow Mr.
Magaziner and Mr. Panetta who due to previous commitments will have
to leave. We will take questions at the end of all of the remarks.
Q
this.
We can't ask Ira a few questions after he briefs?
MR. GEARAN:
Mr. Magaziner.
No, we'll have to proceed to get through
MR. MAGAZINER: First let me apologize for not returning
a lot of phone calls over the past couple of days, we've been a
little busy. And secondly, I guess the biggest change I want to
start with in our program is we have decided to nationalize all
health care facilities in the country starting tomorrow; it's a bit
of a change from what we said to you before. Somebody is going to
believe that and write that I'm sure. (Lauqhter.) It's on the
record, right. Now it's going to be played back, now I'm in trouble.
·
Here we go. First, let me describe what we have been
doing this past period since the document that we took to the Hill
for limited briefings on September 7th became a best seller in Japan.
We have been consulting, as we said we would, with many different
people on the Hill: governors~ different groups that have written
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in, people that had comments. And we tried to prepare a fairly
thorough grid of suggestions that were put to us and concerns that
people had, and then to try to review our document while we were
updating and preparing our legislati~n.
we also went through a fairly thorough process that Leon
will describe to you of OMB and Treasury examiners rerunning through
the numbers and trying to reestimate each piece and to make sure that
the numbers were scrubbed thoroughly. And then we have drafting the
legislation and preparing some policy materials that we'll be issuing
over the coming week. And those materials will describe in detail
the rationale for the policies that we're proposing, as well as the
actual legislation itself, and we'll also provide detail on the
backup assumptions for the numbers that we're releasing. Information
about the computer models we've used, and kinds of processes we've
gone through to get the numbers.
And this speaks to something which we feel very strongly
about and it's something you'll have to figure out how you regard,
but it's something that's important to us. one of the things we've
tried to do with this -- if you look at all the health care bills
that are out there right now, they tend to leave a lot to the
imagination in terms of both how things will work and how much things
will cost. And we didn't want to do that. We have been chastened in
looking at what has happened with past reform efforts, particularly
in health care where estimates were often widely off, and where
general legislation led to very, very detailed regulations after the
fact, and after legislation was passed, that often altered the intent
and certainly the cost of what was put out. And so, what we wanted
to try to do, for example, was to define a benefits package in
detail, not to say some board at some future time will figure out
what the benefits package is, but rather to define one, and then have
many different sources try to cost it out and go through a careful
methodology to figure out what it would cost to have that benefits
package under the kind of circumstances we're proposing. And then to
subject that and the different subsidy and discount structures that
we are proposing to the same kind of scrutiny and lay them out.
It's very easy in a bill, as many of the bills do and
have done, to kind of put a paragraph or two in which says, well,
we're going to provide subsidies -- low income people to 250 percent
of poverty or 150 or whatever. That's an easy statement to make.
There's a tremendous amount of difficulty to actually figure out how
you're going to do that and not make it bureaucratic. Exactly what
is the schedule going to be and how much is it going to cost and
who's going to get what, and to try to project forward different
scenarios of what the would actually look like. And we have tried to
do that and to do it in a thorough and responsible way.
And so, as people talk about how long our legislation
is, and it's not the shortest legislation ever submitted to Congress,
part of the reason is because we've tried to make those kinds of
definitions. The definition of a benefits package might take up all
of a paragraph or a page in other health care bills. It may take up
so times more than that in our bill because we are defining out
specifically what's there. We feel the American public deserves to
understand what's going to be in the benefits package, and similarly
with things like discounts and other things,
...
So, to that extent we are going to be throwing out for
everybody's review what we have done, and everybody's scrutiny, and
then being quite prepared to discuss it as we go through this
discussion.
In the way in which we envisioned things going forward,
we are going to present this detailed proposal. we don't pretend
that we have the good ideas in the world, or that we have thought of
everything, or that others won't find some mistakes in what we have
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put forward. What we hope to do is to try to go through a process of
improving upon what we are putting out now during the course of a
couple of months of national discussion.
-··What ·is·111ost important to·us as we go·through that
discussion, we won't be defensive about it and when we agree to make
changes or feel that other people have suggested ideas that were
be~ter than ours, and I'm sure that's going to happen in many
respects in the details of the plan, we won't view it as a retreat or
a defeat or this or that. We'll basically view it as trying to build
a consensus and improve upon the product that we have put out.
As you know, health care is very complicated, those of
you who have covered it, and it's something that we're going to be
improving upon for the rest of the decade as we implement the changes
in the health care system that are needed -- and this will be the
first stage in that. But what will always be there in our minds as
we go through and have flexibility about these changes is the six
principles that the President laid out. And I'd like to just
reiterate what we see as important in that.
We believe that this health care reform has to be about
health care security. And that means that·there needs to be a
comprehensive set of health care benefits that are there for people
no matter what happens to them -- whether they lose their job or
change a job or become ill, or a child becomes ill, or move to
another state, whatever -- that has to be there.
·
And so by making a requirement for employers and
individuals to make payments into the system, and by requiring that
everybody have health insurance, and by setting in motion processes
to make that affordable, we are guaranteeing that health security.
And to us that does not mean just universal access to unaffordable
health care -- that's not security -- it does not mean a catastrophic
plan with $2,000 deductibles and $3,000 deductibles, that is not
security. It needs to be comprehensive and it needs to be guaranteed
to people and it needs to be affordable. And that principle will
always be there in what we put forward. And at the end of the day
that has to be there. It doesn't have to be done in every detail as
we have suggested it in this proposal, if other people have better
ideas on some of the specifics -- but it has to be there.
Secondly, the simplicity. We have taken some steps, and
what you will see in this legislation, to try to simplify somewhat
what we have proposed in the draft. We've taken to heart things
people have said about things that they thought might be too
regulatory, and we've tried to simplify some of that regulation in
what we are putting forward. For example, the alliances we are
setting up will not have the kinds of abilities that were in that
initial draft to restrict health care plans, and the acceptance or
the offering of health care plans, except if the plan is a certain
percentage above an average. There won't be other more open-ended
ways in which it can restrict health plans -- and things of this
sort. We've done a fair amount to try to simplify even what we have
proposed before.
What I will say to you on this, though, is that -- and I
think .I've said this to some of you who have been at other meetings - when you really look at the health care system we have today, if
you put 1,000 of the brightest people in the country in a room and
said, "Design the most complicated health care system you can," they
could npt possibly come up with today 1 s system. It defies the human
i111agination in how complex it is. And we are trying to simplify
that, but also we don't want to make too much of a radical departure
from what exists. And so we are living with a little more complexity
than we would like, but that is in order to provide continuity.
·
However, we have simplified significantly what was initially proposed
and what is in the current system.
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The third principle -- costs, getting costs under
control. At the end of the day we don't want to rely on somebody's
wish about getting costs under control. It's very easy to say you're
going to put some kind of general cap on·the rate··of growth -- of
Medicaid, or whatever else, or Medicare -- and not define exactly
what you're going to do. What you will see in our proposals is very
specific, scorable definitions of what we propose to do.
.
similarly, in the private sector we have put out -- and
you'll see in the packets we hand out in the next week -- materials
which talk about how we expect the introduction of competition and
the changing of incentives to bring about savings in the system. But
we also are proposing t9 control the rate of growth in our premiums
in the legislation as a backstop to the competition. And, again,
we're not inflexible, but at the end of the day there needs to be
some assurance that the universal coverage that we are proposing and
the requirements for everybody to have insurance doesn't bankrupt the
economy, That basically we get the growth of these costs under
control.
Fourth issue that is of great importance has to do with
choice. We do increase choice -- in fact, in one of the changes we
are making from the September document we go a bit further, and that
is that we require a point of service option to be offered by all
health plans. For those of you who are not into health care in a
significant way, what that means is that even if you joined an HMO or
a preferred provider organization, that you would always have the
option to go to some specialist across town or across the country if
you wanted to. You might have to pay a little bit more, as you would
today to do that, but that that option always will be there fer you.
So we are trying to maximize choice in the way in which we have
structured the system.
Quality is the fifth principle. We don't have a quality
system in health care right now that works. Quality outcomes are
often unknown and they're very disparate around the country and we
are, for the first time, going to try to put a total quality
management system in place that will collect the kind of data that
allows us to develop good practice parameters and to help measure
quality outcomes in the health care system. This is something that I
think is ~idely supported around the health care community, but that
system does not yet exist and we're going to try to get rid of the
kind of micro-managed system we have today that doesn't really work
to ensure quality, but just adds bureaucracy.
And finally, the question of responsibility. And for us
that means not only responsibility for your own health, of which I'm
probably a hypocrite, but we are talking more about responsibility
for preventive care, responsibility for taking care of one's own
health, but also responsibility for everybody contributing to the
system. Where we want everybody to make some contribution, according
to their ability to do so, to their own health care coverage. And
for us the requirements that employers and individuals make payments
to .the health care system is both a way to ensure universal coverage.
And finally, to share the responsibility among everybody and not have
the kind of free rider situation we have today.
So for us, those principles have to be there, but there
is a lot of details in health care reform and we look forward to a
constructive discussion with those who are sincerely interested in
reform.
·
Let me just emphasize a couple of other points before I
turn it over to Leon. We are very encouraged that somewhere around
260 people in Congress have now signed on to some health care bill.
It shows the seriousness with which people understand that we need to
deal with this problem. We hope that the bill we put forward will
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set a new standard for the kind of detail in addressing the problem
that we think is necessary to make sure that we make a careful and
responsible reform. But then we look forward to discussing with
others who are sincerely interested in reform, and trying to build a
bipartisan consensus over a number of mbnths·whidh will allow us to
succeed with health care reform.
A couple of issues that I'll close with that represent
ways in which we've tried to refine and balance what we are
proposing: There are dueling concerns that are legitimate concerns
that we have tried to balance. one concern is to ensure and
guarantee health care security. The other concern is not to have
some kind of open-ended entitlement which does not create a sense of
responsibility about the affordability of that health security. And
we saw what happened when Medicare was first introduced and Medicaid
was first introduced, and it was essentially evolved into a kind of
cost-plus system for a while that skyrocketed out of control.
And so what we want to try to do is to set up a
mechanism that guarantees the health security, which we have done.
But then also to cap the entitlements for the discounts that are part
of the plan, but then set up· a mechanism, a series of mechanisms to
protect the health security. so, for example, you will see in what
we put forward that as we have talked about the amount of discounts
we need nationally, we've coated those carefully but then we've added
in a 15 percent contingency above that. And that contingency will
help give us some cushion against possible behavioral effects, and
we've tried to take a lot of those qualitative behavioral effects and
some of them lower costs, some of them raise costs, but we wanted
enough a cushion in there so that we knew we had enough money in this
pool. Then if, in some way, in a given year that were to be reached
so that we needed more money to insure, then we've set up an
expedited mechanism for Congress to then have to go back and find a
way to secure those funds. So that way you focus attention on the
problem. It's not something that's open-ended, it is something that
is capped. But you have to deal with the problem, you can't breach
the health security. And we think that while we don't expect that
kind of backstop to ever be used, we think it needs to be there to
ensure the health security and also ensure some fiscal responsibility
as we go.
. Second thing that you might·want to focus on is that as
we have gone through trying to make our numbers ones that tie
together when the bill would likely be passed in the first go-around
in June and July when we produced our models, we still were modeling
for a December 1 93 passage which was still our hope in June. I think
that's not likely now, and so we think it's more likely that spring
or summer of '94 we will have passage. And so what you'll see is
that our numbers, in a sense, are all moved backward in time,
somewhat. We've done a lot of consultation with states and governors
and so on, legislators, to think about realistic time frames for when
states might be ready to come into the new system. Some states meet
every two years in their legislature, and so on. And so we have a
phase-in schedule now that meets the new passage date and also has a
kind of, we think, realistic assessment of when states would be ready
to enter the system.
The third thing we have done is to use updated inflation
factors. When we were modeling in June and July, we used the January
CBO inflation forecast which were about 2.5 percent a year -- sorry,
2.7 percent a year. Since then, in August, the Council of Economic
Advisors, and in September CBO came out with revised forecasts. The
CBO at I think 3.1 and CEA at 3.5. In order to be conservative, we
took the·CEA numbers and we're now projecting forward based on those
inflation factors.
you'll see.
So those are some of the significant differences that
The net effect of that, as Leon will show you, is some
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�-,·'
- 6 -
rearrangement of the ways the numbers look, although the basic
structure of what we're proposing remains intact.
The only other point I'd like to highlight. before I
finish is that one of the things that we want to try to do a better
job of is, over the next week to two weeks, and then ongoing through
the debate, is to try to spend enough time with you in the kind of
detailed discussions that we are going to begin tonight so that you
understand the background of what we're doing, you know, the extent
to which you're interested in doing so, and to try to go through the
detail, let you understand the assumptions. You may question them,
just as the American public may do, and then we need to discuss them,
and that's part of what the policy debate should be. But at least we
want it to be based upon as good of information as possible about
what is actually in the numbers.
And sometimes because we're so busy, and sometimes
because you're often on deadlines, things have to get done quickly or
through short phone calls, and as a result there can be
misunderstandings, which are nobody's fault, about what is really in
numbers. What we want to try to do is provide enough information,
because this is going to be a long process of discussion, so that you
have a full sense of what we're doing.
So that's where we are right now. I'll turn it over to
Leon now, who is going to go through the numbers in a little more
detail.
Q
Ira, did you have a backslide on your retirement?
MR. MAGAZINER:
No, that's the same provision.
DIRECTOR PANETTA: To paraphrase Winston Churchill, this
is not the end, and it's not the beginning of the end, but maybe in
the very least, it's the end of the beginning.
This has been a very long and exhaustive process that
we've been through in trying to scrub the numbers and put this
package together. When I entered this process early in the year I
knew one thing, that there was no way that we could sustain the costs
of the existing health care system that we were working with, that we
were essentially really headed toward bankruptcy with the existing
system -- no matter what the President did on an economic plan, no
matter what we did in terms of trying to reduce the deficit -- that
ultimately, unless we were successful with trying to deal with health
care costs and the health care·system in this country, that we would
never be able to truly strengthen our economy for the future.
And so, with that in mind we took on, obviously, what is
a very huge task for any administration to take on. But it's a
necessary task. Our hope is to, obviously, move the legislation to
Capitol Hill tomorrow. And I'd like to give you some idea of the
process we went through as we were developing and putting together
the numbers to support the package.
The Office of Management and Budget and the Treasury
Department basically carried out a responsibility to, a very literal
way, look at each line of the legislation. This is a 1,300 page bill
that will be going to the Hill. A line-by-line analysis of each of
the policies, the assumptions behind those policies, and then
obviously, the legislation itself to ensure that it met our tests
that we traditionally apply at the Office of Management and Budget.
·
While there have been some small changes in policy, I
think the real challenge has been to calculate what are basically the
interactive affects of various policies. Every time you move a
policy, or every time you implement a policy, you've got to look at
what its impacts are on other parts of the plan. And that was
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�- 7 -
obviously the effort that took the most time, was to be able to
analyze each of those effects throughout the legislation. If you
adjusted one policy, or you changed one number in a proposal this
complex -- whether it's an economic assumption, or whether it's a
subsidy, or·whether ·it's a benefit-- it ·can have an impact on every
other part of the package. And that. was the challenge, was that
every time something moved, as you met, and as there were
discussions, and as there were minor changes -- even minor changes
had to be analyzed in terms of their impact across the board.
When all is said and done, we believe that over the past
several weeks we have considered all of the issues associated with
the policies that we are proposing. We've examined the assumptions
behind each of the numbers to try to make sure that these policies
work and that the numbers are accurate, and we have made the changes
that we believe are necessary. We've updated, as Ira pointed out,
the economic assumptions. We have to present the most updated
assessment of where the economy is qoing, and that's why we used the
updated assumptions of the Council of Economic Advisors.
We have adjusted the phase-in period for implementation
of health care reform, which now runs from fiscal year 1 96 through
fiscal year 1 98. We're looking at about 15 percent of the population
coming under the plan by the end of fiscal 1 96, 40 percent by 1997,
and 100 percent by the end of fiscal year 1998. That compares to
what was initially proposed, which was to move from 25 percent to 90
percent to 100 percent. We believe these phase-in assUmptions are
realistic and that they make good sense.
The bottom line is this, that the numbers that we
present we believe are credible, they're responsible, and they are,
most of all, conservative estimates of what we believe these costs
will be. It is exactly the same test we applied to the economic
plan: When we were faced with two different estimates, we always
chose the more conservative estimate. When two agencies came up with
different estimates, as they are likely to do in many instances, we
always tried to choose the more conservative estimate.
As always in these situations, when you're trying to do
responsible financing, it's much easier to simply throw numbers on a
paper if you want to just get by. But if you're trying to do this in
a responsible way, you have to ask questions every time a new number
appears, every time there is a minor change. And so that's what
we've done here.
Let me try to present, if I can, just a quick summary of
the numbers that we have in the bill in terms of its cost. Let me,
first of all, assert, as I have before, that the primary cost of the
basic benefit plan is covered by the premiums that will be paid by
the businesses and individuals. That's where the primary costs are.
on the federal side, though, these are the costs that we will face,
and how we pay for them.
The costs that we are looking at primarily are the costs
of providing, first, the premium discounts for businesses and
families. That's the largest cost -- it's about $116 billion. The
numbers I give you are cost estimates for 1 95 through the year 2000.
so the premium discounts are estimated at about $116 billion over
that period of time. There is a self-employed tax deduction. It's
100 percent tax deduction for the self-employed -- that's $10
billion. The Medicare drug benefit, the additional drug benefit that
is provided to those on Medicare -- $66 billion. Long term care that
we are providing for those in home and in institutions -- $65
billion. · And the public health administration, to try to expand
public health services and try to cover those that will be caught inbetween -- $65 billion.
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�- 8 -
The cushion that was mentioned by Ira is another factor
here. I've mentioned the basic cost, but what we did on the subsidy,
in order to try to protect ourselves, again, in terms of the cost
estimates, was basically to estimate each year what those premium
discounts would be and then add 15 percent as a cushion to protect
us. And the costs of that over that period of time are $45 billion.
When you add up all of those costs, it comes to a total
cost of $331 billion. To pay for that we have used the following:
First, we will get revenue gains that Treasury estimates at $71
billion. This is basically the net estimate of the gains that we
think we can achieve in revenues by virtue of the reductions in
health care costs.
The second is the federal programmatic savings that we
will achieve through, obviously, picking up some of these individuals
in care with the alliances. Those are savings in federal programs
such as DOD, veterans, as well as public employment health care plans
for civil servants. That total is $40 billion.
The tobacco tax and corporate assessment: tobacco tax,
as you know, is 75 cents -- produces about $65 billion in revenues.
The corporate assessment, which is a one percent assessment on those
corporations that are s,ooo and above that don't join the alliances,
that's about $89 billion -- I'm sorry, $24 billion. So you have $65
billion plus $24 billion, the total revenues would be $89 billion •.
Medicaid savings -- $65 billion, largely through savings
and disproportionate share. And then Medicare savings -- we have 25
specific proposals that we are presenting to the Hill for savings in
Medicare that total $124 billion.
So again, the revenue gains, the programmatic savings,
the taxes -- the tax revenue of $89 billion, the Medicaid savings of
$65 billion, Medicare savings of $124 billion produces a total
savings of about $389 billion. That leaves us deficit reduction at
the end of this period of $58 billion. Those are the core numbers
that we will be presenting in the bill and to the congress. And they
are numbers that I believe -- as in the economic plan -- that we can
defend and that we can justify in the process of going through the
debate.
The politics may be one thing in this issue, and people
may disagree with the elements that are a part of this. People may
disagree with the different portions of the plan as to how we pay for
it. And that's okay -- we can disagree. But I think on the numbers
that we have presented they are credible, they are real, and we can
defend them to the Congress and to the country. So that the debate
can then focus on what kind of services, what kind of benefits, we
want to provide the American people.
Let me just end on this note. I served, as many of you
know, for 16 years as a member of Congress. In that 16 years, health
care became a bigger and bigger problem. And during that period, I
think congress largely ignored the crisis. As costs for families and
businesses and governments continued to spiral out of control, a
number of -- the large number of uninsured Americans continued to
grow as more and more families began to fear the loss of their
insurance coverage. There was a failure to deal with this issue.
And, obviously, we are paying the price now. We saw lots of
suggestions, lots of ideas, lots of concepts that were proposed -never did we see anybody step up to the plate and present a
comprehensive plan that was fully paid for. And so what the
President and First Lady have presented here to the country and to
the Congress is what I believe to be a comprehensive, responsible,
detailed plan that will begin the debate on health care reform in
this country.
I would urge you, as others propose alternative plans,
to hold them to the same standard. There can be no shortcut to
�- 9 -
providing comprehensive coverage for Americans in this country. We
look forward to an honest debate. This is the beginning of the
process. There's a long process ahead of us. We anticipate that
we're going to continue to work with Democrats and Republicans in the
Congress as we try to eraft final legislation over these ·next months.
The President we think has taken a huge first step in
putting health care reform in place for this country. This is the
end of the beginning. But we think we will wind up with a very
successful end in providing health care coverage for all Americans in
the United States.
END
7:50 P.M. EDT
�\
··----·-··------·-------
Save the Children v
By JohnJ. DilulioJr.
PRINCETON, N.J.
he $22 billion Federal
anticrime
package
m~ toward passage In Con&ress has
some good lhings In IL
But the bill owes too
much to the latest mass hysteria
about crime, and It will liD almost
nolhing to defuse lhe nation's real
crime bomb.
America's "crime epidemic" Is
largely a myth. In most places and
for most types of crime (even crimes
wtlh guns), rates have been stable or
falling for at least a decade.
But that good news conceals some
very bad news: violence In lhe Inner
cities has never been worse, and Its
face has never been younger. 1be
homicide rate among black youlhs
has nearly tripled since 1978. Over
the past five yean. lhe violent crime
rate for black male teen-agers has
risen sharply, to 113 per 1,000. And
virtually all crim&agatnst black juveniles are comm'lted by black juveniles.
•l
There are at least lhree ways to
deal wtlh lhls trqtc situation. 1be
Inner cities need more pollee officers,
and the states need more prisons to
lock up hardened criminals, bolh juvenile and aduiL And lhen we need to
find some way to remove at·rlsk juveniles from at·rlsk setttnp.
1be crime bill goes partway toward addresatng the first two soJu.
lions. It would provide flmds to help
cities hire about 100,000 more offl.
T
Make cities safer.
And get kids
out of them.
cera. UnfortuDately, that's a small
fraction of wbat's needed.
Inner-city Amertc:a has a severe
cop lhortage, ID the 1980's, u the
· tnner-ctty crime problem
many
bla city pollee forces contracted. Today no major pollee force bas IIIICIU8h
officers to sreatly Increase the num·
ber of officers .on foot patrol In Its
worst nelahborllooda.
So If the crime btu Is to have a real
Impact on the pollee shortage, these
two condlttons must be met: first,
must see to It that the new
cops 10 only to the bla cities that need
them mOIL Second, bla city mayors
must pleclae to deploy the new forcei
In crime-tom nelghbortloocls.
1be bill would also make 18 billtaa
available for new prisons and less
conventional correction proarama,
·like boot camps for nonviolent oftenders. 1bls, too, II a-fraction of the need,
srew.
conaress
J
John J: Dilullo
Is pro(euor o(
polllkl and public af(aJrs at Princeton University and senior feUow at
lite BroollirtlfB lnaUrutlon.
for contrary to pclliular lore, we are
not putting violent and repeat crlml·
nals behind bars and keeping lhem
there for all or most of their terms.
About lhree out of every four people
under correctional supervision some 11tree million convicted crtml·
nels- are no! incarcerated. Imprisonment, not probation or parole, has
become the alternative sentence.
Strategies of Jdentlfyln& arresting
and locking up repeat offenders have
produced sharp decreases In violent
and property crimes. But tnc:arcera·
tlon does not mean warehousing.
Prtson-based drug treatment and
work and education programs reduce
recidivism and must be expanded.
Admittedly, cops and prisons are
Band·Ald solutions. But so are lhe
social programs that have been dl· ·
reeled at Inner cities.
Many people react wllh dismay to
findings on lhe long·term Inefficacy
of programs like Head Start, summer
~lh ~ucatlon and training and
work-based welfare reform. But how
could any combination of piecemeal
programs compete successfully wtlh
the negative forces at work In the
homes, schools and nelahborhoods
where so many city kids spend each
day?
· A recent National Academy of Sci-"
ences study found that America's
"poorest of nelahborhoods seem fn.
creulngly unable to restrain crimf.
nal or deviant behavtors," and harbor
few "pod role models for adoJes.
cents." Like the nipeat felons, Jobless
dereUcts and drug addicts In their
midst, too many kids are arowtng up
radically "present-oriented" - lhat
Is, unable to defer lmm~iate sratlfl.
cationa for the sake of future rewards, and tnc:apable of perceiving
any relatlonshlp between doing
wnllll and being punlsbed. .
HlahlY Impulsive and self-centered
rich kids don't do 88 wen 88 their
peers In the classroom or later In the
boardroom. Poor Inner-city kids wtlh
these character defects wind up OUt·
erate, unemployed or In a poUce body
baa before lhey're old enough to vote.
ID a recent Issue of 1be Brookings
Review, the poJIUcal scientist James
Q. wu- suggested helpblg families
In poor urban neighborhoods to voluntarily enroll· their children, beatnntn8
at an early aae. In boarding schools.
1be boarding school would be anylhtng but a "reformatory." 1be prf.
mary obJects would be to provide
skllls for college or work, and to Instill the pod character traits of poo
llteness, cooperation, kindness, hard
work and self-control.
.
All Americans should share the
desperation ol decent, stnlglfn&
fearful Inner-city citizens. 'l1le moral
obllpUons of ciUzen.shlp require u
muc:h. But lhere Is also an appeal to
enlightened self-Interest tD be made.·
Most Amertc:ana may lhlnk that serf.
ous crime Is stiU somebody else's
.Problem. But unless bold steps are
taken, not Jon& after lhe tum ol the
century It will be everyone's problem.
And there Will be no way - not
thi'OUJh the justice system, not
lhrough social programs - to get
away from IL
0
THB NBW YORK TIMBS,
$AT~RDAY,
NOVBMBBR-13, 1993
I ..
�Bad Medicine v·.~
...
. '·
By Harvey F. Wachsman
enable states to focus their lnvestlgai •
lions on phystclans who are likely to ,
be a public risk and to determine.-•
whether action should be takea..
against them.
. ;
Also, experience shows that physt·
clans who don't carry malpractice .
Insurance are more likely to practice ;
substandard medicine. At the very,
least, requiring Insurance companies ~
to report would allow states to makl!' ·
public the names of doctors who dotl't' •
have Insurance or have had It
voked or severely limited. It would
help patients make Informed judg.;"
GREAT NECK, L.l.
edical negligence
kills more than
100,000 Americans
·
every year and In·
jures more than
half a million. Yet
only about 2,000 physicians are disci·
pllned each year by state medical
boards. The vast majority get a slap
on the wrist - a warning or short
probation - and most of these cases
Involve fraud or other crimes, not
malpractice.
. ··:
Clearly, medical malpractice reform should be a centerpiece of our
~·
new health care system. Yet most of
the recent reform proposals have
been advanced by the Insurance and
. medical lobbies, and they do more to
.,,~
Insulate bad doctors and keep mal·
; practice victims out of court than
they do to protect th' public.
.'\
......
· The proposals lnclll'de no-fault plans
their doctors.
!under which the state or Federal gov· menta In choosing reform would be to·"'
Another Federal
: emments would pay any claims, which
would effectively absolve negligent remake state licensing and disciplindoctors of liability; caps on damage ary proceecllnp. State medical boarcll·'
and peer-review organizations are 11811'••I
1awards, w~lch would discourage law·
! suits by petiple with legitimate clalllls; l.ally composed entirely of physlclaiWI':l
mandatory arbitration outside the who often bend over baCkwards to 81ft!'·
their fellow doctors break. Col!greDcLuns. and panels to screen for "frl~ should require thatathese boards ·lnlw
.lous" lawsuits. These last two prdpos.. '""
. als are tantamount to blocldna the elude nonphyslclans. .
And the Government should 18T1a
courthouse door.
. In my practice, I have seen thou- quire states to open llceoslng ~:1
sands of cases of negligence In which disciplinary heartnga to everyone and
patients' liveli have been destroyed or to make their flndlnp public. Boa~ 11
· lost because of negligent physlclalls. should also be required to Issue theli'1
America needs malpractice reforms findings In disciplinary matters wlU.. ~
that protect patients, not bad doctors. In one year - rather than allcJwlnj_n•
States claim that they lack the them to drag on Indefinitely, as ottiiJW
:u
money and staff to Investigate and happens now.
Congresa can also Improve tfW!9
prosecute all complaints against phy·
slclans. But there are resources watchdog systems that are already triC'l
available to help them locate the bad place. For example, the Federal
doctors, and the Govemmept should Health care Financing Admlnlstra•·
t1on regularly eompUes the mortality
rates at hospitals around the coun~J't'
HEAlTH CARE
but provides no Information on ~ 1
causes of death. Why not require Its
SECOND OPINIONS
Investigators to evaluate whether the
death rates are due to factors beyon4'l i
the hospitals' caatrol or to negJIRerii:S ~
or substandard care?
~~--.1 · 1
Another asset that has been wastecr ,d!J
require states to use them.
A study by Tufts University found Is the National Data Bank- a fedi!r-'1
that Insurance companies restrict or ally financed computer registry that'"
cancel the malpractice policies of Includes the names of physicians wll(ill ~
more than 7,000 doctors every year have been found liable for malpnioal~
because of questions about compe- tlce, who have paid out settlementlrtilul:
tence or Inordinate numbers of mal· victims In malpractice lawsuits 1111!; l
practice suits. That's only a fractloo against whom disciplinary ac:tlanl.i :1
of the Incidents of malpractice, but halve been Imposed. At present, thla
It's more than triple the number of valuable lnformatlan. banlc Is closed , •
doctors who are being disciplined by to the public. President Clinton ~·~
state authorities.
recommended that It be opened. ~T
The c11nton health pian should re- gress should follow suit linmedlately., .:>
quire Insurance companies to report
If the American people are to have '·..
to state medical boards when they confidence In a national health cant' .
cancel or restrict a policy. 1bls wou1c1 plan, they will have to be-assured 11\tlt :~
their ph~lclana are, at the very~ ·:
Harvey F. Wachsman, a lawyer and competeaL 1be President and eon.: J•
neurosurgeon, Is author of "Lethal gress should enact malpractice lawa-1'· .
Medicine: The Epidemic of Medical that protect us from those who are
Malpractice In America."
not.
Cl'~;
M
reo :
-
Malpractice laws.
to help victims, ·~::
not doctors. ·
~HB NBW YORK TIM~ $AT~RDAY,
NOVBMBBR-13, 1993
I
'-,
i
�\ '·
.
James}.. llongan
\.
Health Care: Why We
Failed the Last Time /
I am the doctor who was at the
bedside when the last national health
proposal, put forth by the Carter ad·
ministration. died. The time was May
1980 and the place the Senate Finance
Conunittee. I was the White House
representative lor the Carter adminis·
tration during the committee's bill·
drifting liession. The proposal died
quietly, v.ith little attention lr~m t!Je
media, after a two-year "wasting W·
ness" during which it shrank from a
large, relatively robust proposal to a
small, anemic shadow of its former
sell.
The Carter plan began, under principles released in July of 1978, as a
proposal for a phase-in of universal
coverage. But the administration was
never certain of support for the increaseCI taxes of employer mandates
necessary to make universal coverage
a reality. So the plan began to diminish
even before it was released in "draft
fonn" in January of 1979-to a proposal for a phase-in of coverage, with
each expansion conditional on certain
economic c:irtumstances. This conditional phase-in was then diluted fur·
ther, during congressional consulta·
tiona, to one conditioned on further
congressional votes for implementation at each phase;
FinaUy, uni\-ersality was left behind
in March of 1979 when the Carter
administration feU back to an attempt
to~ a phase-one-only bW tbat would
have achieved some modest expansion
of low-income coverage, along with a
diluted employer mandate of much
less expensive coverage, against only
catastrophicaDy bigh health costs. The
proposal finally expired in May 1980
when the Finance Committee failed to
reach agreement even on this anemic
remnant of the original proposal.
I write now in the hope that we can
learn some lessons from an autopsy of
this case that might lead to a different
outcome for the Clinton proposal.
There are important similarities between the Carter and Clinton plans
and their political context. Both proposals, at least at the outset, have
been quite broad in scope, caDing for a
phase-in of universal coverage, and a
broad set of benefits, financed in good
part through an employer mandate,
with appropriate subsidies. There are
also some similarities in the political
~tting with, in both instances, a Democratic president working with a Con·
gress controlled by Democrats.
There are also, of course, important
differences. Substantively, the Clinton
proposal has a somewhat different administrative structure, re!)ing on
state-based health aDiances that foster
managed competition. There is a rela·
tively large role for state flexibility.
The Carter plan had a larger federal
role, with employers having a choice of
obtaining private coverage, or obtaining covera'e through a federally sponsored public backup program modeled
after Medicare.
As for the political setting, there are
at least two important differences.
First. President Clinton has placed
health insurance high on his agenda
from the earliest months of his admin·
istration. In the Caner administration,
health insurance took a back seat to
energy issues and welfare reform, to
name but tii.'O competing illsues. Secondly, there appears to be somewhat
more cohesion among Democrats than
there was in 1979 and 1980, when
health insurance became an important
battleground in the struggle between
President Carter and Sen. Edward M.
Kennedy prior to the primary election
fights in 1980.
.
What lessons can be learned, then,
from the story of the ill-fated Carter
proposal? First we must establish the
cause of death. The Carter proposal
wasted away a little at a time, graduaUy growing smaUer and smaUer.
Why? Undoubtedly, division among the
Democrats was a major factor: it gave
the administration little choice but to
attempt to build a more conservative
coalition around a much smaUer proposal in the Finance Committee.
Equally important was the subordina·
tion of the goal of universal coverage
to other goals-among them avoiding
tax increases and employer mandates..
which aroused the anger of the smallbusiness community.
The first lesson, then, is to remember the importance of party cohesion.
A health insurance biD cannot be
passed by Democrats alone. It surely
cannot be passed with a badly fractured majority party. Democrats who
want health insurance to pass must not
aUow the best to become the enemy of
the good and bog down the debate in
repeated tests of ideological purity.
Having said tbat, the second lesson
is that during the puB and tug of
congressional action, the moral compass to guide us through the health
insurance debate and lead to a successful conclusion must not be lost or
set aside. That moral compass is the
attainment, by a date certain, of universal coverage. Once this debate begins to slide down the slippery slope
away &om universal coverage,
through contingent universal cover·
age, on down to incremental expansionS of coverage, it will suffer the
same death by degrees as the Carter
proposal.
Although just about everyone in
Congress, of both parties, is ostensibly
in favor of the concept of universal
coverage, there is still a notable queasiness about the employer mandates
and taxes necessary to make universal
coverage reaL
In the quest to gain the broad bipar·
tisan support that will be necessary to
pass legislatioa, ~ is the danger
tbat the goals of avoiding taxes and
mandates will again take precedence
over the goal of achieving nniversal
coverage-and we will again fail to
meet the major moral test. of thi~
debate.
There is a message here for members of Congress. You can negotiate
on the types and mix of taxes and
mandates, but a guaranteed date for
universal coverage must be nonnegotiable if we are to avoid the mistakes
of the past and seize tbis histcirie
opportunity. The test of history will be
simple: Is everybody covered?
The writer was associate dim:tDr of
the White House domestic policy staff
in the Carter administration. He is
now dean ofthe medical sdulol at the
Uniwrsit, of Missouri-Kansas c;ity.
r
'·
��~xcepuon for equ1pmen1 that needec
lreouent or substanual service. That
t'QUipment would contmue 10 be rented.
llt'hen the bill went to a Senate-House
conference commiuee, Mr. Antone recalls, some conferees decided they ·
wanted the bill's language to Include a
couple of specific examples of equip- ·
mentlhat might require frequent serv· ·
ice. And when the bill left the commit· •
tee, the conferees had cited nebulizers ,
and aspirators.
'
Mr. Antone says he does not know
how that happened. But Charles Spal·
ding, chief of the Medical Services Pay·
ments branch at the Health Care Fl·
nance Administration, said, "The In·
dustry proposed lt."
Since that time, however, the Gov·
emment has teamed that the devices
generally need little If any significant
service. And yet, Mr. Spalding said,
"some folks with chronic c:ondiUons
: have 10 pay $30 or $40 a month more or
lesa Indefinitely" In copaymenta to rent
a nebulizer or aspirstor, even though
"a common purchase price for ·one Is
$200 to $250."
Last year the Government spent $120
million reimbursing Medicare patlenta
, for the rental of just these two devices.
1 But this summer, Congress set out to
1 remove both of them from the frequent
1servicing category.
I
Unfavorable publicity along wnh
changmg soc1al and political aunudes
and stricter conflict-of-Interest laws
began making it more dilllcult for
high-profile lobbyists like Mr. Deaver
to be effective. And at about the same
time, lobbyists began to notice that
labor unions and so-called public Inter·
est groups, like Ralph Nader's Public
Citizen, were using a different approach.
These groups generally did not have
super-lobbyists. So when they wanted
to Influence policy, they used what they
called their "grass-roots" networks.
This meant geulng their members
around the country to tell Washington
how they felt.
In the mid· 1980's, one lobbyist, Jack
Bonner, said he and others In his field
began to see "that certain groups were
doing this very well- unlons,'environ·
mental groups, consumer groups while business was doing It rather
poorly." Fewer than 5 percent of the
Fortune 500 companies were using
grass-roots lobbying, Mr. Bonner
found. So he and others adopted the
practice and began trying to Improve
on IL
The difference was that corporate
lobbyists had more money to throw I
behind the effon. And with the added
resources, they were able to take ad- !
vantage of ·the ·latest technology. As I
their strategies grow ever more elabo- l
rate, some of the original grass-roots
lobbyists worry that they can no longer
keep up.
"These developing technologies like computerized grass roots - com·
blned with enormous resources, are
overwhelming the system,'' complained Fred Wenhetmer, head of
Common Cause, one of the first organl·
zallons to use modem grass-roots lobbying. "II gives these organizations
special advantage. And It's gollen to
the point where the Government Is no
longer capable of dealing with lt."
lr
•constaot Stream• of Faxes
While the change was still·belng debated, Deborah Harnsberger, a lobby·
I ist with the equipment suppliers group,
said the Industry's position waa that
aspirators should not be removed from 1
the rental list. Some nebulizers could i
be moved, she added, while some -oth·
ers should not.
;
And to make that point, she said, "we
are using grass roota aa pan and par·
eel of what we are doing. A conataot
stream of· faxes and phone calls Is
going from here to our members."
In the end, the trade group won a
panlal victory. Congress left It up to
the Health and Human Resources [)e.
panment to decide whether nebulizers
and aspirators should be rented or pur·
Defense
chased - giving the Industry another
opponunlty to make Ita case.
At the same time, Corine Parver,
president of the lobbying group, dis·
avows the letters to Mr. Cardin.
"We don't engage In that kind of
Most.Jobbylsts .will qulckly ~cknowl
lobbying" using patienta, she said, sug.edge that their professloiutill bas an
gesting that It was probably the work
·unsavory reputation. The·, · pubHc
of an overzealous affiliate of the trade
·"thinks we are a· small group; In Guccl
group who took grass-roots lobbying to
shoes, somehow controlling Issues Ill a
an unethical extreme.
.way that Is at variance with the the .
bile Interest," Mr; Jaslnowkt said.
Most lobbyists are. not likely to deThe Change
rlbe themselves as altruistic ser. nts of the public good. But they say
e public Is unfairly disdainful of
em.
"The average person forgets that
they have lobbyists too," said Richard
Some lobbyists can point to the moH. Kimberly, president of the Ameriment when their profession began tak·
'can League of Lobbrsts. "Maybe they
lng Its new path: Man:h 3, 1986. That's
i go to church. Wei , chun:hes lobby.:
the day Time magazine published a
Maybe they are retired.· Well, the rephoto on its cover of the ·lobbyist and
tired people have a lobby. But Instead,
former Reagan aide Michael Deaver In
when people think of lobbyists they
the backseat of his limousine talking on
think of organizations like the N.R.A.,"
the phone. The headline asked: '.'Wbo'a
the National RIDe Association.
this man calling?"
.
·
Falr.enou&h. but do any of the corpoRight away the photo sparked new
rate and commercial lobbyists that are
convulsions of concern about blgh-pow·
so often the '-rget of complaint actual-·
er "super-lobbyists."
ly perform work they are proud of? Mr.
"That was the line of demarcation,"
Kimberly said be would try to find a
Mr. Cowan says now.
lobbyist who was working on a cam
palgn that the public might adinlre..
I
Lobbyists' Version
Of a White Knight-
!
'Super-Lobbyists'
On the Bandwagon
~
I
Ten ciays later, he sa1d he was having
' hard time finding anyone willing to
aep forward. But he did point to Casey
)lnges, the lobbyist for the Amelican
;oclety of Civil Engineers.
Mr. Dinges said his organization dls:overed last fall that the Depanment
>f Housing and Urban Developmeaa
was about to propose a new standard
lor the construction of mobile homes.
After Hurricane Andrew destroyed
thousands of trailers In South Florida
In August 1992, the Government de·
cided the building standards were inadequate. So Mr. Dinges's organization
, drafted a detailed new standard and
Ilobbied the Government to adopt it. ,
"Just because someone lives In a
mobile home, why can't they be safe?"
Mr. ·Dinges asked. Besides, he said,
when inadequate building standards
cause problems, "our members are the
ones who have to clean the stuff up.".
HUD decided to adopt the engineers'
standard; a senior Federal official said
the depanment considered It "rigorous
and complete." But as soon as HUD
announced Its decision, one lobbyist's
proud victory became another's desperate battle.
And so the grass roots came Into
play. The Manufactured Housing Institute, representing mobile home manufacturers, unleashed a furious lobbying
campaign to defeat the engineers' proposaL The lobby argued that the engl·
neers' standard would raise traUer
prices In some areas by as much as 38
percenL Bruce Savage, spokesman for
the group, said: "II may be nice to
have a 'safe' home. But If no one Ill
buying them, what's the point?"
When the depanment asked for public comment on the proposed new
standard this summer, the manufacturers "contacted all our members on
:our araas-roota network," Mr. Savage
said. HUD waa flooded with a thousand ·
letters of complaints.
•
The depanment will not malce Its
final ruling until later this autumn. and
so the lobbying continues. But for now,
the engineers' proposal Is still on the
table.
. .Next: Lobbying by foreign interests.
�A Town Full of Queries on Health Care
By ADAM CLYMERV
Spctt~lla lbt New Yortl
TIIMI
Dr. E ugene Dava·d sonwor ried wheth•
er he and his fellow chiropractors
would be Included In the plan:
Debra F0 lkens, a nurse pract It1
oner,
reminded the Washington visitors that
It was cheaper to train nurses than
doctors.
Karl Sommers of the Mennonite Mu·
tual Aid Association wondered If Men·
nonltes would have to join health care
alliances wilh others who did not share
their beliefs about health.
But most concerns focused on two
kinds of distance: the distance between
towns and hospitals in an area where
the high school football team often
travels 150 miles or more for a game,
and the conceptual distance from
Washington, where It seems national
Issues are always decided.
Several people complained that regulations were written In Washington
with urban areas like New Jersey In
mind Mr Roberts said Medicare relm·
burs~me~t rates paid "75 cents on the
dollar" In this area. so the Federal
Government was already to blame for
the shifting of costs that raised the bills
and Insurance rates of everyone else.
GARDEN CITY, Kan., OcL 30- The
health care issue descended on western
Kansas today. Farmers, doctors and
hospital administrators were told that
change was coming. They wondered
about how It would work and how It
would affect their small businesses, or
their hospitals or the chances of getting
a doctor to practice In a small town.
The state's two Senators, Bob Dole
and Nancy Landon Kassebaum, both
Republicans, did not exacUy appear as
advocates of President Clinton's program though they brought two speak·
ers·who did. Indeed. when one speaker
said, "If you assume that the Clinton
plan passes," Mr. Dole grinned and
shook his head vigorously.
But Mr. Dole, the Senate Republican
leader, was there to tell 450 Kansans
assembled in a high school auditorium
to prepare for some kind of change. He
recalled Hillary Rodham Clinton's
openness to compromise and said,
"Give us time In Congress to do It
right."
The audience seemed worried about
Undenone of Agreement
too much change tilo soon. People
looked serious when Mr. Dole warned
Denise Denton, the exeeutive dlrecof job losses and bureaucracy. And tor of neighboring Colorado's Rural
they applauded when· their Republican Health Resource Center, said that she
Representative, Pat Robens, summed was generally enthusiastic about the
up his views by saying, "I don't believe Clinton plan but that she feared that its
the American dream Is for everyone to Intended cuts In the growth of Medl·
be leveled with everyone else."
care would prove "crippling to many of
your rural hospitals." The plan In·
Some ConftlcUna Collcerns
valves $124 billion In Medicare cuts;
Back In Washington, there Is a ten· Senators Dole and Kassebaum did not
dency to believe that whellthe capital pipe up to say that the plan they supIs consumed with an Issue, so Is the
country. Except when the Issue Is war,
that Is rarely the case. But today It Is.
There is a nationwide debate on health
care, even If It lacks the clear dividing
lines of some broad concerns of the
past, like President Richard M. Nixon
and Wateraate or the Vietnam War.
Here In the fiat wheat country the
worries sometimes conftlcled. Edle
Dahlsten from the Kansaa Farm Bu·
· reau complained of Imprecision:
"Don't alve us a percentage and don't
tell us how wonderful the proaram will
l:>e, though that's pan of the vision. But.
what will it cost?"
On the other hand, Penney Schwab
from the Methodist Ministry to Mexi·
can-Americans complained of detail
and said, "I question whether any lea·
islation that takes 1,500 pages to write
can actually reduce Federal bureau·
cracy."
. And some doubta here. like those
heard In Conllre~~&lonal hearlna rooms . .
: or doctors' offices, related to a panac:u- .
jlar worries.
port would call for about as much.
Ms. Denton said, "It's not a lot of
choice If you have to go to Topeka to
access care." (Two hours later, Ms.
Denton experienced the isolation of
Garden City herself, missing the 11:45
plane to Denver. There was not a
scheduled flight to anywhere until Sun·
day afternoon.)
Yet there was an undertone, not of
unanimity, but at least of widespread
agreement. One speaker after another
said It was Important to have universal
health ~re. Mr. Dole put it blun!ly: "If
you can t get health care, you ve got
problems."
When one questioner asked Mrs.
Kassebaum why southwestern Kansas
should have to help pay the costs of
AIDS and gang violence elsewhere
when It did not have those problems,
the Senator suggested that the area
had at least Its share of other major
public health costs, like highway accl·
dents and drug and alcohol abuse. "We
may think there are no problems in
southwestern Kansas," she said. "We
can't Just lanore what's happening."
Jeffrey Human, who came from
Washington where he Is director of the
Office of Rural Health Polley at the .
Depanment of Health and Human
Services, drew nods of agreement
when he said, "If you don't have health
insurance, then all the rest of us have
to pay for it for you."
Carrying the Cllntons' message of
compromise, Mr. Human said, "We
can Jive with a changed plan If It encompasses universal coverage and If It
encompasses comprehensive benen~:·
q
�
Dublin Core
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Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
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White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
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1993
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2006-0223-F
Description
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This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
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72 files in 6 boxes
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Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
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William J. Clinton Presidential Library & Museum
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<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
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Background on Health Reform [1]
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First Lady's Office
Melanne Verveer
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2006-0223-F
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<a href="https://catalog.archives.gov/id/2068127" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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42-t-2068127-20060223F-002-004-2015
2068127
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https://clinton.presidentiallibraries.us/files/original/9863c2c81e83666941d0c3900d0d5395.pdf
b068c5ee7480865231305f07d51cf886
PDF Text
Text
1 .. I
HEALTH CARE
THAT'S ALWAYS THERE
A FIFTEEN MINUTE VIDEO PRESENTATION
OF THE CLINTON HEALTH SECURITY PLAN
�PURPOSE
This program is designed as a primer on the Clinton Health Security
Plan for Members of Congress, Democratic Party activists, community
groups, and anyone else who needs to understand it or to explain it to
others. Although it will be of broadcast quality, it is not intended to be
a stand alone 1V program for the general public.
OYERYIBW
I imagine this piece as a fifteen minute, inspirational, educational
piece. It needs to communicate the urgency and ~ umanity of the
health care issue and at the same time clearly and calmly explain how
the Clinton Health Security Plan will address the problem of a system
out of control.
As such, I feel the tone of the piece should be human and emotional
rather than newsy. I see us relying on real people to communicate the
dimensions of the problem and on .the President to explain the
solutions.
In order to identify people to talk to in the program, we might look to
the thousands of letters the White House has received or the many
people Hillary Clinton has met around the country who have shared
their fears and concerns about the state of our health care system.
STRUCTURE
As I understand It, we have several distinct elements to communicate
in our program.
l. The problem: The system is out of control, costs are skyrocketing
and meanwhile, people live in fear of losing access to health care.
- 1-
�2. The vision:
This plan reflects a commitment on the part of the
President to take on the special interests who
have kept us from reforming the health care
system to give Americans real security that they
will always have health care.
3. The solution:
A The Clinton Health Security Plan will bring the
system under control
B. It will provide security to every American
that their health care will always be there no
matter what.
C. We Will pay for the plan through controlling
costs, and through asking every American -employers, consumers, cveryonem -- to take
responsibility for his/her health care.
I have chosen to divide the plan into three sections to reflect what I
see as distinct themes:
*.How we will fiX the system
* How the system will work for you
* How we will pay for health care
Section 1: Introduction: A System Out of Control
What we say: The introduction must carry the message that, as it
stands, our health care system no lonRer makes sense. Health care
costs are out of control, having quadrupled since 1980. And they are
rising at a rate that \Vill have the cost of care to American families
doubling by the end of the decade.
-2-
�Meanwhile, everyone Uves in fear of losing their coverage, and every
month, 2 million people do. If we do nothing, one in four Americans
will lose their health insurance in the next two years.
In short, everything that is wrong with our health care system is
threatening everything that is right about American health care. We
must fix the system -· preserVing the things people care about: the
right to choose their own doctor and the ability to get high-quality,
affordable care.
What we see; Here we need to communicate the seriousness and
immediacy of problem in an evocative way. I imagine a montage of
"health care" images: doctors in hospital rooms, peoole in clinic waiting
rooms, nurses filling out reams of forms, a crowded urban emergency
room, probably all slowed down and in black and white. Not scary, but
urgent. Over these, we will hear the voices of Americans telling us of
their fears and concerns about the health care system:
Man's voice: "I've been stuck in my job for 10 years because I'm
afraid that if I leave, I'll lose my health insurance."
· Woman's voice: "I work for a small company and they don't cover me
and my little girl. If we get sick, I don't know what I'll do.,,
Man's voice: "I've run a diner for fifteen years and I'd love to get
insurance for the folks who work for me, but I just can't afford it."
Woman's voice: 4'1 became a doctor to help people. Now I spend half my
time just filling out fonns."
-3-
�You get the idea. These people must be real, they must be
expressingtheir concerns, and we must be able to relate to them. I
would intersperse the visual images we're seeing with factoids
(graphically represented on the screen) about the general state of the
health care system so as to broaden these individual experiences to
illustrate the big picture.
This section might even want music. I see it lasting about 3 minutes.
Section 2: The Vision behind the olan
What we saYi Here the President needs to tell us where this plan is
coming from. Something like, "For decades, we have watched our
health care system become bloated and inefficient- costing more and
more, yet leaving Americans without the security of knowing that
when they need health care, it will be available to them. And for
decades special interests have protected their profits and blocked
efforts to meaningfully reform the system. But no more."
He should then elucidate the prtncipals on which this plan is based:
*Security: A plan that let's people know that they can never lose
their health care coverage.
*Savings: A plan that will control the skyrocketing costs.
*Simplicity: A plan that will close the loopholes and reduce the
bureaucracy that are bringing the system to its knees.
*Responsiblllty: A plan that asks every American to take
resoonsibllity for reforming the system so that once again, it will work
for us instead of against us.
-4-
�What we see: This should be the President speaking directly to us,
probably in a setting somewhat less formal than behind his desk in
the Oval Office.
Section 3: Getting the system under control
What we saYi In today's health care system costs are out of control,
and we are awash in a sea of bureaucracy, red tape, waste,
inefficiency and fraud.
The Clinton plan will get the system under control by:
* slashing the
red tape that forces doctors and patients to spend
their time filling out forms and fighting bureaucrats,
*cracking down on fraud by imposing and enforcing stiff penalties
on anyone who takes kickbacks, files fraudulent claims, or in any way
abuses the system for profit.
*reforming malpractice to eliminate "defensive medicine" (doctors
ordering extra tests or procedures just to protect themseJves from
malpractice suits) that hurts the quality of care while driving up the
cost
* controlling costs by stopping overcharging by doctors and
hospitals, and limiting drug prices that are three times higher here
than they are overseas.
-s . .
�What we see; I see this section starting with a montage, not unlike
the introduction, but \Vith people on the screent not just in voice over.
Again, these should be real oeople (lay people, health care
professionals, maybe lawyers) in interview settings, telling personal
stories that specifically telate to the things that are wrong with the
system.
We will hear a patient describing the ordeal of trying to get
reimbursed for an operation only to be told, after filling out
mountains of paperwork and countless phone calls, that the insurance
company was not going to pay. Or a doctor talking about ordering a
whole battery of expensive tests on a patient not because she felt
they were necessary for the health of the patient, but because she
feared a lawsuit if she didn't.
As in the introduction, I see this montage as visually stylized,
interspersed with tmages that relate to the stories we are hearing,
and possibly graphic "facts" relating the individual story to the larger
problems with the health rare system. This segment lasts about one
and a half minutes.
Then the President will respond by describing the way in which the
stories we've just heard relate. to the larger issues at stake and how
the Health Security Plan will address them.
The President's explanations should, I think, be helped out with.
graphics. Not Perot-type charts, but highly produced, animated
graphics to which we would cut away during his explanations. This
section should run about 5 minutes.
-6-
�Section 4: Protecting the best and proyjdlng securitx
What we sav: The Clinton plan protects and·expands access to highquality health c.are for all Americans. Without refotm, one out of tour
people Will lose their coverage in the next two years. This plan will give
every American the security of knowing that they can never lose
their health care coverage, no matter what. How does this work?
Well, under the Clinton plan:
*
Everyone gets a health security card which nobody can ever
take away. It guarantees them access to a comprehensive benefits
package that is at least as good as most Fortune 500 companies
currently offer their employees. And that goes for everyone,
whether they are employed or not, whether they work for a huge
company or a small business. Everyone!
* People stay healthier because, unlike most current insurance
plans, the Clinton plan emphasizes preventive rare by providing
coverage for a wide range of preventive services.
* People have increased options for long-term care. The Clinton
plan makes it possible for more elderly and disabled Americans to stay
in their homes while receiving care rather than being forced into
nursing homes.
* Insurers won't be able to hurt small businesses and
consumers the way they can now because under the Clinton plan, it
will be illegal for them to drop people for any reason. The plan will
close the loopholes that permit insurers to deny coverage because of
preexisting conditions. They won't be able to cancel your insurance if
you lose your job. And they won't be able to ·charge small businesses
and individuals double what they charge big business.
-7--
�* The consumer will be in the driver's seat when it comes to
dealing with insurance companies. Having small businesses and
consumers band together in health alliances will level the playing field
and give them the same bargaining power as big businesses.
What
we see: As in section 3, I see this section starting with a
montage of stories and images, this time relating specifically to issues
of security. A man who has been without health insurance for three
years and is scared death of ever getting really sick. A woman who
couldn't afford to go to the doctor for routine checkups because her
insurance didn't cover them, and only finally went when she
developed a serious illness that required hospitalization which was
covered by her insurance. Or a small business owner whose
insurance premiums were tripled because one of her employees got
sick and racked up some high medical bills.
Again, the President will respond to these stories by describing, with
the help of graphics on the screen, how the Health Security Plan will
give us the security that these people, and so many of the rest of us,
crave, but have never had.
This section should take about 5 minutes.
Section 5: How we're going to oay for this
It seems to me that there is only one way to tell this story and that's
for Bill Clinton to tell it, directly to camera. probably aided by
graphics. This section should be no more than 3 minutes long and
should consist of "nothing but the facts." Here's how we're going to
finance the system, and here's what you will be responsible for.
-8-
�.
We'll get costs under control through:
A reductions in administrative costs,
B. savings in Medicare and Medicaid, and
C. possibly a cigarette tax to fund
long-term care for the elderly and disabled.
And every American will be responsible for participating in the
system:
*
If you are a self-employed individual, it will cost you this much.
*
If you are employed by a company that currently provides
insurance, here's what they'll pay, here's what you'll pay.
*
If you have a small-business that hasn't been able to afford to
provide health insurance for your employees, here's how you'll
be able to and here's what it'll cost. Etc., etc.
Obviously we will need real numbers to make this section work.
We will, I believe, also want to let people know that their costs are
likely to be the same or lower than they are now, and that their
coverage is likely to be the same or better than it is now.
-9-
�Conclusion
Here, the President should make some brief concluding remarks. He
should restate the purpose of the plan, rally the viewers to the
difficult fight we have before us, warn people that the opponents of
change will try to thwart this effort but that we cannot, under any
circumstances let them prevail, and that people must speak out and
let their views be known in order for this plan to succeed.
Following this, I think it would most effective for us to hear how some
oeoole feel about the plan. I'm thinking of very brief testimonial
quotes from a doctor, a health care economist, a small business owner,
etc. This section should, I think, be run with music and last no more
than 2 minutes.
-10-
�'
\
'·
,.-'
.
PRELIMINARY
REALm CARE DECISIONS
�(
/~
\ .
\
..
TABLE 01' CONTENTS
OVERVIEW OF HEALTH REFORM
·PRELIMINARY PLAN FOR NATIONAL
HEALTH REFORM
(
DECISIONS
�( ..
-~
•
OVERVIEW OF HEALTH REFORM
(
·--
�WHAT IS RIGHT WI1'H AMERICA'S HEALTH CARE SYSTEM?
( .'~
MOST AMERICANS ARE HAPPY WITH THE QUALITY OF CARE
THEY RECEIVE FROM THEIR DOCTORS.
MOST AMERICANS HAVE ADEQUATE CHOICE OF DOCTORS
AND TYPES OF CARE <THOUGH NOT IN UNDERSERVED
AREAS).
(
MOST AMERICANS HAVE NEGOTIATED HEALTH CARE
BENEFITS WHICH THEY FEEL ARE ADEQUATE (THOUGH THEY
FEAR LOSING THEM>.
�MAJOR PROBLEMS Wl1'H TODAY'S HEALTH SYSTEM
COSTS ARE HIGH AND RISING TOO FAST -- OVER 14% OF GDP
VS. LESS THAN 9% IN GERMANY AND LESS THAN 8% IN
JAPAN.
LACK OF SECURITY -- ONE IN FOUR AMERICANS LOSES
COVERAGE EVERY TWO YEARS.
NOT USER OR PROVIDER FRIENDLY-- IN SURVEYS, MOST
CONSUMERS AND PROVIDERS FIND THE SYSTEM TO BE
BUREAUCRATIC, CONFUSING AND FRUSTRATING.
MANY AMERICANS ARE UNDERSERVED -- 37 MILLION LACK
COVERAGE; 22 MILLION HAVE ONLY "BARE BONES"
COVERAGE; MANY RURAL AND POOR URBAN AREAS LACK AN
ADEQUATE MEDICAL INFRASTRUCTURE.
INADEQUATE LONG-TERM CARE --AN INCREASING NUMBER
OF PEOPLE REQUIRE LONG-TERM CARE.
�WHY COSTS ARE RISING IN HEALTH CARE
. HIGH ADMINISTRATIVE AND TRANSACTION COSTS
•
INSURANCE UNDERWRITING AND CLAIMS
PROCEDURES
•
INEFFICIENT REIMBURSEMENT AND QUALITY
SYSTEMS
INCENTIVES FOR UNNECESSARY CARE
•
PROVIDERS PAID BY THE TEST OR PROCEDURE
ENCOURAGING MORE TESTS AND PROCEDURES TO
BE PERFORMED
•
CONSUMERS ABLE TO ACCESS THE SYSTEM AS
· THEY WISH WITH FEW INCENTIVES TO LIMIT USE
TO NECESSARY OCCASIONS
•
FEW INCENTIVES TO EVALUATE NEW TECHNOLOGY USAGE AND CAPITAL INVESTMENTS FOR
COST EFFECTIVENESS
•
TO A LESSER EXTENT, DEFENSIVE :MEDICINE
PRACTICED TO AVOID LAWSUITS
�WHY THERE IS LACK OF SECURITY
· THE ORGANIZATION OF THE U.S. INSURANCE MARKET
•
•
...
\
INSURANCE COMPANIES COMPETE BY RISK
SELECTION --TRYING TO INSURE ONLY THOSE
WHO ARE UNLIKELY TO BECOME ILL AND
DROPPING THOSE WHO DO BECOME ILL -- IF YOU
ARE LIKELY TO NEED CARE, YOU HAVE DIFFICULTY
BEING COVERED
HEALTH CARE BENEFITS FOR MOST AMERICANS
(THOSE WHO ARE NOT OVER 65 YEARS OLD OR WHO
ARE NOT POOR OR SEVERELY DISABLED) ARE TIED
TO EMPLOYMENT
NOT ALL EMPLOYERS PAY TO COVER THEIR
EMPLOYEES
LOSING OR CHANGING JOBS CAN MEAN LOSS
OF COVERAGE
(
I
AS COSTS RISE, MORE EMPLOYERS ARE
DROPPING COVERAGE AS A COMPANY PAID
BENEFIT OR INCREASING THE EMPLOYEE
REQUIRED PAYMENTS WinCH CAUSES SOME
EMPLOYEES TO CANCEL COVERAGE
�WHY THERE IS LACK OF SECURITY (CONT'D)
. •
,/
~.
AS A RESULT, 37 MILLION AMERICANS ARE
UNINSURED AND ANOTHER 22 MILLION LACK
ADEQUATE INSURANCE. MANY ADDITIONAL
AMERICANS LIVE IN FEAR OF LOSING THEIR
COVERAGE IF THEY LOSE THEIR JOB, THEIR
EMPLOYER CUTS BACK ON HEALTH CARE
PAYMENTS OR THEY OR A FAMILY MEMBER
BECOME ILL
•.
�THE SYSTEM IS NOT USER OR PROVIDER FRIENDLY
(
'
.. ~-__
'i·
THOUGH MOST AMERICANS FEEL OKAY ABOUT THE QUALITY
OF CARE THEY RECEIVE, THEY ARE FRUSTRATED BY:
•
•
(
. THE COMPLEXITY OF THE CLAIMS AND
REIMBURSEMENT PROCESS
UNCERTAINTIES ABOUT WHAT IS OR IS NOT
COVERED IN THEIR INSURANCE POLICY
HEALTH CARE PROVIDERS ARE ALSO FRUSTRATED BY THE
BUREAUCRACY THEY MUST ENDURE AND THE MICROMANAGEMENT BY GOVERNMENT AND INSURANCE
COMPANIES OF THEIR DAILY ACTMTIES.
•
•
MULTIPLE UTILIZATION REVIEWS
•
CLIA
•
(
DRG AND RBRVS REQUIREMENTS
PRO'S
•
MULTIPLE REGULATING AUTHORITIES
�WHY MANY AMERICANS ARE UNDERSERVED
(
...~-
PROVIDING· COMPREHENSIVE HEALTH BENEFITS FOR
UNINSURED AND UNDERINSURED AMERICANS WILL STILL
LEAVE MANY AMERICANS WITHOUT ADEQUATE HEALTH
CARE.
•
INADEQUATE INFRASTRUCTURE-- DOCTORS,
HOSPITALS, ETC. -- IN MANY RURAL AND POOR
URBAN AREAS
•
POOR HEALTH EDUCATION AND INADEQUATE
PREVENTIVE SERVICES
(
'!
(
�INADEQUATE LONG-TERM CARE
/
-AN INCREASING NUMBER OF AMERICANS WILL REQUIRE
LONG-TERM CARE AT SOME TIME DURING THEm LIVES
•
AGING OF THE POPULATION
•
INCREASING ABILITY TO MAINTAIN LIFE AFTER
SEVERE ACCIDENTS, BIRTH DEFECTS, SEVERE
ACUTE ILLNESSES
THE FAMILY IS LESS ABLE TO PROVIDE CARE AT HOME
•
MOBILITY OF POPULATION
•
·.AGING OF POPULATION MEANS CHILDREN OF OLD
ELDERLY MAY THEMSELVES BE ELDERLY
•
INCREASED PARTICIPATION OF WOMEN IN THE
WORKFORCE
•
DECLINING REAL INCOMES OF MANY FAMILIES
THE PROBLEM GROWS DRAMATICALLY IN 20-30 YEARS
�ADDRESSING THE PROBLEMS: THE WORK TEAM PROPOSALS
PROBLEM
HIGH ADMINISTRATIVE COSTS
SOLUTION
• ELIMINATION OF INSURANCE UNDERWRITING AND
MULTIPLE RISK PRODUCTS
• SIMPLIFICATION OF CLAIMS AND REIMBURSEMENT
-MOVE TOWARDS CAPITATED PAYMENT SYSTEMS
-SIMPLE UNIVERSAL CLAIMS AND REIMBURSEMENT
FORMS DRIVEN BY UNIVERSAL ENCOUNTER FORMS
• ELIMINATION OF DUAL COVERAGE AND COVERAGE
DETERMINATION PRACTICES
• SIMPLIFICATION OF PRODUcr REDUCES NEED FOR
AGENT TO ASSIST CONSUMERS
• REDUCTION IN COSTS OF SMALL GROUP
ADMINISTRATION
• REDUCTION IN REGULATORY REQUIREMENTS -- FORM
FILLING -- FOR CLIA, PRO'S, ETC.
• REDUCI'ION IN MALPRACI'ICE PREMIUMS
• REDUCI'ION IN TIME SPENT BY PROVIDERS AND
INSURERS INVESTIGATING OR DEBATING
REIMBURSABILITY
.
.
�ADDRESSING THE PROBLEMS: THE WORK TEAM PROPOSALS (CONT'D)
PROBLEM
UNNECESSARY TESTS AND
PROCEDURES
SOLuriON
• BUDGETED/CAPITATED SYSTEMS DISCOURAGE
UNNECESSARY UTILIZATION AND INTENSITY OF SERVICE
BY PROVIDERS
r
• GATEKEEPERS QN liMOs OR PJios), SOME USE OF COPAYS
IN FEE FOR SERVICE PLANS AND PRICE COMPE'I'ITION .
WILL DISCOURAGE UNNECESSARY CONSUMER USAGE
• NATIONAL TECHNOLOGY ASSESSMENT AND BE'ITER
INFORMATION ON PRACTICE PA'ITERN DIFFERENCES AND
EFFECTIVENESS OF TREATMENT WILL ENHANCE COST
CONSCIOUS/HIGH QUALITY PRACTICE
• BUDGETED/CAPITATED SYSTEMS ENCOURAGE MORE
PRUDENT USE OF TECHNOLOGY AND MORE COST
EFFECTIVE CAPITAL INVESTMENT
• MALPRACTICE REFORMS WILL CtJT THE COSTS OF
MALPRACTICE INSURANCE AND DEFENSIVE MEDICINE
LACK OF SECURITY
• ALL AMERICANS ARE INSURED
• INSURANCE CANNOT BE DENIED OR TAKEN AWAY
REGARDLESS OF HEALTH STATUS
�·-·
ADDRESSING THE PROBLEMS: THE WORK TEAM PROPOSALS (CONT'D)
PROBLEM
LACK OF SECURITY (CONTD)
SOLUTION
• BENEFITS AT A COMPARABLE LEVEL CONTINUE
REGARDLESS OF EMPLOYMENT OR INCOME STATUS
• ALL AMERICANS AND THEm EMPLOYERS PAY INTO THE
SYSTEM AT THE SAME RATE REGARDLESS OF THEm
HEALTH STATUS
NOT USER FRIENDLY
• GREATER CHOICE OF PLANS FOR MANY AMERICANS
• SIMPLE UNDERSTANDABLE BENEFITS PACKAGE
• ONE COVERAGE PACKAGE FOR A FAMILY
• NO COVERAGE BATrLES AMONG INSURERS
• GUARANTEED ACCESS TO PLANS
• CONSUMER COMPLAINT MECHANISM IN PLANS AND
ALLIANCE
• SIMPLE REIMBURSEMENT AND CLAIMS FORMS
• PUBLISHED QUALITY INFORMATION
PROVIDER FRIENDLY
• CLIA SIMPLIFICATION
• PRO SIMPLIFICATION
• STANDARD REIMBURSEMENT AND ENCOUNTER FORM
•·
�~-·- ....
ADDRESSING THE PROBLEMS: THE WORK TEAM PROPOSALS (CONT'D)
PROBLEM
UNDERSERVED POPULATIONS
SOLUTION
• UNIVERSAL COVERAGE
• INCREASED INVESTMENTS IN INFRASTRUCI'URE IN
POOR URBAN AND RURAL AREAS AND IN PUBLIC HEALTH
• PREVENTION OF "RED LINING• OF HEALTH ALLIANCES ..
• RISK ADJUSTMENT OF POOR POPULATIONS
• HEALTH ALLIANCE RESPONSmiLITY FOR BUILDING
HEALTH NE'IWORKS WHERE NONE EXIST
INADEQUATE LONG-TERM CARE
• EXPANDED OPPORTUNITIES FOR HOME CARE
• RAISING MEDICAID SPEND DOWN LIMITS
• BEGINNING OF SOCIAL INSURANCE PLAN
• INCENTIVES FOR PRIVATE INSURANCE MARKET
.
. .
�HOW THE NEW SYSTEM MAINTAINS WHAT
PEOPLE I,TKE IN THE CURRENT SYSTEM
MAINTAIN NEGOTIATED BENEFITS
• LARGE EMPLOYERS AND EMPLOYEES CAN MAINTAIN
THEIR CURRENT PLANS AS LONG AS THEY MEET
FEDERAL STANDARDS
-EMPLOYERS CAN CONTINUE TO PAY MORE GENEROUS
CO-PREMIUM, COPAY AND DEDUCTIBLE FOR
NATIONALLY GUARANTEED BENEFITS PACKAGE IN A
TAX SUBSIDIZED MANNER
MAINTAIN HIGH QUALITY SYSTEM
• QUALITY OF SYSTEM WILL IMPROVE WITH Bm-t'ER
PRACTICE GUIDELINE INFORMATION, QUALITY REPORT
CARD, CONSUMER SURVEYING
• QUALITY INFORMATION WILL BE MORE AVAILABLE TO
CONSUMERS
MAINTAIN CHOICE OF DocroR
• BUDGETED FEE FOR SERVICE NETWORK ALLOWS ALL
AMERICANS TO CHOOSE THEm DOCI'ORS AS THEY CAN
TODAY
• AVAILABILITY OF MULTIPLE PLANS OF DIFFERENT
TYPES ALLOWS CONSUMERS GREATER CHOICE OF TYPE
OF CARE THAN MANY HAVE TODAY
..
.
�..
.-.
.
WHAT COULD GO WRONG?
WHAT COULD GO WRONG
A LARGE NUMBER OF SMALL
BUSINESSES GO BANKRUPT
SAFEGUARDS
• PHASE IN OF MANDATE
• SUBSIDIES TO SMALL BUSINESS
A TWO-TIERED SYSTEM DEVELOPS
• THE HEALTH ALLIANCES
BECOME SUPER MEDICAID AND
THE SELF-INSURED PLANS ARE
FIRST CLASS
• HEALTH CARE PLANS
SELECT BY INCOME OR
REDLINE
• LARGE HEALTH ALLIANCES
DRAWN ACROSS CONTIGUOUS
BOUNDARIES WITH INCOMEDIVERSITY REQUIREMENTS
• REQUIREMENTS ON SELFINSURED PLANS TO CONFORM TO
NATIONAL GOALS AND TO
CONTRIBUTE TO POOL FOR
DISABLED
• RISK ADJUSTMENT FOR PLANS IN
·POOR AREAS
• UNIFORM QUALITY
REQUIREMENTS FOR PLANS
• HEALTH ALLIANCE
RESPONSffiiLITY TO BOLSTER
PLANS IN UNDERSERVED AREAS
• SOME LIMIT ON PRICE
COMPETITION
�..
---
\
~------------------------~---------------------------.1
WHAT COULD GO WRONG
THE WORST OF MANAGED CARE
COMPANIES ARE VICTORIOUS IN THE
COMPETITION
SAFEGUARDS
• ALLOW PROVIDERS TO JOIN MORE
THAN ONE PLAN
• REMOVE ANTI-TRUST
RESTRICTIONS ON PROVIDER
NEGOTIATIONS WITH INSURERS
• ALLOW PLANS TO SERVE AREAS
OF A REGION AS LONG AS THEY
ARE NOT "REDLINING"
• ESTABLISH REINSURANCE POOL
• ESTABLISH UNIFORM QUALITY
REQUIREMENTS TO PREVENT
ABUSE
STATES CANNOT MEET OR ENFORCE
THE BUDGET
• STATES GIVEN FULL SET "TTOLS"
TO ENFORCE
• FEDERAL BACK-UP
• 'IWO-YEAR BUDGET
�-.
..
--·
WHAT COULD GO WRONG?
WHAT COULD GO WRONG
HEALTH CARE PLANS RATION INSTEAD
OF LOWERING ADMINISTRATIVE COSTS
OR ELIMINATING UNNECESSARY
TREATMENTS AND PROCEDURES
SAFEGUARDS
• UNIFORM QUALITY SYSTEM
o HEALTH ALLIANCE CAN DROP
PLAN
• STATE AND FEDERAL OVERSIGHT
MANAGED COMPETITION DOES NOT
WORK TO REDUCE COSTS
BENEFIT PACKAGE IS MORE EXPENSIVE
THAN ANTICIPATED
SYSTEM IS NEW AND UNTESTED AND IS
A MASSIVE CHANGE -- WHAT ABOUT
ALL OF THE UNINTENDED
CONSEQUENCES?
•BUDGET
• BASELINE FORMULA ON CO-PAYS
AND DEDUCTWLES CAN BE
ADJUSTED DURING PHASE-IN
PERIOD
• STATE FLEXIBILITY PROVIDES
LEARNING
• GRADUAL PHASE-IN
t.
�TBEPLAN
f
!{
�April 13, 1993
The attached memorandum lays out a set of preliminary,
illustrative proposals for national health reform.
These proposals are intended only to stimulate
discussion.
(
(
�\_, ...~-
ILLUSTRATIVE OUTLINE FOR RATIONAL HEALTH REFORM
I. COIOII'l'MENTS UNDER NATIONAL BEALTB REFORM:
A.
All Americans will gain the security of guaranteed
access to comprehensive health care
B.
No lapses or gaps in coverage will occur as Americana
move, change jobs, develop illnesses or experience
other ch~ges in their lives
c.
Cost containment will make coverage more affordable
D.
Consumers will choose their doctors and health plans
E.
Health professionals will choose the health plans in
which they participate
F.
To ensure that choice is meaningful for all consumers,
health reform will address shortages of health
professionals and inadequate infrastructure in rural
and urban underserved areas
G.
Built-in flexibility will allow American communities to
tailor health care to local needs and preferences
H.
Health reform will red~ce the burden of paperwork on
consumers and providers
I.
A renewed emphasis on primary care and new approaches
to resolving consumer problems will make health care
delivery more consumer friendly
J.
Health reform will eliminate abusive insurance
practices, returning to the concept of insurance as the
community sharing the risk of illness and disability
K.
Although health care in America will change
significantly, those changes will proceed in an orderly
fashion over a defined period of time to minimize
unnecessary disruptions
(
PRIVILEGED AND CONFIDENTIAL
�2
( ..~
.. ...1. SYSTEM ORGANIZATION
A.
Under national health reform, the federal government
will:
1.
Establish guarantees for health-care coverage
and delivery to be carried out by the states
2.
Ensure protection of citizens if states fail
to meet federal standards
DECISION 1: WHAT REMEDIES
SHOULD 'l'HE FEDERAL
GOVERNMENT USE IF STATES
DO NOT FULFILL 7BB
REQUIREMENTS OF IIB<B
REFORM?
3.
Establish an employer and individual
responsibility to contribute to health
insurance costs
4.
Enforce a national health budget, holding
states accountable for spending to meet the
budget
DECISION 2: WHAT DEGREE
OF FLEXIBILITY DO STATES
HAVE TO EXCEED THE
NATIONAL HEALTH CARE
BUDGET?
5.
Determine the annual increase in the national
health budget
DECISION 3: SHOULD ~
NATIONAL BUDGET BE SET '1'0
REDUCE DISPARITIES IN
SPENDING LEVELS DUB '1'0
PRACTICE PATTERN
DIFFERENCES ACROSS
STATES?
6.
Establish and oversee formulas for adjusting
payments to health plans based on demographic
and clinical characteristics of enrolled
patients
PRIVILEGED AND CONFIDENTIAL
�3
7.
a.
Establish and oversee federal subsidies for
low-income persons and eligible small
employers
9.
Establish and implement national quality and
access standards
10.
Manage and analyze national collection of
information related to health care access,
quality and coverage
11.
Establish a mechanism for assessment of
health technology and emerging treatments
12.
OVersee federal funding for training of
health professionals
13.
(
Update and refine the comprehensive benefit
package
Provide technical assistance and start-up
grants to support the development of consumer
health alliances and health plans
14.
Administer any limits placed on taxdeductibility of employer contributions to
premiums in excess of locally established
benchmark premium
DECISION 4: SHOULD ~AX
INCENTIVES BE USED ~
PROMOTE CHOICE OP LOWERCOST HEALTH PLANS?
15.
16.
(
Override state anti-managed competition laws
and other statutes inconsistent with the
principles of the new health care system
Delegate these functions variously to a
nat!onal health board and an executive branch
agency
PRIVILEGED AND CONFIDENTIAL
�{
\
--
..
B.
Under national health reform, the states will:
1.
Establish at least one consumer health alliance
2.
If they choose, opt out of the consumer
health alliance structure and operate as a
single payer that negotiates directly with
providers or sets all-payer rates
3.
Set boundaries for consumer health alliances
to ensure:
a.
Minimum population of one million,
or entire state population if less
than one million
b.
No discrimination against lowincome or high-risk populations
c.
Contiguous boundaries
4.
(
Administer and assure compliance with
national health budget
5.
Establish and enforce performance standards
for consumer health alliances under federal
rules, including:
a.
Enrollment in health plans of all
persons residing in assigned
geographic area
b.
Inclusion of a range of health
plans within budget targets
c.
Solvency requirements
d.
Appointments to, composition of,
and membership on policy-making
boards
e.
Administrative expenses
6.
Protect people enrolled in health plans or
health alliances in case of financial failure
7.
Operate a state health plan if necessary to
correct gaps in the market
PRIVILEGED AND CONFIDENTIAL
�5
c.
Under national health reform, Consumer Health
Alliances, established by the states and representing
consumers, will:
1.
Negotiate prices for health plans
DECISION 5: BOW MUCH
PRICE COMPETITION JS
DESIRABLE?
2.
Provide health coverage for employees of
public and private organizations with fewer
than [100, 500, 1000 or more] workers
a.
Depending on size of groups
integrated into the new system, the
Federal Employee Health Benefit
Plan may be integrated or allowed
to continue as a stand-alone plan
DECISION 6: WHICH PRIVATE
AND PUBLIC EMPLOYER
GROUPS WILL BE REQUIRED
TO OBTAIN HEAL'l'H COVERAGE
'l'HROUGH 'l'HE BEAL'l'H
ALLIANCES?
(
\
3.
Provide health coverage for larger employers
that exercise the option of buying into the
consumer health alliance
4.
Enroll all eligible individuals in
accountable health plans
5.
Oversee and stimulate the establishment of an
adequate selection of health plans
6.
Select health plans to offer to consumers,
enforcing national requirements for their
operation and terminating their participation
if necessary
7.
Offer a variety of health plans sufficient to
provide both consumers and providers (who may
participate in more than one plan) a range of
choice in organization and delivery system
including:
a. Health maintenance organizations
PRIVILEGED AND CONFIDENTIAL
�6
b. Preferred provider networks
c. Fee-for-service
8.
Negotiate community rates for premiums and
capitated payments to all health plans,
including fee-for-service plans
9.
Negotiate service areas for plans to prevent
discrimination against low-income people and
high-risk populations
10.
Administer consumer plan selection, billing,
payments and marketing (including outreach
for high-risk populations)
11.
Institute plan-based alternatives to
litigation
12.
Calculate and administer risk adjustments to
payments as defined under federal guidelines
13.
Ensure access to tertiary or other
specialized services through contracts or
other arrangements
14.
Ensure the quality of care delivered through
health plans
15.
·Protect the rights of consumers, including
resolving complaints through an ombudsman
structure
16.
Collect and report required information
17.
Set aside and administer premium revenue for
infrastructure development, public health
activities and services that ensure access
for high-risk and underserved populations
18.
Require health plans to contract with
community-based providers when necessary to
ensure access for underserved and vulnerable
populations
19.
Monitor trends in enrollment, particularly
disenrollment by high-risk populations and
persons with serious illnesses
(
PRIVILEGED AND CONFIDENTIAL
I
----
_ _ _j
�( .".'
7
D.
Accountable health plans, which represent groups of
providers and others organized to deliver care, will
assume responsibility to:
1.
Deliver the nationally defined comprehensive
benefit package
2.
Provide coverage to every applicant (subject
to capacity limits) who chooses the health
plan, regardless of health status or any
other personal factors, without waiting
periods, exclusions or terminations for any
reason
3.
Establish consistent rates without regard to
health status, gender and age
DECISION 7: SHOULD
COMMUNITY RATING BB
MODIFIED TO ACCOUNT FOR
&GE7
4.
Collect and report required data related to
access, service and quality of care
Meet state requirements related to financial
solvency
7.
Establish and administer consumer grievance
and dispute resolution procedures
8.
Provide a core of support services when
necessary to assure access for all patients
enrolled
9.
(
s.
6.
(
Secure an adequate number, mix, availability
and distribution of qualified providers
Designate and contract with providers of
highly specialized services, such as tertiary
care
PRIVILEGED AND CONFIDENTIAL
�8
E.
Large employers that elect to manage their own plans
assume obligations similar to accountable health plans
including the responsibility to:
1.
Deliver the comprehensive benefit package
2.
Ensure equal coverage for all employees
3.
Establish consistent premium rates,
regardless of health status or other
characteristics of the individual
4.
Share in paying national costs of high-risk
or chronically ill populations
5.
Meet quality, access and financial
performance standards that apply to health
plans within consumer health alliances
6.
Offer employees choice of plans or allow them
to choose coverage from plans offered through
a consumer health alliance
7.
Establish community-rated premiums
DECISION 8: WHAT RATINC
AND CHOICE RULES COVERN
STAND-ALONE PLANS?
F.
The state and federal governments will limit private
insurance markets for supplemental insurance in the
following ways:
1.
Insurance coverage for cost-sharing and
services covered in the comprehensive benefit
package will be prohibited
2.
Federal regulations will prohibit:
a.
b.
Tying sale of supplemental
. insurance to purchase of
comprehensive benefit package
Obtaining or disclosing information
about the health status of any
individual for the purpose of
marketing insurance
PRIVILEGED AND CONFIDENTIAL
�.'
9
~·
c.
3.
Compensating agents for encouraging
a person to choose a particular
health plan
State laws will regulate other supplemental
insurance policies
Ill. BUDCE'l'
A.
National health reform will establish a budget for
health care spending consisting of two parts:
1.
The federal government will enforce an annual
budget for spending through consumer health
alliances
a.
b.
Enforced at the state level
c.
States held accountable for
spending in excess of the budget
d.
'
Determined by the average premium
(weighted by enrollment in each
plan) for the comprehensive benefit
package
States and health alliances will
meet budget limits through:
(1)
Authority to negotiate
and regulate premiums
(2)
Authority to freeze
enrollment in plans
(3)
Authority to set and
regulate payments to
providers
(4)
2.
Authority to approve
.investments in health
resources and technology
'\
Self-insured plans also will be required to
meet state budgets
PRIVILEGED AND CONFIDENTIAL
�10
B.
The federal government will enforce budget limits
through the following mechanisms:
1.
Allow states to share in savings for federal
subsidies if costs increase less than
budgeted
2.
Require states that exceed budget to submit
plans for correction
3.
Require states to finance additional cost of
subsidies to small employers, individuals and
families if budget exceeded
4.
If budget exceeded in successive years:
a.
b.
c.
'
Implement rate setting
c.
(
Impose a penalty tax on providers,
with revenues to pay for federal
subsidies
Operate consumer health alliance
Consistent with the national health budget, the federal
government will constrain payments to providers to
limit spending for its programs
IV. COVERAGE
A.
All Americans are entitled to obtain health services
specified in a national, comprehensive benefit package
guaranteed by the federal government
1.
2.
Consumers will have access to all health
plans offered by the consumer health alliance
in their area
3.
(
All Americans and legal residents will receive a
Health Security Card that permits them to choose a
health plan through a local consumer health
alliance or from their employer (if the employer
offers its own plans)
Plans offered through consumer health
alliances must agree to enroll every eligible
person who seeks coverage
PRIVILEGED AND CONFIDENTIAL
�11
4.
All individuals and families will pay a
portion -- perhaps 20 percent -- of the cost
of the health plan they choose but can
receive subsidies to cover that coat if they
are poor or earn a low income.
5.
Medicaid beneficiaries will enroll in health
plans through consumer health alliances
a.
b.
6.
(
Medicaid beneficiaries will receive
subsidies toward the cost of
premiums and co-payments on the
same basis as other low-income
people
Health plans will provide
supplemental services such as
transportation and clinical case
management as appropriate to ensure
access to care
Disabled and elderly Medicare beneficiaries
will continue receiving coverage through an
enhanced Medicare program, which may or may
not be integrated with the new health care
system
DECISION 9: SHOULD
MEDICARE BE INTEGRATED
INTO THE NEW SYSTEM?
7.
Individuals who obtain medical care through
the Veterans Administration, the Department
of Defense and the Indian Health Service will
remain eligible for those programs
8.
Illegal aliens are not covered but may
receive emergency or other care as now occurs
DECISION 10: BOW WILL
CARE FOR UNDOCUMENTED
PERSONS BE I'UNDED?
9.
For families with multiple employers, one
employer will be designated primary, and
financial obligations may be re-distributed
in an annual reconciliation
PRIVILEGED AND CONFIDENTIAL
�12
10.
Unemployed workers will continue their
coverage without interruption, and some will
receive a subsidy based on income
11.
Small companies -- perhaps those with fewer
than 25 workers -- will receive a federal
subsidy toward the cost of the benchmark
premium for low-wage workers if their total
premium exceeds a threshold percentage of
payroll
V. BENEFITS
A.
All Americans are guaranteed a nationally established
comprehensive benefit package
B.
The comprehensive benefit package will cover:
1.
2.
3.
4.
5.
6.
7.
l
Inpatient hospital services
Clinic and outpatient-hospital services
Professional services
Preventive health services
Emergency care
Laboratory and diagnostic services
Reproductive health services
DECISION 11: TO WHAT
EXTEN'l' IS '1'BE RANCE OF
REPRODUCTIVE HEALTH
SERVICES DEFINED IN THE
BENEFIT PACKACE?
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
c.
Emergency ambulance services
Prescription drugs and biologicals
Durable medical equipment, including hearing
aids
Prosthetic and orthotic devices
Hospice services
Post-acute adult rehabilitation services
Post-acute nursing home and home care
Mental health services
Substance abuse treatment
Hearing and vision care for children
Chronic care for children
Dental services for children
Other services, such as vision and dental care for
adults, are desirable but may not be covered in the
guaranteed benefit package because of cost constraints
PRIVILEGED AND CONFIDENTIAL
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D.
The benefit package will provide primary coverage for
medical claims also covered by workers' compensation
and automobile insurance
E.
The listed benefits are covered unless they are not
considered medically necessary or appropriate, within
federal guidelines
F.
Health plans will provide supplemental services -- auch
as transportation, outreach and case management -- as
necessary to ensure access for underserved and highrisk populations
G.
All health plans will include specified cost-sharing
arrangements defined by category of plan, such as
health maintenance organizations and fee-for-service
VI. BENEFITS -- MENTAL HEALTH AND SUBSTANCE ABUSE
A.
The comprehensive benefit package will cover mental
health and substance-abuse treatment, services and
providers on the same terms and conditions as other
medical and health services
1.
The benefit structure will ensure that
persons with mental illness and substanceabuse disorders have access to a
comprehensive array of services
2.
Except for screening services, health plans
will impose cost sharing for mental health
and substance abuse services based on the
same principles as cost sharing for other
health services
3.
Health reform will encourage the use of home
and community-based treatment and
alternatives to hospitalization
4.
Health plans will deliver services with
flexibility to provide the appropriate types,
mix and duration of services
PRIVILEGED AND CONFIDENTIAL
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5.
To protect against inappropriate use of
services and target resources, consumer
health alliances end accountable health plans
will adopt eligibility criteria:
a.
b.
(
Patients will be eligible for
mental health end substance-abuse
services for diagnosable disorders
specified under DSM-III-R and that
create a serious risk for
functional impairment
c.
6.
All persons will be eligible for
screening, assessment end 24-hour
crisis service
Patients' family members may
receive necessary related services
(collateral treatment)
All accountable health plans will provide
qualified mental health screeners to
determine eligibility
:I. QUALITY ASSURANCE
A.
A National Quality Management Program will create and
update a national consumer "report card" that includes
standard measures of:
1.
2.
Acc~ss
3.
Appropriateness of care
4.
B.
Patient satisfaction
Health outcomes
to care
States will monitor the quality of health care using
federal guidelines:
1.
2.
(
Each level of the health cere system will
collect appropriate, uniform data
Specific national measures will assess
performance at the state level
PRIVILEGED AND CONFIDENTIAL
�15
3.
All levels of the system will develop
information systems that enhance the ability
to compare data collected for a variety of
purposes
c.
~he federal government will support development and
dissemination of practice guidelines
D.
~he quality system will minimize retrospective, chartbased quality-assurance measures, replacing them with
performance-based outcomes
E.
Additional changes in the approach to quality assurance
involve:
1.
2.
(
Simplification of requirements under the
Clinical Laboratories Improvement Act of 1988
3.
'.VIII.
Simplification of peer review
Simplification of survey and certification of
health care institutions
ADMINIS~RATIVE SIMPLII'ICA~ION
A.
National health reform will establish rules intended to
reduce burdensome data collection and information
processing while assuring privacy and security of
personal health information:
1.
Simplify information collection requirements
for billing and enrollment purposes
2.
Require use of national, standard forms
3.
Require use of national, standard data sets
for financial, clinical, quality and other
information
4.
Develop national procedures for coordination
of benefits until new health system fully
implemented
5.
Develop and adopt unique provider, patient,
plan and employer-identification numbers
6.
Set national communication standards for
electronic data interchange
PRIVILEGED AND
CONFIDE~IAL
�.--
16
7.
B.
Set uniform national rules regarding privacy
and security
Simplify utilization review
IX. DELIVERY SYSTEM DEVELOPMEift'
A.
The federal government will provide grants, loans and
loan guarantees to invest in health-care delivery sites
in rural and urban underserved areas
B.
Federal funds also will support the development of
alternative delivery sites, including school-based
clinics
c.
Federal policies that restrict conversion of rural
hospitals to multiple uses will be modified
X. PREVENTION AND PUBLIC BEALTB
A.
The public health system will:
1.
Continue traditional measures to monitor and
promote public health
2.
Coordinate public health and prevention with
personal preventive health services provided
through health plans
(
B.
A fixed portion of total health expenditures will
create stable funding for population-based public
health and prevention activities
c.
The federal government will streamline the
administration of existing categorical health programs
XI. WORKFORCE DEVELOPMEN'l'
A.
The federal government will support the provision of an
appropriate mix of primary care physicians, nurse
practitioners, nurse midwives, physician assistants and
community health workers in rural and urban areas by:
1.
Redirecting federal spending on graduate
medical education to emphasize training of
primary care health professionals rather than
medical specialists
2.
Promoting the use of
~tar-disciplinary
PRIVILEGED AND CONFIDENTIAL
teams
�17
3.
4.
Including non-professional health workers in
a national service initiative
5.
B.
Retraining specialists in the use of most
current primary care approaches and knowledge
Providing incentives for health professionals
to locate in underserved areas, including
expansion of the National Health Service
Corps
The federal government will remove legal, regulatory
and institutional barriers that inappropriately
restrict the practices of health professionals
XII. MEDICAL MALPRACTICE AND TORT REFORM
A.
The federal government will institute a system of
medical malpractice and tort reform based on enterprise
liability and plan-based alternatives to litigation
B.
Consumer health alliances will require accountable
health plans to adopt non-binding alternatives to
litigation chosen from a menu of options identified by
the federal government, such as:
(
1.
2.
Mediation
3.
c.
Arbitration
Early settlement offers
Enterprise liability provisions include:
1.
Federal rules will require health plans to
assume sole legal liability for care they
finance
2.
Direct providers of care, such as physicians,
will be exempt from legal liability except in
cases of gross negligence, willful wanton and
malicious conduct
3.
Health plans will obtain insurance or selfinsure against liability in order to create a
clear and direct incentive to sustain high
quality, deter malpractice and resolve
disputes
PRIVILEGED AND CONFIDENTIAL
�(
.'~
18
4.
5.
Certain institutional providers such as major
hospitals will retain their current duty to
oversee the quality of care
6.
When a health plan makes a payment on a claim
of negligent care by a physician, the health
plan will provide the name of the physician
to the National Practitioner Data Bank
7.
D.
Health plans will be forbidden to require
providers to indemnify plans for any
liability
Plans must disclose to consumers the
availability of procedures for the resolution
of grievances
The federal government will establish uniform standards
in medical malpractice cases for:
1.
2.
Double recovery from collateral sources
3.
Contingency fees
4.
(
Non-economic damages
Periodic payment of large awards
DECISION 12: SHOULD ~
FEDERAL GOVERHMENT CAP
NON-ECONOMIC DAMAGES AND
IMPOSE OTHER UNIFORM
RULES FOR MEDICAL
MALPRACTICE CLAIMS?
E.
Substantive rights, such as the applicable standard of
care, will remain as under current law
XIII. ANTITRUST CONSIDERATIONS
Implementing health reform will require strategies to
minimize conflicts between the operation of the new
system and antitrust laws without undermining their
legitimate purposes
PRIVILEGED AND CONFIDENTIAL
�\
19
..~
X.i:V. INDIAN HEAL'l'B SERVICE
·A.
At the election of tribes and depending on location, the
Indian Health Service (including tribal health programs)
will have three options for participation in health reform:
1.
As a provider paid through accountable health
2.
As
3.
As an independent program, to accomm~ate
some tribes' objections to state control
plans
~
accountable health plan
B.
Where appropriate, Indian Health Service will provide
care to non-Indians
c.
All options will require improving and augmenting
Indian Health Service capacity in areas such as:
1.
Primary care including maternal and child
health
2.
Emergency services
3.
Mental health
4.
Specialty services
D.
Under all options, the federal government will pay the
full cost of care for American Indians and Alaska
Natives and continue supplemental public health and
environmental improvements
E.
To compete in the new health system, Indian Health
Service must address legal, organizational and
regulatory barriers including:
1.
Restrictions on hiring and assigning staff
2.
Federal procurement rules
3.
Financial systems not designed to bill for
services
4.
Restrictions on providing services to nonIndians
PRIVILEGED AND CONFIDENTIAL
�20
(
F.
Any change in operations of the Indian Health Service must
accommodate the rights of sovereign tribal governments to
act on behalf of their people
XV. DEPARTMENT OF DEFENSE
A.
The Department of Defense will provide health care
services and capacity necessary to maintain military
readiness
B.
The Department of Defense will make accountable health plans
available in selected geographic areas within the structure
of the consumer health alliances:
1.
2.
C.
{
In areas with military health plans, beneficiaries
will have the option of choosing a civilian health
plan or a military plan
In areas that do not have a military plan,
beneficiaries will choose among civilian
accountable health plans
Benefits and Eligibility
1.
The Department of Defense will pay premium
costs for all dependents of active-duty
personnel and retirees
3.
D.
Active-duty personnel will continue to receive free and
comprehensive health care services through military
facilities, supplemented by local providers
2.
\
After implementation of health reform, the
department will cover a portion of premiums
(like other employers) for dependents of new
active-duty personnel
Competing in the new health system will require changes
in the Department of Defense health system, including:
1.
Adjusting resource allocation and cost-accounting
systems
2.
Establishing uniform employment and compensation
systems for federal health care workers
3.
Closing military health plans that fail to compete,
unless required for military readiness
PRIVILEGED AND CONFIDENTIAL
�(
21
'
XVI. VETERANS ADMINISTRATION
·A.
The Veterans Administration will develop regional health
plans for veterans
1.
Benefits and Eligibility
a.
Low-income veterans and those with serviceconnected disabilities will receive the
comprehensive benefits package plus supplemental
benefits at no cost
b.
Other veterans may purchase the Veterans
Administration health plan through consumer health
alliances or use Veterans Administration centers
on a fee-for-service basis
B.
The Veterans Administration will compete for veterans
not now using VA services, who will be allowed to take
their employer contributions to the VA health plan in
their area if they choose
c.
Competing in the new health system will require
management and regulatory changes in the Veterans
Administration health system, including:
(
1.
2.
Increasing flexibility in hiring and personnel
management
3.
XVII.
Eliminating procurement regulations that restrict the
ability to take advantage of competitive pricing
Altering budget process to enable VA centers to retain
a portion of their •earnings•
LONG-TERM CARE
A.
National health reform will require adaptation of longterm care components of the current Medicaid program
B.
National health reform will expand the public
commitment to provide long-term care
.
DECISION 13: BOW MUCB
SHOULD BE INVESTED Df
LONG-'rERM CARE?
PRIVILEGED AND CONFIDENTIAL
�(
22
,.~
XVIII. INVESTMENT
DECISION 14: WBA~'S ~
PREFERRED SCOPE OF IIBAL'l'B
REFORM: WRA~'S ~
MINXMUM WORTH DOING?
XIX. FINANCING
A.
Under health reform, employers will assume the
following responsibilities:
1.
Assure health coverage for their employees
and their employees' families
a.
b.
2.
B.
Pay a substantial portion -perhaps 80 percent -- of the
premium for full-time and a prorated portion for part-time
employees, although they may
receive a partial subsidy for lowwage workers
Deduct the employee share of the
premium from payroll
Employees will pay the remainder of the
premium -- perhaps 20 percent ~- although
low-income workers may receive a subsidy
States will continue to contribute to the cost of care
for low-income people:
1.
Initially under a requirement for maintenance
of effort and later subject to a new formula
determined by a commission and adopted by
COngress through an expedited procedure
2.
Requirements for maintenance of effort could
include all state health expenditures, not
just Medicaid
PRIVILEGED AND CONFIDENTIAL
�( ..
23
~-
c.
Depending on decisions that shape the delivery and
financing of the health system, prospective sources of
new federal revenue include:
1.
General tax revenues
3.
Premium tax-cap revenues
4.
Provider or insurance tax
5.
Community rating for Medicare and/or Medicaid
disabled population
DECISION 15: BOW WILL BDL'l'B REFORM
BE FINANCED?
DECISION 16: WHO WILL PAY POR
HEAL'l'H REFORM?
DECISION 17: BOW MUCH NEW
INVESTMENT WILL BE MADE IN
HEALTH-CARE SPENDING?
•
~RANSITION
A.
~OTAL
AND SHORT-TERM COST CONTROLS
Managing the transition to the new health system will
involve:
1.
Implementation of reform:
a.
Establish state consumer health
alliances
b.
Enroll consumers in health
alliances
c.
Develop delivery system capacity
d.
Remove statutory and regulatory
barriers, including provisions of
ERISA
PRIVILEGED AND CONFIDENTIAL
�(
,-
24
2.
Protection of consumers from insurance market
dislocation to preserve existing coverage
and/or market failure through:
a.
Negotiating voluntary commitments
from insurers to continue to serve
policyholders and new applicants
during transition with commitments
related to:
(1)
(2)
Treatment of new
applicants
(4)
(
Termination of coverage
( 3)
b.
Rate increases
Procedures for market
exit
Imposing emergency regulations
requiring maintenance of insurance
existing coverage at fair prices
with provisions that:
(1)
(2)
Prohibit insurers from
terminating coverage
except for good cause
(3)
Restrict exits from the
market
( 4)
c.
Prohibit insurers from
targeting large rate
increases to specific
groups or individuals
Require acceptance of new
full-time emplQ7ees to
currently insured groups
Create voluntary federal or state
insurance pools to cover displaced
or uninsured groups or individuals
PRIVILEGED AND CONFIDENTIAL
�(
--
25
3.
Implementation of comprehensive insurance
market reform to:
a.
b.
Require acceptance of all
applicants
c.
Move toward community rating
d.
Enact guaranty renewability
e.
4.
Stabilize premiums
Guarantee portability of coverage
.
Imposition of short-term cost controls
DECISION 18: BOW WILL COSTS BE
CONTROLLED WHILE HEALTH REFORM
IMPLEMENTED?
%8
XXI. ACCELERATING NEW SYSTEM DEVELOPMENT
A.
f.
The implementation of national health reform will occur
in phases:
1•
On a state-by-state basis, allowing broad
flexibility for the pace of state action,
with the goal of covering all Americans by
mid-1995
2.
Or, on a more gradual schedule with the goal
of covering all Americans by the year 2000
DECISION 19: BY WHAT METHOD WILL
THE TRANSITION TO THE NEW SYSTEM
TAKE PLACE?
DECISION 20: BOW FAST WILL
SYSTEM BE IMPLEMENTED?
IJ'IIB
11BW
PRIVILEGED AND CONFIDENTIAL
�-
•
DECISIONS
(
(
.
�DECISION 1:
DECISION 2:
WHAT DEGREE OF FLEXIBILITY DO STATES HAVE
EXCEED '1'HE NATIONAL HEALTH CARE BUDGET?
·DECISION 3:
(
WHAT REMEDIES SHOULD '1'HE FEDERAL GOVERNMENT USE IF
STATES DO NOT FULFILL '!'HE REQUIREMENTS OF HEALTH
REFORM?
SHOULD '1'HE NATIONAL BUDGET BE SET ~ REDUCE
DISPARITIES IN SPENDING LEVELS DUE ~ PRACTICE
PATTERN DIFFERENCES ACROSS STATES?
.r~
~
DECISION 4:
DECISION 5:
SHOULD COMMUNITY RATING BE MODIFIED TO ACCOUNT FOR
AGE?
DECISION 8:
WHAT RATING AND CHOICE RULES GOVERN STAND-ALONE
PLANS?
DECISION 9:
SHOULD MEDICARE BE INTEGRATED INTO '1'HE NEW SYSTEM?
DECISION 10:
HOW WILL CARE FOR UNDOCUMENTED PERSONS BE FUNDED?
DECISION 11:
TO WHAT EXTENT IS THE RANGE OF REPRODUCTIVE HEALTH
SERVICES DEFINED IN THE BENEFIT PACKAGE?
DECISION 12:
SHOULD THE FEDERAL GOVERNMENT CAP NON-ECONOMIC
DAMAGES AND IMPOSE OTHER UNIFORM RULES FOR MEDICAL
MALPRACTICE CLAIMS?
DECISION 13:
HOW MUCH SHOULD BE INVESTED IN LONG-TERM CARE?
DECISION 14:
WHAT'S THE PREFERRED SCOPE OF HEALTH REFORM;
WHAT'S THE MINIMUM WORTH DOING?
DECISION 15:
HOW WILL HEALTH REFORM BE FINANCED?
DECISION 16:
WHO WILL PAY FOR HEALTH REFORM?
DECISION 17:
HOW MUCH NEW INVESTMENT WILL BE MADE IN TOTAL
HEALTH-CARE SPENDING?
DECISION 18:
/
WHICH PRIVATE AND PUBLIC EMPLOYER GROUPS WILL BE
REQUIRED TO OBTAIN HEALTH COVERAGE THROUGH THE
HEALTH ALLIANCES?
DECISION 7:
\ .
HOW MUCH PRICE COMPETITION IS DESIRABLE?
DECISION 6:
(
SHOULD TAX INCENTIVES BE USED TO PROMOTE CHOICE OF
LOWER-COST HEALTH PLANS?
HOW WILL COSTS BB CONTROLLED WHILE HEALTH RBFORM
IS IMPLEMENTED?
DECISION 19:
BY WHAT MBTHOD WILL THE TRANSITION TO '1'HE NBW
SYSTEM TAKE PLACE?
DECISION 20:
HOW FAST WILL
\
'1'HB
NEW SYSTEM BE IMPLEMENTED?
..
�DECISION 1
FEDERAL REMEDIES IN CASE OF STATE FAILURE
BACKGROUND
WHAT REMEDIES SHOULD 1'HE FEDERAL GOVERNMENT
USE IF STATES DO NOT FULFILL REQUIREMENTS OF
HEALTH REFORM?
FEDERAL LEGISLATION WILL REQUIRE STATES TO:
•
CREATE HEALTH ALLIANCES AND HEALTH PLANS
(OR EXERCISE OPI'ION FOR STATE-BASED PLAN),
ACCORDING TO FEDERAL RULES
•
ENSURE THAT ALLIANCES AND PLANS PROVIDE ALL
AMERICANS THE GUARANTEED BENEFIT PACKAGE
•
MEET A FEDERALLY-SET BUDGET
LEGISLATION MUST SPECIFY FEDERAL REMEDIES IF STATES
DO NOT CONFORM TO REQUIREMENTS.
-·
-.-
�(
.r
DECISION 1
FEDERAL REMEDIES IN CASE OF STATE FAILURE
STATEMENT OF OPI'IONS
OPTION 1:
OPTION 2:
(
'·
FINANCIAL SANCTIONS TO INDUCE STATE
ACTION
DIRECT FEDERAL ACTION TO ACHIEVE
PERFORMANCE
�(
DECISION 1
FEDERAL REMEDIES IN CASE OF STATE FAILURE
OPI'ION 1:
FINANCIAL SANCTIONS
.
THE FEDERAL GOVERNMENT IMPOSES FINANCIAL
SANCTIONS TO INDUCE STATE ACTION, WITHHOLDING, FOR
EXAMPLE:
•
•
'
MEDICAL EDUCATION, PUBLIC HEALTH AND
MEDICAL RESEARCH FUNDS
•
(
TAX DEDUCTIONS FOR HEALTH INSURANCE
PREMIUMS
LOW-INCOME SUBSIDIES
THESE SANCTIONS COULD BE APPLIED ON A GRADUATED
BASIS.
PROS:
•
SEVERE PENALTIES MAKE COMPLIANCE LIKELY
•
PRESERVES STATE-BASED SYSTEM
CONS:
•
IF SANCTIONS ARE MILD, THEY MAY BE
INEFFECTIVE; IF THEY ARE TOO SEVERE, THEY MAY
NEVER BE IMPOSED
•
IF IMPOSED, THEY PENALIZE CITIZENS
�(
DECISION 1
FEDERAL REMEDIES IN CASE OF STATE FAILURE
OPTION 2:
DmECT FEDERAL ACTION
DIRECT FEDERAL ACTION TO ACHIEVE PERFORMANCE TO
INCLUDE:
•
CONTRACT WITH ANOTHER ORGANIZATION OR
STATE TO MANAGE THE HEALTH ALLIANCE
•
DIRECTLY MANAGE THE HEALTH ALLIANCE
•
OFFER A FEDERAL HEALTH PLAN TO STATE
RESIDENTS
PROS:
•
GUARANTEES PERFORMANCE UNDER THE LAW
CONS:
•
·COULD BECOME A FEDERAL PROGRAM
�{
DECISION 2
STATE BUDGET FI.EXIBILITY
BACKGROUND
WHAT DEGREE OF FJ.EXJBILITY DO STATES HAVE TO
EXCEED THE NATIONAL HEALTH CARE BUDGET'/
HEALTH REFORM WILL BUDGET THE ANNUAL RATE OF
GROWTH IN SPENDING ON HEALTH PLAN PREMIUMS IN
ORDER TO CONSTRAIN EXPENDITURES (FOR EXAMPLE, GNP
PLUS TWO PERCENT).
STATES WANT FLEXIBILITY TO EXCEED BUDGETS IF:
•
;
(
NATIONAL BUDGET IS ARBITRARILY TIGHT
RELATIVE TO COVERAGE GUARANTEES
•
STATE WANTS OR NEEDS TO SPEND MORE (AT ITS
OWN EXPENSE)
FEDERAL GOVERNMENT WANTS:
•
•
. GUARANTEE EXPENDITURE CONSTRAINT FOR
PUBLIC AND PRIVATE PAYERS
TO LIMIT EXPOSURE OF EMPLOYERS AND
INDMDUALS UNDER MANDATED HEALTH
INSURANCE
�·... ·
DECISION I
STATE BUDGET FJ,EXJBILITY
:
STATEMENT OF OPI'IONS
OPriON 1:
OPriON 2:
HOLD STATES ACCOUNTABLE FOR MULTI-YEAR
BUDGETS
OPTION 3:
i .
HOLD STATES ACCOUNTABLE FOR ANNUAL
BUDGETS
ALLOW A "BAND" OF EXCESS SPENDING WITH
SOME PENALTIES
�DECISION 2
STATE BUDGET FJ.EXJBWTY
OPTION 1:
ANNUAL BUDGET
·-
HOLDING STATES ACCOUNTABLE FOR ANNUAL
BUDGETS REQUIRES STATES TO USE TOOLS TO PREVENT
EXCESS SPENDING, FOR EXAMPLE:
•
REGULATING PROVIDER RATES
•
OFFSET VOLUME INCREASES BY LIMITING RATES
•
FREEZING ENROLLMENT IN HIGH-COST PLANS
IN THE EVENT OF STATE FAILURE, REQUIRES THAT FEDERAL
GOVERNMENT EITHER:
•
INTERVENE TO CONTROL SPENDING
•
IMPOSE FINANCIAL SANCTIONS
WITHHOLD SUBSTANTIAL FEDERAL FUNDS
REQUIRE STATES TO OFFSET OVERAGES
THROUGH GENERAL REVENUES
FEDERAL GOVERNMENT COULD OFFER FINANCIAL
INCENTIVES TO MEET BUDGET <FOR EXAMPLE, PAY STATES
PORTION OF UNSPENT FEDERAL SUBSIDY DOLLARS)
PROS:
•
( .
PREDICTABLE, SCOREABLE SAVINGS
�CONS:
•
MAY NEVER HAPPEN BECAUSE THE PENALTIES ARE
TOO SEVERE
•
LEAVES LI'ri'LE ROOM FOR UNFORESEEN YEAR-TOYEAR VARIATION
�(
DECISION 2
STATE BUDGET FI,.....
EX.,...I,....,BILITY
OPTION 2:
MULTI-YEAR BUDGET
BUDGET BASED ON MULTI-YEAR CALCULATION ALLOWS
STATES TO TAKE CORRECTIVE MID-COURSE ACTION.
•
SPECIFY ALLOWABLE PERCENTAGE INCREASE IN
TWO OR MORE YEARS
PROS:
•
•
(
STATE FLEXIBILITY
CONS:
•
(
PREDICTABLE, SCOREABLE SAVINGS
.
FLEXIBILITY MAY UNDERMINE PERFORMANCE
�DECISION I
STATE BUDGET FI ....... ......
F,X.,...I BILITY
OPTION 3:
"BAND"
~
STATES COULD SPEND ABOVE BUDGETS UP TO A CEILING. IF
SPENDING IS BE'IWEEN THE BUDGET AND THE CEILING,
THAT IS, WITHIN THE "BAND,":
•
FEDERAL SUBSIDIES CAPPED AT BUDGETED LEVEL
OR REDUCED WITHIN THE BAND
•
•
STATE RESPONSmLE FOR ANY EXCESS
FEDERAL GOVERNMENT DOES NOT INTERVENE
IF STATE SPENDING EXCEEDS THE BAND, FULL FINANCIAL
PENALTIES APPLY AND FEDERAL GOVERNMENT INTERVENES.
(
PROS:
•
ALLOWS STATES GREATER FLEXIBILITY WITH NO
(OR LIMITED) FEDERAL COST CONSEQUENCES
•
•
PREDICTABLE OBLIGATIONS FOR PRIVATE PAYERS
MITIGATES ADVERSARIAL RELATIONSHIP BE'IWEEN
STATES AND FEDERAL GOVERNMENT
CONS:
•
•
I
\
•
REDUCES PREDICTABILITY OF PUBLIC AND PRIVATE
SAVINGS
CEILING COULD BECOME THE BUDGET
�DECISION 8
STATE SPENDING DISCREPANCIES
BACKGROUND
SHOULD THE NATIONAL BUDGET BE SET TO REDUCE
DISPARfl'IES IN SPENDING LEVELS DUE TO PRACTICE
PATI'ERN DIFFERENCES ACROSS STATES?
IN SETI'ING BUDGETS FOR STATES, ALLOWANCES WILL HAVE
TO BE MADE FOR DIFFERENTIALS IN CURRENT INSURANCE
COVERAGE, DEMOGRAPHICS AND GENERAL PRICE LEVELS.
EVEN AFTER ADJUSTING FOR THESE DIFFERENCES, PER
CAPITA HEALTH EXPENDITURES VARY WIDELY BY STATE.
•
SPENDING IN THE HIGHEST-COST STATE IS $3031
PER CAPITA WHILE SPENDING IN THE LOWESTCOST STATE IS $1689 PER CAPITA (ADJUSTING FOR
AGE AND INPUT COSTS)
A SIGNIFICANT SHARE OF THE DIFFERENCE REFLECTS
UNEXPLAINED VARIATION IN PRACTICE PATI'ERNS.
INITIALLY, HISTORICAL SPENDING MUST BE USED AS BASIS
FOR BUDGETS.
SETTING PROPER LEVELS OF SPENDING BASED ON PRACTICE
PATTERNS IS DIFFICULT BECAUSE OF INADEQUATE
KNOWLEDGE ABOUT OUTCOMES OF DIFFERENT PATTERNS
OF CARE.
(
'·
�DECISION 8
STATE SPENDING DISCREPANCIES
STATEMENT OF OPriONS
OPTION 1:
OPTION 2:
SET A MULTI-YEAR FORMULA IN REFORM THAT
PEGS STATE SPENDING TO A COMBINATION OF
HISTORICAL SPENDING AND A NATIONAL
NORM
OPTION 3:
l .
PROVIDE INFORMATION ON PRACTICE
PATrERNS AND INCENTIVES TO STIMULATE
ADJUSTMENTS TO PRACTICE PATrERNS
CREATE A "BASE-CLOSING" COMMISSION TO
RECOMMEND FUTURE BUDGET ADJUSTMENTS
�DECISION 8
STATE SPENDING DISCREPANCIES
(
OPI'ION 1:
INFORMATION AND INCENTIVES
A SINGLE NATIONAL GROWI'H RATE (ADJUSTED FOR
INSURANCE COVERAGE, OTHER DEMOGRAPIUCS AND INPUT
COSTS) WILL BE APPLIED TO STATE IUSTORICAL PER CAPITA
SPENDING LEVELS.
THE FEDERAL GOVERNMENT:
•
WILL DEVELOP SCIENTIFICALLY-BASED
GUIDELINES AND DISSEMINATE RESEARCH ON
OUTCOMES
•
WILL PUBLISH INFORMATION ABOUT VARIATIONS
IN STATE PRACTICE PATrERNS
•
MAY APPLY FINANCIAL INCENTIVES (ALLOWING
STATES TO SHARE IN UNSPENT FEDERAL SUBSIDY
DOLLARS) TO ENCOURAGE MORE APPROPRIATE
VOLUME AND INTENSITY
.
l
PROS
•
ALLOWS MAXIMUM STATE FLEXIBILITY
•
PROMOTES EFFICIENCY WITHOUT DISLOCATIONS
•
AVOIDS MAJOR POLITICAL CONFLICT OVER
ALLOCATION
CONS
•
MAY PERPETUATE UNJUSTIFIED DIFFERENTIALS
�DECISION 8
STATE SPENDING DISCREPANCIES
OPTION 2:
NATIONAL FORMULA
NATIONAL FORMULA WILL REDUCE STATE VARIATION OVER
TIME.
•
A STATE'S FIRST-YEAR BUDGET WILL REFLECT
HISTORICAL SPENDING
•
IN SUBSEQUENT YEARS, FORMULA AUTOMATICALLY
ADJUSTS ALLOWABLE INCREASE TO MOVE TOWARD
A NATIONAL NORM
THIS FORMULA COULD BE PHASED IN OVER AN EXTENDED
PERIOD OF TIME TO AVOID SEVERE DISRUPTIONS.
PROS:
•
REDUCES PRACTICE PA'ITERN VARIATION
•
FAVORED BY LOWEST-COST STATES
CONS:
•
•
.
CAUSES PROVIDER DISLOCATIONS IN STATES
FURTHEST FROM THE NORM
•
I
INVITES OPPOSITION TO HEALTH REFORM FROM
CURRENT HIGH-COST STATES LIKE
MASSACHUSETTS AND NEW YORK
WOULD BE DIFFICULT TO ADJUST AND WOULD
TAKE YEARS TO SHOW PROGRESS
�DECISION 8
STATE SPENDING DISCREPANCIES
(
OPTION 3:
CREATE A "BASE-CLOSING"
COMMISSION
PLAN WILL CREATE A "BASE-CLOSING" COMMISSION THAT
WILL MAKE A RECO:MM:ENDATION TO CONGRESS ON A
FORMULA FOR THE BUDGET ALLOCATION TO STATES.
THE CONGRESS WILL TAKE AN UP-OR-DOWN VOTE ON THE
FORMULA. IF CONGRESS REJECTS THE COMMISSION'S
RECO:MM:ENDATIONS, THE ALLOCATION DEFAULTS TO
HISTORICAL SPENDING LEVELS.
PROS
.(
•
•
REMOVES A DIFFICULT POLITICAL DECISION TO AN
· IMPARTIAL ENTITY
ALLOWS SOME STATE FLEXIBILITY
CONS
•
DOES NOT ENSURE THAT VARIATIONS WILL BE
MINIMIZED
•
PUTS PRESSURE ON THE CONGRESS
�DECISION 4
TAX CAP
(
BACKGROUND
SHOULD TAX INCENTIVES BE USED TO PROMOTE CHOICE
OF LOWER-COST HEALTH PLANS?
CURRENT TAX EXPENDITURE FOR HEALTH BENEFITS IS
ESTIMATED AT $75 BILLION.
•
ANY REDUCTIONS WOULD PRINCIPALLY AFFECT
MIDDLE- AND HIGHER-INCOME INDIVIDUALS
TAX-FREE BENEFITS MAY ENCOURAGE WORKERS TO:
•
ACCEPI' MORE IN BENEFITS THAN THEY MIGHT
NEED
•
PREFER HEALTH BENEFITS TO WAGES
•
BE LESS PRICE SENSITIVE THAN DESIRED UNDER
MANAGED COMPETITION
�(
DECISION 4
TAX CAP
;
~.
STATEMENT OF OPTIONS
OPTION 1:
OPTION 2:
\
(
TREAT AS TAXABLE INCOME EMPLOYER
CONTRmUTIONS TO PREMIUMS ABOVE THE
LOWEST-PREMIUM PLAN OR ABOVE SOME
SPECIFIED HIGHER LEVEL
OPTION 4:
.
TREAT.AS TAXABLE INCOME EMPLOYER
CONTRmUTIONS TO PREMIUMS FOR BENEFITS
BEYOND THE GUARANTEED BENEFITS
PACKAGE
OPTION 3:
(
LEAVE BENEFITS TAX-FREE, AS IN CURRENT
LAW
FOR UPPER INCOME ONLY, TREAT AS TAXABLE
INCOME EMPLOYER CONTRmUTIONS TO
PREMIUMS ABOVE THE LOWEST-PREMIUM
PLAN OR ABOVE SOME SPECIFIED HIGHER
LEVEL
�DECISION 4
TAX CAP
/'"-
OPTION 1:
NO CHANGE FROM CURRENT LAW
.
LEAVE HEALTH BENEFITS TAX-FREE, AS IN CURRENT LAW.
PROS:
•
•
AVOIDS A TOUGH POLITICAL ISSUE
ASSURES THOSE WITH GOOD BENEFITS PACKAGES
THAT GOVERNMENT WILL NOT IMPOSE A NEW TAX
ON THOSE BENEFITS
CONS:
LEAVES IN PLACE THE CURRENT INCENTIVES FOR
EMPLOYERS TO PAY FOR BOTH MORE BENEFITS
AND MORE COSTLY PLANS
RETAINS INEQUITIES IN COVERAGE UNLESS
COMPREHENSIVE BENEFIT PACKAGE SET AT VERY
HIGH LEVEL
•
('
•
•
(
DOES NOT REDUCE CURRENT TAX EXPENDITURE
�(
DECISION 4
TAX CAP
r
OPI'ION 2:
TAX BENEFITS ABOVE GUARANTEED
PACKAGE
TREAT AS TAXABLE INCOME EMPLOYER CONTRIBUTIONS TO
PREMIUMS FOR BENEFITS BEYOND THE GUARANTEED
BENEFITS PACKAGE.
•
FOR EXAMPLE, TAXES WOULD APPLY TO COSMETIC
SURGERY BUT NOT TO HIGHER PREMIUMS FOR
GUARANTEED PACKAGE.
PROS:
•
WOULD MODESTLY LIMIT FUTURE GROWTH IN TAXFREE HEALTH CARE SPENDING
•
PERMITS INTRODUCTION OF "TAX-CAP" CONCEPT
WITH MINIMAL OPPOSITION, ASSUMING A
COMPREHENSIVE BENEFITS PACKAGE
(
\
CONS:
•
WILL NOT SIGNIFICANTLY REDUCE CURRENT TAX
EXPENDITURES
•
DOES LI'ITLE TO PROMOTE COST-CONSCIOUS
CONSUMER BEHAVIOR
•
IF BENEFITS PACKAGE NOT COMPREHENSIVE,
WOULD CONSTITUTE TAX INCREASE ON MIDDLE
CLASS
�DECISION 4
TAX CAP
OPTION 3:
TAX PREMIUMS ABOVE LOW-COST PLAN
TREAT AS TAXABLE INCOME EMPLOYER CONTRIBUTIONS TO
PREMIUMS ABOVE THE LOWEST-PREMIUM PLAN OR ABOVE
SOME SPECIFIED HIGHER LEVEL.
PROS:
•
WOULD ENCOURAGE CONSUMERS TO CHOOSE
LOWER-COST PLANS
•
WOULD REDUCE CURRENT TAX EXPENDITURES
CONS:
•
WOULD BE VIEWED BY MANY AS A TAX ON THEIR
BENEFITS AND A TAKEAWAY
•
WOULD LIMIT CHOICE BASED ON INCOME
�(
DECISION 4
t
TAX CAP
OPTION 4:
SAME AS OPTION 3, BUT FOR UPPERINCOME ONLY
I
•
FOR UPPER INCOME ONLY, TREAT AS TAXABLE INCOME
EMPLOYER CONTRIBUTION TO PREMIUMS ABOVE THE
LOWEST-PREMIUM PLAN OR ABOVE SOME SPECIFIED HIGHER
LEVEL.
PROS:
•
•
(
GENERATES REVENUE WITHOUT HARMING
MIDDLE-INCOME PERSONS
REDUCES DISPARITY IN PLANS BASED ON INCOME
•
MAY BE ACCEPTABLE TO GROUPS THAT HAVE
HISTORICALLY OPPOSED TAX CAP
CONS:
•
. REVENUE RAISED MAY NOT BE WORTH POLITICAL
CONTROVERSY OR ADDITIONAL ADMINISTRATIVE
BURDEN
-·-
I
�DECISION 6
PRICE CO:MPETITION
BACKGROUND
HOW MUCH PRICE CO:MPETITION IS DESIRABLE?
PRICE COMPETITION ALLOWS DISPARITY IN PREMIUMS.
DISPARITY IN PREMIUMS MAY CAUSE:
•
GROUPING OF LOW-INCOME INDIVIDUALS IN LOWCOST PLANS; OR
•
HIGHER SUBSIDY COSTS IF LOW-INCOME
INDMDUALS HAVE BROAD CHOICE OF PLAN
DILEMMA OF PRICE COMPETITION:
•
ENCOURAGES EFFICIENTLY-DELIVERED CARE AND
ALLOWS CONSUMER CHOICE REFLECTING
PREFERENCES REGARDING VALUE FOR DOLLAR
BUT
•
SUBSIDIES DETERMINE WHETHER LOW-INCOME
CONSUMERS HAVE WIDE CHOICE OF HEALTH PLANS
OR ARE SEGREGATED IN LOW COST PLANS
•
LOW COST MAY MEAN POOR SERVICE
(
...•.
�DECISION 6
PRICE COMPETITION
STATEMENT OF OPI'IONS
OPTION 1:
OPTION 2:
CONSTRAIN PRICE COMPETITION BY LIMITING
PREMIUM VARIATION; SUBSIDY AMOUNT NOT
TIED TO LOWEST PREMIUM(S)
OPTION 4:
(
FULL PRICE COMPETITION; SUBSIDY AMOUNT
NOT TIED TO LOWEST PREMIUM(S)
OPTION 3:
'
FULL PRICE COMPETITION; SUBSIDY AMOUNT
TIED TO LOWEST PREMIUM(S)
ELIMINATE PRICE COMPETITION; SUBSIDY
AMOUNT DOES NOT VARY
�DECISION 5
PRICE COMPETtl'ION
,
OPTION 1:
FULL PRICE COMPETh'ION; SUBSIDY
AMOUNT TIED TO LOWEST PREMIUM(S)
EACH PLAN NEGOTIATES A PREMIUM WITH HEALTH
ALLIANCE. .
FEDERAL SUBSIDY TIED TO INDMDUAL SHARE OF PREMIUM
FOR LOWEST-PRICED PLAN(S).
PROS:
•
PRICE COMPETITION:
MAXIMIZES INCENTIVES TO KEEP COSTS LOW
{
ENHANCES CHOICE FOR MIDDLE AND UPPER
INCOME
MINIMIZES EMPLOYER COSTS
•
. LIMITED SUBSIDIES MINIMIZE COST TO
GOVERNMENT
CONS:
•
LIMITS CHOICE FOR POOR/NEAR-POOR
•
CONCENTRATES POOR IN LOWEST-COST PLANS
CAPTIVE POPULATION CANNOT EXERCISE
CHOICE
MAY RESULT IN OVERCROWDING AND POOR
SERVICE
-·
-·
�DECISION 6
PRICE COMPETfi'ION
(
OPI'ION 2:
FULL PRICE COMPETITION; SUBSIDY
AMOUNT NOT TIED TO LOWEST
PREMIUM(S)
EACH PLAN NEGOTIATES A PREMIUM WITH HEALTH
ALLIANCE.
FEDERAL SUBSIDY NOT TIED TO LOWEST PREMIUM. FOR
EXAMPLE, SUBSIDY SET AT:
t
•
•
•
110% OF LOWEST PREMIUM
MEDIAN PLAN PREMIUM
ACTUAL PREMIUM, REGARDLESS OF LEVEL
PROS:
•
•
MAINTAINS THE BENEFITS OF PRICE COMPETITION
HIGHER SUBSIDIES REDUCE CONCENTRATION OF
POOR IN LOWEST-COST PLANS
CONS:
•
MAY ALLOW THE VERY POOR BROADER CHOICE
THAN THE NEAR POOR
•
INCREASES PUBLIC SUBSIDY COSTS
......
..
�DECISION 6
PRICE COMPET11'10N
(
OPTION 3:
LIMIT PREMIUM VARIATION; SUBSIDY
AMOUNT NOT TIED TO LOWEST
PREMIUM(S)
ALLIANCE NEGOTIATES WITH PLANS TO LIMIT PREMIUM
VARIATION. FOR EXAMPLE, HIGHEST PREMIUM CANNOT
EXCEED LOWEST PREMIUM BY MORE THAN 20%-30%.
FEDERAL SUBSIDY NOT TIED TO LOWEST PREMIUM. FOR
EXAMPLE, SUBSIDY SET AT:
•
•
(
110% OF LOWEST PREMIUM
MEDIAN PLAN PREMIUM
•
ACTUAL PREMIUM, REGARDLESS OF LEVEL
PROS:
•
LIMITS PREMIUM COSTS FOR ALL INCOME GROUPS
•
CHOICE WITHOUT MARKET SEGMENTATION
•
MAY FACILITATE MEETING BUDGET
CONS:
•
CAPPING PREMIUMS LIMITS INCENTIVE TO
INNOVATE AT THE HIGH END OF COST
NARROWS RANGE OF PLAN OFFERINGS
•
MOVES SERVICE TOWARD LOWEST COMMON
DENOMINATOR
INCREASES PUBLIC SUBSIDY COSTS
..
�(
r
DECISION 6
PRICE COMPETI1'ION
.OPTION 4:
ELIMINATE PRICE COMPETITION
SUBSIDY AMOUNT DOES NOT VARY
HEALTH ALLIANCE NEGOTIATES ONE PRICE FOR ALL PLANS.
FEDERAL SUBSIDY DOES NOT VARY.
PROS:
•
LIMITS PREMIUM EXPENSES FOR INDIVIDUALS TO
20% SHARE
•
.
(
PEOPLE HAVE SAME CHOICE REGARDLESS OF
INCOME
CONS:
•
SINGLE PREMIUM LIMITS INCENTIVE TO INNOVATE
NARROWS RANGE OF PLAN OFFERINGS
MOVES SERVICE TOWARD LOWEST COMMON
DENOMINATOR
•
SINGLE PREMIUM MAY RAISE GOVERNMENT AND
EMPLOYER COSTS
i
(
--.
�DECISION 8
POPULATION GROUPS IN HEALTH ALLIANCES
(
'
BACKGROUND
WinCH PRIVATE AND PUBLIC EMPLOYER GROUPS WILL
BE REQum.ED TO OBTAIN HEALTH COVERAGE THROUGH
THE HEALTH ALLIANCES?
FOR ALLIANCES TO WORK, THEY MUST BE OF SUFFICIENT
SIZE.
•
•
.
(
THEY MUST BE LARGE ENOUGH TO HAVE
PURCHASING POWER
IF THEY ARE TOO SMALL AND INCLUDE THE POOR,
THEY WILL BECOME KNOWN AS "SUPER-MEDICAID"
PLANS AND BE SHUNNED BY THE MIDDLE CLASS
•
SMALL ALLIANCES WOULD BE UNABLE TO CARRY
OUT FUNCTIONS OF QUALITY ASSURANCE, ENSURE
ADEQUATE SERVICE AND CHOICE FOR THE POOR,
ENFORCE BUDGET
FOR THESE REASONS, THE AFL-CIO AND MANY SINGLEPAYER ADVOCATES FAVOR MOVING EVERYONE INTO THE
ALLIANCE.
MANY BUSINESS GROUPS AND THEIR EMPLOYEES WANT TO
LIMIT ALLIANCE SIZE.
•
MOVING PEOPLE INTO LARGE ALLIANCES MAY
CAUSE DISRUPTIONS FOR PEOPLE WHO ARE
CURRENTLY SATISFIED WITH THEIR COVERAGE
•
MANY LARGER FIRMS -- ESPECIALLY MULTI-STATE
EMPLOYERS -- PREFER TO FINANCE AND OPERATE
THEIR OWN PLANS
...
�DECISION 8
POPULATION GROUPS IN HEALTH ALLIANCES
BACKGROUND (CONT)
SPECIAL ISSUES EXIST FOR PUBLIC E:MPLOYEES:
•
FEDERAL E:MPLOYEES MAY BE PARTICULARLY
RESISTANT TO MOVING INTO ALLIANCES
•
SPECIAL EXEMPTIONS FOR FEDERAL AND OTHER
PUBLIC E:MPLOYEES WOULD SEND A NEGATIVE
MESSAGE TO SMALL E:MPLOYERS
NOTE:
RULES ABOUT FIRM SIZE PARTICIPATION WILL
HAVE DIFFERENT IMPACTS IN DIFFERENT STATES.
�DECISION&
POPULATION GROUPS IN HEALTH ALLIANCES
STATEMENT OF OPTIONS
OPTION 1:
REQUIRE PARTICIPATION OF FIRMS WITH 100
OR FEWER EMPLOYEES
OPTION 2:
REQUIRE PARTICIPATION OF
FIRMS WITH 500 OR FEWER
EMPLOYEES
OPTION 3:
REQUIRE PARTICIPATION OF
FIRMS WITH 1,000 OR FEWER
EMPLOYEES
OPTION 4:
REQUIRE PARTICIPATION OF ALL FIRMS,
REGARDLESS OF SIZE
OPTION 5:
SPECIAL RULES FOR PUBLIC EMPLOYERS
(
-~.
�DECISION 8
POPULATION GROUPS IN HEALTH ALLIANCES
/'
OPI'ION 1:
REQumE PARTICIPATION OF FIRMS
WITH 100 OR FBWER EMPLOYEES
PROS:
•
POOLING SMALL EMPWYERS WILL ADDRESS MOST
EGREGIOUS PROBLEMS IN INSURANCE MARKET:
REDUCE ADMINISTRATIVE COSTS
OFFER EMPWYEES A WIDER CHOICE OF
HEALTH PLANS
CONS:
(
•
•
THESE ALLIANCES WOULD HAVE A
DISPROPORTIONATE SHARE OF POOR AND NEARPOOR MEMBERS
· GOVERNMENT MUST REGULATE LARGE NUMBER OF
EMPLOYERS OUTSIDE THE ALLIANCE
�DECISION 8
POPULATION GROUPS IN HEALTH ALLIANCES
OPTION 2:
REQUIRE PARTICIPATION OF Fm.MS
WITH 500 OR FEWER EMPLOYEES
..
118 MILLION NON-ELDERLY PEOPLE (OUT OF 230 MILLION)
WILL BE IN ALLIANCES IF FIRMS WITH 500 OR FEWER
EMPLOYEES ARE REQUIRED TO JOIN. THE NUMBER WILL BE
HIGHER IF ALL PUBLIC EMPLOYEES NOT INCLUDED IN THIS
CATEGORY (ABOUT 15 MILLION WORKERS PLUS THEm
DEPENDENTS) ARE REQUIRED TO JOIN.
PROS:
•
REDUCES THE NEED FOR AN ADDITIONAL LAYER OF
SMALL-GROUP INSURANCE MARKET REGULATION
OUTSIDE THE ALLIANCES
•
SPREADS RISK AND ATrRACTS LEADERSHIP
BEYONDSMALLEMPLOYERS
•
INCREASES ALLIANCE PURCHASING POWER
CONS:
•
APPROXIMATELY 27% OF THE ENROLLED
POPULATION (NOT INCLUDING ALL PUBLIC
EMPLOYEES) WILL BE BELOW POVERTY COMPARED
TO 17% FOR THE POPULATION AS A WHOLE
�I
1
DECISION 8
POPULATION GROUPS IN HEALTH ALLIANCES
r
OPTION 3:
REQumE PARTICIPATION OF
COMPANIES WI1'H 1,000 OR FEWER
EMPLOYEES
131 MILLION NON-ELDERLY PEOPLE (OUT OF 230 MILLION)
WILL BE IN ALLIANCES IF FIRMS WITH 1,000 OR FEWER
EMPLOYEES ARE REQUIRED TO JOIN. THE NUMBER WILL BE
HIGHER IF ALL PUBLIC EMPLOYEES WHO ARE NOT INCLUDED
IN THIS CATEGORY (ABOUT 13 MILLION WORKERS PLUS
THEIR DEPENDENTS) ARE REQUIRED TO JOIN.
PROS:
•
FURTHER STRENGTHENS PURCHASING POWER
•
FURTHER SPREADS RISK
•
REDUCES THE NUMBER OF FIRMS TO REGULATE
OUTSIDE THE ALLIANCE
CONS:
•
( .·
APPROXIMATELY 25% OF THE ENROLLED
POPULATION (NOT INCLUDING ALL PUBLIC
EMPLOYEES) WILL BE BELOW POVERTY COMPARED
TO 17% FOR THE POPULATION AS A WHOLE
..
�DECISION 8
POPULATION GROUPS IN HEALTH ALLIANCES
OPTION 4:
REQumE PARTICIPATION OF ALL FIRMS
·.
PROS:
•
FACILITATES BUDGETARY CONTROL AND
NEGOTIATING POWER
•
CREATES THE BROADEST POOLING OF RISKS
•
BRINGS THE LEADERSHIP OF LARGE
CORPORATIONS INTO HEALTH ALLIANCE
•
EMPLOYERS WITH OLDER THAN AVERAGE WORKERS
WILL WIN
CONS:
•
CHANGES EXISTING COVERAGE THAT MANY
EMPLOYEES BELIEVE IS SATISFACTORY
•
ELIMINATES SELF INSURANCE THAT MANY LARGE
EMPLOYERS PREFER
-~-.
�DECISION 8
POPULATION GROUPS IN HEALTH ALLIANCES
f
(
OPI'ION 5:
SPECIAL RULES FOR PUBLIC
EMPLOYERS
..•
REQUIRING PARTICIPATION BY FIRMS OF 1,000 EMPLOYEES
WOULD NOT ENCOMPASS EMPLOYEES IN URBAN AND
SUBURBAN COUNTIES, LARGE CITIES AND SCHOOL
DISTRICTS, OR FEDERAL AND STATE EMPLOYEES.
IF REQUIREMENTS APPLY TO BARGAINING UNITS, MORE
PUBLIC EMPLOYEES WILL BE INCLUDED.
SPECIAL RULES TO REQUIRE PUBLIC EMPLOYEE
PARTICIPATION WOULD:
•
ACCELERATE TRANSITION BY USING PUBLIC
EMPLOYEE HEALTH BENEFIT PLANS AS A
SPRINGBOARD
•
(
BUILD ON THE EXPERTISE OF STATE PUBLIC
.. EMPLOYEE GROUPS IN OPERATING HEALTH
ALLIANCES
•
EXPAND SIZE OF ALLIANCE
PUBLIC-SECTOR UNIONS MAY:
•
•
(
..
REGARD SPECIAL REQUIREMENTS AS AN UNFAIR
DISRUPTION OF BARGAINING AGREEMENTS
RESIST PARTICIPATION IN ANY POOL THAT IS
DISPROPORTIONATELY LOW-INCOME
�DECISION 7
AGE ADJUSTMENT TO COMMUNITY BATE
BACKGROUND
SHOULD COMMUNITY RATING BE MODIFIED TO ACCOUNT
FORAGE?
UNDER EXPERIENCE RATING, HEALTHIEST GROUPS PAY
BELOW-AVERAGE PREMIUMS REFLECTING:
•
•
CLAIMS ffiSTORY
•
(
HEALTH STATUS
DEMOGRAPmC CHARACTERISTICS
COMMUNITY RATING SPREADS RISK BY REQUIRING ALL
GROUPS TO PAY THE SAME PREMIUM.
A MOVE TO PURE COMMUNITY RATING WILL:
•
PRODUCE IMMEDIATE PREMIUM INCREASES FOR
HEALTHIER, ·yoUNGER GROUPS
•
PREVENT RATE SWINGS AS EXPERIENCE IN SMALL
GROUPS CHANGES
•
ALLOW OLDER, SICKER INDIVIDUALS AND GROUPS
TO PAY LESS
ADJUSTING.COMMUNITY RATES FOR AGE WILL RESULT IN
FEWER EMPLOYERS AND. INDIVIDUALS EXPERIENCING LARGE
INCREASES OR LARGE REDUCTIONS.
JIM'IUYILilD:D a CONI'IDDtiiALit-114
�DECISION 7
AGE ADJUSTMENT TO COMMUNITY BATE
STATEMENT OF OPTIONS
OPTION 1:
AGE-RATE PREMIUMS
OPTION 2:
DO NOT AGE-RATE PREMIUMS
�DECISION 7
AGE ADJUSTMENT TO COMMUNITY BATE
(
OPTIONS 1 & 2:
AGE-RATING PREMIUMS
.
PRQS:
•
•
•
AGE RATING WILL MINIMIZE SHIFT IN
PREMIUM COSTS FROM MIDDLE-AGED
HIGHER EARNERS TO YOUNGER, LOWER
EARNERS
· BECAUSE AGE IS CORRELATED WITH
INCOME, AGE RATING WILL REDUCE
GOVERNMENT SUBSIDY COSTS
AGE RATING WILL REDUCE COSTS FOR
SMALL EMPLOYERS WITH A
PREDOMINANTLY YOUNG WORK FORCE
CONS:
•
MAY CAUSE JOB DISCRIMINATION BASED
ON AGE
•
•
WILL BE ATI'ACKED AS INEQUITABLE
•
ALLOWING ONE EXCEPI'ION TO COMMUNITY
RATING COULD OPEN DOOR TO OTHERS
ADDS ADMINISTRATIVE COMPLEXITY (THE
BENCHMARK PREMIUM AND THE TAX CAP
WOULD ALSO HAVE TO BE AGE-RATED)
•
-
-.
�DECISION 8
STAND-ALONE PLANS
(
BACKGROUND
. WHAT RATING AND CHOICE RULES GOVERN STANDALONE PLANS?
PLANS OUTSIDE THE HEALTH ALLIANCE MUST AT LEAST:
•
•
PAY SAME PREMIUM SHARE AS EMPLOYERS
PARTICIPATING IN THE ALLIANCE
•
COMPLY WITH FEDERAL QUALITY STANDARDS
•
(
PROVIDE THE COMPREHENSIVE BENEFIT PACKAGE
COMPLY WITH BUDGET
•
PAY ASSESSMENT FOR NATIONAL DISABLED POOL
(IF ESTABLISHED)
•
COMPLY WITH SOLVENCY AND REPORTING
REQUIREMENTS
UNLESS RULES ABOUT RATING AND CHOICE ARE
ESTABLISHED, ALLIANCES MAY BE SUBJECT TO ADVERSE
SELECTION AND EMPLOYEE CHOICE WILL BE LIMITED.
�DECISION 8
STAND-ALONE PLANS
(
STATEMENT OF OPTIONS
OPI'ION 1:
OPI'ION 2:
I
•,
ELIMINATE SELF INSURANCE BUT ALLOW
EMPLOYERS TO MANAGE OWN PLANS
OPI'ION 3:
I
RETAIN SELF INSURANCE BUT ALLOW
EMPLOYERS TO JOIN ALLIANCE
RETAIN SELF INSURANCE OUTSIDE THE
ALLIANCE; BUT HAVE SPECIAL RULES FOR
EMPLOYEE CHOICE
�DECISION 8
STAND-ALONE PLANS
(
OPTION 1:
RETAIN SELF INSURANCE BUT ALLOW
EMPLOYERS TO JOIN ALLIANCE
PERIODICALLY, LARGE FIRMS WOULD HAVE THE
OPPORTUNITY TO JOIN THE ALLIANCE.
THESE FIRMS WOULD PAY AN EXPERIENCE-RATED PREMIUM
TO THE ALLIANCE.
•
•
(
NECESSARY TO PROTECT ALLIANCE AGAINST AN
INFLUX OF HIGHER-COST, LARGE FIRMS.
EVENTUALLY <PERHAPS AFTER 10 YEABS), THESE
FIRMS COULD PAY ON A COMMUNITY RATE.
PROS:
•
MANY LARGE FIRMS LIKELY TO FAVOR THIS OPriON
BECAUSE IT EXPANDS CHOICE BUT DOES NOT
·REQUIRE CHANGE
CONS:
•
LARGE FIRMS WITH OLDER OR LESS HEALTHY
WORKERS WILL OBJECT TO CONTINUED HIGHER
COSTS
�DECISION 8
STAND-ALONE PLANS
OPTION 2:
ELIMINATE SELF INSURANCE BUT
ALLOW EMPLOYERS TO MANAGE OWN
PLANS
INSTEAD OF ALLOWING PLANS TO SELF INSURE, LARGE
EMPLOYERS MANAGING OWN PLANS WOULD PAY SAME
COMMUNITY RATE TO ALLIANCE AS OTHER EMPLOYERS.
THESE EMPLOYERS COULD LIMIT THEIR PLAN TO THEIR OWN
EMPLOYEES.
EMPLOYEES MAY CHOOSE ANY PLAN IN THE ALLIANCE OR
THEIR EMPLOYER'S PLAN.
THESE EMPLOYER PLANS, LIKE ANY OTHER PLAN, WILL
RECEIVE A RISK-ADJUSTED PAYMENT FOR THEIR
EMPLOYEES THAT CHOOSE IT.
PROS:
•
PREVENTS ADVERSE SELECTION AGAINST THE
HEALTH ALLIANCE
•
SELF-FUNDED HEALTH PLANS FORCED TO
COMPETE ON EFFICIENCY, NOT RISK-SELECTION
•
REDUCES COSTS FOR FIRMS WITH OLDER AND/OR
LESS HEALTHY WORKERS
CONS:
•
MOST LARGE FIRMS WILL SEE THIS OPI'ION AS
TANTAMOUNT TO JOINING THE ALLIANCE ·
•
RAISES COSTS FOR FIRMS WITH YOUNGER
WORKERS
�DECISION 8
STAND-ALONE PLANS
(
OPTION 8:
RETAIN SELF INSURANCE OUTSIDE THE
ALLIANCE BUT HAVE SPECIAL RULES
TO EXPAND EMPLOYEE CHOICE
POSSIBLE APPROACHES TO EXPAND EMPLOYEE CHOICE:
•
REQUIRE LARGE FIRMS TO ALLOW EMPLOYEES TO
CHOOSE ALLIANCE PLANS
•
REQUIRE LARGE FIRMS TO OFFER 1WO OR MORE
HEALTH PLANS IN ADDITION TO THE FIRM'S
PRIMARY PLAN
PROS:
(
•
GIVES THESE EMPLOYEES BROADER CHOICE OF
HEALTH PLANS
CONS:
•
IMPOSES NEW REQUIREMENTS ON LARGE
EMPLOYERS
FOR INDMDUAL OPT-IN:
•
DIFFICULT TO ADMINISTER INDMDUAL OPT-IN
•
.
EMPLOYERS MAY SELECTIVELY ENCOURAGE
. HIGHER-COST EMPLOYEES TO JOIN THE
ALLIANCE'S PLANS
MANY EMPLOYERS WILL FIND IT DIFFICULT TO
SUSTAIN A SELF-FUNDED PLAN DUE TO
UNPREDICTABILITY OF VOLUME
�I
(
DECISION&
MEDICARE INTEGRATION
r
BACKGROUND
SHOULD MEDICARE BE INTEGRATED INTO THE NEW
SYSTEM?
MEDICARE COVERS 13% OF THE POPULATION:
•
31 MILLION ELDERLY
•
3 MILLION NON-ELDERLY DISABLED
MEDICARE HAS SUBSTANTIAL MARKET SHARE:
•
17 PERCENT OF TOTAL HEALTH SPENDING
•
27 PERCENT OF ALL HOSPITAL SPENDING AND 24
PERCENT OF PHYSICIAN SPENDING
MEDICARE HAS STRONG SUPPORT AMONG BOTH ELDERLY
AND NON-ELDERLY AMERICANS.
MEDICARE HAS NATIONWIDE ADMINISTRATIVE CAPACITY
THROUGH ITS CARRIERS AND INTERMEDIARIES IN EACH
STATE.
1.5 MILLION BENEFICIARIES ARE IN RISK-BASED HMOS.
MEDICARE HAS A NATIONAL PAYMENT SYSTEM FOR
HOSPITALS-AND PHYSICIANS.
(
�DECISION 8
MEDICARE INTEGRATION
STATEMENT OF OPI'IONS
OPTION 1:
OPTION 2:
•
PARTIAL INTEGRATION OF MEDICARE
OPTION 3:
1.
LEAVE MEDICARE PROGRAM ALONE EXCEPT TO
EXPAND BENEFITS
FULL INTEGRATION OF MEDICARE INTO THE
NEW SYSTEM
�DECISIONS
MEDICARE INTEGRATION
(
OPTION 1:
LEAVE PROGRAM ALONE; EXPAND
BENEFITS
MEDICARE REMAINS A SEPARATE PROGRAM FOR ELDERLY
AND DISABLED BENEFICIARIES.
BENEFITS COULD BE IMPROVED TO INCLUDE PRESCRIPTION
DRUGS AND REDUCE COST-SHARING.
INCENTIVES COULD BE PROVIDED TO ENCOURAGE
BENEFICIARIES TO ENROLL IN MANAGED CARE PLANS.
PROS:
•
AVOIDS DISRUPTION FOR MEDICARE
BENEFICIARIES
•
MEDICARE COULD BE USED AS TRANSITIONAL FEEFOR-SERVICE OPTION OR IF NEW SYSTEM NOT
OPERATIONAL IN ALL AREAS
•
RATE-SETTING METHODS COULD BE APPLIED TO
OTHER PAYERS OR USED BY STATES
CONS:
•
CURRENT MEDICARE POLICIES IMPEDE MOVE
TOWARD CARE MANAGEMENT
•
KEEPS IN PLACE SEPARATE ADMINISTRATIVE
REQUIREMENTS WHICH MAY BURDEN PROVIDERS
•
SEPARATE COST CONTAINMENT MEASURES
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
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Paper
Dublin Core
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Envelope of Misc Documents (Health Care Reform) [2]
Creator
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First Lady's Office
Bobbie Greene
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2006-0223-F
Is Part Of
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Box 2
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763273" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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William J. Clinton Presidential Library & Museum
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1/8/2015
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42-t-7763273-20060223F-002-003-2015
7763273
-
https://clinton.presidentiallibraries.us/files/original/d529ae416f02caccae38f8ab53d1f30b.pdf
b0e6730d94b2e65d96136305d1c8b0e2
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
First Lady's Office
Series/Staff Member:
Bobbie Greene
Subseries:
Misc. Subject Files
OA/ID Number:
15629
FolderiD:
Folder Title:
Envelope ofMisc Documents (Health Reform)
Stack:
Row:
Section:
Shelf:
Position:
s
58
3
6
2
�E A~ AD:\1I~ISTRATIVE
. 1ARKI:'iG P~r E.O. 12958 as amended, Sec. 3.3 (c)
Initials: I\;C(2
Date: 04/0f /11
.PRIVILEGED -aND GOHI':tDEiftJ:Aii'
MEMORANDUM
TO:
FR:
RE:
Distribution
April 14, 1993
Chris Jennings, Steve Ricchetti
Congressional Update/Strategy for Health Reform
Following up on the numerous initial consultations with the
Hill by Mrs. Clinton,. Ira and Judy (see Appendix 1 for list) and
the integration of the Democratic staff into the working groups,
we have developed the next stage of our legislative strategy for
passing comprehensive health reform this year.
The legislative strategy is designed to counter much of the
skeptical outlook that a number of Members of Congress currently
have with regard to the prospects of action on a health reform
bill in the first session of this Congress. The reasons for the
Congressional perception problem are outlined in Appendix 2. Far
more important than focusing on the problem, however, is taking
prompt action to change the environment for legislative action.
LEGISLATIVE
STRATEG~
In short, the legislative strategy that follows highlights
(1) the need to finalize a health reform package that can be sold
in a timely fashion, (2) the importance of close consultation on
strategy and substance with the Congress before and after the
legislation is unve5.led, (3) the need to develop a timetable for
Congressional action, (4) the need to target and lobby the those
Democratic and those Republican Members who will be on the fence
on this issue, and to closely coordinate this effort with tho
Communications team, the DNC, Intergovernmental Affairs and t:he
Office of Public Liaison.
1.
Expedited Decision Process Must Be Implemented. The
President must have the information he needs to make
informed first-cut decisions on the structure and content of
the bill. Obviously, constructive and substantive
discussions with the Congress on key issues (e.g. , cost;
containment, financing, benefits, employer responsibility,
etc. ) cannot take place without a much clearer sense ni': the
direction the President is heading.
An
�,
'
II.
Meaningful Consultation with Congress is Imperative Quring
the Recess and Soon After their Return. Because of the
enormous political implications of virtually every key
policy decision that will be made, the President's thinking
must be informed by the political realities in the Congress
as they are perceived by Hill Leaders. Xn addition, to
invest the Leadership in the process and to give them a
sense of ownership, they must feel they have a meaningful
opportunity to offer their own policy and political advice
to the President before he introduces his proposal. All
within the Administration must, therefore, understand that
it is the Hill that controls the agenda for legislative
activity on health care and their vision of how best to
accomplish our goal of passing health care this year should
and will prevail. ~o best assure that the Members are
invested health care, we suggest the following strategy:
A.
As Congress Reconvenes, the President Should Reemphasize His Commitment to Health Care. While Howard
and Ira have been sending strong signals that the
President desires to pass his health reform initiative
this year, the doubts plaguing Members' minds can only
be effectively exorcised by clear signals from the
President himself. We propose informal gatherings at
the White House with the House and Senate Leadership as
the best way to accomplish this.
Specifically, we believe that at least four informal
get-togethers hosted by the President and the First
Lady should be scheduled at or around April 20th: (1)
an informal meeting with the Speaker and the two
Majority Leaders; (2) a dinner with the House
Leadership and their most pertinent health care
Chairmen (Foley, Gephardt, Bonier, Rostenkowski,
Dingell, Ford, Stark, Waxman, and Williams); (3) a
similar dinner with the Senate Leadership and their
Chairmen (Mitchell, Ford, Pryor, Daschle, Moynihan,
Kennedy, Rockefeller, Riegle, and perhaps Breaux); and
(4) an informal meeting with the Congressional
Republican Leadership. Beyond clearly illustrating the
President's desire to passing reform this year, the
goal of these meetings would be multifold:
* To illustrate the President's understanding of the
time and work constraints we have already asked
(through reconciliation, etc.) and would now be asking
of the Chairmen;
* To re-energize the Leadership by asking them how to
develop a realistic legislative strategy. (Although
the President would have a sense of what is likely,
these Members must also be invested in the timing and
political strategy);
_____________ L
�* To advise the Leadership of any new timetable for
public unveiling and introduction of the President's
proposal (they should not read this in the newspaper);
* To work with Committee Chairmen to help coordinate a
hearing strategy before the President's bill
introduction, which would establish an even more
welcome political and media environment for reform; and
* To schedule a series of additional substantive,
consultative meetings between the President and the
First Lady and the Leadership, Committee Chairmen, and
whomever else the Leadership designates. These
meetings will give the President the political and
policy advice necessary to modify his first-cut
decisions in such a way that his bill will be well
received on the Hill. (The third Appendix to this memo
outlines a series of meetings that we should give
serious consideration to holding prior to the
introduction of the bill).
B.
Before the Leadership Meetings, Learn From and Reach
Out to their Staff. During the recess (and this has
already started), Ira, Judy, Steve, Chris, Christine,
Steve E., the Department, and others should be tapped
to conduct briefings with the staff of the Leadership
and other key Congressional Members.
These briefings will serve at least four major
purposes: (1) to give the Leadership (through their
staff) the sense that they are being kept in the loop
during the recess, (2) to establish a solid and
informed foundation for Members' discussions when they
return, (3) to tap into their substantial expertise and
help us reach closure on a myriad of politically and
technically difficult issues; and (4) to get a sense of
where Members stand on them.
C.
Discuss and Align Budget Assumptions with CBO. Robert
Reischauer's assessment about how little yield any cost
containment strategy would produce is petrifying an
already scared Congress. The thinking is that CBO has
the very real potential to sink an already leaking
health reform ship. If our numbers come out completely
different from CBO, the fears of the Congress will be
realized. To head this off, the House Leadership -working with us -- has already requested Ira's (and
appropriate Administration budget number crunchers)
presence at a meeting to attempt to get all parties on
the same page. (Since this will be all staff, we do
not believe it appropriate that Mrs. Clinton attend).
�III. DEVELOP A TIMETABLE FOR CONGRESSIONAL ACTION. In
conjunction with the Congressional Leadership, the
development of a realistic procedural and legislative
timetable is essential for a number of reasons:
* It makes the Congress focus much more intently on the
work it must complete;
* It illustrates to Congress that the White House understands the time constraints that confront the Congress; and
* It helps all other operations of the Administration (the
communications, the DNC, intergovernmental affairs, and
public liaison office) focus their efforts around key
Congressional actions.
For the purposes of this discussion, and consistent with
Howard's conversations with the Leadership, a difficult but
achievable schedule of legislative action on the President's
bill could be:
House and Senate hearings in June and July; House Committees
mark-up bill in mid July; House passes bill before they
leave for the August recess (now scheduled for 8/6/93) OR
soon after they return -- (great preference would be for the
former because a "marked-up" bill awaiting final vote could
make it very vulnerable to recess attacks by opponents);
Senate Committees mark-up bill late September/early October;
Senate passes bill in Nobember or early December; Conference
takes place and Houses work out differences (timing depends
on differences); and the Congress passes final bill in late
December or sometime early in the following year. The
process boiled down to ten steps:
1. Introduction. The bill must originate in the House since
it will have revenue implications and will likely be
introduced by Majority Leader Gephardt. Senator Mitchell
will introduce the President's bill in the Senate. The
timeframe for this obviously depends on the President and
his read of what is best for the health care bill, the
stimulus package and the reconciliation bill. Having said
this, the window of opportunity for Congressional
consideration narrows every day we wait once the bill is
ready for introduction.
2. Bill Referral. The Speaker will work to refer the bill
to Committees for which he has previously worked out time
limited reporting agreements. There could be as many as 9
Committees with some jurisdiction, but most of the work will
emerge from the Ways and Means Committee, the Energy and
Commerce Committee, and the Education and Labor Committee.
In the Senate, it appears as though at least two Committees,
Finance and Labor & Human Resources, will get titles of the
bill -- with the significant preponderance going to Finance.
�'·
3. Hearings. The Committees are likely to hold a good 4-6
weeks of hearings. Their ability to hold and finish these
hearings will depend on what other work requirements are
confronting them. Given the fact that the Senate Finance
Committee will in all probability still be working on the
reconciliation bill, it is likely that they will -- as usual
proceed at a somewhat slower pace.
4. Mark-up. The House Ways and Means Committee, like other
Committees, may choose to mark-up the bill on a full
Committee basis to expedite their work on the proposal.
This process should be budgeted about 3-4 weeks. Under any
scenario, however, Pete Stark's health Subcommittee will
serve as the Committee's bill managers and will be extremely
influential on the substance.
As you could tell today, Pete Stark is already raising
concerns about an overly abbreviated timeframe for House
Committee consideration. We do not believe we should reduce
the pressure at this point, however. Any delay reduces the
prospects of action this year and, as a result, we believe
we should continue to encourage the House Leadership to get
the bill out of the full Committee in mid (and no later than
late) July, and scheduled for a final vote before the August
recess. (If the hearings and mark-up get delayed -- for
whatever reason -- the Leadership may need to consider the
possibility of shortening the length of the August recess;
at bare minimum, we must have the House Committees at a
stage where they are at least ready to finalize their markup soon after they return from Labor Day recess).
The Senate, for a whole variety of reasons, will follow a
different schedule. Following tradition and because the
Senate will want to build on top of the House marked-up
bill, the Finance Committee will probably wait until after
the House brings up its bill for a floor vote before it
marks up its bill. At the very least, Finance will wait
until after the House completes its Committee work before
holding a formal mark-up session.
5. House Rules Committee Mark-up. After all the House
Committees report within the timeframe allocated by the
Speaker, the bill must receive a rule from the Rules
Committee in order to receive floor consideration and to
determine what amendments to the bill will be in order. The
Leadership is likely to ask the Committee for a "modified
closed rule," permitting a limited number of amendments and
a limited period of time for debate. These amendments may
well be limited to substitute amendments, and would likely
cover the issue of abortion, taxes, possibly mandates, and
others.
�•
..
6. Bouse Vote. House vote, assuming all else is worked out,
would then occur in late July/early August. (If a vote
cannot be held before scheduled recess; the Leadership, in
consultation with the President, might consider keeping the
Members in a bit longer into August to assure a vote before
they depart (and to avoid attacks on a vulnerable marked-up
bill). Assuming passage, the bill would go to the Senate
where it would be either held at the desk and placed on the
calendar or referred directly to the Committee(s).
7. Senate Mark-Up. Under this schedule, the Senate
Committees are obviously not likely to have held their
respective mark-ups by the time the House passes its bill.
As soon as the House (hopefully) passes its bill, there will
be an extreme amount of pressure on the Senate to move.
Having said this, while the Labor Committee should have no
problem pushing out a bill, a major push by the White House
on the diverse collection of health care philosophies on the
Finance Committee may well be required.
8. Senate Floor Action. Immediately after the Senate
Committees' hold separate mark-ups, the Majority Leader
Mitchell will likely call it up for action as soon as
practical to start the debate. At that time, he will almost
invariably receive an objection to his unanimous consent
request to bring the bill up for consideration. A cloture
vote to limit debate on the motion to proceed will ensue.
To move to the bill, the Majority Leader would have to find
60 votes. Assuming he fails on the first try, he would
continue repeatedly until he (and us) Successfully
embarassed Members into switching their votes. (The
argument would be that opponents are not even allowing
consideration of reform).
Assuming that we get our first 60 vote clearance, we would
then likely face a second fillibuster and cloture vote on
the substance of the bill. No doubt, this floor vote will
be our most difficult challenge; in order to pass the bill,
we might be doing roll call cloture votes well into the late
Fall and early Winter.
9. Joint Bouse/Senate Conference. Depending on how
different the two bills are, the conference could take a
couple of weeks to several months. Since the Democrats
control the conference, this would (hopefully) be an easier
hurdle to clear.
10. Vote on Final Passage. Once again, in the Senate, you
have the very real potential for another fillibuster by an
unhappy Member. Should this occur, a third and final
cloture petition may have to be filed and passed (60 votes)
in order to get a final vote on passage. If we succeed in
obtaining cloture (probably less difficult than before), we
succeed in passing the historic health reform bill.
�.
•
.
'
I
Obviously, the previously mentioned "regular order" process
will be difficult. Should the reconciliation bill be delayed in
the Senate, there remains an outside possibility for marrying the
two bills, but the 60 vote problem would still remain and such a
.linkage could well threaten the prospects of passing the other
provisions of reconciliation this year. Alternative procedural
approaches are being examined, but we agree with the Senate
Leadership assessment that nothing currently appears very viable.
We will, of course, apprise you should this situation change.
IV.
Target the Members of Congress who are Fence Sitters. There
will be some Members who will want to vote for the
President's proposal because it is his plan. However, for
the vast majority of Members, a decision on whether to vote
for health care will be based -- in large measure -- on
whether the Member concludes it satisfies his constituents.
In order to have a chance of getting 218 votes in the House
and 60 votes in the Senate, the President and the First Lady
will have to lead an extensive public affairs campaign.
Most Members will need to hear from constituents they have
not heard from before on the health care debate. The Member
must have a perception that the general public's support for
the President's proposal, in his or her district, exceeds
any other "special interest" opponent's campaign.
The only way to achieve a large scale public response is
through a massive public communications campaign. While
this effort should be nationwide to the extent possible, it
should particularly focus on a target population of
Democrats we are most nervous about and Republicans we have
the best opportunity to attract.
The targeting effort is now well under way. Several weeks
ago, in consultation with HHS, the DNC, Intergovernmental
Affairs and other Task Force Members, we compiled a list of
possible Republican Senators and vulnerable Democrats (see
Appendix 4). We cross-referenced these target states with
the Governors. Interestingly, 11 out of the 14 Republican
Senators we targeted and 16 out of the 23 Democratic
Senators come from States with Democratic Governors. We
have forwarded this list to communications, the DNC,
Intergovernmental Affairs and the Office of Public Liaison.
we are in the process of developing a detailed House list as
well, but our preliminary analysis has led us to conclude
that the states and Senators we targeted match up very well
with the House.
�I
In addition,.· the War Room is now staffed and computer
equiped. We have begun a file on every Member. The files,
which can be cross-tabulated, include a wide array of
information on the Members (e.g. past and current positions
and priorities with regard to health, information on the
time and substance of your and staff meetings with the
Members, key staff contact information, etc. Added to these
files will be information and research being obtained by the
DNC and Intergovernmental Affairs.
Lastly, as soon as the Members get back, we propose to reach
out to more of the rank and file Congresspersons.
Appropriate White House and HHS Department personnel will be
dispersed to meet with Members or staff to share and collect
information. The most important element of this strategy is
that each of the targeted Members and/or their staffs will
have an in-person vist from someone from the Administration
working on health reform and they will all be given the
opportunity to share information and advice.
Conclusion
The period from the Spring recess until the President
unveils his proposal will be enormously important to us in
securing the strong support of the COngress and reinforcing our
desire to see action on health care this year. It will provide
an opportunity for genuine consultation with the Congress on both
procedural and substantive issues. In addition, it is essential
that we continue to build on the grass roots/public support being
generated for our initiative, particularly with those in the
field who are viewed as "experts" and upon whose advice Members
rely. In order to achieve this, we must work closely with the
Communications, Intergovernmental Affairs, and the Office of the
Public Liaison to pool information and to assure appropriate
Congressional audiences are aware of the broad public support for
health reform.
�••
APPENDIX 1
SUMMARY OF CONGRESSIONAL MEETINGS
(Through spring recess)
BOUSE OF REPRESENTATIVES
Members met with:
Democrats 128
Republicans - 26
TOTAL 154
Members Remaining:
Democrats 127
Republicans - 149
Independent 1
Vacancies 4
TOTAL 281
Meetings with Member of the Committee of Jurisdiction:
WAYS AND MEANS
Democrats - 20 of 24
Republicans - 4 of 14
Democrats Remaining:
Republicans Remaining:
Andrew Jacobs (IN)
Harold Ford (TN)
William Coyne (PA)
Bill Brewster (OK)
Bill Archer (TX)
Philip Crane (IN)
Clay Shaw (FL)
Don Sundquist (TN)
Jim Bunning ( KY)
Amo Houghton (NY)
Wally Herger (CA)
Mel Hancock (MO)
Rick Santorum (PA)
ENERGY AND COMMERCE
Democrats - 21 of 27
Republicans - 6 of 17
Democrats Remaining:
Republicans Remaining:
Philip Sharp (IN)
Al Swift (WA)
Ralph Hall (TX)
Rick Boucher (VA)
Thomas Manton (NY)
Craig Washington (TX)
Jack Fields (TX)
Michael Oxley (OH)
Dan Schaefer (CO)
Joe Barton (TX)
Fred Upton (MI)
Cliff Stearns (FL)
Bill Paxton (NY)
Paul Gillmor (OH)
Scott Klug (WI)
Jim Greenwood (PA)
Michael Crapo (ID)
�..
EDUCATION AND LABOR
Democrats - 12 of 24
Republicans - 3 of 15
Democrats Remaining:
Republicans Remaining:
Bill Clay (MO)
George Miller (CA)
Austin Murphy (PA)
Dale Kildee (MI)
Matthew Martinez (CA)
Donald Payne (NJ) ·
Jolene Unsoeld (WA)
Robert Andrews (NJ)
Jack Reed (RI)
Tim Roemer (IN)
Robert Scott (VA)
Karan English (AZ)
Eni F.H. Faleomavaega
(Amer. Samoa)
Scotty Baesler (KY)
Tom Petri (WI)
Dick Armery ( TX)
Harris Fawell (IL)
Paul Henry (MI)
Cass Ballenger (NC)
Susan Molinari (NY)
Bill Barrett (NE)
John Boehner ( OH)
Randy Cunningham ( CA)
Peter Hoekstra (MI)
Howard McKeon (CA)
Dan Miller (FL)
SENATE
Members met with:
Democrats 45
Republicans - 20
TOTAL 65
Members Remaining:
Democrats 12
Republicans - 23
TOTAL 35
Meetings with Members of the Committees of Jurisdiction:
FINANCE
Democrats - 9 of 11
Republicans - 7 of 9
Democrats Remaining:
Republicans Remaining:
David Boren (OK)
Bill Bradley (NJ)
Orrin Hatch (UT)
Malcolm Wallop ( WY)
LABOR AND HUMAN RESOURCES
Democrats - 11 of 11
Republicans - 5 of 7
Democrats Remaining:
Republicans Remaining:
None
Dan Coats (IN)
Orrin Hatch (UT)
�CONGRESSIONAL MEETINGS
FEBRUARY 3, 1993
Rep. Dick Gephardt
HRC
FEBRUARY 4, 1993
11:30 AM
Rep. Pete Stark
~M,
2:30 PM
Sen. George Mitchell
HRC, IM, JF
3:00 PM
Senate Democrats
HRC, IM, JF
Sens. Mitchell, Baucus, Bingaman,
Boxer, Breaux, Bumpers, Conrad,
Daschle, Feingold, Harkin, Kennedy,
Kerrey, Leahy, Lieberman,
Metzenbaum, Mikulski, Moseley-Braun,
Moynihan, Pell, Pryor, Riegle,
Robb, Rockefeller, Wellstone,
Wofford
4:00 PM
Sens. Bob Dole and John Chafee
HP
HRC, IM, JF
FEBRUARY 10, 1993
11:30 AM
Sen. Jay Rockefeller
HRC
FEBRUARY 11, 1993
Sen. Harris Wofford
Health Reform Conference
Harrisburg, PA
3:00 PM
Sen. Mitchell's Office
IM
FEBRUARY 15, 1993
10:00 AM
Rep. Jim McDermott
IM
FEBRUARY 16, 1993
2:00 PM
House Democratic Leadership Tom Foley, Dick Gephardt
1
HTC, IM, JF
�House Democrats HRC, IM, JF
Andrews, Bonior, Cardin,
c. Collins, Conyers, Cooper,
de la Graza, Derrick, Fazio, Ford,
Hoyer, E.B. Johnson, Johnston,
Levin, Lewis, Matsui, McDermott,
Meek, Obey, Richardson, Rose,
Rostenkowski, Slattery,
Slaughter, Stark, Stenholm,
Strickland, Synar, Waxman,
Williams, Wyden
4:00 PM
House Republican Leadership
Bob Michel, Newt Gingrich,
Dennis Hastert
HRC, IM, JF
House Republicans Bilirakis, Bliley, Goodling,
Goss, Grandy, Gunderson, Hoke,
N. Johnson, Kasich, McCrery,
Moorhead, McMillan, Roberts,
Roukema, Thomas, Walker
HRC, IM, JF
FEBRUARY 18, 1993
11:00 AM
Rep. Dan Rostenkowski
HRC
12:30 PM
Rep. Bill Ford
HRC
Re. John Dingell
HRC
1:30 PM
FEBRUARY 23, 1993
2:00 PM
Congressional Women's Caucus
HRC
Pat Schroeder, Olympia Snowe
Furse, Kaptur, Lambert, Lowey,
Maloney, Mink, Morella, Slaughter,
Waters
3:45 PM
Rep. Pete Stark
HRC
4:30 PM
Rep. Henry Waxman
HRC
5:15 PM
Rep. Pat Williams
HRC
FEBRUARY 24, 1993
11:00 AM
Sen. David J?urenberger
2
HRC
�11:30 AM
House Democratic Leadership and
Committee Chairs
Gephardt, Lewis, Richardson,
Rostenkowski, Stark, Dingell,
Waxman, Ford, Williams
HRC, IM, JF
FEBRUARY 25, 1993
Sen. Jim Sasser
~c
Sen. and Mrs. Reigle
~c
Sen. Paul Wellstone
~c
1:00 PM
Congressional Black Caucus
Clayton, Collins, Conyers, Flake,
Franks, McKinney, Meek, Mfume,
Moseley-Braun, Norton, Rangel,
Stokes, Waters, Watt
~C
2:00 PM
Congressional Hispanic Caucus
HRC
Serrano, Roybal-Allard, Pastor,
de la Graze, de Lugo, Ortiz,
Richardson, Torres, Ros-Lehtinen,
Becerra, Bonilla, Diaz-Balart,
Guttierrez, Mendez, Romero-Barcelo,
Tejeda, Velazquez, Underwood
MARCH 2, 1993
12:00 PM
MARCH 4, 1993
Senators Breaux and Johnston,
Rep. Jefferson
Louisiana Trip
~c
DPC
IM, JF
Mitchell, Daschle, Akaka, Baucus,
Bingaman, Boxer, Bryan, Campbell,
Conrad, Dodd, Exon, Feingold,
Feinstein, Graham, Hollings,
Kennedy, Kerrey, Kerry, Lautenberg,
Leahy, Lieberman, Levin, Mathews,
Metzenbaum, Mikulski, Moynihan,
Pell, Pryor, Reigle, Robb, Rockefeller,
Sarbanes, Sasser, Simon, Wellstone,
Wofford
3
�.
•
MARCH 5, 1993
2:00 PM
Bob Reischauer, Director CBO
IM
Sen. Dianne Feinstein
IM
Rep. John Conyers
HRC
1:00 PM
Rep. Jim McDermott
HRC
2:00 PM
Chmn. John Dingell and
HRC
Energy and Commerce Cmte
s. Brown, Hall, Kreidler, Lambert,
Lehman, Margolies-Mevzinsky,
Markey, Pallone, Richardson,
Schenk, Slattery, Studds, Tauzin,
Towns, Waxman
2:00 PM
Sen. Jeffords
MARCH 6, 1993
10:00 AM
MARCH 9, 1993
MARCH
IM
10, 1993
3:00 PM
Republican Task Force
HRC
Dole, Chafee, Bond, Burns, Cohen,
Craig, Danforth, Gregg, Kassebaum,
Mack, Murkowski, Nickles, Packwood,
Roth, Simpson, Stevens, Thurmond
MARCH 11, 1993
11:00 AM
Rep. Ron Wyden
HRC
1:00 PM
Sen. Edward Kennedy
IM
2:00 PM
Senate Women's Caucus
Mikulski, Kassebaum, Boxer,
Feinstein, Moseley-Braun, Murray
HRC
3:30 PM
Veterans Issues
Sen. Jay Rockefeller,
Rep. Sonny Montgomery,
Rep. Roy Rowland
HRC
�3:30 PM
Gephardt, Rostenkowski, Stark,
Dingell, Waxman, Ford, Willians
IM, JF
5:00 PM
Sen. Daniel Patrick Moynihan
HRC
5:30 PM
House Republicans
Bliley, Gingrich, Goss, Hastert,
Johnson, Thomas
IM
Sen. Bob Graham, Rep. Sam Gibbons
RWJ Forum - Tampa, FL
HRC
Senate Republican Staff
IM
Sen. Tom Harkin, Sen. Charles
Gressley, Rep. Neil Smith
RWJ Forum - Des Moines, IA
HRC
Finance Committee Staff Lawrence O'Donnell, Staff Dir.
CJ, KP, SR
Chmn Dan Rostenkowski and
Democratic Ways and Means Members
Andrews, Cardin, Gibbons,
Hoagland, Jefferson, Kennelly,
Kopetski, Levin, Lewis, Matsui,
McDermott, McNulty, Neal, Payne,
Pickle, Reynolds, Stark
HRC
Rep. Jack Brooks
HRC
House Republicans
Bliley, Goss, Grandy, Hastert,
N. Johnson, McMillan, Thomas
IM
3:45 PM
Reps. Mike Andrews, Jim Cooper,
Charles Stenholm, Lewis Payne
HRC
4:15 PM
Sen. Bob Kerrey
HRC
MARCH 12, 1993
1:45 PM
MARCH 15, 1993
MARCH 17, 1993
2:00 PM
MARCH 18, 1993
7:30
AM
5
-=:
�I
.,
Rep. Reynolds
'
HRC
MARCH 22, 1993
Sen. and Mrs. Don Reigle,
MEG, CR, DS
Rep. and Mrs. John Dingell,
Sen. Carl Levin, Rep. John Conyers
RWJ Hearing - Dearborne, MI
MARCH 23, 1993
9:15 AM
DPC Staff Meeting
John Hilley, Abby Safford,
Diane Dewhirst, Debra Silimeo,
Greg Billings, Michael Werner,
Lawrence O'Donnell, Laura Quinn,
Jim Gottlieb, Larry Stein,
Patricia Zell, John Ball
Begala, BB, CJ
MARCH 24, 1993
Democratic Policy Committee
IM, JF
Sens. Mitchell, Akaka, Baucus,
Bingaman, Boxer, Bryan, Conrad,
Daschle, DeConcini, Dodd,
Feingold, Glenn, Graham, Hollings,
Johnston, Kennedy, Kerry, Leahy,
Levin, Mathews, Moseley-Braun,
Reid, Wellstone, Wofford
MARCH 25, 1993
7:30 AM
House Republicans
Bliley, Goss, Grandy, Hastert,
N. Johnson, McMillan, Thomas
2:00 PM
Democratic Committee Members
IM
Education & Labor, Energy &
Commerce, Ways & Means
Andrews, Cardin, Cooper, Engel,
Lambert, Levin, McDermott, Synar,
Tauzin, Pallone, Woolsey, Slattery,
Rostenkowski, Dingell, Waxman,
Richardson, Markey, Hall, Studds,
Margolies-Mezvinsky, Kennelly,
Hoyer, Fazio, Kreidler, Bryant,
Klink, Sawyer
6
IM
�f
.
MARCH 30, 1993
5:30 PM
Mainstream Forum McCurdy, Bacchus, Browder, Carr,
Cooper, Danner, Glickman, Geren,
Green, Moran, Payne, Penny,
Peterson, Price, Orton, Rowland,
Slattery, Spratt, Tanner
IM
MARCH 31, 1993
8:00 AM
House Democratic Caucus IM, JF
Barlow, Cooper, DeLaura, Derrick,
Dingell, Durbin, Filner, Gephardt,
Geren, Gordon, Hamilton,
Hochbrueckner, Hoyer, Hughes,
Inslee, p. Johnson, E.B. Johnson,
Kaptur, Kennelly, Lancaster, Levin,
Lewis, Lloyd, Lowey, McDermott,
Moran, Obey, Olver, Pomeroy,
Richardson, Romero-Barcelo, Sawyer,
Shephard, Sisisky, Skaggs, N. Smith,
Stark, Stupak, Synar, Thurman,
Velazquez, Volkmer, Wise, Woolsey
Ways and Means Health Sub.
Stark, Levin, Cardin, McDermott,
Andrews, Klezka
APRIL 1, 1993
7:30 AM
House Republicans
Bliley, Goss, Grandy, Gunderson,
Hastert, N. Johnson, McMillan,
Roberts, Thomas
7
Quam
�I
.
HEALTH REFORM LEGISLATIVE STRATEGY
APPENDIX 2
THE CONGRESSIONAL PERCEPTION PROBLEM
There are a number of reasons why the Congress, and
particularly the Leadership, is apparently growing increasingly
dubious about the prospects of health reform this year. Although
each of the following, to various degrees, can and will go away
once we have a plan and we have developed an acceptable
legislative strategy with the Congressional leadership, it is
useful to review the list to understand why some in the Congress
and in the press are currently skeptical.
(1)
Reports of Disarray in the White House. They are hearing
and reading that the White House is in disarray around the
process of developing an initiative and that a significant
delay is very possible:
(2)
Cancellation of House Leadership Meeting in Conjunction with
New York Times Article Hurt. Although last Friday's House
Leadership meeting was cancelled by Majority Leader Gephardt
(for fear of the consequences of another Stark outburst),
there appears to be a perception that this sent another
signal that health care could wait:
(3)
Skepticism that Bill Outside of Reconciliation is Possible.
The Chairmen continue to strongly believe that health care
outside of the reconciliation bill is virtually impossible,
particularly in the Senate, and are extremely skeptical that
two tax hike and benefit cut proposals can receive serious
consideration in one year:
(4)
Current Senate Delav on Reconciliation is Creating Problems.
They view that the White House has an overly optimistic
expectation of a completion time for the reconciliation bill
(they cite Republican trouble-making, Democratic Member
nervousness, and numerous politically-sensitive provisions
in the bill that will be difficult to mark-up in Committee):
�I
i
I
I ,
(5)
Fear that President isn't Assuming Enough Time for Congress.
The Committee Chairmen apparently do not believe that we
fully recognize and appreciate the difficulty of the
abbreviated time constraints we may be assuming for hearings
and mark ups of a health reform bill. More to the point,
the House Chairmen -- and particularly the Subcommittee
Chairmen and their Members -- are becoming more wary that
the assumed timing strategy does little other than "roll
over" the Committees. Because they have yet to feel
"adequately consulted" on the substance of the proposal,
they are very nervous. Moreover, because our strategy
assumes House passage first, the House Chairmen are also
concerned that the Senate will delay so long as to
practically force acceptance of the Senate version; and
(6)
Concern that CBO Numbers Will Kill Any Chances of Reform.
Recent public and private signals by CBO's Robert Reischauer
about how little savings virtually any cost containment
alternative can achieve over the next five plus years raises
great concern that we will be forced into an all and
significant tax strategy. The prospect of a major tax
package on the heels of reconciliation, even for health
care, frightens most Members; and
(7)
Concern that the President is not Actively Engaged.
Although you, Ira, Judy, Howard, Steve and others have sent
unambiguous signals that the President is committed to
getting reform done this year, the media coverage and the
perception of internal squabbling is raising questions in
the minds of Members and staff. Added on top to the sense
that the President himself has not directly raised the
health care issue since the State of the Union, the Congress
is not confident it "knows" where the President now stands
on this issue.
�APPENDIX 3
CONGRESSIONAL MEETINGS TO BE SCHEDULED (4/13/93)
Group. Caucus or Delegation
Date
Task Force Rep.
Congressional Black Caucus
(Hearing)
April 13th
TC, AS, CH
House Democratic Leadership Staff
Contact: Andie King 225-0100
April 13th - 1:30
IM,JF
Ways and Means Subcmte on Health
Contact: David Abernathy 225-7785
April 14th - 10:00
*HRC, IM,
Senate Democratic Staff
Contact: John Hilley
April 15th - 10:00
IM, JF
House Democratic Leadership Staff
Contact: Andie King 225-0100
April 15th - 2:00.
IM, JF
Veterans Group Event
Sec. Brown, Sen Rockefeller
Rep. Montgomery, Rep. Rowland
Contact:
Vic Raymond 523-1802
April 15th - 10:00
*HRC, IM
Congressional Women's Caucus
(Follow up)
Contact: Leslie Primmer
Week of April 12th
IM, JF
Week of April 19th
*BC, AG, HRC
JF
224-5556
225-6740
Democratic Congressional Leadership
Mitchell, Foley, Gephardt·
Contacts: John Hilley (Mitchell) 224-5556
Bonnie Lowery (Foley) 225-8550
Andie King (Gephardt) 225-0100
�Group. Caucus or Delegation
'!'ask Force Rep.
Senate Democratic Leadership
Mitchell, Kennedy, Moynihan, Riegle
Rockefeller, Breaux, Ford, Pryor, Daschle
Contact: John Hilley 224-5556
Week of April 19th
*BC, AG, HRC
House Democratic Leadership
Foley, Gephardt, Rostenkowski, Stark,
Dingell, Waxman, Ford, Williams
Contact: Andie King 225-0100
Week of April 19th
*BC, AG, HRC
Republican Congressional Leadership
Michel, Hastert, Dole, Chafee
Contact: David Kehl (Michel) 225-6201
Sheila Burke (Dole) 225-5311
Week of April 19th
*BC, AG, HRC
Senate Finance Committee
Democrats and Republicans
Contact: Lawrence O'Donnell
April 20th - 4:00
*HRC, IM
Congressional Hispanic Caucus
(Hearing)
Contact: Rick Lopez 226-3430
April 21 - 1:00
BV, CS, ER, RV
Senate Democrats Retreat
Contact: John Hilley 224-5556
April 24th
*HRC, IM, -JF
House Demcratic Caucus
Contact: Melissa Schulman
Week of April 26th
*HRC, IM, JF
Senate Republican Health Task Force
Chafee, et. al.
Contact: Christy Ferguson 224-2921
Week of April 26th
*HRC, IM, JF
Senate Rural Health Caucus
(First Meeting)
Contact: Peter Reinecke (Harkin) 224-3254
Sheila Burke (Dole) 224-5311
Week of April 26
IM, JF
224-4515
226-3210
�•
Group. Caucus or Delegation
Task Force Rep.
House Rural Health Caucus
(First Meeting)
Contact: Rebecca 'l'ice (Stenholm) 225-6605
Week of April.26
IM, JF
Freshman Democratic House Members
(First Meeting)
Contact: Lenwood Long (Clayton) 225-3101
Week of April 26
IM, JF
Week of April 26
IM
Week of April 26
IM
House Democratic Committee Consultation
Contact: Andie King 225-0100
Week of April 26th
*HRC, IM, JF,
(BC?, AG?)
Senate Democratic Leadership Consultation
Contact: John Hilley 224-5556
Week of April 26th
*HRC, IM, JF
(BC?, AG?)
Congressional Republican Leadership Consultation
Contacts: Sheila Burke 224-5311
Dave Kehl 225-6201
Week of April 26th
*HRC, IM, JF
(BC?, AG?)
House Democratic Committee Consultation
Contact: Andie King 225-0100
Week of May 3rd
*HRC, IM, JF
(BC?, AG?)
Senate Democratic Leadership Consultation
Contact: John Hilley 224-5556
Week of May 3rd
*HRC, IM, JF
(BC?, AG?)
Congressional Republican Leadership Consultation
Contacts: Sheila Burke 224-5311
Dave Kehl 225-6201
Week of May 3rd
*HRC, IM, JF
(BC?, AG?)
Conservative Democratic Forum
(First Meeting)
Contact: Rebecca Tice (Stenholm)
Budget Study Group
(First Meeting)
Contact: Gene Conti (Price)
225-6605
225-1784
i
�Group. caucus or Delegation
House Democratic Caucus
Contact: Melissa Schulman
Task Force Rep.
Every Wed.
226-3210
Senate Democratic Policy Committee
Contact: Greg Billings or Michael Werner
224-3232
Eve:ry Thurs.
House Republican Task Force
Contact: Tandi 225-2976
Every Thurs.
�Individual Members
Rep. McDermott
(Sponsor, Single Payer Bill)
Contact: Barbara Smith 225-3106
*HRC, IM
Rep. LaFalce
(Chmn, Small Business Cmte)
Contact: Jeanne Roslanowsick
IM
226-5821
Rep. Stokes
(Chmn, CBC Health Brain Trust)
Contact: Leslie Stokes
225-7032
DS then IM
Rep. Clay
(Chmn, Post Office and Civil Service)
Contact: Gail Weiss 225-4054
IM or JF
Rep. Serrano
(Chmn, Hispanic Caucus)
Contact: Rick Lopez 226-3430
DS or IM
Rep. Moakley
(Chmn, Rules Cmte)
Contact:
Mid May
*HRC
�APPENDIX 4
MEMORANDUM
TO:
FR:
RE:
cc:
Hillary Rodham Clinton
March 22, 1993
Chris Jennings
Senate Republicans to Target as Possible Supporters and
Senate Democrats to Attract and Keep on Board
Legislative/Congressional Distribution List
As you know, it is now virtually certain that the
President's health care proposal will require at least one 60
Member vote to have a chance of passing the Senate. (If the
proposal is merged into reconciliation, 60 votes will be required
to waive the Byrd rule; if it is a free standing bill, 60 votes
will be required to achieve cloture on debate and to bring an end
to a likely Republican fillibuster).
With the above in mind, and because we cannot count on all
57 Democrats (possibly 56 by the time of the roll call) to vote
with us, we must build on and improve our ongoing efforts to
attract a core group of Republicans to vote with the President on
his health reform proposal. Similarly, we must attract and
retain support from a fairly sizable list of Democrats who, for a
variety of reasons, may be nervous about voting with us.
In an effort to pool the information we have on the target
Senate Members, we convened a group including Steve Ricchetti and
his staff, Melanne, Christine Heenan, HHS's Jerry Klepner, Karen
Pollitz and Alan Hoffman, DNC's Celia Fischer, and Steve
Edelstein and his War Room staff. (The group now meets every
Friday). We found ourselves to be in significant agreement on
which Senators we currently believe that the Administration and
the DNC should target; I have attached a list and some crossreferencing information about this list for your use. In
addition, the information we produced through this discussion
will be summarized and distributed in short order.
The 14 Republicans we chose are the ever-shrinking number of
Members who -- because they are viewed as moderates, have special
populations to worry about, and/or are coming up on an election
or retirement -- are the most likely to cross over and support
us. (FYI, according to Republican staff, these Members will
attempt to stick together in a block so as to strengthen their
bargaining leverage IF any such minority block of Republicans
forms; in other words, they plan to exert tremendous pressure on
one another to block "straggler" Republican support).
The Democrats we chose are those who are historically
moderate to conservative Members or who, because of their
constituency or Committee assignment, are particularly sensitive
to specific special interest concerns. It is important to stress
that, as we are targeting these Members, we must not ignore or
alienate our relatively solid progressive support base.
�REPUBLICANS
Senator
Relevant Committee Assignment
1.
2.
3.
Christopher Bond (MO)*
Conrad Burns (MT)* XX
John Chafee (RI) XX
Appropriations Committee
Appropriations Committee
FINANCE COMMITTEE, Health Care
Task Force Chair
4.
5.
6.
Bill Cohen (ME) XX
Alfonse D'Amato (NY) XX
John Danforth (MO)
Judiciary Committee
Appropriations Committee
FINANCE COMMITTEE
7.
8.
9.
Dave Durenberger (MN) XX
Mark Hatfield (OR)
Jim Jeffords (VT) XX
FINANCE and Labor Committees
Appropriations Committee
Labor Committee
10. Nancy Kassebaum (KS)
11. Connie Mack (FL)* XX
12. Bob Packwood (OR)
Labor Committee, Ranking
Appropriations Committee
FINANCE COMMITTEE, Ranking
13. Bill Roth (DE)* XX
14. Arlen Specter (PA)* XX
FINANCE & Gov. Affairs
Appropriations and Judiciary
*
Although all will be a great challenge, these 5 Senators
will be the most difficult to get on board.
XX
Notably, 9 out of the 14 targeted Members have Democratic
Senator counterparts. (In fact, 11 of 14 have Democratic
Governors). If these Dems are on board, it will make it much
more difficult for Republicans to oppose the Clinton plan.
NOTE:
Seven out of the 14 are either Finance or Labor Committee
Members or both (in the case of Durenberger) -- the two
primary Senate health committees. Five of these Members
serve on the all-important Finance Committee.
Lastly, although highly doubtful supporters, significant
efforts should be made to make the following influential Members
uncomfortable about engaging in active opposition: (1) Bob Dole
(KS, Minority Leader, & Finance Committee Member), (2) Alan
Simpson (WY, Minority Whip, Judiciary Committee), (3) Orin Hatch
(UT, Finance and Judiciary Committee, Ranking Member), and
(4) Pete Domenici (NM, Budget Committee Ranking Republican and
Appropriations Committee).
�I ,
DEMOCRATS
I
I
•
Senator
Relevant Committee Assignment
1.
Max Baucus (MT)
Finance Committee
2.
David Boren (OK)
3.
Bill Bradley (NJ)
Finance Committee
4.
John Breaux (LA)
Finance Committee
5.
Richard Bryan (NV)
6.
Dennis DeConcini (AZ)
7.
Chris Dodd (CT)
8.
Jim Exon (NB)
9.
Wendell Ford (KY)
*
Finance Committee
*
Appropriations, Judiciary
Labor and Human Resources
*
10. Bob Graham (FL)
11. Howell Heflin (AL)
*
Judiciary Committee
12. Earnest Hollings (SC)
13. J. Bennett Johnston (LA)
Appropriations Committee
*
Appropriations Committee
14. Bob Kerrey (NB)
Appropriations Committee
15. Herb Kohl (WI)
Judiciary Committee
16. Bob Krueger (TX)
17. Frank Lautenberg (NJ)
Appropriations Committee
18. Joseph Lieberman (CT)
19. Daniel Patrick Moynihan (NY)
20. Sam Nunn (GA)
Finance Committee
*
21. Harry Reid (NV)
Appropriations Committee
22. Charles Robb (VA)
23. Richard Shelby (AL)
*
*
Indicates the 7 Senators who probably will be the most
difficult to get on board.
�I ..
I
I
I
TOTAL STATES/MEMBERS TARGETED IN THE PRELIMINARY SENATE STRATEGY
i
I
I
'
State
SenatorCsl
Governor
1.
2.
3.
4.
5.
Alabama
Arizona X
Connecticut
Delaware
Florida
Heflin and Shelby
DeConcini
Dodd and Lieberman
Roth
Graham and Mack
Hunt (R)
Symington (R)
Weicker (I)
Carper (D)
Chiles (D)
6.
7.
8.
9.
10.
Georgia X
Kansas
Kentucky X
Louisiana
Maine X
Nunn
Dole and Kassebaum
Ford
Breaux and Johnston
Cohen
Miller (D)
Finney (D)
Jones (D)
Edwards (D)
McKernan (R)
11.
12.
13.
14.
15.
Minnesota
Missouri
Montana
Nebraska
Nevada
Durenberger
Bond and Danforth
Baucus and Burns
Exon and Kerrey
Bryan and Reid
Carlson (R)
Carnahan (D)
Raciot (R)
Nelson (D)
Miller (D)
16.
17.
18.
19.
20.
New Jersey
New Mexico X
New York
Oklahoma
Oregon
Bradley/Lautenberg
Domenici
D'Amato and Moynihan
Boren
Hatfield/Packwood
Florio (D)
King (D)
Cuomo (D)
Walters (D)
Roberts (D)
21.
22.
23.
24.
Pennsylvania X
Rhode Island
South Carolina X
Texas X
Specter
Chafee
Hollings
Krueger
Casey (D)
Sundlun (D)
Campbell (R)
Richards (D)
25.
26.
27.
28.
29.
Utah
Vermont X
Virginia X
Wisconsin X
Wyoming X
Hatch
Jeffords
Robb
Kohl
Simpson
Leavitt (R)
Dean (D)
Wilder (D)
Thompson (R)
Sullivan (D)
Total Number of Senators:
*
20 out of 29
are Dem Govs.
This includes the 4 additional target Republican Senators of
Dole, Simpson, Hatch, and Domenici.
NOTE:
41*
If the DNC does not have the resources to target all 29
states, they should choose (generally) to eliminate
first those states that have only one target Senator
and whose Senator does not serve on the Finance
Committee. There are 12 such states marked with an X,
but my 6 lowest priorities would be Georgia, Kentucky,
New Mexico, Texas, Wisconsin, and Wyoming. (I can talk
about others if necessary; in addition, exceptions to
the Finance and/or 2 Member rule might be Delaware,
Utah, and Alabama).
�•
LOW MEDICARE PAYMENT LEVELS COULD RESULT
IN COST-SHIFriNG TO OTHER PLANS
(
�DECISION 8
MEDICARE INTEGRATION
.r
OPTION 2:
PARTIAL INTEGRATION
RETAIN SEPARATE MEDICARE PROGRAM AND BENEFITS FOR
THE ELDERLY AND DISABLED, BUT INTEGRATE MEDICARE
PAYMENTS WITH THE NEW SYSTEM.
MEDICARE BENEFICIARIES WOULD CONTINUE TO RECEIVE
CARE FROM PHYSICIAN OF CHOICE.
PROVIDERS WOULD BE PAID THROUGH ALLIANCE FEE-FORSERVICE NETWORK:
•
INSTEAD OF NATIONAL FEE SCHEDULE, PHYSICIANS
IN THE NETWORK WOULD NEGOTIATE FEES UNDER
THE STATE BUDGET
•
MEDICARE BENEFICIARIES WOULD OBTAIN
PRESCRIPTION DRUG COVERAGE AND MEDIGAP
COVERAGE THROUGH THE ALLIANCE
(
PROS:
•
•
OPEN-ENDED FEE-FOR-SERVICE PAYMENT UNDER
MEDICARE REPLACED WITH PHYSICIAN
NEGOTIATED FEES UNDER A BUDGET
•
\
ELDERLY RETAIN DISTINCT PROGRAM WITH
MINIMAL DISRUPTION
BRINGS MEDICARE PAYMENTS UNDER EACH
STATE'S BUDGET; PROVIDES STATE WITH GREATER
. CONTROL OVER TOTAL SPENDING IN STATE
•
REGULATORY BUREAUCRACY WILL BE REDUCED
IJILIPBIVD.mED A COHftDBN'I1AIA-ll-ll
�DECISIONS
MEDICARE INTEGRATION
OPTION 2:
•
PARTIAL INTEGRATION (CONT)
FAVORED BY STATE OFFICIALS
CONS:
•
UNDERMINES NATIONAL POLITICAL POWER BASE
OF ELDERLY
•
RESTRUCTURES RELATIONSHIP OF BENEFICIARY
AND PROVIDER WITH NEW FISCAL INCENTIVES
•
MAY BE VIEWED BY ELDERLY AS DISMANTLING
MEDICARE AS A NATIONAL SOCIAL INSURANCE
PROGRAM AND ENTITLEMENT
•
DIFFICULTIES IN SETTING CAPITATION RATES AND
RISK ADJUSTERS FOR THE ELDERLY COULD
UNDERMINE QUALITY AND ACCESS
�DECISION8
MEDICARE INTEGRATION
OPTION 3:
FULL INTEGRATION
MEDICARE BENEFICIARIES RECEIVE COVERAGE THROUGH
ALLIANCE HEALTH PLANS.
•
MEDICARE PAYS PLANS USING AGE- AND RISKADJUSTED PREMIUMS
•
MEDICARE BENEFITS SAME AS FOR UNDER-65
•
COULD BE PHASED IN AS PEOPLE TURN 65 BY
GMNG THEM OPTION TO RETAIN EXISTING
COVERAGE WITH MEDICARE PAYING FOR PREMIUMS
PROS:
•
THE ELDERLY WOULD BE TREATED LIKE ALL
OTHER AMERICANS RESULTING IN A SINGLE
SYSTEM FOR THE NATION
•
PURCHASING POWER OF THE ALLIANCE WOULD BE
INCREASED BY 34 MILLION AMERICANS
•
MEDICARE SPENDING WOULD BE INCLUDED IN THE
STATE BUDGETS PROVIDING STATES WITH
BROADER COST CONTROL AUTHORITY
•
ELDERLY WOULD RECEIVE THE COMPREHENSIVE
BENEFIT PACKAGE PROVIDING MORE PROTECTION
THAN CURRENT MEDICARE PACKAGE
•
INTEGRATION ALLOWS FOR GAINS IN SIMPLIFYING
THE ADMINISTRATION OF THE HEALTH SYSTEM
AND REDUCING BURDENS ON PROVIDERS
�i
DECISIONS
MEDICARE INTEGRATION
•
I
(
OPTION 3:
FULL INTEGRATION (CONT)
CONS:
•
•
I
(
REQUIRES SEPARATE PREMIUM STRUCTURE WITHIN
THE ALLIANCE
•
.
REQUIRES SUBSTANTIAL ADDITIONAL FEDERAL
SPENDING TO UPGRADE MEDICARE BENEFITS
•
(
ELDERLY AND THEm ADVOCATES WILL SEE THIS AS
TAKING AWAY A CURRENT ENTITLEMENT AND
PU'ITING THE ELDERLY IN A NEW AND UNTRIED
SYSTEM
RAPID TRANSITION COULD DISRUPT CARE FOR THE
ELDERLY AND COMPLICATE EXISTING PROVIDER
RELATIONSHIPS
�(
DECISION 10
UNDOCUMENTED PERSONS
BACKGROUND
.•
HOW WILL CARE FOR UNDOCUMENTED PERSONS BE
FUNDED?
AS MANY AS 12 MILLION UNDOCUMENTED PERSONS RESIDE
IN THE UNITED STATES, HIGHLY CONCENTRATED IN A FEW
AREAS.
'
I
PUBLIC HOSPITALS, SELECT TEACHING HOSPITALS AND
COMMUNITY AND MIGRANT HEALTH CENTERS RECEIVE
COMPENSATION FOR THESE PERSONS THROUGH
UNCOMPENSATED CARE AND OTHER APPROPRIATED FUNDS.
UNDOCUMENTED PERSONS MAY CARRY COMMUNICABLE
DISEASES SUCH AS TUBERCULOSIS. WITHOUT A STABLE AND
ACCESSmLE CARE DELIVERY SYSTEM FOR THIS POPULATION,
THESE DISEASES MAY GO UNIDENTIFIED AND UNTREATED,
AND INCREASE THE RISK OF TRANSMISSION TO OTHERS.
WITHOUT FINANCIAL SUPPORT IN ONE FORM OR ANOTHER,
INSTITUTIONS TREATING UNDOCUMENTED PERSONS MAY NO
LONGER BE ABLE TO PROVIDE CARE, OR WILL HAVE
DIFFICULTY COMPETING ON THE BASIS OF PRICE..
�(
'
DECISION 10
. UNDOCUMENTED PERSONS
STATEMENT OF OPTIONS
OPTION 1:
OPTION 2:
INSTITUTIONS TREATING UNDOCUMENTED
PERSONS RECEIVE DEDICATED FUNDS
OPTION 3:
(
UNDOCUMENTED PERSONS ELIGmLE FOR THE
COMPREHENSIVE BENEFITS PACKAGE AND ALL
SUBSIDIES
NO EXPLICIT FUNDING FOR CARE
�(
DECISION 10
. UNDOCUMENTED PERSONS
(
'
OPTION 1:
NO COVERAGE DISTINCTION
NO COVERAGE DISTINCTION IS MADE AMONG AMERICAN
CITIZENS, LEGAL RESIDENTS AND UNDOCUMENTED
PERSONS. ALL WOULD BE ELIGIBLE FOR THE
COMPREHENSIVE BENEFITS PACKAGE AND ALL SUBSIDIES.
PROS:
•
•
(
ALLEVIATES UNCOMPENSATED CARE FOR
UNDOCUMENTED PERSONS
SIMPLIFIES ADMINISTRATION FOR PROVIDERS
CONS:
•
•
AMERICAN CITIZENS MAY PROTEST A BENEFIT
THEY FEEL TO BE UNFAIR
•
I
MAY ENCOURAGE ILLEGAL IMMIGRATION TO THE
UNITED STATES
FURTHER COMPLICATES ENFORCEMENT OF
IMMIGRATION LAWS
•
UIIPBIVD..EGED. ~11-18
�DECISION 10
UNDOCUMENTED PERSONS
(
OPTION 2:
DEDICATED FUNDS
UNDOCUMENTED PERSONS WOULD NOT BE ENROLLED IN
HEALTH PLANS. A DIRECT GRANT OR SET-ASIDE
ARRANGEMENTS WOULD BE PROVIDED TO SUPPORT
INSTITUTIONS WITH A DISPROPORTIONATE SHARE OF
UNDOCUMENTED PERSONS.
PROS:
•
ASSURES THAT FUNDS GO DIRECTLY TO THE
PROVIDERS THAT CARE FOR THIS POPULATION
CONS:
•
MAY ENCOURAGE ILLEGAL IMMIGRATION TO THE
UNITED STATES
•
AMERICAN CITIZENS MAY PROTEST A BENEFIT
THEY FEEL TO BE UNFAIR
�DECISION 10
UNDOCUMENTED PERSONS
t
OPTION 3:
NO EXPLICIT FUNDING
UNDOCUMENTED PERSONS WOULD CONTINUE TO RECEIVE
UNCOMPENSATED EMERGENT CARE OR PAY FOR OWN CARE
OUT-OF-POCKET AS UNDER CURRENT SYSTEM.
PROS:
•
NO VISIBLE PUBLIC FUNDS GOING TO
CONTROVERSIAL GROUP
CONS:
•
(
CONTINUES INCENTIVES FOR COST-SHIFTING
•
UNDULY BURDEN SOME PROVIDERS
•
UNDOCUMENTED PERSONS MAY NOT RECEIVE
NECESSARY TREATMENT
�DECISION 11
REPRODUcnNESER~CES
BACKGROUND
TO WHAT EXTENT ARE THE RANGE OF REPRODUCTIVE
HEALTH SER~CES DEFINED IN THE BENEFITS PACKAGE?
THE BENEFIT PACKAGE WILL COVER REPRODUCTIVE HEALTH
SERVICES, FOR EXAMPLE:
•
•
PRE-NATAL CARE
•
{._
PREGNANCY TESTING
LABOR AND DELIVERY
AT ISSUE IS WHETHER "REPRODUCTIVE HEALTH SERVICES"
INCLUDES ABORTION SERVICES.
COVERAGE OF ABORTION SERVICES COULD BE THE MOST
POLITICALLY DMSIVE ISSUE IN THE HEALTH REFORM
DEBATE.
•
WOMEN'S GROUPS AND OTHER PRO-CHOICE
ADVOCATES WANT ABORTION SERVICES CLEARLY
SPELLED OUT, NOT LEFT TO STATES OR HEALTH
PLANS TO DETERMINE
•
ANTI-ABORTION ADVOCATES WILL FIGHT EXPLICIT
COVERAGE OF ABORTIONS AND SEEK TO PROHmiT
THEM
�DECISION 11
. REPRODUCI'IVE SERVICES
BACKGROUND (CONT)
CURRENT COVERAGE FOR ABORTION VARIES:
•
MOST EUROPEAN COUNTRIES COVER ABORTIONS
UNDER CERTAIN CONDITIONS
•
MANY PRIVATE HEALTH PLANS AND HMOS IN THE
U.S. IMPLICITLY COVER ABORTION UNDER
"PREGNANCY-RELATED CARE" OR COVER THEM
SUBJECT TO "MEDICAL NECESSITY"
•
HAWAll'S COMPREHENSIVE HEALTH PLAN COVERS
ABORTION AS "CHILDBIRTH OR OTHER
TERMINATION OF PREGNANCY"
•
TEN STATES CURRENTLY RESTRICT COVERAGE OF
ABORTION IN PRIVATE PLANS, TWELVE STATES
ALLOW STATE-ONLY MEDICAID FUNDS TO PAY FOR
ABORTIONS FOR LOW-INCOME WOMEN
(
�DECISION 11
· REPRODUCTIVE SERVICES
STATEMENT OF OPTIONS
OPTION 1:
EXPLICITLY INCLUDE ABORTION SERVICES IN
BENEFITS PACKAGE, WITHOUT RESTRICTIONS
OPTION 2:
EXPLICITLY COVER ABORTION, BUT INCLUDE
RESTRICTIONS
OPTION 3:
COVER "REPRODUCTIVE HEALTH SERVICES",
LEAVING INTERPRETATION TO THE STATES
OPTION 4:
EXCLUDE ABORTION FROM THE
COMPREHENSIVE BENEFITS PACKAGE
�DECISION 11
REPRODUCTIVE SERVICES
(
OPTION 1:
EXPLICIT COVERAGE, NO RESTRICTIONS
PROS:
•
GUARANTEES ALL WOMEN FREEDOM OF
CHOICE
•
FREES STATES FROM PRO-CHOICE/PRO-LIFE
BATTLES AND PREEMPTS STATE LAWS
RESTRICTING ABORTIONS
•
COULD ENCOURAGE OVERUSE OR
INAPPROPRIATE USE
•
•
WILL MEET WITH SIGNIFICANT OPPOSITION
CONS:
(
(
MAKES HEALTH CARE BILL OR NATIONAL
BOARD FOCAL POINT FOR PRO-CHOICE/PROLIFE BATTLES
�DECISION 11
REPRODUCTIVE SERVICES
{
OPTION 2:
EXPLICIT COVERAGE, WI1'H
RESTRICTIONS
COVERAGE SUBJECT TO LIMITATIONS, SUCH AS "MEDICALLY
NECESSARY OR APPROPRIATE", PARENTAL CONSENT OR A
WAITING PERIOD.
PROS:
•
(
RESTRICTIONS BASED ON MEDICAL NEED ARE
CONSISTENT WITH CURRENT COVERAGE UNDER
MANY PRIVATE PLANS
CONS:
•
•
ABORTION COVERAGE AND AVAILABILITY OF
SERVICE COULD VARY BY STATE OR PLAN
·LITIGATION OR FEDERAL REGULATIONS COULD
. CLARIFY AND ACHIEVE NATIONAL UNIFORMITY
�(
DECISION 11
REPRODUCTIVE SERVICES
!
OPI'ION 3:
IMPLICIT COVERAGE, STATE
INTERPRETATION
FEDERAL LEGISLATION IS SILENT ON ABORTION SERVICES.
STATES OR PLANS DECIDE WHETHER TO COVER ABORTION.
PROS:
•
•
(
PERMITS STATE RESTRICTIONS SUCH AS PARENTAL
CONSENT OR WAITING PERIODS THAT ENJOY
. PUBLIC SUPPORT AND ARE CONSISTENT WITH PAST
POLICY
DEFERS A DIFFICULT POLITICAL DECISION TO THE
STATES
CONS:
•
THREATENS CONCEPT OF NATIONAL BENEFIT
.PACKAGE BY ESTABLISHING PRECEDENT FOR
STATES TO INTERPRET COMPONENTS DIFFERENTLY
•
COULD RESULT IN A "NO-WIN" SITUATION
PRO-CHOICE GROUPS ANGERED BY PERCEIVED
LACK OF PRESIDENTIAL LEADERSHIP ON
ABORTION RIGHTS
PROTRACTED CONGRESSIONAL DEBATE ON
ABORTION
•
COULD RESULT IN WIDELY VARIED ACCESS AND
SERVICES ACROSS STATES
�DECISION 11
REPRODUCTIVE SERVICES
I
OPTION 4:
EXCLUDE COVERAGE OF ABORTION ·
SERVICES
PROS:
•
ATI'EMPTS TO FOCUS DEBATE ON OVERALL HEALTH
REFORM, NOT ON ONE DMSIVE ISSUE
CONS:
•
RESTRICTS ACCESS TO ABORTION FOR ALL WOMEN,
PARTICULARLY POOR WOMEN
•
REDUCES BENEFITS FOR WOMEN FOR WHOM
ABORTION SERVICES ARE CURRENTLY COVERED
•
ANGERS PRO-CHOICE CONSTITUENCIES AND
CO:MPROMISES SUPPORT FOR PLAN
(
�I
(
DECISIONU
CAPS AND OTHER FEDERAL MALPRACTICE RULES
BACKGROUND
SHOULD FEDERAL GOVERNMENT CAP NON-ECONOMIC
DAMAGES AND IMPOSE OTHER UNIFORM RULES FOR
MEDICAL MALPRACTICE CLAIMS?
PHYSICIANS ARGUE THAT THE CURRENT TORT SYSTEM:
•
UNFAIRLY STIGMATIZES PHYSICIANS
•
INCREASES HEALTH COSTS BY STIMULATING
DEFENSIVE MEDICINE
CONSUMER ADVOCATES ARGUE:
•
SEVERELY INJURED PLAINTIFFS RECEIVE TOO
LITTLE COMPENSATION
•
THREAT OF MALPRACTICE SUITS DOES NOT
SIGNIFICANTLY INCREASE HEALTH COSTS
REFORM WILL IMPROVE SYSTEM FOR DISPUTE RESOLUTION:
•
•
UNDER "ENTERPRISE LIABILITY," PLANS, NOT
PHYSICIANS, FACE THREAT OF LIABILITY
•
(
PLANS WILL PROVIDE ALTERNATIVE DISPUTE
RESOLUTION MECHANISMS
UNIVERSAL COVERAGE OF CATASTROPHIC MEDICAL
EXPENSES MAY LIMIT SUITS SEEKING MEDICAL
EXPENSES
�(
DECISION 12
CAPS AND OTHER FEDERAL MALPRACTICE RULES
BACKGROUND (CONT)
.•
STATE EXPERIENCE WITH CAPS ON NON-ECONOMIC
DAMAGES:
APPROXIMATELY 28 STATES CURRENTLY ENFORCE LIMITS ON
TORT AWARDS, MOSTLY LIMITS ON NON-ECONOMIC
DAMAGES.
SOME STATE COURTS HAVE REJECTED LIMITS ON STATE
CONSTITUTIONAL GROUNDS.
LIMITS VARY WIDELY, FROM A $200,000 NON-ECONOMIC
DAMAGE CAP WITH NO INFLATION INDEX IN CALIFORNIA, TO
MUCH HIGHER CAPS WITH INFLATION INDEX IN OTHER
STATES.
STATE EXPERIENCE WITH OTHER TORT REFORMS:
TWO-THIRDS OF STATES HAVE PROHIBITION AGAINST
DOUBLE RECOVERY FROM COLLATERAL SOURCES.
TWO-THIRDS OF STATES HAVE ENACTED PERIODIC PAYMENT
RULES; SOME ARE MANDATORY, OTHERS VOLUNTARY.
ABOUT HALF OF STATES LIMIT CONTINGENCY FEES; SOME
HAVE SLIDING SCALE BASED ON AMOUNT OF AWARD;
OTHERS HAVE SINGLE UPPER LIMIT.
- - - - - - - - - -
�(
DECISION 12
.
CAPS AND OTHER FEDERAL MALPRACTICE RULES
STATEMENT OF OPTIONS
OPTION 1:
CAP NON-ECONOMIC DAMAGES AND IMPOSE
OTHER UNIFORM FEDERAL RULES
OPTION 2:
IMPOSE OTHER UNIFORM FEDERAL RULES
•
•
PERIODIC PAYMENTS OF LARGE AWARDS
•
OPTION 3:
PROHIBITIONS AGAINST DOUBLE
RECOVERY FROM COLLATERAL SOURCES
LIMITS ON CONTINGENCY FEES
NO TORT REFORM
-.
..
�DECISION 12
CAPS AND OTHER FEDERAL MALPRACTICE RULES
OPTION 1:
CAP NON-ECONOMIC DAMAGES AND
IMPOSE OTHER UNIFORM FEDERAL
RULES
A NATIONAL CAP ON NON-ECONOMIC DAMAGES COULD
OPERATE AS A FIXED CAP OR ON A SLIDING SCALE.
PROS:
•
PROVIDES NATIONAL CONSISTENCY
•
REDUCES OR LIMITS COST OF MALPRACTICE
PREMIUMS
•
WINS STRONG SUPPORT FROM PHYSICIANS
CONS:
•
REDUCES AWARDS TO THOSE MOST SEVERELY
.INJURED
•
LAWYERS MAY BE LESS WILLING TO TAKE
MERITORIOUS CASES
•
MAY RAISE CAP IN SOME STATES
•
TRIAL LAWYERS AND SOME CONSUMER GROUPS
WILL OPPOSE PROVISION
IN ADDITION, THE DISCUSSION OF OPTION 2 (ADDITIONAL
UNIFORM FEDERAL RULES) ALSO APPLIES HERE.
�DECISION 12
CAPS AND OTHER FEDERAL MALPRACTICE RULES
OPI'ION 2:
IMPOSE OTHER UNIFORM FEDERAL
RULES
PROHIBITIONS AGAINST DOUBLE RECOVERY FROM
COLLATERAL SOURCES
PROS:
•
REDUCE TOTAL AMOUNT OF AWARD BY
ELIMINATING COMPENSATION FOR AMOUNTS
ALREADY COVERED BY UNIVERSAL COVERAGE
CONS:
•
LEGAL FEES MAY CUT INTO RECOVERY FOR
ECONOMIC LOSS TO INJURED PLAINTIFFS
PERIODIC PAYMENTS OF LARGE AWARDS
PROS:
•
MAY REDUCE PAYOUTS OF LARGE DAMAGE AWARDS
•
MAY BE MORE EQUITABLE TO BOTH PARTIES
CONS:
•
IF DESIGNED TO REDUCE VALUE OF AWARDS, TRIAL
LAWYERS AND SOME CONSUMERS WILL OPPOSE
�DECISION 12
CAPS AND OTHER FEDERAL MALPRACTICE RULES
OPTION 2:
IMPOSE OTHER UNIFORM FEDERAL
RULES (CONT)
LIMITS ON CONTINGENCY FEES
PROS:
•
PROVIDES GREATER SHARE OF AWARD TO INJURED
PARTY
CONS:
•
REDUCES FINANCIAL INCENTIVES FOR LAWYERS TO
BRING MALPRACTICE CLAIMS, EVEN FOR
MERITORIOUS PLAINTIFFS
�DECISION 13
LONG-TERM CARE
(
BACKGROUND
.•
HOW MUCH SHOULD BE INVESTED IN LONG-TERM CARE?
THERE ARE. ABOUT 10 MILLION DISABLED PEOPLE LIVING IN
THE COMMUNITY AND ANOTHER 2 MILLION IN INSTITUTIONS.
PUBLIC ASSISTANCE FOR LONG-TERM CARE IS AVAILABLE
PRIMARILY THROUGH A MEANS-TESTED PROGRAM - MEDICAID.
MEDICAID PAYS DISPROPORTIONATELY FOR INSTITUTIONAL
CARE.
ELIGmiLITY FOR MEDICAID NURSING HOME COVERAGE
REQUIRES THAT PEOPLE EXHAUST MOST OF THEIR
PERSONAL SAVINGS AND ALMOST ALL THEIR MONTHLY
INCOME.
ALTHOUGH MEDICAID OFFERS LIMITED ACCESS TO HOME
. AND COMMUNITY-BASED CARE, THIS ACCESS IS HIGHLY
UNEVEN ACROSS STATES.
MEDICAID HAS DISCOURAGED FLEXIBILITY IN THE DESIGN
OF BENEFITS TO MEET THE NEEDS OF DIVERSE DISABLED
POPULATIONS.
DILEMMA IN DESIGNING SOLUTION:
•
LONG-TERM CARE ENTITLEMENT SENIORS AND
WORKING-AGED DISABLED WANT IS VERY COSTLY
•
GROUPS MAY OPPOSE HEALTH REFORM WITHOUT
SIGNIFICANT LONG-TERM CARE COMPONENT
�DECISION 13
LONG-TERM CARE
(
STATEMENT OF OPTIONS
OPTION 1:
OPTION 2:
FEDERAL HOME CARE PROGRAM FOR LOWINCOME SEVERELY DISABLED
OPTION 3:
FEDERAL SOCIAL INSURANCE FOR HOME CARE
FOR SEVERELY DISABLED, REGARDLESS OF
INCOME
OPTION 4:
(
MEDICAID REFORM THROUGH BLOCK GRANT
OR INCREMENTAL CHANGES TO HOME CARE
AND NURSING HOME SERVICES
FULL SOCIAL INSURANCE FOR HOME AND
NURSING HOME CARE, PHASED IN OVER TIME
�r
DECISION 13
LONG-TERM CARE
OPTION 1:
INCREMENTAL MEDICAID REFORM
REPLACE MEDICAID WITH:
•
A BLOCK GRANT FOR NURSING HOME AND HOME
CARE, WITH NO STRINGS ATrACHED; OR
•
CAPPED MATCHING GRANTS FOR HOME CARE, AND
INCREASED ASSET PROTECTION IN NURSING
HOMES
PROMOTE/REGULATE PRIVATE LONG-TERM CARE INSURANCE
•
TAX PREFERENCES
PROS:
BLOCK GRANTS AND CAPPED MATCHING GRANTS:
•
PROVIDES FLEXIBILITY TO PROMOTE HOME CARE
•
LIMIT FEDERAL LIABILITIES
INCREASED ASSET PROTECTION:
•
REDUCES IMPOVERISHMENT IN NURSING HOMES
CONS:
•
STRONG STATE OPPOSITION TO BLOCK GRANTS
UNLESS FUNDS ARE SIGNIFICANTLY EXPANDED
•
FUNDING LIMITS RESTRICT SERVICE
•
MAY BE SEEN AS PERPETUATION OF WELFARE
.•
�DECISION 13
LONG-TERM CARE
OPTION 2:
FEDERAL HOME CARE PROGRAM FOR
LOW-INCOME
REPLACE MEDICAID WITH FEDERAL HOME CARE PROGRAM
•
FEDERAL FUNDING FOR ALL SEVERELY DISABLED
WITH INCOMES BELOW 100% POVERTY
•
FEDERAL/STATE MATCHING PROGRAM FOR NEARPOOR, LESS SEVERELY DISABLED
TAX EXEMPTIONS TO OFFSET PERSONAL ASSISTANCE COSTS
FOR WORKING-AGE DISABLED
(
PROS:
•
•
FEDERAL FUNDING ESTABLISHES HOME CARE IN
ALL STATES AND FREES UP STATE RESOURCES FOR
OTHER PURPOSES
· TAX EXEMPTIONS ENABLE WORKING-AGED
DISABLED TO ENTER OR REMAIN IN THE WORK
FORCE
CONS:
•
INCOME-TESTED HOME CARE PERCEIVED BY
SENIORS AND DISABLED AS PROGRAM FOR THE
POOR
�DECISION 13
LONG-TERM CARE
OPTION 3:
SOCIAL INSURANCE HOME CARE FOR
ALL SEVERELY DISABLED
FEDERAL PROGRAM TO PROVIDE HOME AND COMMUNITYBASED CARE TO ALL SEVERELY DISABLED, WITHOUT REGARD
TO INCOME
LIMIT PER CAPITA SPENDING
FINANCE THROUGH TAXES AND PREMIUMS (SUBSIDIZED
BASED ON INCOME)
INCLUDE COST-SHARING, WITH INCOME-RELATED SLIDING
SCALE
(
PROS:
•
•
GUARANTEES HOME CARE IN ALL STATES
· OFFERS COMMITMENT SENIORS AND DISABLED ARE
SEEKING
CONS:
•
ESTABLISHES NEW ENTITLEMENT PROGRAM WITH
SUBSTANTIAL COSTS
•
DOES NOT PROTECT AGAINST NURSING HOME
COSTS
�DECISION 18
LONG-TERM CARE
(
OPTION 4:
FULL SOCIAL INSURANCE FOR HOME
AND NURSING HOME CARE, PHASED IN
OVERTIME
ESTABLISH SCHEDULE FOR IMPLEMENTING FULL SOCIAL
INSURANCE IN REFORM LEGISLATION (SEE EXAMPLE BELOW)
MAKE EXPANSIONS AUTOMATIC, ONLY IF NATIONAL BUDGET
IS MET
IF BUDGET NOT MET, SPECIFY THAT CONGRESS REVIEW AND
ADJUST SCHEDULE
PROS:
(
•
LEGISLATIVE CO:MMITMENT TO SOCIAL INSURANCE
MAY WIN SUPPORT FROM SENIOR AND DISABLED
GROUPS
CONS:
•
ESTABLISHES NEW ENTITLEMENT AT SIGNIFICANT
EXPENSE
THE FOLLOWING OFFERS ONE POSSIBLE PHASE-IN
SCHEDULE:
1994
I
.
ESTABLISH FEDERAL HOME CARE FOR
SEVERELY DISABLED POOR AND RAISE
NURSING HOME RESOURCE PROTECTIONS
(OPTION 2)
�:
DECISION 18
LONG-TERM CARE
OPTION 4:
FULL SOCIAL INSURANCE FOR HOME
AND NURSING HOME CARE, PHASED IN
OVER TIME (CONT)
1997
EXTEND HOME CARE PROGRAM TO INCOMES
UP TO 150% POVERTY
2000
EXTEND HOME CARE PROGRAM TO INCOMES
UP TO 200% POVERTY
COVER FIRST SIX MONTHS IN NURSING HOMES
FOR ALL SEVERELY DISABLED, WITHOUT
REGARD TO INCOME
(
2005
EXTEND HOME CARE PROGRAM TO INCOMES
UP TO 300% POVERTY
INCREASE NURSING HOME RESOURCE
PROTECTION FOR STAYS BEYOND SIX MONTHS
TO PROTECT FULL ASSETS OF AVERAGE
SENIOR
2010
PROVIDE FULL COVERAGE OF HOME CARE AND
NURSING HOME CARE WITHOUT REGARD TO
INCOME
(ELIGmiLITY BY DISABILITY LEVEL AND SCOPE OF HOME
CARE BENEFITS COULD ALSO BE MODIFIED OR PHASED IN
OVER THE PERIOD)
�(
DECISION 19
METHOD OF TRANSITION
/
STATEMENT OF OPTIONS
BY WHAT METHOD SHOULD THE TRANSITION TO 1'HE NEW
SYSTEM TAKE PLACE?
THE TRANSITION TO UNIVERSAL COVERAGE AND THE NEW
SYSTEM OF HEALTH ALLIANCES COULD PROCEED BY:
•
STATE
•
POPULATION GROUP
•
BENEFIT LEVEL
ALL OPTIONS ASSUME RAPID:
•
INSURANCE REFORM
•
ERISA REFORM
�DECISION 18
METHOD OF TRANSITION
OPTION 1:
PHASE-IN STATE-BY-STATE
A STATE-BY-STATE PHASE-IN SETS A TARGET DATE FOR
STATES TO INSTITUTE THE NEW SYSTEM FOR ALL ELIGIBLE
CONSUMERS AND ALLOWS STATES A GRACE PERIOD OF ONE .
OR MORE YEARS BEFORE ANY PENALTIES ARE IMPOSED.
STATES COULD RECEIVE SUBSIDIES TO ESTABLISH THE
HEALTH ALLIANCES FOR ALL ELIGIBLE CONSUMERS AND
EMPLOYERS AS OF TARGET DATE.
STATES WOULD BE ALLOWED ONE OR MORE YEARS BEFORE
THEY FACE PENALTIES FOR FAILING TO COMPLY.
THE TARGET DATE AND GRACE PERIOD COULD BE ADJUSTED
FOR A RAPID OR SLOW PHASE-IN.
PROS:
•
SETS A NATIONAL GOAL FOR UNIVERSAL ·
COVERAGE BUT PROVIDES STATES
FLEXIBILITY TO MOVE AT DIFFERENT
SPEEDS
•
FITS THE STATE-BASED STRUCTURE OF
THE ALLIANCES AND BUDGETING SYSTEM
•
STATES THAT IMPLEMENTED LATER .
COULD LEARN FROM THE EXPERIENCE OF
FASTER-MOVING STATES
CONS:
•
SOME STATES MAY HOLD BACK FOR FEAR
OF ATI'RACTING UNINSURED AND LOSING
JOBS TO OTHER STATES
�DECISION 18
METHOD OF TRANSmON
,OPTION 2:
PHASE-IN BY POPULATION
A PHASE-IN BY POPULATION GROUP WOULD
SIMULTANEOUSLY EXTEND COVERAGE IN ALL STATES TO
THE SAME GROUPS (FOR EXAMPLE, CHILDREN, EMPLOYEES
OF VARYING FIRM SIZES).
A POSSIBLE SCHEDULE WOULD:
•
START WITH CHILDREN
•
APPLY MANDATE TO LARGE, THEN SMALL, FIRMS
•
APPLY INDMDUAL MANDATE AND SUBSIDIES FOR
NONWORKERS
•
FOLD IN MEDICAID
PROS:
•
FAST IMPLEMENTATION, WHILE LIMITING
NEAR-TERM FEDERAL BUDGET COSTS
•
MANY UNINSURED GAIN COVERAGE BEFORE
STARTUP OF THE ALLIANCES
•
ADVANCES COVERAGE FOR LOWEST-COST
GROUPS THAT ARE EASIEST TO ABSORB
CONS:
•
DELAYS POOLED PURCHASING THAT
REMEDIES PROBLEMS IN THE SMALLGROUP AND INDMDUAL INSURANCE
�MARKETS
il
(
•
INEVITABLE TRANSITIONAL INEQUITIES
�DECISION 18
METHOD OF TBANSITION
OPTION 8:
PHASE-IN BY BENEFIT
ESTABLISH AN INITIAL BENEFIT WITH lnGHER COST
SHARING <UNSUBSIDIZED) AND PERHAPS FEWER BENEFITS
THAN ULTIMATELY DESIRED.
REDUCE COST SHARING AND EXPAND BENEFITS OVER TIME.
PBOS:
•
I .
•
(
PUTS STRUCTURE IN PLACE WHILE REDUCING
INITIAL COSTS FOR GOVERNMENT AND EMPLOYERS
PROVIDES SECURITY TO PEOPLE WHO LOSE
·coVERAGE
CONS:
•
(
DOES NOT OFFER MUCH TO PEOPLE WHO
MAY NOW HAVE BETTER BENEFITS
�··-;w
_, . .,. . . ,--.~..v··.~. ... ,,.u.vur r.·ul
I
I
I
G unwald, Eskew & Donilon
Fn Tra.osmissio.n
TO:
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DETER!\11~ED TO BE A~ AD:\11~1STRATI\'E
MARKI~G Per E.O. 12958 as amended, Sec. 3.3 (c)
MEMORANDUM
Initials: 4 C$
Date:
oY {~ /1 I
-€cnftdential
TO
President Clinton
FROM
The Political Team
DATE
July 26. 1993
RR
]'be Politics ofllcaltb C11rc 1224 and 1996
-~----·----~--------··---·----~---p·--------~---------~---------·-----·----·-----------
We have been asked to sunumuizc the political implications of action on health care for the 1994
and 1996 elections. We do this with the finn belief that action should be taken this fall on all
three issues cUITently being considered: health care, reinventing government end NAI•TA.
Howev~r, we bclicvo that primacy should be given to health care in tenns ofthe President's public
schedule and in the timing of its 'launch'.
1994 Midterm EIQCtio.ns
Democrats ttn: in difficult shape for the 1994 midterms. There is uncertainty about the health of
the economy by 1994 and in the rate of job creation by then. Further, because of the scaling back
of investments in the economic plan, we leav~ Democrats with a more limited Appeal than we had
hoped for middle elA~s voters.
Right now, the debate would shape up as a RepublicAn "tax and spend" attack versus a
Democratic "action and fairness" argument". Although Democrats will be able to take pride in
reducing the deficit, reversing trickle-down economic!!!, wtd stimulating growth. the cc.onomic
realities of 1994 may undP.rmine that case. Let us be clear: we could lose the Senate in 1994 or
finish with an unworkably narrow majority.
D~ocrats need
a middle class benefit to run on in 12,24.
Hca1U1 care is the n'lo§t compellinQ cboice.
If the Health Security .t'lan is lntrodu\.ied as soon os Consrcss rcturnq from the August recess,
passage ;~ J'Kl~Sible next spring. This will allow Democrats to run on health care in 1994. They
will be able to tell their constituents. particularly the key battlegrowu.l vf middle class voters, that
they have pu."'scd a bill thut will ensure ihat no American will ever again lose their health care.
Further, as we understand the plan, they will be able to say that in the phase-in period before 1996
or 1997 when Americans receive their hadth security o11rds, no American who ha.~ insurance will
lose it, and thnt there will be a cap on the growth of premiwns and on the cost of prescription
drugs. Those are ralbenefits that directly affect millions of people.
I
• V 1:..
�We have seen repeatedly in Stan's rcsc:urch that this is a critical priority for middle class
Americ.an!ll, includin2 Perot voters. It is an economic issue for them·· one of the key reasons for
the sense of economic anxiety and insecurity that still permeates the counlry.
Not only is passage of health care reforrn important to the party a.'t a whole for 1994, there are
specific vulnerable Senators who would be d~;c:ply helped by the passage ofhealth care or
dcvustatingly hurt hy failure to reach passage. Harris Wofford obviously leads this list, but it
includes Diane Feinstein, Ted Kennedy, Don Riegle, Frank Lautenberg and Denni~ DeConcini.
There are also open, formerly Democratic, scats in Tennessee and Ohio where health care could
play a decisive role
If health CIU'e is delaye.d at nll, the prospects for passage diminish. The notion of this debate
occurring dW'iDi the 1994 elections is simply impossible.
One final note about the alchemy between health care reform and NAI•'TA. If we pass NAFTA, jt
will be with relatively few Democrats. Indeed, many Democml~ currently sec NAFTA as an
oppuatunity to demonstrate distance fTom the President and to demagogue about NAFTA as a job
killer and an as.'tauh on the middle cla.c;s. No matter how powerful our arguments about NAFTA
as a job creator, individual Democrats,particulN"Iy on a resional basiALJ>on Rieale et al.l will feel
u politica1 need to attack it. They will be delighted to stand with Ross Perot on this issue. The
combination of uncertainty about the economic plan's benefit to the midc.lle cla~s and NAFTA's
benefit to th~ middle closs could hurt both nemocrats and the President's image.
By contrast, a full scale push tbr health car~ r~form fiW, will allow the President and th~ party to
regain their roles as champions of the middle class, fighting spe<:ial interests to deliver for real
people. That public fight wiJt not only help pass health care, we believe it wm b"Jp pass
NAI'TA.
1996 Elections
Obviously, the President's reelection will tum largely on the health ot"the economy by 1996. But
it will also tum on the quesliuu of whether he has delivered on his promises, particularly his
broadest commitment of keeping taith with those who work hard and pJay by the rules. The
middle class. A number ofissucs will demonstrate that commitment. Ccrt.ninly, the success of
his \.."Cvnomic pJnn and the pafls:agP. of tough welfare reform. Rut the refonn of the health care
system will also be crucial -- not just because he was specific about this promise, but because it
directly affects the lives of more people tlutn virtually any othet" issue he will dca1 with in these
four years.
The Presidcut spoke spcoifically about a lnt of issues in the campaign. Keeping the promise of
reforming the health care system, we feel, is critical to reelection in 1996. It is not just proofthat
this president did something real for the mi~~le class, jt is proof of le.adership and the end of
gridlock.
�·---
I
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.
I
HEALTH CARE
THAT'S ALWAYS THERE
A FIFTEEN MINUTE VIDEO PRESENTATION
OF THE CLINTON HEALTH SECURITI PIAN
�PURPOSE
This program is designed as a primer on the Clinton Health Security
Plan for Members of Congress, Democratic Party activists, community
groups, and anyone else who needs to understand it or to explain it to
others. Although it will be of broadcast quality, it is not intended to be
a stand alone TV program for the general public.
OVERYIBW
I imagine this piece as a fifteen minute, inspirational, educational
piece. It needs to communicate the urgency and humanity of the
health care issue and at the same time clearly and calmly explain how
the Clinton Health Security Plan will address the problem of a system
out of control.
As such, I feel the tone of the piece should be human and emotional
rather than newsy. I see us relying on real people to communicate the
dimensions of the problem and on the President to explain the
solutions.
In order to identify people to talk to in the program, we might look to
the thousanq.s of letters the White House has received or the many
people Hillary Clinton has met around the country who have shared
their fears and concern·s about the state of our health care system.
STRUCTURE
As I understand it, we have several distinct elements to communicate
in our program.
1. The problem: The system is out of control, costs are skyrocketing
and meanwhile, people live in fear of losing access to health care.
-1-
�2. The vision:
This plan reflects a commitment on the part of the
President to take on the special interests who
have kept us from reforming the health care
system to give Americans real security that they
will always have health care.
3. The solution:
A. The Clinton Health Security Plan will bring the
system under control
B. It will provide security to every American
that their health care will always be there no
matter what.
C. We w111 pay for the plan through controlling
costs, and through asking every American -employers, consumers, cveryonem -- to take
responsibility for his/her health care.
I have chosen to divide the plan into three sections to reflect what I
see as distinct themes:
* How we will fiX the system
* How the system will work for you
* Ilow we will pay for health care
SecUon 1: Introduction: A System Out of Control
What we say: The introduction must carry the message that, as it
stands, our health care system no longer makes sense. Health care
costs are out of control, having quadrupled since 1980. And they are
rising at a rate that \vill have the cost of care to American families
doubling by the end of the decade.
-2-
�Meanwhile, everyone lives in fear of losing their coverage, and every
month, 2 million people do. If we do nothing, one in four Americans
will lose their health insurance in the next two years.
In short, everything that is wrong with our health care system is
threatening everything that is right about American health care. We
must ftx the system-- preserving the things people care about: the
right to choose their own doctor and the ability to get high-quality,
affordable care.
What we see; Here we need to communicate the seriousness and
immediacy of problem in an evocative way. I imagine a montage of
"health care" images: doctors in hospital rooms, people in clinic waiting
rooms, nurses filling out reams of forms, a crowded urban emergency
room, probably all slowed down and in black and white. Not scary, but
urgent. Over these, we will hear the voices of Americans telling us of
their fears and concerns about the health care system:
Man's voice: "I've been stuck in my job for 10 years because I'm
afraid that if I leave, I'll lose my health insurance.''
· · Woman's voice: "I work for a small company and they don't cover me
and my little girl. If we get sick, I don't know what I'll do."
Man's voice: "I've run a diner for fifteen years and I'd love to get
insurance for the folks who work for me, but I just can't afford it."
Woman's voice: ''I became a doctor to help people. Now I spend half my
time just filling out forms."
-3-
�You get the idea. These people must be real, they must be
expressingtheir concerns, and we must be able to relate to them. I
would intersperse the visual images we're seeing with factoids
(graphically represented on the screen) about the general state of the
health care system so as to broaden these individual experiences to
illustrate the big picture.
This section might even want music. I see it lasting about 3 minutes.
Section 2: The Vision behind the nlan
What we say; Here the President needs to tell us where this plan is
coming from. Something like, "For decades, we have watched our
health care system become bloated and inefficient- costing more and
more, yet leaving Americans without the security of knowing that
when they need health care, it will be available to them. And for
decades special interests have protected their profits and blocked
efforts to meaningfully reform the system. But no more . "
He should then elucidate the principals on which this plan is based:
*Security: A plan that let's people know that they can never lose
their health care coverage.
*Savings: A plan that will control the skyrocketing costs.
*Simplicity: A plan that will close the loopholes and reduce the
bureaucracy that are bringing the system to its knees.
*Responsibility: A plan that asks every American to take
resoonsibllity for reforming the system so that once again, it will work
for us instead of against us.
-4-
�What we see: This should be the President speaking directly to us,
probably in a setting somewhat less formal than behind his desk in
the Oval Office.
Section 3: Getting the system under control
What we
sav: In today's health care system costs are out of control,
and we are awash in a sea of bureaucracy, red tapet waste,
inefficiency and fraud.
The Clinton plan will get the system under control by:
* slashing
the red tape that forces doctors and patients to spend
their time filling out forms and fighting bureaucrats,
* cracking down on fraud by imposing and enforcing stiff penalties
on anyone who takes kickbacks, files fraudulent claims, or in any way
abuses the system for profit.
* reforming malpractice to eliminate "defensive medicine" (doctors
.·ordering extra tests or procedures just to protect themselves from
malpractice suits) that hurts the quality of care while driving up the
cost
* controlling costs by stopping overcharging by doctors and
hospitals, and limiting drug prices that are three times higher here
than they are overseas.
-5-
�What we see: I see this section starting with a montage, not unlike
the introduction, but \vith people on the screen, not just in voice over.
Again, these should be real people (lay people, health care
professionals, maybe lawyers) in interview settings, telling personal
stories that specifically relate to the things that are wrong with the
system.
We will hear a patient describing the ordeal of trying to get
reimbursed for an operation only to be told, after filling out
mountains of papetwork and countless phone calls, that the insurance
company was not going to pay. Or a doctor talking about ordering a
whole. battery of expensive tests on a patient not because she felt
they were necessary for the health of the patient, but because she
feared a lawsuit if she didn't.
As in the introduction, I see this montage as visually stylized,
interspersed with images that relate to the stories we are hearing,
and possibly graphic "facts" relating the individual story to the larger
problems with the health rare system. This segment lasts about one
and a half minutes.
Then the President will respond by describing the way in which the
stories we've just heard relate to the larger issues at stake and how
the Health Security Plan will address them.
The President's explanations should, I think, be helped out with
graphics. Not Perot-type charts, but highly produced, animated
graphics to which we would cut away during his explanations. This
section should run about 5 minutes.
-6-
�Sectlon 4: Protecting the best and proyiding securit¥
What we sav: The Clinton plan protects and· expands access to highquality health care for an Americans. Without reform, one out of four
people will lose their r.overage in the next two years. This plan ¥till give
every American the security of knowing that they can never lose
their health care coverage, no matter what. How does this work?
Well, under the Clinton plan:
* Everyone
gets a health security card which nobody can ever
take away. It guarantees them access to a comprehensive benefits
package that is at least as good as most Fortune 500 companies
currently offer their employees. And that goes for everyone,
whether they are employed or not, whether they work for a huge
company or a small business. Everyone!
* People stay healthier because, unlike most current insurance
plans, the Clinton plan emphasizes preventive rare by providing
coverage for a wide range of preventive services.
* People have increased options for long-term care. The Clinton
plan makes it possible for more elderly and disabled Americans to stay
in their homes while receiving care rather than being forced into
nursing homes.
* Insurers won't be able to hurt small businesses and
consumers the way they can now because under the Clinton plan, it
will be illegal for them to drop people for any reason. The plan will
close the loopholes that permit insurers to deny coverage because of
preexisting conditions. They won't be able to cancel your insurance if
you lose your job. And they won't be able to ·charge small businesses
and individuals double what they charge big business.
-7--
�* The consumer will be in the driver's seat when it comes to
dealing with insurance companies. Having small businesses and
consumers band together in health alliances will level the playing field
and gtve them the same bargaining power as big businesses.
What we see; As in section 3, I see this section starting with a
montage of stori.es and images, this time relating specifically to issues
of security. A man who has been without health insurance for three
years and is scared death of ever getting really sick. A woman who
couldn't afford to go to the doctor for routine checkups because her
insurance didn't cover them, and only finally went when she
developed a serious illness that required hospitalization which was
covered by her insurance. Or a small business owner whose
insurance premiums were tripled because one of her employees got
sick and racked up some high medical bills.
.Again, the President will respond to these stories by describing, with
the help of graphics on the screen, how the Health Security Plan will
give us the security that these people, and so many of the rest of us,
crave, but have never had.
This section should take about 5 minutes.
Section 5: How we're going to pay for this
It seems to me that there is only one way to tell this story and that's
for Bill Clinton to tell it, directly to camera. probably aided by
graphics. This section should be no more than 3 minutes long and
should consist of "nothing but the facts." Here's how we're going to
finance the system, and here's what you will be responsible for.
-8-
�We'll get costs under control through:
A reductions in administrative costs,
B. savings in Medicare and Medicaid, and
C. possibly a cigarette tax to fund
long-term care for the elderly and disabled.
And every American will be responsible for participating in the
system:
*
If you are a self-employed individual, it will cost you this much.
*
If you are employed by a company that currently provides
insurance, here's what they'll pay, here's what you'll pay.
*
If you have a small-business that hasn't been able to afford to
provide health insurance for your employees, here's how you'll
be able to and here's what it'll cost. Etc., etc.
Obviously we will need real numbers to make this section work.
We will, I believe, also want to let people know that their costs are
likely to be the same or lower than they are now, and that their
coverage is likely to be the same or better than it is now.
-9-
�fw
'
I
-
Conclusion
Here, the President should make some brief concluding remarks. He
should restate the purpose of the plan, rally the viewers to the
difficult fight we have before us, warn people that the opponents of
change will try to thwart this effort but that we cannot, under any
circumstances let them prevail, and that people must speak out and
let their views be known in order for this plan to succeed.
Following this, I think it would most effective for us to hear how some
people feel about the plan. I'm thinking of very brief testimonial
quotes from a doctor, a health care economist, a small business owner,
etc. This section should, I think, be run with music and last no more
than 2 minutes.
-10-
�
Dublin Core
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Title
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Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
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White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
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1993
Identifier
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2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
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72 files in 6 boxes
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Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
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William J. Clinton Presidential Library & Museum
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<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
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Envelope of Misc Documents (Health Care Reform) [1]
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First Lady's Office
First Lady's Press Office
Neel Latimore
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2006-0223-F
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Box 2
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2058152" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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1/8/2015
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42-t-2058152-20060223F-002-002-2015
2058152
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https://clinton.presidentiallibraries.us/files/original/fc2b4010fad8de1c6b8f1604ddb168d0.pdf
3c3a43d6d4ea241cbc66bd7a0f1c7513
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
First Lady's Office
Series/Staff Member:
First Lady's Press Office
Subseries:
Neel Lattimore
OA/ID Number:
7022
FolderiD:
Folder Title:
HRC- Court Ruling Health Care Task Force
Stack:
Row:
Section:
Shelf:
Position:
s
60
1
9
1
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•
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Notice: This opinion is subject to fonnal revision before publication in
the Federal Reporter or U.S.App.D.C. Reports. Users are requested to
notify the Clerk of any fonnal errors in order that corrections may be made
before the bound volumes go to press.
iantttb
~tatts
ClCourt of apptals
FOR THE DISTRICT OF COLUMBIA CIRCUIT
Argued April 30, 1993
Decided June 22, 1993
No. 93-5086
AsSOCIATION OF AMERICAN PHYSICIANS
AND SURGEONS, !NC., ET AL.,
APPELLEES
v.
HILLARY RODHAM CLINTON, ET AL .•
APPELLANTS
No. 93-5092
AsSOCIATION OF AMERICAN PHYSICIANS
AND SURGEONS, INC., ET AL.,
APPELLANTS
v.
HILLARY RODHAM CLINTON. ET AL.,
APPELLEES
Bills of costs must be tiled within 1-l days after entry of judgment.
The court looks with disfavor upon motions to file bills of costs out
of time.
�2
Appeals from the United States District Court
for the District of Columbia
(93cv0399)
Mark B. Stem, Attorney, U.S. Department of Justice,
argued the cause for appellants/cross-appellees Hillary Rodham Clinton, et al. With him on the briefs were J. Ramsey
Johmon, United States Attorney, Stuart E. Schiffer, Acting
Assistant Attorney General, Robert E. Kopp, Patricia A
Millett, and Malcolm L. Stewart, Attorneys, U.S. Department
of Justice. Stuart M. Gerson, Attorney, U.S. Department of
Justice, entered an appearance for appellants/cross-appellees.
Kent Masterson Brown argued the cause for appellees/cross-appellants Association of American Physicians and
Surgeons, Inc., et al. With him on the briefs were Frank M.
Northam and Alan P. Dye.
Steven R. Ross, General Counsel, and Charles Tiefer, Deputy General Counsel, Office of General Counsel, United
States House of Representatives, nled the brief for amicus
curiae Speaker and Bipartisan Leadership Group.
Ronald A Zumbrun, Anthony T. Caso, and Robin L.
Rivett rlled the brief for amici curiae Pacific Legal Foundation and the National Taxpayers Union.
Jane E. Kirtley, J. Laurent Scharff, James E. Grossberg,
Richard M. Schmidt, Jr., Allan R. Adler, Bruce W. Sanford,
HenryS. Hoberman, and Whitney M. Adams nled the brief
for amici curiae Reporters Committee for Freedom of the
Press, et al.
Joseph Gregory Sidak filed the brief for amicus curiae J.
Gregory Sidak.
Samuel B. Wallace, W, filed the brief for amicus curiae
Samuel B. Wallace, IV.
�3
Before:
Judges.
SILBERMAN, BucKLEY, and WILLIAMS, Circuit
Opinion for the Court filed by Circuit Judge SILBERMAN.
Opinion concurring in the judgment filed by Circuit Judge
BUCKLEY.
SILBERMAN, Circuit Judge: This expedited appeal presents
the question whether the President's Task Force on National
Health Care Reform (''Task Force") and its working group
are advisory committees for purposes of the Federal Advisory
Committee Act ("FACA"). If they are, we are asked to
decide whether F ACA unconstitutionally encroaches on the
President's Article II executive powers. We hold that the
Task Force is not an advisory group subject to F ACA, but
remand to the district court for further proceedings to determine the status of the working group.
I.
On January 25, 1993, President Clinton established the
President's Task Force on National Health Care Reform.
The President named his wife, Hillary Rodham Clinton, as
the chairman of the Task Force, and appointed as its other
members the Secretaries of the Treasury, Defense, Veterans
Affairs, Health and Human Services, Labor, and Commerce
Departments, the Director of the Office of Management and
Budget, the chairman of the Council of Economic Advisers,
and three White House advisers. President Clinton charged
this body with the task of "listen[ing] to all parties" and then
"prepar[ing] health care reform legislation to be submitted to
Congress within 100 days of our taking office." 29 WEEKLY
CoMP. PRES. Doc. 96 (Feb. 1, 1993).
On the same day, the President also announced the formation of an interdepartmental working group. According to
the government, the working group was responsible for gathering information and developing various options on health
care reform. It was composed of three tYJ>es of members: (i)
approximately 300 permanent federal government employees
drawn from the Executive Office of the President, the federal
-
_ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ j
�4
agencies, and Congress; (ii) about 40 "special government
employees" hired by the agencies and the Executive Office of
the President for a limited duration; and (iii) an unknown
number of "consultants" who, it is asserted, "attend working
group meetings on an intermittent basis." Ira Magaziner,
the senior adviser to the President for Policy Development,
headed the working group and was the only member of the
Task Force who attended the group's meetings.
According to the government, the working group had no
contact with the President. In addition to gathering information, the working group developed alternative health care
policies for use by the Task Force. But only the Task Force,
it was contemplated, would directly advise and present recommendations to the President. On March 29, 1993, the
Task Force held one public hearing where interested parties
could present comments on health care reform. See 58 Fed.
Reg. 16,264 (1993). However, the Task Force met behind
closed doors at least 20 times in April and May to "formulate"
and "deliberate" on its advice to the President. As the
government publicly has announced, in those meetings "the
Task Force reviewed materials it received from the interdepartmental working group; formulated proposals and options
for health care reform; and presented those proposals and
options to the President." Statement of the White House
Press Secretary (June 4, 1993). In accordance with its
charter, the Task Force then terminated its operations on
May 30. 1 All of the working group's meetings remained
closed to the public.
Appellees are the Association of American Physicians and
Surgeons, which represents physicians; the American Council
for Health Care Reform, which represents health care consumers; and the National Legal & Policy Center, which seeks
to promote ethics in government. They sought access to the
1 The
Task Force's "tennination" does not render this case moot.
AiJ both parties, in anticipation of this event, agreed before oral
argument, this case still presents a live controversy concerning the
availability of Task Force and working group documents, which the
appellees sought below pursuant to F ACA.
�5
Task Force's meetings under the Federal Advisory Committee Act. Pub. L. No. 92-463, 86 Stat. 770 (1972) (reproduced
at 5 U.S.C. App. 1 (1988)). Their efforts were rebuffed by
the Counsel to the President, who informed them that the
Task Force was not an advisory committee subject to FACA.
Appellees thereupon brought suit against the Task Force in
district court. They claimed that the Task Force was a
F ACA committee because it was chaired by Mrs. Clinton, a
private citizen, and that the Task Force had violated F ACA
by failing to file an advisory committee charter. They further asserted that F ACA permitted them to attend all of the
meetings of the Task Force and of any of its subgroups.
Appellees sought a temporary restraining order and a preliminary injunction halting the operation of the Task Force until
it complied with F ACA and allowed the public to attend its
meetings. The government responded that the Task Force
was exempt from F ACA because all of its members-including Mrs. Clinton-were government officers and employees.
The government alternatively challenged any application of
FACA to the Task Force as an unconstitutional infringement
on the President's executive power.
In a memorandum opinion issued on .March 10, 1993, the
district court granted in part appellees' motion for a preliminary injunction. The court determined that appellees had a
substantial likelihood of success on the merits. Mrs. Clinton,
the court held, was not an officer or employee of the federal
government merely by virtue of her status as "First Lady."
Therefore, the Task Force could not qualify for an exemption
from F ACA as an advisory group composed solely of "fulltime officers or employees" of the government. See Association of Am. Physicians & Surgeons v. Hillary Rodham
Clinton, Civil Action No. 93-0399, Mem. Op. at 16-17 (D.D.C.
March 10, 1993) ("Mem. Op."); see also 5 U.S.C. App. 1
§ 3(2)(iii). The court, however, agreed with the government
that F ACA encroached on the President's constitutional authority to receive confidential advice for the purpose of
recommending legislation. But the court thought that executive prerogatives were implicated only when the Task Force
�6
was advising the President, not when it engaged in information-gathering. The district court accordingly granted a preliminary injunction requiring the Task Force to meet all the
requirements of F ACA except when it met to formulate
advice or recommendations for the President.
As to the working group, the district court concluded that
appellees had failed to state a claim under FED. R. C1v. P.
12(b)(6) that the subordinate body was covered by FACA.
Relying on National Anti-Hunger Coalition v. Executive
Committee, 557 F. Supp. 524 (D.D.C.), aff'd, 711 F .2d 1071
(D.C. Cir. 1983), the court held that the working group was
not an advisory committee because it was engaged in factgathering and did not provide advice directly to the President. The court denied appellees motion for expedited discovery concerning the actions and status of the working
group, but nevertheless determined that there were no issues
of material fact and that it could have dismissed on summary
judgment grounds as well. Mem. Op. at 15 n.ll.
The government filed this appeal on March 22, 1993. Appellees subsequently filed a cross-appeal. We have jurisdiction to review a grant of a preliminary injunction under 28
U.S.C. § 1292(a), and we expedited the appeal due to the
short time frame within which the Task Force and the
working group operated.
II.
The government, as appellant and cross-appellee, and the
plaintiffs below, as appellees and cross-appellants, together
challenge much of the district court's ruling. The government takes issue primarily with the court's determination that
Mrs. Clinton is not an "officer or employee" for purposes of
section 3(2) of F ACA. It is claimed that as the "First Lady,"
Mrs. Clinton is the functional equivalent of a government
officer or employee, that the Task Force, therefore, is composed solely of full-time government officials-indeed officers
drawn from among the President's closest official advisersand that thus the Task Force is exempt from F ACA. In the
alternative, the government reiterates its claim that F ACA
�7
cannot be applied constitutionally to the Task Force. We are
urged, in that regard, to discard the distinction drawn by the
district court between the information-gathering function of
the Task Force and its role in advising the President. As
would be expected, the government is content with the district court's ruling concerning the status of the working
group, and it argues that the district court's dismissal of
appellees' claim is an unappealable interlocutory order.
Appellees, on the other hand, support t~e district court's
determination that F ACA covers the Task Force because
Mrs. Clinton is not an officer or employee of the federal
government. However, they challenge the court's ruling as
to the status of the working group, which they contend is also
covered by F ACA. They further maintain that applying
F ACA to either body raises no serious constitutional issues,
and, in any event, that the district court prematurely decided
the constitutional issue. Appellees also contend that the
court should have permitted discovery, which would have
shown more clearly the F ACA status of both groups, and that
a straightforward application of F ACA's procedural requirements would not curtail the President's constitutional powers.
We first consider the status of the Task Force and then
turn to the working group issues.
III.
Congress passed F ACA in 1972 to control the growth and
operation of the "numerous committees, boards, commissions,
councils, and similar groups which have been established to
advise officers and agencies in the executive branch of the
Federal Government." 5 U.S.C. App. 1, § 2(a). As Congress
put it, F ACA's purpose was: to eliminate unnecessary advisory committees; to limit the formation of new committees to
the minimum number necessary; to keep the function of the
commit~es advisory in nature; to hold the committees to
uniform standards and procedures; and to keep Congress
and the public informed of their activities. See id. § 2(b)(1)(6). The statute orders agency heads to promulgate guide-
�8
.
lines and regulations to govern the administration and operations of advisory committees. See id. § 8.
FACA places a number of restrictions on the advisory
committees themselves. Before it can meet or take any
action, a committee first must rue a detailed charter, see id.
§ 9(c). The committee must give advance notice in the
Federal Register of any meetings, see id. § 10(a)(2); and it
must hold all meetings in public, see id. § lO(a)(l). Under
. section 10, the committee must keep detailed minutes of each
meeting, see id. § lO(c), and make the records availablealong with any reports, records, or other documents used by
the committee-to the public, provided they do not fall within
the exemptions of the Freedom of Information Act (FOIA),
see id. § lO(b). Under section 5, an advisory committee
established by the President or by legislation must be "fairly
balanced in terms of the points of view represented," id.
§ 5(b)(2).2 The Act also requires that precautions be taken to
ensure that the advice and recommendations of the committee
''will not be inappropriately influeRced by the appointing
authority or by any special interest." ld. § 5(b)(3).
The Act's definition of an "advisory'' committee is· apparently rather sweeping. Section 3 sta~s:
The term "advisory committee" means any committee,
board, commission, council, conference, panel, task force,
or other similar group, or any subcommittee or other
subgroup thereof (hereinafter in this paragraph referred
to as "committee"), which is . . . (B) established or
utilized by the President . . . in the interest of obtaining
advice or recommendations for the President or one or
more agencies or officers of the Federal Government.
I d. § 3(2). The government does not contend that the Task
Force was not "established" or "utilized" by the President in
2
F ACA's "balanced viewpoint" requirement may not be justiciable, however, because it does not provide a standard that is susceptible of judicial application. See Public Citizen v. National Advisory Comm., 885 F.2d 419, 426 (D.C. Cir. 1989) (Silberman, J.,
concurring).
�9
the interest of obtaining advice or recommendations.
FACA's definition contains one important proviso, however.
Section 3(2)(iii) exempts "any committee which is composed
wholly of full-time officers or employees of the Federal
Government." And, according to the government, the Task
Force was not only wholly composed of government officers,
it was actually (like the Task Force we encountered in Meyer
v. Bush., 981 F.2d 1288 (D.C. Cir. 1993)) a partial, yet
somewhat augmented, cabinet grouping. Thus, subjecting
the Task Force to F ACA would fall outside Congress' purpose of regulating the growth and use of committees composed of outsiders called in to advise government officials.
Appellees would have no quarrel with the government's characterization of the Task Force, except for the description of
its chairman, Mrs. Clinton. Appellees contend that she is not
an officer or employee of the federal government despite her
traditional and ceremonial status as "First Lady." This is not
just a technicality according to appellees; she is statutorily
barred from appointment as an officer because of the AntiNepotism Act. See 5 U.S.C. § 3110(b).
The district court, finding no definition of officer or employee of the federal government in F ACA itself, quite reasonably
turned to Title 6 of the U.S. Code to find a definition. See 5
U.S.C. §§ 2104 & 2105. An officer or employee according to
those sections must be: (i) appointed to the civil service; (ii)
engaged in the performance of a federal function; and (iii)
subject to supervision by a higher elected or appointed official. As the district court held, and as appellees correctly
point out, Mrs. Clinton has not been appointed to the civil
service. Reading these definitions in pari materia with
F ACA would seem to suggest that the Task Force is not
exempt.
Nevertheless, it is true, as the government insists, that
Congress did not adopt explicitly all of Title 5's definitions in
FACA. FACA is not part of Title 5, which was enacted six
years before FACA's passage, see Pub. L. No. 89-554, 80
Stat. 378 (1966), but, instead is only temporarily housed there
as an appendix. Typically, when Congress wishes to add a
statute to Title 5, it amends the Title. See, e.g., Government
�10
in the Sunshine Act, § 3(a), Pub. L. No. 92-409, 90 Stat. 1241
(1976); Privacy Act of 1974, Pub. L. No. 93-579, 88 Stat. 1896
(1974). It did not do so when it passed F ACA, but at that
time it specifically did adopt certain Title 5 defmitions. For
example, adjacent to the defmition of an advisory committee
is F ACA's definition of an agency, which incorporates the
definition in Title 5: " 'agency' has the same meaning as in
section 551(1) of title 5, United States Code." 5 U.S.C. App.
1, § 3(3). But Congress actually deleted from the Senate
version of F ACA defmitions of "officer'' and "employee" that
paralleled those of sections 2104 and 2105. See H.R. REP. No.
1403, 92d Cong., 2d Sess. (1972), reprinted in 1972 U.S. ConE
CoNG. & ADMIN. NEws 3508, 3509. And the Code contains
another definition of a federal officer which tends to support
the government's position. Title 1 provides that a federal
officer "includes any person authorized by law to perform the
duties of the office." 1 U.S.C. § 1. That definition could
cover a situation in which Congress authorizes someone who
is not formally an officer (such as the President's spouse) to
perform federal duties. Even if, as our concurring colleague
argues, Mrs. Clinton does not occupy an "office" specifically
created by Congress, she could still be regarded as an
"employee."
The government would have us conclude that the traditional, if informal, status and "duties" of the President's wife as
"First Lady'' gives her de facto officer or employee status.
The government invokes what it describes as "a longstanding
tradition of public service" by First Ladies-including, we are
told, Sarah Polk, Edith Wilson, Eleanor Roosevelt, Rosalynn
Carter, and Nancy Reagan-who have acted (albeit in the
background) as advisers and personal representatives of their
husbands. We are not confident that this traditional perception of the President's wife, as a virtual extension of her
husband, is widely held today. As this very case suggests, it
may not even be a fair portrayal of Mrs. Clinton, who
certainly is performing more openly than is typical of a First
Lady. Indeed, in the future we may see a male presidential
�11
spouse, which could make the term "First Lady" anachronistic.
More persuasive, however, is the government's argument
that Congress itself has recognized that the President's
spouse acts as the functional equivalent of an assistant to the
President. The legislative authorization to the President to
pay his White House aides includes the following provision:
Assistance and services authorized pursuant to this section to the President are authorized to be provided to the
spouse of the President in connection with assistance
provided by such spouse to the President in the ·discharge of the President's duties and responsibilities. If
the President does not have a spouse, such assistance
and services may be provided for such purposes to a
member of the President's family whom the President
designates.
3 U.S.C. § 105(e) (emphasis added). Of course, even without
section 105(e), the President presumably could draw upon his
spouse for assistance. The statute's importance, rather, lies
in its assistance in helping us interpret the ambiguous terms
of F ACA in pari materia.
It may well be, as appellees argue, that many in Congress
had in mind "ceremonial duties," but we do not think the
presidency can be so easily divided between its substantive
political and ceremonial functions. In any event, section
105(e) neither limits the particular kind of "assistance" rendered to the President, nor circumscribes the types of presidential duties and responsibilities that are to be aided. We
see no reason why a President could not use his or her spouse
to carry out a task that the President might delegate to one
of his White House aides. It is reasonable, therefore, to
construe section 105(e) as treating the presidential spouse as
a de facto officer or employee. Otherwise, if the President's
spouse routinely attended, and participated in, cabinet meetings, he or she would convert an all-government group,
established or used by the President, into a F ACA advisory
committee.
Pursuant to this section, morrover, the President's spouse
is supported by a substantial staff who are undeniably fulltime government officers or empioyees. Therefore, the Pres-
�12
ident could have-as the government points out-easily designated Mrs. Clinton's chief of staff as a member of the Task
Force, perhaps even as the chairman, who would then be
expected to report to Mrs. Clinton. It would seem quite
anomalous to conclude that F ACA would apply if the President's spouse were a member of the committee, but not if her
chief of staff were the actual member.
The President's implicit authority to enlist his spouse in aid
,[ the discharge of his federal duties also undermines appellees' claim that treating the President's spouse as an officer
or employee would violate the anti-nepotism provisions of 5
U.S.C. § 3110. That section prohibits any "public official"
from appointing or employing a relative, such as a spouse, "in
the agency in which he is serving or over which he exercises
jurisdiction or control." lei § 3110(b). Although section
3110(a)(l)(B) defines agency as "an executive agency," we
doubt that Congress intended to include the White House or
the Executive Office of the President. Cf. Franklin v. Massachusetts, 112 "S. Ct. 2767, 2775 (1992) (holding that President is not "agency" for purposes of Administrative Procedure Act); Meyer, 981 F.2d at 1298 (President's advisers are
not "agency'' under FOIA); Armstrong v. Bush, 924 F.2d
282, 289 (D.C. Cir. 1991) (President not'APA "agency"). So,
for example, a President would be barred from appointing his
brother as Attorney General, but perhaps not as a White
House special assistant. Be that as it may, it is not reasonable to interpret that provision to bring it into conflict with
Congress' recognition of (and apparent authorization for) the
President's delegation of duties to his spouse. The antinepotism statute, moreover, may well bar appointment only to
paid positions in government. See 5 U.S.C. § 3110(c). Thus,
even if it would prevent the President from putting his spouse
on the federal payroll, it does not preclude his spouse from
aiding the President in the performance of his duties.
In sum, the government musters a strong argument in
support of its interpretation of "full-time officer or employee"
under F ACA as including the President's spouse-whether or
not a "First Lady." But it is by no means overwhelming.
Indeed, the government is uncomfortable at having to choose
�13
whether Mrs. Clinton should be thought of as an officer or
employee. The government's discomfort is quite understandable. ·Mrs. Clinton has not in any sense been appointed or
elected to office, and, assuming she is an officer under Title 1,
due to the duties delegated to her under 3 U.S.C. § 105(e),
how, one might ask, could she be removed? All officers and
employees of the United States, except the Vice President,
can be removed, at least for cause, through the ultimate
authority of the President. We suppose the President could
withdraw any or all authority delegated to his spouse, but
then he would be left without the official assistance of any
family member. The very provision authorizing the delegation to the spouse provides for a delegation to another
member of the President's family only "[i]f the President does
not have a spouse." 3 U.S.C. § 105(e) (emphasis added).
That language seems to present the President with rather
extreme alternatives.
What is more, section 105(e) would seem to apply whether
or not the President's spouse held another job that an officer
or employee of the government could not possibly hold.
Suppose, for instance, that the President's spouse was counsel
to a major law firm and spent a good portion of his or her
time practicing law. Presumably, the spouse would still be
authorized to provide assistance to the President under section 105(e) and would, thereby, also be an officer or employee
of the government. The government suggests that this hypothetical does not create a problem under F ACA, because a
spouse in that situation, whether or not an officer or employee, would not be full-time and so would not qualify for the
exemption. But that answer may be too facile. How would
we determine how much or what kind of outside activity was
inconsistent with full-time status?
Suffice it to say that the question whether Mrs. Clinton's
membership on the Task Force triggers FACA is not an easy
one.3 The government argues. therefore, that we should
3 It
is not clear how F ACA applies if only one member of an
advisory committee is not a full-time government officer or employee. How does the government carry out its obligation to ensure
�14
construe the statute not to apply here, because otherwise we
would face a serious constitutional issue. The Supreme Court
has noted many times that ''where an otherwise acceptable
construction of a statute would raise serious constitutional
problems, the Court will construe the statute to avoid such
problems unless such construction is plainly contrary to the
intent of Congress." Public Citizen v. Department of Justice, 491 U.S. 440, 466 (1989) (quoting Edward J. DeBartolo
Corp. v. Florida Gulf Coast Building & Construction Trades
Counci~ 485 U.S. 568, 575 (1988)). Only a few years ago the
Court employed that very maxim of statutory construction to
avoid applying F ACA to the ABA committee that advised the
Attorney General on the qualifications of prospective federal
judicial nominees. See id. The government there argued
that applying F ACA would impair the effectiveness of the
committee's deliberations (by exposing them to public examination), and thus would interfere with the advice that the
committee provided to the Attorney General and ultimately, it
was assumed, to the President. Such interference would
encroach on the President's appointment power-his sole
responsibility to nominate federal judges.4 In order to escape that constitutional question, the Court held that the
ABA committee was not "utUized" by the President because it
was established and run by a private organization, even
though the Act covers advisory committees established or
utilized by the executive branch. See id. at 455--65. The
Court adopted, we think it is fair to say, an extremely
strained construction of the word "utilized" in order to avoid
the constitutional question. The gravity of the constitutional
that the committee is "fairly'' balanced in terms of the points of
view represented?
4
Ironically, the ABA committee's role in advising administrations
as to the qualifications of putative judges has over the years become
more of an impediment (reflecting certain ABA institutional and,
perhaps, political interests) than an aid to Presidents. R. Marcus &
S. Torry, ABA Judicial Evaluation Again Under Fire, WASH. PoST,
May 7, 1989, A6; M. Thornton, The ABA's J'U.d4ments on J'U.d4es,
WASH. PosT, Sept. 25, 1987, A23.
�15
issue was revealed by the three concurring justices who were
unable to accept the Court's statutory construction and believed that F ACA was unconstitutional as applied to the ABA
committee. ld. at 467-89 (Kennedy, J., concurring).
It is, of course, necessary before considering the maxim of
statutory construction to determine whether the government's constitutional argument in this case is a powerful one.
In other words, are we truly faced, as the Court thought it
was in Public Citizen, with a grave question of constitutional
law? The government relies primarily on the claim that an
explicit presidential power is implicated. Article II of the
Constitution provides that the President "shall from time to
time give to the Congress Information of the State of the
Union, and recommend to their Consideration such Measures
as he shall judge necessary and expedient." U.S. CoNST. art.
II, § 3, cl.l. According to the government, this clause gives
the President the sole discretion to decide what measures to
propose to Congress, and it leaves no room for congressional
interference. To exercise this power, the government claims,
the President also must have the constitutional right to
receive confidential advice on proposed legislation.
Under the government's theory, F ACA would interfere
with the President's unbounded discretion to propose legislation. President Clinton formed the Task Force specifically to
recommend legislation dealing with health care reform.
F ACA's requirement of public meetings would inhibit both
candid discussion· within the Task Force and its presentation
of advice to the President. Challenging the district court's
ruling, the government argues that this encroachment occurs
regardless of whether the Task Force is engaged in information-gathering or internal deliberation. In either situation,
the glare of publicity would inhibit the free flow of frank
advice and would handicap the President's ability to develop
legislation.
Appellees point out that the cnncurring opinion in Public
Citizen commanded the votes of only three justices and rely,
�16
instead, on the Court's opinion in Morrison v. Olson, 487 U.S.
654 (1988).6 Morrison upheld the Ethics in Government
Act's creation of an independent counsel because it did not
prevent the President "from accomplishing (his] constitutionally assigned functions," id. at 695 (quoting Nixon v. Administrator of General Services, 433 U.S. 425, 443 (1977)), even
though the counsel was largely immune from the executive
branch's operational control (she was appointed by a panel of
judges and was removable only for good cause). Applying
F ACA to the Task Force, according to appellees, has a rather
minor impact on the institution of the presidency compared to
the much greater encroachment on the President's core executive function sanctioned in Morrison.
Nevertheless, the government maintains that Morrison is
not directly on point. Picking up on Justice Kennedy's
concurrence in Public Citizen, the government contends that
the Morrison Court's imprecise balancing test, which is apparently less favorable to the President, does not apply when
a textual grant of presidential authority is implicated. In
distinguishing Morrison, Justice Kennedy said:
Thus, for example, the relevant aspect of our decision in
Morrison involved the President's power to remove Executive Officers, a power we had recognized is not conferred by any explicit provision of the text of the Constitution (as is the appointment power) but rather is inferred to be a necessary part of the grant of the "Executive Power."
Public Citizen, 491 U.S. at 484 (Kennedy, J., concurring). 6
But because Public Citizen involved the President's textually
5
Justice Kennedy, who was recused in Morrison, was joined by
Chief Justice Rehnquist and Justice O'Connor in Public Citizen.
Justice Scalia, who dissented in Morrison, was, in turn, recused in
Public Citizen.
6 But
see Bowsher v. Synar. 478 U.S. 714, 721-27 (1986) (removal
power more important than appointment power in controlling subordinate officials).
�17
granted power to appoint federal judges, the concurrence
would have struck F ACA down:
Where a power has been committed to a particular
Branch of the Government in the text of the Constitution,
the balance already has been struck by the Constitution
itself.
Id. at 486. The government argues that here, as in Public
Citizen, but unlike in Morris on, we have an explicit textual
delegation to the President to propose legislation.
We perceive several weaknesses in the government's position. First, the government ignores the Morrison Court's
consideration of the President's Article II, section 3 responsibility to "take Care that the Laws be faithfully executed."
See Morrison, 487 U.S. at 692-93. The Court specifically
recognized that the statute before it encroached upon or
burdened that responsibility, but concluded that the burden
was not great enough to be unconstitutional.
This is not a case in which the power to remove an
executive official has been completely stripped from the
President, thus providing no means for the President to
ensure the "faithful execution" of the laws. . . . We do
not think this limitation as it presently stands sufficiently deprives the President of control over the independent
counsel to interfere impermissibly with his constitutional
obligations to ensure the faithful execution of the laws.
Id. (emphasis added) (footnote omitted). Morrison v. Olson,
thus, cannot be easily disposed of in accordance with the
government's (and Justice Kennedy's) suggested distinction.
The President's constitutional duty to take care that the
laws be faithfully executed, moreover, seems far greater in
importance than his authority to recommend legislation. The
Framers intended the Take Care Clause to be an afrlrmative
duty on. the President and the President alone. In contrast,
the Recommendation Clause is le~s an obligation than a right.
The President has the undisputed authority to recommend
legislation, but he need not exercise that authority with
L ____________
!
�18
respect to any particular subject or, for that matter, any
subject. 7 Only the President can ensure that the laws be
faithfully executed, but anyone in the country can propose
legislation.
The government's focus on the Recommendation Clause
seems somewhat artificial. Discussions on policy-whether
they take place in executive branch groups or in pure FACA
advisory committees-to some extent always implicate proposed legislation. Whenever an executive branch group considers policy initiatives, it discusses interchangeably new legislation, executive orders, or other administrative directives.
Thus, virtually anytime an advisory group meets to discuss a
problem, it will implicate the Recommendation Clause, from
which all executive branch authority to recommend legislation
derives. Accordingly, if the application of F ACA to groups
advising the President or anyone else in the executive branch
were constitutionally problematic, insofar as those groups
were advising on proposed legislation, F ACA would be problematic with regard to virtually all policy advice. Under
that reasoning F ACA would be constitutionally suspect on its
face-an argument the government declined to make.
We do think that the government's alternative, albeit implicit, argument is more persuasive. Application of FACA to
7 To
be sure, during the Constitutional Convention in Philadelphia, the Framers changed the language of the clause from "may
recommend" to "shall recommend." AJ; James Madison recorded in
his notes· of the convention for August 24, 1787:
On motion of Mr. Govr Morris, "he may" was struck out, &
"and" inserted before "recommend" in the clause 2d. sect 2d
art: X in order to make it the duty of the President to
recommend, & thence prevent umbrage or cavil at his doing it.
J.
MADISON, NOTES OF DEBATES IN THE FEDERAL CONVENTION OF 1787,
464 (G. Hunt & J. Scott, eds. 1987). Gouverneur Morris' amendment suggests that the clause was intended to squelch any congressional objections to the President's right to recommend legislationhence the prevention of "u:nbrage or cavil." See J. Sidak, The
Recommendation Clause, 77 GEo. L.J. 2079, 2082 (1989).
�19
th~
Task Force clearly would interfere with the President's
capacity to solicit direct advice on any subject related to his
duties from a group of private citizens, separate from or
together with his closest governmental associates. That advice might be sought on a broad range of issues in an
informal or formal fashion. Presidents have created advisory
groups composed of private citizens (sometimes in conjunction
with government officials) to meet periodically and advise
them (hence the phrase "kitchen cabinets") on matters such
as the conduct of a war.8 Presidents have even created
formal "cabinet committees" composed in part of private
citizens. 9 This case is no different. Here, the President has
formed a committee of his closest advisers-cabinet secretaries, White House advisers, and his wife-to advise him on
a domestic issue he considers of the utmost priority.
8
For example, President Johnson often sought advice from Clark
Clifford and Justice Fortas, "two old and trusted friends from
outside the Executive Branch," along with government officials on
matters concerning the Vietnam War. See, e.g., L. JoHNSON. THE
VANTAGE POINT: PERSPECTIVES OF THE PRESIDENCY 1963-1969 at 23~
37 (1971)
9 President
Ford, in 1975, convened a "cabinet committee" composed of the Secretary of State, the Secretary of Commerce, the
Secretary of Labor, the President of the AFL-CIO, and the President of the Chamber of Commerce to formulate the government's
policy toward the International Labor Organization. President
Carter continued the same body. See, e.g., Committee Fails to
Agree on U.S. /LO Membership, WASH. PoST, Oct. 13, 1977, A24.
Neither President apparently acknowledged F ACA's application.
See, e.g., GENERAL SERVICES ADMINISTRATION, FEDERAL ADVISORY
COMMITTEES: FOURTH ANNUAL REPORT OF THE PRESIDENT COVERING
CALENDAR YEAR 1975 at 54-55 (1976) (no mention of ILO committee
in list of presidential advisory committees); see also GENERAL
SERVICES ADMINISTRATION. FEDERAL ADVISORY COMMITTEES: FIFTH
ANNUAL REPORT OF THE PRESIDENT CO\'ERING CALENDAR YEAR 1976 at
55-56 (1977) (same). In 1980, however, President Carter continued
that structure, but explicitly recognized F ACA's coverage (after the
issue that gave rise to the committee-whether the United States
should withdraw from the ILO-had been resolved). See Exec.
Order No. 12,216, 45 Fed. Reg. 41.619 (1980).
�20
Applying F ACA to the Task Force does not raise constitutional problems simply because the Task Force is involved in
proposing legislation. Instead, difficulties arise because of
the Task Force's operational proximity to the President himself-that is, because the Task Force provides advice and
· recommendations directly to the President. The Supreme
Court has recognized that a President has a great need to
receive advice confidentially:
[There is a] valid need for protection of communications
between high Government officials and those who advise
and assist them in the performance of their manifold
duties; the importance of this confidentiality is too plain
to require further discussion. Human experience teaches that those who expect public dissemination of their
remarks may well temper candor with a concern for
appearances and for their own interests to the detriment
of the decisionmaking process. Whatever the nature of
the privilege of confidentiality of Presidential communications in the exercise of Art. II powers, the privilege can
be said to derive from the supremacy of each branch
within its own assigned area of constitutional duties.
United States v. Nixon, 418 U.S. 683, 705-06 (1974) (footnotes
omitted); see also Nixon v. Administrator of Gen. Servs., 433
U.S. 425, 441-49 (1977). Nixon v. Administrator of General
Services further explains that the President is entitled to
confidentiality in the performance of his "responsibilities" and
"his office," and " 'in the process of shaping policies and
making decisions."' 433 U.S. at 449 (quoting United States
v. Nixon, 418 U.S. at 708). Article II not only gives the
President the ability to consult with his advisers confidentially, but also, as a corollary, it gives him the flexibility to
organize his advisers and seek advice from them as he wishes.
In Meyer v. Bush., 981 F.2d at 1293-97, for example, we held
that the President could create a Task Force composed of
cabinet secretaries and other close advisers to study regulatory reform without having to comply with FOIA. In this
regard, F ACA's requirement that an advisory committee
must be "fairly balanced in terms of the view represented"
�21
would-if enforceable and applied to groups of presidential
advisers-restrict the President's ability to seek advice from
whom and in the fashion he chooses.
The ability to discuss matters confidentially is surely an
important condition to the exercise of executive power. Without it, the President's performance of any of his dutiestextually explicit or implicit in Article II's grant of executive
power-would be made more difficult. In designing the
Constitution, the Framers vested the executive power in one
man for the very reason that he might maintain secrecy in
executive operations. As Alexander Hamilton wrote in the
Federalist Papers:
Decision, activity, secrecy, and dispatch will generally
characterise [sic] the proceedings of one man, in a much
more eminent degree, than the proceedings of any greater number; and in proportion as the number is increased, these qualities will be diminished.
THE FEDERALIST No. 70, at 472 (J. Cooke, ed., 1961) (emphasis
added). The Framers thus understood that secrecy was
related to the executive's ability to decide and to act quickly-a quality lacking in the government established by the
Articles of Confederation. If a President cannot deliberate in
confidence, it is hard to imagine how he can decide and act
quickly.
This Article II right to confidential communications attaches not only to direct communications with the President,
but also to discussions between his senior advisers. Certainly
Department Secretaries and White House aides must be able
to hold confidential meetings to discuss advice they secretly
will render to the President. Congress, in another context,
has recognized that the President's right to confidential communications extends to meetings between his top advisers.
For example, FOIA, 5 U.S.C. § 552, exempts "the President's
immediate personal staff or units in the Executive Office
whose sole function is to advise and assist the President."
See Kissinger v. Reporters Com m.. for Freedom of the Press,
445 U.S. 136, 156 (1980) (quoting H.R. REP. No. 1380, 93d
�22
Cong., 2d Sess. 14 (1974)); Meyer v. Bush, 981 F.2d at 129192.
A statute interfering with a President's ability to seek
advice directly from private citizens as a group, intermixed,
or not, with government officials, therefore raises Article II
concerns. This is all the more so when the sole ground for
asserting that the statute applies is that the President's own
spouse, a member of the Task Force, is not a government
official. For if the President seeks advice from those closest
to him, whether in or out of government, the President's
spouse, typically, would be regarded as among those closest
advisers.
As we have indicated, we do not place much significance on
the government's claim that this sort of interference is qualitatively, in constitutional terms, more troublesome insofar as
it relates to advice the President seeks concerning the exercise of an enumerated power. If we were to go on to decide
the constitutionality question, we· would be obliged to ask
whether, in Morrison v. Olson terms, this asserted application of F ACA "impermissibly" burdens executive power.
Morrison tells us to balance how much the interference with
the President's executive power prevents the President "from
accomplishing his constitutionally assigned functions," Momson, 487 U.S. at 695, against the "overriding need to promote
objectives within the constitutional authority of Congress."
Nixon v. Administrator of Gen. Servs., 433 U.S. at 443. We
readily confess that this balancing test is not one that, as
judges, we can apply with confidence. This is all the more
reason to view the constitutional issue soberly. We are
satisfied that tht! application of F ACA to the Task Force
seriously burdens executive power. And our reading of Morrison does not lead us easily to a conclusion that the burden
placed is a permissible one.
The court below correctly recognized the constitutional
difficulties that F ACA's application to the Task Force created. The court, therefore. ruled the Act partially unconstitutional, insofar as it was applied to the meetings in which the
Task Force actually advised the President. When the Task
�23
Force was engaged in "information-gathering and information-reporting," however, the court thought that the President's constitutional interests were not so seriously implicated.
We believe it is the Task Force's operational proximity to
the President, and not its exact function at any given moment, that implicates executive powers and therefore forces
consideration of the Morrison test. The President's confidentiality interest is strong regardless of the particular role
the Task Force is playing on any given day. Indeed, the two
functions naturally interrelate and can only be divided artificially. If public disclosure of the real information-gathering
process is required, the confidentiality of the advice-giving
funetion inevitably would be compromised. If you know what
information people seek, you can usually determine why they
seek it. A group directly reporting and advising the President must have confidentiality at each stage in the formulation of advice to him. As we said in Meyer, "[p]roximity to
the President, in the sense of continuing interaction, is surely
in part what Congress had in mind when it exempted [from
FOIA] the President's 'immediate personal staff.'" 981 F.2d
at 1293 (citation omitted). And, as we recognized in Soucie v.
David, 448 F.2d 1067 (D.C. Cir. 1971), FOIA's exemption may
be constitutionally required to protect' the President's executive powers. In any event, the district judge decided to
truncate the statute in light of constitutional concerns only
because it determined that F ACA applied to the Task Force.
We think the district court should have acted otherwise.
Prudent use of the maxim of statutory construction allows us
to avoid the difficult constitutional issue posed by this case.
The question whether the President's spouse is "a full-time
officer or employee" of the government is close enough for us
properly to construe F ACA not to apply to the Task Force
merely because Mrs. Clinton is a member. We follow the
Supreme Court's lead, if not its strict precedent, in recognizing that [if the Act] were "[r]ead unqualifiedly, it would
extend F ACA's requirements to any group of two or more
persons, or at least any formal organization, from which the
President or an executive agency seeks advice." Public
Citize~ 491 U.S. at 452 (footnote omitted). Because it be-
�24
lieved that Congress could not have intended such a result,
the Public Citizen majority read "utilize" to exclude the ABA
committee. If the Supreme Court correctly construed the
statute not to cover the advice the Attorney General receives,
on behalf of the President, from the ABA, the statutory
construction issue we face should be resolved a fortiori in
favor of the government.
We, therefore, read the phrase "full-time officer or employee of the government" in F ACA to apply to Mrs. Clinton.
In doing so, we express no view as to her status under any
other statute. 10
IV.
The district court, having concluded that the Task Force
was a F ACA advisory committee, dismissed under Rule
12(b)(6) appellees' claim that the working group was also
covered by F ACA. The court thought that under National
Anti-Hunger Coalition v. Executive Committee, 557 F. Supp.
524 (D.D.C.), a.ff'd, 711 F.2d 1071 (D.C. Cir. 1983) ("AntiHunger"),. subgroups of a F ACA committee should be regarded as staff of the advisory committee and not as advisory
committees themselves. See Anti-Hunger, 557 F. Supp. at
529. Based on Mr. Magaziner's affidavit, the district court
determined that the working group merely gathered information to be passed on to the Task Force. Appellees crossappeal the district court's ruling and its corollary refusal to
permit further discovery into the status and operations of the
working group.
.
The government challenges our jurisdiction to consider the
cross-appeal because the district court's rulings on the working group are neither independent final judgments, nor covered by the preliminary injunction against the Task Force
which is before us on an interlocutory appeal pursuant to 28
IO We do not need to consider whether Mrs. Clinton's presence on
the Task Force violates the Hatch Act, 5 U.S.C. § 7324(a), the
Anti-Deficiency Act, 31 C.S.C. § 1342, or any conflict of interest
statutes.
�25
U.S.C. § 1292(a). We have said that our jurisdiction over an
interlocutory appeal, however, is considerably broader:
[R]eview quite properly extends to all matters inextricably bound up with the remedial decision . . . . [T]he
scope of review may extend further to allow disposition
of all matters appropriately raised by the record, including entry of fmal judgment. Jurisdiction of the interlocutory appeal is in large measure jurisdiction to deal with
all aspects of the case that have been sufficiently illuminated to enable decision by the court of appeals without
further trial court development.
Wagner v. Taylor, 836 F.2d 578, 585 (D.C. Cir. 1987) (emphasis added) (quoting Energy Action Educational Found. v.
Andrus, 654 F.2d 735, 745 n. 54 (D.C. Cir. 1980), rev'd on
other grounds, 454 U.S. 151 (1981)); see also 16 C. WRIGHT. A.
MILLER. E. CooPER & E. GRESSMAN. FEDERAL PRACTICE &
PROCEDURE § 3921, at 17-20 (1977). The "district court's final
disposition of the claim against the working group was
"bound up" with its reasons for granting the injunction
against the Task Force. Once it is determined that the Task
Force is not covered by F ACA, the implicit ·analytical premises of the district court's decision as to the working group are
removed. Moreover, had the district court determined, as
have we, that the claim against the Task Force was invalid
and then also dismissed the claim against the working group,
the latter unquestionably would be appealable as well. Under these circumstances, we think it is appropriate to consider the cross-appeal. 11
11 The lower court dismissed appellees' claim under Rule 12(b)(6)
because it found that appellees had failed to state a claim upon
which relief could be granted. Mem. Op. at 15. It also noted that
it could have dismissed appellees' claims under FED. R. CIV. P. 56,
because appellees had failed to state that further discovery was
necessary before summary judgment could be granted. !d. at 15
n.ll. AS we will discuss, the legal ba.;;is for the Rule 12(b)(6) ruling,
or a Rule 56 ruling, was incorrect. furthermore, contrary to the
district court's decision, Rule 56 does not require a party to state in
its discovery motion that discovery is necessary before a court may
�26
As it argued below, the government claims that the working group is not in contact with the President and is not,
therefore, "utilized" by him. That seems to us a strange
argument. There are two exceptions to FACA's inclusion of
all presidential advisory groups: (i) where the advisory committee is independently established and operated by a private
organization, see Public Citiz~ 491 U.S. at 457-09; and (ii)
where the group is composed wholly of full-time government
officials. See 5 U.S.C. App. 1, § 3(2)(iii). We have construed
the second exception here to extend to a cabinet committee
that includes the First Lady. The government now presses
upon us a third exception, one for advisory committees that
do not meet face-to-face with the President. The government's argument, however, conflicts with the serious constitutional concerns we have recognized concerning the Task
Force. The statute cannot be properly interpreted as applying only to those advisory committees, established in the
Executive Office of the President, that present the most
delicate constitutional problems. 12 Otherwise, the government's argument effectively would render almost all presidential advisory committees free froln FACA. Committees in
direct contact with the President implicate the President's
executive power and hence cannot be covered by FACA,
while committees not directly in contact are not "utilized." In
rule on summary judgment. Indeed, a party's filing of a discovery
motion would seem implicitly to assert just that. But under Rule
12(b)(6), once the Magaziner affidavit was filed and considered the
district judge was obliged to pennit reasonable discovery as to the
facts set forth in the affidavit. See First Chicago Inn v. United
Exchange Co., 836 F.2d 1375, 1380 (D.C. Cir. 1988).
12 The
government, only at oral argument, and rather tentatively,
suggested that application of F ACA to any advisory groups established and utilized by the President, because they advise someone in
the Executive Office of the President, raises constitutional problems. We do not think we should entertain a constitutional argument of such enonnous signiricance made in so glancing a fashion.
After all, it could be thought :o come close to an argument that the
government disavowed-that FACA is unconstitutional on its face.
�•
27
any event, the statutory language does not remotely support
the government. Not only does FACA define an advisory
committee as a task force or "any subcommittee or other
subgroup thereof," 5 U.S.C. App. 1, § 3(2), but it also specifies that an advisory committee is a group that is either
established or utilized by the President. See id. Certainly
the President can establish an advisory group that he does
not meet with face-to-face. In Public Citizen the Court did
not suggest that F ACA could be avoided merely because the
ABA committee communicated with the Justice Department
rather than with the President.
The district court accepted a variation of the government's
argument by concluding that the working group was not
really a subgroup of the Task Force within the meaning of
FACA, but rather only staff to the Task Force. The court
relied, as we noted, on the Anti-Hunger case, in which we
affirmed Judge Gesell's decision to similarly treat subordinate
working groups operating under the Executive Committee of
the Private Sector Survey. Although we affirmed the decision, we did not explicitly approve the judge's reasoning
relating to the supposed staff groups; rather, we rejected an
effort to challenge his decision based on new information not
in the record. See National Anti-Hunger Coalition v. Executive Committee, 711 F.2d 1071, 1075 (D.C. Cir. 1983). In
any event, Anti-Hunger presented crucially different facts.
That case involved the Executive Committee of the Private
Sector Survey, formed by President Reagan to obtain management and cost control advice from the private sector. The
Executive Committee, composed of 150 private citizens, had a
subcommittee composed of 30 members and also had 36 task
forces that performed the preliminary work of the survey.
Anti-Hunger, 557 F. Supp. at 525-26. The government
conceded, in that litigation, that the Executive Committee and
the subcommittee were both F .\CA committees and it was
only thereafter that the district court determined that the
task forces were not F ACA committees, but staff.
Our conclusion that the Task f' orce is a committee wholly
composed of government officiuis makes this case entirely
different. In contrast to the situation here, in Anti-Hunger
�28
the top levels of the outside advisory groups were covered by
F ACA-both the executive committee of 150 and the subcommittee of 30. In that scenario, there is less reason to focus on
subordinate advisers or consultants who are presumably under the control of the superior groups. It is the superior
groups, after all, that will give the advice to the government,
and which, in accordance with the statute, must be "reasonably'' balanced. But when the Task Force itself is considered
part of the government-due to the government officials
exemption-we must consider more closely F ACA's relevance
to the working group. For it is the working group now that
is the point of contact between the public and the government. The district court's conclusion that the working group
could be disregarded as staff depended on its determination
that the Task Force was covered by F ACA. Our disagreement with :he district court on the latter issue therefore
compels a different analysis of the working group's status.
Alternatively, the government argues that the working
group is not, as a matter of law, a F ACA advisory committee
because it is not expected to offer consensus advice. In
making this argument, the government relies on a regulation
issued by the General Services Administration:
The following are examples of advisory meetings or
groups not covered by the Act or this subpart;
(i)
Any meeting initiated by a Federal official(s) with more
than one individual for the purpose of obtaining the
advice of individual attendees and not for the purpose of
utilizing the group to obtain consensus advice or recommendations. However, agencies should be aware that
such a group would be covered by the Act when an
agency accepts the group's deliberations as a source of
consensus advice or recommendations.
41 C.F.R. § 101-6.1004(i) (1992).
As we have so often noted, we do not defer to an agency's
construction of a statute interpreted by more than one agency, see, e.g., FLRA vo Department of Treasury, 884 F.2d 1446,
1451 (D.C. Cir. 1989). let alone one applicable to all agencies,
0
0
0
see Reporters Comm. for Freedom of the Press v. Department
�•
29
of Justice, 816 F .2d 730, 734 (D.C. Cir. 1987), rev'd on other
grounds, 489 U.S. 749 (1989). Nevertheless, we think the
government's regulation expresses a concept similar to one
that we find embedded in the statute. It is not so much that
a group is not a F ACA advisory committee unless it gives
"consensus" advice. To be sure, many committees are convened with that expectation. See, e.g., The Commission on
the Future of Worker-Management Relations, 58 Fed. Reg.
27,311 (1993). Others, however, are established presumably
with the full expectation that the positions to be taken and
the advice to be offered may well be sharply divided. See,
e.g., The Presidential Commission or the Assignment of Women in the Armed Forces, 57 Fed. Reg. 49,394 (1992). And
since one of the purposes of F ACA is to achieve some
balance, and thereby diverse views on advisory committees, it
would be passing strange if F ACA only applied to those
committees that would offer consensus recommendations.
The point, it seems to us, is that a group is a F ACA
advisory committee when it is asked to render advice or
recommendations, C13 a group, and not as a collection of
individuals. The group's activities are expected to, and appear to, benefit from the interaction among the members both
internally and externally. Advisory committees not only provide ideas to the government, they also often bestow political
legitimacy on that advice. As the House Committee that
investigated advisory committees before F ACA's passage
stated: "The work product of a committee composed of
distinguished and knowledgeable individuals appointed by the
President to advise him is presumed to have value and should
be considered." H.R. REP. No. 1731, 91st Cong., 2d Sess. 12
(1970).
Advisory committees are not just mechanisms for transmitting policy advice on a particular subject matter to the
government. These committees also possess a kind of political legitimacy as representative bodies. Membership on a
committee is often highly prized and sought after because it
carries recognition and even p:·estige. When the executive
branch endorses its advice anri :;eeks to promote the policy
course suggested by the committee, ·the executive branch
�30
draws upon the committee's political legitimacy. Congress'
effort to ensure that these committees are balanced in terms
of viewpoint recognizes their usefulness for political (and
patronage) purposes. But committees bestow these various
benefits only insofar as their members act as a group. The
whole, in other words, must be greater than the sum of the
parts.
Thus, an important factor in determining the presence of
an advisory committee becomes the formality and structure of
the group. Judge Gesell, in another district court case.
Nader v. Baroody, 396 F. Supp. 1231 (D.D.C. 1975), seems to
have approached the same notion by focusing on the word
"established" in F ACA. Nader involved meetings between
an assistant to the President and a changing slate of federal
officials and private sector groups. See id. The groups met
for the express purpose of exchanging views on a variety ot
subjects. In exempting these meetings from F ACA, the
court noted that "the committees were not formally organizec
and there is little or no continuity." /d. at 1234.
Since form is a factor, it would appear that the governmen1
has a good deal of control over whether a group constitutes s
F ACA advisory committee. Perhaps, for that reason, it is ~
rare case when a court holds that a particular group is c
F ACA advisory committee over the objection of the executive
branch. In order to implicate F ACA, the President, or hi!
subordinates, must create an advisory group that has, in largl
measure, an organized structure, a fiXed membership, and ~
specific purpose. The government suggests that the workin!
groups, composed as they are of a crowd of 340 virtual!:
anonymous persons. do not bear the characteristics of th'
paradigm F ACA advisory committee. That may well be sc
The working groups. as a whole, seem more like a horde tha1
a committee. On the other hand, the groups have beer
created ("established") with a good deal of formality an<
perhaps are better understood as a number of advisor:
committees. We simply cannot determine how to classify th
working groups based on the record before us.
Finally, the government claims that all of the members c
the working groups are full-time officers or employees of th
�31
\
'
I
I
government, and, for that reason alone, the working groups
are not F ACA advisory committees. The three-hundred
members drawn from the agencies, the Executive Office of
the President, and from the congressional staffs are concededly within that category. The working group also includes, however, 40 "special government employees." The
government claims that these individuals are also "full-time"
government employees, even though they have been employed by an agency or the Executive Office of the President
for less than 130 days in a year, some without compensation.
The record does not reflect where these persons come from,
nor does it show how many hours they work. We are,
moreover, unsure whether F ACA's defmition of "full-time"
extends to a person who works for the government for less
than 130 days out of a year. The government directs us to
the conflict of interest provisions of Title 18, which define a
"special Government employee" as:
an officer or employee of the executive or legislative
branch of the United States Government . . . who is
retained, designated, appointed, or employed to perform,
with or without compensation, for not to exceed [130]
days during any period of [365] consecutive days, temporary duties either on a full-time or intermittent basis.
18 U.S.C. § 202(a) (1988) (emphasis added). The government
argues that section 202 clearly implies that a temporary
employee can be "full-time." Intermittent (or non-full-time)
applies, according to the government, to those who work less
than a full day.
We do not believe section 202(a) helps the government.
Just as we did not read 5 U.S.C. §§ 2104, 2105 to govern the
question of whether Mrs. Clinton is a federal officer or
employee, we do not think that Title 18's defmitions should
necessarily control F ACA. We must construe F ACA in light
of its purpose to regulate the growth and operation of advisory committees. F ACA would be rather easy to avoid if an
agency could simply appoint 10 private citizens as special
government employees for two days, and then have the
committee receive the section 3(2) exemption as a body
�32
composed of full-time government employees. Moreover, section 202 contrasts "full-time" with "intermittent," and so "fulltime" seems to mean no more than not "intermittent." There
is no reason to think that not "intermittent" for section 202
purposes has any bearing on whether the employee is "fulltime" for F ACA purposes. Whether the special government
employees are full-time, however, is, in part, a factual issue
that was not developed below due to the lack of discovery.
A third class of persons are described as consultants.
According to the government, the consultants attend meetings on an intermittent basis, with or without compensation,
and have no "supervisory role or decision-making authority."
Drawn from the ranks of the medical profession, the academy, and from business, they only provide information and
opinion. These consultants raise a different question from
that presented by the other two classes of working group
employees. The key issue, it seems to us, is not whether
these consultants are "full-time" government employees under section 3(2), but whether they can be considered members of the working group at all. When an advisory committee of wholly government officials brings in a "consultant" for
a one-time meeting, F ACA is not triggered because the
consultant is not really a member of the advisory committee.
In that situation, the relationship between the temporary
consultant and committee is very similar to the one between
the White House officials and various private sector representatives exempted from FACA in Nader. We are confident
that Congress did not intend FACA to extend to episodic
meetings between government officials and a consultant. To
do so would achieve the absurd result Public Citizen warned
against: reading F ACA to cover every instance when the
President (or an agency) informally seeks advice from two or
more private citizens.
But a consultant may still be properly described as a
member of an advisory committee if his involvement and role
are functionally indistinguishable from those of the other
members. Whether they exercise any supervisory or decisionmaking authority is irrelevant. If a "consultant" regularly attends and fully participates in working group meetings as
�33
if he were a "member," he should be regarded as a member.
Then his status as a private citizen would disqualify the
working group from the section 3(2) exemption for meetings
of full-time government officials.
*
*
*
*
When we examine a particular group or committee to
determine whether F ACA applies, we must bear in mind that
a range of variations exist in terms of the purpose, structure,
and personnel of the group. Perhaps it is best characterized
as a continuum. At one end one can visualize a formal group
of a limited number of private citizens who are brought
together to give publicized advice as a group. That model
would seem covered by the statute regardless of other fortuities such as whether the members are called "consultants."
At the other end of the continuum is an unstructured arrangement in which the government seeks advice from what
is only a collection of individuals who do not significantly
interact with each other. That model, we think, does not
trigger FACA.
We simply have insufficient material in the record to
determine the character of the working group and its members. We understand why the district .court, believing the
Task Force covered by F ACA, thought it unnecessary and
inappropriate to put the working group under further scrutiny. But, as we have indicated, because we differ with the
district court concerning the Task Force, we believe further
proceedings, including expedited discovery, are necessary before the district court can confidently decide whether the
working group is a F ACA committee.
Accordingly, we reverse the district court and lift the
preliminary injunction on the operations of the Task Force.
The Task Force need not comply with the requirements of
FACA because it is a committee composed wholly of full-time
government officials. We also reverse the district court's
dismissal of appellees' claims as to the working group under
Rule l2(b}(6}. We remand for further proceedings, including
expedited discovery, regarding the working group.
So ordered.
�1
BucKLEY, Circuit Judge, concurring in the judgment: I
admit at the outset the persuasive force of the majority's
opinion-a force derived, I think, from a comparison of the
most obvious facts of this case with those of Public Citizen v.
United States Department of Justice, 491 U.S. 441 (1989).
Public Citizen interpreted the word "utilized" so as to exclude the Justice Department's use of a committee of the
American Bar Association whose only mission was to advise
on appointments to the federal judiciary. In concluding that
Congress did not intend to subject the ABA Committee on
the Judiciary to FACA's requirements, the Court acknowledged that what "tip[ped] the balance decisively against
F ACA's application," id. at 465, was the "cardinal principle"
that where "a serious doubt of constitutionality is raised, ...
the Court will first ascertain whether a construction of the
statute is fairly possible by which the question may be
avoided." I d. at 46~6. Here, to achieve a similar end, we
are asked only to stretch the phrase "officer or employee of
the Federal Government" far enough to include a person who
is greeted like a head of state, guarded by the Secret Service,
and funded from the public fisc. On first appearances, Public
Citizen would seem to support both the majority's result and
the reasoning used to reach it.
If this case is to be distinguished from Public Citiz~ it is
not because of a lack of gravity in the constitutional issues it
presents. In United States v. Nixon, 418 U.S. 683 (1974)
("Nixon I"), and Nixon v. Administmtor of General Services, 433 U.S. 425 (1977) ("Nixon II"), the Supreme Court
recognized a constitutionally grounded doctrine of executive
privilege which holds that Presidential communications are
presumptively privileged against disclosure:
Human experience teaches that those who expect public
dissemination of their remarks may well temper candor
with a concern for appearances and for their own interests to the detriment of the decisionmaking process ....
A President . . . must be free to explore alternatives in
the process of shaping policies and making decisions and
�2
to do so In a way many would be unwilling to express
except privately. These are the considerations justifying
a presumptive privilege for Presidential communications.
The privilege is fundamental to the operation of Government and inextricably rooted in the separation of powers
under the Constitution.
Nixon I, 418 U.S. at 705, 708. The Court found that this
privilege extends
to communications in performance of a President's responsibilities . . . and made in the process of shaping
policies and making decisions.
Nixon II, 433 U.S. at 449 (quoting Nixon I, 418 U.S. at 708,
711, 713) (internal quotation marks, brackets, and citations
omitted). And it set forth standards for evaluating intrusions
on privileged communications:
[I]n determining whether the Act disrupts the proper
balance between the coordinate branches, the proper
inquiry focuses on the extent to which it prevents the
Executive Branch from accomplishing its constitutionally
assigned functions. Only where the potential for disruption is present must we then determine whether that
impact is justified by an overriding need to promote
objectives within the constitutional authority of Congress.
Id. at 443 (citations to Nixon I omitted).
We confront in this case a task force consisting of the
President's closest advisors that was established to address a
paramount political priority. Because it included his wifeby all accounts, a person whose policy advice he has relied on
throughout his public life-the Task Force on National
Health Care Reform arguably was bound by law to conduct
its proceedings in public. Given these circumstances, the
considerations animating the Presidential privilege, like the
President's claim of privilege itself, are before us in pointed
fashion. My colleagues, sensing the weight of these issues,
hold that we may avoid addressing them through "prudent
�3
use" of Public Citizen's umaxim of statutory construction."
Maj. Op. at p. 23, I cannot agree.
I begin with the axiom that in interpreting a statute, a
court must ascertain the will of the enacting Congress. Here
I admit to detecting something of an implicit argument in the
Government's pleadings before this court. To the extent that
it may be discerned, this argument begins with an assumption
that Public Citizen's result could not have been reached
through genuine interpretation-interpretation that is consistent with the will of Congress-and ends with the conclusion
that Public Citizen authorizes courts to avoid constitutional
issues by ascribing implausible meanings to the most unambiguous language. The suggestion, I admit, is tempting. But
it is also barred by the very decision on which the Government places its principal reliance. Public Citizen states
explicitly that courts ucannot press statutory construction to
the point of disingenuous evasion, even to avoid a constitutional question." 491 U.S. at 467 (internal quotation marks
and citation omitted).
The weakness of the position that F ACA may be interpreted to exclude the Task Force is suggested by the Government's vacillation on the question of Mrs. Clinton's status.
Before the district court, the Government argued that the
Task Force was not subject to F ACA because Mrs. Clinton
was the functional equivalent of a federal employee. In its ·
opening brief here, it argued that she was either an officer or
an employee without saying which. On reply, it said explicitly that Mrs. Clinton was an 16officer." And at argument, it
retreated to ambiguity and again refused to categorize her.
In fact, the Government's only consistent position has been
that FACA is not subject to those statutory definitions of
"officer" and 16 employee" that most logically apply to it.
FACA appears in the appendix to Title 5 of the United
States Code. Sections 2104 and 2105 of Title 5 contain the
following deimitions:
�4
§ 2104. Officer
(a) For the purpose of this title, "officer", except as
otherwise provided by this section or when specifically
modified, means a justice or judge of the United States
and an individual who is(1) required by law to be appointed in the civil
service by one of the following acting in an official
capacity(A) the President;
(B) a court of the United States;
(C) the head of an Executive agency; or
(0) the Secretary of a military department;
(2) engaged in the performance of a Federal function under authority of law or an Executive act; and
(3) subject to the supervision of an authority
named by paragraph (1) of this section, or the
Judicial Conference of the United States, while engaged in the performance of the duties of his office ....
§ 2105. Employee
(a) For the purpose of this title, "employee", except as
otherwise provided by this section or when specifically
modified, means an officer and an individual who is(1) appointed in the civil service by one of the
following acting in an official capacity(A) the President;
(B) a Member or Members of Congress, or
the Congress;
(C) a member of a uniformed service;
(D) an individual who is an employee under
this section;
(E) the head of a Government controlled corporation; or
(F) an adjutant general designated by the
Secretary concerned under section 709(c) of title
32;
�5
(2) engaged in the performance of a Federal function under authority of law or an Executive act; and
(3) subject to the supervision of an individual
named by paragraph (1) of this subsection while
engaged in the performance of the duties of his
position ....
5 U.S.C. §§ 2104, 2105 (emphasis added).
The common denominator of these provisions is the requh:'ement that both officers and employees be "appointed in
the civil service." In the Executive Branch, the civil service
consists of (1) positions requiring Senate confirmation, (2) the
"Senior Executive Service," (3) the "competitive service," and
(4) "positions which are specifically excepted from the competitive service by or under statute." 5 U.S.C. § 2102(a).
Mrs. Clinton does not wear any of these labels. See, e.g., 5
U.S.C. § 3132(a)(2) (defming "Senior Executive Service position"). The Government's (and the majority's) strategy, then,
is to argue that she need not satisfy the section 2104 and 2105
definitions because they do not apply to F ACA. Specifically,
because F ACA has been codified in an appendix to Title 5,
not in the title proper, the Government contends that the
sections do not govern the meaning of "officer'' and 11employee" as used in the defmition of "advisory committee." For
several reasons, I disagree.
First, there is the plain meaning of the statutory language.
An appendix to a title of the United States Code necessarily
qualities as a part of that title. If it did not, then the
appendix would be part of no title whatever and would be an
appendix to the Code as a whole. Yet F ACA appears in the
Code under the banner, "Title 5, Appendix." Because sections 2104 and 2105 state plainly that they apply "[f]or the
purpose of" Title 5, and because F ACA is a part of that title,
the definitions apply to FACA
Second, Congress surely knew that F ACA would be codified under Title 5. The same statute that adopted sections
2104 and 2105 also stipulated that Title 5 be captioned:
"Government Organization and Employees." Pub. L. No. 89554, 80 Stat. 378, 408-09 (1966). A glance at the captions of
�'
6
the remaining 49 titles in the Code confll'I11s that Title 5 is the
only one under which F ACA could have been codified.
Third, there are the practical considerations. The Ethics
in Government Act, codified alongside F ACA in Title 5's
appendix, requires fmancial disclosures from "each officer or
employee in the executive branch" who meets certain criteria.
Ethics in Government Act of 1978, 5 U.S.C. App. 3, §§ 101(a),
101(t)(3) (1991 Supp.). F ACA imposes open-meeting and
other requirements on committees not "composed wholly of
full-time officers or employees of the Federal Government."
5 U.S.C. App. 1, § 3(2) (1988). And, although each of those
statutes contains a sizable definitional section, neither defines
either "officer" or "employee." See 5 U.S.C. App. 1, § 3
(1988); 5 U.S.C. App. 3, § 109 (1991 Supp.). The Government tells us that those terms are intentionally left undefined
even though Congress took the trouble, in those statutes, to
define terms that are of far less significance. See, e.g., 5
U.S.C. App. 1, § 3(4) (1988) ("The term 'Presidential advisory
committee' means an advisory committee which advises the
·President"); 5 U.S.C. App. 3, § 109(3) (1991 Supp.) (" 'designated agency ethics offici~l' means an officer or employee who
is designated to administer the provisions of this title within
an agency''). But without definitions of "officer'' and "employee," neither statute could be sensibly administered. The
better explanation for the absence of these defmitions is that
their repetition in F ACA and the Ethics in Government Act
would have been redundant.
Finally, there is the apparent reasoning behind F ACA's
location in Title 5's appendix. The United States Code is
published pursuant to 1 U.S.C. §§ 201-13 (1988). That law
requires the codification of new laws in annual Code supplements and permits the publication of an entirely new Code
every five years. See id. § 202. Thus, the current United
States Code and supplement contain all laws of the United
States that are "general and permanent in their nature." /d.
§ 204(a). As of 1988, ten of the fifty U.S.C. titles contained
an appendix. See 5, 10, 11, 18, 26. 28, 40, 46, 49, 50 U.S.C.
(1988). Some statutes have been placed in appendices because, while considered more than temporary, they are
viewed as less than permanent additions to the Code. See 40
U.S.C. App. (Appalachian Regional Development Act of 1965).
�7
Other statutes have been relegated to appendices because
they were not enacted directly by Congress. See 11 U.S.C.
App. (Bankruptcy Rules and Official Forms as promulgated
by Supreme Court pursuant to 28 U.S.C. § 2075). With
respect to Title 5, Congress has divided it into three parts:
"The Agencies Generally'' (Part 1), "Civil Service Functions
and Responsibilities" (Part II), and "Employees" (Part Ill).
See Pub. L. No. 89-554, 80 Stat. 378 (1966), as amended by
Pub. L. No. 96-54, § 2(a)(1), 93 Stat. 381 (1979). An appendix to Title 5, then, is the natural place to codify statutes that
relate to "Government Organization and Employees" but do
not pertain to "The Agencies Generally," "Civil Service Functions and Responsibilities," or "Employees." As of 1988, five
acts, including F ACA, had been codified in Title 5's appendix.
None of these fits within any of the three pigeonholes into
which the main body of the title has been divided.
As against all of this-the statute's plain language, the
imputed knowledge of its draftsmen, the practical need for
Title 5's defmitions to apply to its appendix, and the apparent
reasons for F ACA's placement there-the Government can
offer a bare shred of legislative history. It points out that
the Senate version of F ACA explicitly incorporated the Title
5 defmitions of "officer'' and "empl9yee," but that these were
dropped at conference. The question, of course, is whether
the conferees discarded the definitions because they were
redundant (as F ACA was destined for codification under Title
5), or because they wished the definitions not to apply to
FACA.
The evidence on this issue consists of statements from the
reports of the Senate Committee on Government Operations·
and the House-Senate Conference Committee. Referring to
the section of the Senate bill that incorporated definitions to
be found in the main body of Title 5, namely, those for
"agency'' (5 U.S.C. § 551(1 )), "officer'' (5 U.S.C. § 2104), and
"employee" (5 U.S.C. § 2105), the Senate Report stated only
that these three defmitions had "been chosen to give the
broadest interpretation to the coverage commensurate with
generally accepted principles of law." S. Rep. No. 1098, 92d
Cong., 2d Sess. 8 (1972). The Conference Committee Report
�'
----~-··
8
merely noted that "[t]he conference substitute deletes the
Senate amendment definitions of 'officer' and 'employee.' "
H.R. Conf. Rep. No. 1403, 92d Cong., 2d Sess. 9 (1972). The
definition of "agency," however, was retained.
The Government infers, from the deletion of two of the
Senate definitions and the retention of the third, that the
conferees found the definitions of "officer" and "employee"
inapplicable to F ACA. There is a far more plausible explanation. As sections 2104 ("officer'') and 2105 ("employee") were
applicable to all statutes codified under Title 5, they were
superfluous. The definition of "agency," by contrast, appears
under the heading, "For the purpose of this subchapter-," 5
U.S.C. § 551 (emphasis added), and therefore would not
apply to F ACA unless specifically incorporated into that Act.
Even if we could disregard the definitions found in Title 5,
we would still be compelled to attach meanings to the words
"officer" and "employee" that Congress ~ight reasonably
have had in mind. To this end, I have examined other
sources for defmitions of these terms. At the outset, I
dismiss the possibility that Mrs. Clinton might be considered
an employee. In these proceedings, the Government has not
attempted to argue that Mrs. Clinton is an employee for
purposes of F ACA-no doubt because her services are unpaid. Cf. Black's Law Dictionary 471 (5th ed. 1979) (defining
employee as "[o]ne who works for an employer; a person
working for salary or wages"). And while the majority does
assert that Mrs. Clinton "could still be regarded as an
'employee'" under FACA, Maj. Op. at p. 10, it too lacks an
argument in support of the proposition. In particular, it
ignores the fact that, while subsections (a) and (b) of 3 U.S.C.
§ 105 explicitly "authorize( ]" the President "to appoint and
fix the pay of [White House] employees," subsection 105(e),
the statutory acknowledgment of the First Lady's role, is
carefully phrased so as not to authorize her appointment as
an employee or any remuneration for her services. An
"unpaid employee" is an oxymoron. although an "unpaid
officer" is not. F ACA's strictures can be avoided, then, only
if it can credibly be argued that Mrs. Clinton is an officer of
the Federal Government. I can find no such argument.
�9
To begin with the beginning, the Constitution imposes
certain requirements on those who are to serve as officers of
the United States. Such persons must be appointed by the
President with the consent of the Senate unless Congress, by
law, has vested the power of appointment "in the President
alone, in the Courts of Law, or in the Heads of Departments,"
U.S. Const. art. II, § 2, cl. 2. Furthermore, all officers must
take an oath to support the Constitution. I cL, art. VI, cl. 3.
Congress has enacted laws to implement these requirements.
See, e.g., 5 U.S.C. § 3331 (officers of the United States
required to swear an oath); 5 U.S.C. § 2906 (offi~ers' oath to
be "preserved"); 5 U.S.C. § 2902 ("officer[s] appointed by the
President" must have commissions made out and sealed by
the Secretary of State); 5 U.S.C. §§ 3333, 7311 (anyone who
accepts either "office or employment in the Government of
the United States" required to swear their loyalty by affidavit). We have received no indication that any of these
requirements have been met with regard to Mrs. Clinton.
More generally, an officer implies an office, and an office
implies duties. Title 1 of the United States Code defines
"officer" by reference to an "office" with "duties"-" 'officer'
includes any person authorized by law to perform the duties
of the office." 1 U.S.C. § 1. And the Supreme Court has
interpreted "officer" similarly with reference to the Constitution. In Burnap v. United States, 252 U.S. 512, 516 (1920),
the Court reasoned: "Whether the incumbent is an officer or
an employee is determined by the manner in which Congress
has specifically provided for the creation of the several positions, their duties and appointment thereto." Burnap held
that a "landscape architect" was an employee, not an officer,
because "[t]here [was] no statute which creates an office of
landscape architect . . . nor any which defines the duties of
the position," ici at 517, and because "[t]here [was] no statute
which provides specifically by whom the landscape architect
... shall be appointed." lei
The undoubted value of the services that the wives of
Presidents have rendered their husbands and their country
notwithstanding, it cannot be said that they have occupied an
office with duties. The provision of the U.S. Code on which
�r.
10
the majority relies, 3 U.S.C. § 105(e), is carefully phrased so
as not to name a position or prescribe duties a President's
spouse is to fulfill. In fact, section 105(e), strictly speaking,
does not even authorize a First Lady to assist the President;
rather it authorizes federal employees to assist the First
Lady, and, in the course of doing so, acknowledges the
assistance that First Ladies commonly render their spouses.
In sum, Mrs. Clinton carries none of the indicia of a federal
officer. She has neither been appointed to nor confirmed in
the position of "First Lady," she has taken no oath of office,
and she neither holds a statutory office nor performs statutory duties.
Having searched the U.S. Code and the Government's
briefs in vain for definitions of "officer'' that might give aid
and comfort to the Government, I conclude that under any
fair interpretation of the term, Mrs. Clinton is not an officer
of the United States. But to complete this tour through the
statute books, I note that section 105(e) does not, as the
Government and the majority contend, require a fmding that
Congress has acknowledged that a President's spouse performs the duties of an officer. Another direct congressional
statement on the subject of the First Lady's duties appears in
the Anti-Nepotism Act. That Act declares that public officials (expressly including "the President") may not employ
relatives (expressly including a ''wife") in "a civilian position
in the agency in which he is serving or over which he
exercises jurisdiction or control." 5 U.S.C. § 3110(a), (b).
The use of the defmite article in the phrase "the agency in
which he is serving'' appears to imply that every "public
official" belongs to some agency and that their relatives may
not be employed in that agency, whatever it happens to be.
Moreover, as a matter of policy and consistency, the restrictions on the President under the Anti-Nepotism Act must be
viewed to be as broad as the Executive Branch: It is inconceivable that Congress, in combatting nepotism, intended to
forbid Mrs. Clinton's service as Attorney General while permitting her appointment as National Security Advisor.
Viewed purely as a matter of congressional intent, the argument that the Anti-Nepotism Act applies only to the Depart-
•
�11
ments and not to the White House, see Maj. Op. at p. 12, is a
weak one. As a result, any gravitational pull exerted in the
· direction of congressional acceptance of a President's spouse
as a "de facto officer'' attributable to section 105(e) is overwhelmed by the opposite force exerted by the Anti-Nepotism
Act.
One final consideration. Although we may assume that,
when drafting F ACA, Congress gave no thought to the
possibility that a President might appoint his spouse to an
advisory committee, we may not assume that it failed to
contemplate the relationship between F ACA and the legal
obligations and sanctions imposed on officers and employees
of the Federal Government.
As one reviews the affidavit filed with the district court by
Ira Magaziner, Senior Advisor to the President for Policy
Development, one is struck by the fact that every member of
the Task Force and Interdepartmental Working Group, but
one, was subject to one or more of the statutes that Congress
has enacted to ensure the proper conduct of members of the
Federal Government-the "insiders," as the Government describes those who qualify as "full-time officers and employees" within the meaning of FACA. These laws impose burdensome ethics requirements. See, e.g., Ethics in Government Act of 1978, 5 U.S.C. App. 3, § 101(f)(3) (1991 Supp.)
(applying financial disclosure requirements on all higher paid
"officers and employees" in the Executive Branch); id.
§§ 501(a)(l), 505(2) (1991 Supp.) (applying outside income
limitations on all higher paid officers and employees except
"special government employees"); 18 U.S.C. § 205 (1991
Supp.) (prohibiting any "officer or employee" from representing outsiders in "matters affecting the Government"); id.
§ 207 (prohibiting anyone who formerly was an "officer or
employee" from participating in certain governmental proceedings and decisions after leaving government employment); id. § 208 (prohibiting an "officer or employee" from
"participat[ing] personally" in a matter affecting "a financial
interest"); 5 U.S.C. § i324 (1988) (prohibiting an "employee
in an Executive agency" from taking "an active part" in
political campaigns). .-\nd even though the Government argues that the Interdepartmental Working Group was not an
�•
12
advisory committee within the meaning of F ACA, Mr. Magaziner nevertheless took pains to stress the fact that every
member of and consultant to the Group-whether a regular
or special government employee, whether working full time or
part, for pay or without-was required to flle a fmancial
disclosure statement and to comply with other requirements
of these laws. See Magaziner Mfidavit, Gov't App. at 41-43.
These requirements, then, appear as a signal distinction
between what would normally be considered to be "inside"
and "outside" members of advisory committees. In fact, this
distinction-the legal obligations and sanctions imposed on
officers and employees of the Government as opposed to
private citizens-undoubtedly provides a substantial part of
the justification for the very different requirements imposed
by F ACA on committees that are composed exclusively of
federal officers and employees and those that are not. In
enacting F ACA, Congress found that "[o]ne of the great
dangers in the unregulated use of advisory committees is that
special interest groups may use their membership on such
bodies to promote their- private concerns." H.R. Rep. No.
1017, 92 Cong., 2d Sess. 6 (1972). Because committees not
composed exclusively of federal officers and employees have
members who are not required to foreswear their private
associations and insulate themselves against potential con- .
flicts of interest, F ACA requires, as an alternative check, that
their deliberations be conducted in the open.
When the majority states that we "need [not] consider
whether Mrs. Clinton's presence on the Task Force violates
any conflict of interest statutes," Maj. Op. at p. 24 n.10, it
indicates that we have not been presented with claims under
these statutes that call for adjudication. The question remains, however, whether Congress. if it had ever considered
that the President's spouse might be appointed an official
member of a Presidential advisory committee, would have
labelled her an "officer or employee" within the meaning of
FACA. To put it another way, could Congress have intended
that Mrs. Clinton, alone of the tweive members of the Task
Force and 340 members of the Working Group, would be
0
•
0
�13
entirely exempt from the reach of ethics laws that Congress
has imposed on the President himself? I think not.
In visiting these sundry provisions, I doubt I have said very
much with which my brethren in the majority would disagree.
Our disagreement centers, I think, not on Congress's intent
in enacting the relevant statutes, but on the lens through
which we must view that intent in this particular case. The
majority argues (1) that construing the phrase, "officers and
employees," to exclude Mrs. Clinton would give rise to
weighty constitutional issues, Maj. Op. at p. 22; (2) that the
Public Citizen Court avoided deciding similar issues by embracing "an extremely strained construction of the word
'utilized,'" Maj. Op. at p. 14; (3) that "[i]t is reasonable ... to
construe section 105(e) as treating the President's spouse as a
de facto officer or employee," Maj. Op. at p. 11; and hence (4)
that the phrase "full-time officer or employee of the government" must a fortiori be read to apply to Mrs. Clinton, Maj.
Op. at p. 24. I remain unconvin~ed.
First, I do not think that section 105(e) can reasonably be
read to create an officer or employee, either de facto or
otherwise; and even if it could, I do not think we could avail
ourselves of such a reading in this case. I noted above that
section 105(e) has been carefully phrased so as not to recognize an office, an officer, or an employee. But equally
important, I know of no case in which the Supreme Court has
saved one provision from constitutional difficulty by liberally
construing another, entirely unrelated provision. In Public
Citizen itself, as well as in every case cited in Public Citizen
in which the Court avoided a constitutional challenge, the
Court sidestepped the constitutional claims presented
through an interpretation of the statute under attack. See
Public Citizen, 491 U.S. at 465-66 (citing cases); see also id.
at 465, 467 (avoiding a constitutional challenge to FACA by
construing F ACA § 3(2)); see also, e.g., Edward J. DeBartolo
Corp. v. Florida Gulf Coast Bldg. & Constr. Trades Council,
485 U.S. 568, 575, 588 (1988) (avoiding a constitutional challenge to the National Labor Relations Act by construing
NLRA § 8(b)(4)); St. Martin Evangelical Lutheran Church
v. South Dakota, 451 U.S. 772, 78(}..81, 788 (1981) (avoiding a
�r.
14
constitutional challenge to the Federal Unemployment Tax
Act by construing FUTA § 3309(b)). Because it is FACA
that is under attack, I think that any additional degree of
interpretive freedom we enjoy in construing F ACA cannot be
extended to a statute authorizing expenditures for White
House staff.
Second, I cannot believe that Public Citizen establishes the
rule my colleagues tacitly embrace. In reaching their holding, the majority implicitly distinguishes between "extremely
strained construction," which, under their reacliDg, Public
Citizen permits or even requires, and "disingenuous evasion,"
which it explicitly forbids. Compare Maj. Op. at p. 14 with
491 U.S. at 467. The rule the majority appears to adopt,
then, is that judges must strain (but may not evade) the plain
meaning of a statute before they may entertain an "asapplied" constitutional challenge. If my colleagues are right,
the line between "extremely strained construction" and "disingenuous evasion" will determine the outcome in every case
involving an as-applied challenge presenting "formidable constitutional difficulties.'~ Public Citizen, 491 U.S. at 466.
While I suspect my colleagues may have some sympathy (as I
do) with Justice Kennedy's position that the Supreme Court
majority in Public Citizen had stretched· its interpretation of
FACA ..beyond the point at which such a construction remains 'fairly possible,' " id. at 481 (Kennedy, J., concurring in
judgment) (emphasis in original), I cannot believe the Court
intended to establish a rule requiring such constructions in
cases posing serious constitutional questions.
A review of its reasoning demonstrates that Public Citizen
neither explicitly nor implicitly sanctions "strained" statutory
interpretation. Its holding-that the ABA Committee was
not "utilized" by the President within the meaning of
FACA-was based principally on three considerations. The
first of these was that, in the Court's memorable phrase,
" 'utilize' is a woolly verb,'' id. at 452, which necessarily
requires judicial definition. Second, it recognized that a
"dictionary reading [of the word "utilize" in] FACA's definition of 'advisory committee' " would lead to a statute of
"almost unfettered breadth" and produce "absurd results."
...
�15
/d. at 452 & n.B, 452-54. Taken literally, FACA's definition
would have endowed the President with Midas ears capable of
turning any continuing source of consensus opinion into a
F ACA committee. In such a world, the physicians jointly
consulted to protect the President's health, the editorial board
of the President's favorite newspaper, and two dietitians
jointly planning the President's meals could all be classified
as "Presidential advisory committees" subject to regulation.
Because "the literal reading of [utilize] would 'compel an odd
result,'" the Court "search[ed] for other evidence of congressional intent to lend the term its proper scope." /d. at 454
(citation omitted). Third, on examining F ACA's origins and
legislative history, the Court concluded that while "it seems
to us a close question whether F ACA should be construed to
apply to the ABA Committee, . . . we are fairly confident it
should not." I d. at 465.
The Court reached this last conclusion in significant part on
the basis of the following passage from the F ACA Conference
Report: "The Act does not apply to persons or organizations
which have contractual relationships with Federal agencies
nor to advisory committees not directly established by or for
such agencies." /d. at 462 (emphasis added by Public Citizen ). The Court also noted that the relationship between the
ABA Committee and the Justice Department had not fallen
within the scope of President Kennedy's Executive Order No.
11007, from which FACA was derived. /d. at 462~3. From
this, the Court concluded that "[t]he phrase 'or utilized'
therefore appears to have been added simply to clarify that
F ACA applies to ad\;sory committees established by the
Federal Government in a generous sense of that term," id. at
462; and that "[r]ead in this way, ... the word 'utilize' does
not describe the Justice Department's use of the ABA Committee," id. at 463.
In applying what the majority, Maj. Op. at p. 8, has
laconically (and accurately) described as a "rather sweeping"
statutory definition of "advisory committee" to the unique
relationship between the Justice Department and the ABA
Committee, the Court concluded that it was more probable
than not that Congress did not intend that F ACA apply to
...
�I
16
such privately organized groups. Nevertheless, because it
considered the question close in light of the broad sweep of
the definition, literally interpreted, it applied its venerable
rule of statutory construction to tip the balance away from
one that would have presented "formidable constitutional
difficulties." I d. at 466.
In this case, we deal not with woolly terms but with the
meaning of two words in common legal usage, uofficer'' and
"employee." Far from creating absurdity, literal interpretations of these terms are necessary in order to give effect to
the congressional policy of drawing sharp distinctions between individuals outside the Government and those within it.
And in contrast with Public Citizen, in which no statutory
definition of uutilize" was available and great weight was
placed on legislative history, definitions of both "officer'' and
"employee" have been enacted into law by Congress. In this
case, none of the considerations animating Public Citizen are
remotely presented; and because we do not deal with ambiguous terms, there is no "balance" to be tipped by resort to
legal maxims. Despite appearances, Public Citizen has little
to do with the case we decide today.
Finally, to conclude my statutory analysis, I note that the
Nixon I Court engaged in a patently straightforward interpretation of Federal Rule of Criminal Procedure 17(c), 418
U.S. at 697-702, even though it recognized that "[i]f we
sustain[ ] this challenge, there [will] be no occasion to reach
the claim of privilege asserted." I d. at 698. Needless to say,
the considerations counseling avoidance of difficult constitutional issues were never more pressing than on the facts of
Nixon I. Because I can find no credible argument to the
contrary, and because I cannot bring myself to strain the
meaning of "officer" or "employee" to produce one, I would
hold that the Task Force was not exempt from the public
disclosure requirements of FACA; and having done so, I
would address the constitutional implications of that holding.
As I pointed out earlier, the Supreme Court has acknowledged a Presidential right to confidentiality that uis fundamental to the operation of Government and inextricably root-
�17
ed in the separation of powers under the Constitution."
Nixon I, 418 U.S. at 708. Although the privilege is not
absolute, the Court has only twice found that it must yield to
competing constitutional interests, such as "the primary constitutional duty of the Judicial Branch to do justice in criminal
prosecutions," id. at 707; and in each case, it has protected
the confidentiality of Presidential communications from unwarranted disclosure.
In Nixon I, in which President Nixon sought to enjoin the
subpoenaing of certain of his papers, the Court found it
necessary to
weigh the importance of the general principle of confidentiality of Presidential communications in performance
of the President's responsibilities against the inroads of
such a privilege on the fair administration of criminal
justice.
/d. at 711-12. It concluded that the President's "generalized
interest in confidentiality . . . cannot prevail over the fundamental demands of due process of law in the fair administration of criminal justice." ld. at 713. Accordingly, it ordered
the examination in camera of the papers subject to an
instruction that the district court be scrupulous in "protect[ing] against any release or publication of material not
found by the court [to be] probably admissible in evidence
and relevant to the issues of the trial for which it is sought."
ld. at 714.
Nixon II involved a balancing of the President's interest in
the confidentiality of his communications against other national interests. In that case, former President Nixon asserted
the Presidential privilege in a challenge to the constitutionality of the Presidential Recordings and Materials Preservation
Act, which placed his papers in the custody of the Administrator of General Services. See 433 U.S. at 429-30. The
Supreme Court found that the statute was constitutional
because of the Nixon papers' historical importance and their
possible significance as aids to the legislative process, and
because of "the safeguards built into the Act to prevent
disclosure of [confidential] materials and the minimal nature
.•.
�18
. of the intrusion into the confidentiality of the Presidency."
I d. at 454. Those safeguards included the requirement that
"any party's opportunity to assert any ... constitutionally
based right or privilege" be protected. !d. at 450 (quoting
section 104 of the Act). The Court concluded "that the
screening process contemplated by the Act [, which was to be
conducted by Executive Branch archivists,] . . . will not constitute a more severe intrusion into Presidential confidentiality than the in camera inspection by the District Court
approved in [Nixon I]." /d. at 455.
In these two cases, the Court permitted only the most
limited intrusions on the privilege. FACA, by contrast,
would have required that the Task Force operate in the full
glare of provisions requiring public meetings and disclosure
of records. It is hard to imagine conditions better calculated
to suppress the "candid, objective, and even blunt or harsh
opinions," Nixon /, 418 U.S. at 708, that the President was
entitled to receive from the twelve advisors he had appointed
to his Task Force. Because none of Congress's purposes in
enacting F ACA are of a gravity that would justify overriding
the Presidential privilege in this case,· I would conclude that
F ACA is unconstitutional as applied to the Task Force.
For the foregoing reasons, I concur only in the majority's
conclusion, in Part III of its opinion, that F ACA's public
disclosure provisions may not be applied to the Task Force.
With respect to Part IV, I agree that the district court must
develop further facts before it can determine whether the
Working Group, or any division thereof, qualified as an
advisory committee under F ACA.
•
�
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Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
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White House Office of Records Management
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First Lady's Office
National Security Council
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1993
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2006-0223-F
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This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
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72 files in 6 boxes
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Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
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<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
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HRC - Court Ruling Health Care Task Force
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First Lady's Office
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Neel Latimore
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<a href="https://catalog.archives.gov/id/2058152" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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1/8/2015
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42-t-2058152-20060223F-002-001-2015
2058152
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https://clinton.presidentiallibraries.us/files/original/98ea181a12e774b19554b94e94beab2f.pdf
c492932d8baee2980e22da35acc4aea4
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FOIA Number: 2006-0223-F
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Series/Staff Member:
Paul Oetken
Subseries:
40308
OA/ID Number:
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Folder Title:
AAPS- Health Care Task Force
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DOCUMENT NO.
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001. note
SUBJECT/TITLE
DATE
[Handwritten notes regarding the Ira Magaziner case]. (1 page)
n.d.
RESTRICTION
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COLLECTION:
Clinton Presidential Records
Counsel's Office
Oetken, Paul
OA/Box Number: 40308
FOLDER TITLE:
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2006-0223-F
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P3 Release would violate a Federal statute [(a)(3) of the PRA)
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financial information [(a)(4) of the PRA)
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and his advisors, or between such advisors [a)(5) of the PRA)
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b(l) National security classified information [(b)(l) of the FOIA)
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�-
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UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC,
et al.,
Plantiffs.
v.
HILLARY RODHAM CLINTON,
DONNA E. SHALALA, Secretary of
Health and Human Services,
)
)
)
)
)
)
)
)
)
Defendants.
__________________________________
Civil Action
No. 93-399 (RCL)
)
}
)
)
)
DEFENDANTS' MEMORANDUM OF POINTS AND AUTHORITIES
IN OPPOSITION TO PLAINTIFFS', MOTION FOR
ATTORNEYS FEES AND COSTS UNDER THE iAJA
Preliminary Statement
Following the Court of Appeals' definitive rejection of
their previous lengthy efforts to sanction defendants,
plaintiffs, using their familiar tactics of abusive rhetoric and
accusation unencumbered by fact, once again ask this Court to
impose sanctions in the form of attorneys fees.
Rather than
relying on the employment status of working group participants,
the focus of their earlier efforts and a matter categorically
foreclosed by the Court of Appeals, plaintiffs now repeat their
earlier claim that the Task Force process was an elaborate sham
to enable secret meetings between select working group
participants and the President, contrary to defendants'
representations.
Their efforts to lab.el those representations as
bad faith and a basis for sanctions are even less substantial
�than their prior efforts regarding the employment status of the
working group, efforts which the Court of Appeals has ruled to be
insufficient to sustain plaintiffs' burden.
efforts should fare no better.
Their current
Plaintiffs• motion should be
denied ..
Factual Background
This is the fourth time in this Court that plaintiffs have
attempted to show that the working group directly advised the
President, and the second time that plaintiffs have alleged this
to be a basis for a finding of bad faith.
Plaintiffs first argued that defendants had incorrectly
represented that the working groups did not advise the President
in opposing defendants• motion to dismiss this case as moot.
See
Plaintiffs' Memorandum in Opposition to Defendants• Motion to
Dismiss, pp. l6-l7 (Sept. 26, 1994).
Citing many of the same
documents cited in their most recent iteration of this argument,
plaintiffs alleged that working group participants directly
advised the President and that this precluded records of such
alleged meetings from being Presidential records. 1
1
Compare Attachment A to that memorandum with Pl. App. 1382
("MEETING SCHEDULE WITH THE PRESIDENT"); 1763 (Memo to Ira
Magaziner from Jennifer Klein); 920 ("GUIDELINES FOR MEETINGS
WITH THE PRESIDENT TO DISCUSS HEALTH CARE REFORM ISSUES").
Defendants responded to this argument by.showing that the
Presidential Records Act was applicable regardless of whether the
working group directly advised the President, contrary to
plaintiffs' position. Defendants' Reply brief~ p.7, n.6 (Oct. 5,
1994) •
2
�Plaintiffs were then permitted discovery concerning mootness
and chose to conduct only limited discovery in the form of three
depositions, including that of Mr. Magaziner.
Plaintiffs
directed virtually no questions to Mr. Magaziner concerning
whether the working group or any of its participants met with the
I
I·
President. 2
On cross-examination, however, Mr. Magaziner
explained that plaintiffs' previously-stated theories of secret
working group meetings with the President were incorrect:
Q: As far as - let me see if I can direct your
attention to Exhibit 8 which referred to some plan
(sic) meetings with the President. You discussed those
meetings in your direct testimony.
Why did those meetings occur?
A: The President was interested in becoming more
educated on some of the areas of health care and he
asked me if he could meet with some of the experts we
had brought together and who were working on the health
care proposal just to kind of kick around ideas and
help him become more educated in some of the areas.
* .., .,
Q: l believe you said in your direct examination
that these were not Working Group meetings. What did
you mean by that?
A: That's correct. The Working Groups were
producing option materials to be considered by the Task
Force and we had a kind of set process for this to
2
Plaintiffs asked only whether Mr. Magaziner could identify
the documents entitled "MEETING SCHEDULE WITH THE PRESIDENT" and
"GUIDELINES FOR MEETINGS WITH THE PRESIDENT TO DISCUSS HEALTH
CARE REFORM ISSUES." While unable to recall specifics about the
documents themselves, Mr. Magaziner did state on direct that the
documents referred to "meetings that we were going to have with
the President to make sure that they were conducted properly."
Magaziner Dep. at 37.
3
�-
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--
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.
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___ .
occur.
This set of meetings with the President were not
designed to do that, that is present options. They
were more ~o informally meet with experts in different
areas and kick ideas around. We were very concerned
that the process that we has set up with the Working
Groups and the Task Force maintain its integrity. For
example, the people who might have been at some of
these meetings were - might have been a couple of
people who were participating in Working Groups, but
they were a very small percentage and we didn•t want
other members of the Working Groups to feel
circumvented and things of that sort.
And we wanted to be true to the process of the
working groups only working with the Task Force. So
these were not full meetings.
Magaziner Deposition, pp. 55-57.
11
As to why there were formal
Guidelines 11 for these informal meetings, he explained that they
resulted from consultation with counsel:
Because I knew there was a lawsuit pending and I
wanted to be sure that these kind of informal meetings
that the President wanted were done proper and didn•t
in any way go against what was legally proper for such
meetings.
so I wanted their advice on whether there was any
problems with the meetings going ahead, and any
guidelines in terms of those issues.
!d., p. 5'7.
Following this discovery, plaintiffs represented that no
additional discovery was needed and the Court ordered final
briefing on mootness.
Order, Oct. 28, l994.
Plaintiffs then
submitted a supplemental brief on mootness on November l, 1994,
once again reiterating their claim that the working groups met
with the President
11
every night.
11
Plaintiffs• Supp. Mem. in
opposition to Motion to Dismiss for Mootness, pp. 7-8, n.9.
4
Once
�more, plaintiffs submitted several of the same documents relied
upon in their present motion in their efforts to show that the
working group directly advised the President, as part of their
efforts to show that defendants had failed to produce all working
group documents. 3
Following. this round of briefing and 1n camera review of
certain withheld documents, the Court found that the case was
11
almost moot," and. ordered defendants to provide an index for the
withheld documents.
Memorandum and Order, p. 1, December l,
The Court also rejected plaintiffs' attempts to show that
1994.
the scope of defendants' document production was too limited,
finding that their attempts to prove that the working group's
membership and scope were much broader was based on a ''flawed
methodology. ''
.!9. ,
p. 6 .
In lieu of indexing, defendants elected to produce the
previously-withheld documents and, as a result, the Court
dismissed the merits of this case as moot on December 2l, 1994.
Noting that plaintiffs had the opportunity to take discovery on
the scope of defendants' production of documents, the court found
that plaintiffs had failed to show.that any documents remained.
3
Attachments to this brief included "MEETING SCHEDULE WITH
'I'HE PRESIDENT, 11 (Pl. App. 1382): "GUIDELINES FOR MEETINGS WITH
'I'HE PRESIDENT TO DISCUSS HEALTH CARE REFORM ISSUES, 11 (Pl. App.
920); the memo from Jennifer Klein to Ira Magaziner (Pl. App.
1763}; and the May 5, 1993 memo from Meaghan Prunty and Judy
Whang to the working group (Pl. App. 945).
5
�Memorandum and Order, p. 2.
The Court then referred plaintiffs'
allegation of perjury concerning Mr. Magaziner•s prior
declaration concerning the composition of the working group to
the United States Attorney.
After the United States Attorney found no basis upon which
to initiate a criminal proceeding, the parties addressed
plaintiffs' motion for fees and sanctions.
Again, plaintiffs
repeated their earlier claim that, in addition to the issue of
the employment status of the working group, the working group had
directly advised the President and that defendants'
representations to the contrary were sanctionable. 4
In response, defendants pointed out that the Court had
already rejected this claim in the context of plaintiffs•
arguments that the scope of the document production was too
limited.
Defendants• Surreply, p. 30, Dec. 13, 1995.
Defendants
also pointed out that, as early as May, 1994, defendants had
stated that working group participants were present at
preliminary meeting with the President and others and that
working group participants were also present as Task Force staff
at meetings attended by the President.
4
Surreply, pp. 30-31;
Indeed, their current memorandum, pp. 22-25, is virtually
identical to their earlier argument, Plaintiffs• Mem. in Support
of Motion for Fees and Sanctions and Response to Submission of
Defendants, Nov. 6, 1995, pp. 40-44, as well as their appellate
brief. Brief of Plaintiffs-Appellees, pp. 27-34. Indeed, their
nine volume appendix appears to be identical to their appellate
appendix.
6
�-----·---- ---
Third Magaziner Declaration, ,, 26-28, May 4, 1994.
Defendants
noted then that the working group prepared papers and briefing
books which assessed the potential impact of key policy choices
which would ultimately be made by the President.
Dec., , 23.
Third Magaziner
Defendants also pointed out that the only record
evidence in this case showed that several informal meetings
between the President and some working group participants did
occur to
11
kick around" some ideas and that Mr. Magaziner received
advice on how to structure those informal chats to avoid legal
difficulties.
Defendants further pointed out that some of the
documents cited by plaintiffs demonstrated those facts.
~.g.,
See,
GUIDELINES FOR MEETINGS WITH THE PRESIDENT TO DISCUSS
HEALTH CARE ISSUES. As to the isolated references in documents
pertaining to
11
advice 11 and
11
recommendations 11 to the President,
defendants demonstrated that such references were fully
consistent with the working group's function of preparing
briefing books for, and interacting with, the Task Force.
Surreply. p. 32.
In ruling on plaintiffs' motion for sanctions, the Court
found that defendants had acted in bad faith, based on its
conclusion that the First Magaziner declaration was incorrect in
its description of the composition of the working group.
Supp.
a, 11 (D.D.C. l997).
989 F.
It therefore awarded attorneys fees
and costs in excess of the statutory cap in the Equal Access to
7
�Justice Act, under the bad faith exception, after taking
reductions for improper charges and expenses.
.
On review, the Court of Appeals held that the finding of bad
.
faith based upon the First Magaziner Declaration•s statements
concerning the composition of the working group was
supported.
11
187 F.3d 655, 662.
11
inadequately'
It held that a further award
based on this issue was foreclosed, but that the district court
could consider awarding fees on another basis, including the
issue of whether the working group ever directly advised the
President.
Argument
Plaintiffs ask the Court to award the same fees and costa
previously awarded by this Court.
They alternately invoke the
EAJA, the bad faith exception to the American Rule, Rule ll and
Rule 37.
Ultimately, however, all of their arguments devolve to
one fundamental claim, that the entire health care review process
was a sham, that it was convened to allow the working group to
provide advice and recommendations directly to che President, and
that defendants were not justified in arguing to the contrary.
In so doing, plaintiffs gloss over a number of issues and ignore
applicable law in their haste to reargue their charges of
deception for yet another time.
Because it is the basis for all
of plaintiffs• claims, we again address plaintiffs' claim that
the working group directly advised the President.
8
We then review
�----~--
...
--- ----.--
---
....
...
~~,
....
their asserted entitlement to fees under the bases they cite.
I. The Working Group Did Not Directly
Advise the President
Consistent with their previous attempts to show that every
name mentioned on any working group document was a working group
participant, plaintiffs now argue that every scrap of paper
showing any contact with the President, whether direct or
indirect- as well as.papers without any references- somehow
shows that the working group directly advised the President and
that the Task Force, with ostensible responsibility for
formulating recommendations to the President, was a sham.
Indeed, when faced with direct and uncontroverted evidence that
defendants were careful to limit interactions of the working
group to comply with all applicable laws, plaintiffs resort to
their familiar tactic of claiming, without a shred of evidence,
the existence of a massive cover-up, thereby seeking to transfer
to defendants the burden of disproving their unfounded claim.
As
the Court of Appeals ruled, plaintiffs' burden, at least in
proving bad faith, ie one of clear and convincing evidence, a
burden that cannot be satisfied by mere accusation.
Nevertheless, we will again review why plaintiffs'
al~egations
are simply unfounded.
As the Court will recall, it has never been defendants•
position that the working group was hermetically sealed such that
its members or work product were never in contact with the
9
�-
President.
-......... -. . ·- -..,.
'
,,~--
..... ,-
--
Rather, defendants have always maintained that the
working group's role was to research and present policy options
to the Task Force, which, in turn, made recommendations to the
President.
Thus, individual working group participants could
have had contact with the President in the context of preparation
for Task Force activities, Task Force meetings, or in informal
gatherings held at the President's request.
As Mr. Magaziner
explained in his Third Declaration, filed in May 1994:·
I attended all of these Task Force meetings
and the President also attended a small number of them.
A few working group members attended some of these
meetings as well, to serve as a resource to answer
questions. At the meetings, Task Force members asked
me on a number of occasions to obtain additional
information for the Task Force's consideration. I, in
turn, called on working group participants to obtain
the needed information or to examine issues discussed
at the Task Force meetings. Working group members
provided the requested information .to me and I shared
it with the Task Force.
"27.
28.
In March and April, prior to these Task Force
meetings, t.he President and Vice-President convened
several preliminary meetings to discuss health care
reform. Changing groups of Cabinet members and senior
White House officials, some .of whom served on the Task
Force, and different working group members attended
these meetings. The working group members in
attendance provided information, answered questions and
reported on their efforts to develop a range of policy
options. The working group members received input and
guidance on the issues to be addressed in their
tollgate papers. 11
And, as noted previously, Mr. Magaziner also explained in
his deposition that, at the President's request, certain working
group participants were invited to meetings to the President to
10
�----· -----------·
-
discuss ideas, not as representatives of the working group, but
as knowledgeable persons.
Magaziner Dep. at 55.
Mr. Magaziner•s
executive assistant at the time, Marjorie Tarmey, also confirmed
that some senior persons on the working group were invited to a
separate meeting with the President outside of the context of the
working group.
Tarmey Dep. at 78.
Indeed, several of the
documents cited by plaintiffs confirm this. 5
Because of the pendency of this action, which questioned the
legality of the entire process, Mr.
Magazine~
obtained advice
from counsel as to how to best accommodate the President•s desire
for informal sessions with the ongoing Task Force/working group
processes.
Magaziner Dep. at 57.
The resulting GUIDELINES
stressed that attendees could do so only in their personal
capacities, not as representatives of the working group.
Pl .
.APP. 920.
Thus, it is hardly surprising, and not evidence of bad
faith, that plaintiffs can cite documents which show that certain
s See Pl. App. 2229 (attributing to
Ira 11 a description of
these planned meetings as 11 [i]nteractive discussion meetingsexpose [President] to expertise - expose us to things he's been
thinking about."); 2262 (attributing to 11 lM" that the "President
and Mrs. Clinton have requested to begin meeting with small
groups of representatives of the workgroups). Pl. App. 2262,
which purports to be notes of a working group cluster, also
attributes to 11 IM" the reassurance to the attendees that "[t]here
is no small group in a small room really making the policy
decisions ... Mr. Magaziner testified in his deposition that he
was concerned that the large percentage of working group
participants who did not meet with the President not feel
"circumvented. 11 Magaziner Dep. at 57.
11
11
�members of the working group met with the President.'
Nor, given
its role as staff to the Task Force, is it surprising that the
working group's work product was available to the President in
the form of background briefing books. 7
These facts hardly show
that the Task Force process was a sham to conceal secret meetings
between the working group and the President.
Nor is it
surprising that a Task Force comprised of the First Lady, six
Cabinet Secretaries, and five senior government officials did not
drop their many other ofticial duties to personally write
de~ailed
briefing books and other materials and, instead,
utilized the working group to do so.
That plaintiffs can now,
seven years later, find records indicating that the working group
6
Pl. App. 1382 ("MEETING SCHEDULE WITH THE PRESIDENT") ; 1629
(meeting by 11 certain members".of the LTC group with the
President): 1763 (listed persons from groups to meet with the
President); 2262 (notes attributing to "IM" that the President
asked for meetings with small groups from the working group) ;
2255 (noting a meeting by the author with the President); 2259
(noting a scheduled Presidential meeting) ; 1025 (same) ; 932
(transmitting working group documents to White House records
office, referencing briefing for President); 2247 ("members of
various task forces meeting with the President"); 1003 (memo
noting by 'named persons with President) .
7
Plaintiffs simply point to evidence that this process,
previously described by defendants, actually occurred. Pl. App.
2248 (reference to briefing book for President); 2250 (comments
on paper for President and First Lady) ; 2616 (draft briefing
paper for President and First Lady labeled "Discussion Draft for
Illustrative Purposes Only"); 945 (reference to briefing books
for President and First Lady) .
12
�performed those .functions is equally unsurprising. 8
At the same
time, other documents cited by plaintiffs actually confirm
defendants' representations -- that it was the Task Force that
had the ultimate decision-making authority to present to the
President the recommendations that formed the basis for the
President's health care reform plan, finalized and submitted to
Congress four months after the Task Force and working group had
disbanded.
See Pl. App. 2689,
~
seq. 9
In short, plaintiffs' most recent attempt to revisit this
issue differs only in volume from their prior attempts.
Their
shrill claims and now-discredited tactics should be rejected.
II. Plaintiffs Haye Failed to Show Bad Faith
Plaintiffs claim that they are entitled to the full amount
of this Court's original fee award under the EAJA, including fees
8
One document does expressly reference 11 recommendations" of
one working group being presented to the President, but that
document was written in January 1994, and it is not clear what
"recommendations" refers to and who presented those
recommendations to the President. See Memorandum "For the Record"
-- Summary Memo/The Health Care Reform Task Force -- Workgroup 12
from Fitzhugh Mullan, M.D., Assistant Surgeon General, Department
of Health and Human Services (Jan. 24, 1994), Pl. App. 2614.
9
Other documents cited by plaintiffs for their argument
that the working group reported directly to the President simply
do not support their argument. Pl. App. 1370 appears to be a
draft index for a Tollgate document. Pl. App. l651 simply refers
to a briefing by Mr. Magaziner of former working group
par~icipants.
Pl. App. 2499 and 2509 contain suggestions from
the authors for meetings with members of Congress. Other
documents cited, Pl. 991, 1771, and 2221, appear simply
irrelevant.
13
�----- -·---··--- ·-·---- --------
in excess of the EAJA cap, because defendants are guilty of bad
faith, this time because defendants allegedly improperly asserted
that the working group did not directly advise the President. 10
As the Court of Appeals held in this case, plaintiffs bear the
burden of proving their claims of bad faith by clear and
convincing evidence.
As discussed above, they have failed to
meet this standard.
In reversing the initial award of fees based on alleged bad
faith, the Court of Appeals stressed that "the substantive
standard is •stringent' and •attorneys• fees will be awarded only
when extraordinary circumstances or dominating reasons of
fairness so demand.'"
187 F.3d at 659 (citations omitted).
Implementing this high stanqard, the Court of Appeals held that a
party claiming bad faith must provide clear and convincing
evidence to prevail:
Further, the finding of bad faith must be supported by
"clear and convincing evidence, 11 see Shepard v.
American Broadcasting Cos .. Inc., 62 F.3d 1469, l47G-78
(D.C. Cir. 19.95), which "generally requires the trier
of fact, in viewing each party's pile of evidence, to
reach a firm conviction of the truth on the evidence
about which he or she is certain." Unit~d States v.
Montague, 40 F.3d 1251, 1255 (D.C. Cir. 1.994).
10
Plaintiffs also still appear to argue their claim that
defendants improperly argued that the working group was comprised
of full time federal employees. Pl. Br. at 22-23. The Court of
Appeals, however, was ruled that its "decision forecloses an
award based on the government's alleged assertion of the federal
employee exemption (whether for bad faith or under the EAJA) ••.• "
187 F.Jd 662.
14
�-a·v-·a·-
Id. (emphasis added) .
_ , . ..,..,. .•
--
-
. - . , - ._..,
Applying this
standard~
·---- ·---- -----
the Court must
''give the benefit of the doubt to the defendant.
11
Montague, 40
F.3d at 1255.
Plaintiffs' "evidence"·is insufficient on its face even to
support their claim, and hardly enables the Court to conclude
with any certainty, as plaintiff claim, that the entire Task
Force process was a sham and that the working group reported
directly to the President.
Plaintiffs' claim of bad faith rests
entirely on inferences from unauthenticated and out-of-context
documents, which, as discussed above, are either consistent with
the process as described by defendants throughout this case,
irrelevant, or directly contrary to plaintiffs' arguments.
Indeed, faced with direct testimonial evidence from Mr.
Magaziner and contemporaneous documentary evidence, such as the
GUIDELINES, which refutes their claims, plaintiffs• sole response
is to call the first a lie and the secorid a cover-up, without any
evidence to allow the Court to be "certain" that. plaintiffs are
right. 11
Epithets, however, are no substitute for evidence.
Rather, under the "clear and convinc=ing" burden of proof, where
evidence is disputed, the Court must "put that evidence in the
11
Plaintiffs' lack of evidence provides no excuse for
further discovery at this late date. Plaintiffs had a full
opportunity to take discovery on the issue of alleged working
group meetings with the President during the earlier phase of
this case and represented to this Court that no further discovery
was needed. Order, Oct. 28, 1994.
15
�-------...,-~~
defendant's pile."
Montague, 40 F. 3d at 1255.
At best, plaintiffs' evidence to support their claim on this
issue is even less substantial than that which the Court of
Appeals rejected regarding the previous finding on the
composition of the working group.
While we will not review the
substance of plaintiffs' prior claim that the working group
included members who were not federal employees, suffice it to
say that even defendants conceded that the difficulties of proof
made pursuing that defense untenable.
Even as to that claim,
however, the Court of Appeals found that the previous finding of
bad faith failed to meet the clear and convincing evidence
standard, in part, because there was no evidence that the
drafters and signer of the Magaziner Declaration "disbelieved"
its representations, 187 F. 3d at 661, or "intended to mislead
the court .... "
Id. at 662.
Absent from their customarily
vituperative brief and massive, nine-volume appendix is any
evidence of an intent to mislead this Court on this matter.
Without such evidenee, plaintiffs' claim of bad faith must fail.
III. Plaintiffs' Claims for Fees Under
the EAJA Should be Denied or Reduced
This Court previously awarded plaintiffs fees and costs
under the EAJA of $285,864.78, finding that defendants were not
substantially justified in their defense of this case arid that
plaintiffs were entitled to hourly tees above the
EAJA
cap until
August, 1994, because defendants had acted in bad faith.
16
Both
�-------- ·---·------
findings were predicated on the court's conclusion that
defendants• representations concerning the composition of the
working group were erroneous.
The Court of Appeals' decision on
that issue, however, expressly
11
forecloses an award based. on the
government's alleged assertion of the federal employee
exemption.
11
187 F.Jd a.t 663.
This Court must therefore review
the issue of substantial justification anew, .without reference to
or regard for the prior bad faith findings.
Such a review shows
that defendants' position was substantially justified.
Even if
this Court disagrees, however, the Court of Appeals• decision
requires that the prior award be reduced for plaintiffs' pursuit
of the now-foreclosed claim. 12
l. Under the EAJA, a plaintiff may not recover fees if the
defendant's position was substantially justified . . "[I]f a
reasonable person could think it correct,n Pierce v. Underwood,
487
u.s. 552, 560 (1988), a defendant's position must be deemed
substantially justified "even though it is not correct."
U.S. at 566, n.2.
487
Even if the government's position proves
untenable, EAJA fees may not be awarded unless the government
"had no reasonable basis for taking the position it took."
12
We previously argued, unsuccessfully in this Court, that
plaintiffs failed to prevail on their claims that the Task Force
was subject to the FACA, and that plaintiffs' refusal to settle
unnecessarily protracted thie litigation, contrary to 28 U.S.C. §
2412(d) (1) (E). While we continue to adhere to those positions
and believe them to remain open on remand, we rely on our prior
argument as to those issues.
17
�Public Citizen Hea1th Research Group v. Young, 909 F.2d 546, 552
(D.C. Cir. 1990).
See also Natural Resources pefense Council v.
Jamison, 8l5 F. Supp. 4Sl, 453 (D.O.C. 1992).
Plaintiffs' sole contention on this issue is that
defendants• position that the working group served as staff
function was inaccurate and that the entire Task Force structure
was a sham to mask the "organized, disciplined" operations of the
working group. 13
As shown above, it was entirely reasonable for
defendants to maintain that 'the Task Force was not an elaborate
facade to mask the secret operation of the working group.
Indeed, the .Task Force, consisting of senior government
officials, met on numerous occasions in the Spring of 1993 to
develop recommendations to the President.
26.
Third Magaziner Dec . •
That plaintiffs can find isolated references to meetings
between the President and working group participants is hardly
surprising, inasmuch such informal meetings did occur outs.ide the
13
As the Court knowst the notion that the working group was
organized or disciplined is laughable. Plaintiffs' opportunistic
advocacy cannot be made more plain by contrasting their current
characterization of the working group as organized and
disciplined with their prior portrayals of its irregular nature.
See, ~.g., Plaintiffs' Supplemental Memo. on Mootness at 5
(failure to maintain adequate membership or attendance records);
6 (failure to account for records); 7 {"lac::k of meaningful
record-keeping"); 11 (failure to document nature of meetings);
12-13 (failure to maintain adequate financial records) . Indeed,
plaintitfs' latest briefs puts on and sheds charac::terizations
when convenient .. Cf. Pl. Mem. at 20 (working group was designed
to be expert panel in which public could have confidence) with 45 (identities of working group participants deliberately kept
secret) .
18
�Task Force/working group process and care was taken to insure
that those meetings were not working group sessions.
Similarly,
as discussed above, that plaintiffs can point to isolated
documents showing that the working group was used to prepare
materials for submission to the President is entirely consistent
with its role as staff to a Task Force composed of high-level
government officials.
Indeed, if plaintiffs' theory that the
Task Force was a sham and that the working group directly advised
the President is credited, the only surprising fact would be that
plaintiffs can find so few references to support their argument.
Detendants were therefore substantially justified in arguing that
the working group did, indeed, serve as staff to the Task Force
and did not directly report to the President.
2. Even assuming that the Court were to disagree and hold
that defendants
~ere
not substantially justified, the prior award
must necessarily be reduced.
First, without any showing of bad
faith, plaintiffs are not entitled to fees in excess of the EAJA
cap.
Action on smoking and Health v. C.A.B., 724 F.2d 211, 217
(D.C. Cir. 1984).
The Court's prior award allowed for fees in
excess of the cap until August, 1994.
Those fees must be
reduced. 14
14
We calculate this reduction to be $15, 2 96. 10. This amount
would be reduced to $13,3~5.42 if the Court further eliminates
plaintiffs' fees for their claim that the working group was not
comprised of federal employees.
19
�--- --·
------ -
---
-·- --- -·- ...... ·-- . ----- ---....
Second, the Court of Appeals has foreclosed any award, even
under EAJA, based on plaintiffs' claim .that the working group was
not comprised of federal employees.
l87 F. 3d at 663.
Following
the first remand in this case, it is indisputable that, apart
from the settlement efforts and the litigation over mootness,
virtually all of the time expended by plaintiffs' counsel in this
case pertained to their claim that the working group was not
composed of federal employees and their efforts to sanction
defendants for their alleged misrepresentaeion of· that fact.
As
we noted originally, ·a plaintiff is not entitled to fees for
claims which were unsuccessful.
Hensley v. Eckhart, 461 U.S.
424, 435 (1983); Raton Gas. Transmission Co. v. F.E.R.C., 891 F.2d
323, 331 {D.C.
Ci~.
1989).
While this Court declined to parse
plaintiffs' claims previously for purposes of determining the
amount of the fee award, 989 F. Supp. 8, l4 (D.D.c. 199?), the
Court of Appeals has squarely ruled that no award may be made
under the EAJA for plaintiffs' claims regarding the composition
of the working group.
This issue was the focus of plaintiffs'
motions for summary judgment and for contempt against Mr.
Magaziner. 15
We calculate that a minimum reduction for
plaintiffs' claim regarding the status of the working group to be
15
As the Court knows, the same membership issue was also the
focus of the mootness phase of this ease. As the Court has
already denied our request to discount plaintiff's fee petition
for that issue, we have not included it in our current discount
calculation for the membership claim.
20
�e
$9 3 , 2 2 . 3
:a •16
IV. Plaintiff's Claim for Rule 11
Sanctions Must Be Penied
Plaintiffs' claim for Rule l l sanctions is also based on
their assertion that the Task Force process was a sham and that
the working group reported directly to the President, a claim
responded to above.
As with their prior Rule ll motion, this
current motion is procedurally defective.
Perhaps
e~en
more
importantly, their rhetorical excess fails to show a Rule ll
violation.
Rule ll(c) (l) (A) requires that, prior to filing a motion for
sanctions, a party serve that motion on the opposing party and to
not file the motion in Court for 21 days.
As with their prior
Rule 11 motions, plaintiffs have once more ignored this
requirement.
The importance of this requirement cannot be
overstated, as the focus of a Rule 11 inquiry is the
reasonableness of a representation at the time it was made, not
what a court later concludes to be true.
H~lton
Hotels CorP. y.
Banov, 899 F.2d 40, 44, n.7 (D.C. Cir. 1990): Threaf Props,, Ltd.
v. Title Ins.
co. of Minn., 875 F.2d
16
831, 835 (llth Cir. 1989).
This amount includes all identifiable fees for these
pleadings by Brown & Brown, then-lead counsel, and the Health
Hotline, which researched and prepared the Affidavit of Genevie~e
Young, to accompany these pleadings. It does not include an
amount for Webster, Chamberlain, then-local counsel, because
their bills do not identify their hours by pleading or subject,
and, as local counsel, were unlikely to have spent significant
time on this issue.
21
�--·-- -....
--~-·-
···~-
-··~-
Indeed, even where a representation is found to be inaccurate,
Rule
ll
does not require a prior filing to be withdrawn or
corrected.
Hilton Hotels, 899 F.2d at 44, n.6.
S~e
also Def.
Mem. in Response to Court's Inquiries, 10/5/95, pp. 30-32 and
cases cited therein.
Without identifying any particular stacement, plaintiffs
appear to argue that defendants were never justified in
representing that the working group served as staff to the Task
Force and consistently
~dvised
the President directly:
The government almost ab initio discovered that the
contentions made by Ira Magaziner and the government
relative to the composition and function of the working
groups were false and that not even under the most
ridiculous definition could it be argued that such
groupe were not providing advice to the President.
Pl. Brief. at 30.
This statement is startling in its temerity,
if not itself sanctionable, for several reasons.
Firat, despite
the conclusion by the Court of Appeals that there is a complete
absence of evidence to support their assercion, plaintiffs
nevertheless repeat again their now-discredited claim that the
Magaziner declaration's statements concerning the composition of
the working group was known to be false when made.
Second, the
Court of· Appeals has unequivocally stated that this issue is no
longer open on remand.
Third, the assertion that defendants knew
that the working group directly advised the President from the
outset bears no citation to the
recor~,
apparent reason that none exists.
22
perhaps for the now-
�We do agree with plaintiffs that "discovery demonstrated
that the working groups were clearly'involved in a structured
advisory process,
11
Pl. Brief at 30, albeit a structure which
included a deliberately fluid
working group functioning as staff
to the Task Force, including the preparing of background papers
or other materials at the direction of Mr. Magaziner or other
members of the Task Force.
Indeed, as discussed above, discovery
developed precisely that process and revealed that, when the
President requested to meet directly with some working group
participants, care was taken to insure that those occasions were
not part of the overall process and that working group
participants who did not engage in those informal meetings did'
not "feel circumvented.
11
Magaziner Dep. at 57.
Plaintiffs have
simply failed to demonstrate any right to sanctions under Rule
ll.
v.
Plaintiffs' Motion for Sanctions
Under Rule 37 Is Baseless
Plaintiffs' final argument is that they are entitled to fees
for the entire litigation under Rule 37 for defendants• alleged
improper assertion that the Task Force was a sham.
Plaintiffs'
argument has absolutely no foundation.
Rule 37 applies to discovery sanctions, not to pleadings,
declarations, or argument.
Plaintiffs do not identify any
discovery response which was improper or incorrect.
Rule 107(b)
Cf. Local
(requiring a party filing discovery motion as to
23
�unfiled discovery to recite the specific inquiry and response) .
Absent the identification of a specific response alleged to have
been improper, Rule 37 does not apply.
Similarly, to the extent
plaintiffs allege that defendants failed to supplement a
discovery response, it is incumbent on ehem to identify it before
defendants can be expeceed to reepond. 17
Rule 37 is simply
irrelevant to plaintiffs' motion. 19
Conclus~on.
Plaintiffs' prior attempts to utilize the same tactics
against defendants' to obtain sanctions have been judged by the
Court of Appeals to be legally and factually deficient.
repetition here is even less subseantial.
should
~e
Their
Plaintiffs• motion
denied.
Respectfully submitted,
DAVID W. OGDEN
17
The cases cited by plaintiffs do not support the .
proposition that Rule 37 sanctions can be granted outside the
scope of specific discovery requests. Murphy v. Magnolia Electri
Power Ass'n, 639 F.2d 232 (5th Cir, 1981) (failure to supplement
interrogatory answers; (Alimenta (U.S.A.). Inc. v. Anheuser-Busch
Companies. Inc., 803 F.2d 1160 (11th Cir. 1986) (same); Outley y.
City of New York, 837 F.2d 587 (2d Cir. 1988) (same); Campbell
Industries v. M/y Gemini, 619 F.2d 24 (9th Cir. 1980) (sanction
for improper ex parte contact with opponent's expert witness).
18
We understand the Court of Appeals' reference to Rule 37,
in discussing the scope of the remand, 187 F.3d at 663, to mean
the reduction of the previously-awarded discovery sanction by
this Court to an amount, not an invitation to the kind of misuse
of Rule 37 proposed by plaintiffs. see 187 F.3d at 657.
24
�---·-
-vul,-~g-~~
-.a;.;;J··~..,
·
-
-------- -- ---· --· ·-··-·
-·-··- ---
Acting Assistant Attorney General
WILMA LEWIS
United States Attorney
DENNIS G. LINDER
THOMAS MILLET
Attorneys, Civil Division
Department of Justice
901 ESt., NW
Washington, D.C. 20530
(202) 514-3313
Attorneys for Defendants
2S
TOTAL P.26
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
. 001. note
[Handwritten notes regarding the Ira Magaziner case]. ( 1 page)
n.d.
RESTRICTION
PS
COLLECTION:
Clinton Presidential Records
Counsel's Office
Oetken, Paul
OA/Box Number: 40308
FOLDER TITLE:
AAPS -Health Care Task Force
2006-0223-F
vz73
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)]
Freedom of Information Act- ]S U.S.C. SS2(b)]
PI National Security Classified Information [(a)(l) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute ((a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA[
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - --------------
�\
..:..
...
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
ASSOCIATION OF AMERICAN
PHYSICIANS AND SURGEONS, INC.
AMERICAN CO UNCD.. FOR HEALTH
CARE REFORM AND NATIONAL
LEGAL & POLICY CENTER,
Plaintiffs,
CIVIL ACTION
NO.: 93-399 (RCL)
v.
HILLARY RODHAM CLINTON,
DONNA E. SHALALA,
Secretary of Health aud Human Services, et al.
DefendaDts.
------------------------------'
PLAINTIFF'S MEMORANQYM OF POINTS AND AUTHORITIES
IN SUPPORT OF MOTION FOR AttORNEYS FEES AND COSTS
JJNDER THE EQUAL ACCESS TO JUSTICE ACT
Thomas R. Spencer. Jr.
SPENCER & KLEIN, P.A.
801 Brickell Avenue
Suite 1901
Miami, Florida 33131
(305) 374--7700 Tel.
(30S) 374-4890 Fax
Counsel for Plaintiffs
�STATEMENT OF THE CASE
1
A. Nature of the Case og Remand.
This case in on remand from the decision of the Circuit Court of Appeals, D.C. Circuit,
which reversed the award by this Court of$285.864.78 in attorney's fees and costs in favor of
Plaintiff AAPS based on the Equal Access to Justice Act (EAJA) and a finding of bad faith.
B. Issue before the Court.
The Court of Appeals, D.C. Circuit, framed the issue to be decided by the Court as follows:
(See 187 F.3d.655 (D.C. Cir. 1998):
\Vhile our decision forecloses an award based on the govenunent's alleged
assertion of the federal employee exemption (whether for bad faith or under the
EAJA), the district Court may, if it fmds the evidence so warrants, award fees
under the EAJA or Fed.R. Civ. P.ll based on another asserted defense (such as
the·goverrunent's argw:nent that the working group was not a FACA committee
because it ..d[id] not offer advice or recrommendations directly to the President,"
JA 120, which the record suggests may not be true, see, e.g., JA 2262). In
addition or in the alternative, the district Court may consider assessing the
sanctions (under Fed.R.Civ.P. 37) to which the Court found AAPS was entitled
in its November 9, 1993 order granting AAP's motion to compel. See AAPS,
837 F.Supp. at 354.
C. Statement of the Facts. the Proceedings. and Decisions.
On January 25, 1993, President Clinton appointed th~ First Lady, Mrs. Hillary Rodham
Clinton, as the Chairperson of the President's Task Force on National Health Care Reform. The
.
.
Task Force was charged with the responsibility ofdrafting and submitting to Congress the American
Health Secwity Act of 1993 within 100 days from the Inauguration. (DE 1; Ex.SS). Ira Magaziner
was designated to lead the advisory effort ofthe Task Force, the Interdepartmental Working Group,
1
Exhibit references are to Exhibits filed in Support of this Memorandwn and are referred
to as (''Ex. gg,_"). References to the Docket are ("DE _ " ) . The Exhibits, which are portions
·of the Record in this case, consist of 9 volumes, and are numbered sequentially by page.
2
�·and its individual Working Groups. He selected the participants with the advice of other
participants. staff, and the First Lady. (Ex. 1371,1376,2494,2500,2687) The Working Groups
planned the policy, met with and advised the President and First Lady and ultimately drafted the
legislation. (Ex. 1370,1382,1629,16Sl,l763,22SS,22S9,2278,2499,2S09,261S,2616,2689·3725)
Various members ofthe Department of Justice were assigned to the Working Groups to advise them
as their work progressed. (Ex. 2590,2683,2684,2688)
Mr. Magaziner submitted an organizational plan to the President on January 26, 1993,laying
· out a proposal to plan health care policy by utilizing a combination of federal employees, outside
health care experts, economists, ethicists, sociologists, la'W)'ers. doctors, and others. (Ex. 493-
652,717,933,1344-1350,1371,2491) Many were to come from health care organizations. (Ex. 493685). These persons were tightly controlled and organized into specific Working Groups identified
I
by specific issues. (Ex. 926,933,1376). Most of-the individual Working Groups were organized
with other Working Groups into "Clusters". (Ex. 493-68S,733t926). These Working Groups then
reported to Mr. Magaziner and to the President and the First Lady. sometimes through Cluster
. leaders and sometimes through representatives of the groups. (Ex. 932, 991,1025, 1382,1771,2544,
2616,2499,2214,2221,2229,2248,2250,2255,2262).
·Through an analytical process known as the Tollgate Process, the Working Groups each
developed and submitted advisory papers, which were then subjected to peer review and ultimately
developed into briefing books for the President and First Lady. Each working group was required
to pass the five scheduled Tollgates. (E". 733, 933, 952, 955,957, 981, 1009, 1138, 1150, 1451276), On Jariuary 27, 1993, the First Lady briefed the then members ofthe Working Croups on the
advisory process. (Ex. 949). As the process developed in February, 1993, numerous additional
3
�J 01'1 eJb 2eJeJeJ
L :> • :>:>
CXVlL:
DIY' 1 ........
I
e\01
,....,,
·persons were recruited from all over the country and assigned to the 41 various Working Groups and
15 Clusters, and the additional free-standing advisory groups~ (Ex.
1365~
1371,2218, 2248, 2491 ).
According to the first Lady,.over 1,000 of these people were working on the process by April29,
1993. (Ex. 1458,2210, 2682). Many of them never completed the paperwork required by the
federal govenunent under conflict of interest and other laws. (Ex. 616-63 7,683,684,685). Many were
unpaid volunteers receiving only expenses. (Ex. 657·682,1340,1529,1637-1638).
On February 9, 1993, AAPS sent a demand. pursuant to the provisions ofFACA, that it
receive notice of meetings and access to documents regarding the proceedings and meetings of the
Task Force and its components.
(Ex. 61). In response, on February 12, 1993. Bernard Nussbaum,
Counsel to :the President, ~sponded that FACA did not apply to the Task Force or the Working
Groups, contending that the Interdepartmental Working Group consisted only of"govemment
employees". He also claimed that the TaskForce reviewed the information provided by the Working
Group, but only the Task Force would make recommendations to the President. (Ex. 64). Mr.
.Nussbaum refeued AAPS to Mr. Steve Neuwirth or Vincent Foster in his office for further
infonnation. 2
A substantial procedure was developed within the Working Groups to maintain secrecy of
the proceedings. the names and origins of the participants, and the development ofthe Plan. (Ex.
961,1378.1457,1529.1534,2247,2369,2608). WorkingGroupmemberswereforbiddentotalktothe
Press. (Ex. 928,948,2247). Even the list of members of the Working Groups was a closely held
secret. (Ex. 923,1457, 1529). According to the White House, this was to shield the participants from
2
The same Jetter was sent on February S, 1993, to Representative William Clinger,
Committee on Governmental Operations. (Ex. 75, 76).
4
�44
lobbying,, (Ex. 2484, 2463-2486, 2608).
1.
Initial Litigation in this District Court.
On February 24, 1993, AAPS,joined by ACHCR and NLPC, conunenced this action in this
district court. (DE 1; Ex. 38). Plaintiffs sought the entry of a temporazy restraining order and a
preliminary injunction seeking ~ompliance with the provisions ofFACA. (DE 4; Ex. 38). In
response, the government contended that the Task Force was not subject to FACA because it was
composed wholly of full time officers or employees of the federal govenunent. (DE 9; Ex. 94). The
goverrunent further argued that the Interdepartmental Working Group also :was not subject to FACA
because it performed strictly staff functions for the Task Force, such as research, and performed no
advisory functions. It contended that only the Task Force advised the President. (DE 9; EX. 94, 120,
1763).It represented to this court in its initial papers that the Working Groups also were composed
solely of federal employees. (DE 8,9).
At the time the government made these representations to the district court, and unknown
to the plaintiffs or the district court, a meeting schedule was being set up for various members of
the Working Groups to meet with the President. (Ex. 921, 1651, 22SS. 2259, 2615). Indeed.
Working Group members reflected that some of the groups or persons on the groups were meeting
with the President during the height of Working Oroup activity. "every night". (Ex. 1382,2248,2255,
2259, 2260, 2262, 2250). In response to this litigation, Mr. Magaziner requested that "guidelines"
be drawn up for the meetings with the President. (DE. 169;Deposition oflra Magaziner, at 37; Ex.
920, 1382, 1629, 2229, 2262).
To support their request for a Temporary InJunction, plaintiffs sought discovery as to the
government's defenses and factual representations.
s
I
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(DE. 7; Ex. 79.174).
The government
�- ------·--- ----- -· . -··-p --
successfully resisted the discovery requests, making representations to the Court about the prejudice
to the important work ofthe Task Force and its Working Groups. (DE 8; Ex. 82, 152, 157).
Moreover, allegedly to assuage the plaintiffs' concerns, and to support its position, the government
filed on March 3. 1993, a Declaration of Mr. Magaziner (Magaziner I) which purported to describe
the function and composition of the Task Force and the ulnterdepartmental Working Group". {DE
9; Ex. 130, 132). It also made representations to the Court as to the function and activities of the
Working Groups. (DE 9; Ex. 135, 94,128). The Declaration was prepared by the White House
CoWlSel's Office (Stephen Neuwirth) under guidance from Vincent Foster, Ms. Nolan, Mr.
Magaziner and his staff at the White House. It was reviewed by three attorneys in the Federal
Programs Branch ofDOJ Civil Division and by Associate Attorney General, Webster Hubbell. (DE
201 at 37). ·
I
Mr. ~agaziner claimed in Magaziner I that the Working Group was charged only with
"gathering information concerning the impact of existing health care policies and delivery services,
and possible alternatives to those policies in order to assist the Task Force in developing
comprehensive health care reform legislation". (Ex. 135). He stated that while "(t]he information
that is gathered and analyzed by the working group will be used • • • by the Task Force in
formulating its recommendations to the President,"3 the Working Group "is not charged with
responsibility for making, and will not make, recommendations to the President, and will not
otherwise directly advise him". (Ex. 134). Mr. Magaziner also noted that the Working Group had
,.
I
3
No Task Force Advisory Report to the President was ever produced in public or to
plaintiffs. Instead, at least 30 Briefing Books for the President were prepared by the Working
Groups. (Ex. 945-947, 1305). Two Summary Books for the President were prepared {Ex.l306)
and five Tollgate Books. {Ex. 1305). See Ex. 961, 1768-1770.
6
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been divided into a number of 44cluster" groups to address specific health care subjects, and that
several of the cluster groups had been further divided into smaller "subgroups". (Ex. 138).
Finally, in a sentence that became one of many c:oncems to the plaintiffs, he attested.that
"{o]nly federal government employees serve as memben of the interdepartmental working
group". (Ex.135). 4 The Declaration explained that the employee members of the Working Group
fell into two categories: (I) "full-time, permanent employees" working for the executive branch or
congress, ibid.• and (2) ''special government employees" who were "employed by an agency or the
Executive Office of the President for less than 130 days in a 365-day period, with or without
compensation." (Ex. 136). He claimed there were only 40 such SGEs. (Ex. 136). In addition,
the Declaration stated that the Working Group had ·~etained a wide range of consultants, who attend
Working Group meetings on an intennittent basis, either with or without compensation". Magaziner
'
represented that these "consultants", who came from a ''wide..range ofbackgrounds", did not have
"any supervisory role or decision-making authority, • • • but instead provide information and
opinion to the Working .Group members."
Mr. Magaziner claimed that he had arranged for the full-time permanent federal employees
to be informed "that they are subject to the conflict of interest provisions set forth in 18 U.S.C. §§
202-209 the Standards of Ethical Conduct for Employees of the Executive Branch; and all related
ethics laws and regulations," (Ex. 136), and for the special government employees and consultants
to be informed that they were subject to ••a limited version" of the same provisions. (Ex. 13 7).
He maintained that "(a]s of March 1, [1993), approximately 300 such permanent employees" and
4
The government successfully contended on appeal that it ,nsm really advanced the ''all
employee" argument before this court. 187 F. 3d. 655 (D.C. Cir. 1998).
7
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uapproximately 40 such special government employees were serving as working group members.,
(Ex. 136). He said that he was .the only member of the Task Force to attend meetings of the
Working Groups. (Ex. 139).
2.
The District Court's 1993 FACA DecisioD.
On March 10, 1993, this district court entered a partial preliminary iqjunction against the
Task Force's operations, but granted the government's motion to dismiss plaintiffs' claims against
the Working Group. 813 F.Supp. 82, 95.
The district court rejected the argument that F ACA •s full-time federal employee exemption
applied to the Task Force. It concluded that the First Lady was not an officer or employee of the
United States. 813 F.Supp. at 88. The court held. however, that to the extent that the Task Force
..
directly advised the President on legislation, the Task Force was constitutionally immune from·
•
FACA's requirements. Id at 92. The district court therefore refused to enjoin Task Force meetings
"which are held for the purpose of formulating advice an~ recommendations for the President.'' Id.
at 95. By contrast, the court determined that the Working Group and its various components were
not subject to the FACA because they were "gathering information and formulating proposals to be
reported to the Ta.$k Force," and were "not providing the Task Force with 'consensus advice':· Id.
at 89. (Emphasis added), Both sides appealed.
Meetings with Cluster leaders, Working Group members, and President Clinton occWTed in
March and April1993. (Ex. 988, 1025, 1629,2229,262, 2487). On March 29. 1993, the White
House released to the Press a list ofFTEs, SGEs, and consultants on the Working Groups. Over 300
FTEs, over 80 SGEs, and approximately 17 consultants were listed. (Ex. 1455, 2350..2363). (See
Ex. 1529). The work of the various Working Groups proceeded with option papers presented to the
8
�President in April, 1993. (Ex. 977,2528, 2531,253 7,2544). In late April, 1993, in response to a
FOIA request by Public Citizen's Congress Watch, Mr. Magaziner declared that all records created
by the Working Groups were Presidential Records and that DOJ was tasked to keep them :from the
public. He set out the required procedure. (Ex. 977, 1383). Various "review," '"audit," and
"drafting" groups, pan of the original Working Group plan, worked through June 1993, refining the
options prepared by the other Working Groups. (Ex. 1341, 1342, 1352, 1631, 1651).
According to Mr. Magaziner and his secretary, the Task Force disbanded in May, 1993 (DE.
179,180,1685, 1775), and the Worldng Groups allegedly ceased operations around the same time.
(DE. 179,180, Ex. 1533,1535,1537, 1543,1575,1631) They testified that another Working Group,
~'::Imposed of some of the s~e peop\e as the "Interdepartmental Working Group.. operated over the
summer of 1993, drafting the final legislative proposal. (DE. 179, 180). (Deposition of Magaziner,
'
at 14, 59). (Ex. 1685.1651-1658, 1761, 2211).
3,
First Appellate Proceedings.
The Court of Appeals, D.C. Circuit, held oral argument on April 30, 1993 (Ex. 199, 306),
and reversed the district Coun on June 22, 1993, holding that the First Lady is the functional
equivalent of an officer or employee of the federal government and that FACA therefore did not
apply to the Task Force, The opinion stated that FACA dQCs not apply to unstructured arrangements
in which the govenunent seeks advice from what is only a loose collectio~ of individuals who do not
significantly interact with each other. The Court held that discovery was necessary to determine the
:functions and. operations of the Working Groups and the relationships ofso·called Special
Governmental Employees to the Working Groups. The case was remanded for further proceedings.
9
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.
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997 F.2d 898 (D.C. Cir. 1993).
4.
The Proceedings After Fint Remand.
Immediately after remand, the govenunent adopted a "wandering horde" defense based on
language in the Circuit Court's opinion. It attempted to paint the highly disciplined, highly
structured advisory process as unstructured, fluid and disorganized. (DE. 63,73,77). Through the
Swruner and Fall of 1993. contentious discovery litigation ensued. (DE. 63,70, 71, 73, 78, 80).
Most ofthe documents ofthe Working Groups, contended to be Presidential Records, were scattered
in various departments, and across the country with the Working Group me~bers. (Ex. 1972-1979).
At the same time, DOJ embarked on a strategy to make the documents produced
by the Working
Groups not subject to FOIA (Ex. 1981, 1982, 2588)s and "stonewalled" plaintiffs in discovery. (DE.
77-80, 83, 84).
On July 18, 1993. in response to discove'ry motions and other assertions of the plaintiffs, Ira
Magaziner submitted a second Declaration (Magaziner II). (Ex. 302). Among other things,
Magaziner asserted: ''the interdepartmental working group was not c:harged with responsibility for
making~ and
did not make recommendations to the President, and did not otherwise directly advise
him." Instead, Magaziner asserted: The Task Force had presented to the President a comprehensive
set of proposals and options for health care reform legislation. (Ex. 302). No Task Force Report or
"comprehensive set of proposals and options of the Task Force" has ever been made public or
produced to plaintiffs. In the Fall of1993, the legislation was submitted to Congress (Ex. 1759) and
5
Mr. Jeff Gutman who, at the time was handling this case for the DOJ, wrote on July 9,
1993, to various departments concerning this case. He wrote concerning potential FOIA requests
for Working Group docwnents: "To enhance our litigation position should a requestor file suit,
we offer a number of suggestions...." (Ex. 2588).
10
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briefing meetings of the Workmg Groups were called by Mr. Magaziner. (Ex. 1531, 1759).
On November 9, 1993, this district Court issued Orders on the plaintiffs' motion to compel
discovery. 837 F.Supp. 454. (Ex. 334).
As this district Court observed, the government had engaged in egregious tactics designed
to obstruct adequate discovery. The govenunent had provided incomplete infonnation, inadequate
information and had "improperly thwarted plaintiffs' legitimate discovery requests." ld. at457, The
Court condemned the tactics, noted that certain responses were "preposterous," and warned that the
Court ~~will not tolerate it in future responses in this case." The Court n~ted the imporiance· of the
government's argument with regard to the ethics laws. Id. at 459. It observed that Mr. Magaziner
had taken pains to stress the fact that every member of and consultant to the group was required to
'file a fman~ial disclosure ·statement and to comply with other requirements of federal laws. The
district Court noted that plaintiffs were entitled t9 discovery into the truth of the Magaz.iner Affidavit
on this point, as well. Id. at 456.
The district court granted the motion to compel and awarded attorneys fees and costs, but
did not assess them. ld. at 458. (Ex. 389).
The parties continued to develop discovery, punctuated by various motions. While President
Clinton expected the Bill to be enacted quickly, it began to stall in Congress. In the Spring of 1994,
both sides filed extensive motions fo:r summary judgment. (DE.ll7-132). In their motion for
sununary judgment, the plaintiffs sought a declaratory judgment that the Working Groups, their subg~oups
and the other advisoxy groups were subject to FACA, and sought the disclosure of the
Groups' documents. The government resisted this argument, contending that the Working Groups
had none of the organization or structure contemplated by FACA and this Cowt. It stated that while
11
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15:57
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it had previously contended that the Working Groups consisted only of governmental employees,
person-by~person
analysis would be burdensome. It argued that the groups were an amorphous
"horde". Only for summary judgment pUl'poses did it avoid, but it did not concede, the na11
employee" exemption. (DE. 128).
Plaintiffs submitted extensive exhibits, which they obtained through discovery and
investigation; (DE 107). Much of the material was ncit produced by the govenunent but obtained
at a tax-exempt foundation center library and through other means. (DE. 107; Ex. 471 ). Extensive
lists of participants were produced by plaintiffs. (DE. 107). The government was successful in
having all agendas and minutes of the Working Groups it produced "sealed" from public view. (DE.
86,90). Plaintiffs moved for a contempt proceeding against Mr. Magaziner. (DE. 124).
The.cross-motions "for s~azy judgment filed in May 1994, were heard on July 25, 1994.
(Ex. 743). In support, the government submitted a Third Declaration ofMagaziner (Magaziner
III). (Ex. 701). In it, Magaziner reiterated the position that he had taken in the previous two
Declarations, but admitted for the first time the President had attended "some"' meetings with
members of the Working Groups. Howevert he contended that no consensus advice
was given
directly from any Working Group to the President. (Ex. 711,1337,2689-3726,2214, 2616).
This Court denied all motions for summary judgment and set the case for trial.
Settlement discussions occWTed, but did not result in a settlement even though the district Court
recommended settlement to the parties. (DE. 140, 144, 147, .189).
After the American Health Security Act bill failed in Congress, the President decided in
Augus~
1994, to release some of the documents of the Working Groups and place them for public
view at the National Archives. (Ex. 917, 1284, 1286, 1336). At the same time, the goverrunent
12
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announced that it would move to have the case dismissed as moot. (DE. 154; Ex. 867). The
. government also requested an expedited "ruling.. by the Court that Mr. Magaziner had not co~itted
a contemptuous act. (Ex. 839). The Court stated that such a determination would require a trial
of the entire case on the merits, which was set for December, 1994. (DE. 148). It denied the
government's motion for summary ruling on Mr. Magaziner. (DE. 157; Ex. 1387).
Thereafter, various proceedings ensued, including additional discovery relating to
11
mootness." (DE. 152-171 ). The govenunent produced various lists ofWorking Group participants,
which increased in number after each hearing. (Ex. 1287~1304, 1305-13.34, 1503·1527). Finally,
'
a list of over 614 persons and over 400 boxes of materials were produced by the government at the
I
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\
National Archives and to the Court. (Ex. 1389-1452, 1670-1674). Over 40 boxes of additional
materials were collected by defendants from Working Group members from around the country .
during the "mootness" argwnents .. (Ex. 1978, ~1980). Plaintiffs successfully contended that the
government was not making full disclosure available to the public of the documents which would
be disclosable under FA CA. (DE. 168). In fact, the government finally admitted (after plaintiffs
discovered Working Group documents produced after the alleged disbanding of the Working
Groups) that it had removed from various boxes of materials supplied to the National Archives,
certain relevant records, including those produced after May, 1993. (Ex. 1447). The Court
conducted an extensive in camera inspection of these materials, wJ:Uch was substantial (13 boxes).
(DE. 168). The government thereupon agreed to make these removed documents public. (DE. 172;
Ex. 1670-1673). After additional hearings (DE 173), and further public release of documents and
computer disks (Ex. 1675-1678), the Court dismissed the case as moot. 879 F.Supp. 103.
In dismissing the case, the district CoW1 stated that it was concerned about the defendants'
13
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'6
conduct during the litigation;
"The Court understands plaintiffs' frustration with the defendants'
misconduct during the course of this litigation and the Court intends to
impose sanctions here." 879 F.Supp. 103.
In its dismissal Order, the district Court turned to the issue of Magaziner I, government
misconduct, and the plaintiffs' motion for fees and costs. 879 F.Supp. 106. The district Court
observed:
Both sides agree that dismissal of this case moots the question of possible
civil contempt of Court raised by plaintiffs against Ira Magaziner.
The Court further observed that a serious question was raised as to whether Mr. Magaziner
had committed the criminal offense of contempt of Court, perjury and/or making a false statement
when he signed Magaziner I on M~ch 3, 19993 ..that led this Court to initially dismiss the claim for
.
records of the iinerdepartmental working group." 879 F~Supp. at 107. The Court then referred the
..
maner to U.S. Attorney Holder and to the Attorney General for the possible application of the
Independent Counsel Act. A further status conference was scheduled. (DE. 181).
After a newspaper article quoted criticism of the district Court from the White House
Counsel's Office (Joel I<lein) for the referral to the U.S. Attorney and for allegedly not providing
a civil contempt hearing to Mr. Magaziner, the Court on January 9, 1995, sua sponte held an in
camera conference with plaintiffs' counsel form DOJ, including Frank Hunger, Assistant Attomey
General and head of the Civil Division. At the conference, the district Court questioned the Attorney
General's representatives as to whether the Court had misunderstood their representations about
wanting to ''moot" the case and avoid a civil contempt proceeding regarding Mr. Magaziner. Mr.
Hunger announced that DOJ was no longer representing Mr. Magaziner for purposes ofthe criminal
14
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15·58
investigation, and that Charles F.C. Ruff was counsel for Magaziner. The conference was then
adjourned. (DE. 222).
On January 17, I 995, the Court held another in camera meeting with representatives of the
U.S. Attorney and with Mr. Charles F.C. Ruff, and a separate meeting with plaintiffs' counsel and
the government to give Mr. Magaziner and the government another opportunity for a civil
proceeding. The Court then announced in Open Court on the same day that it had offered Mr.
Magaziner a civil hearing before the Court and that Mr. Magaziner had declined. {DE. 223; Ex.
1985). This fact was widely circulated in the Press. (Ex. 1985). On Januazy 25. 1995. the Court
deferred consideration of fees and sanctions and stayed the case until after the criminal investigation
was completed. (DE. 181 ).
On August 3, 199S:Mr. Hold~r presented a letter to the Court which outlined his conclusions
concerning the criminal investigation. (DE. 196; Ex. 1988·2006). The Court thereupon held a
hearing on August 11, 1995, regarding the Holder letter, and requested submissions from the parties
on the issues of fees and sanctions. (DE. 189). The Court requested the govenunent to provide it
with additional information regarding the preparation of Magaziner I and various representations
made to the Court during the litigation. The Court requested further submissions from the plaintiffs.
(DE. 189;201; Ex. 2007).
As a result of comments made by the Court, Mr. Holder felt it necessary sua sponre on
August 30, 1995, to
explain his previous letter to the Court. (Ex. 2030). In it, he indicated that
he had not intended to convey to the Court any conclusion on his part that the government had ·
intended to misrepresent facts to the Court. (Ex. 2030). None of the purportedly "extensive''
statements, the "five hour•• interview with Magaziner, and interviews of the other witnesses or other
15 -
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factual materials Mr. Holder said resulted from his investigation were provided to the Court.
5.
This ·court's decision on Fees and Sanctions.
Finding merit in plaintiff's position, this Court entered an award of$285,864.78 in attorneys
fees and costs. The Court held that AAPS was the prevailing party in this litigation and that the
position of the United States in tltis litigation was not substantially justified, because it litigated in
bad faith, See 989 F.Supp.8.
6.
The Second Appeal.
Defendants filed and successfully prosecuted an appeal of this Court's fees and costs award.
The Court of Appeals, D.C. Circuit held that this Court's bad faith findings were in eiTor and that
the government did not really rely or argue the ''all employee" defense that the plaintiffs (and the
•.
'
..
court of appeals) said it argued.
t
~187
F.3d.655.
16
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.
ARGUMENT
1.
THE GOVERNMENT CANNOT AVOID THE APPLICATION OF EAJA BY
MOOTING A CASE THROUGH TOTAL CAPITULATION ON THE EVE OF
TRIAL WHEN ITS POSITION WAS NOT SUBSTANTIALLY JUSTIFIED.
A. Plaintiffs Were the Prevailing Parties.
A party may be deemed "prevailing" if it obtains a favorable settlement of the case, if it
achieves a voluntary dismissal of a groWidless complaint, or even if it does not ultimately prevail
on all issues. See Naekel v. DepartroentofTransp.. Fed. Aviation Admin., 884 F.2d 1378 (Fed. Cir.
1989) (discharged air tmffic controller who prevailed on four out of six issues on appeal was
..prevailing party"). Moreover, the legislative history makes clear that the tenn '"prevailing party'
should not be limited to a victory only after entry of a final judgment following a full trial on the
riierits." H.R.Rep·. NO .. l4'18. 96u. c'ong. 2d Sess. 11. Thus. to detennine whether a party has
"prevailed," a Court should look to the substance. 9fthe litigation and whether the merits of the claim
materially alters the legal relationship between the parties by modifying the defendants' behavior in
a way which directly benefits the plaintiffs. Cooper v. United States Railroad Retirement Board, 24
F.3d 1414 (D.C.Cir. 1994); F.J. Vollmer Co .• Inc. y. Magaw, 102 F.3d 591, 594 (D.C.Cir. 1996).
See Green v. Bowen, 877 F.2d 204 (2d, Cir. 1989) (claimant awarded benefits following disrnissal
was ''prevailing party"); See also Devine v. Sutermeister, 733 F.2d 892 (Fed. Cir. 1984) (union
awarded attorneys fees as prevailing party though consent decree entered).
A plaintiff may be a prevailing party for EAJA purposes where the suit has been rendered
moot by virtue of granting ofthe requested relief. See Fosterv. Boorstin, 561 F.2ci 340.342-343
(D.C. Cir. 1977); Jones v. Luian, 883 F. 2d 1031, 1033 (D.C. Cir. 1989). According to Hensley v.
Eckerhart, 103 S.Ct. 1933 (1983), a plaintiff may be considered a ..prevailing party" if it succeeds
17
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.
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on any significant issue in the litigation which achieves some of the benefit it sought in bringing suit.
103 S.Ct. at 1939, quoting Nadeau v. Helgemoe, S81 F;2d 215, 278~279 (1" Cir. 1978); Lundin v.
Mecham, 980 F.2d 1450 (D.C.Cir. 1992); Ootches v. Heckler, 773 F.2d 108 (71h Cir. 1985) (widow
whose benefits were canceled was the ''prevailing party,. where benefits increased significantly after
lawsuit lawsuit was filed), amended, 782 F.2d 765 (7r.h Cit. 1985). As this Court found here,
"(t]his total capitulation by the United States necessarily resul~ in the inescapable conclusion that
plaintiffs prevailed in this litigation.'' 989 F.Supp. 8, 13. See Lundin 980 F.2d at 1459. See also
Montes v. Thombprgh, 919 F.2d 531,538 (9r.h Cir. 1990)("[T]he case became moot only because
appellee 1 s achieved their objective, and this objective was achieved because of appellee's suit.").
Accordingly, Plaintiffs were necessarily the prevailing party to this litigation.
.
'
B. The Government's Position Was Not Substantially Justified.
\
In Pierce v. Underwood, 108 S.Ct. 2541 (1988), the United States Supreme Court set forth
the standard by which to judge the government's position in EA.JA disputes:
["substantially justified" does not mean] ''justified to a high degree," but
rather "justified in substance or in the main'' - that is, justified to a degree
that could satisfy a reasonable person. That is no different from the
reasonable basis both in law and fact formulation ....
108 S.Ct. at 2550. (Emphasis added). In fact, fees are generally awarded only when the govenunent
offers "no plausible defense, explanation, or substantiation for its action." Sec. Beta Systems.
Inc. v. United States, 866 F.2d 1404, 1406 (Feel. Cir. 1989) (fees awarded when government
provided no plausible defense or explanation for its position); Tr;ilian v. Brady. 907 F.2d 121 S, 1218
(D.C. Cir. 1990).
Defendants, position was not substantially justified in fact or in law. and no reasonable
18
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person reviewing the case today could conclude that the test in Pierc:e v. UndeiWood, small's Supra.
was met by the government. See F.J. Vollmer, supra at 595. Whatever the application to this case
ofNational Anti-Hunger Coalition v. Executive Committee, 557 F. Supp. 524 (D.D.C. 1983), aff'd,
711 F.2d 1071 (D.C. Cir. 1983), the analysis of this c:ase by this Court was based upon a set of
represented facts which did not exist.
Defendants presented as a fact to this CoUrt that all members of the Working Group were
ufederalized" and that the group was merely acting as unstructured non-advisory federal "staff'.
These were their very first representations on March 3, 1993, and it were r~lied upon by this Court
to formulate its view of the facts. It was repeated time and again by government lawyers and Mr.
Magaziner.
The government should rec:ogruze that the bW'den is on it to demonstrate substantial
justification for its position both in law and in fac~. Janes v. Lui an.. 887 F.2d 1096, 1098 (D.C. Cir.
1989); Hanover Potato Product§. Inc. v, Shalala, 989 F.2d 123 (3d Cir. 1993). Pursuant to 28 U.S.C.
§ 2412 (d)(2)(D), ''the position of the United States'' includes not only the position taken in the
litigation, but the agency position (here the Executive Office ofthe President) that made the litigation
necessary in the fJISt place. See Lundin 980 F.2d at 1459. See also Hanover, 989 F.2d at 128.
This litigation was not necessary. The Working Groups were clearly a federal advisory
committee (or committees) providing organized consensus advice and the government's factual and
legal position as to activities, pUipose, function, organization and character of the groups and their
utilization was misrepresented to plaintiffs, Congress, and the Courts.
The government's position, supported by direct representations to the Court that the Working
Groups were federal interdepartmental staffand not providing advice to the President and First Lady,
. 19
�••
was simply fiction. Included as filings in support of the Motion for Sanctions. Plaintiffs have
supplied this Cowt with numerous examples of the advisory products of the Working Groups-a
paradigm advisory conunittee. (DE. 205, 107). This included samples ofthe Briefing Books
for the President prepared by each Working Group. Also included were schedules for meetings of
the Working Groups with the President and reports on the meetings. (Ex. 2214, 2680). Ultimately,
in order to "moot'" the caseJ the government even supplied the public with the Briefing Books for
the President and the Tollgate Reports. (DE. 205; Ex. 2680).
The rigid procedure and structured meetings, reporting and briefing system including me
"tollgate" process belies any possible reasonable suggestion of a wandering undisciplined "horde''
advising the President. (Ex. 926, 165 1). In fact, the picture projected in writing to the public and
•
"
•
f
to Congress was that of an organized, disciplined. wide-reaching and independent panel of fede~l
medical experts upon whom the President, Congress, and the public could rely and have confidence
to restructure the entire health care system· 14% of the American Economy. (Ex. 657-682, 24832488).
2. PLAINTIFF'S FEE REQUEST
This Court has previously detennined that AAPS is an eligible, prevailing party, a concept
which the government did not contest on appeal. The government also did not challenge on appeal
the eligibility wtder EAJA of AAPS, or the calculation of the fee award. Plaintiff, AAPS, did not
contest or appeal the reductions and calculations of the fee award which was $285,864.78. This fee
request is again renewed by AAPS.
3. THE GOVERNMENT LITIGATED IN BAD FAITH
AAPS is entitled to fees and costs under EAJA if the Court finds that the government's
20
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position was not substantially justified. AAPS is entitled to some fees in excess ofEAJA rates.
however, because the government litigated in bad faith. Courts will award fees under the bad faith
exception if the conduct giving rise to the sanction occurs either before or during the litigation
process. Hall v. Cole, 93 S.Ct. 1943, 1951 (1973). American Employers Ins. Co. v. American Sec.
Bank. 747 F.2d 1493, 1502 (D.C.Cir. 1984). See a}so Alveska Pipeline Service Co. v. Wilderness
Sociew, 95 S.Ct. 1612, 1622 (I 975). Thus, wanton or 'vexatious actions occurring during the course
of litigation give rise to this common law exception. Such actions occurring during the course of
litigation give rise to this common law exception. Such actions occ~g during the discovery
process have also been held to justify a shift of fees. See American Hosl!ital Association v. Sullivan,
938 F.2d 216,220 (D.C. Cir. 1991). FritZ v. Honda Motor Co .. Ltd., 818 F.2d 924 (D.C. Cir. 1987),
If a party through the course 'of litigation proffers a position whieh has no foundation in law
or fact or postulates a claim or tactic whose putp~se is to harass or obstruct the judicial pro~ess, the
Court can assume that such actions were taken in bad faith. With this determination in hand the
Court can then, utilizing the common law exception, shift fees to that party. American Hospital v.
Sullivan 938 F.2d at 220. Here, not only did the government act in bad faith initially (by
misrepresenting facts concerning a clearly FACA committee), but in the litigation as well.·
By deliberately failing to produce all the responsive documents requested by plaintiffs, by
failing to comply with the mandates of the discovery rules, by misrepresenting crucial facts solely
within its possession, and by failing to correct its mis·characterizations, the government showed its
clear intent to delay tbe truth finding process for purely political purposes, harass AAPS and try to
win by tactics of attrition. This is classic bad faith.
A. Magaziner I Was False and CosmetlcaUy Contrived.
21
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Upon the filing ofthe Complaint herein. Plaintiffs, sought to develop a factual record to show
that FACA was being violated. The Declaration of March 3, 1993, by (Magaziner I) was submitted
to avoid discovery and live testimony, and to manufacture a factual basis for Defendants' positions.
The government says (which argument was accepted by the appellate Court) that it never "really
argued" the federal employee exemption argument for the Working Groups, it was in fact
represented under oath to this Court.
While on March 3, 1993, Mr. Magaziner confidently presented under oath to this Court an
interdepartmental group of federal employees organized into three neat categories in a "staff"
scenario. the truth was really that the groups and the process were designed not just as "fact
gathers", but as analytical "tollgates, preparing options for the President and First Lady through a
••
.
I
deliberative process leading to direct advice to and feed-back from the President. Actually, the
Working Groups effectively drafted the Health .Secwity Act. {Ex. 750-831 ).
Indeed, Magaziner told Congress through a "handout" at a Congressional briefmg that:
In the most open poliq making process in history, more than 500 people
from all over the country are direc~ly involved in developing policy within the
working groups. (Ex. 933). (Emphasis added)?
Furthermore, the government attempted to disguise the activities and functions ofthe groups
when making representation to the Court:
In their March 3, 1993, Memorandum in Opposition to Plaintiffs' Motion for Temporary
Restraining Order, the government represented (F.N. 25, page 31):
If plaintiffs are concerned that working group members have met with Mr.
Magaziner, such meetings would not be covered by FACA. All working group
members, like Mr. Magaziner, are federal employees. Magaziner Decl., 11.
Moreover they said, at page 34:
22
�...
Here, the working group and its ''cluster groups" gather and analy~ the enonnous
body of facts and opinion relating to aspects of our health care system. Magaziner
Dec!. ft S, 10, 19. The working group merely obtains and analyzes infonnation; it
has no authority to furnish advice and recommendations directly to me President /d.
Whether or not Task Force members attend working group meetings, because the
working group does not offer advice or recommendations directly to the President,
they are not FACA committees.
Similarly, Defen~ants filed on March 3, 1993, a Statement of Material Facts As to Which
There is no Genuine Dispute: (Page 3):
10.
The worlcing group is not charged with the responsibility for making and will not
Il'l8.ke, recommendations to the President, and will not otherwise directly advise him.
11.
The working group, which contains approximately 340 members is comprised solely
of federal government employees.
Meanwhile, Plaintiffs. in seeking preliminary discovery, freely admitted that:
Bec~use of the secrecy which surrounds the Task Force, I have no knowledge of those who
sit on the aforementioned "interdepartme~tal working group~· or any of the cluster groups or
subgroups .... (Page 3,1 9), Declaration of Brown. (DE 7. 10, 12, 13).
Plaintiffs challenged the assertion that "only federal government employees serve as
m~mbers
of the interdepartmental working group," See Page 3 of Declaration of Brown, March
2, 1993. (DE 12). Plaintiffs asserted that they needed discovery and testimony regarding the
composition and funetions of the Working Groups. But in their Opposition to Plaintiffs, Request
to Present Live Testimony, defendants asserted: (March 2, Page 2) (DE 8):
On February 25, counsel for plaintiffs provided the Wldersigned a written list of
categories of information they regarded as relevant to the Court's consideration ofthe
motion for a TRO. As explained to plaintiffs' counsel on several occasions since
then, defendants are preparing a comprehensive declaration of Mr. Magaziner that
will be provided in support of their opposition to plaintiffs' motion for a TRO.
Defendants' papers will be filed and served by the close ofbusiness on Wednesday.
March 3.
23
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Although little of the factual information sought by plaintiffs bu any legal
siguificance here, the declaration will provide substantially all of the information
requested by plaintiffs and will discuss the more limited categories of infonnation
now sought in testimony. Moreover. counsel for defendants agreed to provide
plaintiffs' counsel a summary of the declaration by mid-clay today to assure him that
a full explanation of the facts plaintiffs believe are relevant to this action will be
presented to this Court.
Under Local Rule. 205(d), the Court may decline to hear live witnesses at a
preliminary injunction hearing if their need is outweighed by considerations of
"waste of time, or needless presentation of cumulative evidence!' Beca\lSe the.
testimony sought by plaintiff will largely duplicate the infonnation that will be set
forth in his forthcoming declaration, no need exists for Mr. Mag82iner' s cumulative
testimony.
·
The Court denied Plaintiffs' request to take discovery and issued its di~mis.sal order on the
pending motions. The Declarations of Magaziner were the oaly evidentiary documents upon
which the District Court's fact findings were based. 813 F.Supp. 82 (D.D.C. 1993).
• ,•
••
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I
B. Magaziner II Was False.
In his second Declaration filed June 18, 1993, Mr. Magaziner swore that:
The interdepartmental working group was not charged with responsibility for
making. and did not make, recormnendations to the President, and did not otherwise
directly advise him. ·
This was completely untrue. In order to disguise the meetings of various Working Groups
and Clusters leaders with the President, the White House, at Mr. Magaziner·s request, drew up
..Guidelines for Meeting With the President" sometime in February or March, 1993 Deposition of
Maga.zlner, page 9, (Ex. 920). This was never disclosed to Plaintiffs or the District Court until
Plaintiffs retrieved them from Archives in September, 1994! (Ex. 920). These ''talking points.. were
a thinly disguised ruse for the Working Groups to give direct advice, but for the President and
government claim they did not. What is shocking is that someone convinced the inner circles ~fthe
I
I
i
24
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White House, including the President, to play a charade even with hi~ schedule, to defeat Plaintiffs
and the public and keep what they were doing secret:
Privileged and Confidential
Attorney-Client/Work Product
GUIDELINES FOR MEETINGS WITH THE PRESIDENT
TO DISCUSS HEALTH CARE REFORM ISSUES
1.
Each meeting is convened by the President.
2.
The persons attending the meeting are attending in their individual capacities,
either as government officials or member of the Task Force or working
group. The persons attending are not representing the Task Force or working
group, and do not have authority to speak on behalf of the Task FolCe cr
working group.
3.
The p~rsons attending the meeting have been invited by the President.
Neither the Task Force nor the working group has appointed individuals to
attend the meeting.
.
.
4.
The meetings are for the purpose of allowing the President, at his request, to
obtain information and/or advice from the individuals attending. The
President does not seek advice from the group as a whole, and the group does
not form a consensus opinion to present to the President.
5.
No business of the Task Force or the working group is conducted at these
meetings.
6.
Those present at the meeting have not been designated either a subgroup or
subcommittee by either the Task Force or the.working group.
7.
No documents will normally be presented to the President during these
meetings. A:n.y documents that are presented will not be documents produced
by the working group for the pi.Upose of advising the President.
.8.
If such meetings are listed in the President's schedule. they shall be described
as "meetings with individuals to discuss health care reform". (Ex. 920, 2616)
Can there be any question that it was relevant to the work of the courts that the Working
Groups were exploding in numbers in February and early March, 1993, and meeting with and
25
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IM.'PORT ANT! This faC!Iilnile i.s mtc.o.de:cl ooly &r the usc of the individual or entity to whic:b it is addressed. It
may contain infom:aatiCj)n that is privileged. confid.cntial, or otherwise prutected.fi'om clisclosu.re under applicable
law. I! the reader of this tnnsmis.sion is not the latended recipient or the employee or ageot responsible 'for
delivering the tranmtission ta the intended recipient. you are hereby notified that any dissemination, d.isaibution,
copying or use of this tr;msmissian ar it's contents is saictly prohibited. Ifyc:~u ha.ve received this transmission in
error, plea.:oe notifY us by telephcm1ug a:ad retum the original tranmtission to us at the address given below.
FROM:
DATE!
Dep~entofJustice
Civil Divisian
Federal Programs
901 E.
Str~etN.W.
#
Washington, DC 20004
Fax No. (202) 516-8202
. .NTJM:BER OF PAGES SENT
?,eLUDING COVER PAGE):
TO:
fjb;,...., (J_t'r"L{(,'_ .
SPECIAL INSTRUCTIONS:
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advising the President and the First Lady in small, defmed and organized advisory groups't Should
not, in an exercise of candor, the Defendants and their counsel have at a minimum infonned the
courts and the Plaintiffs ofthe alleged "'dramatic change" in the landscape and of
the personnel?
The government's theory of the adversarial nature of our system is a distorted view of the
relationship between the parties, and certainly a perversion of the expected duties of parties and
lawyers to the courts. Moreover, it can be fairly argued that the DOJ should have an even higher
standard of :frankness, overriding the attractive political considerations of protecting its client's
and policy and political interests. Complete candor in this case would have saved this Court, the ·
appellate Cowt and Plaintiffs substantial labor and funds.
Indeed, almost as soon as the appellate court remarked th~t the group looked like a ..horde,.
and ·an:iculated the "continuwn" con~ept and discussed "fixed membership, structure.. criteria,
Defendants changed the represented facts and cUlo_pted a discovery strategy to fit the "horde" theory. 7
6
Working Group member, Pat Kery, wrote (and we have included) an extensive c;iiary to
her boss, a Congresswoman. It is a comprehensive, well written description of the process. On·
March 26, 1993 she wrote: (See Ex. 1578.. 1628, 2248).
The variow clusters are meeting with the President virtually every night to
discuss options. (Ex. 1587).
1
See the following discovery responses dated August 11, 1993, (signed by Magaziner
among others) in the Hm& document, after this court ruled:
The 'interdepartmental working group' was a group of permanent or special
government employees, ultimately numbering over 500, who together served an
essentially stafffunction, gathering infonnation about the c\ln'ent health care system
and developing options for its reform. (DE 63)
Defendant's Responses and Objections to Plaintiffs First Set of Interrogatories and Second Set of
Requests, 8-11-93 at 4. (DE 63, 64)
,.
I
26
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(DE 63 ). The government says that this is just nonnallawyering.
C. MagaziDer Dl Was False.
Magaziner III, filed with Defendants' response to the motion for summary judgment
recited virtually the same history as the First and Second Declarations, but with a vastly different
spin. It was also clearly false. For example, Magaziner I stated that no ad~ice was to be given to the
President by working group members. Magaziner III painted an entirely different (although still false
and misleading picture) of the interrelationship of the working groups and the President.•
Magaziner never mentioned the many meetings of different groups with the President.' He did. not
disclose the Brieflng Books which had been prepared not for the Task Force, but for the President
Tabs 2 and 3 should not be considered 'membership' rosters. A number of
individuals listed servd as part-time or intermittent 'consultants' who were regarded
not as 'members' of the interdepartmental working group, but instead as advisors on
particular issues to specific working groups. Given the fluid and dynamic process by
which the interdepartmental working group was fonned and operated, 'membership·
was not a significant or operative concept. Instead, Tabs 2 and 3 were compiled were
standard information forms submitted by many working group participants.
Interestingly, these "standard information fonns" have never been produced. We found
approximately 6 of them in Archives. They were also clearly covered by discovety requests.
8
Plaintiffs included samples of the Briefing Books for the district court which were used
for the President and First Lady. See Memo of MayS, 1993, from Meeghan Prunty to the
Working Group members as to the format for briefing the President. (DE 205; Ex. 94S, 1305,
1337, 2221, 2229, 2247).
Q
See~ for example the Memorandum from National Archives Box 1463 "Important
Schedule Changes" (Attachment 27) (Ex. 1003):
"March 22
4:00-6:00
Robyn Stone, Mary Harahan, Susan Daniels. Debbie Lucas, Josh Wiener and Peter
Kemper will meet with President Clinton to discuss the current working group option
packages (White Home)."
27
�..
and First Lady directly. (Ex. 945,2221, 2229, 2247, 2250, 2255, 2262). While Working Group
members had been told that their work was for the direct use of the President, the district court was
told in Magaziner I, U and III that the Working Groups were acting as staff to the Task Force and that
only the Task Foree was to advise the President. (Ex. 2394,2416, 2420).
At oral argument on July 25, 1995, this Court was clearly trying to understand lhe work and
role of the groups:
THE COURT: But ifyou have some of those- we'll call them private people- non.,;
full-time government employees at the toll gate meeting, and then I take it some of ·
those toll gate meetings resulted in sessions where President Clinton was being
briefed by some of the working group members. So the President is in the session
as welL As I read Magaziner's affidavi~ I thought that- MR. STERN: I don't think
-I think that Mr. Magaziner was saying that the President was attending some task
force meetings of the First Lady's Health Care Task Force.
•
I
THE COURT: And a working group person would come in to brief them.
MR. STERN: It's not-
I.
THE COURT: Which could have been a cluster leader who was private.
MR. STERN: The- all I can recall from the Magaziner declaration is that he said
both that the President attended some meetings. and that also at some meetings - I
don't know if they were the same meetings, and I am not sure it matters- but they
would sometimes get briefing from people from the working group on some
particular - when there were some particular question to be asked.
THE COURT: So it may not have been at the same meetings where the President was
present?
MR. STERN: I don't think that the declaration tells us that.
THE.COURT: Okay.
Transcript, July 25, 1994 at 75.
28
�..
What is disturbing is that DOJ had reviewed' 0 much of the documentalion ofthe Working
Groups the summer before. (Ex. 1788, 1892, 1893, 1894, 1906 ). Why the lawyers and their clients
permitted the Court to remain under the illusion that the Working Groups were advising the Task
Force and the Task Force provided all the advice to the President is another unanswered and
troubling question in this case. Defendants knew the facts and again, just as in Magaziner I, in
Magaziner III in carefully .crafted words obscuring meaning, they gave misleading information.
(Ex. 2427, 2616).
4. RULE 11 SANCTIONSSHOULDBEIMPOSEDASAREASONABLEINQUIRY
WOULDHAVEREVEALEDTHATTHEREWASNOREASONABLEBASISINLAWOR
FACT FOR THE GOVERNMENT*S CLAIM.
Sanctions under Rule 11 should be imposed only if a reasonable inquiry would have
-.
.
.
revealed that there was no basis in law or fact for the asserted claim. 11
•
If the government at the initiation of its defense would have conducted even a cursory
investigation into the claim that the working groups were not providing nor destined to provide
concensus advice it would have concluded that such a position was untenable. The fact that this
investigation did p.ot take place, is in and of itself unreasonable and illustrati-'le of the cavalier
attitude with which the government felt it could and did handle this case. Since a reasonable inquiry
would have revealed that there was no basis in law or fact for the asserted claim, sanctions under
10
At least 16 members of the DOJ participated with the Working Groups. They c;:ame
from a wide range of divisions ofDOJ. There was a substantial understanding of the make up of
the groups within DOJ. (Ex.2590-2591, 2684). See also Memorandum to Stuart Gerson and
Webb Hubbella March 3, 1993. (Ex. 2683; 2688).
11
Washington v. Said. 812 F.Supp. 1256, 1275 (D.D.C. 1993) (Lamberth, J.) (citing
Cooter & Gell v. Hartmarx Com., 496 U.S. 384 (1990). See Avirgan v. Hull, 705 F.Supp. 1544
(S.D. Fla.1989) (another case involving another false affidavit which kepi another meritless case
alive).
29
�.. .
Rule 11 are appropriate and should be awarded.
Although lhe failure to amend or update pleadings upon the discovery of new information
is not itself grounds for the imposition of sanctions under Rule I 1, the c;;ontinua.tion to advocate
positions which are discovered to be false and/or meritless does. The govenunent almost ab initio
discovered that the contentions made by Ira Magaziner and the government relative to the
composition and function of the working groups were false and that not even under the most
ridiculous definition c;;ould it be argued that such groups were not providing advice to the President.
Though Rule 11 does not impose sanctions for failure to supplement pleadings, it does allow
for their imposition when a litigant continues to advocate legal positions which have, with the
l'.assage of time, proven in~orrect, f~se and/or meritless. 12 Since discovery demonstrated that the
working groups were clearly were involved in a stNctured advisory process, the govemment had
'
an obligation to stop representing and arguing that the facts were otherwise.
The Court could impose sanctions under Rule 11 as the government failed to conduct a
reasonable inquiry into the allegations made by Maguiner, which would have revealed that there
was no basis in law or fact for the claim assert as a result of such allegations. Alternatively,
sanctions should be imposed under Rule 1.1 for the government's continued advocacy of a legal
position which had been proven meritless and/or false.
S. THE GOVERNMENT SHOULD BE SANCTIONED UNDER RULE 37 FOR ITS
FAlLURE TO COMPLY WITH THE MANDATES OF RULE 16 (e). FEDERAL RULES
OF CIVIL PROCEDURE.
Rule 26 (e), of the Federal Rules of Civil Procedure, mandates that parties supplement
12
Hilton Hotel Corp. v. Banov, 899 F. 2d 40 (D.C. Cir. 1990).
30
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'
discovery disclosures when a party "learns that in some material respect the information disclosed
is incomplete or incorrect. . .'' 13 This duty to supplement is present even without a Court order
demanding compliance. 14
Thus, it is the obligation of all parties to cure any defects which are discovered through~ut
the course of litigation. This obligation is essential so as to limit SUl'prise and insure a fair jwidieal
playing field. In its efforts to guarantee that these goals do in fact come to pass, the Federal District
Courts are given the task of policing the overall discovery process.
In its efforts to assure compliance under Rule 26 {e), the District Courts have held that they
. possess the inherent power to s.anction violations of the Rule's mandates." As such, even if
sanctions ~annat be imposed as a result of any other statute or regulation, the Court still possesses
..
.
the inherent-power and authority to punish a non-complying party.
In the instant case, the government, had' the obligation to cure all factual defects discovered
·through the course of litigation, which appeared in the sworn statements produced by Magaziner.
As the lengthy discovery process began to take root, it became increasingly clear that many of the
assertions postulated by Mr. Magazin.er were factually incorrect. Even so, the government never
saw the need, even in light of the obligations imposed on all litigants to cure factual inaccuracies
which come to light, to supplement or correct this disclosure.
Even more alarming is that the government would continue to rely on these knowingly
'
.
13
Rule 26 {e), Federal Rules of Civil Procedure (1995).
14
Campbell Industries v. MN Gemini, 619 F.2d 24 (9"' Cir. 1980).
15
See Mumhy v. Magnolia Elec. Power Ass'n.• 232, 234·235 (5th Cir. 1981); Outley v.
City of New York, 837 F. 2d 587, 590 (2d Cir. 1988) and Aliments (U.S.A.). Inc. v, AnheiseiBusch Cos., 803 F. 2d 1160, 1163 (lllh Cir. 1986).
31
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inaccur.tte statements to push its legal positions forward. These actions not only delayed the
ultimate resolution of the action but also caused great expense both to the Plaintiffs and the Court.
These dilatory actions and procedural violations are precisely the kind of conduct which
courts should and do frown upon. 16 This is even more true when the non-complying party is the
Federal govenunent which appears to have failed to supplement in an effort to unreasonably delay,
possibly to achieve some other political agenda.
It is clear from the record that the Declarations and submissions were factually erroneous
in many respects. 1his reality was known to counsel for the Defendants~ Still the government
~:hose
to disregard these discrepancies and proceed forward in clear violation ofth Rule 26 (e)'s
:requirements. Given the clarity of the record and the authority vested in the District Courts to
.
·-
.
punish such·c:al]ous disregardt sanctions should be imposed against the government for its discovery
violations.
16
See United States v. Excellair. Inc., 637 F. Supp. 1377 (D. Colo. 1986). There the
government also dangerously played with words and argued that it should not be sanctioned over
interpretation of language. They lost that argument.
32
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CONCLUSION
This court has more than enough basis to award EAJA fees and costs or fees and costs under
Rule 11 or Rule 37 in this case against the government, a fact even the court of appeals seemed
to recognize in its opinion.
Respectfully submitted.
SPENCER & KLEIN, P.A.
Attorneys for Plaintiffs
Assodation of American
Physiciaus and Surgeons, Inc.
801 Brickell Avenue, Suite. 1901
Miami, Florida 33
Phone: 30S-3 - 700
Fax: 3os..
33
-4890
�...
. .,
CERTIFICATE OF SERVICE
I hereby certify that I caused a copy of the foregoing to be served this _/_ day of June,
2000, on:
Irvin B. Nathan
Thomas Millet
U.S. Department of Justice
Civil Division
901 E. St., N.W.
Washington, D.C. 20530
Telephone: (202) 514·3313
Attomeys for Defendants
James L. Cooper
"ARNOLD & PALMER
SSS Twelfth Street, N.W.
Washington, D.C. 20004
SPENCER & KLEIN;P.A.
801 Brickell Avenue
Suite 1901
Miami, Florida 3313
(305) 374-7700 T ~
Attorney for P riff
34
TOTAL P.36
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
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72 files in 6 boxes
Provenance
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Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
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William J. Clinton Presidential Library & Museum
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
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Paper
Dublin Core
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Title
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AAPS - Health Care Task Force
Creator
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Office of the Counsel to the President
Paul Oetken
Identifier
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2006-0223-F
Is Part Of
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Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7409209" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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William J. Clinton Presidential Library & Museum
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Adobe Acrobat Document
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Reproduction-Reference
Date Created
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1/8/2015
Source
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42-t-7409209-20060223F-001-021-2015
7409209
-
https://clinton.presidentiallibraries.us/files/original/dad4cdd951dce9e08acd98c95de0c116.pdf
c60e6ab3b059915c6db82fe1242a317a
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Counsel Office
Series/Staff Member:
Ed McNicholas
•
Subseries:
23679
OA/ID Number:
FolderiD:
Folder Title:
Health Care Task Force
Stack:
Row:
Section:
Shelf:
Position:
v
7
2
5
1
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.
'·;
TH.E WH.ITE H.OUSE
Wf>.SHINGTON
l .
Received S"S
fqqs f£8 -8 PM 4: 35
.
February 8, 1995
MEMORANDUM FOR WHITE HOUSE OFliCE STAFF
J..
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.
FROM
JOEL KLEIN/ " ~..--\:..\.....·DEPUTY COUN EL TO THE PRESIDENT
r
RE:
u.s. Attorney's office
u.s. Attorney's office is
Document Request by
As you are aware, the
initiating
an inquiry into certain matters related to the Health care Task
Force and Interdepartmental· Working Group. In that regard, .the
U.S. Attorney's office has requested that the White House make
available for review:
All documents and records, in whatever form, and whenever
created reiat~d to
1) the conception, planning., ...development, oz:ganization
structure, and membership of the President's Health
Care Task Force and the related Interdepartmental
~orking Group; and
2) the civil···lit-iqaticm·--eapti'Ofted Associati:on of
American Physicians. et al. y. Hillary Rodham Clinton.·
et al. 93-399___ (D.Q.C •. ) •. ··· .Thi.s ..should incl.udS., . .hu:t ...not
be limited to, all files and recor9s concerning the
litigation maintained in the office of [any] named
defend~nt, and in -the o!ffiee ·'Of ·the Counsel to the
President.
The u.s. Attorney specifically notes that his request
includes records stored on computer disks and hard drives, as .
well as E-Mail. In addition,· he requests both "of·ficial files"
and files ~·main~ained by individual employees."
-Pl~ase produce all potentially relevant documents to the
office of Associate counsel Christopher cerf (OEOB 136) by the
close of business Monday, February 13th.
At this point, we are merely collecting documents for
review ~y·the·counsel's Office. To the extent any documents are
made ~vailable to the u.s. Attorney's Office, we will inform the
individual or individuals who submitted them.
If you have any quest.ions, feel free to call Chris Cerf at
6-6229 •.
I'
�TH.E WHITE HOUSE
WASHINGTON
.
February 8,
- ..
19~5
MEMORANDUM FOR WHITE HOUSE OFFICE STAFF
FROM
JOEL KLEIN ~{· (J~.c____:_
DEPUTY co~_$~L TO THE PRESIDENT
RE:
Document Request by
1
u.s. Attorney's office
u.s. Attorney's office is
As you are aware, the
initiating
an inquiry into certain matters related to the Health Care Task
Force and Interdepartmental Working Group. In that regard, the
U.S. Attorney's office has requested that the White House make
available for review:
All documents and records, in whatever form, and whenever
created reiat~d to
1) the conception, planning.. ..development, or.-qa.n-ization
structure, and membership of the President's Health
Care Task Force and the related Interdepartmental
Workinq.Group; and
.
2) the civil ...l.it:iqatiGn··-eapti'Oiled Associati:on ·of
American Physicians. et al. v. Hillary Rodham Clinton.·
et al. 93-399.- ·(D.Q.c..•. ) •....This ..should .include... ,hut ...not
be limited to, all files and recorf!\s concer~inq the
litigation maintained in the office of [any] named
defendant, and in· ~the offiee ··of ·the Counsel to the
President. ·
The u.s. Attorney specifically notes that his request
includes records stored on computer disks and hard'drives, as .
well as E-Mail. In addition,'he requests both "official files"
and files ~·maintained by individual employees. "
-Pl~ase produce all potentially relevan~ documents to the
office of Associate Counsel Christopher Cerf (OEOB 136) by the
close of business Monday, February 13th.
At this point, we are merely collecting documents for
review ~Y the Counsel's Office. To the extent any documents are
made available to the u.s. Attorney's Office, we will inform the
individual or individuals who submitted them.
·
If you have any questions, feel free to call Chris Cerf at
6-6229.
!
I
I.
�SENT BY=Xerox Telecopier 7020
1- 5-96
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.
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a, 1995
Doaument Request by o.s. Attorney's office
you.are aw•r•, the u.s. Attorney's o~fice is initiating
~to certain aattars related to the Health Care Task
Porca and Interdepartmental working Group. In that regard, the
v.. s. Attorney'• office ha• requested that the White House make
.
Aa
an inquiry
•vailable for review:
'
.
·
All doCWilenta .and recorda, in whatever form, and whenever
created related to
1) ·the conception, planninq, development, organization
a~cture, and membership of tbe President's Health
~· Task Force and the related Interdepartmental
WOJ:king
Gr~:nzp;
and
2) the civil litigation captioned Association pf
Jmorican Pbyaician1. at al. y, Hillary Bodham Clinton.
at 1a.1. 93-399 (D. D.c.). This should include, but not
be liaitad to, all files and record• concerninq the
li~igation
maintained in the office of [ClOY] named
~ounael to the
derandant:, and in the office of the
Pr-14ent.
T.be u.s. Attorney specifically notes that his request
1nclud. . reco~a stored on qomputer disks and hard drives, as
V.ll ••·· E-Mail. :tn addition, he requests both "official files•
Md fi·lea •JDalntainecl by individual employees.•
:·
Plea•• p:toduce all potentially relevant documents to the
Office Of Aas~iate Counsel Christopher Cerf (OEOB 136) by the
o~osa ot buaihass Monday, February 13th.
At this point, we are merely collecting documents for
tbe.Counsa1's Office. To the extant any documents· are
ada available to the U.S. Attorney's Office, we w111 inform the
.
review~
1Ddivi4Ual or ·individuals who submitted them.
.
Xf you have any questions, fea1 free to.call Chris Cart at
6~6229.
'
.... ---·-· -··
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............ -·.··
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task force February 9, 1995 US Attorney
Creator
An entity primarily responsible for making the resource
Office of the Counsel to the President
Ed McNicholas
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7408712" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7408712-20060223F-001-020-2015
7408712
-
https://clinton.presidentiallibraries.us/files/original/cf88c0e198924b514c47f7fd546b4003.pdf
30b6815386c4a490885aa9374039e9d7
PDF Text
Text
Case Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the Clinton Presidential
Library Staff.
Folder Title:
Health Care Task Force
;114&4-L.JAH!~ --- H£tLTlt- C4R.£ v"114JC.E. (AP
' 1\.}
vesT"te.-4;16-'J
Staff Office-Individual:
Counsel's Office-Whalen
Original OAIID Number:
CF 812
Row:
Section:
Shelf:
r:Position:
Stack:
21
~
5
3
~
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECTffiTLE
RESTRICTION
001. memo
Memorandum for Jennifer O'Connor. From: Cherly Mills and Beth
Nolan. Subject: Additional Guidance on Health Care Support. (2
pages)
10/19/1993
P5
002. report
Wire Report. Associate Press article. U. S. Attorney Finds 'Missteps';
Lawmaker Seeks Action On. (2 pages)
08/04/1995
P5
003.letter
From William I. Weston. To. Beth Nolan [Re: Maryland's Health Care
Claims Arbitration Program.] (2 pages)
04/10/1993
P5
004. note
[handwritten notes regarding health care issues.] (2 pages)
n.d.
P5
005. fax
Photocopy. From Bill Gadsby, GAO to Christopher Cerfat 16:35.
[Re: Health Care Task Force and Working Groups.] (7 pages)
1994
P5
006(a). note
[Unknown Recipient or Sender. Re: Health Care Case Investigation].
(1 page)
n.d.
P5
006(b). draft
[Annotated draft oflegal document]. (5 pages)
n.d.
P5
007. memo
Memorandum to Abner Mikva and James Castello. From: Chris Cerf.
Re: Magaziner Case. (2 pages)
06/08/1995
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF812
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz72
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom oflnformation Act- [5 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
DATE
SUBJECT/TITLE
Memorandwn for Jennifer O'Connor. From: Cherly Mills and Beth
Nolan. Subject: Additional Guidance on Health Care Support. (2
pages)
10/19/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF812
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz72
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA(
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. report
DATE
SUBJECT/TITLE
Wire Report. Associate Press article. U. S. Attorney Finds 'Missteps';
Lawmaker Seeks Action On. (2 pages)
08/04/1995
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF812
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz72
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. letter
DATE
SUBJECTffiTLE
From William I. Weston. To. Beth Nolan [Re: Maryland's Health Care
Claims Arbitration Program.] (2 pages)
04/10/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF812
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz72
RESTRICTION CODES
Presidential Records Act- 144 U.S.C. 2204(a))
Freedom of Information Act -IS U.S.C. SS2(b))
PI National Security Classified Information l(a)(l) of the PRA)
P2 Relating to the appointment to Federal office l(a)(2) of the PRA)
P3 Release would violate a Federal statute l(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information l(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors 1a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy l(a)(6) ofthe PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency l(b)(2) of the FOIA)
b(3) Release would violate a Federal statute l(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information l(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes l(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions l(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells l(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. note
DATE
SUBJECT/TITLE
[handwritten notes regarding health care issues.] (2 pages)
n.d.
RESTRICTION
PS
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF812
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz72
RESTRICTION CODES
Presidential Reeords Aet- [44 U.S.C. 2204(a))
Freedom of Information Aet -IS U.S.C. 552(b))
PI National Seeurity Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal offiee [(a)(:Z) ofthe PRA)
P3 Release wouid violate a Federal statute [(a)(3) of the PRA)
P4 Release would diselose trade seerets or eonfidential eommereial or
finaneial information [(a)(4) ofthe PRA)
PS. Release would diselose eonfidential adviee between the President
and his advisors, or between sueh advisors [a)(S) ofthe PRA)
P6 Release would eonstitute a dearly unwarranted invasion of
personal privaey [(a)(6) of the PRA)
b(l) National seeurity elassified information [(bXl) ofthe FOIA)
b(:Z) Release would diselose internal personnel rules and praetiees of
an ageney [(b)(:Z) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would diselose trade seerets or eonfidential or finaneial
information [(b)(4) of the FOIA)
b(6) Release would eonstitute a dearly unwarranted invasion of
personal privaey [(b)(6) of the FOIA)
b(7) Release would diselose information eompiled for law enforeement
purposes [(b)(7) ofthe FOIA)
b(8) Release would diselose information eoneerning the regulation of
finaneial institutions [(b)(8) of the FOIA)
b(9) Release would diselose geologieal or geophysieal information
eoneerning wells [(b)(9) of the FOIA)
C. Closed in aeeordanee with restrietions eontained in donor's deed
of gift.
PRM. Personal reeord misrue defined in aeeordanee with 44 U.S.C.
2201(3).
RR. Doeument will be reviewed upon request.
- - - -
------------
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. fax
SUBJECT/TITLE
DATE
Photocopy. From Bill Gadsby, GAO to Christopher Cerfat 16:35.
[Re: Health Care Task Force and Working Groups.] (7 pages)
1994
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
OA/Box Number:
CF812
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz72
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4. Release would disclose. trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
I
I
Freedom of Information Act- [5 U.S.C. 552(b))
b(l) National security classified information ((b)(l) ofthe FOIA)
b(l) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA]
b(3) Release would violate a Federal statute ((b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
_I-
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006(a). note
SUBJECT/TITLE
DATE
[Unknown Recipient or Sender. Re: Health Care Case Investigation].
(1 page)
n.d.
RESTRICTION
PS
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
OA/Box Number: CF812
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz72
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act -(5 U.S.C. 552(b)(
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisorS, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA(
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006(b). draft
SUBJECTffiTLE
DATE
[Annotated draft oflegal document]. (5 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF812
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz72
RESTRICTION CODES
Presidential Records Ad- [44 U.S.C. 2204(a)]
Freedom of Information Ad -]5 U.S.C. SS2(b)]
PI National Security Classified Information [(a)(l) ofthe PRA]
P2 Relating to the appointment to Federal office ](a)(2) of the PRA]
P3 Release would violate a Federal statute ((a)(3) of the PRA]
P4 Release would disdose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA]
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) of the PRA]
b(l) National security dassified information ((b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and pradices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute ((b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA]
b(7) Release would disdose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disdose geological or geophysieal information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
007. memo
DATE
SUBJECT/TITLE
Memorandum to Abner Mikva and James Castello. From: Chris Cerf.
Re: Magaziner Case. (2 pages)
06/08/1995
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF812
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz72
RESTRICTION CODES
Presidential Records ACt· 144 U.S.C. 2204(a))
Freedom of Information Act -IS U.S.C. SS2(b))
Pl National Security Classified Information l(a)(l) of the PRAI
P2 Relating to the appointment to Federal office l(a)(2) of the PRA)
P3 Release would violate a Federal statute l(a)(3) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information l(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors Ia)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy l(a)(6) of the PRA)
b(l) National security classified information l(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency l(b)(2) of the FOIA)
b(3) Release would violate a Federal statute l(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information l(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy l(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes l(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions l(b)(8) ofthe FOlA)
b(9) Release would disclose geological or geophysical information
concerning wells l(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force
Creator
An entity primarily responsible for making the resource
Office of the Counsel to the President
Whalen
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7409265" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7409265-20060223F-001-019-2015
7409265
-
https://clinton.presidentiallibraries.us/files/original/583791d57f81ca85c638332bc4e7f795.pdf
787a1109904ad3da153f2f87ed741142
PDF Text
Text
Case Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the Clinton Presidential
Library Staff.
Folder Title:
Health Care Task Force
Staff Office-Individual:
Counsel's Office-Whalen
Original OAIID Number:
CF 818
Row:
Section:
Shelf:
Position:
Stack:
21
~
8
1
K'
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECTffiTLE
RESTRICTION
001. form
White House Office Supplimental Information Sheet for Personnel
Action. WHP2(3/87). [Annotated]. (1 page)
n.d.
P5
002. form
Attachment 2. EOPOA-92-09. Restrictions Against Disclosure
Statement. [Annotated]. (1 page)
n.d.
P5
003. report
[Partial outline for unknown project]. (2 pages)
n.d.
P5
004. memo
Memorandum for Tom Pyle. From Beth Nolan and Richard
Werksman. Subject: Participation as Consultant in Tollgate Review.
(1 page)
04/02/1993
P5
005. note
[Handwritten notes concerning the memo of April2, 1993]. (1 page)
n.d.
P5
006. note
[Handwritten note regarding Working Group Organization]. (1 page)
n.d.
P5
007. note
[Whalen's handwritten notes regarding Tom Pyle]. (1 page)
n.d.
P5, P6/b(6)
008. note
[Handwritten notes regarding health care working groups]. (5 pages)
n.d.
P5
009. memo
Memorandum for Steve Pigeon. From: Marjorie Tarmey. Subject:
Tom Pyle. ( 1 page)
04/06/1993
P5
010. resume
Curriculum vitae for Tom Pyle. [Annotated by staff]. (5 pages)
n.d.
P5, P6/b(6)
011. note
[Handwritten notes from meeting with Marjorie Tarmey re: health
care working groups]. ( 1 page)
04/02/1993
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz71
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
PI National Security Classified Information [(a)(l) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
Freedom of Information Act- 1.5 U.S.C. 552(b))
b(l) National security classified information ((b)(l) of the FOIA)
· b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECT/TITLE
RESTRICTION
012. note
Legal Audit List. (1 page)
n.d.
P5, P6/b(6)
013. note
Administrative Simplification Audit. Suggested Names. (1 page)
n.d.
P5, P6/b(6)
014. photocopy
Photocopy. Federal Personnel Manual. [pages 304-A-2 and 304-A-3].
(2 pages)
n.d.
P5
015. photocopy
Photocopy. Federal Personnel Manual. [pages 304-A-2 and 304-A-3].
[Second copy] (2 pages)
n.d.
P5
016. letter
From Charles A. Samuels, esquire To: Anne Hall, Office of the
Special Counsel for Ethics and A1 Cutino, Office of the Assistant
Secretary for Planning and Evaluation, Department of Health and
Human Services. [Re: employment forms for Tom Pyle]. (1 page)
05/17/1993
P5
017. memo
Memorandum. To: Peter Pappas, Gary Ginsberg, and Liz Fine. From:
William H. Kennedy, III. Re: Vetting. (2 pages)
03/24/1993
P5
018. list
Tollgate 5. Schedule. Saturday April3rd. [Annotated]. (1 page)
04/02/1993
P5
[Partial outline for unknown project. Revised 317]. (1 page)
[unknown]
P5
020. resume
Curriculum Vitae for Thomas Pyle. [Annotated]. (5 pages)
n.d.
P5, P6/b(6)
021. folio
[Packet of Information for Richard Werksman regarding the Health
Care Task Force]. (54 pages)
[none]
P5
· 019. list
COLLECTION:
Clinton Presidential Recox:ds
Counsel's Office
Whalen
OA/Box Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz7l
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)[
Freedom of Information Act· [5 U.S.C. 552(b)[
PI National Security Classified Information [(a)(l) of the PRA[
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRAJ
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
· b(l) National security classified information ((b)(l) of the FOIA)
b(2)'Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
/
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
022. memo
SUBJECTffiTLE
DATE
To: All Health Care Task Force and Working Group Personnel. From:
John D. Podesta and Stephen R. Neuwirth. Re: Task Force and
Working Group Records. (2 pages)
04/02/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz71
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. SS2(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOlA)
b(9) Release wouid disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
I
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. form
SUBJECT/TITLE
DATE
White House Office Supplimental Information Sheet for Personnel
Action. WHP2(3/87). [Annotated]. (1 page)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz71
. RESTRICTION CODES
Presidential Records Act -.[44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. SS2(b)]
PI National Security Classified Information [(a)(l) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or betWeen such advisors [a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a·dearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning weDs [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. form
SUBJECT/TITLE
DATE
Attachment 2. EOPOA-92-09. Restrictions Against Disclosure
Statement. [Annotated]. (1 page)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz71
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [S U.S.C. SS2(b))
Pl National Security Classified Information [(a)(l) of the PRA)
Pl Relating to the appointment to Federal office [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
·ps Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. report
DATE
SUBJECTffiTLE
[Partial outline for unknown project]. (2 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
OA/Box Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz7l
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)l
Freedom of Information Act- [5 U.S.C. 552(b)J
PI National Security Classified Information [(a)(l) of the PRAJ
P2 Relating to the appointment to Federal office [(a)(2) of the PRAJ
P3 Release would violate a Federal statute [(a)(3) of the PRAJ
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRAJ'
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRAI
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRAJ
b(l) National security classified information [(b)(l) of the FOIAJ
b(:Z) Release would disclose internal personnel rules and practices of
an agency [(b)(:Z) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfLle defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. memo
SUBJECT/TITLE
DATE
Memorandum for Tom Pyle. From Beth Nolan and Richard
Werksman. Subject: Participation as Consultant in Tollgate Review.
(1 page)
04/02/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
OA/Box Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz71
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would viol.ate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
'·---------------------
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. note
.DATE
SUBJECT/TITLE
[Handwritten notes concerning the memo of April2, 1993]. (1 page)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
OA/Box Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz71
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)[
Freedom of Information Act- [S U.S.C. SS2(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of .
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
. ANDTYPE
DATE
SUBJECTffiTLE
RESTRICTION
I
I.
006. note
[Handwritten note regarding Working Group Organization]. (1 page)
n.d.
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
OA/Box Number: 'CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz71
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a)(
Freedom of Information Act- (S U.S.C. SS2(b))
Pl National Security Classified Information ((a)(l) of the PRA]
P2 Relating to the appointment to Federal office ((a)(2) of the PRA]
P3 Release would violate a Federal statute ](a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA]
b(l) National security classified information ((b)(l) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute ((b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or finandal
information ((b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfde defined in accordance with 44 U.S.C.
2201(3).
· RR. Document will be ·reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE.
007. note
SUBJECT/TITLE
DATE
RESTRICTION
[Whalen's handwritten notes regarding Tom Pyle]. (1 page)
·n.d.
P5, P6/b(6)
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF818
FOLDER TITLE: ·
Health Care Task Force
2006-0223-F
vz71
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)]
Freedom of Information Act- [S U.S.C. SS2(b)]
Pl National Security Classified Information [(a)(l) ofthe PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
008. note
DATE
SUBJECT/TITLE
[Handwritten notes regarding health care working groups]. (5 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
· OA/Box Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz71
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- (5 U.S.C. 552(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misflle defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
-----
---
--------
�Withdrawal/Redaction Marker
c;Iinton Library
DOCUMENT NO.
AND TYPE.
009. memo
SUBJECT/TITLE
DATE
Memorandum for Steve Pigeon. From: Marjorie Tanney. Subject:
Tom Pyle. (1 page)
04/06/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
OA/Box Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz71
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom oflnformation Act- [S U.S.C. SS2(b))
Pl National Security Classified Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(~) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misflle defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
010. resume
DATE
SUBJECT/TITLE
Curriculum vitae for Tom Pyle. [Annotated by staff]. (5 pages)
RESTRICTION
n.d.
P5, P6/b(6)
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
OA/Box Number: CF818
FOLDER TITLE:
Health Care TaskForce
2006-0223-F
vz71
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. SS2(b)J
Pl National Security Classified Information [(a)(l) of the PRAJ
P2 Relating to the appointment to Federal office [(a)(2) of the PRAJ
P3 Release would violate a Federal statute [(a)(3) of the PRAJ
· P4 Release would diselose trade secrets or confidential commereial or
financial information [(a)(4) of the PRAJ
PS Release would diselose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a elearly unwarranted invasion of
personal privacy [(a)(6) of the PRAJ
b(l) National security elassified information [(b)(l) of the FOIAJ
b(2) Release would diselose internal personnel rules and practices of
an agency [(b)(2) of the FOlAJ
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would diselose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
.
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOlAJ
b(8) Release would diselose information concerning the regulation of
financial institutions [(b)(8) of the FOlA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
011. note
DATE
SUBJECT/TITLE
[Handwritten notes from meeting with Marjorie Tanney re: health
care working groups]. (1 page)
04/02/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz71
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release woUld disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of ·
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
·RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
012. note
DATE
Legal Audit List. (1 page)
RESTRICTION
n.d.
SUBJECT/TITLE
P5, P6/b(6)
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
OA/Box Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz71
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)]
Freedom of Information Act- [5 U.S.C. 552(b)]
Pt National Security Classified Information ](a)(l) ofthe PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(t) National security classified information [(b)(t) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information ](b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
per5$)nal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
· b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
013. note
DATE
SUBJECTfi'ITLE
Administrative Simplification Audit. Suggested Names. (1 page)
RESTRICTION
n.d.
P5, P6/b(6)
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz71
RESTRICTION CODES
. Presidential Records Act- [44 U.S.C.ll04(a))
PI National Security Classified Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of·
personal privacy [(a)(6) of the PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be rt:viewed upon request.
Freedom of Information Act- [5 U.S.C. 552(b))
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
�Withdrawal/Redaction Marker
Glinton Library
DOCUMENT NO.
AND TYPE
014. photocopy
SUBJECTffiTLE
DATE
Photocopy. Federal Personnel Manual. [pages 304-A-2 and 304-A-3].
(2 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz71
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
Pl National Security Classified Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIAl
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
015. photocopy
SUBJECTffiTLE
DATE
Photocopy. Federal Personnel Manual. [pages 304-A-2 and 304-A-3].
[Second copy] (2 pages)
n.d.
RESTRICTION
P5
COLLECTION:
. Clinton Presidential Records
Counsel's Office
Whalen
OA/Box Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz7l
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7)'Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
016. letter
DATE
SUBJECT/TITLE
From Charles A. Samuels, esquire To: Anne Hall, Office of the
Special Counsel for Ethics and AI Cutino, Office of the Assistant
Secretary for Planning and Evaluation, Department of Health and
Human Services. [Re: employment forms for Tom Pyle]. (1 page)
05/17/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz71
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRAJ
P3 Release would violate a Federal statute [(a)(3) ofthe PRAJ
P4 Release would disclose trade secrets or confidential commercial or
. financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
.
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIAJ
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
017. memo
DATE
SUBJECT/TITLE
Memorandum. To: Peter Pappas, Gary Ginsberg, and Liz Fine. From:
William H. Kennedy, III. Re: Vetting. (2 pages)
03/24/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
OA/Box Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz71
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [S U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
018. list
DATE
SUBJECT/TITLE
Tollgate 5. Schedule. Saturday April3rd. [Annotated]. (1 page)
04/02/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz71
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRAJ
P2 Relating to the appointment to Federal office ((a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and 'practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disdose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIAJ
C. Closed in accordance with restrictions contained in donor's deed
'of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
019. list
DATE
SUBJECT/TITLE
[Partial outline for unknown project. Revised 3/7]. (I page)
[unknown]
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF818
FOLDER TITLE:
Health Care Task Force.
2006-0223-F
vz71
RESTRICTION CODES
Presidential Records Act- (44 U.S.C.2204(a))
Freedom of Information Act- (5 U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidentiai commercial or
fmancial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(l) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
· concerning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal· record misfile defined in accordance with 44 U.S.C.
2201(3).
· RR. Document will.be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
. 020. resume
SUBJECT/TITLE
DATE
Curriculum Vitae for Thomas Pyle. [Annotated]. (5 pages)
RESTRICTION
n.d.
P5, P6/b(6)
'\\
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz71
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
PJ Release would violate a Federal statute [(a)(J) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of.the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(J) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
.
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
021. folio
DATE
SUBJECT/TITLE
[Packet of Information for Richard Werksman regarding the Health
Care Task Force]. (54 pages)
[none]
RESTRICTION
PS
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
OA/Box Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223"F
vz71
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors. or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of. the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for .law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
022. memo
SUBJECT/TITLE
DATE
To: All Health Care Task Force and Working Group Personnel. From:
John D. Podesta and Stephen R. Neuwirth. Re: Task Force and
Working Group Records. (2 pages)
04/02/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Whalen
ONBox Number: CF818
FOLDER TITLE:
Health Care Task Force
2006-0223-F
vz71
RESTRICTION CODES
'Presidential Records Ad- [44 U.S.C. 2204(a))
Freedom of Information Ad- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(bXl) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of .
an agency [(b)(2) of the FOIA)
b(3) Release would, violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(bX7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
' 2201(3).
RR. Document will be reviewed upon request.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force
Creator
An entity primarily responsible for making the resource
Office of the Counsel to the President
Whalen
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7409265" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7409265-20060223F-001-018-2015
7409265
-
https://clinton.presidentiallibraries.us/files/original/7f53472e3c099466b667901ea29e753e.pdf
9c487a016e22732effa57545f1b0c81f
PDF Text
Text
Case Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the Clinton Presidential
Library Staff.
Folder Title:
Health Care Task Force: Background
Staff Office-Individual:
Counsel's Office-Waldman
Original OA/ID Number:
CF640
Row:
Section:
Shelf:
rosition:
Stack:
17
4
6
~
v
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. report
SUBJECT/TITLE
DATE
Background: Litigation Involving the Health Care Task Force and the
Interdepartmental Working Group. (4 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Waldman
ONBox Number: CF640
FOLDER TITLE:
Health Care Task Force: Background
2006-0223-F
vz70
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act -IS U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(1) of th!! FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) ofthe FOIA)
C. Closed ip accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
- - - - - - - - - - - - - - - - - - - -
--------
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. report
DATE
SUBJECTffiTLE
Background: Litigation Involving the Health Care Task Force and the
Interdepartmental Working Group. (4 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Waldman
ONBox Number: CF640
FOLDER TITLE:
Health Care Task Force: Background
2006-0223-F
vz70
RESTRICTION CODES
Presidential Records Ad- [44 U.S.C. 2204(a))
Freedom of Information Ad- [5 U.S.C. 552(b)]
Pl National Security Classified Information [(a)(l) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security elassified information [(b)(l) ofthe FOIA)
b(2) Release would diselose internal personnel rules and pradiees of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOlA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force: Background
Creator
An entity primarily responsible for making the resource
Office of the Counsel to the President
Michael Waldman
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763296" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7763296-20060223F-001-017-2015
7763296
-
https://clinton.presidentiallibraries.us/files/original/92f5f86911f8b01c9570a29e5b7b7e66.pdf
e4119942803d886de7fd905ad40cd175
PDF Text
Text
Case Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the Clinton Presidential
Library Staff.
Folder Title:
White House: Health Care Task Force
Staff Office-Individual:
Counsel's Office-Sherburne
Original OAIID Number:
CF397
!Row:
Section:
Shelf:
ti>osition:
Stack:
21
~
10
3
~
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECT/TITLE
RESTRICTION
001. fax
To Cristopher D. Cerffrom Eric Holder at 12:08. Remarks: Hard
Copy also in Mail. [Re: Ira C. Magaziner]. (6 pages)
02/28/1995
P5
002. memo
Photocopy. Memorandwn to File from Christopher D. Cerf. Re:
Magaziner Docwnent Review and Production. (3 pages)
03/18/1995
P5
003(a). report
Wire Report. Clintons Backed into Legal Comer. Paul Craig Roberts,
Scripps Howard News Service. Rocky Mountain News. Editorial.
[Annotated by staff.] (2 pages)
08/06/1994
P5
003(b ). report
Wire Report. Listening to Ollie's Mom: That was no lady--That was
Hillary Clinton. Suzanne Fields. Atlanta Journal and Constitution.
Editorial. [Annotated by staff.] (2 pages)
11/03/1994
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Sherburne
ONBox Number: CF397
FOLDER TITLE:
White House Health Care Task Force
2006-0223-F
vz69
RESTRICTION CODES
Presidential Records Aet - [44 U.S.C. 2204(a)J
Freedom of Information Aet- [S U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRAJ
P3 Release would violate a Federal statute [(a)(3) of the PRAJ
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRAJ
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. fax
DATE
SUBJECT/TITLE
To Cristopher D. Cerffrom Eric Holder at 12:08. Remarks: Hard
Copy also in Mail. [Re: Ira C. Magaziner]. (6 pages)
02/28/1995
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Sherburne
OA/Box Number: CF397
FOLDER TITLE:
White House Health Care Task Force
2006-0223-F
vz69
.RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act -IS U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) ofthe PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) ofthe PRA(
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA]
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
· b(4) Release would disclose trade secrets or· confidential or financial
information ((b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) ofthe FOIA]
b(S) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
·
concerning wells ((b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
��i (] ;
pyJ
THE WHITE HOUSE
WASHINGTON
December 29, 1995
BY FACSIMILE
The Honorable William F. Clinger, Jr.
Chairman Committee on Government
Reform and Oversight
2157 Rayburn House Office Building
Washington D.C. 20515-6163
Dear Mr. Chairman,
We are in receipt of your December 19, 1995 letter
requesting certain information pertaining to Patsy Thomasson's
testimony about the costs of the Health Care Task Force. The
purpose of this letter is to request an additional two weeks to
respond.
As you are aware, Ms. Thomasson now serves as Deputy
Assistant to the President for Presidential Personnel. Any
documents she may have that are responsive to your request would
have been generated in her capacity as Special Assistant to the
President and Director of the Office of Administration.
Despite
diligent efforts to retrieve those documents from off-site
storage, it now appears that we will be unable to do so in time
to meet the ten-day deadline provided.in your letter. The fact
that this period coincides with the holiday season has also
complicated our efforts to meet this tight schedule.
Accordingly, we respectfully request a two week extension,
until January 12, 1996, to submit our response.
Sincerely,
s£~erfy
~~e
Associate Counsel
President
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Fax: 202-458·2259
FAX COVER SHEET
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••e of Brprermttatftlet
COMMITTI!I!! ON GOVeANM!!NT REPOAM AND OVI:RSIBHT
:111111 RAvauRN Hove~ 01"P~e• But'-'»t...O
WA!iiHINIIITnw.
ce 20&1&-s14s
December 19, 1995
IX PACAIMILJi
Ms. Patsy L. Thomaaaon
Special Assistant to the President
for Manag6me~t and Admini•tra~ion
The White House
1600 Penney!vania Avenue, Ncrtnweat
Wa•hin~ton,
D.C.
20SOO
Dear Ma. Thoma8aon•
Under Rules X ana XI ot the Rulea of th• United states House
of Repreaentativea, tbe Committee on Governmant RAform and
overa1ght haa jurisdiction over the overall management and
offi~ienay of c~e~utive branch ope~•tion• an4 activitie•·
Pursuant to its overaighe reeponsibilitiea, the Committee
ia
-- of well ever $13.5 million
-- between your l!lworn tea·timony before C(Jnqresa concerninq the·
ravi•win9 the
appa~ent dis~~epancy
costa of the Health Care Tagk FQr~• and the coat$ determined by
the General Accounting Offi~• in ita Novo~r, 1D~G rcpo~~.
I.
Plea•e submit to this Committee all documents, recorde,
notes, memoranda, phone logs and any other relevant information
~elating to your basis ro~ the previously·sworn accounting of
eoeta fo~ ~~e llc•l~b Ca~
figures. Include in thia
and how you ·~~i~G at th~ee
p~oduction all t~ose Hea~th Cara Task
roroe membe~•• oon•ultanta •nd volunteera, in~luding executive
and legislative branch personnel, whom you oont~oted in ~n effort
T~ek For~e
to eacount for the costs to u.s. taxpayer& of the H&alth Oar•
Taek l"o~~;~o,
Thcute ehoulr£ inQl ude document" r· memorcmda 1 recorde 1
··'-;FL
1-'f"lGE
--
1
�I'IU
---
....
--
.vo~
J-..J
.
notes and any other relev&nt information ariaing from
communi~ation•
you cr any of your colleagueG mi$ht have had with
Mr. Ira Magaziner, Firat Lady Hillary Rodham Clinton, members of
her seat:!, volu.nteere and tr1enas, 1nclu41ng M•. ~uaan 'rhomasee
aa wall as any othera whou• input wa• aolicited in order to·
provide the Congress with an accounting of the coets of the
Health
~•r•
Ta8k
~o~ce.
The requ•ete4 1nto~mation ahould be provide4 no·later than
the close of buainees on Friday, December 29, 1995. If you have
any qu•atic;ms conce~:ning this request, please contact Barbara IC.
8ra~h•r ef the Co~ittee inva•tiga~ive aeaff at 202·22S·SD74.
... F· c.a ~ .
· .<s
l:linoerely,
w·tJJ.~
William P. Clinger, 3r.
Cba1rman
r .v0
Pf"'GiE
2
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. memo
SUBJECT/TITLE
DATE
Photocopy. Memorandum to File from Christopher D. Cerf. Re:
Magaziner Document Review and Production. (3 pages)
03/18/1995
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Sherburne
OA/Box Number: CF397
FOLDER TITLE:
White House Health Care Task Force
2006-0223-F
vz69
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a)J.
Freedom of Information Act- (5 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�REV[EW & OU}I'LOOK .
Ira's
..
.,..
. · ·.
·-t~
Story
AB the Clinton Administration ·court. In addition, the late Vincent
marks the. halfway point of its _term · Foster ·and Clinton crony ·Webster
today, tlie mystery of exactly how its ·· Hubbell both played key roles In the
$ileret 1\ealth care task force operated Administration's defense of the task (.• :
and what ccirnel'S it cut ls as deep as force. It was only late last month that
ever; Health care czar Ira Magaziner ,. Mr. Magaziner cut loose his Justice ·
·is-being Investigated by a U.S. .Attor,- lawyers and retained private counsel
ney to. find out If he deliberately lied · . Charles Ruff.
to a federal court tO block a lawsuit . We have_ our own concerns about
challenging the talik force's closed Mr. Magaziner .placing .his fate in the
rileetirigs. Everything the White hands of Proseclitor Holder. They are
House does to fre~ itself from this eth· familiar concerns ,Involving. the r:e-~~ tar pit. merely raises additic.mal .peated manner in which Clinton ope~
troublitig questio114 about its mores · atioi!S become a tangle of friendships,
and operating standardS.
. policy and trouble.
:· By all accounts, Mr. Magazinerhas
· On. January 6, ·the Was!tlngtc.ln
completely exasperated . Federal Post reported that two -White House
Judge Royce Lam~erth. Last month, officials had approached Mr. Holder
Mr. Lamberth .announced he- would to see If he woilld be interested .in
. ~pose sanctions against the ·White becoming ajudge on the U.S. COurt ·
· ijouse for misconduct in court. He de- of AppeaJs for the D.C. Circuit, .the ..
cJared "misleading, at best" ;Mr. Mag- second most powerful federal coun....... ·
This naturally set, off alarms in peo. aziner's statements ·
, that . · eve:cyone
pie watching the progress of the
viot~g on- the
· health care '-case before Judge Lam·
helilth care · task
· berth. ·Days later, White. House
~brce was a govern·
.Counsel Abner Mikva, who ·vacated
ment employee or ·
tlie court seat ~at Mr. Holder might
eorisuitant and thus·
ffil; told Legal Times that ~·was not
exempt from open·
.and Is not being considered." Howmeeting Jaws. The.
ever, Justice offlci8Js tell Us ·that Mr.
judge called on Eric
Mikva has been less categorical In
Holder, the u.s. At·
private conversations and has only
tOrney for the Dis·. .
said that Mr. Holder Is "probably
. tiict of. Columbia, lraMagaztner
not" the White House's choice.
to determine If Mr. Mli.gaziner had in·
Now by all acco~ts. Mr ,'Holder Is
·tentionally made _false statements to a .fine and up~tanding lawyer. That
the court.
·
· .said, our one encounter with him had
The judge.'s harsh words prompted to. dO with the appointment of Laurl
Deputy White House Counsel' JQel Fltz·Pegado to be director general of.·
'IOein· to· angrily accuse the judge of the U.S. and- Foreign Commercial
not giving Mr. Magazin_er _a c~ce 'to Service- under' her -friend and. former
defend himself against · contempt business ass()clate, Commerce Secrecharges. "That judge has put hini un·. tary. Rein Brown. :
.· ·
·
· der a cloua," Mr. Klein claimed.
· In an edltori81 at the time t'Who ·
Judge Lamberth promptly offered Is Lauri Fltz·Pegado?"l, we noted
:Mr. Magulner the chance for a civil that she had lobbied: for the Marxist
trial on charges that he· made false · regime IIi Angola, the Duvalier faintly ......
.statements to the court, and last week of Hli.lti ·I!Jld t.he rulers of· Kuwait.
;a lawyer for.Mr. Magazine~ indicated With the Kuwaitis, she ~as aceused ;;,;.::::. ·
'his cJient wanted to proctled \Yith a: of concocting false congressional tes· ....
civil trial before Mr. Holder conCluded tlmony; Days later ari over-the-tran·
.his criminal Investigation: .
·
som' letter arrived from u.s. Attorney_ ·
_ Mr. Magaziner suddenly changed ·Eric .Holder, effusively testifying to
.his mind this week and' decided to let the credentials of his friend Lauri
Mr. Holder's probe proceed. If there · Fltz·Pegado. That's admirable, w~ .
·had been a civil trial, the standllrdS guess, but now he's. being· asked to
:for proving contempt would have been rule dispassionately on an even big·
:tower and' ·top White· House officials ·ge_r friend· of the extended Clinton
:would have· been subpoenaed, includ-· family, Ira Magaziner.
ing HfUs,ry Rodham.Clinton.
All of this may lead Iowa Senator .
: Mr. Maga$1er · alsti would. have Charles Grassley and other Members .
:waived some· of his rights to remain. to demand that a special cotinsel in·
sllen~ in, any flitur:e crimln81 tiial.
vestigate Mr. Magaziner instead. We
."The White House didn't want to al· . have Jorigstandi'ng problems with the
·.. )ow full.' discovery II!to .exactly. what concept of a special c<iunsel, and won't
the task force did," says Dr. J:ane. Ori· join in any such call. But there may be
· :ent, the physician who Jed the suit grounds for turning _over the !leclslon ;;..
over the task force.
·
. to prosecute Mr.. Magaziner to a ca- _,..
Mr. Hollier's office says, It is re· ·reer civil servant at Justice.
·
· .viewing the case and takes It "very se· . Mr. Holder's unfortunate predlca· ·
)'lously."Butthathasn~tsatisfledsev·
merit is of a piece with.an Admlnis· ·
·era! Members· of Congress who say · tration that seems to have a habit of
that Mr .. Holder's investigation of Mr._ enmeshing Its own appointees In aw·Magaziner poses an inherent conflict . fui ethical snares that arise from its .
· :of interest. That's because the Justice o\vn Byzantine political· intrigues.
·Department, for whom Mr. Holder · ABk Webster Hubbell or Roger Alt·
.works, went to extraordinary lengths man or Jean Hanson. Eventually the
· 'to defend Mr. Magaziner and-the task · Administration Is going to have to ex·.
;force in court. Justice lawyers.helped -plain to Judge Lamberth why after
· :prepare Mr. MagaZiner's disputed two years IL just keeps sinking
:statements and presented them to the ·. deeper Into ~ tar pit.
·
.....
�.'Ji
.·:
.. ·:~::.
·f::
-.....,_,......--~~....,;...___:....;,;· ~----"'····,
.··:;:;,
Faith in Hap.oi
'·'
.
The liberalization of ·the VIet• · ·iorelgn ·paymasters:to s~e why Bud. . ··~amese economy .has meant a quail· dhlsts might yea.r:n ·for a more ac· ·
:tum lmprovement·tn religious. free- . countable political system.
'
· :dom 1il Vietnam. Tens of thousands of · .. Hanoi ~aintalns tjlere·are only six
monkS have been allowed out of the re· · ·million Buddhists In the country. By ·
·education camps· and back· to their the' estimate of every other observer,
· pagodas. According to ·the State De· some.Soo/o of VIetnam's 72 million peop~ent, people lire freer to practice pie. are believers. Assumlng.they had
their faith than at' any time since something to say about it, Hanoi
Hanoi tOQk· over. That IS,· unless they ~uld have to legalize the UBCV, Viet· . ·
question· why the Communist ·Party nam 's dominant Buddhist congrega. still holds all the cards. ·
< tlon, outlawed since 1981. ·
. . .: . So, while . five. million Filipinos . . The party's flat, even when backed
were turning out to cheer the Pope; up by the horrors of re-education, ·
Hanoi made news this week by jailing wasn't likely to make much of a dent In
:two· elder)y Buddhist monks. This Is · a2;000-year-old tradition. The UBCV
the same gbverninent that has a list a never really went away and lately has · .
.mile .lc11ig. of .aid projects .Its .wants beep attracting thrO!lgs of young and ·
:Western governments to finance.
. upwardly mQbile Vietnamese. The
· There can be little doubt that'Thich · same iS true 'of the Vietnamese
){uyen Quang, the .TT~year-Old patrt-~ catholic Church (the 'Qiggest In Asi~.
archofthe·UnifledBilddhlstChurchelf outside thePhillppines), and sever&
VIetnam, went out of his way to annoy other· sects. While the. Communists
the. authorities. While effectively. un· .don't exactly smile on any of these ex·
der a fomi of pagoda arrest ln Quang · presslons .of Independent thought, It's
Nal provtnce"he peRiled a letter sug- Buddhists who bear the. brunt of the
gestlng that the. party hold free elec· · reglril~'s political Insecurities. . . .
tions. His 68-year-old deputy, Thich · Like Its counterparts in Beijing, the
Quang Po, who was apprehended at ·Hanoi regime Is said to be captivated·
his pagoda In Ho Chi ~ City, had by the ~'Singapore model," or at least
nlso mllltated for democratic reforms. Hanol;s lnterpre~tlon of lt. 0~ own.
Self-determination ls, still h~resy.
, view Is that' freedom -Is ultimately lndl·
· Hanoi's propagan!fa m~n~ con· visible, and economics won't COlUlt for
nects these gentlemen fci what it calls · much if religious freedoms are train·
the "peaceful evolution" conspiracy; pled on. But the Vietnamese Commudark pl~ttlngs.carrled out by overseas nist Party, weighed down by historical
Vie.tnamese groups, human · rights bugaboos, falls more out of step by the
campaigner& an,d the U;S.. govei'J!· day. Its bylaws still require. party
.ment.·.,But you don't-'have.to imagine · memberstodlsavowanygodbutMarx.
·'
I
'
I
Asides
...
· NEA
(•.
Bookend~
. .
No. 1 New York City (six times. the
The speJ1ding lobby is practiced at nearest other locality in total grants)
.·lettiilg states ·and local jurisdictions ·and No. 2 Sail Francisco· (highest total·
know ·how much aprospective cutback . per capital to be the big NEA winners
will hurt them. But with the National ·.• Jn 1994. That alone might be ~nough to
Endowment .for the Arts; this. strategy get ~ongr~ssmen from middle Amer·
could be double-edged. It would shoW lea to-close down the show.
··:.;.:·:·:·
:t
·~·
TJiij WALL ~'l'REE'r'JOURN.
.
·~-...:.....
.-..
____f!
AL FRIDAY, JANUARy 20, 1995
?:.
. :~::.
\.
I.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003(a). report
DATE
SUBJECT/TITLE
Wire Report. Clintons Backed into Legal Comer. Paul Craig Roberts,
Scripps Howard News Service. Rocky Mountain News. Editorial.
[Annotated by staff.] (2 pages)
08/06/1994
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Sherburne
OA!Box Number: CF397
FOLDER TITLE:
White House Health Care Task Force
2006-0223-F
vz69
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- (S U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified .information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute ((b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for hiw enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
i ·-----------------------------------
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003(b ). report
Sl}BJECTITITLE
DATE
Wire Report. Listening to Ollie's Mom: That was no lady--That was
Hillary Clinton. Suzanne Fields. Atlanta Journal and Constitution.
Editorial. [Annotated by staff.] (2 pages)
11/03/1994
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Sherburne
OA/Box Number: CF397
FOLDER TITLE:
White House Health Care Task Force
2006-0223-F
vz69
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)J
Freedom of Information Act- (5 U.S.C. 552(b)J
PI
P2
P3
P4
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA(
b(3) Release would violate a Federal statute [(b)(3) of the FOIA[
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
· personal privacy [(b)(6) ofthe FOIA[
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disdo,se information concerning the regulation of
financial institutions [(b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
National Security Classified Information ((a)(l) of the PRA[
Relating to the appointment to Federal office ((a)(2) of the PRAJ
Release would violate a Federal statute ((a)(3) of the PRA)
Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) ofthe PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
j
�THE WHITE HOUSE
WASHINGTON
December 29, 1995
BY FACSIMILE
..
The Honorable William F. Clinger, Jr.
Chairman Committee on Government
Reform and Oversight
2157 Rayburn House Office Building
Washington o.c. 20515-6163
Dear Mr. Chairman,
We are in receipt of your December 19, 1995 letter
requesting certain information pertaining to Patsy Thomasson's
testimony about the costs of the Health Care Task Force. The
purpose of this letter is to request an additional two weeks to
respond.
As you are aware, Ms. Thomasson now serves as Deputy
Assistant to the President for Presidential Personnel. Any
documents she may have that are responsive to your request would
have been generated in her capacity as Special ~ssistant to the
President and Director of the Office of·Administration.
Despite
diligent efforts to retrieve those documents from off-site
storage, it now appears that we will be unable to do so in time
to meet the ten-day deadline provided in your letter. The fact
that this period coincides with the holiday season has also
complicated our efforts to meet this tight schedule.
Accordingly, we respectfully request a two week extension,
until January 12, 1996, to submit our response.
c:L ;6 ~
Christopher D. Cerf
Associate counsel t
the President
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
White House: Health Care Task Force
Creator
An entity primarily responsible for making the resource
Office of the Counsel to the President
Sherburne
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12308047" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-12308047-20060223F-001-016-2015
12308047
-
https://clinton.presidentiallibraries.us/files/original/09c8c6a87a0e1b927a93988e07ba3a7d.pdf
3a640255576a8e524f55a3e6417ed4ce
PDF Text
Text
Case Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the Clinton Presidential
Library Staff.
Folder Title:
Dec 17 93 Memo For The President And Mrs. Clinton From Ira C. Magaziner Re Health
Care Reform
Staff Office-Individual:
Counsel's Office-Podesta
Original OAIID Number:
CF 356
(Row:
Section:
Shelf:
Position:
Stack:
20
~
3
1
rv
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
DATE
SUBJECTffiTLE
Memorandum to President Clinton [and] Hillary Rodham Clinton.
From: Ira C. Magaziner. Subject: Health Care Reform. (2 pages)
12/17/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Podesta
OA/Box Number: CF356
FOLDER TITLE:
Dec. 17 '93 memo for the President and Mrs. Clinton from Ira C. Magaziner Re: Health
Care Reform
2006-0223-F
vz68
RESTRICTION CODES
Presidential Records Ad- [44 U.S. C. 2204(a))
Freedom oflnformation Ad- [5 U.S.C. 552(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) ofthe PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) ofthe PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(S) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECTffiTLE
DATE
RESTRICTION
AND TYPE
001. memo
Memorandum to President Clinton [and] Hillary Rodham Clinton.
From: Ira C. Magaziner. Subject: Health Care Reform. (2 pages)
12/17/1993
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Podesta
OA/Box Number: CF356
FOLDER TITLE:
Dec. 17 '93 memo for the President and Mrs. Clinton from Ira C. Magaziner Re: Health
Care Reform
2006-0223-F
vz68
RESTRICTION CODES
Presidential Records Act -(44 U.S.C. 2204(a))
Freedom of Information Act- (S U.S.C. SS2(b))
Pl National Security Classified Information ((a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
PJ Release would violate a Federal statute ((a)(J) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) ofthe FOIA)
b(J) Release would violate a Federal statute ((b)(J) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for Jaw enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Dec 17 93 Memo for the President and Mrs. Clinton from Ira C. Magaziner RE Health Care Reform
Creator
An entity primarily responsible for making the resource
Office of the Counsel to the President
John Podesta
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12392070" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-12392070-20060223F-001-015-2015
12392070
-
https://clinton.presidentiallibraries.us/files/original/772e7b2b8d7085804c6b7f1aac81d6b2.pdf
a769a2a654755cb1eae9dc5e4cf257c0
PDF Text
Text
Case Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the Clinton Presidential
Library Staff.·
Folder Title:
Health Care Task Force- GAO Investigation
Staff Office-Individual:
Counsel's Office-Neuwirth
Original OAIID Number:
CF 375
Row:
Section:
Shelf:
~osition:
20
3
8
1
Stack:
v
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. fax
DATE
SUBJECT/TITLE
Lynn Gibson to Steve Neuwirth at 17:43. [Re: GAO investigation of
RESTRICTION
03/17/1993
P5
Health Care TaskForce and FACA]. (4 pages)
002. note
AK to MV. Continued rumblings re Hillary and FACA. (1 page)
03/22/1993
P5
003. fax
Lynn Gibson to Steve Neuwirth at 17:43. [Re: GAO investigation of
02/17/1993
P5
Health Care Task Force and FACA]. [second copy] (4 pages)
COLLECTION:
Clinton Presidential Records
Counsel's Office
Neuwirth
OA/Box Number: CF375
FOLDER TITLE:
Health Care Task Force GAO Investigation
2006-0223-F
vz67
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)]
Freedom of Information Act- [S U.S.C. SS2(b)]
Pl National Security Classified Information [(a)(l) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information ](a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or cqnfidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerni!Jg the regulation of
financial institutions [(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
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!'be JSDDGnlble CbUlea A. lJGW&!ael'
CQIIIpb:oll.er Genel:"al ot:: 1:AC United Statell
44l. C SUeat, .li.W., Rlt. 70004
1fasJ:ain9ton, c. 20S48
n.
.tt baa been ~t to laY a't..cmtion that 'the Pnaideee•s Ta&k
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1et:ter is ~ seet a legal opi n.ion ·trail t:hB G&Mn1 Accou.nt.inq
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~· sougb'C to :bring into 'tbe aunahi.Da t.1lz'oa9h tha ea~t of
rACA.
Please GQnduct a revi• ~the Feaeral ....,:~.seEr en.ittoe Act
cleteraine Whether it: i& ap-plicable to the Pre&id.allt 1 s 'laak. :!'or:cc:
ou Haal.th care.. Spec=ifi<=atly, (l) deter.ei.M if tile preseuc:e of tha
l!'irat ta~ em ttle bsk force violatM the e.xpre.ss 1~ D:t I'ACI.,
(2} U-.U!'y t:o ~ clegl'ee non-fe4a:ta1 Oft'iclen ar employees iU1!
working Wit'b t:.be u.~ torce or on ~au:pa raportU.W 1:o the task
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. fax
DATE
SUBJECT/TITLE
Lynn Gibson to Steve Neuwirth at 17:43. [Re: GAO investigation of
Health Care Task Force and FACA]. (4 pages)
03/17/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Neuwirth
OA/Box Number: CF375
FOLDER TITLE:
Health Care Task Force GAO Investigation
2006-0223-F
vz67
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b)J
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRAJ
P3 Release would violate a Federal statute [(a)(3) of the PRAJ
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIAJ
b(3) Release would violate a Federal.statute [(b){3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
----
---------------
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. note
SUBJECT/TITLE
DATE
AK to MV. Continued rumblings re Hillary and FACA. (1 page)
03/22/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Neuwirth
ONBox Number: CF375
FOLDER TITLE:
Health Care Task Force GAO Investigation
2006-0223-F
vz67
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act- (5 U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Glinton Library
DOCUMENT NO.
AND TYPE
003. fax
DATE
SUBJECT/TITLE
Lynn Gibson to Steve Neuwirth at 17:43. [Re: GAO investigation of
02/17/1993
RESTRICTION
P5
Health Care Task Force and FACA]. [second copy] (4 pages)
COLLECTION:
Clinton Presidential Records
Counsel's Office
Neuwirth
OA/Box Number: CF375
FOLDER TITLE:
Health Care Task Force GAO Investigation
2006-0223-F
vz67
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)]
Freedom of Information Act- [5 U.S.C. 552(b)]
Pl National Security Classified Information [(a)(l) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
.financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed In accordance with restrictions contained in donQr's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
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23-421· 400 SETS
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�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force GAO Investigation
Creator
An entity primarily responsible for making the resource
Office of the Counsel to the President
Steven R. Neuwirth
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7408726" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7408726-20060223F-001-014-2015
7408726
-
https://clinton.presidentiallibraries.us/files/original/751ca7a9e7cfb3c959576a71616ed02e.pdf
c7c1b8b43b71a862a94ff093e89db148
PDF Text
Text
Case Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the Clinton Presidential
Library Staff.
Folder Title:
OLC Memo ToM. Verveer Regarding Health Care- Sep 27 93
Staff Office-Individual:
Counsel's Office-Neuwirth
Original OAIID Number:
CF 370
Row:
Section:
Shelf:
!Position:
20
~
6
~
Stack:
tv
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECTffiTLE
DATE
RESTRICTION
001. memo
Memorandum for Attorney General Janet Reno and Associate
Attorney General Webster Hubbell. From Walter Dellinger and H.
Jefferson Powell, Department of Justice. Re: The Constitutionality of
Health Care Reform. (7 pages)
10/29/1993
P5
002. memo
Memorandum for Attorney General Janet Reno and Associate
Attorney General Webster Hubbell. From Walter Dellinger and H.
Jefferson Powell, Department of Justice. Re: The Constitutionality of
Health Care Reform. (7 pages)
10/29/1993
P5
003a. memo
Memorandum for Melanne Verveer. From Walter Dellinger,
Department of Justice. [Re: Health Care Task Force]. (1 page)
09/27/1993
P5
003b. memo
Memorandum for the Health Care Task Force. From Walter Dellinger,
Department of Justice. Re: Anticipated Constitutional and Legal
Challenges to the President's Health Care Task Force. (5 pages)
09/16/1993
P5
004a. memo
Memorandum for Melanne Verveer. From Walter Dellinger,
Department of Justice. [Re: Health Care Task Force]. (I page)
09/27/1993
P5
004b. memo
Memorandum for the Health Care Task Force. From Walter Dellinger,
Department of Justice. Re: Anticipated Constitutional and Legal
Challenges to the President's Health Care Task Force. (5 pages)
09/16/1993
P5
004c. memo
Memorandum for Melanne Verveer. From Walter Dellinger,
Department of Justice. [Re: Health Care Task Force]. (1 page)
09/27/1993
P5
005a. memo
Photocopy. Memorandum for Melanne Verveer. From Walter
Dellinger, Department of Justice. [Re: Health Care Task Force]. (1
page)
09/27/1993
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Neuwirth
OA/Box Number: CF370
FOLDER TITLE:
OLC Memo to M. Verveer Regarding Health Care September 27, 1993
2006-0223-F
vz66
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom oflnformation Act- (S U.S.C. SS2(b))
PI National Security Classified Information ((a)(I) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
PJ Release would violate a Federal statute ((a)(J) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(I) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of .
an agency ((b)(2) of the FOIA)
b(J) Release would violate a Federal statute ((b)(J) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) oftbe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
005b. memo
DATE
SUBJECTffiTLE
Photocopy. Memorandum for the Health Care Task Force. From
Walter Dellinger, Department of Justice. Re: Anticipated
Constitutional and Legal Challenges to the President's Health Care
Task Force. (5 pages)
RESTRICTION
0911611993
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Neuwirth
OA/Box Number: CF370
FOLDER TITLE:
OLC Memo toM. Verveer Regarding Health Care September 27, 1993
2006-0223-F
vz66
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a)J
Freedom of Information Act- (S U.S.C. SS2(b)J
Pl National Security Classified Information ((a)(l) ortbe PRA)
P2 Relating to tbe appointment to Federal office ((a)(2) oftbe PRA)
P3 Release would violate a Federal statute ((a)(3) ortbe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) oftbe PRA]
PS Release would disclose confidential advice between tbe President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA]
b(l) National security classified information ((b)(l) oftbe FOIA)
b(2) Release would disclose internal personnel rules and practices or
an agency ((b)(2) oftbe FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) orthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) oftbe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of girt.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
- - - - - - - -
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
DATE
SUBJECT/TITLE
Memorandum for Attorney General Janet Reno and Associate
Attorney General Webster Hubbell. From Walter Dellinger and H.
Jefferson Powell, Department of Justice. Re: The Constitutionality of
Health Care Reform. (7 pages)
10/29/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Neuwirth
ONBox Number: CF370
FOLDER TITLE:
OLC Memo toM. Verveer Regarding Health Care September 27, 1993
2006-0223-F
vz66
RESTRICTION CODES
Presidential Records Aet - [44 U.S.C. 2204(a))
Freedom of Information Aet- [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(l) of the PRA]
Pl Relating to the appointment to FederaJ.office [(a)(l) ofthe PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(l) ofthe FOIA)
b(l) Release would disclose internal personnel rules and practices of
an agency [(b)(l) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. memo
SUBJECT/TITLE
DATE
Memorandum for Attorney General Janet Reno and Associate
Attorney General Webster Hubbell. From Walter Dellinger and H.
Jefferson Powell, Department of Justice. Re: The Constitutionality of
Health Care Reform. (7 pages)
10/29/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Neuwirth
OA/Box Number: CF370
FOLDER TITLE:
OLC Memo toM. Verveer Regarding Health Care September 27, 1993
2006-0223-F
vz66
RESTRICTION CODES
Presidential Records Aet- (44 U.S.C. 2204(a))
Freedom of Information Aet -IS U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would diselose trade secrets or confidential commereial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security elassified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(J) Release would violate a Federal statute ((b)(J) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003(a). memo
SUBJECT/TITLE
DATE
Memorandum for Melanne Verveer. From Walter Dellinger,
Department of Justice. [Re: Health Care Task Force]. (1 page)
09/27/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Neuwirth
OA/Box Number: CF370
FOLDER TITLE:
OLC Memo toM. Verveer Regarding Health Care September 27, 1993
·2006-0223-F
vz66
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)]
Freedom of Information Act- [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(l) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(bXl) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(bX3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
·
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained In donor's deed
ofgift.
'
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003(b). memo
SUBJECT/TITLE .
RESTRICTION
DATE
Memorandum for the Health Care Task Force. From Walter Dellinger,
Department of Justice. Re: Anticipated Constitutional and Legal
Challenges to the President's Health Care Task Force. (5 pages)
09/16/1993
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Neuwirth
ONBox Number: CF370
FOLDER TITLE:
OLC Memo toM. Verveer Regarding Health Care September 27, 1993
2006-0223-F
vz66
RESTRICTION CODES
Presidential Records Act - (44 U.S.C. 2204(a)(
Freedom oflnformation Act -(S U.S.C. SSl(b)(
PI National Security Classified Information ((a)(l) of the PRAJ
P:Z Relating to the appointment to Federal office ((a)(l) of the PRAJ
P3 Release would violate a Federal statute ((a)(3) of the PRAJ
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRAJ
b(l) National security classified information ((b)(l) of the FOIA)
b(l) Release would disclose internal personnel rules and practices of
an agency ((b)(:Z) of the FOIAJ
b(3) Release would violate a Federal statute ((b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) ofthe FOIAJ
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs ((b)(9) of the FOIAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
-----------------'
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004(a). memo
DATE
SUBJECT/TITLE
Memorandum for Melanne Verveer. From Walter Dellinger,
Department ofJustice. [Re: Health Care Task Force]. (1 page)
09/27/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Neuwirth
ONBox Number: CF370
FOLDER TITLE:
OLC Memo toM. Verveer Regarding Health Care September 27, 1993
2006-0223-F
vz66
RESTRICTION CODES
Presidential Records Ad- 144 U.S.C. 2204(a))
Freedom of Information Ad- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA) ·
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004(b). memo
SUBJECT/TITLE
DATE
Memorandum for the Health Care Task Force. From Walter Dellinger,
Department of Justice. Re: Anticipated Constitutional and Legal
Challenges to the President's Health Care Task Force. (5 pages)
09/16/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Neuwirth
OA/Box Number: CF370
FOLDER TITLE:
OLC Memo toM. Verveer Regarding Health Care September 27, 1993
2006-0223-F
vz66
RESTRICTION CODES
Presidential Records Ad- [44 U.S.C. 2204(a))
Freedom of Information Ad- [5 U.S.C. 552(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
fmancial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
· an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004c.memo
DATE
SUBJECTrfiTLE
Memorandum for Melanne Verveer. From Walter Dellinger,
Department of Justice. [Re: Health Care Task Force]. (1 page)
09/27/1993
RESTRICTION
PS
COLLECTION:
Clinton Presidential Records
Counsel's Office
Neuwirth
OA/Box Number: CF370
FOLDER TITLE:
OLC Memo to M. Verveer Regarding Health Care September 27, 1993
2006-0223-F
vz66
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act- (S U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
PJ Release would violate a Federal statute ((a)(J) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors. or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) ofthe PRA)
b(l) National security classified information ((b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(J) Release would violate a Federal statute ((b)(J) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005(a). memo
DATE
SUBJECT/TITLE
Photocopy. Memorandum for Melanne Verveer. From Walter
Dellinger, Department of Justice. [Re: Health Care Task Force]. (1
page)
09/27/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Neuwirth
OA/Box Number: CF370
FOLDER TITLE:
OLC Memo toM. Verveer Regarding Health Care September 27, 1993
2006-0223-F
vz66
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act -IS U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information ((b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA(
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005(b). memo
DATE
SUBJECTffiTLE
Photocopy. Memorandwn for the Health Care Task Force. From
Walter Dellinger, Department of Justice. Re: Anticipated
Constitutional and Legal Challenges to the President's Health Care
Task Force. (5 pages)
09/16/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Neuwirth
ONBox Number: CF370
FOLDER TITLE:
OLC Memo toM. Verveer Regarding Health Care September 27, 1993
2006-0223-F
vz66
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Aet- (5 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disdose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disdose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security dassified information ((b)(l) of the FOIA)
b(2) Release would disdose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disdose information compiled for law enforcement
purposes'((b)(7) of the FOIA)
b(8) Release would disdose Information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disdose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
OLC Memo to M. Verveer Regarding Health Care September 27, 1993
Creator
An entity primarily responsible for making the resource
Office of the Counsel to the President
Steven R. Neuwirth
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7408726" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-7408726-20060223F-001-013-2015
7408726
-
https://clinton.presidentiallibraries.us/files/original/70ad0b4e4110ed70299a2064652346a9.pdf
dec5dc1c4a3318b30c01d9e3c431751b
PDF Text
Text
-
,
Withdrawal/Redaction Sheet
Clinton Library ·
DOCUMENT NO.
AND TYPE
SUBJECTtriTLE
DATE
RESTRICTION
001. memo
Photocopy. Memorandum to Vincent Foster and Stephen Neuwirth
from Robert E. Kopp and David J. Anderson. Re: Compliance Issues
and Appeal Prospects in Ass'n of American Physicians and Surgeons
v. Hillary Rodham Clinton et al., No. 93-399 (D.D.C.) (9 pages)
n.d.
P5
002. memo
Talking Points Health Care Task Force Case (1 page)
n.d.
P5
003. memo
Photocopy. Memorandum for File from Stephen R. Neuwirth. Subject:
Contact with GSA Acting General Counsel. (2 pages)
06/14/1993
P5
004. memo
Photocopy. Memorandum for Leon Panetta from Joel Klein and
Stephen Neuwirth. Subject: Health care working group
documents/litigation. (2 pages)
10/28/1994
P5
005. note
Photocopy. [Health Care Task Force Q & A]. (4 pages)
n.d.
P5
006. draft
Photocopy. Draft ofletter from Vicent Foster. [Re: National Health
Care Reform]. (1 page)
n.d
P5
007. note
Photocopy. Q & A's on Health Care Task Force Appeal. (3 pages)
n.d.
P5
008. note
Photocopy. Talking Points on Health Care Task Force Case. (2 pages)
n.d.
P5
009. memo
Photocopy. Memorandum for Robert E. Kopp, Mark B. Stem, Patricia
A. Millett, and Malcolm L. Stewart, Civil Division, DOJ from
Stephen R. Neuwirth. Re: Plaintiffs Appeal Brief in AAPS. (4 pages)
04/07/1993
P5
010. note
Talking Points on Wall Street Journal Editorial. (2 pages)
n.d.
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents [Neuwirth Potentially Priv. Copies]
2006-0223-F
vz75
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)]
Freedom of Information Act- [5 U.S.C. 552(b))
PI Nation~l Security Classified Information [(a)(l) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA[
P6 Release would constitute a clearly unwarranted invasion of
perso.nal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
.
b(3) Release would violate a Federal statute ((b)(3) of the FOIA(
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA) ·
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological. or geophysical information
concerning wells ((b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�.,
...
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECT/TITLE
RESTRICTION
011. memo
Photocopy. Memorandwn to: Health Care Task Force andWorking
Group Personnel from John D. Podesta and Stephen R. Neuwirth. Re:
Task Force and Working Group Records. (2 pages)
04/29/1993
P5
012. memo
Photocopy. Memorandwn for File from Stephen R. Neuwirth. [Re:
Health Care Task Force]. (3 pages)
04/2311994
P5
013. memo
Photocopy. Memorandwn to Steve neuwirth from Nicole Gueron. Re:
Relevance of Audit Groups in ft.rst set of interrogatories in Assocation
of American Physicians and Surgeons, Inc. v. Hillary Rodham Clinton
et al. (6 pages)
07/16/1993
P5
014. memb
Photocopy. Memorandwn to Steve Neuwirth from Harold Ickes. Re:
Lawsuit against the National Health Care Task Force. (1 page)
04/25/1994
P5
015. note
Photocopy. [Handwritten draft of legal docwnent regarding the Health
Care Task Force lawsuit]. (10 pages)
n.d.
P5
I
I.
I
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: .CF453
FOLDER TITLE:
Health Care Task Force Docwnents [Neuwirth Potentially Priv. Copies]
2006-0223-F
vz75
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [S U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRA)
Pl Relating to the appointment to Federal office [(a)(l) of the PRA)
P3 Release would violate a Federal statute [(a)(3) ofthe PRA) ·
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(bXl) ofthe FOIA)
b(l) Release would disclose internal personnel rules and practices of
'
an agency [(b)(l) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
·
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
SVBJECTffiTLE
DATE
Photocopy. Memorandum to Vincent Foster and Stephen Neuwirth
froin Robert E. Kopp and David J. Anderson. Re: Compliance Issues
and Appeal Prospects in Ass'n of American Physicians and Surgeons
v. HillaryRodham Clinton et al., No. 93-399 (D.D.C.) (9 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents [Neuwirth Potentially Priv. Copies]
2006-0223-F
vz75
RESTRICTION CODES .
Presidential Records Ad- [44 U.S.C. 2204(a)[
Freedom of Information Act- [S U.S.C. SS2(b))
Pl National Security Classified Information [(a)(l) of the PRA)
Pl Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release w.ould disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Rele~se would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA[
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. memo
SUBJECT/TITLE
DATE
Talking Points Health Care Task Force Case (1 page)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents [Neuwirth Potentially Priv. Copies]
2006-0223-F
vz75
RESTRICTION CODES
Presidential Rec:ords Ac:t- [44 U.S.C. 2204(a))
PI National Sec:urity Classified Information [(a)(l) of the PRA)
· P2 Relating to the appointment to Federal offic:e [(a)(2) of the PRA).
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disc:lose trade sec:rets or c:onfidential c:ommerc:ial or
financ:ial information [(a)(4) of the PRAJ
PS Release would disclose c:onfidential advic:e between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
Freedom of Information Ac:t- [S U.S.C. SS2(b))
b(l) National security classified information [(b)(l) of the FOIAJ
b(2) Release would disc:lose internal personnel rules and prac:tices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would c:onstitute a clearly unwarranted invasion of
personal privac:y [(b)(6) of the FOIA)
b(7) Release would disclose information c:ompiled for law enforc:ement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information conc:erning the regulation of
financ:ial institutions [(b)(8) of the FOIA)
b(9) Release would disc:lose geologic:al or geophysic:al information
c:onc:erning wells [(b)(9) ofthe FOIA)
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. memo
DATE
SUBJECT/TITLE
Photocopy. Memorandum for File from Stephen R. Neuwirth. Subject:
Contact with GSA Acting General Counsel. (2 pages)
06/14/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents [Neuwirth Potentially Priv. Copies]
"2006-0223-F
vz75
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [S U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRAJ
P2 Relating to the appointment to Federal office J(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRAJ
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIAJ
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIAJ
b(8) Release would disclose information concerning the regulation of
·
financial institutions [(b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning weDs [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. memo
DATE
SUBJECT/TITLE
Photocopy. Memorandum for Leon Panetta from Joel Klein and
Stephen Neuwirth. Subject: Health care working group
documents/litigation. (2 pages)
10/28/1994
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
·Nemetz, Miriiun
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents [Neuwirth Potentially Priv. Copies]
2006-0223-F
vz75
RESTRICTION CODES
Presidential Records Ad- (44 U.S.C. 2204(a)(
Freedom of Information Ad -15 U.S.C." 552(b))
PI National Security Classified Information ((a)(l) of the PRA(
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA(
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRAJ
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRAJ
b(l) National security classified information ((bXl) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
·
b(3) Release would violate a Federal statute [(bX3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation ·of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DATE
SUBJECT/TITLE
DOCUMENT NO.
AND TYPE
Photocopy. [Health Care Task Force Q & A]. (4 pages)
005. note
n.d.
RESTRICTION
P5
'
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Docwnents [Neuwirth Potentially Priv. Copies]
2006-0223-F
vz75
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) of the PRA)
Pl Relating to the appointment to Federal office [(a)(l) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted invasion of
persona.l privacy [(a)(6) of the PRAJ
b(l) National security classified information [(b)(l) ofthe FOIA)
b(l) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIAI
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44·U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006. draft
DATE
SUBJECTri'ITLE
Photocopy. Draft ofletter from Vicent Foster. [Re: National Health
Care Reform]. (1 page)
n.d
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Car~ Task Force Documents [Neuwirth Potentially Priv. Copies]
2006-0223-F
vz75
RESTRICTION CODES
Presidential Records Act- (44 U.S.(:. ll04(a))
Freedom of Information Act -IS U.S.C. SSl(b))
Pl National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office ((a)(l) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a. clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(l) Release would disclose internal personnel rules and practices of
an agency ((b)(l) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA) ·
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
ll01(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
007. note
SUBJECT/TITLE
DATE
Photocopy. Q & A's on Health Care Task Force Appeal. (3 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents [Neuwirth Potentially Priv. Copies]
2006-0223-F
vz75
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information ·
concerning wells [(b )(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
008. note
DATE
SUBJECT/TITLE
Photocopy. Talking Points on Health Care Task Force Case. (2 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents [Neuwirth Potentially Priv. Copies]
2006-0223-F
vz75
RESTRICTION CODES
Presidential Records Act· [44 U.S.C. 2204(a)[
Freedom of Information Act- [S U.S.C. SS2(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would· disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf'lle defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
009. memo
DATE
SUBJECT/TITLE
Photocopy. Memorandwn for Robert E. Kopp, Mark B. Stem, Patricia
A. Millett, and Malco~ L. Stewart, Civil Division, DOJ from
Stephen R. Neuwirth. Re: Plaintiffs Appeal Brief in AAPS. (4 page~)
04/07/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Docwnents [Neuwirth Potentially Priv. Copies]
2006-0223-F
vz75
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) of the PRAI
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financiallnformation [(a)(4) of the PRAI
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIAJ
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) of the FOIAI
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
010. note
DATE
SUBJECT/TITLE
Talking Points on Wall Street Journal Editorial. (2 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents [Neuwirth Potentially Priv. Copies]
2006-0223-F
vz75
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b)J
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose intermit personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial i!lstitutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
011. memo
DATE
SUBJECT/TITLE
Photocopy. Memorandum to: Health Care Task Force and Working
Group Personnel from John D. Podesta and Stephen R. Neuwirth. Re:
Task Force and Working Group Records. (2 pages)
04/29/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents [Neuwirth Potentially Priv. Copies]
2006-0223-F
vz75
RESTRICTION CODES
Presidential Records Ad- [44 U.S.C. 2204(a))
Freedom of Information Ad -IS U.S.C. SS2(b))
Pl National Security Classified Information l(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information l(a)(4) of the PRA)
PS Release would disclose confidential advice between the President ·
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information l(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute l(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information l(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes I(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wens l(b)(9) of the FOIA)
C. Closecl in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
. DOCUMENT NO.
AND TYPE
012. memo
DATE
SUBJECTffiTLE
Photocopy. Memorandum for File from Stephen R. NeuWirth. [Re:
Health Care Task Force]. (3 pages)
04/23/1994
RESTRICTION.
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents [Neuwirth Potentially Priv. Copies]
2006-0223-F
vz75
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [S U.S.C. SS2(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would· constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute ((b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA).
b(9) Release would disclose geological or geophysical information
·
concerning wells ((b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will· be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
013. memo
DATE
SUBJECT/TITLE
Photocopy. Memorandwn to Steve neuwirth from Nicole Gueron. Re:
Relevance of Audit Groups in flrst set of interrogatories in Assocation
of American Physicians and Surgeons, Inc. v. Hillary Rodham Clinton
·
et al. (6 pages)
07/16/1993
RESTRICTION
PS
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Docwnents [Neuwirth Potentially Priv. Copies]
2006-0223-F
vz75
RESTRICTION CODES
Presidential Records Ad- [44 U.S.C. 2204(a))
Freedom of Information Ad- [S U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
·
DOCUMENT NO.
AND TYPE
014. memo
Clinton Library
DATE
SUBJECTffiTLE
Photocopy. Memorandwn to Steve Neuwirth from Harold Ickes. Re:
Lawsuit against the National Health Care Task Force. (1 page)
04/25/1994
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
. FOLDER TITLE:
Health Care Task Force Docwnents [Neuwirth Potentially Priv. Copies]
2006-0223-F
vz75
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)[
Freedom of Information Act- [S U.S.C. SS2(b)[
PI National Security Classified Information [(a)(l) ofthe PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
015. note
DATE
SUBJECT/TITLE
Photocopy. [Handwntten draft of legal document regarding the Health
CareTaskForce lawsuit]. (10 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents [Neuwirth Potentially Priv. Copies]
2006-0223-F
vz75
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)]
Freedom oflnformation Act- [5 U.S.C. SS2(b)]
PI National Security Classified Information [(a)(l) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) ofthe PRA]
P4 Release would disdose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disdose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
6(1) National security dassified information [(b)(l) of the FOIA]
b(2) Release would disdose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disdose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
b(8) Release would diselose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would diselose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misftle defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Documents [Neuwirth Potentially Priv. Copies]
Creator
An entity primarily responsible for making the resource
Office of the Counsel to the President
Miriam Nemetz
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12309349" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-12309349-20060223F-001-012-2015
12309349
-
https://clinton.presidentiallibraries.us/files/original/23b72950dd5d56a610009f86639bd160.pdf
242a2a6d7566eb0e4d55b5dbf7713719
PDF Text
Text
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. memo
Photocopy. Talking Points on the Health Care Task Force and the
"Tollgate" Policy Development Process. (3 pages)
n.d.
P5
002. memo
Photocopy. Revised talking points on the Health Care Decision. (1
page)
10/10/1993
P5
003. memo
Photocopy. Q and A's on Health. Care Task Force Appeal. (3 pages)
n.d.
P5
004. memo
Photocopy. Health Care Task Force and Interest Groups: Talking
Points. (3 pages)
n.d
P5
005. memo
Photocopy. Memorandum from Meeghan K. Prunty, Office of
Communications to George Stephanopoulos, Riki Seidman and David
Dreyer. Subject: Health Task Force, Talking Points: To Replace Ones
From [truncated]. (3 pages)
03/05/1993
P5
006.memo
Photocopy. To Vince, Steve, George, Dee Dee, Lisa, Melanne,
Boorstin. From Maggie. Re: Health Care Task Force Talking Points.
(5 pages)
02/03/1993
P5
007. memo
Photocopy. Memorandum for: Jeff Eller, Boob Boorstin, and Lisa
Caputo. From Carolyn Gatz. Subject: Conclusion of Task Force on
Health Reform and Working Group. (3 pages)
05/28/1993
P5
008. memo
Photocopy. Memorandum for George Stephanopolus and Lisa Caputo.
From Cheryl Mills. Subject: Wall Street Journal Article on Illegality
of Volunteers on the Health Care Task Force. (2 pages)
03/10/1993
P5
009. memo
Photocopy. Settlement Talking Points 8/12/94 ~9:00AM. (1 page)
08/12/1994
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Documents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. ll04(a))
Freedom of Information Act- [S U.S.C. SSl(b)[
PI National Security Classified Information [(a)(l) of the PRA]
Pl Relating to the appointment to Federal office [(a)(l) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(l) Release would disclose internal personnel rules and practices of
an agency [(b)(l) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning weDs [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
ll01(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
010. memo
Photocopy. Q&As 8/12/94 - 9:00 AM. (2 pages)
08/12/1994
P5
011. draft
Photocopy. Talking Points on Settlement Disucssions. ( 1 page)
08/04/1994
P5
012. memo
Photocopy. Openess of the Task Force Process. (2 pages)
n.d.
P5
013. memo
Photocopy. Q&As. (2 pages)
n.d.
P5
014. draft
Photocopy. Background: Litigation Involving the Health Care Task
Force and the Interdepartmental Working Group. (4 pages)
n.d.
P5
015. draft
Photocopy: Background: Litigation Involving the Health Care Task
Force and the Interdepartmental Working Group. (7 pages)
n.d.
P5
016. draft
Photocopy. From Steve Neuwirth and Jason Solomon. Talking Points
on Health Care Task Force Court Order. (1 page)
06/15/1993
P5
017. memo
Photocopy. Talking Points on Health Care Task Force Case. (1 page)
n.d.
P5
018. memo
Photocopy. Memorandum for Howard Pastor. From Vincent W.
Foster and Stephen R. Neuwirth. Re: Health Care Task Force. (6
pages)
02/03/1993
P5
019. memo
Photocopy. Memorandum to Lisa Caputo. From Vincent W. Foster.
Re: Health Care Task Force- FACA. (1 page)
02/05/1993
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Docuinents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. SS2(b))
Pl National Security Classified Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed In accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
DATE
SUBJECT/TITLE
Photocopy. Talking Points on the Health Care Task Force and the
"Tollgate" Policy Development Process. (3 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Documents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act -15 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) of the PRAJ
P2 Relating t9 the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commerelal or
financial information ((a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy.((a)(6) of the PRAJ
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or 'financial
information ((b)(4) of the FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed In accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. memo
DATE
SUBJECT/TITLE
Photocopy. Revised talking points on the Health Care Decision. (1
page)
10/10/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Documents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
Presidential Records Ad- (44 U.S.C. 2204(a)J
Freedom of Information Ad -IS U.S.C. SS2(b)J
PI National Security Classified Information ((a)(l) of the PRAJ
P2 Relating to the appointment to Federal office ((a)(2) of the PRAJ
P3 Release would violate a Federal statute ((a)(3) of the PRAJ
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRAJ
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRAJ
b(l) National security classified information ((b)(l) ofthe FOIAJ
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIAJ
b(3) Release would violate a Federal statute ((b)(3) of the FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIAJ
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIAJ
b(S) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) ofthe FOIAJ ·
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. memo
SUBJECTffiTLE
DATE
Photocopy. Q and A's on Health Care Task Force Appeal. (3 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Documents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. ll04(a)(
Freedom of Information Act -(S U.S.C. SS2(b)(
P1 National Security Classified Information ((a)(1) ofthe P~(
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(1) National security classified information ((b)(1) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(:Z) ofthe FOIA)
b(3) Release would vioiate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA(
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) ofthe FOIA(
C. Closed in accordance with restrictions contained in donor's deed
of gift.
·PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. memo
DATE
SUBJECT/TITLE
Photocopy. Health Care Task Force and Interest Groups: Talking
Points. (3 pages)
n.d
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Documents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a)J
Freedom of Information Act- [S U.S.C. SS2(b)J
PI National Security Classified Information ((a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRAJ
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRAJ
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIAJ
b(3) Release would violate a Federal statute [(b)(3) of the FOIAI
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) ilfthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. memo
DATE
SUBJECT/TITLE
Photocopy. Memorandum from Meeghan K. Prunty, Office of
Communications to George Stephanopoulos, Riki Seidman and David
Dreyer. Subject: Health Task Force, Talking Points: To Replace Ones
From [truncated]. (3 pages)
03/05/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Documents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information [(bXl) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(bX3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
----
------
--------
----~------------------__j
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AN~ TYPE
006. memo
DATE
SUBJECT/TITLE
Photocopy. To Vince, Steve, George, Dee Dee, Lisa, Melanne,
Boorstin. From Maggie. Re: Health Care Task Force Talking Points.
(5 pages)
02/03/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Docwnents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
Presidential Records Act - (44 U.S.C. 2204(a))
Freedom of Information Act- (S U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIAJ
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIAJ
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
007. memo
DATE
SUBJECTffiTLE
Photocopy. Memorandwn for: Jeff Eller, Boob Boorstin, and Lisa
Caputo. From Carolyn Oatz. Subject: Conclusion of Task Force on
Health Reform and Working Group. (3 pages)
05/28/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Docwnents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a)]
Freedom of Information Act- [5 U.S.C. 552(b)]
Pl National Security Classified Information [(a)(l) ofthe PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute ((a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA]
P6 Release would-constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA]
b(3) Release would violate a Federal statute ((b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wens ((b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
008. memo
DATE
SUBJECTffiTLE
Photocopy. Memorandum for George Stephanopolus and Lisa Caputo.
From Cheryl Mills. Subject: Wall Street Journal Article on Illegality
of Volunteers on the Health Care Task Force. (2 pages)
RESTRICTION
03/10/1993
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Documents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
U.~.C.
Presidential Records Ad- [44 U.S.C. 2204(a))
Freedom of Information Act- [S
Pl National Security Classified Information [(a)(l) of the PRAJ.
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRAJ
b(l) National security classified information [(b)(l) of the FOIAJ
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIAJ
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIAJ
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
SS2(b)[
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
009. memo
SUBJECT/TITLE
DATE
Photocopy. Settlement Talking Points 8/12/94-9:00 AM. (l.page)
08/12/1994
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Documents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRAJ
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf'lle defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
010. memo
DATE
SUBJECT/TITLE
08/12/1994
Photocopy. Q&As 8/12/94 - 9:00 AM. (2 pages)
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Documents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a)(
Freedom of Information Act -(5 U.S.C. SS2(b)(
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the ·PRA)
P3 Release would violate a Federal statute [(a)(3) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRAJ
b(l) National security classified information ((b)(l) ofthe FOIAJ
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy J(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Doc~ment will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
011. draft
DATE
SUBJECTffiTLE
Photocopy. Talking Points on Settlement Disucssions. (1 page)
08/04/1994
RESTRICTION
PS
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Documents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
Presidential Records Aet- [44 U.S.C. 2204(a))
Freedom of Information Aet- [S U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commereial or
finaneialinformation [(a)(4) ofthe PRA)
PS Release would diselose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security elassified information [(b)(l) ofthe FOIA)
b(l) Release would diselose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would diselose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would diselose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
012. memo
SUBJECT/TITLE
DATE
Photocopy. Openess of the Task Force Process. (2 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Documents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. ll04(a))
Freedom of Information Act- [5 U.S.C. SSl(b))
PI National Security Classified Information [(a)(l) of the PRA)
Pl Relating to the appointment to Federal office [(a)(l) of the PRA)
PJ Release would violate a Federal statute [(a)(3) of the PRA[
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(l) Release would disclose internal personnel rules and practices of
an agency [(b)(l) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
ll01(3).
RR. Document will be reviewed upon request.
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Clinton Library
DOCUMENT NO.
AND TYPE
013. memo
SUBJECTffiTLE
DATE
Photocopy. Q&As. (2 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Documents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [S U.S.C. SS2(b))
Pl National Security Classified Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA) ·
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
014. draft
DATE
SUBJECTffiTLE
Photocopy. Background: Litigation Involving the Health Care Task
Force and the Interdepartmental Working Group. (4 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Documents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [S U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(bXI) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(bX3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release wouid disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Close4 in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
015. draft
SUBJECTffiTLE
DATE
Photocopy. Background: Litigation Involving the Health Care Task
Force and the Interdepartmental Working Group. (7 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Documents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
. Presidential Records Act- (44 U.S.C. 2204(a)(
Pl National Security Classified Information ((a)(l) of the PRAJ
P2 Relating to the appointment to Federal office ((a)(2) of the PRAJ
P3 Release would violate a Federal statute ((a)(3) of the PRAJ
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA(
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
Freedom of Information Act -IS U.S.C. SS2(b)J
b(l) National security classified information ((b)(l) of the FOIAJ
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA(
b(3) Release would violate a Federal statute ((b)(3) of the FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA(
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIAJ
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA(
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIAJ
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
016. draft
SUBJECTffiTLE
DATE
Photocopy. From Steve Neuwirth and Jason Solomon. Talking Points
on Health Care Task Force Court Order. (1 page)
06/15/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Documents Caputo Potentially Privileged Copies
2006-0223-F
· vz65
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)]
Freedom of Information Act- [S U.S.C. SS2(b)]
PI National Security Classified Information [(a)(l) ofthe PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
Information [(b)(4) ofthe FOIA]
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA[
C. Closed In accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
017. memo
SUBJECT/TITLE
,
DATE
Photocopy. Talking Points on Health Care Task Force Case. (1 page)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Documents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)J
Freedom of Information Act- [5 U.S.C. 552(b)J
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRAJ
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information [(bXl) ofthe FOIAJ
b(l) Release would disclose internal personnel rules and practices of
an agency ((bX2) of the FOIA) '
b(3) Release would violate a Federal statute ((bX3) of the FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
018. memo
DATE
SUBJECT/TITLE
Photocopy. Memorandum for Howard Pastor. From Vincent W.
Foster and Stephen R. Neuwirth. Re: Health Care Task Force. (6
pages)
02/03/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Documents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. :Z:Z04(a))
Freedom of Information Act- [5 U.S.C. 55:Z(b))
PI National Security Classified Information [(a)(l) of the PRA)
P:Z Relating to the appointment to Federal office [(a)(:Z) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(:Z) Release would disclose internal personnel rules and practices of
an agency [(b)(:Z) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordan,ce with 44 U.S.C.
:Z:Z01(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
·
DOCUMENT NO •.
AND TYPE
019. memo
Clinton Library
DATE
SUBJECT/TITLE
Photocopy. Memorandum to Lisa Caputo. From Vincent W. Foster.
Re: Health Care Task Force.- FACA. (1 page)
02/05/1993
RESTRICTION
PS
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Reform Task Force Documents Caputo Potentially Privileged Copies
2006-0223-F
vz65
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a)J
Freedom of Information Act -(5 U.S.C. 552(b)J
PI National Security Classified Information ((a)(l) of the PRAJ
P2 Relating to the appointment to Federal office ((a)(2) of the PRAJ
P3 Release would violate a Federal statute ((a)(3) of the PRAJ
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRAJ
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRAJ
b(l) National security classified information ((b)(l) of the FOIAJ
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIAJ
b(3) Release would violate a Federal statute ((b)(3) of the FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIAJ
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) ofthe FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfJ.Ie defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Documents Caputo Potentially Priv. Copies
Creator
An entity primarily responsible for making the resource
Office of the Counsel to the President
Miriam Nemetz
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12309349" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-12309349-20060223F-001-011-2015
12309349
-
https://clinton.presidentiallibraries.us/files/original/11a3e0196ff4995d8713b479297f1983.pdf
f783aecebace49c9e683c3ae9d462374
PDF Text
Text
.....
. -
Withdrawal/Redaction Sheet
·~
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
OOI.letter
William T. Fitzsimmons to BernardS. Arons. Subject: Financial
Interests. ( 1 page)
03/29/1996
P5, P6/b(6)
002. report
Executive Branch Confmdential Financial Disclosure Report. (11
pages)
01129/1993
P5, P6/b(6)
003. note
Photocopy of handwritten notes by Beth Nolan. [Re: Health Care Task
Force]. (4 pages)
n.d.
P5
004. fax
To: Beth Nolan. From: Jane. [Re: Financial Disclosures for White
House Stafl]. (4 pages)
10/05/1993
P5
005; memo
Photocopy. Memorandum for Jennifer O'Connor from Bruce R.
Overton. Subject: Funding Optio~ regarding the Health Care Task
Force. (3 pages)
03/12/1993
P5
006. note
Photocopy. Note to Beth Nolan. [Re: plan for public input into Health
Care Reform.] ( 1 page)
05/13/1993
P5
007. memo
Photocopy. Memorandum for Dr. Thomas Pyle, Health Care Task
Force Board Member from Bernard Nussbaum and Beth Nolan.
Subject: Employment Status. (2 pages)
03/22/1993
P5
008. letter
Photocopy. Charles Samuels to Ira Magaziner. [Re: Thomas Pyle]. (2
pages)
03/19/1993
P5
009. resume
Photocopy. Resume for Thomas 0. Pyle. (2 pages)
n.d.
P5, P6/b(6)
010. resume
Photocopy. Curriculum Vitae for Thomas 0. Pyle. (2 pages)
n.d. ·
P5, P6/b(6)
COLLECTION:
Clinton Presidential Records
Counsel's Office
,Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
. Health Care Task Force Nolan Potentially Priv. Copies
2006-0223-F
vz74
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Feder.al office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose informa.tion compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wens [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
011. memo
SUBJECT/TITLE
DATE
Photocopy. Memorandwn to Ira Magaziner from Beth Nolan. Subject:
Outside auditors on Health Care Task Options. (4 pages)
03/24/1993
RESTRICTION
P5
COLLE<:TION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Nolan Potentially Priv. Copies
2006-0223-F
vz74
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)[
Freedom of Information Act- [5 U.S.C. 552(b)[
P1 National Security Classified Information [(a)(1)'ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
·
b(1) National security classified information [(b)(1) of the FOIA)
b(2) Release would disclose internal personnef rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a.clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
·b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutionsl(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. letter
DATE
SUBJECT/TITLE
William T. Fitzsimmons to BernardS. Arons. Subject: Financial
Interests. ( 1 page)
03/29/1996
RESTRICTION
P5, P6/b(6)
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
. Health Care Task Force Nolan Potentially Priv. Copies
2006-0223-F
vz74
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a)(
Freedom of Information Act -15 U.S.C. 552(b)]
PI National Security Classified Information ((a)(l) of the PRA]
P2 Relating to the appointment to Federal office ((a)(2) of the PRA]
P3 Release would violate a Federal statute ((a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRAJ
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) ofthe PRA]
b(l) National security classified information ((b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA]
b(3) Release would violate a Federal statute ((b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
co~cerning wells ((b)(9) ofthe FOIAJ
)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3)..
RR. Docuinent will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. report
DATE
SUBJECT/TITLE
Executive Branch Confindential Financial Disclosure Report. (11
pages)
01129/1993
RESTRICTION
P5, P6/b(6)
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Nolan Potentially Priv. Copies
2006-0223-F
vz74
RESTRICTION CODES
Presidential Reeords Ad- [44 U.S.C. 2204(a))
Freedom of Information Ad- [S U.S.C. SS2(b))
P1 National Seeurity Classified Information [(a)(1) of the PRA)
P2 Relating to the appointment to Federal offiee [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would diselose trade seerets or eonfidential commereial or
finandal information [(a)(4) of the PRA)
·
PS Release would disdose eonfidential adviee between the President
and his advisors, or between sueh advisors [a)(S) of the PRA)
P6 Release would eonstitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(1) National seeurity elassified information [(b)(1) of the FOIA)
b(2) Release would disdose internal personnel rules and pradiees of
an ageney [(b)(2) of the FOIA[
b(3) Release would violate a Federal statute [(bX3) of the FOIA)
b(4) Release wo.uld disdose trade seerets or eonfidential or finandal
information [(b)(4) of the FOIA)
b(6) Release would eonstitute a dearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disdose information eompiled for law enforeement
purposes [(b)(7) of the FOIA)
b(8) Release would diselose information coneerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disdose geologieal or geophysieal information
coneerning wells [(b)(9) of the FOIA[
C. Closed in aeeordanee with restridions eontained in donor's deed
of gift.
PRM. Personal reeord misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request..
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. note
SUBJECT/TITLE
DATE
Photocopy of handwritten notes by Beth Nolan. [Re: Health Care Task
·
Force]. (4 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Neinetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Nolan Potentially Priv. Copies
2006-0223-F
vz74
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act -[5 U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
_
Clinton Library
DOCUMENT NO.
AND TYPE
004. fax
DATE
SUBJECT/TITLE
To: Beth Nolan. From: Jane. [Re: Financial Disclosures for White
House Staff]. (4 pages)
10/05/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Nolan Potentially Priv. Copies
2006-0223-F
vz74
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRAJ
P4 Release would disclose trade secrets.or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a){S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statl~te [(b)(3) of the FOIAJ
b(4) Release would diselose trade secrets or confidential ,or financial
information [(b)(4) of the FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. memo
DATE
SUBJECTffiTLE
Photocopy. Memorandum for Jennifer O'Connor from Bruce R.
Overton. Subject: Funding Options regarding the Health Care Task
Force. (3 pages)
03/12/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force NolanPotentially Priv. Copies
2006-0223-F
vz74
RESTRICTION CODES
Presidential Records Ad- [44 U.S.C. 2204(a)]
Freedom of Information Ad- [S U.S.C. SS2(b)]
Pl National Security Classified Information [(a)(l) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would diselose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would diselose confidential advice between the President
. and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security elassified information [(b)(l) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA]
b(7) Release would diselose Information compiled for law enforcement
purposes [(b)(7).ofthe FOIA]
b(8) Release would diselose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006. note
DATE
SUBJECT/TITLE
Photocopy. Note to Beth Nolan. [Re: plan for public input into Health
Care Reform.] (lpage)
05/13/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number:
CF453
FOLDER TITLE:
Health Care Task Force Nolan Potentially Priv. Copies
2006-0223-F
vz74
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom oflnformation Act- [S U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(J) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(bXI) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
·b(3) Release would violate a Federal statute [(bXJ) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
007. memo
DATE
SUBJECTffiTLE
Photocopy. Memorandwn for Dr. Thomas Pyle, Health Care Task
Force Board Member from Bernard Nussbawn and Beth Nolan.
Subject: Employment Status. (2 pages)
03/22/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Nolan Potentially Priv. Copies
2006-0223-F
vz74
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)]
Freedom of Information Act- [5 U.S.C. 552(~)]
Pl National Security Classified Information [(a)(l) ofthe PRA]
Pl Relating to the appointment to Federal office [(a)(l) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(l) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
·
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift~
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
008.letter
DATE
SUBJECTffiTLE
Photocopy. Charles Samuels to Ira Magaziner. [Re: Thomas Pyle]. (2
pages)
03/19/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Nolan Potentially Priv. Copies
2006-0223-F
vz74
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. SS2(b)]
Pl National Security Classified Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors Ia)(5) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(bXl) of the_ FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial iJ,Istitutions [(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions .contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 V.S.C.
2201(3).
RR. Document will be reviewed upon request.
I
J I_______________________________________
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
009. resume
DATE
SUBJECT/TITLE
Photocopy. Resume for Thomas 0. Pyle. (2 pages)
RESTRICTION
n.d.
PS, P6/b(6)
•·
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Nolan Potentially Priv. Copies
2006-0223-F
vz74
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act- (5 U.S.C. 552(b)J
Pl National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRAJ
P4 Release would disclose trade secrets or confidential commercial or
financial information((a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRAJ
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) ofthe FOIAJ
b(3) Release would violate·& Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
· information ((b)(4) ofthe FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) ofthe FOIAJ
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
------------------------------------------
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
010. resume
DATE
SUBJECT/TITLE
Photocopy. Curriculum Vitae for Thomas 0. Pyle. (2 pages)
RESTRICTION
n.d.
P5, P6/b(6)
•'
COLLECTION:
Clinton Presidential Records .
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Nolan Potentially Priv. Copies
2006-0223-F
vz74
RESTRICTION CODES
Presidential Records Ad- (44 U.S.C. l204(a))
Freedom of Information Ad- (5 U:S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disdose trade secrets or confidential commereial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential adviee between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security dassified information [(b)(l) of the FOIA)
b(2) Release would disdose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disdose trade secrets or confidential or finaneial
information [(b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA]
b(7) Release would disdose information compiled for law enforceme~t
purposes [(b)(7) of the FOIA)
·
b(8) Release would diselose information concerning the regulation of
finaneial institutions [(b)(8) of the FOIA)
b(9) Release would disdose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
011. memo
DATE
SUBJECT/TITLE
Photocopy. Memorandum to Ira Magaziner from Beth Nolan. Subject:
Outside auditors on Health Care Task Options. (4 pages)
03/24/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Nolan Potentially Priv. Copies
2006-0223-F
vz74
RESTRICTION CODES
Presidential Records Ad- [44 U.S.C. 2204(a)[
PI National Security Classified Information [(a)(l) of the PRA[
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such·advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined.in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
Freedom of Information Aet- [S U.S.C. SS2(b)J
b(l) National security classified information [(bXl) of the FOIA[
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIAJ
·
b(3) Release would violate a Federal statute [(bX3) ofthe FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIAJ
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
· b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
(
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Documents Nolan Potentially Priv. Copies
Creator
An entity primarily responsible for making the resource
Office of the Counsel to the President
Miriam Nemetz
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12309349" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-12309349-20060223F-001-010-2015
12309349
-
https://clinton.presidentiallibraries.us/files/original/075c3d31f02080ac0a81081b72afc8a0.pdf
3a4e6b98f615bb0fcff048703ce0a7a0
PDF Text
Text
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. note
Photcopy. Note from Vincent Foster to Hillary Rodham Clinton. [Re:
Health Care Task Force lawsuit]. (1 page)
n.d.
P5
002. photocopy
photocopy of post-it note and handwritten notes. [Re: VFW notes
1993]. (1 page)
n.d.
P5
003. note
Photocopy. Vince Foster, handwritten notes regarding Health Care
Task Force. (1 page)
n.d.
P5, P6/b(6)
004. note
Photocopy. Vince Foster, handwritten notes regarding Health Care
Task Force. (1 page)
n.d.
P5, P6/b(6)
005. note
Photocopy. Vince Foster, handwritten notes regarding Health Care
Task Force. (1 page)
n.d.
P5
006. note
Photocopy. Vince Foster, handwritten notes regarding Health Care
Task Force. (1 page)
n.d.
P5;.P6/b(6)
007. note
Photocopy. Vince Foster, handwritten notes regarding Health Care
Task Force lawsuit. (26 pages)
n.d.
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Foster Potentially Privileged Copies
2006-0223-F
vz62
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. ll04(a)]
Freedom of Information Act- [5 U.S.C. SSl(b)]
PI National Security Classified Information ](a)(l) of the PRA]
Pl Relating to the appointment to Federal office [(a)(l) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of '
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(l) of the FOIA]
b(l) Release would disclose internal personnel rules and practices of
an agency [(b)(l) of the FOIA]
b(3) Release would violate a. Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions ](b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contain'ed in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
ll01(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library .
DOCUMENT NO.
AND TYPE
001. note
DATE
SUBJECT/TITLE
Photcopy. Note from Vincent Foster to Hillary Rodham Clinton. [Re:
Health Care Task Force lawsuit]. (1 page)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Foster Potentially Privileged Copies
2006-0223-F
vz62
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)[
Freedom of Information Act- [S U.S.C. SS2(b))
Pl National Security Classified Informatioil((a)(l) of the PRA)
P2 Relating to the appoint8lent to Federal office ((a)(2) of the PRA)
P3 Release .would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA) ·
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIAJ
b(3) Release would violate a Federal statute ((b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(S) Release would disclose information concerning the regulation of
financial institutions [(b)(S) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. photocopy
SUBJECTffiTLE
DATE
photocopy of post-it note and handwritten notes. [Re: VFW notes
1993]. (1 page)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Foster Potentially Privileged Copies
2006-0223-F
vz62
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [S U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release. would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
· RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. note
DATE
SUBJECT/TITLE
Photocopy. Vince Foster, handwritten notes regarding Health Care
Task Force. (1 page)
n.d. ·
RESTRICTION
P5, P6/b(6)
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Foster Potentially Privileged Copies
2006-0223-F
vz62
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) ofthe PRAJ.
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
·
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed ·
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. note
DATE
SUBJECT/TITLE
Photocopy. Vince Foster, handwritten notes regarding Health Care
Task Force. (1 page)
RESTRICTION
n.d.
P5, P6/b(6)
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Foster Potentially Privileged Copies
2006-0223-F
vz62
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act -IS U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRA)
Pl Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) ofthe PRA)
b(l) National security classified information ((b)(1) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
·
DOCUMENT NO.
AND TYPE
005. note
Clinton Library
DATE
SUBJECTffiTLE
Photocopy. Vince Foster, handwritten notes regarding Health Care
Task Force. (1 page)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Foster Potentially Privileged Copies
2006-0223-F
vz62
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [S U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office )(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commerelal or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(l) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
·
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or finanelal
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(S) Release would disclose Information concerning the regulation of
financial institutions ((b)(S) of the FOIA)
b(9)Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006. note
DATE
SUBJECT/TITLE
Photocopy. Vince Foster, handwritten notes regarding Health Care
Task Force. (1 page)
RESTRICTION
n.d.
P5, P6/b(6)
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Foster Potentially Privileged Copies
2006-0223-F
vz62
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2l04(a))
Freedom of Information Act -15 U.S.C. 552(b))
Pl National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commer.cial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(l) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA)
·b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misflle defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed.upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
007. note
DATE
SUBJECT/TITLE
Photocopy. Vince Foster, handwritten notes regarding Health Care
Task Force lawsuit. (26.pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
.Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Foster Potentially Privileged Copies
2006-0223-F
vz62
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)]
Freedom of Information Act- [S U.S.C. SS2(b)]
Pl National Security Classified Information [(a)(l) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) ofthe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
· concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Documents Foster Potentially Priv. Copies
Creator
An entity primarily responsible for making the resource
Office of the Counsel to the President
Miriam Nemetz
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12309349" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-12309349-20060223F-001-009-2015
12309349
-
https://clinton.presidentiallibraries.us/files/original/e1b4a425ac2c3de18bbf9460820fb270.pdf
0b607874aeb5a75d0a50c083b563e049
PDF Text
Text
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECTffiTLE
RESTRICTION
OOla. fax
Fax Cover from Jeff Gutman to Steve Neuwirth at 5:15pm. [Re:
Health Care Reform Task Force]. [partial] (l page)
05/1111993
P6/b(6)
OOlb. fax
Jeff Gutman to Steve Neuwirth at 5:15pm. [Re: Health Care Reform
Task Force] (l page)
05/1111993
P5
OOlc. fax
Bretton G. Sciaroni to Brenda Dolan [Re: Health Care Reform Task
Force] (2 pages)
04/26/1993
P5
002. form
Freedom of Information Act Request from the American Council for
Health Care Reform reguesting records relating to the Health Care
Reform Task Force. (2 pages)
03/1711993
P5
003a. form
Freedom of Information Act Request from the American Council for
Health Care Reform reguesting records relating to the Health Care
Reform Task Force. (2 pages)
03/17/1993
P5
003b. draft
Stewart M. Gerson to Dr. Jane M. Orient, Association of American
Physicians and Surgeons, Inc., Re: Request for Documents and
Information. (3 pages)
03/30/1993
P5
003c. letter
Stewart M. Gerson to the Honorable Michael J. Astrue. [Re: Federal
Advisory Committee Act]. (2 pages)
03/17/1993
P5
003d. photocopies
Photocopy of Legal decision in the case of Food Chemical News v.
Department ofHealth and Human Services (DCCA, 91-5318; decided
12/18/1992) (10 pages)
03/17/1993
P5
003e.memo
Draft, Memorandum to Vincent Foster and Stephen Neuwirth from
03/24/1993
P5
David J. Anderson. Re: Issues relating to the Document Disclosure
Provision of the Federal Advisory Committee Act. (10 pages)
COLLECTION:
Clinton Presidential Records
Counsel's Office
Miriam Nemetz
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privileged Copies [3] [2]
2006-0223-F
vz57
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
Freedom oflnformation Act- [5 U.S.C. 552(b))
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECTffiTLE
DATE
RESTRICTION
003f. fax
Fax cover sheet. Jeff Gutman to Stephen Neuwirth. (1 page)
03/2411993
P5
004a. fax
No cover sheet. Letter draft to Dr. Jane M. Orient, Association of
American Physicians and Surgeons, Inc., Re: Request for Documents
and Infonnation. (3 pages)
03/3111993
P5
004b. fax
Letter draft to Dr. William H. Shaker, American Council for Health
Refonn. Re: Request for Documents and Infonnation. (2 pages)
03/31/1993
P5
005a. letter
Bernard W. Nussbaum to Dr. Jane M. Orient, Association of American
Physicians and Surgeons, Inc., Re: Request for Documents and
Infonnation. (3 pages)
04/01/1993
P5
005b. letter
Bernard W. Nussbaum to Dr. William H. Shaker, American Council
for Health Refonn. Re: Request for Documents and Infonnation. (3
pages)
04/01/1993
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Miriam Nemetz
ONBox Number: CF4 53
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privileged Copies [3) [2)
2006-0223-F
vz57
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [S U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
PJ Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001a. fax
DATE
SUBJECTffiTLE
Fax Cover from Jeff Gutman to Steve Neuwirth at 5:15pm. [Re:
Health Care Reform Task Force). [partial) (1 page)
05/11/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Counsel's Office
Miriam Nemetz
OA/Box Number: CF4 53
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privileged Copies [3) [2)
2006-0223-F
vz57
RESTRICTION CODES
Presidential Records Ad -144 U.S.C. 2204(a))
Freedom oflnformation Ad- (S U.S.C. SS2(b))
PI National Security Classified Information l(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office f(a)(2) of the PRA)
P3 Release would violate a Federal statute f(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information f(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors fa)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information f(b)(l) of the FOIA)
b(2) Release would diselose internal personnel rules and practices of
an agency f(b)(2) orthe FOIA)
b(3) Release would violate a Federal statute f(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information f(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy f(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes f(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions l(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells f(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001b. fax
SUBJECTffiTLE
DATE
Jeff Gutman to Steve Neuwirth at 5:15pm. [Re: Health Care Reform
Task Force] (1 page)
05/1111993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Miriam Nemetz
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privileged Copies [3] [2]
2006-0223-F
vz57
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act- (5 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) ofthe PRA)
PJ Release would violate a Federal statute ((a)(J) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors. or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(J) Release would violate a Federal statute ((b)(J) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
OOlc. fax
DATE
SUBJECT!TITLE
Bretton G. Sciaroni to Brenda Dolan [Re: Health Care Refonn Task
Force] (2 pages)
04/26/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Miriam Nemetz
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privileged Copies [3] [2]
2006-0223-F
vz57
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act- (S U.S.C. SS2(b))
PI National Security Classified Information ((a)( I) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) ofthe PRA)
P3 Release would violate a Federal statute ((a)(3) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) oftbe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�c·~~,~~ ~ ~\~E:A
--\~\.~~ ~
J,, \l '-Dt' .
.
~\.j\
~~-\\~
l
l9~~ ,,
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. form
DATE
SUBJECT/TITLE
Freedom oflnformation Act Request from the American Council for
Health Care Reform reguesting records relating to the Health Care
Reform Task Force. (2 pages)
03/17/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privileged Copies [3] [2]
2006-0223-F
vz57
RESTRICTION CODES
Presidential Records Act -(44 U.S.C. 2204(a))
'
Freedom of Information Act - (S U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA)
PS Release would disdose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security dassified information ((b)(l) ofthe FOIA)
b(2) Release would diselose Internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disdose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted Invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disdose information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disdose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disdose geological or geophysical information
concerning wells ((b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003(a). fonn
SUBJECTfi'ITLE
DATE
Freedom oflnfonnation Act Request from the American Council for
Health Care Refonn reguesting records relating to the Health Care
Refonn Task Force. (2 pages)
03/17/1993
RESTRICTION
PS
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privileged Copies [3] [2]
2006-0223-F
vz57
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))·
Freedom of Information Act- [S U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would diselose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security elassified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would diselose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would diselose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would diselose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf"de defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003(b). draft
SUBJECTffiTLE
DATE
Stewart M. Gerson to Dr. Jane M. Orient, Association of American
Physicians and Surgeons, Inc., Re: Request for Documents and
Information. (3 pages)
03/30/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privileged Copies [3] [2]
2006-0223-F
vz57
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act- [S U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRA]
Pl Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would diselose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or fmancial
Information ((b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforeement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
finaneial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning weDs [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
I
I
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003(c). letter
DATE
SUBJECTffiTLE
Stewart M. Gerson to the Honorable Michael J. Astrue. [Re: Federal
Advisory Committee Act]. (2 pages)
03/17/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privileged Copies [3] [2]
2006-0223-F
vz57
RESTRICTION CODES
Presidential Records Ad- [44 U.S.C. 2204(a)[
Freedom of Information Act- [S U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commerelal or
fmanciallnformation [(a)(4) ofthe PRA)
PS Release would diselose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted Invasion of
personal privacy [(a)(6) ofthe PRA)
b(l) National security dasslfied Information [(b)(l) of the FOIA)
b(2) Release would disclose Internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would diselose trade secrets or confidential or fmandal
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would diselose Information compiled for law enforeement
purposes [(b)(7) of the FOIA)
b(B) Release would diselose Information concerning the regulation of
fmaneiallnstitutions [(b)(B) of the FOIA)
b(9) Release would disdose geological or geophysieal information
concerning wells [(b)(9) of the FOIA)
C. Closed In accordance with restrldlons contained in donor's deed
of gift.
PRM. Personal record misfile defmed In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003(d).
photocopies
SUBJECTri'ITLE
DATE
Photocopy of Legal decision in the case of Food Chemical News v.
Department ofHealth and Human Services (DCCA, 91-5318; decided
12/18/1992) (10 pages)
03/17/1993
RESTRICTION
P5
COLLECTION:
Glinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privileged Copies [3] [2]
2006-0223-F
vz51
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Ad- [S U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA) ·
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(S) Release would disclose Information concerning the regulation of
financial institutions [(b)(S) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed In accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Docu·ment will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003(e). memo
SUBJECTffiTLE
DATE
Draft, Memorandum to Vincent Foster and Stephen Neuwirth from
David J. Anderson. Re: Issues relating to the Document Disclosure
03/24/1993
RESTRICTION
P5
Provision of the Federal Advisory Committee Act. (10 pages)
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privileged Copies [3] [2]
2006-0223-F
vz57
RESTRICTION CODES
Presidential Records Act -144 U.S.C. ll04(a))
Freedom of Information Act -IS U.S.C. SSl(b))
Pl National Security Classified Information ((a)(l) ofthe PRA)
Pl Relating to the appointment to Federal office ((a)(l) of the PRA)
P3 Release would violate a Federal statute f(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information f(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information f(b)(l) of the FOIA)
b(l) Release would disclose internal personnel rules and practices of
an agency f(b)(l) of the FOIA)
b(3) Release would violate a Federal statute f(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information f(b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy f(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions f(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs f(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf'de defined in accordance with 44 U.S.C.
ll01(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003(f). fax
DATE
SUBJECTfi'ITLE
Fax cover sheet. Jeff Gutman to Stephen Neuwirth. (1 page)
03/24/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privileged Copies [3] [2]
2006-0223-F
vz57
RESTRICTION CODES
Presidential Records Act -(44 U.S.C. :Z:Z04(a))
Freedom of Information Act -IS U.S.C. SS:Z(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(:Z) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
fmancial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf"lle defined in accordance with 44 U.S.C.
:Z:Z01(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004(a). fax
DATE
SUBJECfffiTLE
No cover sheet. Letter draft to Dr. Jane M. Orient, Association of
American Physicians and Surgeons, !fie., Re: Request for Documents
and Information. (3 pages)
03/31/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privileged Copies [3] [2]
2006-0223-F
vz51
RESTRICTION CODES
Presidential Records Aet -(44 U.S.C. 2204(a))
Freedom of Information Aet -(5 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the .PRAJ
b(l) National security classified Information ((b)(l) ofthe FOIA)
b(2) Release would disclose Internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004(b). fax
DATE
SUBJECTfi'ITLE
Letter draft to Dr. William H. Shaker, American Council for Health
Reform. Re: Request for Documents and Information. (2 pages)
03/31/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privileged Copies [3] [2]
2006-0223-F
vz57
RESTRICTION CODES
Presidential Records Aet -144 U.S.C. 2204(a))
Freedom of Information Aet- IS U.S.C. SS2(b))
Pl National Security Classified Information ((aXl) of the PRA)
P2 Relating to the appointment to Federal office ((aX2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would diselose trade secrets or confidential commerelal or
finaneial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) ofthe PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security dassified information ((b)(l) of the FOIA)
b(2) Release would diselose Internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or finanelal
information ((b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disdose Information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(S) Release would disdose Information concerning the regulation of
financial institutions ((b)(S) of the FOIA)
b(9) Release would disdose geological or geophysical information
concerning weDs ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record mist"lle defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005(a). letter
SUBJECTffiTLE
DATE
Bernard W. Nussbaum to Dr. Jane M. Orient, Association of
American Physicians and Surgeons, Inc., Re: Request for Documents
and Information. (3 pages)
04/0111993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privileged Copies [3] [2]
2006-0223-F
vz57
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Ad - (S U.S.C. SS2(b))
Pl National Security Classified Information ((a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors. or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA]
b(l) National security classified information [(b)(l) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed In accordance with restrictions contained in donor's deed .
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�-----~~-~-
-
--
- ----
'
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005(b). letter
DATE
SUBJECTffiTLE
Bernard W. Nussbaum to Dr. William H. Shaker, American Council
for Health Reform. Re: Request for Documents and Information. (3
pages)
04/0111993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privileged Copies [3] [2]
2006-0223-F
vz57
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a)]
Freedom of Information Act -15 U.S.C. 552(b))
PI National Security Classified Information l(a)(l) of the PRA)
P2 Relating to the appointment to Federal office l(a)(2) ofthe PRA]
P3 Release would violate a Federal statute l(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information l(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors la)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy l(a)(6) of the PRA]
b(l) National security classified information l(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency l(b)(2) of the FOIA]
b(3) Release would violate a Federal statute l(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or fmancial
information l(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy l(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes l(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions l(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells l(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Documents Gibson Potentially Priv. Copies [3] [2]
Creator
An entity primarily responsible for making the resource
Office of the Counsel to the President
Miriam Nemetz
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12309349" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-12309349-20060223F-001-008-2015
12309349
-
https://clinton.presidentiallibraries.us/files/original/85a6737a2310698038d0a72f3e3514d7.pdf
2fa63194024f20a67ad0e25f2323d488
PDF Text
Text
-
~~
Withdrawal/Redaction Sheet
~
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECT/TITLE
DATE
RESTRICTION
001. memo
Memorandum for Jennifer O'Connor, Office Administrator from Beth
Nolan, Associate Counsel to the President. Subject: HHS
Representative on the Health Care Task Force. (1 page)
0311011993
P5
002. draft
Comments for the last couple of pages of the Brief. ( 1 page)
n.d.
P5
003. fax
Fax cover sheet. Stephen Neuwirth to Web Hubbell at 1:40pm. [Re:
draft ofMagaziner declaration]. (1 page)
0310211993
P5
004. fax
Stephen Neuwirth to Web Hubbell at 1:40 pm. [Re: draft of
Magaziner declaration]. (14 pages)
0310211993
P5
005. note
Talking points on Health Care Task Force. (1 page)
0210311993
P5
006. memo
Memorandum from Ira Magaziner to unknown. Subject: Health Care
Reform Working Groups--Catagories ofParticipants. (1 page)
03101/1993
P5
007. memo
Memorandum for Jennifer O'Connor, Office Administrator from Beth
Nolan, Associate Counsel to the President. Subject: HHS
Representative on the Health Care Task Force. (1 page)
0311011993
P5
008. fax
Jeff Gutman to Stephen Neuwirth. [Re: Response to Washington
Times Article]. (3 pages)
1012111993
P5
009.memo
Memorandum for Leon Panetta from Joel Klein and Stphen Neuwirth.
Subject: Health Care working group documents I litigation. (1 page)
1012811994
P5
010. memo
Memorandum for Leon Panetta from Joel Kle~ and Stphen Neuwirth.
Subject: Health Care working group documents I litigation. (2 pages)
1012811994
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Priv. Copies [4]
2006-0223-F
vz58
RESTRICTION CODES
Presidential Records Ac:t- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disc:lose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a c:learly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disc:lose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wens [(b)(9) of the FOIA)
1 P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
i
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disc:lose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a c:learly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf"de defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECTffiTLE
RESTRICTION
011. order
Photocopy of Judge Royce C. Lamberth's Order in the case of
Association of American Physicians and Surgeons, Inc. et al v. Hillary
Rodham Clinton, et al. ( 1 page)
09/28/1994
P5
012. fax
Stephen Neuwirth to Jeff Gutman. [Re: Draft responses to Health
Care Task Force Freedom oflnformation Act Requests.] (6 pages)
n.d.
P5
013. note
From Steve Neuwirth and Jason Solomon to unknown. Draft for
Discussion: Talking Points on Health Care Task Force Court Order.
(1 page)
06/15/1993
P5
014. note
Photocopy, Vince Foster to Hillary Rodham Clinton. [Re: Health Care
Task Force lawsuit]. (1 page)
03/14/1993
P5
015. memo
Memorandum for Christopher Cerf from Kumiki Gibson. Subject:
Document Request Re: Health Care Task Force. (15 pages)
02/13/1995
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Priv. Copies [4]
2006-0223-F
vz58
RESTRICTION CODES
Presidential Records Ad- [44 U.S.C. ll04(a))
Freedom of Information Ad- [S U.S.C. SSl(b))
PI National Security Classified Information [(a)(l) ofthe PRA)
Pl Relating to the appointment to Federal office [(a)(l) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted Invasion of
· personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(1) of the FOIA)
b(l) Release would disclose internal personnel rules and practices of
an agency [(b)(l) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or eonfidential or finaneial
·
information [(b)(4) ofthe FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
ll01(3).
RR. Document will be reviewed upon request.
-----------
----------
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
DATE
SUBJECTfi'ITLE
Memorandum for Jennifer O'Connor, Office Administrator from Beth
Nolan, Associate Counsel to the President. Subject: HHS
Representative on the Health Care Task Force. (1 page)
03/10/1993
RESTRICTION
PS
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Priv. Copies [4]
2006-0223-F
vzS8
RESTRICTION CODES
Presidential Records Aet- (44 U.S.C. 2204(a))
'
Freedom of Information Aet- [S U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) ofthe PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA)
PS Release would disdose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. draft
SUBJECTffiTLE
DATE
Comments for the last couple of pages of the Brief. ( 1 page)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Priv. Copies [4]
2006-0223-F
vz58
RESTRICTION CODES
Presidential Records Act -(44 U.S.C. ll04(a))
Freedom of Infor~ation Aet -IS U.S.C. SSl(b))
PI National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office ((a)(l) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would diselose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would diselose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) ofthe PRA)
b(l) National security elassified information ((b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a elearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would diselose information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would diselose information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would. diselose geological or geophysical information
concerning weDs ((b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. fax
SUBJECTffiTLE
DATE
Fax cover sheet. Stephen Neuwirth to Web Hubbell at 1:40pm. [Re:
draft ofMagaziner declaration]. (1 page)
03/02/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Priv. Copies [4]
2006-0223-F
vz58
RESTRICTION CODES
Presidential Records Aet -144 U.S.C. :Z:Z04(a))
Freedom of Information Aet -IS U.S.C. SS:Z(b))
PI National Security Classified Information [(a)(l) ofthe PRA)
P:Z Relating to the appointment to Federal office [(a)(:Z) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(:Z) Release would disclose internal personnel rules and practices of
an agency [(b)(:Z) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs l(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. fax
DATE
SUBJECTfi'ITLE
Stephen Neuwirth to Web Hubbell at 1:40pm. [Re: draft of
Magaziner declaration]. (14 pages)
03/02/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Priv. Copies [4]
2006-0223-F
vz58
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)]
Freedom of Information Act- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would diselose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA]
P6 Release would constitute a elearly unwarranted Invasion of
personal privacy ((a)(6) of the PRA]
b(l) National security elassified information ((b)(l) ofthe FOIA]
b(2) Release would disclose Internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute ((b)(3) of the FOIA]
b(4) Release would diselose trade secrets or confidential or fmancial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy ((b)(6) of the FOIA]
b(7) Release would diselose Information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would dlselose information concerning the regulation of
fmanelal institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf'de defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. note
DATE
SUBJECTffiTLE
Talking points on Health Care Task Force. (1 page)
02/03/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records .
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Priv. Copies [4]
2006-0223-F
vz58
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a))
Freedom of Information Act -IS U.S.C. 552(b))
PI National Security Classified Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b){4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006. memo
DATE
SUBJECTffiTLE
Memorandum from Ira Magaziner to unknown. Subject: Health Care
Reform Working Groups--Catagories ofParti~ipants. (1 page)
03/01/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Priv. Copies [4]
2006-0223-F
vz58
RESTRICTION CODES
Presidential Records Ad -(44 U.S.C. 2204(a))
Freedom of Information Ad -(5 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) ofthe PRA)
Pl Relating to the appointment to Federal office ((a)(l) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified Information ((b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(l) o(the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or fmaneial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the .FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf'lle defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
007.memo
DATE
SUBJECfffiTLE
Memorandum for Jennifer O'Connor, Office Administrator from Beth
Nolan, Associate Counsel to the President. Subject: HHS
Representative on the Health Care Task Force. (1 page)
03/10/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Priv. Copies [4]
2006-0223-F
vz58
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. :Z:Z04(a))
Freedom of Information Act- (5 U.S.C. SS:Z(b))
Pl National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office ((a)(:Z) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disc:lose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a c:learly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(:Z) Release would disc:lose internal personnel rules and practices of
an agency ((b)(:Z) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disc:lose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a c:learly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disc:lose information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
:Z:Z01(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
008. fax
DATE
SUBJECT/TITLE
Jeff Gutman to Stephen Neuwirth. [Re: Response to Washitigton
Times Article]. (3 pages)
10/2111993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Priv. Copies [4]
2006-0223-F
vz58
RESTRICTION CODES
Presidential Rec:ords Ac:t- [44 U.S.C. 2204(a))
Freedom of Information Ac:t- [S U.S.C. SS2(b))
Pl National Sec:urity Classified Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal offic:e [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would dlsc:lose trade secrets or confidential commercial or
financ:ial information [(a)(4) of the PRA)
PS Release would dlsc:lose c:onfidential advic:e between the President
and his advisors, or between suc:h advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privac:y [(a)(6) ofthe PRA)
b(l) National security classified Information [(b)(l) of the FOIA)
b(2) Release would disc:lose internal personnel rules and prac:tices of
an agenc:y [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would dlsc:lose trade sec:rets or c:onfidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would c:onstitute a dearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would dlsc:lose information compiled for law enforc:ement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disc:lose geologic:al or geophysical information
c:onc:erning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal rec:ord misfile defined in ac:c:ordanc:e with 44 U.S.C.
2201(3).
RR. Document wUI be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
009. memo
DATE
SUBJECTffiTLE
Memorandum for Leon Panetta from Joel Klein and Stphen Neuwirth.
Subject: Health Care working group documents I litigation. (1 page)
10/28/1994
RESTRICTION
P5 .
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Priv. Copies [4]
2006-0223-F
vz58
RESTRICTION CODES
Presidential Records Act -(44 U.S.C. 2204(a)J
Freedom of Information Act -(5 U.S.C. 552(b)J
Pl National Security Classified Information [(a)(l) of the PRAJ
P2 Relating to the appointment to Federal office [(a)(2) of the PRAJ
P3 Release would violate a Federal statute ((a)(3) of the PRAJ
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose Internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 V.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
010. memo
DATE
SUBJECTffiTLE
Memorandum for Leon Panetta from Joel Klein and Stphen Neuwirth.
Subject: Health Care working group documents I litigation. (2 pages)
RESTRICTION
10/28/1994
PS
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Priv. Copies [4]
2006-0223-F
vz58
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)]
Freedom of Information Act- [S U.S.C. SSl(b))
PI National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office [(a)(l) ofthe PRA]
P3 Release would violate a Federal statute [(aX3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(aX4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (aXS) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified Information [(bXl) ofthe FOIA]
b(l) Release would disclose internal personnel rules and practices of
an agency ((bXl) of the FOIA]
b(3) Release would violate a Federal statute [(bX3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(bX4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(bX6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((bX7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wens [(bX9) ofthe FOIA)
C. Closed In accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
------
-----
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
011. order
DATE
SUBJECTffiTLE
Photocopy of Judge Royce C. Lamberth's Order in the case of
Association of American Physicians and Surgeons, Inc. et al v. Hillary
Rodham Clinton, et al. ( 1 page)
09/28/1994
RESTRICTION
PS
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Priv. Copies [4]
2006-0223-F
vz58
RESTRICTION CODES
Presidential Records Aet -(44 U.S.C. 2204(a))
Freedom of Information Aet -(5 U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA)
PS Release would diselose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would diselose internal personnel rules and practices of
an agency ((b)(2) of the FOIA]
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA]
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would diselose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�-------
---
-I
-
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
012. fax
DATE
SUBJECT!TITLE
Stephen Neuwirth to Jeff Gutman. [Re: Draft responses to Health
Care Task Force Freedom of Information Act Requests.] (6 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Priv. Copies [4]
2006-0223-F
vz58
RESTRICTION CODES
Presidential Reeords Aet- (44 U.S.C. 2204(a))
Freedom of Information Aet- (5 U.S.C. SS2(b))
PI National Seeurity Classified Information ((a)(l) ofthe PRA)
P2 Relating to the appointment to Federal offiee ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would dlselose eonfidential adviee between the President
and his advisors, or between sueh advisors (a)(S) of the PRA)
P6 Release would eonstitute a elearly unwarranted invasion of
personal privaey ((a)(6) of the PRA)
b(l) National seeurity elassified information ((b)(l) of the FOIA)
b(2) Release would diselose internal personnel rules and praetiees of
an ageney ((b)(l) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would dlselose trade seerets or eonfidential or finaneial
information ((b)(4) ofthe FOIA)
b(6) Release would eonstitute a elearly unwarranted invasion of
personal prlvaey ((b)(6) of the FOIA)
b(7) Release would dlselose information eomplled for law enforeement
purposes ((b)(7) of the FOIA)
b(8) Release would dlselose information eoneerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would diselose geologieal or geophysieal information
eoneerning wells ((b)(9) of the FOIA)
C. Closed in aeeordanee with restrietions eontained in donor's deed
of gift.
PRM. Personal reeord misf'de defined in aeeordanee with 44 U.S.C.
2201(3). .
RR. Doeument will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
013. note
DATE
SUBJECT!fiTLE
From Steve Neuwirth and Jason Solomon to unknown. Draft for
Discussion: Talking Points on Health Care Task Force Court Order.
(1 page)
06/15/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Priv. Copies [4]
2006-0223-F
vz58
RESTRICTION CODES
Presidential Records Act - (44 U.S.C. 2204(a)]
Freedom of Information Ad- (5 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) ofthe FOIA) ·
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
014. note
DATE
SUBJECT/TITLE
Photocopy, Vince Foster to Hillary Rodham Clinton. [Re: Health Care
Task Force lawsuit]. (1 page)
03/14/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Priv. Copies [4]
2006-0223-F
vz58
RESTRICTION CODES
Presidential Records Ad- (44 U.S.C. 2204(a))
Freedom of Information Act -15 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(J) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disc:lose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disc:lose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf"de defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
015. memo
DATE
SUBJECTffiTLE
Memorandum for Christopher Cerf from Kumiki Gibson. Subject:
Document Request Re: Health Care Task Force. (15 pages)
02/13/1995
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Priv. Copies [4]
2006-0223-F
vz58
RESTRICTION CODES
Presidential Records Act - (44 U.S.C. 2204(a))
Freedom of Information Ad- (5 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commerelal or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security elassified information ((b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or finaneial
information. ((b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
· ofgift.
PRM. Personal record misfde defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Documents Gibson Potentially Priv. Copies [4]
Creator
An entity primarily responsible for making the resource
Office of the Counsel to the President
Miriam Nemetz
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12309349" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-12309349-20060223F-001-007-2015
12309349
-
https://clinton.presidentiallibraries.us/files/original/0fadac2c65b0f750b054eb8d0579c214.pdf
3981e2c137758dc9a12c30306435df8d
PDF Text
Text
------~--
--
-
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECTffiTLE
DATE
RESTRICTION
OOla. note
Post-it, handwritten. [Re: responsive documents.] (I page)
n.d.
P5
OOlb. fax
No Cover Sheet at 3:07pm. Memorandum to Robert E. Kopp from
Stephen R. Neuwirth, Re: Material for Government's Appeal in the
Health Care Task Force Case. (1 page)
04/07/1993
P5
OOlc. memo
Vincent Foster, Jr. to Melanne Verveer. [Re: Federation of American
Hospitals and Health care Leadership Council.] (6 pages)
06/17/1993
P5
OOld. letter
Jeffery S. Gutman to Kent Masterson Brown and Frank M. Northham.
Re: Ass'n of American Physicians and Surgeons v. Hillary Rodham
Clinton, et al., No. 93-399. (2 pages)
03/02/1993
P5
OOle. fax
Jeff Gutman to Steven Neuwirth at 5:06pm. [Re: Facts for a
Stipulation.] (3 pages)
02/25/1993
P5
OOlf. fax
No Cover Sheet at 2:04pm. Letter to the Honorable William V. Roth,
Jr. and the Honorable John C. Danforth from William J. Danforth,
Director GAO. Subject: Selected Aspects of the Federal Advisory
Committee Act. (4 pages)
02/26/1993
P5
OOlg. memo
Health Care Reform Working Groups. (11 pages)
n.d.
P5
002a. note
Post-it; handwritten. [Re: contents of folder marked VWF notes
1993]. (I page)
n.d.
P5
002b. note
Handwritten notes (photocopy) [Re: task force lawsuit]. (I page)
n.d.
P5
002c. note
Handwritten notes (photocopy) [Re: task force lawsuit]. (I page)
n.d.
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Miriam Nemetz
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potential Priv. Copies [3] [I]
2006-0223-F
vz56
Presidential Records Act- [44 U.S.C. 2204(a)l
RESTRICTION CODES
Freedom of Information Act- [S U.S.C. SS2(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) ofthe PRA)
I
1
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
b(l) National security classified information ((b)(l) of the FOIA)
b(l) Release would disclose internal personnel rules and practices of
an agency ((b)(l) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECTffiTLE
DATE
RESTRICTION
002d. note
Handwritten note. [Re: contact infonnation.] (1 page)
02/19/1993
P5, P6/b(6)
002e. note
Handwritten notes. [Re: Task force lawsuit]. (27 pages)
n.d.
P5
002f. memo
Q and A's on Health Care Task Force Appeal. (3 pages)
n.d.
P5
002g. note
Phone call message to Vincent Foster from Kevin Sabo, re: Fed.
Advisory Comm. Letter (photocopy). (1 page)
02/05/1993
P5
002h.draft
Draft of a decleration from Ira Magaziner regarding the Health Care
Task Force. (12 pages)
n.d.
P5
002i. memo
Howard Panter and Vincent Foster, discussion Regarding March 11,
1993 letter from Henry R Wray to Bernard W. Nussbaum. (3 pages)
03/14/1993
P5
002j. memo
To George Stephanopoulus and Lisat Caputo from Cheryl Mills.
Subject: Wall Street Journal Article on Illegality of Volunteers on the
Health Care Task Force. (2 pages)
03/10/1993
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Miriam Nemetz
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potential Priv. Copies [3] [I]
2006-0223-F
vz56
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a))
Freedom of Information Act- (S U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
PJ Release would violate a Federal statute [(a)(J) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Relea.se would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion or
personal privacy ((a)(6) ofthe PRA)
b(l) National security classified information [(b)(l) orthe FOIA)
b(2) Release would disclose internal personnel rules and practices or
an agency l(b)(2) ofthe FOIA)
b(J) Release would violate a Federal statute [(h)(J) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information l(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy l(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation or
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
OOI(a). note
· SUBJECTffiTLE
DATE
Post-it, handwritten. [Re: responsive documents.] (1 page)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potential Priv. Copies [3] [1]
2006-0223-F
vz56
RESTRICTION CODES
Presidential Records Ad- (44 U.S.C. :Z:Z04(a))
Freedom of Information Act- (5 U.S.C. SS:Z(b))
PI National Security Classified Information ((a)(l) of the PRA)
PZ Relating to the appointment to Federal office ((a)(:Z) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would diselose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) ofthe PRA]
b(l) National security classified information ((b)(l) of the FOIA)
b(:Z) Release would diselose internal personnel rules and practices of
an agency ((b)(:Z) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA]
b(6) Release would constitute a elearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) ofthe FOIA]
b(8) Release would diselose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfde defined in accordance with 44 U.S.C.
:Z:Z01(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
OOl(b). fax
SUBJECTffiTLE
DATE
No Cover Sheet at 3:07pm. Memorandum to Robert E. Kopp from
Stephen R. Neuwirth, Re: Material for Government's Appeal in the
Health Care Task Force Case. (1 page)
04/07/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potential Priv. Copies [3] [1]
2006-0223-F
vz56
RESTRICTION CODES
Presidential Records Ad- (44 U.S.C. 2204(a))
Freedom of Information Ad- (5 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) of the PRA]
P2 Relating to the appointment to Federal office ((a)(2) of the PRA]
P3 Release would violate a Federal statute ((a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA]
b(3) Release would violate a Federal statute ((b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financ:lal
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financ:lal institutions ((b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001(c). memo
DATE
SUBJECTfi'ITLE
Vincent Foster, Jr. to Melanne Verveer. [Re: Federation of American
Hospitals and Healthcare Leadership Council.] (6 pages)
06/17/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Docwnents Gibson Potential Priv. Copies [3] [1]
2006-0223-F
vz56
RESTRICTION CODES
Presidential Records Ac:t- [44 U.S.C. 2204(a)[
Freedom of Information Ac:t- [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disc:lose trade secrets or confidential commercial or
financ:ial information [(a)(4) ofthe.PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA)
P6 Release would constitute a c:learly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security c:lassified information [(b)(l) of the FOIA]
b(2) Release would disc:lose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or fmancial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a c:learly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disc:lose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf'lle defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001(d). letter
DATE
SUBJECTffiTLE
Jeffery S. Gutman to Kent Masterson Brown and Frank M. Northham.
Re: Ass'n of American Physicians and Surgeons v. Hillary Rodham
Clinton, et al., No. 93-399. (2 pages)
03/02/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemeiz,Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potential Priv. Copies [3] [1]
2006-0223-F
vz56
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. ll04(a))
Freedom of hiformation Act- [5 U.S.C. SSl(b))
Pl National Security Classified Information [(a)(l) of the PRA)
Pl Relating to the appointment to Federal office [(a)(l) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disc:lose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(l) Release would disclose internal personnel rules and practices of
an agency [(b)(l) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or c:onfidential or fmancial
information [(b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(h)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforc:ement
purposes [(h)(7) of the FOIA)
b(8) Release would disc:lose Information conc:erning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disc:lose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
ll01(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
OOle. fax
DATE
SUBJECTffiTLE
Jeff Gutman to Steven Neuwirth at 5:06pm. [Re: Facts for a
Stipulation.] {3 pages)
02/25/1 993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Miriam Nemetz
ONBox Number: CF4 53
FOLDER TITLE:
Health Care Task Force Documents Gibson Potential Priv. Copies [3] [I]
2006-0223-F
vz56
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a))
Freedom of Information Act- [S U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) orthe PRA)
b(l) National security classified information J(b)(l) orthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency J(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy J(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions J(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA)
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information J(a)(4) orthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy J(a)(6) of the PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
OOl(f). fax
DATE
SUBJECTffiTLE
No Cover Sheet at 2:04pm. Letter to the Honorable William V. Roth,
Jr. and the Honorable John C. Danforth from William J. Danforth,
Director GAO. Subject: Selected Aspects of the Federal Advisory
Committee Act. (4 pages)
02/26/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potential Priv. Copies [3] [1]
2006-0223-F
vz56
RESTRICTION CODES
Presidential Records Act -(44 U.S.C. 2204(a))
Freedom of Information Act -(5 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) ofthe PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA]
b(l) National security classified information ((b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(J) Release would violate a Federal statute ((b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA) ·
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
·
DOCUMENT NO.
AND TYPE
001(g). memo
Clinton Library
DATE
SUBJECTffiTLE
Health Care Reform Working Groups. (11 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potential Priv. Copies [3] [1]
2006-0223-F
vz56
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
Pl National Security Classified Information [(a)(l) ofthe PRA]
b(l) National security classified information [(b)(l) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning weDs [(b)(9) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002(a). note
SUBJECT/TITLE
DATE
Post-it; handwritten. [Re: contents of folder marked VWF notes
1993]. (1 page)
n.d.
RESTRICTION
PS
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potential Priv. Copies [3] [1]
2006-0223-F
vz56
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)]
,
Freedom of Information Act- [5 U.S.C. 552(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(S) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf'IIe defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�------------
----
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002(b). note
SUBJECTffiTLE
DATE
Handwritten notes (photocopy) [Re: task force lawsuit]. (1 page)
n.d.
RESTRICTION
PS
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potential Priv. Copies [3] [1]
2006-0223-F
vz56
RESTRICTION CODES
Presidential Records Act -(44 U.S.C. 2204(a))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf'lle defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
· Freedom of Information Act -IS U.S.C. SS2(b))
b(l).National security classified information ((b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
· purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
fmaneial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002(c). note
SUBJECT/TITLE
DATE
Handwritten notes (photocopy) [Re: task force lawsuit]. (I page)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potential Priv. Copies [3] [1]
2006-0223-F
vz56
RESTRICTION CODES
Presidential Records Aet- (44 U.S.C. 2204(a))
Freedom of Information Act- (5 U.S.C. 552(b))
Pl National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
finanelallnformation ((a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified Information ((b)(l) of the FOIA)
b(2) Release would disclose Internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs ((b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record mlsfde defined in accordance with 44 U.S.C.
2201(3).
· RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002(d). note
SUBJECTffiTLE
DATE
Handwritten note. [Re: contact information.] (1 page)
02/19/1993
RESTRICTION
P5, P6/b(6)
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potential Priv. Copies [3] [1]
2006-0223-F
vz56
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act- (5 U.S.C. 552(b))
Pl National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
-personal privacy ((a)(6) of the PRA)
b(l) National security classified informatio~ ((b)(l) of the FOIA)
b(l) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information. compiled for law enforcement
· purposes ((b)(7) of the FOIA)
b(8) Release would disc.lose information coneerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b )(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002e. note
DATE
SUBJECTffiTLE
Handwritten notes. [Re: Task force lawsuit]. (27 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Miriam Nemetz
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potential Priv. Copies [3] [1]
2006-0223-F
vz56
RESTRICTION CODES
Presidential Records Act -(44 U.S.C. 2204(a))
Freedom of Information Act- [S U.S.C. SS2(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
PJ Release would violate a Federal statute [(a)(J) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(5) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(J) Release would violate a Federal statute ((b)(J) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes l(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002(f). memo
DATE
SUBJECTffiTLE
Q and A's on Health Care Task Force Appeal. (3 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potential Priv. Copies [3] [1]
2006-0223-F
vz56
RESTRICTION CODES
Presidential Records Act -(44 U.S.C. 2204(a))
Freedom of Information Act -(5 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information )(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information complied for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document wlll be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002(g). note
DATE
SUBJECTffiTLE
Phone call message to Vincent Foster from Kevin Sabo, re: Fed.
Advisory Comm. Letter (photocopy). (1 page)
02/05/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OAfBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potential Priv. Copies [3] [I]
2006-0223-F
vz56
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a))
Freedom of Information Act -IS U.S.C. SSl(b))
PI National Security Classified Information ((aXl) ofthe PRA)
Pl Relating to the appointment to Federal office l(a)(l) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information l(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy l(a)(6) of the PRA)
b(l) National security classified information l(b)(l) of the FOIA)
b(l) Release would disclose internal personnel rules and practices of
an agency ((b)(l) of the FOIA)
b(3) Release would violate a Federal statute l(b)(3) of the FOlA)
b(4) Release would disclose trade secrets or confidential or financial
information l(bX4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy l(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes l(b)(7) ofthe FOIA)
b(S) Release would disclose information concerning the regulation of
financial institutions l(b)(S) ofthe FOlA)
b(9) Release would disclose geological or geophysical information
concerning wells l(bX9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record mlsf'de defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reViewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002(h). draft
DATE
SUBJECT/TITLE
Draft of a decleration from Ira Magaziner regarding the Health Care
n.d.
RESTRICTION
P5
Task Force. (12 pages)
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potential Priv. Copies (3] [1]
2006-0223-F
vz56
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. :Z:Z04(a))
Freedom of Information Act- [5 U.S.C. SS:Z(b))
PI National Security Classified Information [(a)(l) of the PRA)
b(l) National security classified Information [(b)(l) of the FOIA)
b(:Z) Release would disclose internal personnel rules and practices of
an agency [(b)(:Z) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would diselose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would diselose Information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
·
b(8) Release would disclose Information concerning the regulation of
financial Institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs [(b)(9) of the FOIA)
P2 Relating to the appointment to Federal office [(a)(:Z) of the PRA)
1
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial Information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf'de defined in accordance with 44 U.S.C.
:Z:Z01(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002(i). memo
DATE
SUBJECTIJ'ITLE
Howard Panter and Vincent Foster, discussion Regarding March 11,
1993 letter from Henry R. Wray to Bernard W. Nussbaum. (3 pages)
03/14/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potential Priv. Copies [3] [1]
2006-0223-F
vz56
RESTRICTION CODES
Presidential Records Aet- [44 U.S.C. 2204(a)[
Freedom of Information Act - [S U.S.C. SS2(b))
Pl National Security Classified Information [(a)(l) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disc:lose trade secrets or confidential commerc:ial or
financial information [(a)(4) of the PRA)
PS Release would disc:lose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(l) ofthe FOIA]
b(2) Release would disclose Internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disc:lose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financ:ial institutions [(b)(8) of the FOIA]
b(9) Release would disc:lose geological or geophysical information
concerning weDs [(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfde defined in accordance with 44 U.S.C.
2201(3).
RR. Document wiD be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002(j). memo
DATE
SUBJECffi'ITLE
To George Stephanopoulus and Lisat Caputo from Cheryl Mills.
Subject: Wall Street Journal Article on Illegality of Volunteers on the
Health Care Task Force. (2 pages)
03/10/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potential Priv. Copies [3] [1]
2006-0223-F
vz56
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a))
Freedom of Information Act -IS U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade ·secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or fmandal
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
,
.
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misf"de defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Documents Gibson Potentially Priv. Copies [3] [1]
Creator
An entity primarily responsible for making the resource
Office of the Counsel to the President
Miriam Nemetz
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12309349" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-12309349-20060223F-001-006-2015
12309349
-
https://clinton.presidentiallibraries.us/files/original/502f7dffece4e83286b32385922cad2d.pdf
86a4100db852b757650f817323819028
PDF Text
Text
..
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECTffiTLE
DATE
RESTRICTION
001. letter
Bernard W. Nussbaum, Counsel to the President to the Honorable
William F. Clinger, Jr. concerning the President's health care task
force. (2 pages)
02/05/1993
P5
002. memo
Memorandum to Thomas F. McLarty and Bruce Lindsey. From:
Vincent W. Foster [Re: the American Association of Physicians and
Surgeons, Inc., et. al.] (1 page)
02/19/1993
P5
003.memo
Phone message for B. Nussbaum, V. Foster, S. Neuwirth at 11:00 am.
From Tim Smith of Webster, Chamberlin & Bean and Frank
Northam. [Re: American Association of Physicians and Surgeons,
Inc., et. al.lawsuit.J (1 page) .
02/19/1993
P5
004. memo
Talking points regarding the FACA (2 pages)
n.d.
P5
005.letter
Bernard W. Nussbaum, Counsel to the President to the Honorable
William F. Clinger, Jr. concerning the President's health care task
force. (2 pages)
02/04/1993
P5
006. memo
Talking points Re FACA. (2 pages)
n.d.
P5
007. fax
Henry R. Wray, Senior Counsel, GAO to Bernard Nussbaum, Counsel
to the President at 5:23pm. [Re: Federal Advisory Committee Act.]
(3 pages)
02/17/1993
P5
008. fax
Jeff Gutman to Steve Neuwirth at 4:46pm. [Re: Draft of Charter,
President's Health Care Task Force.] (3 pages)
03/12/1993
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vz55
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
Pl National Security Classified Information [(a)(l) of the PRA)
b(l) National security classified information ((b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
lnf!)rmation ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs ((b)(9) of the FOIA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
C. Closed in accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
-
___________________________
___)
�•
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECT/TITLE
RESTRICTION
009. fax
Jeff Gutman to Steve Neuwirth at 3:58pm. [Memorandum to Vincent
Foster and Stephen Neuwirth from Robert E. Kopp and David J.
Anderson. Re: Compliance Issue and Appeal Prospects in Assn. of
American Physicians and Surgeons v. Hillary Rodham Clinton] ( 10
pages)
03/12/1993
P5
010. memo
Privileged and Confidential Attomey-Client/Work Product. Pros and
Cons of Appealing or Not Appealing the FACA Decision (2 pages)
n.d.
P5
011. fax
Jeff Gutman to Steve Neuwirth at 4:48 pm. [Re: GSA review of task
force charters.] (6 pages)
03/15/1993
P5
012.memo
Privileged and Confidential Attomey-Client/Work Product.
Guidelines for Meetings with the President to Discuss Health Care
Reform Issues. (4 pages)
n.d.
P5
013.letter
Draft ofletter from Bernard W. Nussbaum to the Honorable William
02/03/1993
P5
F. Clinger, Jr. [Re: the President's.Health Care Task Force.] (2 pages)
014.memo
Memorandum to Hillary Rodham Clinton from Bernard W.
Nussbaum, Vmcent W. Foster, and Stephen F. Neuwirth. Re: Health
Care Task Force/Federal Advisory Committee Act. (6 pages)
02/02/1993
P5
015(a). note
To Counsel's Office from Kevin Sabo, Committee on Government
Operations. Re: attached letter to the President from Congressman
Clinger on the Federal Advisory Committee Act/Health Care Task
Force· (1 page)
02/04/1993
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vz55
RESTRICTION CODES
Presidential Records Aet- (44 U.S.C. 2204(a))
Freedom of Information Aet - (5 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would diselose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
P5 Release would. disclose confidential advice between the President
and his advisors, or between such advisors (a)(5) of the PRA)
P6 Release would constitute a elearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security elassified information ((b)(l) of the FOIA)
b(2) Release would diselose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would diselose trade secrets or confidential or fmancial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a elearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would diselose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would diselose information concerning the regulation of
finaneial institutions ((b)(8) ofthe FOIA)
·
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrietions contained in donor's deed
of gift.
PRM. Personal record misfile defined in aeeordanee with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�.
Withdrawal/Redaction Sheet
Clinton Library
DATE
RESTRICTION
DOCUMENT NO.
AND TYPE
SUBJECTffiTLE
015(b). fax
To White House Counsel from Kevin Sabo, Minority General Counsel
at 5:12pm. [Re:letter to the President from Congressman Clinger on
the Federal Advisory Committee Act/Health Care Task Force.] (3
pages)
02/01/1993
P5
016. fax
No cover sheet. Letter to Gloria Gutierrez, Commerce Department.
From: Ira C. Magaziner [Re: staffmg for the Health Care Task Force.]
(1 page)
02/24/1993
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vz55
RESTRICTION CODES
Presidential Records Act - (44 U.S.C. 2204(a))
Freedom of Information Act -(5 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) ofthe PRA)
Pl Relating to the appointment to Federal office ((a)(l) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(l) Release would disclose internal personnel rules and practices of
an agency ((b)(l) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the ·regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed In accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�------------------------------
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. letter
DATE
SUBJECTfi'ITLE
Bernard W. Nussbaum, Counsel to the President to the Honorable
William F. Clinger, Jr. concerning the President's health care task
·force. (2 pages)
02/05/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vz55
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a))
Freedom of Information Act -IS U.S.C. SS2(b))
Pl National Security Classified Information ((a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) ofthe PRA)
P3 Release would violate a Federal statute ((a)(J) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(J) Release would violate a Federal statute ((b)(J) of the FOIA)
b(4) Release would disclose trade secrets or confidenqal or finaneial
Information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf'de defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002.memo
DATE
SUBJECTfi'ITLE
Memorandum to Thomas F. McLarty and Bruce Lindsey. From:
Vincent W. Foster [Re: the American Association of Physicians and
Surgeons, Inc., et. al.] (1 page)
02/19/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vz55
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(aX2) ofthe PRA)
P3 Release would violate a Federal statute [(aX3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [aXS) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information l(bXI) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency l(bX2) of the FOIA)
b(3) Release would violate a Federal statute [(bX3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(bX4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(bX6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes l(bX7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(S) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wens [(bX9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. memo
DATE
SUBJECTffiTLE
Phone message for B. Nussbaum, V. Foster, S. Neuwirth at 11:00 am.
From Tim Smith of Webster, Chamberlin & Bean and Frank
Northam. [Re: American Association of Physicians and Surgeons,
Inc., et. al. lawsuit.] (1 page)
02/19/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vzSS
RESTRICTION CODES
Presidential Records Act -(44 U.S.C. 2204(a))
Freedom of Information Ad -IS U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compUed for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004.memo
DATE
SUBJECTffiTLE
Talking points regarding the FACA (2 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vz55
RESTRICTION CODES
Presidential Records Ad -144 U.S.C. 2204(a))
Freedom of Information Ad -IS U.S.C. SS2(b))
PI National Security Classified Information f(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office l(a)(2) of the PRA)
P3 Release would violate a Federal statute f(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information l(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors fa)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy l(a)(6) of the PRA)
b(l) National security classified information l(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency l(b)(2) of the FOIA).
b(3) Release would violate a Federal statute l(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information l(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy f(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes l(b)(7) ofthe FOIA)
b(S) Release would disclose information concerning the regulation of
financial institutions l(b)(S) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs l(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005.letter
DATE
SUBJECT/TITLE
Bernard W. Nussbaum, Counsel to the President to the Honorable
William F. Clinger, Jr. concerning the President's health care task
force. (2 pages)
02/04/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vz55
RESTRICTION CODES
Presidential Records Ad- [44 U.S.C. 2204(a))
Freedom of Information Ad- [5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) of the PRA)
Pl Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(l) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) ofthe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006. memo
SUBJECTffiTLE
DATE
Talking points Re FACA. (2 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vz55
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a))
Freedom of Information Act -[5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) of the PRA]
b(l) National security classified information [(b)(l) of the FOIA]
b(l) Release would disclose internal personnel rules and practices of
an ~gency [(b)(l) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning weDs [(b)(9) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(l) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) oftbe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictiops contained in donor's deed
of gift.
PRM. Personal record misf"lle defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
007. fax
DATE
SUBJECT/TITLE
Henry R. Wray, Senior Counsel, GAO to Bernard Nussbaum, Counsel
to the President at 5:23 pin. [Re: Federal Advisory Committee Act.]
(3 pages)
02/17/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TilLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vzSS
RESTRICTION CODES
Presidential Records Ac:t- [44 U.S.C. 2204(a))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disc:lose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a c:learly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misflle defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
• Freedom of Information Ac:t- [5 U.S.C. 552(b))
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a c:learly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would dlsc:lose informa~on compHed for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs [(b)(9) ofthe FOIA)
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
008. fax
DATE
SUBJECTffiTLE
Jeff Gutman to Steve Neuwirth at 4:46pm. [Re: Draft of Charter,
President's Health Care Task Force.] (3 pages)
03/12/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vz55
RESTRICTION CODES
Presidential Records Aet -144 U.S.C. 2204(a))
Freedom of Information Aet -IS U.S.C. 552(b))
PI National Security Classified Information l(a)(l) of the PRA)
b(l) National security elassified information l(b)(l) of the FOIA)
b(2) Release would diselose internal personnel rules and practices of
an agency l(b)(2) of the FOIA)
b(3) Release would violate a Federal statute l(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy l(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes l(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions l(b)(8) of the FOIA)
b(9) Release would diselose geological or geophysical information
concerning wells l(b)(9) of the FOIA)
P2 Relating to the appointment to Federal office l(a)(2) of the PRA)
P3 Release would violate a Federal statute l(a)(3) of the PRA)
P4 Release would dlselose trade secrets or confidential commercial or
financial information l(a)(4) of the PRA)
· PS Release would disclose confidential advice between the President
and his advisors, or between such advisors la)(S) ofthe PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy l(a)(6) of the PRA)
C. Closed In accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�---------------------------------------------------------------------------
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
009. fax
SUBJECTffiTLE
DATE
Jeff Gutman to Steve Neuwirth at 3:58pm. [Memorandum to Vincent
Foster and Stephen Neuwirth from Robert E. Kopp and David J.
Anderson. Re: Compliance Issue and Appeal Prospects in Assn. of
American Physicians and Surgeons v. Hillary Rodham Clinton] (10
pages)
03/12/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vz55
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act- (S U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for Jaw enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�-~
-
-
---- - - ---- - --
---------
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
010. memo
DATE
SUBJECTffiTLE
Privileged and Confidential Attorney-Client/Work Product. Pros and
Cons of Appealing or Not Appealing the FACA Decision (2 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vz55
RESTRICTION CODES
Presidential Records Ad- (44 U.S.C. 2204(a))
Freedom of Information Ad- (S U.S.C. SS2(b))
Pl National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) ofthe PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose Internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would diselose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf"tle defined in accordance with 44 U.S.C.
2201(3).
RR. Document wiD be reviewed upon request.
�~----
-
-----
--~
-
-
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
011. fax
DATE
SUBJECT/TITLE
Jeff Gutman to Steve Neuwirth at 4:48pm. [Re: GSA review of task
force charters.] (6 pages)
03/15/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vz55
RESTRICTION CODES
Presidential Records Aet -(44 U.S.C. 2204(a))
Freedom of Information Act- (S U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) of the PRA]
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would diselose trade secrets or confidential commereial or
financial information ((a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b{l) National security elasslfied information ((b)(l) ofthe FOIA)
b(2) Release would diselose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) ofthe FOIA)
b(4) Release would diselose trade secrets or confidential or financial
Information ((b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs ((b)(9) ofthe FOIA]
C. Closed in accordance with restrietions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
012. memo
SUBJECT/TITLE
DATE
Privileged and Confidential Attomey-Client/Work Product
Guidelines for Meetings with the President to Discuss Health Care
Reform Issues. (4 pages)
n.d.
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vz55
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a))
Freedom of Information Act -IS U.S.C. 552(b))
Pl National Security Classified Information l(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office l(a)(2) of the PRA)
P3 Release would violate a Federal statute l(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information l(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors la)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy l(a)(6) of the PRA)
b(l) National security classified information l(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency l(b)(2) of the FOIA)
b(3) Release would violate a Federal statute l(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information l(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy l(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes l(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions l(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs l(b)(9) ofthe FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�-------------------
-
- - - - -
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
013.letter
SUBJECTtriTLE
DATE
Draft of letter from Bernard W. Nussbaum to the Honorable William
F. Clinger, Jr. [Re: the President's Health Care Task Force.] (2 pages)
02/03/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vz55
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act- (5 U.S.C. 552(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(S) Release would disclose information concerning the regulation of
financial institutions [(b)(S) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document wiD be reviewed upon request.
�-----------------
i
---- -
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
014. memo
DATE
SUBJECTffiTLE
Memorandum to Hillary Rodham Clinton from Bernard W.
Nussbaum, Vincent W. Foster, and Stephen F. Neuwirth. Re: Health
Care Task Force/Federal Advisory Committee Act. (6 pages)
02/02/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vz55
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [S U.S.C. SS2(b))
Pl National Security Classified Information [(a)(l) ofthe PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disdose information concerning the regulation of
financial institutions [(b)(8) ofthe FOIA)
b(9) Release would disdose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained In donor's deed
. of gift.
PRM. Personal record misf"tle defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
OlS(a). note
DATE
SUBJECTffiTLE
To Counsel's Office from Kevin Sabo, Committee on Government
Operations. Re: attached letter to the President from Congressman
Clinger on the Federal Advisory Committee Act/Health Care Task
Force (1 page)
02/04/1993
RESTRICTION
PS
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vz55
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a))
Freedom of Information Act -IS U.S.C. 552(b))
PI National Security Classified Information l(a)(l) of the PRA]
P2 Relating to the appointment to Federal office l(a)(2) of the PRA]
P3 Release would violate a Federal statute l(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial Information l(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors la)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy l(a)(6) ofthe PRA]
b(l) National security classified information l(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency l(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute l(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information l(b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy l(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes l(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions l(b)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells l(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
015{b). fax
DATE
SUBJECTfi'ITLE
To White House Counsel from Kevin Sabo, Minority Geneml Counsel
at 5:12pm. [Re:letter to the President from Congressman Clinger on
the Federal Advisory Committee Act/Health Care Task Force.] (3
pages)
02/01/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vz55
RESTRICTION CODES
Presidential Records Ad -(44 U.S.C. 2204(a))
Freedom of Information Ad -IS U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) ofthe PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential eommerelal or
financial information ((a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors(a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(l) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
016. fax
DATE
SUBJECT/TITLE
No cover sheet. Letter to Gloria Gutierrez, Commerce Department.
From: Ira C. Magaziner [Re: staffing for the Health Care Task Force.]
(1 page)
02/24/1993
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Health Care Task Force Documents Gibson Potentially Privilged Copies [2]
2006-0223-F
vz55
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [S U.S.C. S52(b))
PI National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Documents Gibson Potentially Priv. Copies [2]
Creator
An entity primarily responsible for making the resource
Office of the Counsel to the President
Miriam Nemetz
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12309349" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-12309349-20060223F-001-005-2015
12309349
-
https://clinton.presidentiallibraries.us/files/original/5741bf8b7e8edf651a863dd401734d3a.pdf
d2b826058069492de8a9b8d64a9f1405
PDF Text
Text
Case Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the Clinton Presidential
Library Staff.
Folder Title:
Health Care Task Force Docurp.ents
Staff Office-Individual:
Counsel's Office-Nemetz
I
Original OA/ID Number:
CF453
I
I
~ow:
Section:
Shelf:
tposition:
Stack:
20
2
11
3
v
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECTffiTLE
RESTRICTION
001. memo
Memorandum to File. From Christopher D. Cerf. Re: Magaziner
Document Review and Production. (3 pages)
03/15/1995
P5
002. fax
From: Eric H. Holder, United States Attorney. To: Christopher D.
Cerf, Associate Counsel. [February 28, 1995 letter from Eric H.
Holder to Charles F. C. Ruff regarding Ira Magziner.] (6 pages)
02/28/1995
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Healthcare Task Force Documents Gibson Potentially Privileged Copies [ 1] Ira
Magaziner
2006-0223-F
vz54
RESTRICTION CODES
Presidential Records Ad- [44 U.S.C. 2204(a))
Freedom of Information Ad- [5 U.S.C. 552(b))
Pl National Security Classified Information [(a)(l) of the PRA)
b(l) National security elasslfied information [(b)(l) ofthe FOIA)
b(2) Release would disdose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would diselose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) ofthe PRA)
P4 Release would disdose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) ofthe PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document wiD be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
DATE
SUBJECTffiTLE
Memorandum to File. From Christopher D. Cerf. Re: Magaziner
Document Review and Production. (3 pages)
03/15/1995
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
OA/Box Number: CF453
FOLDER TITLE:
Healthcare Task Force Documents Gibson Potentially Privileged Copies [1] Ira
Magaziner
2006-0223-F
vz54
RESTRICTION CODES
Presidential Records Act -(44 U.S.C. 2204(a))
Freedom of Information Act -(5 U.S.C. 552(b))
Pl National Security Classified Information ((a)(l) ofthe PRA]
P2 Relating to the appointment to Federal office ((a)(2) of the PRA]
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) ofthe FOlA]
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOlA)
b(3) Release would violate a Federal statute ((b)(3) of the FOlA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOlA]
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information·concerning the regulation of
financial institutions ((b)(8) of the FOlA]
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document wiU be reviewed upon request.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. fax
SUBJECT/TITLE
DATE
From: Eric H. Holder, United States Attorney. To: Christopher D.
Cerf, Associate Counsel. [February 28, 1995letter from Eric H.
Holder to Charles F. C. Ruff regarding Ira Magziner.] (6 pages)
02/28/1995
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Counsel's Office
Nemetz, Miriam
ONBox Number: CF453
FOLDER TITLE:
Healthcare Task Force Documents Gibson Potentially Privileged Copies [1] Ira
Magaziner
2006-0223-F
vz54
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a))
Freedom of Information Act- [S U.S.C. SS2(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would diselose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a elearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would diselose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a elearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would diselose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Documents Gibson Potentially Priv. Copies [1] Ira Magaziner
Creator
An entity primarily responsible for making the resource
Office of the Counsel to the President
Miriam Nemetz
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12309349" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-12309349-20060223F-001-004-2015
12309349
-
https://clinton.presidentiallibraries.us/files/original/f0478be81a3bb69ed0530e7d40a638f9.pdf
3472893b21c79a4530fdc9a24bb1685c
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Records Management- SUBJECT FILE
Series/Staff Member:
Subseries:
OA/ID Number:
23292
Scan ID:
006616
Document Number:
Folder Title:
FG258-25
Stack:
Row:
Section:
s
84
3
Shelf:
8 .
Position:
1
�lP
ID# 006616
THE WHITE HOUSE
CORRESPONDENCE TRACKING WORKSHEET
INCOMING
DATE RECEIVED: MARCH 11, 1993
NAME OF CORRESPONDENT: MS. MARY ELLEN LLOYD
SUBJECT: SUPPORTS THE PRESIDENT'S RECENT HEALTH CARE
INITIATIVES AND CHOICE OF HILARY RODHAM
CLINTON TO LEAD THE PRESIDENT'S TASK FORCE ON
NATIONAL HEALTH CARE REFORM
ACTION
ROUTE TO:
OFFICE/AGENCY
DISPOSITION
ACT
DATE
CODE YY/MM/DD
(STAFF NAME)
TYPE
RESP
C COMPLETED
D YY/MM/DD
ORG
93/03/11
~ ~{CJ/~
RSI
ALEXIS HERMAN
REFERRAL NOTE:
REG.:J.NA MONTOYA
93103111
C
I
~!W.~ ;:F~~OTE:
93~~11. :·
REFERRAL NOTE:
REFERRAL NOTE:
COMMENTS:
f~::$id@l~~:::'
-
URG~ ~OCUS
7ofY'
I
I
BE PUT ON RURAL STATES LIKE IDAHO
2 MEDIA:L
USER CODES: (A) ________
INDIVIDUAL CODES:
(B) _ _ __
~~-·~.
----·~
{jf[E
ADDITIONAL CORRESPONDENTS:
PL MAIL
I I
---
(C) _ _ __
***********************************************************************
*ACTION CODES:
*DISPOSITION
*OUTGOING
*
*CORRESPONDENCE:
*
*
*
*A-APPROPRIATE ACTION *A-ANSWERED
*TYPE RESP=INITIALS
*
*C-COMMENT/RECOM
*B-NON-SPEC-REFERRAL
*
OF SIGNER
*
*C-COMPLETED
*
CODE = A
*
*D-DRAFT RESPONSE
*F-FURNISH FACT SHEET *S-SUSPENDED
*COMPLETED. = DATE OF
*
*I-INFO COPY/NO ACT NEC*
*
OUTGOING *
*
*
*R-DIRECT REPLY W/COPY *
*S-FOR-SIGNATURE
*
*
*
*X-INTERIM REPLY
*
*
*
***********************************************************************
REFER QUESTIONS AND ROUTING UPDATES TO CENTRAL REFERENCE
(ROOM 75,0EOB) EXT-2590
KEEP THIS WORKSHEET ATTACHED TO.THE ORIGINAL INCOMING
LETTER AT ALL TIMES AND SEND COMPLETED RECORD TO RECORDS
MANAGEMENT.
SCANNED
�'IV ~Jr ~-~c, ~~~ LOLU2EED
~ T~ISTRIC~)
8J
I
~ac,TENAt,
.
•
SHOSHONE
COUNTIES
RESOURCES & ENVIRONMENT
',..'v; BENEWAH
'4(_~·
COMMITIEES
STATE AFFAIRS
HOME ADDRESS
10 GIESA ROAD
•·
J COEUR D'ALENE, IDAHO 83814
(208) 664-3564
(208) 664-1813
DEMOCRATIC LEADER
Idaho State Senate
CAPITOL BUILDING
BOISE, IDAHO 83720
February 25, 1993
The President
The White House
Washington, D.C. 20500
Dear Mr. President:
The current session of the Idaho State Legislature, like legislatures throughout the
country, is struggling with developing sound solutions to the health care crisis that we face. As
Democrats, ~e are writing to express our suppo_!t for y~mr rec~t initiatives and our concern for
-Jhe immediate and long-term problems that must be solved .
. First, we ap laud your order to the Health and Human Services Department to allow
reater flexibili to states to design speci 1c an appropr1ateSOiiiiions to cover tlie growmg
number of Medicaid applicants by tailoring programs to meet a state spa 1cu ar nee s.
Your goal of streamlining the waiver process is one that we strongly support. This is
an important step and, we believe, it has the potential of saving administrative dollars on both
the national and state level: taxpayer dollars that can be better utilized to cover actual costs of
health care not bureaucratic red tape.
Returning control of the administration of health care programs to the states is one of our
highest priorities. Individual states, like Idaho, are best equipped to deal with solving the short
and long-term problems without excessive interference from the federal government that adds
unnecessary time delays and administrative costs. We cannot over-emphasize our support for
any steps your administration takes to reach this goal.
,Second, your designation of Hilary Rodham Clinton to lead the President's Task Force
_ on National Health Care Reform to develop a national health care policy gives us, your
Democratic Senate supporters in Idaho, great hope that solid, comprehensive and affordable
solutions will be forthcommg.
"------~-~-=~~.0~~~~~~-,-
�•
"
-2-
The President
February 25, 1993
You have an impressive record of fighting for change and building coalitions for action.
We are confident that you can accomplish this job on a national level because you are willing
to challenge status quo thinking and put people first, not special interests with big gun lobbyists.
We would, most respectfully, request that focus be put on the p~icular needs of rural
..ttates, such as Idaho. We know that, as former Governor of Arkansas, you are very familiar
with the unique problems that rural states confront with in this nationwide crisis. We strongly
urge that the special circumstances facing rural American be given equal consideration to those
of our urban neighbors.
For our part, we acknowledge the need for universal access to an adequate level of
quality health care with emphasis on wellness so that we foster a health care system, not the
sick-care system we presently have. We recognize Idaho's particular needs for rural access and
community-based solutions and we support cost effectiveness and flexibility so that we use our
limited resources wisely.
Working with the new Administration and our congressional delegation, we want to do
all we can to help the federal government take the lead in solving our health care dilemma for
the good of our state and the nation.
On behalf of the Idaho Senate Democrats, we pledge our support for your efforts.
Yours truly,
~~~/hAMf~M
Mary Ellen Lloyd
Caucus Chair
Mary Lou Reed
Democratic Lcader
cc: Idaho Congressional Delegation
D~~
Assistant Democrat Leader
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
6616
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Subject Files
FG258-25
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/1127610" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-1127610-20060223F-001-003-2015
1127610
-
https://clinton.presidentiallibraries.us/files/original/a38b08e6033f62bcefc013dc59ee90c8.pdf
0a24d48f71805316986bc3e3c5320791
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Colle~tion/Record
Group:
Subgroup/Office of Origin:
Clinton Presidential Records
Records Management - SUBJECT FILE
Series/Staff Member:
Subseries:
23292
OA/ID Number:
000669
Scan ID:
Document Number:
Folder Title:
FG258-25
Stack:
Row:
Section:
Shelf:
Position:
s
84
3
8
1
�•...
~
ID# 000669
THE WHITE HOUSE
CORRESPONDENCE TRACKING WORKSHEET
INCOMING
DATE RECEIVED: JANUARY 27, 1993
NAME OF CORRESPONDENT: THE HONORABLE LUCIEN E. BLACKWELL
SUBJECT: COMMENDS THE PRESIDENT ON CHOOSING HILLARY
RODHAM CLINTON AS THE HEAD OF THE PRESIDENT'S
TASK FORCE ON NATIONAL HEALTH CARE REFORM
ACTION
ROUTE TO:
OFFICE/AGENCY
DISPOSITION
ACT
DATE
CODE YY/MM/DD
(STAFF NAME)
HOWARD PASTER
REFERRAL NOTE:
-
REFERRAL NOTE:
REFERRAL NOTE:
TYPE
RESP
_,_,_
_,_,_
C COMPLETED
D YY/MM/DD
-
_,_,_
_,_,_
_7_7_ - - - - _7_7_
_7_7_
- _7_7_
REFERRAL NOTE:
REFERRAL NOTE:
COMMENTS:
ADDITIONAL CORRESPONDENTS:
MAIL
MEDIA:L
USER CODES: (A) ________
INDIVIDUAL CODES:
(B) _ _ __
1230
(C) _ _ __
***********************************************************************
*ACTION CODES:
*DISPOSITION
*OUTGOING
*
*CORRESPONDENCE:
*
*
*
*A-APPROPRIATE ACTION *A-ANSWERED
*TYPE RESP=INITIALS
*
*C-COMMENT/RECOM
*B-NON-SPEC-REFERRAL
*
OF SIGNER
*
*D-DRAFT RESPONSE
*C-COMPLETED
*
CODE = A
*
*F-FURNISH FACT SHEET *S-SUSPENDED
*COMPLETED = DATE OF
*
*I-INFO COPY/NO ACT NEC*
*
OUTGOING *
*R-DIRECT REPLY W/COPY *
*
*
*S-FOR-SIGNATURE
*
*
*
*X-INTERIM REPLY
*
*
*
***********************************************************************
REFER QUESTIONS AND ROUTING UPDATES TO CENTRAL REFERENCE
(ROOM 7S,OEOB) EXT-2590
KEEP THIS WORKSHEET ATTACHED TO THE ORIGINAL INCOMING
LETTER AT ALL TIMES AND SEND COMPLETED RECORD TO RECORDS
MANAGEMENT.
�THE WHITE HOUSE
,,
I
WASHINGTON
February 19, 1993
Dear Lucien:
Thank you very much for your support of my
decision to name Hillary as the head of the health
care task force.
As you know, health care reform remains one of
the major issues facing this country and I am
committed to submitting legislation this spring to
bring about much needed changes.
It was qreat to see you last week.
With b8st wishes,
Sincerely,
'•
The Honorable Lucien E. Blackwell
House of Representatives
Washington, D.C. 20515
-----..._..,.
...
�-·· ·-
-
LUCIEN E. BLACKWELL
1725 LONGWORTH HOUSE OFFICE BUILDING
SECOND DISTRICT. PENNSYLVANIA
WASHINGTON. DC 20515-3B02
(202) 225-4001
..:.
COMMITTEE ON PUBLIC WORKS
AND TRANSPORTATION
SUBCOMMmEE ON SURFACE
TRANS PORTION
SUBCOMMITTEE ON WATER RESOURCES
SUBCOMMITTEE ON INVESTIGATIONS
AND OVERSIGHT
COMMITTEE ON MERCHANT MARINE
AND FISHERIES
~ongrtss of tbt 11 nittb ~tatts
J}oust of 1\tprtstntatibts
llasbington, aec 20515-3802
SUBCOMMITTEE ON MERCHANT MARINE
3901 MARKET STREET
PHILADELPHIA. PA 19104
(215) 387-2543. 2544
January 26, 1993
President William Jefferson Clinton
The White House
Washington, DC 20500
Dear Mr. President:
I write to commend you on choosing your wife, Hillary Rodham Clinton, as the head of
the President's Task Force on National Health Care Reform.
I am extremely pleased at the good judgement you have shown in choosing Mrs. Clinton
to address this most crucial issue. I have no doubt that Mrs. Clinton's prior experience,
combined with her proven ability to accomplish tremendous tasks will allow her to move
swiftly and successfully in bringing the dream of guaranteed health care to the 37 million
Amencans who are currently uninsured. This staggering statistic is a national disgrace, and
I look forward to working with you and Mrs. Clinton here in Congress to make universal
health care a reality.
Mr. President, unfortunately there are a certain few in this nation who do not recognize
the fact that Mrs. Clinton is an exceptionally qualified candidate for this position. I
wholeheartedly reject their position, or anybody who feels that it is not the First Lady's
position to become involved in policy discussion and formulation. On the contrary, there is
no one better qualified to stand by the President on the single most important issue facing
our nation today.
Prior to my election to Congress in November 1991, I served as the Majority Whip of
the Philadelphia City Council. During my tenure on the Council, my wife Jannie L.
Blackwell served as my top aide, and provided me with the invaluable advice that allowed
me to best serve my constituents. Indeed, Jannie faced a great deal of the criticism that you
and Mrs. Clinton sometimes must face, that it is not a woman's job to become involved m
her husband's affairs. We chose to ignore that sexist drivel, and proceeded to do the best .
job we could. Today Jannie holds the City Council seat that I once held. Perhaps someday,
you will prove your critics wrong, and Mrs. Clinton will ascend to the Presidency in her
·
own right!
Once again Mr. President, I would like to reiterate my support for your excellent
choice. Speaking on behalf of the residents of Pennsylvania's Second Congressional
District, we are finally looking forward to seeing some real and much needed progress in
the area of health care reform.
Lucien B. Blackwell
Member of Congress
---~-
----
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
669
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Subject Files
FG258-25
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/1127610" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-1127610-20060223F-001-002-2015
1127610
-
https://clinton.presidentiallibraries.us/files/original/32a7a6cc9239dbbe2ec2a083e08a241d.pdf
181c1238f6304d8b5b7a3ea1b6bb0f8e
PDF Text
Text
FOIA Number: 2006-0223-F
FOIA
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
· Collection/Record Group:
Subgroup/Office of Origin:
Clinton Presidential Records
Records Management- SUBJECT FILE
Series/Staff Member:
Subseries:
OA/ID Number:
23292
Scan ID:
001393
Document Number:
Folder Title:
FG258-25
Stack:
Row:
Section:
Shelf:
Position:
s
84
3
8
1
�. ,,..
'
..
..
ID# 001393
THE WHITE HOUSE
CORRESPONDENCE TRACKING WORKSHEET
INCOMING
DATE RECEIVED: FEBRUARY
01, 1993
NAME OF CORRESPONDENT: THE HONORABLE MARTHA KEYS
SUBJECT: OFFERS THE SERVICES OF THE NATIONAL MULTIPLE
SCLEROSIS SOCIETY IN HEALTH CARE REFORM; AND
ALSO SUPPORTS THE APPOINTMENT OF HILLARY
CLINTON TO CHAIR THE HEALTH REFORM TASK FORCE
ACTION
ROUTE TO:
OFFICE/AGENCY
DISPOSITION
ACT
DATE
CODE YY/MM/DD
(STAFF NAME)
TYPE
RESP
C COMPLETED
D YY/MM/DD
------
AL-E-XI-S-HE-RMAN----..~~'il""i'""""~~-~---·~-~-~~ ~1~.~-0
-
c_
~-~~~-~~(}-~
~
REFERRAL NOTE: ~,==~~~~.~~~==~~~~~~--------~
-1
REFERRAL NOTE:
REFERRAL NOTE:
_7_7_
_7_7_
_7_7_
REFERRAL NOTE:
REFERRAL NOTE:
COMMENTS: WRITER IS FORMER MEMBER OF CONGRESS AND
~d,~R ~TEtfZ.t:;zN-
ADDITIONAL CORRESPONDENTS:
PL MAIL
MEDIA:L
USER CODES: (A) _________ (B)
- _7_7_
- _7_7_
- _7_7_
e-.3.~~
INDIVIDUAL CODES:
4900
DY-
(C) _ _ __
***********************************************************************
*ACTION CODES:
*DISPOSITION
*OUTGOING
*
*
*CORRESPONDENCE:
*
*
*A-APPROPRIATE ACTION *A-ANSWERED
*TYPE RESP=INITIALS
*
*C-COMMENT/RECOM
*B-NON-SPEC-REFERRAL
*
OF SIGNER
*
*D-DRAFT RESPONSE
*C-COMPLETED
*
CODE = A
*
*F-FURNISH FACT SHEET *S-SUSPENDED
*COMPLETED = DATE OF
*
*I-INFO COPY/NO ACT NEC*
*
OUTGOING *
*R-DIRECT REPLY W/COPY *
*
*
*S-FOR-SIGNATURE
*
*
*
*X-INTERIM REPLY
*
*
*
***********************************************************************
REFER QUESTIONS AND ROUTING UPDATES TO CENTRAL REFERENCE
(ROOM 75,0EOB) EXT-2590
KEEP THIS WORKSHEET ATTACHED TO THE ORIGINAL INCOMING
LETTER AT ALL TIMES AND SEND COMPLETED RECORD TO RECORDS
MANAGEMENT.
�·--
'1
•.
'
.
...._--~-
--
'
~
�.
'
.
.
...
CODER:._ __
. miALTH CARE TASK FORCE SORTING SHEET
TYPE OF MATERIAL:
_Requests:
_General mall
_Personal stories
_Casework
..,i_Letterhead
_Offers to help
_EmplOYJDent
_Letter Campaign
_Policy
...X.Advocacy
-speech
-meeting
_Other
Explanation:·--------------------------ADVISORY
PANEL?
__physician
_large employei'B
_other health provider
_seniol'8
_small business
_r.n.
_other coDBUJDei'B
Explanation:._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
PRIMARY INTEREST:
COST
_
_
_
_
_
ISSUES
Drug Prices
Physician Fees
Hospital Fees
Unnece88ary Procedures
Medical Equipment
Fraud and Abuse
_PUBUC HEALTH/SPECIAL POPULATIONS
Prevention
AIDS
Women's Health
Immunizations
Rural
Urban
COVERAGE
_Working Families
_Unemployed/Low Income
Benefits
Providel'&
ORGANIZATION
Insurance Premiums
Insurance Reform
Insurance Pools
_
Boards and Ovel'&ight
GOVERNMENT PROGRAMS
Medicare
Medicaid
Veterans
DoD
_
LONG-TERM CARE
INFRASTRUCTURE/WORKFORCE
_
Quality Assurance (Guidelines)
_Administration, ReimbUI'8ement
& Patient Information Systems
_Malpractice & Tort Reform
_Manpower Issues (Training)
MENTAL HEALTH
_
:p:--, rl~.NCI N~
OTHER~-------Explanation:._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
PLAN PREFERENCE· (Support = +; Oppose = -)
CP
SP
OP
Clinton Plan
Single Payer
Other Plan
MC
Managed Competition
PP
Pay or Play
Credits, Vouchei'B,
Medical Savings Accts.
CV
CA
BR
GE
Canadian
British
German
.
....
�·'
60!~9~ ..
...
'71 '-/! 3 I
NATIONAL MULTIPLE SCLEROSIS SOCIETY
733 THIRD AVENUE, NEW YORK, N.Y. 10017·3288
(212) 986·3240
FAX (212) 986·7981
January 27, 1993
President Bill Clinton
The Vhite House
Washington, DC 20500
Dear President Clinton,
I want to express the congratulations
Sclerosis Society upon your inaugural
the office of President of the United
working with you to improve the lives
particularly those who live with MS.
of all of us at the National Multiple
week events and your assumption of
States. Ve pledge our support in
and futures of our citizens and most
Ve are grateful for your emphasis on health reform as the number one
domestic priority as the current system poses so many problems for the
third of a million people with multiple sclerosis and their families and
caregivers.
Our highest kudoes are reserved for your appointment of Hillary Rodham
Clinton to chair the group developing your initiative. I can think of
none as intellectually capable of negotiating concensus out of this
enormously difficult and complex problem and as well skilled by the
experiences of her past accomplishments. Nothing could prove the
commitment of your administration in a better way.
As one who has worked on health policy as both a member of Congress and
also of the Carter administration, I only hope that our system's failure to
respond to the needs of chronic disabling disease will be addressed as well
as the obvious imperative of access. Ve look forward to helping in every
possible way to enable your health reform initiative to be comprehensive in
its strategic plan.
The National Multiple Sclerosis Society is proud to be a source ol information about multiple sclerosis. Our comments are
based on professional advice, published experience and expert opinion, but do not represent therapeutic recommendation
or prescription. For specific information and adviee. consult your personal physician.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
1393
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Subject Files
FG258-25
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 1
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/1127610" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-1127610-20060223F-001-001-2015
1127610